Dr. Kassam Your Ultimate Guide To Healthy Sleeping (From Infancy To Teens)

Your Ultimate Guide To Healthy Sleeping

(From Infancy To Teens)

     Sleep is one of the most commonly discussed topics during well-child visits. Did you know that up to 50% of children will experience a sleeping problem at some point in their childhood and if they are caught early enough it can prevent a whole slew of other health conditions? 
A good night’s sleep is often taken for granted. Sleep is a physiological process that begins very early and is one of the most important factors in predicting your child’s current and future health status. Both sleep quality and quantity matter. Sleep is the time when the body can conserve energy, rest and restore. Good sleep can promote healthy immune regulation, mood, energy, growth and digestion. 

Sleep In Infants

Sleeping patterns change dramatically over the first few years of life. In newborns sleep is spread over a 24-hour day. Within a few weeks of life sleeping patterns are established and sleep is mainly at night which allows for longer wake periods. One of the most important aspects of sleeping infants is that within 1 hour of waking them in the morning they need to go down for a nap. Ensuring your infants this nap will set the routine for the rest of the day. After about 5 months of age, infants then have the ability to sleep for long periods of time. At 6 months, infants are able to go a whole night without any feedings (YAY!)

Sleep Throughout The Years

The sleeping schedule and amount of sleep time changes with age. Below is a schedule for how much time your infant, toddler, child and teen need on an everyday basis: 
  • 0-2 months: 16-18 hours of total sleep time
    • 3.5 naps per day
  • 2-12 months: 12-16 hours of total sleep time
    • 2 naps per day
  • 1-3 years: 10-16 hours of total sleep time
    • 1 nap per day
  • 3-5 years: 11-15 hours of total sleep time
    • 50% of 3 year olds do not require a nap
  • 5-14 years: 9-13 hours of total sleep time
  • 14-18 years: 7-10 hours of total sleep time
    • Napping in this age group can suggest insufficient sleep or a possible sleeping disorder
Kids are not born knowing how and when to sleep. It is an acquired skill. It is super important to establish regular sleeping routines with specific times for naps and early bedtimes.  The timing of when kids fall asleep can make a big difference in sleep quality. At infancy and school-age children sleep quality is improved if they can fall asleep between 7-8 pm and children who go to bed after 9 pm tend to take longer to fall asleep and wake up more frequently during the night. 
It is therefore important to recognize the signs of when your child is trying to ensure you catch their ideal sleeping window. When you catch the signs early, kids will have an easier time falling asleep. Here are signs to watch out for: 
  • They will become quieter
  • Activity becomes decreased
  • Yawning is persistent
  • Movements are delayed
  • They are not interested in what is going on around them
  • Their eyelids start to droop 
If you miss these signs, putting your child to bed will become a whole lot more difficult.  Here are some signs that your child is overtired:
  • Rubbing their eyes
  • Irritability
  • Increased crankiness


Common Sleep Disorders in Children

About 50% of children can experience sleeping problems, the most recognized consequence of inadequate sleep is daytime sleepiness but can also manifest as irritability, behavioural problems, learning difficulties and poor academic performance.
Now, about 4% of children can have a formal sleep disorder diagnosis which is a lot more serious than difficulty sleeping. Below are some sleeping disorders that can be experienced by children: 
  • Obstructive Sleep Apnea 
    • Onset: Between 2-9 years of age
    • Features: Snoring, unusual sleep positions, nightmares, morning headaches, large tonsils, daytime sleepiness
  • Sleepwalking
    • Onset: 8-12 years of age
    • Features: Difficulty to awaken during episode, confusion, rapid return to sleep, no memory of the event
  • Sleep Terrors
    • Onset: early childhood
    • Features: Intense fear (screaming, crying, confusion), difficulty to awaken from episode
  • Nightmares
    • Onset: 3-6 years of age
    • Features: unpleasant dreams, increased heart rate, sweating, reluctance to sleep
  • Insomnia
    • Features: Difficulty maintaining or initiating sleep, frequent nighttime awakenings, falling asleep takes long, stalling bedtime
If the above conditions are persistent and affecting quality of life it is important to get your child assessed so that appropriate treatment can be administered. 

What Are Some Negative Health Effects Of Not Sleeping Enough?

It is well-established that insomnia in adults can interfere with daily functioning at a physical, emotional and mental level. The same is true for infants and children who lack good quality sleep. Lack of adequate sleep increases the risk for obesity, metabolic syndrome, increased hyperactivity, fatigue and irritability during the day. 
In one study, they looked at the sleep of children aged 6, 12 and 24 months and then assessed their BMI at 3 years of age. This study concluded that “daily sleep duration of < 12 hours during infancy appears to be a risk factor for being overweight and adiposity in preschool-aged children”. 
An interesting note to add is that the interaction between the mother’s mood and child’s sleep also beings very early - even before the baby is born. Mothers who are distressed before pregnancy or during pregnancy increased infant night awakenings and decreased total sleep time at 2-8 months of age. 

Bedtime Routines That Will Help Your Child Sleep Better

Engaging in the same activities in the same order each night can help to establish a routine  every night. Research found that when a standard bedtime routine was implemented for 2 weeks, infants fell asleep more quickly and woke up less often during the night. Work on establishing a short 30 minute bedtime routine with a couple activities. It is important whatever activities you chose before are the SAME ones every night. Being consistent is the most important. Some examples of night-time activities include:  
  • Changing into PJ’s
  • Reading them a bedtime story
  • Brushing teeth
  • Taking a bath
  • Castor oil belly rubs before bed or pressure massage of the lower legs and feet 
  • Cuddling
  • Allocating a certain amount of time to talk through what happened during their day
As important as regular bedtime routines are, there are also some good sleep hygiene techniques that can be implemented alongside bedtime routines. Here are some recommendations to improve sleep hygiene:
  • Avoid napping during the day
  • Avoid eating dinner at least 2 hours before bedtime
  • Screens should be stopped at least one hour before bed
  • Playing relaxing music in the background
  • Dimming the lights 2 hours before bed and closing the curtains to avoid blue light
  • Put all phones on 'do not disturb' mode and charge all electronics outside of the bedroom
  • Make sure kids are active during the day so they are tired to fall asleep at night
Try your best to keep these same sleep routines on weekends and vacation. A little shift here and there is fine, but overall aim to keep the routine the same regardless of where you are. Variations can throw the body off making it harder to sleep. 
Lack of sleep in infants and children can have many negative long term health implications like obesity, increased hyperactivity and constant fatigue. If difficulty sleeping becomes persistent and symptoms start to resemble the ones above for sleep disorders in children it is important to seek professional help. To help your child fall asleep quicker and maintain sleep try some of the sleep hygiene tips as well as some consistent bedtime routines. Most importantly,  keep in mind that children tend to listen more when parents are also incorporating these same actions. 
  1. Taveras EM, Rifas-Shiman SL, Oken E, Gunderson EP, Gillman MW. Short sleep duration in infancy and risk of childhood overweight. Arch Pediatr Adolesc Med. 2008;162(4):305-311.
  2. O’Connor TG, Caprariello P, Blackmore ER, Gregory AM, Glover V, Fleming P; ALSPAC Study Team. Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood. Early Hum Dev. 2007;83(7):451-458
  3. Mindell JA, Telofski LS, Wiegand B, Kurtz ES. A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep. 2009;32(5):599-606.
  4. Darley. C. Sleeping like a baby. Ndnr. 2010. 
  5. Carter et al. Common Sleep Disorders in Children. Am Fam Physician. 2014:89(5):368-377.
** Disclaimer: The advice in this article is for informational purposes only. It does not replace the care of a Naturopathic physician.