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Sleep Problems

What’s there to know about sleeping?
Sleep problems are some of the most common problems parents face with their kids.  You may wonder about how to get your child to sleep through the night.  Maybe you have a new baby and want to learn how to help them develop good sleep habits that will last a lifetime.  Some children may have chronic sleep difficulties, and many children (like most adults!) are actually going through their days sleep-deprived.  Read on for information on all these issues and more, and for lots of links to even more resources to help your kids (and you) get a better night’s sleep.

What do I need to know about sleep cycles?
When people sleep, they cycle between rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep.  In REM, your eyes move around fast, you don’t move your body much, and you dream.  REM is light sleep and the stage when your infant or child is most likely to wake up.  NREM sleep is deep sleep. 

In normal sleep, a child cycles between light sleep and deep sleep.  Each light sleep stage is a time when the child is more likely to wake up. 

What do I need to know about how babies sleep?
Infants go through a complete sleep cycle about every 50-60 minutes, so they are in light sleep and could wake up many times each night! 

Newborns just sleep any old time, on and off, all through the day and night.  By age four months, your baby will probably be sleeping a 6-8 hour chunk at night, and by age 6 months, about 10-12 hours.  But that’s not to say that they won’t wake up during that time!  Most babies still wake up at least once a night even at age nine months.  Some can get back to sleep by themselves, and some need you to help them fall back asleep.  If all this night waking is not working for your family, then you may find some helpful resources on this page, so read on! 

A special note about babies and sleep safety: Healthy babies should be put down to sleep on their backs to lower the risk of SIDS. Be sure all your baby’s caregivers are aware of the safe sleep guidelines. Find out more about Safe Sleep.

What do I need to know about school-age children and sleep?
School-aged children still need somewhere between 9 and 12 hours of sleep at night. At this age, kids usually start a trend toward becoming more and more sleep deprived. As the parents, you will need to help figure out how much sleep your child needs. Your child is getting the right amount of sleep if they:

In other words, if your child can go to bed, fall asleep easily, wake up easily, and not be tired during the day, then they're probably getting enough sleep.

Is your child complaining about a bedtime that’s earlier than their friends’ bedtimes, and saying that everyone else gets to stay up later?  Let them know that every child is different and that this is their bedtime.  Tell your kid that you’re keeping their bedtime at the right time for them because it’s healthy. They’ll feel better during the day if they sleep well at night.

One survey [1] of kindergarten through fourth grade kids and their teachers found that teachers reported that about 10% of the kids were falling asleep in school.  Like us adults, many of our school-age kids are sleep deprived.  Remember, letting kids stay up later isn’t doing them a favor.

What if my teenager seems tired all the time?

How do I teach my child good sleep habits?
Here are some "Do’s and Don’ts":

DO:

DON’T:

What are the problems that can come up with kids' sleep?
Sleep deprivation: Not getting enough sleep can lead to serious problems for your child and is all too common in our society.
Night waking All children have times at night when they sleep more lightly or wake up.  Night waking can become a problem when it is very frequent or when your child has trouble getting back to sleep.
Sleep onset associations:  This is the most common cause of children not being able to settle back to sleep.  Whatever they associate with falling asleep, like being rocked or a sucking a pacifier needs to be present for them to fall back to sleep.
Separation issues:  Separation problems can affect either you or your child.  Your child may feel anxious if you are not there, and so is unable to relax and sleep.  Likewise, you may feel anxious about your child, and go in to them every time they make a peep at night, even if they don’t need you.
Resistance to sleep/settling problems:  This is when your child does not want to go to bed at night.  They throw a tantrum, or stall, and just refuse to go to sleep.
Parasomnias:  These are disruptive sleep-related problems.  They are usually not anything serious.  They include things like teeth grinding and night terrors.

How can I tell if my child is sleep deprived?  How much sleep do kids need? 
This chart shows you some averages.  It will give you an idea of the ballpark you should be aiming for, depending on your child’s age.  Some kids will need more or less sleep, and differ in how they nap. 

 Age

 Nighttime Sleep

 (hours)

 Daytime Sleep

 (hours)

 Total Sleep

 (hours)

 1 month

 8.5 (many naps)

 7.5 (many naps)

 16

 3 months

 6-10

 5-9

 15

 6 months

 10-12

 3-4.5

 14.5

 9 months

 11

 3 (2 naps)

 14

 12 months

 11

 2.5 (2 naps)

 13.5

 18 months

 11

 2.5 (1-2 naps)

 13.5

 2 years

 11

 2 (1 nap)

 13

 3 years

 10.5

 1.5 (1 nap)

 12

 4 years

 11.5

 0

 11.5

 5 years

 11

 0

 11

 6 years

 11

 0

 11

 7 years

 11

 0

 11

 8 years

 10-11

 0

 10-11

 9 years

 10-11

 0

 10-11

 10 years

 10

 0

 10

 11 years

 10

 0

 10

 12-13 years

 9.5-10

 0

 9.5-10

 14 years

 9.5

 0

 9.5

 15 years

 9.5

 0

 9.5

 16 years

 9.25

 0

 9.25

Different people need different amounts of sleep.  Remember that charts that list the average amount of sleep for each age group are just that—averages.  These are not magic numbers.  The best way to tell if your child is getting enough sleep is to look at how they act while they are awake.  Here are some things to consider about how much sleep is enough

If your child’s poor sleep is causing daytime problems, then they are sleep deprived.

Ask yourself these questions:

If you answer “yes” to any of these questions, your child may be sleep deprived (not getting enough sleep).  We live in a very sleep deprived society.  Sleep deprived children (and adults) have more trouble controlling their emotions.  The part of the brain that helps us to control our actions and our response to feelings is affected greatly by lack of sleep.  Not getting enough sleep can lead to all kinds of problems, such as behavior problems, attention problems, and not doing well in school [5]. Kids who don't get enough sleep are also more apt to hurt themselves [6] [7].

Go more in depth on sleep deprivation:

What do I need to know about night waking?  What if my child wakes up a lot at night?
Infants and night waking
Does everyone always ask you: ”So, is your baby sleeping through the night yet?”  Sleep is often a major topic of conversation when there’s a baby in the family. Remember:  it is normal for babies to wake up at night.  Breastfed babies may wake more often than formula fed babies because breast milk is so quickly and easily digested.  Your new baby is likely hungry every two or three hours, and needs to nurse to get back to sleep.  Some time after about 6 months of age, your breastfed baby will probably be able to go 6-8 hours without nursing. 

To help you cope with night waking, try taking turns with your partner to get up and comfort your baby.  Remember, this is a time to comfort and re-settle your child, not a time for play or anything else exciting.  Be comforting but boring.  Don’t respond to any games your child may try to start.

What causes night waking
Babies and young children are less likely to sleep through the night if they:

If your child is waking often, here are some possible causes to consider—and to talk to your child’s doctor about:

If your child wakes, how quickly and easily they fall back asleep will depend in part on what their sleep onset association is, so read on….

What are sleep-onset associations?
Whatever your baby connects with falling asleep (like being rocked, fed, or sucking their thumb, for example) is called a sleep-onset association.  When they wake up, they will need that thing to be able to fall back to sleep.  If you want your child to go back to sleep on their own when they wake up at night, then you should encourage sleep-onset associations that do not involve you, the parents.  How do you do this?  When you put your child to bed, you can rock or feed your child to make them sleepy, but stop before they actually go to sleep.  Put your child to bed when they are still awake, so they learn to go to sleep without you there.  Children who have a more difficult temperament may have more trouble with sleep-onset associations.

What do separation problems have to do with sleep? 
Separation anxiety is a very common reason for children under three years to cry at night. By eight or nine months, children have learned that their parents exist even if they can't see them. However the inner confidence to be able to feel secure when their parents are not there is still developing until three or four years of age. Night waking usually drops off quickly after this. You can tell if your child is waking due to separation anxiety because if you are nearby to reassure them, they will settle back to sleep.  For older children, you can put a foam mattress and sleeping bag on the floor near your bed, so they can come in and sleep near you if they need nighttime reassurance.  

To help prevent separation problems at night, when your child is between four months and a year old, give them a transitional object (like a blanket, doll or other favorite thing).  Then when they wake up, having that object there will comfort them and help them go back to sleep.

Your baby may groan and move around, or even cry out during REM sleep.  Wait a little before you go to them.  If you want your baby to be able to sleep without your help, give them a chance to fall back into deep sleep on their own.

Sometimes parents are overly anxious about their baby or child.  Have you ever been away from your baby?  Do you worry about your baby all the time when you are away?  Do you have trouble not going to your baby at night every time they stir or make a peep?  You might have separation issues of your own.  Some parents have lots of trouble separating from their baby.  This is something you need to work on if you want your baby to be able to sleep through the night.  Your difficulty with separation can cause problems for your child down the road in many areas. 

What if my child has problems settling in at night or resists going to sleep?
There are different reasons your child may not want to go to bed at night. Your child may have issues with autonomy.  In other words, they may want to have more control over their body and their environment.  This usually starts to happen after about nine months of age, and is what two-year-olds are famous for!  Give your child some limited choice and “control” over the type of bedtime activities and the order of the bedtime routine.   If your child has more control over these activities, they may feel less need to exercise control over when they fall asleep.

If your older child resists going to sleep at night, remember this:  It is your responsibility to put your child to bed, but it is your child’s responsibility to go to sleep.  Put your child to bed at a reasonable time after a reasonable bedtime routine.  Have clear rules (stay in bed, no eating, etc.).  Then, if your child doesn’t fall asleep, it may be that they don’t need so much sleep.  If they stay awake late, and then want to sleep late in the morning, wake them up 10 minutes to a half hour earlier every morning until they are falling asleep at the time you want at night. 

Basically, you should discuss the bedtime routine during the day so that the child knows what to expect at night.   Then stick with it each night. If kids know what to expect, then they'll usually do okay.

What are parasomnias?
Parasomnias are disruptive sleep-related events, and usually not too serious.  They include:

What are nightmares and night terrors (also called sleep terrors) and how are they different?

 

 Night terrors

 Nightmares

 Time of night

 Early, usually within 4 hours of bedtime

 Later in the night

 How child acts

 Confused and disoriented

 Scared and upset

 Response to parents

 Doesn’t know parents are there, can’t comfort

 Can be comforted

 Memory of event

 Usually none

 Can remember dream

 Return to sleep

 Usually quick, unless fully awakened

 Often delayed by fear

 Sleep stage

 Deep non-REM sleep

 Light, REM sleep

If your child wakes up with a nightmare, gently lay them down and say “go back to sleep, now”.  It is very important not to try to talk much about it, because talking doesn’t work.  Just soothe them however you usually do (for example, by gently stroking their hair or back) until they can relax and go back to sleep. 

If your child has night terrors, you will not be able to comfort them.  Your child is actually still asleep, like with sleepwalking or talking in their sleep.  Try not to disturb your child, but stay near them and make sure they don’t hurt themselves.  Being overtired and staying up too late can cause night terrors, so make sure your child is getting enough sleep.  Read more about coping with night terrors.

What is sleep apnea?
Apnea means having short pauses in the breathing pattern. The pauses in breathing are usually normal, but sometimes can be a problem. The usual cause of obstructive sleep apnea is enlarged tonsils or adenoids that block the upper airway when the child is sleeping. If your suspect your child has obstructive sleep apnea, talk to your doctor about having your child evaluated.

How can I help my child (and myself) sleep better?  What are some strategies I can try?
There are different reasons kids have trouble sleeping, and some different expert opinions on how to help them.  Your family should learn about the various approaches, and decide what feels most comfortable for you and for your child.  Remember, with any of these approaches, to be consistent, keep bedtime calm, and let your child know you love them.  You should not to follow any program to the letter if your intuition tells you it’s not right for your child.  Different approaches may work better or worse for different children in different families.  If you feel you or your child is just too distressed by a given method, try something else more comfortable for you.

Here are some approaches you could try, along with some links for more detail on how to follow the program:

What is a sleep diary?  How might it help with my child’s sleep?
Try keeping a sleep diary for a period of time.  Looking at this information over a period of days or weeks may help you find some patterns.  Once you see patterns, you may be able to find a solution.  Also, if you go to see your child’s pediatrician about your child’s sleep problems, bring along the sleep diary.  Here’s what you should keep track of:

How can I decide whether a crib or sharing sleep (co-sleeping) is better for my family?

Surveys show that many American parents sleep with their children for all or part of the night.  A study by the National Institute for Child Health and Human Development called the National Infant Sleep Position (NISP) study estimated that nearly 50 percent of the infants in the study spent at least some time in the last two weeks sleeping on an adult bed at night, with 20 percent doing so half the time or more, and 13 percent usually sleeping on an adult bed at night [8].

Doctors do not all agree on whether co-sleeping is safe. Their concern is based on statistics that show that half of all child suffocation deaths occur in adult beds due to overlaying or suffocation in bedding. Therefore, many experts recommend not sleeping with your baby at all. Other doctors, however, believe co-sleeping can be safe if the necessary safety precautions are taken. For more information on safe sleeping arrangements, visit YourChild: Safe Sleep.

Here are some of the pros and cons of each arrangement:

 

Crib

Parents’ Bed

Pros

A restless baby is less likely to disturb parents, and vice versa.

It’s easier for parents to be intimate at night.

Sleeping independently is valued in American culture.

Parents get a break from time with baby to “recharge their batteries.”

Parents don’t have to get up at night to soothe or nurse baby, and can soothe baby back to sleep without anyone fully waking.

Working parents can spend more time with child.

Sharing sleep can help foster a strong attachment to your child.

The time your child will spend sharing sleep with you is very short in the big picture.

Around the world, the norm is for babies to sleep with their parents, and, some would say, it is the “natural” way to sleep.

Cons

Parents have to get up at night to soothe baby.

Your baby may be very upset and difficult to soothe back to sleep by the time you wake and go in to them.

It may become difficult to transition child to their own bed until age 2-4, if they still sleep in parent’s bed after about age 6 months.

Sleep-sharing creates a sleep-onset association that involves the parents (but parents who enjoy sharing sleep do not view this as a negative).

Both parents must be committed to the arrangement, or it will cause conflict between them.

It is important that parents be comfortable with the sleeping arrangements, and choose an arrangement that will help everyone get the best possible sleep.  Whatever you choose, make sure your family bed or your baby's crib is safe, by reading about safe sleep. In spite of some cultural fears we may have in this country, bed-sharing does not have any negative psychological effects for children or parents in the long-term [9].

What about medications to help my child sleep better?
Research has shown that behavioral treatments (in other words, parents using good sleep time strategies) work better, and have longer lasting effects than medicines.  If your child needs more than a behavioral program to help them fall asleep, you may want to talk to your child’s doctor about trying Melatonin.  When used under the direction of your child’s doctor, Melatonin can be a safe and effective treatment for kids [10], and is especially useful for kids with special needs who have more troublesome sleep problems [11,12,13].

Melatonin is an over-the-counter medication in the U.S. But even though you do not need a prescription to get it, be sure to talk with your child's doctor to find out whether it is appropriate for your child, and how to use it safely.

How can I find out more about sleep and related topics?
Visit these pages on YourChild:

More tips and information:

Organizations:

Check out these books:

References

Written and compiled by Kyla Boyse, R.N.  Reviewed by faculty and staff at the University of Michigan

Updated November 2010

U-M Health System Related Sites:
U-M Pediatrics

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