Sleep difficulties in children

Sleep deprivation can have a devastating effect on families. Disabled children are more likely to have sleep problems than other children. Often there are simple measures that can be put into place to help to overcome the difficulty. Scope’s Sleep Solutions service supports families of children with sleep difficulties.

It is estimated that up to 20 per cent of all two year-old children and five per cent of eight year-old children wake regularly during the night. Approximately 12 per cent of all eight year-olds have problems settling to sleep. Research has shown that, while the vast majority improve over time, disabled children are more likely to have persistent problems in settling to sleep. Download our age-related chart of average sleep needs.

Causes of sleep problems

There are a number of reasons why your child may not be sleeping. These can include your child being:

• Too hot or too cold
• Hungry or thirsty
• Wet or soiled
• Unwell
• Uncomfortable in their cot or bed
• Disturbed by noise
• Over-stimulated by their bedroom environment
• In pain
• Unable to self-settle
• Over-stimulated before bedtime
• Under-active during the daytime or having too many naps

Tips for keeping a sleep diary

Keeping a sleep diary is a useful way of evaluating the problem.

• To establish whether there is a pattern to your child’s sleep disturbance you should keep the diary for at least two weeks
• Fill the diary in honestly
• If your child sleeps elsewhere, such as a respite centre or with grandparents, ask them to complete the diary too
• Check with carers to see if your child is napping during the day
• Share the diary with professionals to see if they can assist you in finding a possible cause for your child’s sleep difficulties
• Keep the diary by the bed with a pencil so that you can fill it in during the night, rather than trying to remember the times and lengths of wakings.

Research has shown that using a behavioural programme can help most children to some extent, regardless of the cause of the sleep problem.

The bedroom environment

It is important that the bedroom is a relaxing environment that promotes sleep. Follow this simple checklist to make sure your child’s bedroom is a restful environment:

• Ensure that the bed is comfortable and safe
• A child’s bedroom needs to be prepared for sleep. TV, video players, music or computers all need to be removed or turned off and covered. Toys and all distractions should be put away for the night
• If possible, use a blackout blind or thick curtains at the windows and keep lights low, or use a special nursery night light if the child does not like complete darkness
• Make sure that the room is at the correct temperature; you can buy nursery thermometers that indicate the right temperature, ideally between 16 - 20 degrees Celsius. High temperatures disturb sleep
• Is the room quiet? Is there any environment noise outside the room? If noise is a problem, you may want to consider using a fan in the room. The whirring of the fan will help to mask any background noise
• The room should be decorated in pastel or pale colours. Bright colours are often stimulating to children.

Bedtime routine

Children respond positively to routines, and it is important that a good routine is established at bedtime. Follow top tips for tackling sleep problems to help you to devise a good routine:

• Lively play should become quiet play in the hour before bedtime
• Keep a regular, age-appropriate bedtime for the child. Check the average sleep needs chart to work out the correct time the child should be going to bed
• The same sequence of events should happen every night. Visual timetables can help a child understand the order of events and what is going to happen next
• Use clues to signal bedtime, such as closing the curtains or playing a set piece of music each night. Bathtime should be relaxing, and once you have left the bathroom to go to the bedroom you should remain in the bedroom with your child
• Read a bedtime story, but ensure that it is within a clearly defined time and that it does not go on indefinitely
• Dim the lights
• Say goodnight in the same way each night and for the same length of time (for around one to three minutes)
• Wake your child at the same time each morning (not before 6am) to help them to get into a routine and strengthen the daily cycle.

Diet

Make sure the child does not go to bed hungry. Do not give a child over six months old feeds or drinks during the night. Some drinks or snacks may have an effect on a child's bedtime routine, and drinks with colouring or sweeteners can affect settling. Instead give milk, water or very diluted fruit juice. Consider sleep-inducing foods in the last meal before bedtime.

Medication

In certain circumstances a GP may consider prescribing medication. This can be useful for very short periods. It is not a cure for sleeping problems but, combined with management changes, can be useful. However children quickly become accustomed to medication, and a good bedtime routine should still be used.

Conclusion

Research has shown that using a behavioural programme can help almost all children, regardless of the cause of the sleep problems. However, it is important to remember that it may take longer to see an improvement if a child has a neurological impairment.

Sleep problems are exhausting for parents and children but, given time and patience, there are many approaches that may help. Talking to other parents about methods they have used may also be useful. Scope’s Sleep Solutions Service can offer support around sleep issues. Contact Scope Response in the first instance.

Sleep: suggested reading

Sleep Better! A guide to improving sleep for children with special needs

Durand, VM, Paul H Brookes Publishing Co, 1998

ISBN: 1557663157

Sleep: further information

It may be helpful to discuss the situation with the GP or Health Visitor. Many health authorities run sleep clinics, and referrals can be made via the GP.

Sleep Solutions

Sleep Solutions provides one-to-one support to families of disabled children and young people with additional support needs and severe sleep problems in the United Kingdom. Sleep Solutions also provides Time 2 Sleep workshop courses for parents and professionals around good sleep practice and basic strategies to support parents in establishing new routines. Read more about the Sleep Solutions course.

Parents - download a referral form

Professionals - download a referral form

For further information, telephone 01432 355308, email sleepsolutions@scope.org.uk or visit www.sleepsolutions.org.uk

For referrals to this service contact Scope Response on 0808 800 3333 or email response@scope.org.uk

Sleep Scotland provides support to families of children with special needs and severe sleep problems in Scotland. Support line available Monday to Friday, 9.30am to 5pm

Tel: 0131 651 1392

For more information on Scope

Contact Scope Response for information, advice and support on cerebral palsy and disability issues. Copies of all our factsheets can be downloaded from our website or obtained from Scope Response.

Scope Response hours are:

Monday to Friday 9am to 5pm.

Closed weekends and Bank Holidays.

Scope Response
PO Box 833
Milton Keynes
MK12 5NY

Tel: 0808 800 3333 (freephone Helpline)

Fax: 01908 321051

SMS Text: Type SCOPE plus your message to 80039

Email: response@scope.org.uk

Scope acknowledges the help and support of everyone who has been involved in the production of this information. Although we have taken care to ensure the accuracy of this information, Scope cannot accept responsibility for errors or omissions. We always recommend getting independent advice from a professional before embarking on any process, therapy or medical intervention.

We have information about Scope and cerebral palsy available in some languages on CD-ROM. We also offer a telephone interpreting service to people whose preferred language is not English. Please contact Scope Response for more details of these services.

This was last reviewed June 2010.

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