Pediatrician Insights on Childhood Sleep Problems

It’s 9 p.m. and all is quiet, except for your young toddler, who just won’t stay in bed. Or maybe it’s your 12-year-old who is staying up late to watch one more TikTok video.

There are many reasons why kids don’t sleep well, but help is available. Nora Fahden, MD, a parent and pediatrician with Bayside Medical Group in San Ramon, answers common questions about children’s sleep issues. She also addresses these same issues in a HealthTalks podcast.

What happens when kids don’t get enough sleep?

Aside from the fact that once the kids are in bed, you can finally get a chance to unwind yourself, good sleep is vital for a child’s overall health and development.

“Sleep is so important for their physical health, their brain development, and their ability to regulate their emotions,” Dr. Fahden said. “A sleepy kid is more likely to be super-irritable or throw tantrums or get angry really quickly,” she added.

“Sleep deprivation looks contrary to what you’d think in kids. They’re not going to be lethargic or drowsy. They actually get kind of hyper and wild.”

These behavioral changes add extra challenges that can affect the whole family. Babies and toddlers will be irritable, harder to console and calm down. This cascade of emotions makes it even harder to get them to sleep—and if the baby isn’t sleeping, no one is sleeping!

For older kids, Dr. Fahden explained, parents will see a decline in their executive functioning or higher-level skills for time management and organization. They may forget to turn in their homework, be impulsive, make poor decisions, or not be able to regulate their feelings.

How much sleep is enough for kids?

While every child’s specific sleep needs will vary, there are general guidelines to help you figure out if your child is getting enough sleep:

• 0 to 3 months: Consult your pediatrician.
• 4 to 11 months: 12 to 16 hours (including naps).
• 1 to 2 years: 11 to 14 hours (including naps).
• 3 to 5 years: 10 to 13 hours.
• 6 to 12 years: 9 to 12 hours.
• 13 to 18 years: 8 to 10 hours.

However, when it comes to the sleep needs of older kids and teens, that’s where Dr. Fahden sees a lot of misunderstanding. 

“If you have an 8-year-old who is getting eight hours of sleep, that’s probably not enough. They really need more like 9 to 12 hours,” she advised. “And I would be careful with teens because sometimes even though they are in bed by 11, they’re on their phone and not really asleep, and then they still have to get up at seven.”

How can you support healthy sleep for your child?

If your child is having trouble sleeping, Dr. Fahden recommends bringing it up with your pediatrician soon and often. A good bedtime behavior plan and consistent routine is important, she explained. With the support of your pediatrician or a sleep specialist, you can start making changes to help with building a healthy sleep routine.

“One of the main things that parents can do is practice setting and holding limits with their child,” she said. “Set a bedtime and stick to it. Create a brief bedtime routine; I have some parents who say, ‘Oh, yeah, we have a two-hour wind-down every night,’ and that’s too long. It should be no more than 20 to 30 minutes.”

Dr. Fahden also recommends a few more things you can do at night to support your child’s bedtime routine:

• Avoid high-energy play and encourage quiet time/quiet play before bed.
• Limit screen time for at least one hour before bedtime.
• Keep the bedroom cool, around 65 to 68 degrees.
• Make sure the bedroom is very dark; install backout shades to limit light from the windows.

But setting your child up for a good night’s sleep starts long before the sun goes down. Dr. Fahden explained that what you do during the day also plays an important role in your child getting healthy sleep.

“Having time outside every day where the child can be exposed to natural light and get exercise is going to make their sleep quality much better,” she said. “Exercise is super-important. We want kids to have at least an hour of rigorous activity at least five times a week.”

When is it OK for kids to use a sleep aid?

Sometimes, even if you do everything right, sleep will still be a struggle for your child. Dr. Fahden suggests talking to your pediatrician about options for adding a sleep aid to your kid’s bedtime routine, particularly when it comes to neurodiverse children who may need additional help.

“We know that kids who have neurologic differences have a harder time getting good quality sleep,” she said. “If that’s the case for your child, I would recommend bringing it up to your pediatrician, because those kids have a hard time sometimes winding down and shutting off their brain.”

She urges parents to exhaust other options first and avoid giving their children herbal supplements that claim to improve sleep without consulting their pediatrician.

“With Stanford Medicine Children’s Health, we’re lucky to have pediatric sleep medicine specialists,” she said. “You can get referred to the sleep medicine clinic, and they can do a really deep dive with you in terms of the issues that the child is having when it comes to sleep or staying asleep.”

“I always say, ‘Choose your battles,’ and this is actually a battle really worth fighting because of how much of an impact good quality sleep has in all areas of child development,” Dr. Fahden said. “I encourage parents to be brave and get the support they need.”

What about using sound machines?

When used safely, sound machines, also known as white noise machines, are a great aid to lull infants and children to sleep for two main reasons, Dr. Fahden said.

“For very young infants, it mimics the environment in utero (in the womb), where they hear the whoosh of mom’s blood flow all the time. This can be very soothing to them.”

Also, if the child’s bedroom is near the kitchen or living room, where there is activity, the sound machine helps drown out noise from other family members.

“There are some safety measures to consider,” Dr. Fahden explained. “The American Academy of Pediatrics recommends keeping the volume of the sound machine to 50 decibels or less to avoid possible hearing damage. For the same reason, don’t put the sound machine right next to your baby’s ear or in the crib or bassinet.”

Sometimes parents worry that their child will become dependent on a sound machine. If this is a concern, Dr. Fahden suggests slowly turning the volume down a tiny bit every few nights until the machine is completed turned off.

Quality sleep is essential for the overall well-being of children, and your pediatrician is there to help support your family through the journey to better sleep. For more advice from Dr. Fahden, check out Managing Your Teen’s Acne and Healthy Skin Habits for Your Family. Or for more about sleep: Creating a Safe Sleep Environment for Your Baby and Advice to Help Your Teens Get Enough Sleep.