Top tips for tackling sleep problems

There are many reasons why your child may not be going to sleep or may be waking during the night. Have a look at the following list and see if you can identify why your child may be having sleep difficulties. Check through your sleep diaries too. Do you recognise any of the following as being an issue for your child?:

• Room temperature – is your child too hot or too cold? Ideally the temperature in the bedroom should be between 16 – 20 C. You can buy thermometers to hang in your child’s bedroom from nursery shops.
• Bedding – is your child kicking the bedding off during the night and waking because they are cold? If so, you can consider using a double duvet tucked under the mattress of a single. You may also wish to consider whether your child would be more comfortable wearing a sleep suit. Some specialist clothing companies provide sleep suits that fasten at the rear to stop children taking them off during the night.
• Noise – is there any noise inside or outside the home that may be disturbing your child? Some children with sensory issues, such as those children with autistic spectrum disorders, can be particularly sensitive to noise - what may seem like a quiet sound to you can seem very loud to them. The noise of an electric fan can mask other noises in your home and may be worth considering if noise is an issue.
• Light – is the room dark enough? Melatonin is produced when the room is dark. You might consider buying black-out blinds to make the room darker.
• An over-stimulating bedroom – does your child get out of bed to play with toys? Are they playing computer games or watching TV before they go to bed? If so, your child may be over stimulated by the bedroom environment. Bright colours are often stimulating to children. You will need to consider creating a restful bedroom environment. It is important that your child’s bedroom is a calm and suitable environment for them to get to sleep in.
• Comfort – is their bed comfortable? Try lying on it during the day and seeing how it feels. Is your child wet or soiled? Could this be causing them to wake up?
• Hunger – could your child be hungry? What time are they having their tea-time meal? Does their meal-time need to be later? Giving your child a snack mid-afternoon can help if you want to try moving their meal-time to later in the day.
• Lack of understanding about day and night – do they understand the difference between day and night? Sometimes children with additional needs require help to learn when it is day-time and when it is time to sleep, particularly if they have a visual difficulty. Tried and tested strategies can help with this. The same sequence of events should happen every night. Visual or other timetables can hep a child understand the order of events and what is going to happen next.
• Lack of routine – do you have a good bedtime routine for your child? Has their routine become unsettled lately because of an event like a family holiday or Christmas?
• Getting up too early – if your child wakes in the night do you treat it as a night awakening, or as the start of the day? You should consider what is a reasonable time to begin the day, and if your child wakes before that time they should be returned back to their bed. This will help to strengthen their body clock.
• Pain – is your child in pain? Could they be teething? Some disabled children cannot reposition themselves at night which can disrupt their sleep. If you think that your child may be in pain you should seek advice from medical professionals.
• Medication – is your child on any medication that may be impacting on their sleep? Or do they have to be given medication during their sleep which may be disturbing them? Check with a medical practitioner if you are unsure.

Twelve steps to good sleep practice

1. Make sure that the child’s room is quiet and dark. No TVs or electrical items to be used; toys to be hidden or covered. Close the curtains; black-out blinds will make the room darker if necessary.

2. Wake the child at a regular hour each morning so that the circadian (daily) cycle is strengthened. Not before 6am!

3. Keep a regular, age-appropriate bedtime for the child. Check the average sleep needs chart to work out the correct bedtime.

4. Ensure a consistent bedtime routine is followed each night. Try making a picture, or photographic timetable of previous routine activities to help the countdown and for the child to understand the order of events, and what is going to happen next.

5. Keep room temperature to a comfortable level, ideally between 16 - 20 degrees Celsius. High temperatures disturb sleep.

6. Environmental noise within the home should be kept to a minimum (no loud TVs).

7. Make sure that the child does not go to bed hungry - but do not give a child over six months old feeds / drinks during the night.

8. Help the child to learn to fall asleep alone in his or her bed, without your presence. Further guidance on this is available from a sleep practitioner.

9. Avoid stimulating activity in the hour before bedtime. Encourage quiet play, such as jigsaws or colouring.

10. Do not let the child have prolonged naps in the late afternoon. If the child still needs to sleep, schedule the nap for early afternoon.

11. Include sleep-inducing foods in the last meal before bedtime. Avoid drinks of cola, chocolate, tea and coffee – that is, no drinks with caffeine and additives - before bedtime. Instead have a warm milky drink.

12. Try this as an example of a good bedtime routine:

After tea-time, allow free play for an hour, followed by quiet play for 20 minutes. Offer a snack and drink. Use clues to signal bedtime, such as closing the curtains, or playing a set piece of music each time. Bath-time, for around 20 minutes, should be relaxing.

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’s within a clearly defined time and does not go on indefinitely. Ten minutes is usually good for this.

Dim the lights. Say goodnight in the same way each night, and for the same length of time (kisses and cuddles lasting no longer than three minutes).

Then leave the child to settle alone.