Advocacy for Inclusion

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Information Sheet

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Sleep Disturbance in Young Children

Children between two and six years of age spend up to 50 per cent of their time asleep, so we need to understand children’s sleep as part of their overall development. Sleep is a natural but complex process that does not always occur without difficulties. Parents and carers often report their child’s sleep as inadequate, disrupted, of poor quality or non-restful. The lack of adequate sleep can affect their child’s moods, behaviour, learning and health.

Six good reasons to consider your child’s sleep

1. Sleep disturbance is common.

   Studies report that 25 to 30 per cent of toddlers, 15 to 30 per cent of preschoolers and 37 per cent of school-age children experience sleep disturbance at some stage. This can range from temporary difficulties due to illness, through to serious sleep disorders such as sleep-related breathing difficulties (apnoea).

   

   Sleep disturbance is common in children who have a significant developmental delay. A range of studies has reported sleep difficulties in between 37 per cent and 88 per cent of children who have a developmental delay and intellectual disability. Certain groups tend to have different types of sleep disturbances. For example, children who have autism spectrum disorders may have trouble getting to sleep and staying asleep, while children who have Down syndrome may have breathing-related sleep disturbance.
   
   

2. Sleep disturbance can be long-term.

   For some children, sleep improves with age. However, some children continue to experience sleep difficulties into their school years. Children with long-term sleep difficulties will require support and intervention to help them develop better sleeping patterns.
   
   

3. Sleep disturbance in children impacts on the whole family.

   Families may experience additional emotional and physical stress due to disturbed nights. Parents and carers may become exhausted. Siblings’ sleep can also be disrupted which impacts on their moods, behaviour and learning.

   
   
   

4. Adequate sleep is essential for all children’s health and development.

   Lack of adequate sleep impacts on children’s:

   • Emotional wellbeing (eg may lead to increased irritability)
   • Learning (eg poor attention and concentration)
   • Behaviour (eg may cause sleepiness or hyperactivity during the day)
   • Sensory processing (eg increased sensitivity to noise)
   • Physical coordination (eg slower reaction time)

   Children who have a developmental delay experience additional challenges in their daily lives when their sleep is disturbed. There is an increased probability of behaviours including hyperactivity, mood swings, lethargy, aggression or self-injurious behaviour.
   
   

5. Early intervention can help.

   Some parents may think that their child’s sleep disturbance is related to their diagnosis and that successful intervention is not possible. However, there is a growing body of knowledge and research into the various approaches that can reduce sleep disturbance in young children who have a developmental delay.

   

   Behavioural, sensory and communicative approaches can assist children settle to sleep and experience less night waking. Consistent use of interventions is likely to improve the child’s sleep to some degree, to the benefit of both the child and family members. Medical intervention may be required for specific problems such as certain sleep-related breathing difficulties.
   
   

6. Sleep disturbance can be prevented.

   Just like learning to eat lunch or go to the toilet by themselves, children can learn to sleep independently. By fostering positive sleep practices, parents and carers can develop their child’s independence in sleeping and minimise the likelihood of ongoing sleep disturbance. The following tips may assist in developing positive sleep practices:

   • Set a regular time for bed each night and wake up time each morning. Keep the time the same on weekdays and weekends.
   • Establish a predictable and consistent bedtime routine of approximately 30 minutes incorporating calm activities, with the last part of the routine occurring in the child’s bed.
   • Keep the hour before bedtime relaxing. Too much activity can keep a child awake (over-aroused).
   • Exercise and time spent outside during the day are beneficial.
   • Avoid large meals close to bedtime. A small healthy snack before teeth-cleaning may assist in settling to sleep. Avoid foods with caffeine (eg chocolate) for at least 4–6 hours prior to bedtime. Reduce or eliminate night feeds.
   • Provide a comfortable bed ‘nest’, a reduced noise level and make the bedroom as dark as possible. Use a night light if needed.
   • Aim for the child to fall asleep by themselves in the same place in which they will sleep all night.

     

   • Daytime naps need to be geared to the child’s age and development. Very long naps, extra naps or naps in the late afternoon can result in sleeping difficulties at night.

By Annie O’Connell
Senior Occupational Therapist IDSC South Australia

Useful References:

Durand, V. M. (1998).
Sleep Better: A guide to improving sleep for children with special needs.
Baltimore: Paul Brookes Publishing Co.
An easy-to-read, comprehensive text for parents and professionals.

Mindell, J. A., & Owens, J. A. (2003).
A Clinical Guide to Pediatric Sleep. Diagnosis and Management of Sleep Problems.
Philadelphia: Lippincott Williams & Wilkins.
Excellent reference text, easy-to-read layout, outlining development of sleep, sleep disorders and treatment.

Parenting SA (2003).
Sleep (0–6 years), ParentLink Guide
A general guide for parents. Available through selected pharmacies and community information centres or download at www.parentlink.act.gov.au

Garfield’s Star Sleeper
A website for parents, teachers and health professionals. Outlines good sleep practices and provides general information sheets. Available at: www.nhbi.nih.gov/health/public/sleep

ACT Resources

The ACT has a number of resources available to parents of children who have sleep disturbances. Many of these resources can be accessed through a single phone call to ACT Community Health Intake, on:

6207 9977

ACT Community Health is able to refer you to services for children such as:

• Day stay service for children under four months
• Four day residential program through QEII Family Centre for children up to 3 years old

Your Maternal and Child Health nurse can advise on health issues for mother and baby either at your child’s regular check-up, or through ACT Community Health’s drop in clinics. For more information please call Community Health Intake on 6207 9977 between 8:00 am and 6:00 pm weekdays.

Most of ACT Community Health's parenting support services are provided free of charge.

Things to consider…

• Children with breathing-related sleep problems, epilepsy, pain or severe anxiety will require referral to an appropriate medical professional.
• Other types of sleep disturbances may be successfully reduced by the development and implementation of a sleep plan, unique to each child, based on a combination of behavioural, sensory and communicative strategies.
• Your Maternal & Child Health nurse will be able to help you develop, implement and assess the effectiveness of your child’s sleep plan.
• In the long-term, promoting positive sleep practices can improve a child’s sleep pattern to the benefit of both the child and the family.

Using a Sleep Diary

Completing a sleep history and keeping a sleep diary (for around 2 weeks) can be a useful tool for identifying possible types of sleep disturbance and can assist you to provide relevant information to your doctor or Maternal & Child Health nurse.

Settle/sleep chart

Start the chart from a time that suits you. Mark it for the 24 hour day.

• Blank square – your baby/child was awake
• Shaded square – you helped your baby/child to ‘settle’
• Filled square – your baby/child was asleep

For more information please contact:
ACT Community Health intake line: 6207 9977
Tresillian After Hours Parenting Hotline: 1800 631 357
ParentLink: 6205 8800

Do you need more information or can we assist you?
Please contact Advocacy for Inclusion on 6286 9422

Source:
inform (Winter/Spring, 2005), a publication of The Intellectual Disability Services Council (IDSC) South Australia
Additional sources include:
ACT Health – http://www.health.act.gov.au and ParentLink - http://www.parentlink.act.gov.au

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