Children's Sleep Habits

There is a growing body of evidence that good (and enough) sleep is closely related to improved health and behavioral outcomes. (Of course, that is something we all know from our sleep deprived years in residency.) Whether it is attention-deficit/hyperactivity disorder (ADHD), abnormal weight gain, or even cardiovascular disease, getting enough sleep makes children healthier. That is easier said than done, of course. Given the number of things to get done in any given day – homework, after-school activities, dinner, and bath – it is a wonder any child gets to bed before midnight. Additionally, just as good sleep makes children happier and healthier, it also makes parents happier and healthier and is a common concern for families.

A recent study in Pediatrics examines the impact of genetic and environmental influences on infant sleep (Pediatrics 2012;129:1091-6).

The investigators asked parents of more than 1,900 pairs of twins to complete a questionnaire about their children’s sleep habits both during the day and at night. They concluded that there are BOTH genetic and environmental influences on sleep – again, this is perhaps not a great surprise for those of us who have talked to countless numbers of parents about this issue, but it is helpful to have some evidence behind this observation. I have cared for many families who could easily address their children’s sleep problems with some simple environmental changes and others who seemed to be doing everything "right" who still struggled. This study helps me to both assure parents that environmental changes do matter, but also to reassure them that there are some babies who just have a harder time with sleep. While this study looks only at infant sleep, sleep concerns are present at all ages.

The authors note a few environmental conditions associated with more disrupted or less sleep – in some cases up to 2 years of age. These include increased television viewing, early introduction of solid foods (less than 4 months), maternal depression, and attending a child-care center outside the home. Additionally, good "sleep hygiene" is recommended, including no television in bedrooms, early bedtimes (before 9 p.m.), consistent routines, avoidance of caffeinated drinks, and going to sleep alone (in other words, not in the parents’ bed). It is worth noting, as the authors do, that some of these are changes that might be harder for families with low socioeconomic status who may be sharing living space or have other influences that make consistent routines challenging.

Knowing this, how much sleep should children get? A review of the literature published earlier this year reported average sleep duration at different ages, including data from different countries and cultures (Sleep Med. Rev. 2012;16:213-22).

For infants, the average total amount of sleep was 12.8 hours, for toddlers and preschoolers it was 11.9 hours, and for older children it was 9.2 hours. These are only averages, of course, but if a child who is getting a dramatically different amount of sleep, parents may need to make some changes.

Improved sleep benefits everyone in the house. When needed, I encourage parents to think through what changes they would like to start with and then think about how they can implement them – recognizing that they are probably tired and frustrated with the problem. Some things are relatively easy (just unplug that television and remove it from the room) and others are more challenging (a child used to going to bed anytime between 9 p.m. and 1 a.m. isn’t just going to start hopping into bed each night at 8 p.m. on the nose), but taking an individualized approach improves chances for success and will hopefully lead to a better rested family.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is a member of the Pediatric News editorial advisory board, chair of the American Academy of Pediatrics Committee on Residency Scholarships, and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures.

There is a growing body of evidence that good (and enough) sleep is closely related to improved health and behavioral outcomes. (Of course, that is something we all know from our sleep deprived years in residency.) Whether it is attention-deficit/hyperactivity disorder (ADHD), abnormal weight gain, or even cardiovascular disease, getting enough sleep makes children healthier. That is easier said than done, of course. Given the number of things to get done in any given day – homework, after-school activities, dinner, and bath – it is a wonder any child gets to bed before midnight. Additionally, just as good sleep makes children happier and healthier, it also makes parents happier and healthier and is a common concern for families.

A recent study in Pediatrics examines the impact of genetic and environmental influences on infant sleep (Pediatrics 2012;129:1091-6).

The investigators asked parents of more than 1,900 pairs of twins to complete a questionnaire about their children’s sleep habits both during the day and at night. They concluded that there are BOTH genetic and environmental influences on sleep – again, this is perhaps not a great surprise for those of us who have talked to countless numbers of parents about this issue, but it is helpful to have some evidence behind this observation. I have cared for many families who could easily address their children’s sleep problems with some simple environmental changes and others who seemed to be doing everything "right" who still struggled. This study helps me to both assure parents that environmental changes do matter, but also to reassure them that there are some babies who just have a harder time with sleep. While this study looks only at infant sleep, sleep concerns are present at all ages.

The authors note a few environmental conditions associated with more disrupted or less sleep – in some cases up to 2 years of age. These include increased television viewing, early introduction of solid foods (less than 4 months), maternal depression, and attending a child-care center outside the home. Additionally, good "sleep hygiene" is recommended, including no television in bedrooms, early bedtimes (before 9 p.m.), consistent routines, avoidance of caffeinated drinks, and going to sleep alone (in other words, not in the parents’ bed). It is worth noting, as the authors do, that some of these are changes that might be harder for families with low socioeconomic status who may be sharing living space or have other influences that make consistent routines challenging.

Knowing this, how much sleep should children get? A review of the literature published earlier this year reported average sleep duration at different ages, including data from different countries and cultures (Sleep Med. Rev. 2012;16:213-22).

For infants, the average total amount of sleep was 12.8 hours, for toddlers and preschoolers it was 11.9 hours, and for older children it was 9.2 hours. These are only averages, of course, but if a child who is getting a dramatically different amount of sleep, parents may need to make some changes.

Improved sleep benefits everyone in the house. When needed, I encourage parents to think through what changes they would like to start with and then think about how they can implement them – recognizing that they are probably tired and frustrated with the problem. Some things are relatively easy (just unplug that television and remove it from the room) and others are more challenging (a child used to going to bed anytime between 9 p.m. and 1 a.m. isn’t just going to start hopping into bed each night at 8 p.m. on the nose), but taking an individualized approach improves chances for success and will hopefully lead to a better rested family.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is a member of the Pediatric News editorial advisory board, chair of the American Academy of Pediatrics Committee on Residency Scholarships, and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures.

There is a growing body of evidence that good (and enough) sleep is closely related to improved health and behavioral outcomes. (Of course, that is something we all know from our sleep deprived years in residency.) Whether it is attention-deficit/hyperactivity disorder (ADHD), abnormal weight gain, or even cardiovascular disease, getting enough sleep makes children healthier. That is easier said than done, of course. Given the number of things to get done in any given day – homework, after-school activities, dinner, and bath – it is a wonder any child gets to bed before midnight. Additionally, just as good sleep makes children happier and healthier, it also makes parents happier and healthier and is a common concern for families.

A recent study in Pediatrics examines the impact of genetic and environmental influences on infant sleep (Pediatrics 2012;129:1091-6).

The investigators asked parents of more than 1,900 pairs of twins to complete a questionnaire about their children’s sleep habits both during the day and at night. They concluded that there are BOTH genetic and environmental influences on sleep – again, this is perhaps not a great surprise for those of us who have talked to countless numbers of parents about this issue, but it is helpful to have some evidence behind this observation. I have cared for many families who could easily address their children’s sleep problems with some simple environmental changes and others who seemed to be doing everything "right" who still struggled. This study helps me to both assure parents that environmental changes do matter, but also to reassure them that there are some babies who just have a harder time with sleep. While this study looks only at infant sleep, sleep concerns are present at all ages.

The authors note a few environmental conditions associated with more disrupted or less sleep – in some cases up to 2 years of age. These include increased television viewing, early introduction of solid foods (less than 4 months), maternal depression, and attending a child-care center outside the home. Additionally, good "sleep hygiene" is recommended, including no television in bedrooms, early bedtimes (before 9 p.m.), consistent routines, avoidance of caffeinated drinks, and going to sleep alone (in other words, not in the parents’ bed). It is worth noting, as the authors do, that some of these are changes that might be harder for families with low socioeconomic status who may be sharing living space or have other influences that make consistent routines challenging.

Knowing this, how much sleep should children get? A review of the literature published earlier this year reported average sleep duration at different ages, including data from different countries and cultures (Sleep Med. Rev. 2012;16:213-22).

For infants, the average total amount of sleep was 12.8 hours, for toddlers and preschoolers it was 11.9 hours, and for older children it was 9.2 hours. These are only averages, of course, but if a child who is getting a dramatically different amount of sleep, parents may need to make some changes.

Improved sleep benefits everyone in the house. When needed, I encourage parents to think through what changes they would like to start with and then think about how they can implement them – recognizing that they are probably tired and frustrated with the problem. Some things are relatively easy (just unplug that television and remove it from the room) and others are more challenging (a child used to going to bed anytime between 9 p.m. and 1 a.m. isn’t just going to start hopping into bed each night at 8 p.m. on the nose), but taking an individualized approach improves chances for success and will hopefully lead to a better rested family.

Dr. Beers is assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is a member of the Pediatric News editorial advisory board, chair of the American Academy of Pediatrics Committee on Residency Scholarships, and president of the District of Columbia chapter of the American Academy of Pediatrics. She said she had no relevant financial disclosures.