Insomnia in Children Ages 5-12

In children 5-12 years of age the most common causes of insomnia include:

1. Bedtime resistance as children gain more autonomy and control over setting their sleep schedule. This is present in approximately 27% of children, and in those with trouble getting to sleep on time, it plays a role in 80% of cases.¹
2. Delayed sleep onset is also common. Called Delayed Sleep Phase Syndrome (DSPS), it may begin in this age group and continue into adulthood. It may have associated resistance issues, and is associated with malfunctioning of our internal clock (called the "circadian rhythm").
3. Poor sleep hygiene — e.g., drinking caffeine and sugar-containing beverages such as sodas near bedtime, engaging in exercise or excitement before bedtime.
4. Situational stress — e.g., worry over parents fighting or divorcing, or being bullied at school.

Each child needs a different amount of sleep, and it is reasonable to have autonomy be associated with whether the child's choices are working. If they are happy and doing well in school, their choices are working for them and there is no issue. If they have problems at school or with being overly sleepy during the day, that is the time to address sleep issues with the child.

For bedtime resistance, letting the child know that bedtime decisions are not a matter of "who is in charge" but rather of "what works" can sidestep some of the conflict. It can be the child's school grades that determine the level of autonomy, and a written-out and agreed-to "contract" can help (e.g., "If your grades stay above a certain level you can stay up later. Otherwise you are in bed at an earlier time"). Setting a clear routine, with the hour before bed assigned to calming activities and avoiding sugar/caffeine are simple and helpful ways to begin. Though naps are usually healthy, with this problem you should have your child avoid naps during the day. Meanwhile, "reset" their bedtime by making it 10-15 minutes earlier each day until they are in bed at a good time. Also, no TV or music in bed.

If the child wants to go to sleep, but cannot fall asleep despite the above, adding Benadryl, melatonin (½-3 mg), or herbals (e.g., chamomile or chamomile tea, valerian, passion flower) can be helpful. For children over 8 years of age, I would use an herbal supplement that promotes healthy sleep. The smell of lavender helps promote sleep as well, so put a small lavender filled pillow or stuffed animal in their bed. Also make sure the child's situational stresses are addressed. Do they feel safe and secure both at home and at school? If they are being bullied at school or are having problems or fears at home, they often will not say so unless you ask. And even then, make sure you ask them at a time and place that feels private, safe and secure.

If insomnia is associated with severe fatigue, and perhaps a sudden onset with viral symptoms, consider the possibility of Chronic Fatigue Syndrome. This is becoming increasingly common in children, and responds well to the "SHINE Protocol." In addition, there are special issues that are especially important to address in childhood CFS. For more on this, see “Addressing CFS and Fibromyalgia in Children.”

References

¹Blader JC, Koplewicz HS, Abikoff H, Foley C. Sleep problems of elementary school children. Arch Pediatr Adolesc Med 1997;151:473-480 for a survey of almost 1,000 children 5-12 years old.