Sleep Problems in Children

1. See Also
   1. Night Awakening in Children
   2. Sleep Stage
   3. Co-Sleeping
2. Epidemiology
   1. Prevalence of sleeping through the night
      1. Age 6 months: 58% (on at least 5 nights weekly)
      2. Age 1 year: 90%
   2. Night awakenings may persist in 10-30% of children under age 3 years old
   3. Night awakenings transiently recur between 9 and 18 months
      1. Episodes coincide with period of increased stranger anxiety
3. Physiology: Normal sleep patterns in children
   1. Age 0-2 months old
      1. Total sleep time: 16-18 hours/day
      2. Naps: 3.5/day (7-8 am, 9-11 am, 1-3 pm, 5-7 pm)
      3. Night awakenings at 2-4 am are common until 6 months old
   2. Age 2-12 months old
      1. Total sleep time: 12-16 hours/day
      2. Naps: 2/day by 12 months old
      3. Typical sleep schedule from 8 pm to 6 am by 12 months old (sleeping through the night)
   3. Age 1-3 years old
      1. Total sleep time: 10-16 hours/day
      2. Naps: 1/day by 18 months old
   4. Age 3-5 years old
      1. Total sleep time: 11-15 hours/day
      2. Naps: 1/day in up to 50% of 3 year olds (remainder do not nap)
   5. Age 5-14 years old
      1. Total sleep time: 9-13 hours/day
      2. Naps: Variable
   6. Age 14-18 years old
      1. Total sleep time: 7-10 hours/day
      2. Naps: Uncommon unless underlying sleep disorder
   7. References
      1. Iglowstein (2003) Pediatrics 111(2): 302-7 [PubMed]
4. Types: Sleep Problems
   1. Night Awakening in Children
      1. Trained Night Feeders
      2. Trained Night Crier
      3. Fearful Night Criers
   2. Frightening Dreams
      1. Night Terrors (Pavor Nocturnus)
      2. Nightmares
   3. Miscellaneous Sleep Conditions
      1. Somnambulism (Sleepwalking)
      2. Sleep Talking (Somniloquy)
      3. Nocturnal Enuresis
      4. Obstructive Sleep Apnea in Children (esp. Adenotonsillar Hypertrophy)
      5. Narcolepsy
   4. Insomnia-related conditions
      1. Behavioral Insomnia of Childhood
      2. Delayed Sleep Phase Disorder
      3. Restless Legs Syndrome in Children
5. Management: Night Awakening in Children
   1. See Trained Night Feeders
   2. See Trained Night Crier
   3. Behavioral management is not effective under age 6 months old
   4. Behavioral management is recommended for ages 6 months to 4 years old
      1. Unmodified Extinction
         1. Infant placed in crib at defined bedtime and not removed for crying
         2. Monitor infant for safety
      2. Modified Extinction (graduated extinction)
         1. Infant placed in crib at defined bedtime and not removed for crying
         2. Infant is periodically rechecked at intervals of increasing duration (without removing from crib)
      3. Positive Bedtime Routine
         1. Scheduled bedtime activites (e.g. reading) make bedtime enjoyable for child
   5. Avoid sedating medications
      1. Diphenhydramine is not recommended (ineffective)
      2. Merenstein (2006) Arch Pediatr Adolesc Med 160(7):707-12 [PubMed]
6. References
   1. Adair (1993) Curr Probl Pediatr 23:147-70 [PubMed]
   2. Carter (2014) Am Fam Physician 89(5): 368-77 [PubMed]
   3. Mahowald (1990) Pediatrician 17(1):21-31 [PubMed]
   4. Nasir (2015) Am Fam Physician 92(4): 274-8 [PubMed]
   5. Thiedke (2001) Am Fam Physician 63(2): 277-84 [PubMed]