As seen on Nationwide Children's Hospital's 700 Childrens® Blog
Getting a good night’s sleep is so important for our mental and physical health. Sleep difficulties are common beginning in school-age children due to school demands, extracurricular activities that may result in a later bedtime, increased use of electronics (i.e., tablet, phone, computer, TV), and school schedules.
COVID-19 has led to even more disruption in sleep schedules because of variable school schedules and increased stress. Common sleep problems include:
- Bedtime refusal
- Difficulty falling and staying asleep
- Requiring a caregiver to be present in order to fall asleep
- Nightmares and nighttime fears
- Parasomnia including sleep terrors, sleepwalking and sleep talking
During the teen years, caregivers may be less aware of sleep difficulties or problems due to increased independence and decreased limit setting from caregivers.
Sleep problems are associated with a number of other concerns:
- Excessive daytime sleepiness
- Irritability or moodiness
- Increase in tantrums or other disruptive behaviors
- Decline in grades or academic functioning
- Increased anxiety or depression
- Difficulty managing stress
The good news is there are things caregivers and kids can do to get back to a healthy sleep routine. But before we get to that, it is helpful to know the recommended sleep totals based on age.
Recommended Sleep Totals (AASM, 2016)
Recommended Sleep (in a 24-hour period)
Infants (4-12 months)
Toddlers (1-2 years)
Preschoolers (3-5 years)
School-Aged Children (6-12 years)
Adolescents (13-18 years)
Tips for a Healthy Sleep Routine
- Try to stick to a schedule during the day, including waking up and going to bed around the same time each day (even on weekends).
- Create a consistent bedtime routine. You can start a bedtime routine as early as 2 months old. Try to do the same activities in the same order about 20-30 minutes before going to bed.
- Take a shower
- Brush teeth
- Use the bathroom
- Change into pajamas
- Read a book or listen to calming music or a relaxation script
- App recommendations: Insight Timer, Stop, Breathe & Think, Smiling Mind, Calm, and CBT i-coach
- Search online or YouTube for other relaxation or meditation ideas
- The bedtime routine may look different for an infant or toddler.
- Feeding should be the first step once your infant is 6 months old
- Change diaper
- Brush teeth (if needed)
- Change in to sleep clothes
- Read, sing or listen to music
- Say goodnight. The goal is for the child to be put in crib or bed when they are awake but tired, so they fall asleep within 10-15 minutes.
- Limit time spent in the bedroom, especially time in bed, during the day. Ideally, kids should be in bed only when they are sleeping and not in bed when they are watching TV or on their phone, doing schoolwork or eating. This helps to create a strong connection between sleep and bed.
- Avoid naps. In a perfect world, there would be no naps for school-aged children and older, but sometimes they happen. If a nap is needed, set a timer to wake up in 20-30 minutes. You may need to put the alarm somewhere so that your child has to get up to turn it off.
- Get outside and be active. Even if it is just for 5 minutes, spend time outside. Have your child go for a walk, play basketball or throw a football, jump rope, play tag or dance. Anything that gets your heart beating fast will help with sleep later. Plus, seeing bright lights like sunshine in the morning is important to keep your body’s clock in rhythm.
- Avoid screens. Ideally, stop screen use about 30 minutes before bedtime. If this is not possible, avoid using screens after bedtime.
- Use the “Do Not Disturb” setting on phones.
- Put screens away from the bed so they cannot be accessed easily while lying in bed but could still be used to listen to music or a relaxation script.
- Have kids turn their phones or tablets in at a set time at night and charge them outside of the bedroom.
- Remove TVs and video game systems from bedrooms.
- Be a good model. This means that caregivers should be following this advice as well, and even say what they are doing out loud to really drive the point home, “I’d like to watch my show right now, but I know it’s too close to bedtime and I want to make sure I can sleep well tonight.”
Cody Hostutler, PhD, Pediatric Psychology, and Tyanna Snider, PsyD, Psychology and Neuropsychology
Cody Hostutler, PhD, is a licensed pediatric primary care psychologist at Nationwide Children's Hospital and assistant professor in the Department of Pediatrics at The Ohio State University. He obtained his PhD at Lehigh University.