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My Child Has Trouble Sleeping
American Sleep and Epilepsy Centers




My Child Has Trouble Sleeping, What Now? Sleep Expert Answers
Common Questions about Kids and Sleep
Article written by Melisa Moore, PhD / Clinical Psychologist / The Pediatric Sleep Center of The Pediatric Lung Center /
Fairfax Neonatal Associates, Fairfax, VA

   As every parent, grandparent, relative, and friend of a child with difficulty sleeping knows, sleep
problems have a strong impact not only on the child’s life but also on the sleep and daytime functioning
of other family members. What is not as well known is that there are effective medical and behavioral
treatments available for childhood sleep problems. Because such problems tend to persist or recur from
infancy to adulthood, early identification and management by a sleep specialist is critical to improving
the quality of life of the child and the entire family.

Here are answers to common questions from parents about their child’s sleep
apnea and other sleep problems.

   My child has just been diagnosed with sleep apnea. What can I expect next?
After your child is diagnosed with sleep apnea, you will have a discussion with your sleep specialist
about next steps. Often a referral to an ear, nose and throat doctor is recommended to see if surgery
(typically removal of the tonsils and/or adenoids) is a good option. About 75 percent of children will be
cured by this type of surgery. Several months after surgery, it is recommended that your child have a
follow-up study in order to see if the sleep apnea has resolved.

   You may also be asked to come back to the clinic to discuss other treatment options such as CPAP
(continuous positive airway pressure) if your child is not a candidate for surgery, or if a follow-up sleep
study shows that he/she still has sleep apnea after surgery.

What questions should I ask the sleep doctor or pediatrician?

   Describe your worries openly. Often in sleep medicine, the details will help the doctor make the best
plan for your child. Additionally, you should discuss any concerns about your child’s growth and
development, feeding (including reflux), ear infections, eczema, or other health concerns that could
impact your child’s sleep.

Will my insurance cover the equipment?

   In most cases if your child has been diagnosed with sleep apnea by polysomnography, it will be
covered.

What if my child is having problems adjusting to the CPAP? What different things could we try?
It is important to consider the child’s age when developing a strategy, as the focus will be different at
each stage of development. For example, teenagers have more social concerns and are likely worried
about what their friends will think. A realistic discussion about the costs and benefits of CPAP may be
helpful. On the other hand, younger children often have difficulty keeping the mask on. No matter what
your child’s age, CPAP can feel strange at first, so a gradual approach is best.

   Allow your child to investigate his/her CPAP machine with you present. Reassure him/her that
although it makes noise, it is still safe. Focus on the benefits that your child may notice, such as having
more energy at school or being able to get up earlier to play on weekends.  
 
   Once your child has adjusted to the idea, it’s time to actually use the machine. This can be a little
tricky and may take a few days, depending on your child’s comfort level and age. First you may want to
have the child put the mask on for a few minutes, then a little bit longer without the pressure turned on.
Then you may want to put the mask on your child with the air on just for a few seconds, then a minute,
then a few minutes, etc. It is crucial to reinforce each of these steps with praise and even with a small
treat. The best reinforcements are things that can be given immediately and that the child likes. For
example, 10 minutes of computer time or playing a game with a parent.

What can I do to ensure that my child is receiving the best treatment?

   Finding a provider who specializes in pediatric sleep is ideal, but they are not everywhere. Look for a
doctor who is board certified in sleep medicine at the minimum. If you suspect your child has a
behavioral sleep problem such as difficulty falling asleep or frequent night waking, look for a
psychologist who specializes in sleep or in cognitive behavioral therapy with children.

My baby won’t stop crying, and I can’t get her to sleep. Of course, I can’t sleep
either. What can I do?

   Keep in mind that some babies cry a total of 3-4 hours per day, which can feel like an eternity. From
birth until your baby is several weeks old, the best advice may be to ask your friends or family for help
(this is a good time to schedule that visit from a relative) and to try and sleep when the baby sleeps.
Eventually at 2-3 months, you can help your baby differentiate night from day by keeping your baby
active and in a light room during the day and the opposite at night. When you’re ready, you can help
your little one learn to self soothe and to sleep through the night. The key to this is to pick a consistent
bedtime and allow your baby to fall asleep independently (with as little help as possible). In time, your
baby will develop the skills he/she needs to fall asleep and stay asleep without you.

What should I keep in mind when setting up the nursery?

   The ideal nursery should be a cool yet comfortable temperature, quite, and dark. Let’s face it though;
many parents are faced with creaky floors, crying siblings, or an otherwise noisy house. Consider using
a white noise machine or even just a loud fan to block out nighttime sounds. If the nursery is near a
street lamp or is especially light, consider room-darkening shades. For infants it is most important to
minimize blankets, pillows, and other fluffy items in the crib in order to reduce the risk of sudden infant
death syndrome (SIDS). Also remember that babies should be put on their backs to sleep.

I get home very late from work. Is it wrong to let my baby stay up so I can see
him?

   It is tough for many working parents who worry about developing healthy bonds with their children.
Remember that relationships are formed whenever you are with your child, not just at night. It is the
quality of your time together that is most important. Sleep is critical for developing infants and children,
and sacrificing sleep is like cutting down on other important needs such as food.

How much sleep do my 10 and 15 year olds need?

   Ten year-olds need about 10 hours of sleep per night, and contrary to popular belief, teenagers do
not need much less. The recommended amount of sleep for adolescents is just over 9 hours. This is
easier said than done, as a combination of biological and social factors makes it difficult for teens to get
to bed on the early side. Keeping a consistent sleep schedule on weekdays and weekends can help (in
other words, no sleeping in until 2:00 pm on weekends).        

What strategies might help in getting my child to settle down for bed?

   A consistent sleep schedule and bedtime routine are absolutely essential. Children generally have a
“window” when they are most likely to fall asleep and once that window has passed, it can seem like
they have boundless energy. Deciding on a bedtime and sticking to it will help. A regular routine will
signal your child’s brain that it is time for sleep. A good routine is one that is the same every night, is
short, and involves activities that your child likes. For an infant this might be a bath, baby massage, and
a song. For a toddler, this could be a bath, a book, a drink of water, and a goodnight kiss. The routine
should all go in one direction – toward the bedroom.

Is it normal for kids to snore?

   Three to 12 percent have a sleep disorder called obstructive sleep apnea (OSA), where the airway
may be fully or partially blocked during the night, causing difficulty breathing during sleep. The
American Academy of Pediatrics has recommended that all children who snore have an overnight sleep
study (polysomnography) to determine if they have OSA.

What kinds of sleep problems and symptoms should I discuss with my
pediatrician?

   A pediatrician can provide advice (or a referral to a sleep specialist) if your child is having trouble
falling asleep, staying asleep, or waking up too early. Noisy breathing or snoring, repetitive movements,
and sleep walking or talking during the night can also be discussed.