You are here

Insomnia and Children

We spoke to Dr Wang from Shanghai United Family hospital about some of the issues that children can have with sleep

by Anna Dixon | Thu, May 11, 2017

Twenty to thirty percent of children in cross-sectional studies have significant bedtime problems or night waking, and in most cases, these have behavioral causes and solutions. The estimated prevalence of behavioral sleep disturbances in children is remarkably similar across studies, despite some variation in the definitions used. Behavioral sleep problems are found in all age groups:

Infants and toddlers — Night wakings are one of the most common sleep problems in infants and toddlers; 25 to 50 percent of children over the age of six months continue to awaken during the night. Bedtime resistance is found in 10 to 15 percent of toddlers.

Preschool-aged children — 15 to 30 percent of preschool-aged children have difficulties falling asleep or night wakings and, in many cases, these issues coexist in the same child.

Middle childhood — Although previously thought to be rare in middle childhood, more surveys suggest that sleep problems are present in 25 to 40 percent of 4 to 10-year-old children. 15 percent of these children have bedtime resistance and almost 11 percent have sleep-related anxiety (i.e. psychophysiologic [conditioned] insomnia).

Adolescents — Studies have estimated that 11 percent of adolescents (13 to 16 years of age) have a history of significant insomnia. Children with neurodevelopmental (i.e. autism, mental retardation) and psychiatric disorders (i.e. depression, anxiety, attention deficit hyperactivity disorder [ADHD]) are at particularly high risk for sleep disturbances.

Q: What kinds of behaviors can you expect to see from a child that isn’t getting enough sleep?

A: Sleeplessness may cause a child to have problems with daytime performance, behavior, or mood, regardless of the underlying cause of the sleeplessness.

Q: Can lack of sleep have an effect on a child’s physical and/or mental health?

A: Children with sleep disorders may present different symptoms than adults. As an example, in contrast with adults, most children with obstructive sleep apnea (OSA) are not obese, and many children present with daytime attentional or behavioral problems rather than overt sleepiness. Even within the pediatric age group, the clinical manifestations of sleep problems may vary by age and developmental level. For example, a school-aged child with excessive sleepiness may exhibit motor overactivity, inattentiveness, irritability, or oppositional behavior rather than overt sleepiness. Sleep problems such as difficulty initiating or maintaining sleep (insomnia) may coexist with anxiety or depression in the adolescent, and may worsen certain medical or psychiatric problems.

Q: Can children suffer from insomnia? And if so, how is this treated?

A: Yes! The 2014 revision of the International Classification of Sleep Disorders (ICSD-3) no longer separates insomnia disorders into discrete diagnostic categories. Rather, they are all included under the terms "chronic insomnia disorder," "short-term insomnia disorder," or "other insomnia disorder." However, for the purposes of evaluation and application of specific behavioral interventions in clinical practice, it is useful to consider the contributors to childhood insomnia in the following categories:

• Behavioral insomnia of childhood

• Related to sleep-onset associations

• Related to inadequate limit-setting by parents

• Psychophysiologic (conditioned) insomnia

• Transient sleep disturbances

Q: Why is napping so important for very young children?

A: Identification of sleep problems in children is important because a growing body of evidence suggests that sleep disorders may interfere with physical, cognitive, emotional, and social development. Conversely, children with neurodevelopmental problems, learning differences, or behavior problems may be at heightened risk for sleep problems compared with the general pediatric population.

Dr. Wang Xiumin has worked in the Pediatric Division of Shanghai’s Ruijin Hospital since 1989. She was formerly also a visiting scholar of Endocrinology at the Children’s Hospital of Lyon. Dr Wang’s clinical experience includes endocrine diseases in children, hematological diseases, and treatment for leukemia and lymphoma. She also has over 20 years of experience teaching pediatric courses at the Medical College of Shanghai Jiaotong University.