Sleep Problems in Children and a Healthy Bedtime Routine

Why do sleep problems in children happen? This guide covers trouble falling asleep, night waking and nightmares, with routines by age and when to seek support.

Bedtime negotiations that drag on, requests for "one more drink of water" and "one more story", little feet appearing at your bed in the middle of the night, and a child who cannot be woken in the morning... Sleep problems in children are an issue that deeply affects the daily life of many families and leaves parents sleepless too. Sleep is a basic need for a child's physical growth, learning, attention and ability to regulate emotions. Insufficient or broken sleep can show up during the day as restlessness, tantrums and difficulty concentrating at school. The good news is that a significant share of sleep problems can improve markedly with a consistent bedtime routine and a thoughtful approach from parents. In this article we look at the most common sleep problems by age, their causes and the methods you can apply at home step by step.

What Are Sleep Problems in Children?

Sleep difficulties encountered in childhood can be grouped under a few headings:

• Difficulty falling asleep: Being unable to sleep for a long time after being put to bed, getting up repeatedly, constantly postponing bedtime
• Night waking: Waking several times through the night and calling for a parent or coming to the parent's bed
• Being unable to sleep alone: Being able to fall asleep only when a parent is beside them
• Nightmares: Waking because of frightening dreams; the child usually remembers the dream and needs comforting
• Night terrors: In the first hours of sleep, the child suddenly sits up screaming in fear, eyes open but not fully awake; the child usually does not remember in the morning
• Sleepwalking and sleep talking
• Early waking: Waking very early in the morning and being unable to go back to sleep
• Snoring and pauses in breathing during sleep: These symptoms must be assessed by a paediatrician or an ear, nose and throat specialist

Some of these difficulties are specific to particular developmental stages and decrease on their own over time. Sleep problems in children are considered a matter to be addressed separately only when they recur frequently, last a long time and clearly affect the child's or the family's daily functioning.

It is important to distinguish a nightmare from a night terror. In a nightmare, the child wakes, recognises you and wants a hug. In a night terror, the child is not fully awake and often does not respond to comfort. In a night terror, rather than trying to wake the child, it is generally recommended to make sure they are safe and wait calmly beside them.

Sleep Needs by Age and Common Problems

Every child's sleep need is different; the information below offers a general framework. If your child seems alert, energetic and relatively balanced during the day, you can assume their sleep is sufficient.

Ages 1–3: Daytime naps continue. In this period, when separation anxiety is pronounced, resistance to sleeping alone and night waking are common.

Ages 3–6: Imagination develops; fears of the dark, monsters and burglars may appear. Daytime sleep usually decreases or ends in this period. Testing limits at bedtime is common.

Ages 6–12: The pace of school, homework, extra courses and screen use can push sleep times later. Worries about school and friends can make falling asleep harder.

Adolescence: The biological clock naturally shifts to later hours. Combined with phones, social media and a heavy study schedule, chronic sleep deprivation can become widespread. We discuss this separately in our article on sleep in teenagers.

What Causes Sleep Problems in Children?

Irregular sleep times: Big differences between weekdays and weekends, evening visits and family schedules that run late strain the child's biological clock. In Turkey, extended-family visits and evening meals that stretch into the late hours are a familiar situation for many families.

Screen use: Using a tablet, phone or television before bed can delay falling asleep, both because of the screen light and because of how stimulating the content is. For more information, see our article on screen addiction.

Sleep-onset habits: If a child has become used to falling asleep only by being rocked, being breastfed, having a parent lie beside them or with the television on, they look for the same conditions during brief night wakings and find it hard to fall back asleep on their own.

Anxiety and fears: Separation anxiety, fear of the dark, worries about school, tension within the family or frightening news can occupy the mind before sleep. In many children who lived through the earthquake or were exposed to images of it, an unwillingness to sleep alone and more night waking have been observed.

Life changes: The birth of a sibling, moving house, starting school, divorce or the loss of a loved one can temporarily disrupt the sleep pattern.

Physical causes: Conditions such as ear infections, allergies, enlarged adenoids, reflux and itchy skin problems can affect sleep. For this reason, medical assessment is one of the first steps in long-lasting sleep problems.

The Impact of Sleeplessness on Daily Life

When adults are short of sleep, they mostly look tired and sluggish. In children the picture can be the opposite: a sleep-deprived child can be more active, more restless, and quicker to cry and get angry. For this reason, lack of sleep can sometimes be mistaken for a behaviour problem or difficulty with attention.

Imagine a six-year-old who cannot fall asleep for hours every evening, is woken with difficulty in the mornings and often argues with friends at school. The teacher mentions distractibility. When the sleep pattern is put in order, some of these behaviours may be seen to decrease. This example shows why looking at sleep matters when assessing behaviour.

Sleep problems affect parents too. Broken nights reduce parents' patience, can create tension between partners and can lower work performance during the day. That is why sleep problems in children are not only the child's concern but the whole family's; putting the child's sleep in order is also an investment in the wellbeing of the whole family.

How to Build a Healthy Bedtime Routine

1. Set a fixed bedtime and wake-up time

Going to bed at about the same time and waking at the same time every day is one of the most effective ways of regulating the biological clock. Try not to deviate too far from these times at weekends. Fixing the morning wake-up time also makes falling asleep in the evening easier.

2. Set up a calm and predictable pre-bed routine

A routine of about 20–40 minutes, repeated in the same order every evening, gives the child's body and mind the message "Sleep time is approaching". An example order:

1. A light evening snack (if needed)
2. A warm shower or washing hands and face
3. Putting on pyjamas, brushing teeth, going to the toilet
4. Reading a book together in bed or having a quiet chat
5. A short "best moment of the day" conversation
6. A goodnight kiss, lights dimmed

For young children, preparing an illustrated routine card turns following the steps into a game and reduces negotiation.

3. Switch off screens before sleep

Aim to switch off screens at least an hour before bedtime. Keep televisions, tablets and phones out of the child's room. For teenagers, charging the phone overnight in a shared space can be set as a family rule; having the rule apply to parents too increases compliance.

4. Arrange the sleep environment

• The room should be cool, dark and quiet; for children who are afraid of the dark, a dim night light can be used.
• The bed should be associated only with sleep and calm activities; it should not be a place of punishment or a homework area.
• A favourite toy or blanket can give the child security as a transitional object.

5. Watch daytime habits

• Spending time outdoors and being physically active during the day supports sleep.
• Limit caffeinated foods and drinks such as tea, cola and chocolate in the evening.
• Avoid eating dinner too close to bedtime and avoid very heavy meals.
• For preschool children, make sure the daytime nap is not too close to the evening.

6. Teach falling asleep alone gradually

If your child can only sleep when you are beside them, a gradual transition is less difficult than a sudden change:

1. For the first few nights, sit beside the bed, accompanying the child by staying nearby rather than by holding them.
2. After a few nights, move your chair a little closer to the door.
3. Then sit in the doorway.
4. Then leave the room for short intervals, saying "I'll come back to check on you in five minutes", and return; keep your word.
5. Gradually lengthen the check-in intervals.

Consistency is the most important element in this process. Parents taking turns to carry out the process both shares the load and allows the child to learn to fall asleep securely with both parents. On some nights the struggle may increase; this is usually a temporary phase.

7. Be calm and boring during night wakings

When the child wakes at night, respond briefly, calmly and with little stimulation: without turning on the light and without getting into long conversations, take them back to their bed saying "It's night-time, sleep time. I'm here." It is important that night wakings are not rewarded with play, screens or special attention.

8. Extra suggestions for anxious children

• Set aside a short "worry time" early in the evening, rather than right before bed, to talk about worries.
• Keep frightening stories, news and films away from the evening hours.
• Use creative methods such as "chasing away nightmares": for example, drawing the nightmare and turning it into a story with a happy ending.
• Add breathing exercises and muscle-relaxation games to the bedtime routine.

A good bedtime routine is not built in a single night; small steps repeated consistently make a big difference over time.

When Should You Seek Professional Support?

In the following situations, it is recommended that you first consult your paediatrician:

• Regular snoring, pauses in breathing during sleep, mouth breathing
• Night terrors or sleepwalking that are very frequent, or the child putting themselves in danger
• Sleep problems accompanied by weight loss, pain or other physical symptoms

After medical causes have been assessed, it may help to consult a mental health professional who works with children and adolescents in the following situations:

• If sleep problems have lasted several weeks and do not change despite the adjustments made at home
• If difficulty falling asleep is accompanied by intense fears, anxiety or frequent nightmares
• If the sleep problems began after a loss, a traumatic event or a major change
• If the child shows marked unhappiness, anger, school problems or withdrawal during the day
• If the family has been seriously worn down by sleeplessness

How Are Sleep Problems in Children Addressed in Therapy?

Sleep problems in children often make sense when they are addressed together with daytime anxiety, family routines and habits, rather than on their own. The psychological support process usually begins with sessions with parents. The child's daytime and night-time routine, sleep history, changes in the family and the period when the sleep problems began are discussed in detail. In some cases, families may be asked to keep a simple sleep diary for a few weeks.

Parent guidance: An age-appropriate bedtime routine, a gradual plan for sleeping alone and ways of responding consistently to night wakings are planned together with parents.

Cognitive behavioural approach: With school-age children and adolescents, work focuses on noticing anxious thoughts before sleep, relaxation skills and habits that support sleep.

Play therapy: If there are fears, separation anxiety or a difficult experience behind the sleep problems, young children can express and process these feelings through play. You can find detailed information on this on the child and play therapy page.

The assessment of whether medication is needed should be made only by a physician; children should not be given any sleep product without a doctor's recommendation.

Frequently Asked Questions

At what age should I move my child to their own room?

There is no single age that suits everyone. The family's living conditions, the child's temperament and their readiness are decisive. Making the transition gradual, talking with the child beforehand and preparing the room together make the process easier.

My child comes to our bed at night. What should I do?

If your family's goal is for the child to sleep in their own bed, calmly and briefly taking them back to their own bed every time they come gives a consistent message. In the first days this may be repeated several times. In the morning, noticing and appreciating the time they stayed in their own bed increases motivation.

How should I respond to a child who has nightmares?

Hug them, tell them in a calm voice that they are safe and accompany them back to sleep. You can leave discussing the dream in detail until the morning. If there are frequently recurring nightmares, it helps to be curious about what is worrying the child during the day.

Can sleep problems be confused with attention deficit?

Yes. In sleep-deprived children, restlessness, distractibility and impulsivity can increase. For this reason, when attention problems are being assessed, the sleep pattern must always be looked at too.

• #sleep problems in children
• #bedtime routine
• #night waking
• #nightmares

Yazar

Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

Eğitimler