Having problems getting your child to sleep? Dr. Jared Johnson, a family medicine physician with Via Christi Clinic in Wichita, Kan., presented "Sleep problems in children and teens" at the March Via Christi Women's Connection luncheon.

1. Sleep issues in children and teens
Jared Johnson, MD
Family Medicine
Via Christi Clinic
3/12/2013

3. Today’s discussion
Normal sleep in children and teens
SIDS
Bed wetting
Behavioral sleep problems and insomnia
Nightmares
Sleep walking

4. Sleep trends in America
Average sleep period in late 1800s was
approximately 9-11 hours
Average sleep period today is around 6.5
hours
Much more sleep debt than our ancestors

5. Why?
Electric lights
More shift workers
More distractions
 Busier lifestyles, especially for children
 Internet
 TV
 Video/computer gaming
Stress

6. Normal sleep in children and teens
Age Hours of sleep needed
0–2 months 12–18 hours
3–11 months 14–15 hours
1–3 years 12–14 hours
3–5 years 11–13 hours
5–10 years 10–11 hours
10–17 years 8.5–9.25 hours
Adults 7–9 hours

7. Sudden Infant Death Syndrome
(and other sleep-related infant deaths)
Rare: less than one in 1000 births
Still the leading cause of death from ages 1
month to 1 year in the US
More common in black and Native American
children
Slightly more common in boys

8. Sleep-related infant deaths
“Back to Sleep” introduced in 1992
Rate of SIDS was cut in half
Risk factors
 Mother < 20 years old
 Mother smoked during pregnancy
 No prenatal care (or very little)
 Premature baby
 Baby shares bed
 Loose blankets and pillows

10. Nocturnal bed wetting
Common: occurs in 16% of 5-year-olds,
10% of 7-year-olds, 5% of 10-year-olds
Occurs during sleep
Additional symptoms might indicate a more
complicated problem:
 Daytime incontinence
 Pain in genitals
 Bowel symptoms (i.e. constipation)

11. Nocturnal bed wetting
Almost always stops on its own if enough
time is allowed
Treatment is unlikely to succeed if child is
not motivated
Never ever punish child for wetting the bed

12. Nocturnal bed wetting
Initial measures:
 Calendar of wet and dry nights
 Child should go to the bathroom before bed
 Avoid caffeine in the evening
 Try to take in majority of daily fluids in the
morning and afternoon, while restricting fluids
in the evening
 Avoid diapers and pullups (may use during
sleepovers, camps, etc.)

13. Nocturnal bed wetting
Motivational therapy
 Reward system (a star chart)
 Works best in younger children who do not
wet the bed every night
 Start easy and work up to tougher goals
 Penalties are counterproductive
 Generally done for three to six months

14. Nocturnal bed wetting
Enuresis alarms
 Most effective treatment
 Child must be able to take charge of alarm
with only some parental supervision
 May be used anywhere from one to six
months, generally should be some
improvement by three months

15. Nocturnal bed wetting
Desmopressin
 Works immediately
 Generally safe
 High relapse rate after stopping medication

16. Behavioral sleep problems
Most common sleep issues in children
Mostly seen in children 0–5 years of age,
but may persist longer
May involve prolonged night awakenings,
bedtime resistance or some combination

17. Behavioral sleep problems
More commonly in infants and toddlers the
problem stems from learning to fall asleep
only under certain conditions that require the
parent to intervene
For example, child must be rocked or fed to
fall asleep
Child does not learn to self-soothe during
normal brief arousals between sleep cycles

18. Behavioral sleep problems
More commonly in pre-school age and older
children, the problem is active resistance to
bedtime rather than prolonged wakings
during the night

19. Behavioral sleep problems
Infants and toddlers: 25–50% over 6 months
old continue to awaken during the night, and
10–15% of toddlers resist going to bed
Preschool-aged children: 15–30% either
resist falling asleep or wake in the night, or
both

20. Behavioral sleep problems
Children 4 to 10 years old: 25–40% have
sleep problems
Adolescents 13 to 16 years old: 11%

21. Behavioral sleep problems
Bedtime routine
 Include 3 or 4 soothing activities
 Should last 20–45 minutes
 Put child to bed drowsy but awake
 Coincide bedtime with child’s natural sleep
onset time to reinforce circadian clock

23. Behavioral sleep problems
Systematic ignoring or “extinction”
 Unmodified version is known as “crying it out”
 Documented to be a highly successful
treatment, but difficult for parents to adhere to
 Alternative is to do this more gradually, with
longer periods between checking on child
 Keep contact brief and avoid picking child up

24. Behavioral sleep problems
Bedtime fading
Positive reinforcement

25. Insomnia
Caused by anxiety surrounding falling
asleep or staying asleep
Most common sleep problem in adults
Insomnia in adolescents is treated similarly
to adults

26. Insomnia
Principles of sleep hygiene in children
 Have a set bedtime
 Bedtime and wake-up should be about the
same on school nights and weekends
 Don’t go to bed hungry
 Avoid caffeine for several hours before bed

27. Insomnia
Principles of sleep hygiene in children
 Spend time outside every day and exercise
regularly
 Keep bedroom quiet and dark
 Keep bedroom at a comfortable temperature
 Don’t use bedroom for time-out or punishment
 NO TV IN BEDROOM!

28. Nightmares
Severe nightmares are associated with
anxiety or post-traumatic stress disorder
If severe enough to require intervention,
they are usually addressed by psychologists
or therapists
Medications are rarely used and often serve
to trigger the nightmares instead

29. Sleepwalking
Seen in 15% of young children in one study
Will often go away after a year or two
Sometimes triggered by sleep deprivation,
or another sleep disorder such as sleep
apnea or restless legs
Keep environment safe

30. Questions?