Sleep problems are common in childhood. They may happen once or many times in a single week. They usually do not need to be treated, unless they keep happening over and over again.

Refusal to go to bed: Children over 2 should have a bedtime routine that is the same every night. These things can help with a routine:

• Begin to quiet down the household activities about 1 hour before bedtime. For example no tag, horsing around or wrestling.
• Begin with a bedtime schedule every night. This might include things like a snack, brushing teeth, taking a bath, reading a book, and saying prayers. This should be a calm, quieting time for your child.
• Shorten the length of naps during the day. Have your child take naps early enough in the day, so he is tired for bedtime.
• At bedtime, close the door if your child tries to come out of the room or if he cries and screams. When he is quiet, you may open the door.
• Everyone has to go to bed. Don't let your child control bedtime. Set the rules and stick with them. If your child is screaming, it does not mean he gets to get out of bed.
• If your child gets out of bed, quietly walk him back to his bedroom and remind him that he has to stay in bed.
• Praise your child for going to bed and staying there. It is much more fun to be praised for being good, than to be yelled at for being bad.

Nightmares:   Nightmares are "Bad" dreams that can happen at any age.  They sometimes occur because something has made your child anxious. Your child may cry and scream and wake up remembering it is a scary dream. Nightmares are often caused by scary TV shows or movies, fear of monsters, or fears of being separated from parents.

What you can do:

• Comfort and reassure your child and take him back to bed.
• Talk about the scary dream the next day.  Sometimes children don’t remember their nightmares.
• Decrease daytime stress.
• Monitor television programs and video games for excessive violence or things that upset your child.

Night Terrors: Common in school-age children, especially around 5-6 years of age. Your child may suddenly wake up during the first part of night frightened, crying, confused, disoriented, breathing rapidly, sweating, with eyes open, but not seeing anything. He may sleepwalk. When finally awakened, your child can't remember the dream. These spells usually stop by age 12 years.

What you can do:

• These spells are harmless and no treatment is needed.
• You can't wake your child up, so don't try.
• Talk slowly and repeat often during a spell: "You're okay", "You're safe", "You can sleep now."
• Hold your child if this comforts him.
• If having nightly terrors, figure out what time they usually happen. Wake your child up 15 minutes before that time. Keep him awake and out-of-bed for 5 minutes. Then return him to bed - do this 7 nights in a row.

Sleepwalking and sleeptalking: These are common in children. The child suddenly wakes up, looks around, walks in house but even though his eyes are open, you can't wake him up.

What you can do:

• Protect him from injury. Place locks on all the doors leading to the outside, so he cannot leave the house.
• Gently steer him to the bathroom, then back to bed.
• If it happens on nights when your child is very tired let him go to bed earlier.
• If it happens every night, figure out what time they usually happen, and then wake your child up 15 minutes before that time. Keep him awake and out-of-bed for 5 minutes. Then return him to bed - do this 7 nights in a row.

Sleep Apnea in Children: A disorder where a child stops breathing for short periods of time while asleep. One kind is common in premature babies and improves over time. Medications may be used to treat this. Another kind of sleep apnea is where a child has trouble breathing at night, usually due to large tonsils and adenoids. The child snores, has pauses in breathing, may get bluish lips and often wakes up tired from not sleeping well. If you are concerned about your child having sleep apnea, contact your child's doctor. Learn more about our Pediatric ENT specialists who treats disorders of the ear, nose and throat.

Narcolepsy:   This is a condition when a child falls asleep a lot during the day at times when he is not supposed to. This usually doesn't happen until the teenage years. The child sleeps normally at nighttime. He may do poorly in school because he is always falling asleep.

Insomnia: Means difficulty falling asleep and waking up too early without being rested. This happens to everyone once in awhile. In young children, it may be a reaction to a change in their lives, like an illness, move, trip, new baby-sitter or death in the family. If it happens a lot, it may be due to poor sleep habits, in older kids it may be a sign of depression.

Call your child's doctor if:

• Your child has persistent nightmares and you don't know why.
• Your child has too much daytime sleepiness and is doing poorly in school.
• If night terrors persist.
• During a "night terror", your child is making jerking movements, drooling, tongue biting, or wetting his pants - it may be a seizure.
• You have other questions or concerns.

Children's Mercy Hospitals and Clinics

Kansas City,Missouri                                                       Overland Park,Kansas

Care cards are provided as a public education service. The information does not replace instructions your physician gives you. If you have questions about your child's care, please call your physician.

Estas instruccions son provistas como un servicio educacional. La information no sustituye las instrucciones de su medico. Si tiene preguntas encuanto al duidado de su niño, por favor llame a su medico.