August 2020 | Reviewed by: John Saito, MD and Shelley Hershner, MD
What is child insomnia?
A form of child insomnia called bedtime resistance occurs when children don’t go to bed on time unless a parent or guardian enforces a bedtime. If the children are made to go to bed on time, then they tend to fall asleep at a normal hour. If they are not given strict bedtimes, then they may linger awake for hours at night.
This disorder occurs commonly in young children. Adults may also have varying bedtimes and poor sleep schedules, but this is not called child insomnia.
What are symptoms of child insomnia?
Children with insomnia may:
- Demonstrate bedtime resistance by asking for repeating glasses of water, book reading, or other distractions
- Have no problem falling asleep with an enforced bedtime
- Stay awake as long as possible without an enforced bedtime
- Have parents that struggle with maintaining a regular sleep and wake schedule
It is important to assess the habits of all parents or guardians who help put the child to bed. The child often will fight and resist when parents or adults try to keep a regular sleep schedule. The adult normally has no idea how it all began.
What causes child insomnia?
Child insomnia due to bedtime resistance often has behavioral causes that are responsive to behavioral modification techniques. First consider starting a strict bedtime with the child. The adult should not allow the child to “bargain” for drinks or stories after the formal bedtime is reached. The child should go to bed and stay there until morning. By simply enforcing a bedtime, this form of insomnia often will stop on its own. To accomplish this improvement, the adult often has to overcome the tactics of a small child who is trying not to go to bed.
Many times there is not a need to see a sleep doctor.
How to diagnose child insomnia?
If you discuss this problem with a doctor, bring a completed sleep diary. Keep track of the times that the child goes to bed and wakes up for two weeks. You should also chart the times when the child wakes up during the night. List any ways the child tries to stay awake at past bedtime. Include how the adult reacts to these actions. For example, the doctor needs to know if the adult lets the child get up 10 times for a glass of water every night. This will help the doctor to recognize and treat child insomnia.
No tests should be needed to diagnose child insomnia. The child’s history of going to sleep and waking is normally enough to pinpoint this disorder. Actigraphy could be used in extreme cases.
How to treat child insomnia?
Child insomnia is best treated by having the adult set firm limits. If bedtime is 8 p.m., then the child should be in bed by 8 p.m. A bedtime routine can be helpful but needs to not extend past bedtime. Routines of a snack, bath, and book reading are appropriate. Then the child should go to bed. There should be no reason for the child to get out of bed over and over again. If the child resists, you can take away things the child enjoys or create an award system as an incentive. A more strictly enforced bedtime can be achieved with consistent enforcement. This will produce an improved sleep pattern and will benefit the child.
Young children should fall asleep in their cribs or beds without being rocked to sleep. If a child must be rocked to sleep, then the child will not learn how to go to sleep without help. Falling asleep or falling back to sleep on their own is a skill that a child can learn. It is normal for a child to wake up during the night. Adults even wake up for a few minutes several times per night. Helping a child learn to fall asleep in bed benefits both the child and the adult.