When your little ones can’t sleep

When your little ones can’t sleep

All you need to know about behavioural insomnia in children

Getting enough sleep is an important factor when it comes to child’s physical, mental and emotional development. However, research shows that over 25% of children get less sleep than recommended for their age bracket. While the lack of sleep may be due to various factors, behavioural insomnia in children (BIC) is currently one of leading child sleep disorders, outranking parasomnias (e.g. night terrors), and breathing disorders like obstructive sleep apnoea (see our blog post about Obstructive sleep apnoea in children to learn more about OSA and its symptoms). It is estimated that one in four children experiences BIC at some point in their life in the form of either sleep-onset association or limit-setting insomnia.

Sleep-onset association

  • Present mostly in infants, toddlers and young children.
  • Involves negative connotations with sleep, resulting in children being unable to fall asleep without a particular association – typically a parent or a certain action.
  • Could manifest itself by a child needing to be nursed, rocked to sleep or nodding off only in parents’ bed. If a child wakes up at night, they are not able to get back to sleep on their own.
  • Replacing the habits that cause sleep troubles with a rotation of other relaxing pre-bedtime activities may help children with not becoming too attached to a specific routine and relying on it for sleep.
  • If a child can’t fall asleep without a parent being present, more complex solutions – like self-soothing, graduated extinction, and scheduled awakenings – may need to be considered.


Limit-setting insomnia

  • Common with toddlers, pre-school and school-age children.
  • Involves children refusing to go to sleep or delaying bedtime by asking for “just one more” story, food or drinks, or going to the bathroom again. These unending requests may occur at bedtime and/or after waking up during the night.
  • Despite stalling attempts, parents should enforce the bedtime even if the child seems still full of energy and alert.
  • If parents remain consistent, stick to a set bedtime routine and refuse unreasonable demands, stalling should decrease and stop over time.

There is no universal solution to child insomnia, but the key to resolving it often lies in parents’ awareness of children’s sleep needs at every age and enforcing good sleeping habits. The first step to treating BIC is optimising the sleep environment and introducing a healthy, consistent sleep routine (see our blog post about Tips for good sleep hygiene for kids of all ages for more details). Medications are rarely prescribed as behavioural techniques are typically more effective. If BIC persists or intensifies despite maintaining good sleep hygiene, no underlying medical conditions and lack of stress indicators, consulting a paediatric sleep specialist is recommended.

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