UNC Health Care
Baby climbing over parents who are trying to sleep

Why Won’t My Kid Sleep?

Extra bedtime stories, a special nightlight, lavender-scented lotion … you’ve tried it all, but your child still won’t sleep. Virtually every parent deals with it at some point, and it’s miserable. But you’re not alone. Zheng (Jane) Fan, MD, a children’s sleep expert and neurologist with the UNC Department of Neurology, says 50 percent of kids have problems sleeping at some point in their development. So what can you do about it? Dr. Fan gives us some tips for addressing pediatric sleep issues.

What are some reasons kids have issues sleeping?

The reasons kids don’t sleep vary by age. For babies, sleep-onset association begins at 4 or 5 months. That’s when babies connect sleep with being held, rocked or nursed. If a baby or toddler associates sleep onset with those bad habits, they become conditioned to expect that attention whenever they try to fall asleep or if they wake up in the middle of the night.

Elementary school-aged kids typically get the best sleep. Most have settled into a good sleep routine because school starts later and is not yet too stressful. They usually don’t have sleep-onset problems. Occasionally, there are school-age kids who struggle with developing the habit of co-sleeping with their parents, which can lead to problems when they sleep away from home, like over at a friend’s house.

Most teens get an insufficient amount of sleep because they have too much schoolwork, too many extracurricular activities and are on social media too much, which delays or interrupts sleep. Studies have shown that the blue light from cellphones, tablets and computers keeps you awake. When it’s dark outside, our brains secrete melatonin to prepare our bodies for sleep. But that melatonin is suppressed when we stare at the light from our cellphone screens. What’s worse—that blue light suppresses the melatonin in a teenager’s brain even more than in an adult’s.

Can medical conditions keep a child from sleeping?

Yes. Sometimes medical conditions can disrupt a child’s sleep. These conditions include enlarged tonsils or adenoids that cause sleep apnea or obesity-related sleep apnea.

Why is sleep so important for my child’s development?

Every organ and system in your body needs a good night’s sleep, and that’s true for children and adults. Your body gets recharged, and your brain reconnects when you sleep. During the dream-sleep phase of a sleep cycle, our brains connect what’s learned during the day to the knowledge already stored in our brains. Dream sleep is very important for maturation during childhood development, which is why teenagers still need good, quality sleep. Their brains continue to mature through the teen years. At night, sleeping also allows their immune and gastrointestinal systems to reset. Hormones, including the growth hormone, are also secreted during deep sleep.

What are signs my child is not getting enough sleep?

If your child is not getting enough sleep or is experiencing sleep disruption, you might notice hyperactivity, behavior problems, problems paying attention, learning problems, mood swings and irritability. Another sign of sleeplessness is if you consistently have a hard time waking up your child in the mornings. In babies, failure to thrive can be a sign of insufficient sleep.

What can I do to help my child get the sleep he or she needs?

The key is to have a routine, and everyone needs to be on the same page. For babies, feed and burp them, make them feel safe and comfortable, and then put a sleepy but awake baby down to sleep. Babies need to be able to fall asleep without any interference from parents. The same advice works for toddlers, school-age kids and even teens. A good routine for toddlers is to read stories after they have a bath. As your kids get older, their routine could change to include a shower and then reading in bed. It’s good to have a set bedtime, and remove or turn off electronic devices. Make sure there is nothing in the room to disrupt your child’s sleep, like a flashing light from a computer, cellphone or tablet. Another way to ensure a good night’s sleep is exercise during the daytime. The more exercise your child gets, the deeper the sleep.

Where do I begin?

The key is to try to eliminate unhealthy sleep association. If you’re putting a baby to sleep without her usual association—such as rocking or back-rubbing—she will cry at first, but usually after three days to a week, she will be fine. Remember things will get worse before they get better. Of course, listening to your child cry is hard. Most parents cannot tolerate it, so we recommend a gradual extinction. For example, if you’ve been rocking your baby to sleep, try not to rock her and hold her instead. The next week, don’t hold her but lay down beside her. The following week, don’t lay with her, but sit by her bed. Finally, stop doing all of those things and focus on making her feel safe and comfortable. It will get worse before it gets better, but eventually you will break the habit.

It’s very important both parents and caregivers are on the same page. If one parent cannot tolerate the child crying for five minutes and gives in, the child will continue to have sleep problems and test your limits. This also applies to grandparents and other caregivers. You should use the same rules and routine no matter who is putting the child to bed. The same rules should also apply on the weekends.

If my older child or teen doesn’t get enough sleep during the week, can he just catch up on weekends?

To work properly, the brain and organs need a regular sleep-wake cycle. If a teen wakes up at 6 a.m. during the week but at 9 a.m. on the weekends, it’s like his brain and organs shift back and forth from Eastern to Pacific Time. His brain is constantly tired, and his organs may not function properly. It’s like the orchestra is not synchronized. This is why when you travel into a different time zone, even if your sleep cycle gets corrected, you may have an upset stomach. We recommend you don’t shift bedtime by more than one to two hours on a weekend.

 


If you think your child’s sleeplessness could be something more serious, talk to a pediatrician. If you need a pediatrician, find one year you.

Kids sleep infographic