Day: June 2, 2021

Here we are sharing tips for sleep hygiene for kids, and the role that occupational therapy has on sleep. Did you know that sleep is an occupation? It’s a part of our daily activities that impact function. And, sleep has been established as critical for optimal health, wellbeing, occupational performance and participation (American Occupational Therapy Association, 2012). When it comes to sleep hygiene, occupational therapy can be a big help in offering tips for better sleep, suggestions for more efficient or effective sleep, and how to manage areas that impact sleep.

sleep hygiene for kids

It seems as though every parenting book has something to say about sleep; Whether you are a parent of young children or a therapist serving kids (and their families), you’ll probably come across sleep questions such as:

• How to get your infant on a sleep schedule?
• How many hours a day a child should sleep based on their age?
• How some behavior problems may be related to the amount or quality of sleep?

As kids get older, they may change their sleeping habits, or never grow out of old ones. They may be too needy or dependent on you come nighttime, or maybe your five-year-old still co-sleeps and you’re wondering how in the world can you get them to sleep in their own bed. Sleep hygiene is necessary at each stage of childhood.

When it comes to babies and newborns, there is a big range in sleep, but the intervention of an occupational therapist can support families during this stage of parenting. Specifically, OT professionals can support caregivers with newborns not sleeping as this can be a new change to the family dynamic that changes many activities of daily living for the whole family.

What is sleep hygiene for kids?

Sleep hygiene refers to quality sleep and making the actions, habits, and necessary actions to set up a child for success in their sleep. Sleep hygiene involves nightly routines, modifications to the environment (quiet sleep space, dark room, etc.), and daily decisions (limiting caffeine in the hours before bedtime, being active during the day, etc.) that will optimize sleep.

According to the CDC, there are specific amounts of time that children of different ages need to sleep. And, the amount of sleep needed at each age changes as you grow. Here is a simple breakdown of sleep needed at each age:

Age	Hours of sleep needed per 24 hour day
Newborn (0-3 months)	14-17 hours
Infant (4-12 months)	12-16 hours
Toddler (1-2 years)	11-14 hours
Preschool (3-5 years)	10-13 hours
School age (6-12 years)	9-12 hours
Teen (13-18 years)	8-10 hours
Adult (18 years +)	7+ hours

The Importance of Sleep Hygiene

Occupational therapists can help with sleep hygiene. OTs help to improve sleep in children (or adults) because sleep has been determined to be an occupation, or a task that occupies your time. Not only that, but sleep impacts your ability to complete functional tasks, and perform activities. When poor sleep occurs, mood, cognitive processes, emotional regulation, can suffer. In kids, sleep hygiene is needed to learn, play, and complete tasks.

OTs work with individuals on task completion, participation in activity, and engagement in daily tasks. In each of these aspects of function, sleep is pivotal. Sleep is needed for overall health and wellbeing.

Just some of the implications of consistently poor sleep hygiene include:

• Poor focus
• Trouble concentrating
• Problems paying attention
• Health problems: obesity, type 2 diabetes, poor mental health, and injuries
• Attention and behavior problems
• Poor academic performance in school
• Excess weight
• Decreased physical activity
• Increased food intake
• Poor mental health, including depression, depressive symptoms
• Unhealthy risk behaviors including alcohol, tobacco, and drug use
• Risk-taking behaviors, bullying, school violence-related behaviors, and physical fighting
• Higher risk of unintentional injury

In this article we will break down sleep hygiene for children, and how you can improve sleep so that kids can perform functional tasks.

healthy sleep habits for babies

For starters, we want to reassure you that no one has the exact right answer that will work for everyone. What works for you and your family may not work for your neighbor. We hope to provide you with education, resources, and maybe even some new things to try, as you and your family find what works best for you.

One thing to remember is to start healthy sleep habits early.

Sleeping habits, like most things, are easier to maintain if you start off on the right foot early in life. For example, if you know that you want your child to sleep independently for whatever reason, do not have them sleep in your bed from the start. Simply put: do not start a habit if you do not want it to continue.

This is easier said than done, as with most things in parenting life, but remain resilient. For those of you with babies, start their sleeping journey off right with a routine that you can stick to for years to come.

Usually 4 months old is a good time to start developing a routine, and by 6 months, most babies can sleep through the night. For older children, it is never too late to start these healthy sleep habits! Better now than never.

Healthy Sleep Habits for Toddlers

Sleep in the toddler years builds on the earlier baby stage. Habits that were established in the first year can become routine. This is when you may see the toddler that needs to sleep in the parent’s bed every night. You may have a pre-bedtime routine that is long and tedious. You might see separation anxiety at bedtime rear it’s head. Maybe you have the toddler that wanders from their bed and room each night. In each of these cases, a few bedtime relaxation stretches may support the child.

Sleep hygiene for toddlers involves different environmental set-up compared to babies. For toddlers, optimal environment can involve a toddler bed that is low to the ground for safe entry and exit, bed bars for safety, comfortable sheets, or stuffed animals that comfort the toddler. Children may begin to prefer a nightlight at this age, or a dim light that shines onto the ceiling.

Other strategies to promote sleep hygiene in toddlers can include:

• Bedtime routine with bath, story, song, prayers, etc.
• Cozy pajamas with feet to prevent diaper removal during the night or socks being lost
• Settling down an hour or more before bedtime
• Physical activity during the day time hours
• Reading the same story each night as part of a routine
• Consistent routine and sleep space
• Quiet the home after bedtime
• Remove screens, tablets, phones, etc. from the bedroom
• Limit screen time prior to bedtime
• Safe sleep space (toddler bed, bed rails)
• Comfortable sleep space with sheets, blankets)
• Stuffed animal or special blanket to comfort the child

Healthy Sleep Habits for Preschoolers

During the preschool years, children may be more exposed to tablets, cell phones, and learning apps. They may have more use of these screens as a learning tool. But when limits are not put into place, we can see overuse at this young age. For preschoolers, we might see screen use right before bedtime so that it impacts sleep quality.

In the preschool years, there is much learning. Children are gaining physical, cognitive, emotional, social, and communication skills daily it seems! Sleep is very much needed as a rest for the brain and body. But, some children may fight the sleep time and it is possible to impact hygiene of sleep.

Let’s break down healthy sleep hygiene habits in preschool aged children:

• Bedtime routine
• Consistent bedtime
• Dark room or dimmed lights
• Nightlight
• Bedtime stories
• Bath before bed
• Songs and/or prayers before bed
• Limit caffeine during the day
• Consistent nap times or quiet time during the day
• Consider a wake up clock so that kids can see the time to get out of bed in the morning (and not wake up too early)
• Quiet, cool, and calm sleeping space
• Calm bedtime routine (try to incorporate these bedtime stretches)

Healthy Sleep Habits for Older Children

When it comes to older kids, including grade school aged kids (6-12 years), middle school aged children (12-14), and high school aged kids (14-18 years), healthy sleep habits change. Even within these age ranges, there are different sleep requirements, but many of the contributing factors of sleep hygiene are similar. Also, many of the tips for healthy sleep hygiene are alike in these age ranges. I’m including these tips and contributing factors together, for these reasons.

In older children, factors that impact sleep hygiene may include:

• Later bedtimes
• Earlier rise times related to earlier school star
• Increase in schoolwork (later bedtimes as a result)
• Later afterschool and evening activities
• Working in the evening
• More child-led decisions and fewer parent-set bedtimes
• Use of late-night technology in the bedroom
• Puberty
• Caffeine intake in the afternoon or evening

Many of these reasons for poor sleep qualitity can not be changed, such as the need to work or complete school work in the later evening hours, or puberty that impacts sleep and circadian rhythems. However, in the older children, there are some ways to impact healthy sleep:

• Limit screen use before bed
• Remove screens from the bedroom
• Limit caffeine use in the evening hours
• Encourage physical activity
• Relaxation strategies
• Low lights and relaxing music in the bedroom
• Limit snacks before bedtime
• Sound machines
• Create a sleep log to monitor sleep and outcomes
• Try light reducing shades or curtains for a darker sleep environment
• Avoid sleeping in during the weekends; stick to a routine on the weekends

This literature review covers aspects of sleep hygiene in older students.

Like previously mentioned, there are many different aspects of sleep habits in this stage, and no two children and family dynamics may be the same.

Successful Bedtime Routines

Following a bedtime routine, no matter the age, will convince the brain that it is almost time to sleep, and it will start producing melatonin. This sleep hormone will cue the yawns, stretches and sleepy eyes that parents dream of.

Allow for some habit-breaking if it is a special day (late-night sleepover, anyone?), your child is sick, or the routine is just not going to work that day. Otherwise, maintain your chosen routine and your child is likely to sleep soundly throughout their lives.

Using a bedtime routine signals relaxation to the body and the brain. For some children, a visual schedule is needed for sleep routines. It can become automatic for other children.

Example of a sleep routine

1. Baths before bed- Start at a specific time
2. Reading books in bed- Consider a selection of the same books or types of books
3. Singing a song together- Use the same songs
4. Saying your prayers- Follow a consistent or similar prayer
5. Always sleep in the same spot
6. Lights out, parent leaves the room (door open or closed, nightlight or not, etc.)

General Tips for Good Sleep Hygiene

The ideas and tips below are general strategies that can impact sleep hygiene across different ages and stages.

If your child needs you in order to fall asleep, you are their sleeping aide. This is not always sustainable, and if your child wakes in the middle of the night without you by their side, you may be in for a rude awakening in the way of nighttime wake-ups or a difficult to change routine.

1. Go for a tired/awake stage- Leave the room before they are asleep, and offer them a different sleeping aide that they can snuggle all night long. They may be over-tired if they are screaming and crying for hours, have the delirious “sillies” late at night, or cannot settle their bodies, minds, or voices after 30 minutes.
2. Shift the bedtime routine up a bit if you sense that they are getting tired earlier than usual. If this doesn’t work, think about their activities from that day. Did they eat too much sugar? Not enough physical activity? How was their rest time? Find the right balance of daily activities that leads them to be ready to sleep around bedtime. Bedtime stalling is another reason why kids may not be getting enough sleep. If your child tends to ask for one more story (again), another drink of water, to go “check” on one of their toys, or needs more than one potty break at bedtime, they are a bedtime staller.
3. Stick to your bedtime routine! Be kind, but be firm: it is time to sleep. Make return visits to their room as short as possible, and know when to stop going back. What if your child just doesn’t like sleep? Every night is a struggle and nothing seems to be working. You may be frustrated and dread bedtime, too.
4. Check your attitude towards sleep, your child’s perspective, and what both of your emotions are like at bedtime. The caregiver’s mood is most important – you must believe that they will sleep in their bed (or whatever desired place), happily and peacefully. You should also try and use your mood to signal that sleeping is wanted and really, quite lovely. If you believe it, and your emotions follow, your child is likely to follow along. Although it can be frustrating, never use anger or threaten your child into going to bed – this may work short-term, but it is not going to benefit their sleep in the long run.
5. Create a “bedtime” and stick to it even on weekends. (Ex: In bed by 8:30pm)
6. Remove stimulating toys, video games, TV, music, lights, etc. an hour before bedtime. Tip: Install light dimmers so that you can lower the lights in the house at this time.
7. Think about sleeping space. If your child sleeps better on the floor, let them!
8. Keep sleeping areas consistent (i.e. always the floor in front of their bed), and eventually your child will want to climb into their bed.
9. Find the “cozy” in your child’s life. Maybe they have a special blanket or lovey. Perhaps they feel most restful underneath only a sheet, while your other child needs a weighted blanket to find rest.
10. Light and Noise Sound machines and nightlights can be a nice signal for bedtime and provide comfort, but they are not always necessary. Hold off on purchasing them until you see a need.

SLEEP RESOURCES

• Sleep advice from the Mayo Clinic
• Bedtime books from the Baby Sleep Site
• Sleep Practices from the Child Mind Institute
• Strategies from the Sleep Foundation
• Recommendations from the Centers for Disease Control (CDC)

It should go without saying that these “easy fixes” may not work overnight. They may not feel all that easy, either. Be patient, be kind, and be strong. You can do this! If all else fails, talk to the learner about how animals sleep and bring it all together with a few hibernation activities for building skills in therapy, the home, or the classroom.

Don’t hesitate to reach out to your physician to discuss your child’s sleeping habits, especially if you or your child are getting significantly less sleep than you should. They will guide you in the right direction.