Sleep

While We’re Asleep

While it’s one of our most basic needs, what sleep does for our bodies is quite complicated. It may come as a surprise to know our brains are actually just as active when we are asleep as when we’re awake. When we sleep, our brains are busy multi-tasking. They’re making decisions, putting together creative connections, forming and recycling memories, processing information, clearing out toxins that build up throughout the day, and learning and remembering how to do physical tasks (e.g., shooting a free throw or playing the guitar). Our brains also release growth hormones while we sleep, enabling us to promote muscle growth and cell repair within our bodies after a busy day. As it turns out, there is plenty of truth in telling a young child, “We sleep so the muscles in our bodies can grow!”

In fact, young children specifically need more sleep than older children and adults for many reasons. One of the most significant reasons is that young children’s brains are establishing and refining more neuronal connections (and at a faster rate!) for new skills and experiences (e.g. learning how to walk, engage in new routines, eat with a fork, develop expressive language, etc.) than we tend to establish and refine later in life.

Overall, a good night’s sleep plays a vital role in priming, protecting, and restoring our bodies and brains, enabling us to feel our best and make the most of our skills and abilities.

Quality and Quantity

In children, sleep can be affected by several factors – e.g., if a child’s basic needs are being met; if they have a regular routine; if a child feels safe and secure, stressed or anxious; and if a child is able to self-regulate. When children get enough quality sleep, they are more likely to exhibit positive outcomes related to improved attention and memory, behavior, learning, emotional regulation, quality of life, and overall mental and physical health.

Healthy sleep patterns are all about balance. If children are getting too little sleep, they may experience impacted attention skills (i.e., difficulty thinking/focusing and poor memory), behavioral or mental health issues, learning problems, and an increased risk for accidents and injuries. In the long term, getting too little sleep as a young child contributes to poor sleep patterns, which put these children at an increased risk of developing more serious health conditions later in life – including ADHD, high blood pressure, obesity, diabetes, stroke, heart failure, and depression.

If children are regularly sleeping too much, it may be an indicator that they are not sleeping for an appropriate or adequate amount of time on a regular basis during nighttime hours. (For example, they might be experiencing frequent wakeups.) They are also at a higher risk for developing diabetes, obesity, and other mental health conditions.

Here are some signs and symptoms that could indicate your child is either getting too much or too little sleep:

When a child isn’t getting enough sleep, they might exhibit…

• Excessive excitement or hyper-like behavior prior to bedtime (e.g., running around).
• Difficulty attending or focusing in school (i.e., symptoms mirroring Attention Deficit Hyperactive Disorder, aka ADHD).
• Increased emotional reactivity or “moodiness” related to things that wouldn’t otherwise warrant as intense a reaction.
• Out-of-the-norm symptoms of clumsiness or appearing accident-prone.

When a child is getting too much sleep, they might exhibit…

• Drowsiness or low energy during the day.
• Increased feelings of anxiousness.
• Increased sleepiness or fatigue that is not resolved by daytime naps.
• Depression or other mental health issues.

(American Academy of Pediatrics, 2016)

The American Academy of Pediatrics (AAP) reports that about 25% of children under the age of 5 aren’t currently getting enough sleep. How do we know if our kids are getting enough sleep? The AAP supports the following guidelines set by the American Academy of Sleep Medicine (AASM), outlining recommended sleep duration for children from infants to teens (Journal of Clinical Sleep Medicine, 2016):

*per 24 hour period (including naps for infants through age 5) on a regular basis and without disturbances to promote optimal health

(Journal of Clinical Sleep Medicine, 2016)

Setting the Stage for Success

How do we set our children up for the ‘just-right’ amount of quality sleep? Research tells us that there are things we can offer our children during the day to support their sleep quality. These include physical exercise, sunlight, and plenty of outdoor time. Scaffolding your child’s daily schedule around these targets may provide a payoff in their nighttime sleep quality and duration – and yours, too.

At night, sleep routines are a wonderful and healthy way to support your child in getting the right amount (and quality) of sleep by offering a consistent sequence of activities to do each night. The repetitive nature of these routines will add predictability, give your child an increased sense of security, and ultimately support their own sleep independence. Here are some key pieces to consider as you establish, manage, or modify the sleep routine of your growing child:

• Power off the screens. Turn off screens (e.g. TV’s, tablets, videogames) at least two hours before bedtime. Light from screens actually suppresses melatonin (the hormone responsible for controlling our sleep-wake cycle) in our bodies, which impacts our ability to fall asleep and stay asleep and delays our REM (Rapid Eye Movement) sleep – the stage of sleep in which our brains are most active. Screens also act as an alert to our brains to stay engaged, making it harder to fall asleep (American Sleep Association, 2021).
• Start earlier. Begin your child’s bedtime routine 30-60 minutes before you expect them to fall asleep. This sends an important message to your child’s brain that sleep is coming, and they will naturally begin to anticipate sleep-related routines and environmental cues during this time. Most importantly, this type of anticipation is comforting, regulating, and calming.
• Stick to the sequence. As much as possible, keep the sequence of bedtime tasks within your child’s bedtime routine the same. Again, this repetitive sequence helps your child anticipate sleep-related routines and environmental cues and is comforting and calming. For example, a 3-year-old child’s sleep routine sequence may be to put on pajamas/a nighttime diaper, brush their teeth, read three books (it’s ok to set a firm and predictable boundary here), hug and kiss goodnight, and turn off the lights.
• Reconnect together. Engaging in quiet and simple conversation with a parent or caregiver before bedtime can provide your child with a warm connection that is calming and reassuring. Here are some age-specific examples of calming conversations that are developmentally appropriate:
  • With a 2-year-old, recount their day: “Today you woke up, ate cereal for breakfast, went to school, painted a purple pumpkin, and then came home and spent time with Mom and Dad. Tomorrow we will go visit Grandpa. First night-night, then Grandpa.”
  • With an 8-year-old, offer simple, reflective questions that are encouraging and comforting: “How was your Tuesday? I noticed how you helped your brother get off the bus this afternoon; that was very kind and helpful. I appreciate you. What is something good that happened to you today?”
• Have an exit strategy. Give your child a tender yet brief hug and/or kiss, say goodnight, turn off the lights, and leave the room while they’re still awake. This will help them learn to have more independence with falling asleep on their own (a lifelong skill), improved self-regulation, and an increased sense of internal security. Lingering for an excessive amount of time can be confusing and cause a child to have additional worries or feelings of anxiousness.
• Wrap it up. A full bedtime routine for young children (<5 years old) should be about 30 minutes in duration – and slightly longer if a bath is included.

Adapting

One of the most important pieces of info to keep in mind as you establish, navigate, and problem-solve a sleep routine is to remember how normal it is for these routines to “ebb and flow” as your child grows. Expect to adapt your child’s sleep routine as they grow and mature. Offering a visual, such as a picture chart (consisting of simple images that reflect each task of the sleep routine, such as a toothbrush for the task of brushing teeth), can be a good reminder and an easy way to modify the sequence of your routine as needed. Adding modifications to your child’s sleep environment can serve as good ‘signals’ to our brains that sleep is coming. These include white-noise machines, blackout curtains, and a screen-free bedroom. Most of all, though, investing your time and thoughtfulness into consistently offering your child a loving, nurturing, and regular sleep routine can support your child’s health and sleep skills for years to come.

To learn more about St. David’s Center’s occupational therapy services, visit our Pediatric Therapies page.

If you have additional questions, please feel free to reach out. Our CORE Navigators are available to help answer questions about St. David’s Center services.

Bridget Topousis has been an occupational therapist for 10 years. At St. David’s Center she works with children and families on everything from identifying and treating sensory processing differences in young children to developing executive functioning strategies with adolescents. She has special interest and training in the areas of motor incoordination and dyspraxia, handwriting skill foundations and remediation, multi-disciplinary assessment teaming, and teaching and learning with occupational therapy graduate students and course instruction.