Article
Your child's sleep affects their brain
Anyone who's had a bad night's sleep understands that not getting enough good sleep can affect just about everything.
Poor sleep affects our mood, energy level, and how well we can focus. It also affects the choices we make and how we interact with others, not to mention our metabolism and how well we can prevent illness and long-term health problems.
“When a child – or an adult – sleeps well, they’re much more likely to make better food choices and better choices in how they engage with friends and family. And that’s huge in terms of overall well-being,” says Michelle Caraballo, M.D., Pediatric Pulmonologist and Sleep Medicine Specialist at Children's Health℠ and Associate Professor at UT Southwestern.
Dr. Caraballo, who is a parent of one neurotypical and one neurodiverse kid, spends her days helping kids – and parents – find effective ways to get better sleep.
A child’s sleep problems can affect siblings, parents – everyone in the home. So if I can help a kid sleep, it’s an opportunity to improve everyone’s quality of life in the home.
Dr. Michelle Caraballo, M.D.
The importance of sleep
Getting good sleep has so many benefits – and research keeps uncovering more.
“The benefits of sleep are incredible. But they’re often underappreciated, by both kids and parents,” says Dr. Caraballo.
Good sleep positively impacts your:
Energy level
Ability to regulate emotions
Attention and ability to focus
Learn more about how sleep affects your child’s brain.
Good sleep also helps your:
Immune system
Ability to fight off illness
Metabolism and gut health
Appetite
Decision-making
Consistent, good sleep also reduces your risk of long-term health problems, including:
How much sleep kids really need
The American Academy of Pediatrics recommendations are:
Ages 4 to 12 months: 12-16 hours per day (including naps)
Ages 1 to 2: 11-14 hours per day (including naps)
Ages 3 to 5: 10-13 hours per day (including naps)
Ages 6 to 12: 9-12 hours per day
Ages 13 to 18: 8-10 hours per day
Within these recommended ranges, sleep needs vary from kid to kid. In general, you can tell your kid is getting enough sleep when they:
Wake up refreshed and not too groggy
Have a good mood
Are alert all day
Function well in school
“If you have to drag a kid out of bed, that’s a good sign they’re not getting enough sleep. But if they wake up without an alarm, that’s a sign they are getting enough,” says Dr. Caraballo.
Creating a healthy sleep environment
To create a sleep-friendly space, it’s important to make the space:
Cool. The ideal sleeping temperature is about 68 degrees.
Dark. Dark doesn’t mean pitch black, but the brighter a light is, the more it interferes with sleep. If you use a night light, have it be dim and low to the ground, so no light shines in your child’s eyes.
Quiet. If it’s difficult to control noise, try using a fan or a white noise machine to drown out the noise.
“Quiet and dark means no TV in the bedroom. I tell all parents that TVs do not belong in any bedrooms in the house. And, sometimes, that change can be game-changing, even when people swear to me that they can’t sleep without the TV on,” says Dr. Caraballo.
How does light affect sleep?
From infancy, our bodies develop a simple circadian rhythm: we sleep at night and we’re awake during the day.
“The abundance of artificial light in our modern world confuses the body because when light hits your eyeball, your brain interprets that as, ‘Oh, it’s light, that means it’s daytime – time to be awake,’” says Dr. Caraballo.
Darkness is the cue that tells your brain to release melatonin, which is the hormone we need to help us fall asleep. If you have all the lights on and the TV on, your body can’t do its job.
Establishing a bedtime routine
A bedtime routine doesn’t have to be long or complicated. The best bedtime routine is one that’s consistent and calm.
“When my kids were younger, I’d read one or two books to them. Now that they’re older, they’ll shower, brush their teeth and read to themselves in bed for 20 minutes. Then we pray and it’s a hug, a kiss – and that’s it,” says Dr. Caraballo.
For kids who are masters of stalling, Dr. Caraballo recommends setting expectations ahead of time.
Earlier in the day, you might tell them: Tonight, we’re going to read two books and sing one song and then we’ll go to bed.
“If kids try to stall, or ask for another book, you can calmly point to the chart and say, ‘Oh no, look, we already did that step.’ That way, the chart you made together becomes the authority – which can help you avoid negotiation and power struggles,” says Dr. Caraballo.
Why is having a bedtime routine important for kids?
Kids thrive when they have daily routines. And sticking to a sleep schedule can be the biggest sleep gift you can give your body – for both kids and adults.
When the body knows what to expect when it comes to sleep, it does better. And the more you vary your sleep schedule, the more the body gets confused.
Dr. Caraballo tells parents to think about how “off” your body can get when you travel, or when it’s daylight savings. Even just that single hour shift of daylight savings can really mess with the sleep rhythms and routines our bodies love.
“If you vary your sleep schedule a lot, it’s almost like you’re jet-lagged all the time,” says Dr. Caraballo. “From kids all the way to adulthood, the body responds really well to routine, which means going to bed at roughly the same time every night and waking up at roughly the same time every day – even on the weekends and holidays.”
Teaching young kids to self-soothe
Just about everyone has something that helps them fall asleep. For example:
For babies: They may use a pacifier to self-soothe. (You can put several in their crib, in case they can’t reach one or one falls out.) Note: Because it’s not safe for babies under 1 year of age to have any blanket, lovies or pillows in their crib (due to the risk of SIDS). a pacifier is a good choice.
For young kids: They may cuddle with a favorite stuffie or lovie.
For older kids: They may put a pillow under their arm at night.
“A favorite lovie or a pillow under the arm are examples of what’s called a ‘sleep-onset association,’” says Dr. Caraballo. “It’s something that’s easy to retrieve during a period of wakefulness.”
Many times, kids just roll over and go back to sleep without even realizing they were awake. But when they don’t, their lovie or other sleep-onset association can help them self-soothe to get back to sleep.
“Many parents feel guilty about letting a child self-soothe. But parents have to sleep too,” says Dr. Caraballo. “So if they’re in a crib, you can let them cry or fuss a little bit. You’re not going to do your child any long-term harm. They’re still going to wake up in the morning and give you a big smile and hug, just like they do any other day.”
And what if your child doesn’t easily latch on to a lovie or stuffie?
Dr. Caraballo says you can help create that bond.
“Every time they go to bed or to nap – or any time they cry or stub their toe or don’t get their way, you can put the lovie right in their face. Over time, they’ll start to create that bond,” she says.
Tips to help tweens and teens sleep better
Teens are the age group that are most likely to skimp on sleep. They have more social and academic demands – and parents have less control over their routine and schedule.
While it’s important to allow a maturing teen to have more responsibility in their lives, they still need parental guidance and support to make healthy choices, even if that means taking their phone away at night.
I often remind parents that even when it feels punishing to take your teen’s phone before bed, you’re actually doing your child a favor.
Dr. Michelle Caraballo, M.D.
Hormonal shifts during puberty change a teen’s circadian rhythm, which means they often prefer to go to sleep later and wake up later.
So what can you do if your teen needs to be at the bus stop at 6:30 a.m.?
When a teen struggles to fall asleep early enough to get enough sleep. Dr. Caraballo recommends they:
Avoid naps. Even if they’re very tired after school, have them push through the day and go to bed earlier.
Try a small dose of melatonin. A tiny dose of half to one milligram of melatonin, 4 to 6 hours before bed can help regulate a teen’s circadian rhythm.
Get outside first thing in the morning. The sun is the strongest waking stimulus, and it’s been proven to help us wake up and get ready for the day, much more than artificial light.
Stay off screens for an hour before bed. Try to set a homework schedule that keeps teens off laptops for the last hour of the day. And if having a central charging station to keep phones out of bedrooms doesn’t work, consider getting a cell phone lock box.
Take a warm shower or bath before bed. Research shows a warm bath or shower before bed can help us sleep better.
Read something boring. A boring history textbook will help a teen fall asleep better than a gripping mystery.
Avoid caffeine within 8 hours of bedtime. Caffeine is a long-acting drug that can stay in the body’s system for up to 8 hours. So any caffeine in the late afternoon or evening is likely to keep a teen up, whether they realize it or not.
Getting help for better sleep
Many parents have a sense of when it’s time to get help for a kid who is struggling with sleep. But a few signs to look for are:
Regular snoring (snoring more than half the time)
Restless sleep (lots of tossing and turning or kicking their legs while they sleep)
Falling asleep instantly
Still needing to nap regularly (after age 5)
Frequently taking longer than 30 minutes to fall asleep
Regular snoring usually warrants an evaluation by a sleep doctor and maybe a sleep study to look for sleep apnea. And restless sleeping could be a sign of restless leg syndrome, night terrors or sleepwalking. And when it takes longer than 30 minutes for a child to fall asleep, it could be a sign that they may need psychological support for anxiety.
Kids who have ADHD or autism and sleep problems
There’s a higher prevalence of sleep problems in kids with ADHD and autism.
“Because they’re wired differently, kids with ADHD or autism can struggle to fall asleep. Or they may be wide awake after only 4 or 5 hours sleep, ready to hit the day,” says Dr. Caraballo.
Dr. Caraballo recommends that all kids with ADHD have their pediatrician do a basic sleep history to see if a referral to a sleep specialist might be a good idea.
Even after making all the behavioral changes, some kids with autism still struggle to sleep well. And that’s when medicines can become a good option to optimize sleep, especially when the kid seems fine with 5 hours sleep, but the parent or caregiver is not.
Given how important sleep is for everyone, it’s sometimes better to give a child a sleep aid and have everyone start sleeping better than to continue to struggle.
“I’ve had so many families tell me, ‘You’ve changed our lives,’ which is such a gratifying part of my job,” says Dr. Caraballo.
Learn more
The highly experienced sleep specialists at Children’s Health can help diagnose and treat children with all sleep disorders from birth to early adulthood. Learn more about our programs.
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