NANTES, France – Sleep disorders affect up to 30% of children under 5 years old. But what makes paediatric insomnia unique, and how can parents effectively manage it?

These questions were addressed by Professor Stéphanie Bioulac from the Child and Adolescent Psychiatry Service at Child Couple Hospital, CHU Grenoble, and the University of Grenoble Alpes. She spoke on the topic during the French Society of Paediatrics congress held from 15-17 May in Nantes.

Examine Daytime Effects

Sleep issues in children under 5 are relatively common, with a prevalence ranging from 20% to 30%. Symptoms can show up in both nighttime and daytime behaviours. During the night, children often struggle to fall asleep or experience frequent awakenings. According to Bioulac, "Daytime symptoms in children differ from those in adults." While adults tend to be drowsy and tired after poor sleep, children are more often hyperactive and unstable. They "fight" sleep, leading to agitation, mood swings, impulsivity, irritability, tantrums, and even difficulty focusing.

The Behavioural Roots of Childhood Insomnia

Insomnia in children stems from different sources depending on their age. From 1 to 6 years, 70% of insomnia cases have behavioural causes while 30% are medical in origin. Common behavioural causes include poor bedtime habits, chaotic nap schedules, lack of boundaries, nighttime eating, or excessive stimulation. Bioulac explained that "abnormal bedtime conditioning" is the most common issue in children under 3. "If the child has never fallen asleep alone or associates falling asleep with being rocked, held, or fed, they won't know how to fall asleep by themselves or fall back asleep after waking during the night." Teaching children to independently fall asleep — whether for naps or at bedtime — is essential to solving these issues.

Challenging Cognitive Misconceptions

Parents may unwittingly reinforce poor sleep habits due to cognitive distortions. Bioulac highlighted some common misconceptions, such as the fear that children aren’t sleeping enough, or the belief that they should never be woken once asleep. "Identifying and addressing such irrational beliefs is key to successful cognitive behavioural therapy," she said.

Nocturnal awakenings, followed by oversleeping in the morning or poorly-timed naps, can also throw off a child's natural sleep rhythm.

Behavioural Methods for Better Sleep

Behavioral therapy is often an effective way to treat sleep disorders in children. Techniques include educating parents about their child's sleep needs, setting bedtime routines, using the method of gradual extinction, and rewarding appropriate sleeping behaviors. The "bedtime fading" technique, where bedtime is gradually adjusted, is another popular tool.

General sleep-duration recommendations include:

• Newborns (0-3 months): 14-17 hours (some variation possible).
• Infants (4-11 months): 12-15 hours (with possible variations).
• Toddlers (1-2 years): 11-14 hours (range may vary).
• Children (3-5 years): 10-13 hours (variations possible).

The Gradual Extinction Method

Ensuring a child has a consistent schedule, exposure to natural light, regular physical activity, and a screen-free bedtime routine is crucial for healthy sleep. The bedroom environment should be calm with a temperature between 18°C and 20°C.

Bioulac emphasized that before trying these methods, it’s critical to rule out serious psychiatric or family relationship issues. For children over 1 year, the gradual extinction method is a helpful tool. This approach reduces parental interference gradually. The process starts with a soothing bedtime routine that lasts about 15 minutes. Then, parents should leave the room while the child is still awake and wait through intervals (e.g., 3, 5, or 10 minutes) if the child cries. These intervals are extended each night, allowing the child to learn to self-soothe.

Bedtime Fading for Sleep Resistance

For children resistant to bedtime or with delayed sleep routines, the bedtime fading method helps recalibrate when they feel sleepy. The concept is to progressively shift bedtime earlier, starting with when the child naturally falls asleep, until you reach the desired bedtime.

This method, alongside gradual extinction, proves highly effective. “Both techniques offer dependable, long-lasting results in managing sleep disorders,” Bioulac said. Around 80% of children experience significant improvements with these interventions.

In cases where insomnia is more complex, such as with children on the autism spectrum, melatonin supplements may be beneficial.

This piece was translated from the French edition of Medscape and involved multiple editorial tools, including AI. Content was reviewed by human editors before publication.

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