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Harvard Commentaries
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A Parent's Life A Parent's Life

Children and Sleep -- What Parents Need to Know

March 14, 2012

Parents aren't the only ones who worry and their kids' sleep habits. It's something we doctors worry about, too.

Sleep is crucial for a child's good health, development and behavior. However, parents and doctors don't always worry about the same things when it comes to children and sleep. Here are the most important things I want parents to know.

We don't know how much sleep kids need. There are guidelines, but it turns out that they aren't really based on solid evidence. For adults, we know that eight hours is a good amount to shoot for. But it's just not that clear for kids. For some, eight hours might be enough; others might need much more. Some babies might need 14 hours but other babies of the same age might do fine with 12. It depends on the child and her activity and metabolism. As we study sleep more, we may come up with better guidelines. But right now they are mostly guesswork.

We can tell if your child is getting enough sleep. If your child isn't sleepy during the day, is active, healthy and behaving well, they are getting enough sleep. It doesn't always work the other way around: If your child isn't healthy or behaving well, it may or may not be due to lack of sleep. But if all is going well, you don't need to worry about their sleep, with one exception …

Noisy breathing during sleep isn't good. Snoring concerns doctors, especially if a child stops breathing at all while snoring. But any mouth breathing or noisy breathing might be a problem. It can be a sign of a blockage, which can cause a child's sleep to be disturbed and less restful. Lack of sleep can cause health and behavioral problems. The most common causes of the blockage are enlarged tonsils or adenoids, or obesity. If your child is having noisy breathing at night, let your doctor know.

Being tired during the day isn't the only sign of too little sleep. Sometimes, lack of sleep can show up as behavior problems, especially attention problems like attention deficit hyperactivity disorder (ADHD).

Many kids don't get enough sleep because of a poor sleep environment or poor sleep habits. Here are some things to do — and not do:

  1. Try to create a sleep environment that is dark, quiet and relaxing. Use light-blocking curtains. Try to keep the noise level in the house down after bedtime.
  2. Have a consistent bedtime. This helps create good sleep habits and ensure that your child is sleepy at bedtime. For school-age kids, aim for 8 to 10 hours; add more if they seem tired during the day.
  3. Have a calming routine before bedtime. It's hard to go from bouncing around or watching a scary or exciting TV show to falling asleep. Ease into bedtime with things like a warm bath, snuggling and a bedtime story. Have older kids shut off the TV and stop homework at least a half hour before bedtime so that they can relax.
  4. If your child has a cell phone, charge it somewhere other than the bedroom. A remarkable number of teens text and use the phone when they should be sleeping.
  5. Don't put a TV in your child's bedroom. Kids with a TV in their bedroom sleep less and watch more TV, which isn't good for their health or behavior either.
  6. Don't get too far off the schedule on weekends or holidays. "Sleeping in" the next morning may not be enough to make up for the schedule change. And they will have trouble when they need to go back to school.

Sleep habits can be taught and changed. If your child wakes up and climbs into bed with you every night — and you are a bear every morning because he kicks for the rest of the night — there is hope.

If your child insists that he can't fall asleep without the TV, it's not true — he can. It may take a few nights and may not be pleasant, but most sleep habits can be changed if you are consistent and lovingly firm. Talk to your doctor; together you can find the best way to change bad habits into good ones.

In general, your doctor is your best resource when it comes to questions about your child's sleep. We may not have all the answers, but we can work with you to be sure that your child — and everyone else in the house — gets the sleep they need.

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Claire McCarthy, M.D., a senior medical editor for Harvard Health Publications, is an assistant professor in pediatrics at Harvard Medical School. She is an attending physician and Medical Communications Editor at Children's Hospital Boston.

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