Sleep and Sleep Problems

A child sleeping at night doesn't just mean resting. Sleep is one of the times the brain works hardest. Everything learned during the day, every new step taken, every new word spoken, and every emotion felt settles into the brain for good only during good sleep. In other words, sleep is the hours when the brain "saves" that day. That's why the care you give to your child's sleep is very valuable not just so they're less cranky, but to protect their developing brain. In this chapter, we'll explain in plain language why sleep is so important, how much sleep is needed at each age, how healthy sleep habits are built, common sleep problems, and when you need to see a specialist.

Why sleep is so important

The information we see, hear, and learn while awake first waits in a temporary store in the brain. During sleep, this information is moved to long-term memory. That's why a baby just learning to walk, or a child studying a new topic at school, needs good sleep for what they learn to last. In a child who sleeps little or whose sleep is often broken, learning and holding on to new information becomes harder. Sleep is also a repair time when the brain sheds the fatigue that builds up during the day, cleans itself, and prepares for the next day. Most of the growth hormone that drives physical growth is also released during deep sleep. In short, sleep is as basic a need as nutrition for learning, growth, and emotional balance.

Sleep's effect on the daytime

The sign of sleep deprivation in children is often not sluggishness like in adults. On the contrary, a sleep-deprived child usually becomes more active, can't sit still, can't focus their attention, and gets irritable more quickly. In other words, a child can mask their fatigue by becoming more active. That's why, in a child who can't focus in class and seems active and impulsive, before considering anything else, how they sleep and whether they snore must be reviewed. Sometimes, beneath what looks like an attention or behavior problem, a correctable sleep problem turns out to be the cause.

Sleep needs by age

A child's sleep pattern changes with age from birth onward. Newborns sleep on average 14 to 17 hours a day, but they take this sleep in three- to four-hour blocks, without a day-night distinction. Waking often in the first months is not an illness, but a natural feature of that age. After about the third month, the baby starts to tell day from night, and nighttime sleep slowly lengthens. A toddler's daily sleep need, including daytime naps, is about 11 to 14 hours. In the preschool period this need drops to 10 to 13 hours, and daytime naps are usually given up between ages 3 and 5. In the primary-school years, 9 to 12 hours of sleep at night is typical; this is the period when sleep is most regular and directly affects attention and school performance. Teenagers need 8 to 10 hours of sleep, but because their biological clock shifts toward going to bed late, many teenagers sleep less than this on school days.

What can be done at home for healthy sleep

The foundation of healthy sleep is the child learning to fall asleep on their own. The habits that support this are called sleep hygiene. Sleep hygiene is a simple but consistent routine that regularly gives the child's brain the message "it's sleep time now." The points below work at every age, from infancy to adolescence.

• Go to bed and get up at the same time every day; keep the difference between weekdays and the weekend to no more than an hour.
• Set up a calm routine before bed that always follows the same order; for example, a warm bath, brushing teeth, pajamas, and reading a book together.
• Turn off the TV, tablet, and phone at least an hour before sleep; the light from screens keeps the brain awake.
• Take care that the bed is associated only with sleep; don't let homework be done in bed, don't allow screens, and don't make the bed a place of punishment.
• Keep the room dark, quiet, and cool; these conditions make the transition to sleep easier.
• Set aside the last hour before bed for a calm transition rather than rushing around and active play.

For newborns, classic sleep training is not yet applied. In this period the aim is to teach the baby the difference between day and night by keeping the day bright and active and the night dark and quiet. Putting the baby down "drowsy but awake" when it's clear they're sleepy, before they fully fall asleep, is the first step in learning to fall asleep on their own. For safe sleep, the baby should be placed on their back for every sleep, the mattress should be firm, pillows, quilts, and toys should not be placed in the crib, and the baby should sleep in the same room as the parents but in their own crib.

Common sleep problems

The most common sleep problem in children is difficulty falling asleep and staying asleep. Some children can fall asleep only under certain conditions, for example while being rocked, nursed, or with a parent beside them. When they wake briefly at night, which is a natural thing that happens to everyone, they look for the condition they first fell asleep under, and when they can't find it, they cry to call someone over. In some children the problem shows up as resisting bedtime, stalling, and bargaining. These situations are not an illness, but a learned habit, and they improve with a consistent, patient approach.

Another common topic is confusing nightmares with night terrors; yet these are different from each other. Night terrors usually occur in the first half of the night: the child suddenly sits up screaming, their eyes are open but they're asleep, they don't recognize their surroundings, they may be sweaty, and in the morning they remember none of it. Trying to wake the child during these episodes can make things worse; the best thing is to keep them safe and wait for the episode to pass on its own. Night terrors are usually harmless and disappear on their own in most children by adolescence. Nightmares, on the other hand, occur toward morning: the child wakes fully, remembers the frightening dream clearly, and wants to be comforted. A calm, reassuring attitude and reducing daytime stress help a child who has nightmares.

Some children sleepwalk or talk in their sleep. In sleepwalking, the child may get out of bed and wander aimlessly; during this their consciousness is not fully awake, and they don't remember the event. These situations are usually benign and occur more often with fatigue, sleep loss, or fever. The most important issue here is safety: the home's doors and windows should be made safe, and precautions taken to prevent the child from falling and getting hurt. There is also restlessness in the legs: some children can't keep their legs still once they get into bed in the evening, they want to keep moving them, and so they struggle to fall asleep. This complaint is sometimes brushed off as "growing pains"; yet there may be correctable causes behind it, so it's important to tell the doctor.

When to see a specialist

Some signs show that the situation needs to be assessed by a specialist. Be sure to see a doctor in the following situations:

• If your child snores loudly every night.
• If you notice their breathing briefly stops during sleep and then continues with a deep gasp.
• If they breathe with their mouth constantly open, or seem to struggle to breathe.
• If they are excessively sleepy and sluggish during the day even though they sleep enough at night.
• If sleep problems last for weeks, don't improve, and wear down both the child and the family.
• If they start wetting the bed again at night despite being of school age.

These signs may point to a problem where the child isn't breathing well enough during sleep. The most common cause is enlarged adenoids and tonsils, and often, once these are corrected, not only sleep but also appetite, growth, and daytime attention improve noticeably. That's why these signs should not be ignored as "naughtiness" or "it will pass."

• Sleep is not passive rest, but an active process in which the brain saves what it has learned, repairs itself, and supports growth.
• Waking often in infancy is natural, but snoring and excessive daytime sleepiness at school age are not normal; they should be assessed.
• A regular bedtime and wake-up time, a screen-free and calm routine before bed, and a dark, cool room are the strongest supports for sleep.
• A sleep-deprived child usually doesn't become sluggish but, on the contrary, more active; a lack of sleep may lie beneath an attention or behavior problem.
• If there is snoring, pauses in breathing, an ongoing sleep problem, or excessive daytime sleepiness, see a doctor without losing time.