Common Sleep Conditions in Infants, Children and Adolescents - What it is
Sleep is important
Sleep is an important part of healthy growth and development in children, just like nutrition and physical activity.
Contrary to the common perception that sleep is only a passive state during which the bodily processes slow down and the body rests itself at the end of the day, many active physiological processes take place in the body during sleep.
Amongst these are memory consolidation and growth hormone secretion which are important physiological processes in children.
The paediatric sleep specialist is concerned with both the quality and quantity of sleep in children.
What can affect sleep?
Sleep-related disorders such as obstructive sleep apnoea can disrupt a child’s sleep.
Medical conditions in children, such as uncontrolled asthma, allergic rhinitis and eczema, can affect the quality and duration of a child’s sleep.
School and social pressures and the increased usage of electronic devices in this day and age can also impact the bedtime and the duration of sleep in children and adolescents.
Why get a good night’s sleep?
Effects of Poor Sleep
Poor sleep can have various adverse effects on a child’s health:
- Sleep deprivation can affect daytime alertness, judgement, memory, reaction time and motor performance.
- The lack of sleep is associated with behavioural problems and emotional disturbances which may reduce the ability of the child to perform optimally at school.
- Decreased slow wave sleep (one of the stages of sleep) is associated with decreased growth hormone secretion during sleep.
- Sleep deprivation is related to type 2 diabetes, obesity, hypertension, metabolic syndrome, reduced immunity and cardiovascular problems.
Sleep requirements in infants and children
Sleep architecture (the pattern and proportion of the different sleep stages during sleep) and sleep requirements evolve with the development and maturation of the central nervous system, as a child progresses from infancy through childhood and adolescence to adulthood.
Newborns under four months old spend 14 to 17 hours in a 24-hour period asleep. They may sleep for three to five hours at a stretch (two to three hours in breastfed babies), and then wake for one to three hours in between.
Infants between four and 12 months old sleep between 12 and 16 hours in a 24-hour period. This includes sleep in the night, with usually two to four daytime naps.
Toddlers one to two years old sleep between 11 and 14 hours in a 24-hour period (including daytime naps). The sleep duration decreases further in pre-schoolers aged three to five years, to between 10 and 13 hours. By five years of age, most children stop taking daytime naps.
School-going children aged six to 12 years should be highly active and alert during waking hours, and the majority require between nine and 12 hours of sleep at night.
At the onset of puberty, adolescents may develop a two-hour phase delay in their circadian rhythm (‘body clock’) leading to a natural tendency to fall asleep at later times. The majority of adolescents and teenagers aged 13 to 18 years require an average of about eight to 10 hours of sleep.
Source: American Academy of Sleep Medicine
There is no ‘golden rule’ to the exact amount of sleep needed at different ages, and there are often individual variations in sleep requirements, sleep patterns as well as tolerance to sleep deprivation. In general, the duration of sleep is sufficient if the child feels wellrested on waking spontaneously and is able to function normally throughout the day.
Some of the signs of insufficient sleep include:
- Excessive daytime sleepiness
- Mood disturbances
- Behavioural problems such as inattention, hyperactivity, oppositional behaviour and poor impulse control
- Impaired cognitive functioning, such as poor concentration, impaired vigilance, delayed reaction time and learning problems
Good sleep hygiene and practices
The following advice can help children achieve better sleep:
- Maintain a consistent sleep and wake time daily, including school days and non-school days.
- Avoid using the bed for any other activity (e.g. reading, watching television, playing games on personal electronic devices, eating) other than sleeping.
- Avoid using the bedroom for timeout or punishment.
- Ensure that the bedroom is conducive for sleeping. Keep it dim, cool and quiet.
- Establish a regular relaxing routine before bedtime (e.g. brushing teeth, changing into pyjamas, reading of a story).
- Go to bed only when tired or sleepy, rather than spending too much time awake on the bed. If your child is unable to fall asleep after 20 minutes, consider letting him get out of bed to do some low stimulation activity (e.g. quiet reading) and then returning to bed later.
- Avoid caffeine (e.g. coffee, tea, chocolate, cola and soda drinks) and nicotine (exposure to environmental tobacco smoke) at least four to six hours before bedtime.
- Avoid going to bed with a full stomach or when too hungry.
- Avoid stimulating activities before sleep (for e.g. watching of exciting/ frightening television programmes, playing of games on personal electronic devices).
- Regular exercise is encouraged, but avoid exercise or strenuous activities at least four hours before bedtime.
Sleep advice for parents of newborns and infants
The sleep and wake times of newborns and infants are often influenced by their need to be fed or changed.
It is important that parents understand how newborns and infants sleep so that they can set realistic expectations.
- Babies do not understand what is ‘sleeping through the night’, and many do not do so until they are more than three to six months old.
- Every baby is different; your baby may have different sleep patterns from other babies and still be normal and healthy.
- Your baby will begin to sleep for longer periods of time at night as he/she grows and develops over time.
- All babies wake up spontaneously at least a few times during the night. They may require soothing and intervention from caregivers to fall back to sleep in the first couple of months. From the age of three to six months onwards, most will have the ability to self-soothe themselves back to sleep.
Parents with newborns and infants may consider the following advice to help their babies develop the ability to selfsoothe (It is never too early to start!):
- Put your baby to the crib/bed drowsy but still awake so that he/ she can learn to fall asleep on his/ her own. Babies/children who are accustomed to parental assistance at bedtime often require help again to fall back to sleep when they wake in the night.
- Avoid breastfeeding or bottle feeding your baby to sleep so that he/she does not require this to fall asleep. Some parents find gentle rhythmic patting of their babies helpful in settling them to sleep, but it is best to stop the patting when the baby is quiet and about to fall asleep.
- Learn to identify signs of sleepiness in your baby. Babies may express their need to sleep in different ways. Some babies fuss or cry, some rub their eyes or pull their ears, others lose focus in ongoing play or activity.
- Avoid picking your baby up immediately each time he/she cries or fusses in the night. As long as safety is not a concern, allow your baby to try to fall back to sleep on his/her own first. If you need to check on your baby in the night, keep it brief and avoid turning on bright lights and engaging/ stimulating activities. When feeding or changing your baby during the night, do so in a quiet and calm manner.
- Wrapping newborns snugly with a thin baby blanket may help them feel more secure and reduce ‘startles’ during sleep. Always check that the wrapping is not too tight and that the baby’s breathing is not obstructed.
- Engage in play and stimulating activities during your baby’s wake period, but keep the environment dimmer and quieter with less activity as the evening approaches to help your baby sleep better and longer during the night.
- Avoid night feedings after the age of six months. Night feedings are not necessary for growth after the age of six months and may potentially disrupt sleep.