Children’s sleep

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THE GOOD NIGHT GUIDE


DR. GARIMA GARG SETH is a pediatrician with a mission to help children learn good sleep habits. Here she explains to us what that means, and how as parents we can provide the best possible environment for children to develop a healthy sleep lifestyle.


Early to bed and early to rise,
makes a man healthy, wealthy, and wise.
-Medieval Proverb

We all grew up with our elders quoting this old adage, but somehow today sleep has become a casualty of modern life. I often find parents saying that their children do not sleep until 12 or 1 in the night. Some are happy and proud about it, while some are worried. Sleep is extremely important to support children’s development both physically and mentally. Establishing good sleep patterns can help children to meet their full potential. It can improve a child’s quality of life, memory, learning, attention, and behavior. Children with good sleep do better in school and have lower rates of mental and physical health problems than those with sleep problems.

It is also important for parents’ mental health. As a parent, it is important to introduce good sleep habits early in your child’s life. A well-rested household usually makes for a happier home.

How much sleep do children need?

Sleep needs change as children get older. There are set guidelines that define the amount of sleep needed by children for optimal health. Regularly getting this number of hours of sleep can help your child avoid health risks associated with sleep deprivation. Now this is a general guideline that applies to most children, but some will have different sleep needs. If your child sleeps less or more than the average time prescribed, it’s not always an issue. But, it might also be tempting to think that your children can get away with less sleep than they need or that they should be able to cope fairly well with a few skipped hours of sleep. This is not true either.

The recommended sleep per 24 hours according to the age of the child, as per the American Academy of Sleep Medicine (AASM) is:

Newborn to 3 months: 16 to 18 hours (including naps)
4 to 12 months: 12 to 16 hours (including naps)
1 to 2 years: 11 to 14 hours (including naps)
3 to 5 years: 10 to 13 hours
6 to 12 years: 9 to 12 hours
13 to 18 years: 8 to 10 hours

What are the signs that children are not getting enough sleep?

They may show decreased levels of alertness, poor school performance, and bad moods. Young children may even have too much energy or hyperactivity leading to behavioral issues. In teenagers it can sometimes show up as mood changes and irritability.

Listed below are just a few of the symptoms of sleep deprivation in children:

Learning problems: concentration issues, difficulty remembering things, hyperactivity
Poor mental health, behavioral issues, headaches
Lowering of immune system function
Weight gain, growth issues
In older age groups: hypertension, obesity, depression etc.

Is a nap required during the day?

Napping is normal behavior in children. Most young children take naps during the day. Newborns and young infants usually take several naps: by 9 to 12 months infants have a pattern of 2 naps a day, and by 15 to 24 months most children take only a single afternoon nap. Older children may not nap at all.

Naps usually disappear by 5 years of age. Naps help preschool children to avoid becoming overtired. Ironically, an overtired toddler is harder to get to sleep than a well-rested one. Naps in preschool children can be encouraged and scheduled so that they aren’t too close to bedtime, as a poorly timed nap can affect your child’s sleep at night.

Good sleep routines

Everybody can benefit from a sleep routine, including adults. This is also called good sleep hygiene. A good sleep routine is planned. Consistency and firmness are also keys.

1. Make sufficient sleep a family priority

As a parent, you are a role model for your children. First, understand the benefits of getting enough sleep for yourself. Set a good example. Show them it is part of a healthy lifestyle, just like healthy eating and exercise. It is understandable that sometimes, with current job profiles, it is difficult, but at least give it a try.

2. Stick to a realistic and consistent age-appropriate routine

We all have an internal daily body clock, sometimes referred to as the circadian rhythm. Our body functions according to it. Have a set bedtime and wake-up time for your children every day of the week, including non-school nights. It is better if there is not more than an hour difference from one day to another. Regular late weekend nights or sleeping-in can throw your body clock out of rhythm.

3. Predictable sequence

Have a set daily bedtime routine following a predictable sequence of events, such as brushing teeth, taking a warm shower, going to the toilet, changing into nightwear and reading a story, etc. It should not last for more than 15 to 20 minutes. Many parents like to use the 4 Bs of brush, bath, book, bed.

4. Beds are for sleeping

Avoid spending a lot of non-sleep time in bed. Spending hours lying on the bed doing other things before bedtime keeps the brain from associating bed with sleep.

5. A comfortable, cozy room

A child’s bedroom can be cool, quiet and comfortable. Melatonin is a hormone which aids sleep and it occurs naturally in our bodies when it gets dark. So it is a good idea to put your children to bed in a dark environment and to dim the lights before sleep. A low-level night light is acceptable for children who find completely dark rooms frightening. Keep your child’s bedroom at a comfortable temperature (around 75° F, 25-26° C) and not too hot or cold.


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6. Relaxing activities

The hour before sleep can be for shared quiet time, like listening to relaxing, calm music, or reading a favorite story book. Avoid high stimulation activities such as watching television, playing video games or exercise. Children can easily develop the habit of “needing” the television to fall asleep. It’s also difficult to control your children’s viewing if the set is in the bedroom. Melatonin production is interfered with by screen activities, both before bed and during the night. It is best not to have video games, televisions or telephones in children’s bedrooms. Set a “technology curfew,” especially for older kids.

7. Exercise

Make sure your children spend time outside every day when possible and are involved in regular exercise. Having physical exercise as part of the day, at least 3 hours before bed, often helps with falling asleep and staying asleep for a longer time.

8. Avoid caffeine

Avoid caffeine (sodas, chocolate, tea, coffee) in the afternoons and evenings. Even if caffeine doesn’t prevent falling asleep, it can still lead to shallow sleep or frequent waking.

9. Eat a healthy meal well in advance and avoid big meals in the evening

But don’t send your children to bed hungry. A glass of milk before bed is a good idea. Heavy meals within an hour or two of bedtime may interfere with sleep.

10. Falling asleep routine

It is best for children to go to bed drowsy but still awake. Letting them fall asleep in other places forms habits that are difficult to break.If a child is awake in bed tossing and turning, it is better for them to get out of bed, do a low stimulation activity like reading, then return to bed later. This keeps the bed from becoming associated with sleeplessness. If still awake after 20 to 30 minutes, spend another 20 minutes out of bed before lying down again. Be gentle but firm if your child protests.If your child is never drowsy at the planned bedtime, you can try a temporary delay of bedtime by 30-minute increments until the child appears sleepy, so that they experience falling asleep more quickly once they get into bed. The bedtime should then be gradually advanced earlier until the desired bed time is reached.

11. Cuddle up

Give a hug or a kiss, say goodnight to your children, sing a lullaby. Security objects at bedtime are often helpful for children aged 1 to 3 years who need to feel safe and secure, especially when their parent is not present or they are sleeping alone. Try to include their favorite doll, toy or blanket when you cuddle or comfort your child, but make sure it does not pose a choking hazard or cause injury. Cover toys or remove them if they are causing a distraction at night, so that they are out of sight.

12. Clocks are for waking up

Turn clock faces away so that children cannot stare at them.

13. Discipline elsewhere

If you need to discipline your children, use another space in the house, not the bedroom.


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14. Make sure your children feel safe at night

If a child feels scared about going to bed or being in the dark, praise and reward them whenever they are brave. Avoid scary TV shows, movies and computer games. Don’t ignore their fears.

15. No worries

Avoid children worrying at bedtime. Children with this problem can try having a “worry time” scheduled earlier, when they think about and discuss their worries with someone they trust.

16. Short and sweet bedtime checkups

When checking on children at night, when they are sleeping in separate rooms, checks should be “brief and boring.” The purpose is to reassure the child you are present and that they are okay.

17. Maintain a sleep diary

This is so you can keep track of naps, sleep times and activities to find patterns and address problem areas when things are not working.If your children still have trouble getting to sleep, contact your pediatrician or healthcare provider to rule out any sleep disorder.


With a butterfly kiss and a ladybug hug, sleep tight little one, like a bug in a rug!
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Reference: AASM guidelines, May 2016, Journal of Clinical Sleep Medicine.



Article by DR. GARIMA GARG SETH
Illustrations by ARATI SHEDDE



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