Most parents will go through the pain and helplessness of being unable to get their children to sleep at some stage or another. And we all know, when your tiny screaming bundle of sleeplessness suffers, so do you. It's important – for the sake of your sanity if nothing else – to remember that this is a stage most babies and small children go through, and it won't last forever – even if every time it happens the night seems to last an eternity.
The first step you need to take when your baby or child can't or won't get to sleep is to determine the underlying cause of the problem. Only then can you find the right solution. So...
Why won't my baby sleep?
When it comes to babies and infants there are a great many causes of sleep difficulties, so it's important to get the diagnosis right.
One of the most common causes of sleep problems in babies and very young children is parents misreading their children's tiredness signals. The child then becomes overtired, making it even tougher for them to get off to sleep (or for you to get them into bed).
Lack of routine
Although their routine shouldn't be too rigid, it should be established and stuck to as much as possible. A change in routine, such as moving home or travel, can upset a child's sleep, just as it can with adults. (When travelling, take your child's pillow along!)
Two children from the same family can be different: the one who's more alert than the other may find it harder to fall asleep.
Sometimes sleep difficulties can be caused by health issues, such as reflux, lactose intolerance, asthma or allergies. Sleep apnoea can also cause constant waking, daytime inattention and hyperactivity. If your child is having problems sleeping that won't go away with improved sleep hygiene or settling methods, see your doctor.
How can I settle them?
- Learn to recognise your child's tiredness signals, and act quickly when you see them. In babies these may be grizzling, crying and fist clenching. They may also make jerky hand and foot movements or grimaces. Children may get upset suddenly, lose their concentration, rub their eyes or start yawning.
- Learn the appropriate settling techniques for your child's age. The main aim here is to help the child learn how to self-soothe and go off to sleep. Karitane has a useful guide to settling babies and toddlers.
- Background 'white noise' such as a fan or quiet soothing music can be helpful (and also has the benefit of soothing you). It's important that the music be continually playing, such as a CD on repeat, so that the child hears it if they wake up at night – see sleep onset association disorder.
- Develop a sleep routine. For example, always give your baby a massage or bath before putting them to bed.
- Make sure you get support. A stressed child can make a parent anxious, which can make the child's stress worse, and so on. Having someone to talk to, such as a supportive friend, family member or community health worker can help.
- Getting some time out can help alleviate stress, especially if you're very tired.
- Asking for help is not a sign of failure – children's sleep problems can be challenging for the whole family and many people need assistance and support.
Over-the-counter sleep aids
Experts say children shouldn't be given any kind of sleep aid products (including over-the-counter ones such as antihistamines or complementary medicine) without first seeking medical advice. It's important that a sleep disorder be correctly diagnosed, as each child is different, and by treating them incorrectly you may be doing more harm than good.
These are a specific type of sleep disorder and include sleepwalking, 'night terrors' and nightmares. If your child is a sleepwalker, the most important thing to do is minimise their ability to hurt themselves. Make sure knives, medicines and chemicals are locked up, and doors and windows are closed. If you find your child sleepwalking, don't try to wake them, but gently guide them back to bed.
A child who wakes up in the middle of the night screaming may be experiencing night terrors. They usually happen during deep sleep, very often at exactly the same time each night. The child may appear to be awake, but they don't respond to you talking to them. They may sweat, breathe quickly and have enlarged pupils. If your child is having regular night terrors at the same time, try to partially wake them before the episode happens and pat them gently on the back for a few minutes. Then allow the child to settle themselves back to sleep.
After a nightmare, a child may need some time to tell you what their dream was about, as well as getting some reassurance from you. It's best then to put them back in their own bed if you've moved them.
Affecting children as well as adults, apnoea literally blocks off the airway and stops breathing over and over again throughout sleep. According to Dr Jim Papadopoulos, thoracic (sleep) paediatrician at St George Private Hospital, Sydney, about three per cent of children aged two to six suffer from obstructive sleep apnoea, but it can occur at any age.
Symptoms can include snoring or loud breathing, pauses in breathing accompanied by choking or gasping noises, restless sleep, sweating in sleep, and daytime tiredness, moodiness and hyperactivity.
The good news is that having their tonsils and adenoids removed (adenotonsillectomy) is an effective treatment for most (but not all) children. Obesity can also be a contributing factor to sleep apnoea, which can also cause sleepiness on its own.
If you suspect your child has a sleeping disorder, it's important to get them diagnosed correctly. A physical examination with a doctor or a paediatrician specialising in sleep disorders is the first step. They may also ask you to keep a sleep diary, or want to monitor sleep with special sensors by having your child stay overnight in a children's sleep unit. The parent also stays the night in the same room and the sleep sensors don't as a rule distress the child, as they don't hurt or stress them.
Children with delays and disabilities
Children who are neurologically impaired (those with conditions such as Angelman's syndrome or autism) or who have psychological illnesses (such as ADHD) commonly have trouble getting to sleep or staying asleep. Sleep hygiene is vital to help these children.
Other behavioural strategies, such as using reward systems or changing sleep onset associations (see below), have shown some success. It's also important to have the child diagnosed for possible sleep disorders such as sleep apnoea, which could be connected with their condition.
Some preliminary testing using valerian had positive results with neurologically disabled children, but because the test group was so small further studies are needed. Some children have also responded to melatonin replacement therapy. While it's not recommended that supplements be used on children without careful monitoring by a paediatric sleep specialist, it's worth noting these are possibilities that warrant further investigation.
Sleep onset association disorder
Sometimes a child has no trouble getting off to sleep, but will wake regularly crying and needs a parent to put them back to sleep. This constant disruption to everyone's sleep can create a very sleep-deprived household. The pattern can be set up from what the child associates with sleep. This is because, during the sleep cycle, we all partially wake up approximately every 60 to 90 minutes and check our environment (though we usually don't remember doing so).
However, if we wake and our environment has changed, we might then completely wake up. For example, if a child goes to sleep with the light on but wakes to find it's been switched off, they may react to the change in the environment and become fully awake. They may become frightened and cry until the parent comes and turns the light on, after which they'll go to sleep again.
To overcome this pattern, a more useful sleep association needs to be set up. For instance, if your child won't sleep without being rocked in your arms, continue to do this for three or four nights, but also introduce a couple of other sleep associations like a teddy bear or soft blanket for the child to hold. After a few nights, instead of rocking your child, sit next to them and pat them while they go to sleep, as well as using the teddy and blanket. Then, after a few more nights, sit next to them without patting them. After a few more, stand by the door while they go to sleep. Finally, let them fall asleep with just the teddy and blanket to comfort them.
Insomnia in teenagers
Teens need more sleep than adults – it's true, they're really not just being lazy. Sleep problems in teenagers can often be caused by poor sleep hygiene — see our tips below for ways of correcting poor sleep habits.
Another common problem for teenagers is known as sleep onset delay. Teenagers tend to go to bed late but need to get up early for school, sporting activities and the like. It's not clear if this tendency to stay up is due to a developmental stage of the body clock or a result of lifestyle (most probably both).
Even if they do have an early night they may not be able to sleep, as their body clocks are set to go to sleep at a late hour. As a consequence they may end up feeling permanently jetlagged. It's a serious issue, as sleepiness can affect grades and behaviour, and may even increase car accidents among adolescents. In some US states they've changed the starting hours of high school to help address the problem of sleep deprivation among teens.
This teenage sleep problem can be treated with a behavioural therapy known as sleep restriction. This works by their going to bed late when they're sleepy, and then over a few weeks going to bed earlier (about 15 minutes at a time every three or four nights). Eventually their body clock is reset and their morning sleepiness goes away.
Exposure to bright light (preferably natural light) on awakening also helps to reset the body clock. Limiting the amount of exposure to evening light may also help.
Lack of sleep in children can result in crankiness, irritability and even inattention, hyperactivity and learning problems in some children. The following sleep hygiene tips were provided by Dr Papadopoulos:
- Their bedroom should be quiet, dark and not too hot or cold.
- Use the bed for sleeping only – no TV, video games, computer use or reading in bed.
- It's best if the TV, computer games and internet-enabled devices are out of the bedroom altogether (this applies particularly to teenagers).
- Try to have mealtimes around the same time each day, and avoid caffeine – cola and energy drinks, coffee, tea and chocolate – particularly after 4.00pm. Don't give them a big meal or too much liquid close to bedtime.
- If your child is having sleeping problems it's best they get up at the same time each morning, even on weekends. As soon as they wake they should get out of bed and go into the brightest room in the house. This helps to set their body clock. Sunlight is better than artificial light.
- Exercise during the day is great, but don't let them do anything too active for at least two hours before bed.
- Children shouldn't nap after 3.00pm.
Where to get help
Australian Capital Territory
Tresillian Parent Help Line: 1800 637 357
QEII Family Centre: (02) 6207 9977 (8 am–6 pm weekdays)
New South Wales
Karitane Care Line: (02) 9794 1852
(outside Sydney metropolitan area): 1800 677 961; 1300 CARING (1300 227 464)
Tresillian Parent Help Line: (02) 9787 0855 (outside Sydney metropolitan area): 1800 637 357
Children's Sleep Medicine Service: (02) 9553 1033
Parent Line: 1300 301 300
Department of Health and Community Services: (08) 8999 2400
Riverton Early Parenting Centre: (07) 3860 7111
Child Health Line: (07) 3862 2333
(outside Brisbane metropolitan area): 1800 177 279
Parent Helpline: 1300 364 100
Torrens House: (08) 8303 1500
PITAS — Parent Information Telephone Assistance Service (toll-free): 1800 808 178
Parentline: 13 22 89
Tweddle: (03) 9689 1577
O'Connell Family Centre: (03) 8416 7600
Ngala Helpline: (08) 9368 9368
(8.30 am–9.00 pm; no overnight service is provided).
(outside Perth metropolitan area): 1800 111 546