Some of you might be exhausted even reading this – 1-in-4 kids have problems getting to bed, falling asleep or staying asleep through the night.
Now, a Western-led study has identified the 10 biggest risk factors causing sleep issues among children – and its authors are offering exasperated parents research-backed insights into helping little ones get the rest they need.
Drawing on data from almost 500 studies, sleep researcher Adam Newton cracked open some of the most puzzling questions of child insomnia.
The study, Risk and protective factors and processes for child sleep problems among preschool and early school-aged children: A systematic review, was newly published in Sleep Medicine Reviews.
“What factors predispose kids to sleep problems? What factors might work to maintain that sleep problem? What factors might protect against the development of a sleep problem?” said the Psychology PhD candidate and lead author of the paper. “This review offers the largest synthesis of the reasons why kids develop sleep problems, covering over 30 years of research.”
By “sleep problem,” he doesn’t mean children’s occasional tell-me-another-story stall or the infrequent monster-in-the-closet nightmare that sends kids scurrying to their parents’ rooms.
No, this is about toddlers who linger wide-eyed for hours past the time when they should be in dreamland; children who bounce off the walls when everyone is asleep, but nod off in math class; and youngsters who wake multiple times through the night for weeks or months – or years.
Good sleep is essential to a child’s physical, emotional and intellectual growth. It’s also key to moms’ and dads’ sanity. But for many, it remains an elusive and frustrating problem. It’s made even more complex by the surfeit of advice from grandparents, friends, books, physicians and pop-culture articles.
“Parents are often inundated with tons of reasons that kids might struggle with sleep – tons of advice about what to do,” Newton said. “This review really boils it down to the 10 best, research-supported reasons why these sleep problems might exist.”
The research is aimed primarily at psychology clinicians and researchers, but it’s instructive for parents, too.
Children between the ages of 1-10 years old, Newton found, are more likely to have sleep issues if they:
- Have a genetic/biological temperament predisposed to sleep disorders or disruptions;
- Had difficulty at an early age with mental-health issues such as depression and anxiety;
- Have problems with opposition, inattention, hyperactivity and/or following rules;
- Had a history of sleep problems when they were babies. (This doesn’t mean all sleepless babies go on to be insomniac pre-schoolers, but that older kids with insomnia often had the same issue as infants;
- Are from families with lower incomes or whose parents have lower education levels. That’s probably not a direct result of income or education, Newton noted, and more likely a result of related issues such as being in a noisy apartment complex or having parents with unpredictable work schedules;
- Have parents with lax or permissive parenting styles. “Parents who are very consistent in either their rules in the house or their discipline in the house, tend to have kids with fewer sleep problems, everything else being equal,” Newton said.
- Have parents who stay beside them (in their room or in the car, for example) until they fall asleep. Kids whose parents always linger with them until they doze off are slow to learn how to ease themselves back to sleep;
- Use electronics in bed or less than an hour before bedtime;
- Are on the younger side of the ages 1-10 years. Even fussy babies tend to grow out of sleep problems and insomnia is unlikely to start when a child is older; and
- Have no consistent time or routine to bedtime. Whether it’s a bath just before bed or reading a storybook on the couch or saying night-night to the dog, kids who follow the same sort of sequence of events each night are less likely to have sleep problems.
Of those 10 factors, Newton stressed, parents have control over fewer than half.
But that’s not insignificant influence, said Psychology professor Graham Reid, who is Newton’s supervisor and a co-author of the study along with Sarah Honaker of Indiana University.
“Really, some of these things may be challenging to implement, but they’re relatively simple. That can be helpful for parents,” Reid said.
Advice that stems from the research includes:
- Practise a positive, consistent parenting style that clearly outlines the rules and expectations in the home;
- Establish a predictable and calming bedtime routine. For example: Bath at 7:30 p.m., storytime at 8 p.m., lights-out at 8:30 p.m.;
- Reduce your presence with the child before they’re asleep. Staying with a child until they’re asleep just cues them to stay awake unless the parent is there; and
- Eliminate screens (television, computer, tablet, cellphone) an hour before bedtime and remove screens from the room. The action and lights of electronics act as a stimulant that may make it tougher for kids to fall asleep.
Newton scoured articles published in English-language, peer-reviewed journals – studies that included measures of sleep quality and quantity and involved the effects of sleep (or lack of sleep) on child participants.
Newton’s first pass included more than 15,000 articles. He then narrowed the field to a detailed look at 482 studies and an in-depth examination of 98. By starting broadly, researchers were able to find common threads.
Newton also was surprised to find no clear patterns where common wisdom might have suggested correlation – between children’s insomnia and how light/dark or noisy/quiet a room is, for example.
That’s not to suggest there’s no connection. That’s simply because not a ton of research has been done for this age range, Newton said.
Another uncertainty is how socio-economic status, of both the household and the family’s neighbourhood, may impact on children’s sleep problems.
There’s still a lot to discover, said Newton, whose primary research is on the developmental importance of napping in pre-schoolers.
Reid said research into children’s sleep issues and benefits really started to develop in the 1990s. “Relatively speaking, pediatric sleep is a young field. So, the timing was right for this.”