Ask the Doctor: How much sleep does your child need, is melatonin safe, and more common questions

Sleep is a time to rest and recharge, but some children may not get the restful sleep they need. Whether this is because of trouble falling asleep or staying asleep, a lack of rest can lead to a variety of other issues, including poor performance in school and behavior problems.

Every child is different and the amount of sleep needed varies depending on their age. A good rule of thumb is that a 10-year-old child needs 10 hours of sleep each night. Younger children need even more sleep, and teens should aim for 9 hours of sleep each night.

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One of the most common problems a child may have is a lack of sleep. When children don’t get enough sleep, it can lead to other problems during the day. In addition to sleepiness, hyperactivity, mood problems such as depression or anxiety, and learning difficulties may result from too little sleep.

Setting a Bedtime Routine

Following the same routine every night helps your child mentally prepare for sleep. A bedtime routine can be as simple as a warm bath and a little bit of reading.

Following the same pattern at the same time every night will create cues for the brain to start getting ready to sleep. Use these tips for setting a bedtime routine:

1. Consistent bedtime and wake time for 2 weeks prior to school.
2. Dimming the light for four hours prior to bedtime and eliminating electronics for one hour prior to bed will help the child go to sleep easier and earlier.
3. Exercise during the day, but not during the 2 hours prior to bed.
4. School-aged children should not take naps.
5. Ensure the bedtime and wake time are age/circadian rhythm appropriate. Which brings us to the next question…

What time should my child go to bed each night?

• Elementary-aged children should try to go to bed between 7:30-9 p.m.
• Middle school-aged children should go to bed between 8:30-10 p.m.
• Teens should try to go to bed between 9-11 p.m.

Recalling the wake time should allow the child to achieve an age-appropriate amount of sleep.

More bedtime routine tips for back to school:

• Start the routine at the same time every night.
• Reduce indoor lights to encourage the release of melatonin, which will help your child feel sleepy sooner. Start this around 6 p.m. or when it starts to get dark outside. Think of it as pretending to have no electricity.
• Stop using electronics (TV, tablet, computer, phone, etc.) at least one hour before bed.
• Prepare a warm bath before bedtime. Many children may find this soothing.
• Prepare a small, quiet activity such as reading a book or singing a soft song. Be sure to keep the activity short. For example, no more than two short books.
• Be consistent between caregivers. Any change in the routine can disturb your child’s ability to rest.
• Walk your child back to their room with as little interaction as possible to help them settle back into sleep easier if they wake up during the night and come to you.
• Set a wake-up time for when your child is allowed to leave their room. If they wake up earlier, staying in their room will help them fall back asleep instead of getting up to go play or watch TV.

Remember, do not allow bargaining when following a bedtime routine. Children will often ask for “one more hug” or “one more song” to delay going to bed. Though it may be difficult, stick by the rules you have set so your child can be at their best the next day.

Along with a routine, make sure your child’s room is a relaxing environment. A TV in the room or having lots of toys in the bed can send mixed messages to the brain about if it is time to play or sleep.

During the day, encourage your child to do homework, play games, talk on the phone and do other activities off of their bed and away from the bedroom. This helps their body associate their bed with sleep and not with any other activity.

I’ve read about about melatonin and kids. Is melatonin safe for kids?

Parents know excellent sleep hygiene and a consistent bedtime and wake time are important strategies to ensure a good night’s sleep. For children who continue to struggle with difficulty sleeping despite these interventions, low-dose melatonin may be considered if recommended by a physician.

Although melatonin is one of the best studied sleep aids for children, there are concerns it may impact the release of other hormones. In addition, recent studies note melatonin accidental ingestion or overdose is on the rise for children.

If parents and the child’s physician feel melatonin will be beneficial, it is good to have a plan to wean it over time once the sleep problem has improved.

Teens and Sleep

If your teenager tends to be a night owl, you aren’t alone. Even though our society requires teens to be awake and functioning during the daytime, teenagers are biologically designed to stay up all night and sleep through the day.

Tired teens have an increased risk of car accidents and poor grades, making good sleep patterns especially important for teens. Set a bedtime, just as you would for younger children, and enforce it each night to make sure they can get about 9 hours of sleep.

If possible, bedtime should not be earlier than 10 p.m. Limiting the use of electronics is also key to ensuring your teen gets a good night’s sleep.

Common Sleep Issues in Kids

• Nightmares: Dreaming is the way people sort through their thoughts and process information from the past day. Nightmares are common in children ages 6-10, a time when they develop their imagination. Scary dreams typically occur after midnight and your child will be able to describe the dream they wake up. Removing “scary” media can make nightmares less likely. Even TV shows or books that seem relatively harmless – think Goosebumps or Scooby Doo – can lead to a nightmare. Occasionally, underlying trauma can result in persistent nightmares.
• Night Terrors: Young children may experience a type of parasomnia known as sleep terrors which occur soon after falling asleep. Parasomnias are unusual behaviors that occur during sleep, such as sleep talking and sleep walking. Children with night terrors usually do not remember what the terror was about, and they are not truly awake even though they appear to be. Getting more sleep is often the best remedy for night terrors and other parasomnias.

• Sleeping In the Same Bed As A Parent: If your child feels the need to sleep in the same bed as you, it is a matter of family preference and not necessarily an issue that needs to be addressed. However, if you or your child is experiencing poor sleep quality due to co-sleeping, it is time to have a family discussion. The best ways to encourage children to sleep in their own bed are: putting your child to bed in their own bed every night, following good sleep habits, and being consistent in following a standard routine. If underlying anxiety problems may be preventing your child from sleeping on their own, those should be addressed along with establishing a bedtime routine.

• Bed Wetting: A common issue for 6-8-year-olds, bed wetting tends to run in families and most children will outgrow it. If you or someone else in your family wet the bed as a child, there is a good chance your child will too. To prevent nighttime accidents, try reducing the amount of fluids that your child drinks before bed. If your child wets the bed around the same time every night, plan to wake the child up and take them to the bathroom before wetting occurs. If your child has been “dry” for three months or more and then suddenly starts wetting the bed again, it could be a sign of another issue that needs medical attention, such as a urinary tract infection.

• Sleep Apnea: If your child’s breathing is interrupted for a brief period of time repeatedly during sleep, they may have a condition known as sleep apnea. This happens when either the muscles in the back of the throat fail to keep the airway open or when the brain fails to properly control breathing during sleep. Several different methods are used to treat sleep apnea, ranging from lifestyle changes to medication. Your child’s doctor will be able to determine how to best treat your child’s sleep apnea.

When should my child see a sleep doctor?

Children who lack sleep may not exhibit daytime sleepiness. They may be more hyperactive, inattentive, or have behavior difficulties.  Obesity, depression, anxiety , and headaches are just a few disorders that have been related to sleep problems.

Inability to initiate sleep, difficulty sleeping through the night, snoring, daytime sleepiness , or hyperactivity should prompt a visit with your physician.

About the Author: Bobbi Hopkins, M.D., is a board-certified pediatric sleep specialist and medical director of the Sleep Center at Johns Hopkins All Children’s Hospital. She completed her training in pediatrics, child neurology , and sleep medicine at Baylor College of Medicine and Texas Children’s Hospital in Houston, Texas. Dr. Hopkins has a clinical focus on comprehensive evaluation and management of sleep disorders and sleep education for children of all ages.