What Are Symptoms and Causes of Behavioral Insomnia in Children?

Difficulties Sleeping May Be Linked to Parents' Behavior

Behavioral insomnia of childhood can cause difficulty falling asleep in children
Behavioral insomnia of childhood can cause difficulty falling asleep in children. Getty Images

There may be many reasons why your child has difficulty sleeping at night, but two common causes are classified under a condition called behavioral insomnia of childhood. What are the symptoms and causes of difficulty falling asleep in children? Parents especially might be interested in learning how bedtime routines can optimize sleep training in newborn infants, babies, toddlers, and even older kids.

What Is Insomnia in Children?

Insomnia refers to any difficulty falling or staying asleep, as well as sleep that simply is not refreshing. Children may suffer from insomnia for various reasons, including difficulties related to their sleep environment or poor sleep habits. Parents may unwittingly contribute to their child's insomnia by affecting their behavior in two ways:

These conditions both result in insomnia, but for distinct reasons. In the first condition, the sleep-onset association type, soothing behaviors by the parent may disrupt a child's ability to fall asleep when the parent is not present. In the limit-setting type, parents may lose control of their child's behavior (especially in toddlers) around bedtime and during awakenings from sleep.

The Symptoms of Insomnia in Children

In general, children need more sleep than adults. This varies somewhat based on age.

When sleep is needed, a child will simply fall asleep and get it. A newborn baby may sleep 16 hours in a 24-hour period, with short periods of sleep and wakefulness scattered through the day and night. By the age of 3, the amount of sleep needed averages closer to 12 hours. It is best to optimize the amount of time in bed overnight to meet these sleep needs.

Younger children may take 1-2 naps during the day to get adequate rest. By the age of 4 or 5, however, most children will stop taking daytime naps.

Children who do not sleep enough begin to have problems during the daytime. Imagine how you feel after a bad night of sleep - and then multiple it in magnitude without adequate coping skills or even ways to verbalize your frustrations. Children become cranky, refuse to cooperate with simple requests, cry more, and suffer from complete meltdowns and tantrums. Older children may begin to have problems at school, with poor attention, hyperactivity, and impaired school performance.

Beyond simply being unable to fall asleep, other aspects of behavior and even growth spiral out of control.

What Causes Insomnia in Children?

There are a variety of potential causes of insomnia in children. It can sometimes relate to improper expectations by parents. For example, as children get older, they may need less sleep. If the bedtime is not delayed later, the child will have trouble falling asleep.

This can be hard on parents who enjoyed the quiet time in the evening once the children were put to bed.

Infants should be put down when they are falling asleep, and preferably before they fall asleep. If every time the child falls asleep it is in a parent's arms, the child will cry if the parent is not there when awakening. It can sometimes be helpful to transition the bed to a crib prior to the onset of sleep. Older children may wake at night and be able to soothe themselves back to sleep without requiring a feeding or diaper change. If crying persists, it can be helpful to follow the Ferber method of graduated extinction. In a nutshell, the amount of time spent waiting before responding the to crying child is gradually lengthened until the child no longer cries for assistance.

In toddlers, especially those who are able to verbalize their preferences, the incessant requests for another story, a favorite toy, a glass of water, a trip the bathroom, etc. can be used to delay bedtime effectively. If parents are able to enforce strict rules and boundaries, these behaviors will gradually cease.

Rarely, children may have insomnia that requires additional evaluation and treatment.

How to Improve Insomnia in Children

When either of these behavioral problems occurs, the sleep of parents may be greatly impacted as well. It often leads to significant distress within families, but thankfully the difficulties are readily addressed with simple changes related to each condition. The two types of behavioral insomnia can improve quickly with education and observation of consistent rules.

In some cases, further assistance may be needed. It can be helpful to discuss concerns with a pediatrician or even a pediatric sleep specialist. Children with special needs may require additional support. In some cases, melatonin may be used as a sleep aid. Other prescription medications are not approved by the U.S. Food and Drug Administration (FDA) for use in children.

If you are struggling, get the support that you need so that everyone in the house can sleep better.

Sources:

Durmer, JS and Chervin, RD. "Pediatric sleep medicine." Continuum. Neurol 2007;13(3):162.

Mindell, JA and Owens, JA. "A clinical guide to pediatric sleep: diagnosis and management of sleep problems." Philadelphia: Lippincott Williams & Wilkins, 2003.

Spruyt, K et al. "Odds, prevalence and predictors of sleep problems in school-age normal children." J Sleep Res. 2005;14(2):163-176.

Touchette, E et al. "Factors associated with fragmented sleep at night across early childhood." Arch Pediatr Adolesc Med. 2005;159(3):242-249.

Continue Reading