2. Sleep is Critical to a Child’s Development, Health and Quality of Life

3. Childhood is an Opportune Time for Parents to Help Their Children Establish Good Sleep Habits This is important for: Prevention of common sleep problems Developing a positive attitude about sleep Developing a healthy “sleepstyle”

4. The Drive to Sleep is Regulated by Biology Biological Time Clock and Circadian Rhythms

5. Sleep Architecture Changes Over Time Hours in Sleep Sleep Stages Children’s Sleep Awake REM 1 2 3 4 12345671234567

6. Sleep Needs, Characteristics, Patterns and Issues Vary Throughout Childhood Amount of Sleep Needed Characteristics of SleepSleep Developmental Tasks (Milestones)/Issues Newborns (0–2 months) 10.5–18 hrs. Irregular sleep patterns until about 6–8 weeks that interact with hunger; multiple sleep periods in day and night; Sleep is active: smiling, sucking, body movements Sleep on back to prevent SIDS: Facilitate nighttime sleep; Create a positive and safe sleeping environment; Identify signs of sleepiness Infants (2–12 months) Total Average: 14.5 hrs. [Naps: 2.5–5 hrs] Increasing nighttime sleep; sleep pattern emerges; 3–4 naps to 1–2 by end of first year Create a regular bedtime schedule and routine; Nighttime awakenings; Learning to self-soothe Toddlers (1–3 years) Total Average: 12–14 hrs. [Naps: 1.5–3.5 hrs.] Morning naps cease around 18 months; most sleep through the night on regular sleep schedule Follow a bedtime routine; Set limits; Encourage falling asleep independently; Transition from crib to bed Preschoolers (3–5 years) Total Average: 11–13 hrs. Naps usually end by 5 years; nighttime fears may emerge Consistent sleep/wake time and bedtime routine School-Age (5–12 years) Total Average: 10–11 hrs. Increasing demands on children’s time can lead to sleep deprivation; Impact of TV, computers, caffeine and medical conditions on sleep Establish lifetime sleep and health habits; Be alert for persistent sleep problems and daytime sleepiness

7. Tips for Newborns Observe the baby’s sleep patterns and identify signs of sleepiness Put baby in the crib when drowsy, not asleep Place baby to sleep on his/her back with face and head clear of blankets and other soft items The crib should be safety approved A quiet and dark room at a comfortable temperature is best for sleep Encourage nighttime sleep

8. Increasing nighttime sleep; Regular sleep pattern emerges; 3–4 naps to 1–2 by end of first year Infants Amount of Sleep Needed Characteristics of SleepSleep Developmental Tasks (Milestones)/Issues Newborns (0–2 months) 10.5–18 hrs. Irregular sleep patterns until about 6–8 weeks that interact with hunger; Multiple sleep periods in day and night; Sleep is active: smiling, sucking, body movements Sleep on back to prevent SIDS; Facilitate nighttime sleep; Create a positive and safe sleeping environment; Identify signs of sleepiness Infants (2–12 months) Total Average: 14.5 hrs. [Naps: 2.5–5 hrs] Create a regular bedtime schedule and routine; Nighttime awakenings; Learn to self-soothe Toddlers (1–3 years) Total Average: 12–14 hrs. [Naps: 1.5–3.5 hrs.] Morning naps cease around 18 months; most sleep through the night on regular sleep schedule Follow a bedtime routine; Set limits; Encourage falling asleep independently; Transition from crib to bed Preschoolers (3–5 years) Total Average: 11–13 hrs. Naps usually end by 5 years; Nighttime fears may emerge Consistent sleep/ wake time and bedtime routine School-Age (5–12 years) Total Average: 10–11 hrs. Increasing demands on children’s time can lead to sleep deprivation; Impact of TV, computers, caffeine and medical conditions on sleep Establish lifetime sleep and health habits; Be alert for persistent sleep problems and daytime sleepiness

9. Tips for Helping Infants Sleep Well Develop a regular daily and bedtime schedule Create a consistent and enjoyable bedtime routine Establish a regular “sleep friendly” environment Encourage your baby to fall asleep independently and to become a “self-soother”

10. Toddlers (1–3 years) Total Average: 12–14 hrs. [Naps: 1.5–3.5 hrs.] Morning naps cease around 18 months; most sleep through the night on regular sleep schedule Follow a bedtime routine; Set limits; Encourage falling asleep independently; Transition from crib to bed Amount of Sleep Needed Characteristics of SleepSleep Developmental Tasks (Milestones)/Issues Newborns (0–2 months) 10.5–18 hrs.Irregular sleep patterns until about 6–8 weeks that interact with hunger; Multiple sleep periods in day and night; Sleep is active: smiling, sucking, body movements Sleep on back to prevent SIDS; Facilitate nighttime sleep; Create a positive and safe sleeping environment; Identify signs of sleepiness Infants (2–12 months) Total Average: 14.5 hrs. [Naps: 2.5–5 hrs] Increasing nighttime sleep; Regular sleep pattern emerges; 3–4 naps to 1–2 by end of first year Create a regular bedtime schedule and routine; Nighttime awakenings; Learn to self-soothe Preschoolers (3–5 years) Total Average: 11–13 hrs. Naps usually end by 5 years; Nighttime fears may emerge Consistent sleep/ wake time and bedtime routine School-Age (5–12 years) Total Average: 10–11 hrs. Increasing demands on children’s time can lead to sleep deprivation; Impact of TV, computers, caffeine and medical conditions on sleep Establish lifetime sleep and health habits; Be alert for persistent sleep problems and daytime sleepiness Toddlers

11. Tips for Helping Toddlers Sleep Well Maintain a daily sleep schedule and consistent bedtime routine The bedroom environment should be the same every night and throughout the night Set limits Encourage use of a security object

12. Preschool-Age Children Amount of Sleep Needed Characteristics of Sleep Sleep Developmental Tasks (Milestones)/Issues Newborns (0–2 months) 10.5–18 hrs. Irregular sleep patterns until about 6–8 weeks that interact with hunger; Multiple sleep periods in day and night; Sleep is active: smiling, sucking, body movements Sleep on back to prevent SIDS; Facilitate nighttime sleep; Create a positive and safe sleeping environment; Identify signs of sleepiness Infants (2–12 months) Total Average: 14.5 hrs. [Naps: 2.5–5 hrs] Increasing nighttime sleep; Regular sleep pattern emerges; 3–4 naps to 1–2 by end of first year Create a regular bedtime schedule and routine; Nighttime awakenings; Learn to self-soothe Toddlers (1–3 years) Total Average: 12–14 hrs. [Naps: 1.5–3.5 hrs.] Morning naps cease around 18 months; Most sleep through the night on regular sleep schedule Follow a bedtime routine; Set limits; Encourage falling asleep inde- pendently; Transition from crib to bed Preschoolers (3–5 years) Total Average: 11–13 hrs. Naps usually end by 5 years; Nighttime fears may emerge Consistent sleep/ wake time and bedtime routine School-Age (5–12 years) Total Average: 10–11 hrs. Increasing demands on children’s time can lead to sleep deprivation; Impact of TV, computers, caffeine and medical conditions on sleep Establish lifetime sleep and health habits; Be alert for persistent sleep problems and daytime sleepiness

13. Tips for Helping Preschoolers Sleep Well Maintain a regular and consistent sleep schedule Follow-through with a bedtime routine every night The child should sleep in the same sleeping environment every night. It should be cool, quiet, dark and without a TV Watch for difficulty breathing, unusual nighttime awakenings, chronic sleep problems, and behavioral problems during the day

14. Amount of Sleep Needed Characteristics of Sleep Sleep Developmental Tasks (Milestones)/Issues School-Age Children Newborns (0–2 months) Total Average: 10.5–18 hrs. Irregular sleep patterns until about 6–8 weeks that interact with hunger; multiple sleep periods in day and night; Sleep is active: smiling, sucking, body movements Sleep on back to prevent SIDS; Facilitate nighttime sleep; Create a positive and safe sleeping environment; Identify signs of sleepiness Infants (2–12 months) Total Average: 14.5 hrs. [Naps: 2.5–5 hrs] Increasing nighttime sleep; Regular sleep pattern emerges; 3–4 naps to 1–2 by end of first year Create a regular bedtime schedule and routine; Nighttime awakenings; Learn to self-soothe Toddlers (1–3 years) Total Average: 12–14 hrs. [Naps: 1.5–3.5 hrs.] Morning naps cease around 18 months; Most sleep through the night on regular sleep schedule Follow a bedtime routine; Set limits; Encourage falling asleep inde- pendently; Transition from crib to bed Preschoolers (3–5 years) Total Average: 11–13 hrs. Naps usually end by 5 years; Nighttime fears may emerge Consistent sleep/ wake time and bedtime routine and sleeping environment School-Age (5–12 years) Total Average: 10–11 hrs. Increasing demands on children’s time can lead to sleep deprivation; Impact of TV, computers, caffeine and medical conditions on sleep Establish lifetime sleep and health habits; Be alert for persistent sleep problems and daytime sleepiness

15. Tips for Helping School-Age Children Sleep Well Introduce healthy sleep habits, disease prevention and health promotion Continue to emphasize the need for a regular and consistent sleep schedule and bedtime routine The child’s bedroom should be conducive to sleep: dark, cool and quiet. TV’s and computers should be off and out of the bedroom Set limits Avoid caffeine Watch for signs of chronic difficulty sleeping, loud snoring, difficulty breathing, unusual nighttime awakenings and frequent daytime sleepiness

16. Common Sleep Problems Lead to Serious Consequences Not enough sleep Disruption of sleep (poor sleep) Disruption of sleep (poor sleep) Inappropriate timing of sleep Inappropriate timing of sleep Daytime sleepiness

17. Managing Common Sleep Problems Bedtime Struggles— Limit Setting Disorder Nighttime Awakenings

18. Managing Common Sleep Problems (cont.) Nightmares Sleep Terrors Sleepwalking Sleeptalking

19. Sleep Disorders in Children are Treatable Difficulty initiating or maintaining sleep Insomnia Partial or complete obstruction in the airway leading to pauses in breathing. The brain is alerted and the child resumes breathing. Sleep Apnea Airway passage is partially blocked and air from the nose or throat passes around the blockage causing throat structures to vibrate against each other making the snoring noise Snoring SymptomsSleep Problem/Disorder

20. Symptoms Sleep Disorders in Children are Treatable (cont.) Excessive daytime sleepiness Involuntary sleep attacks during the day Can include: cataplexy or sudden loss of muscle tone in response to emotion; sleep paralysis; hypnagogic hallucinations; disturbed nighttime sleep Narcolepsy Unpleasant, tingling, or creepy- crawly feelings in the legs with an irresistible urge to move Restless Legs Syndrome Sleep Problem/Disorder

21. Talk to Your Child’s Doctor if Any of the Following Symptoms are Observed: A newborn or infant is extremely and consistently fussy A child is having problems breathing or breathing is noisy A child snores, especially if the snoring is loud Unusual nighttime awakenings Difficulty falling asleep and maintaining sleep, especially if you see daytime sleepiness and/or behavioral problems

22. Keep a Sleep Diary of the Child’s Sleep Habits and Patterns

23. Parents Can be Effective Models of Good Sleep for Their Children

24. General Tips for All Children Establish a regular sleep/wake schedule Recognize signs of sleepiness in your child Understand that sleep needs and patterns change Follow a 20-30 minute relaxing bedtime routine Bedroom should be quiet, dark and cool Have a light snack (no caffeine) before bed Quiet activities (not television) are more conducive to falling asleep Exercise daily Get good nutrition Children should nap according to age and sleep needs

25. References American Academy of Pediatrics. Guide to Your Child’s Sleep: Birth Through Adolescence. George J. Cohen, ed. New York: Villard, 1999. American Academy of Sleep Medicine. “My Child Snores” brochure, 2000. Chervin RD, Clarke DF, Huffman JL, et al. “School Performance, Race, and Other Correlates of Sleep-Disordered Breathing in Children.” Sleep Medicine, 2003;4:21- 27. Ferber R, Kryger MH, eds. Principles and Practice of Sleep Medicine in Child. Philadelphia: WB Saunders, 1995 Goodwin JL, Babar SI, Kaemingk KL, et al. “Symptoms Related to Sleep-Disorder Breathing in White and Hispanic Children: The Tucson Children’s Sleep Assessment.” Chest, 2003;124(1):196-203. Gottlieb DJ, Vezina RM, Chase C, et al. “Symptoms of Sleep-Disordered Breathing in 5-Year-Old Children Are Associated with Sleepiness and Problem Behaviors.” Pediatrics, 2003;112(4):870-877. Mindell JA. Sleeping Through the Night: How Infants, Toddlers and their Parents Can Get a Good Night’s Sleep. New York: HarperCollins, 1997.

26. Mindell JA, Owens JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia: Lippincott Williams & Wilkins, 2003. National Sleep Foundation. “Children and Sleep” sleep sheet. National Sleep Foundation. Sleep in America Poll, 2004. Children and Sleep. National Sleep Foundation and Johnson and Johnson. “Babies and Sleep” package for parents and pediatricians, 2002. Owens JA, Maxim R, McGuinn M, et al. “Television-Viewing Habits and Sleep Disturbance in School Children.” Pediatrics, 1999;104(3). Owens JA, Spirito A, McGuinn M, et al. Sleep Habits and Disturbance in Elementary School-Age Children. Developmental and Behavioral Pediatrics 2000;21(1):27-34. Rosen G. “EDS [Excessive Daytime Sleepiness] in Children.” Sleep Medicine Alert 1999;4(3):5-6, National Sleep Foundation. References

27. American Academy of Sleep Medicine (AASM)T: (708) 492-0930 1 Westbrook Corporate Center, Suite 920www.aasmnet.org Westchester, IL 60514 Sleep Research SocietyT: (708) 492-0930 1 Westbrook Corporate Center, Suite 920www.sleepresearchsociety.org Westchester, IL 60514 National Center of Sleep Disorders Research (NCSDR)P: (301) 435-0199 2 Rockledge Center, Suite 7024 www.nhlbi.nih.gov/about/ 6701 Rockledge Drive, MSC 7920nscdr/index.htm Bethesda, MD 20892-7920 Narcolepsy Network Inc.P: (513) 891-3522 10921 Reed Hartman Highwaywww.narcolepsynetwork.org Cincinnati, OH 45242 e-mail: narnet@aol.com American Sleep Apnea AssociationP: (202) 293-3650 A.W.A.K.E Networkwww.sleepapnea.org 1424 K Street, NW, Suite 302e-mail: asaa@sleepapnea.org Washington, D.C. 20005 Restless Legs Syndrome Foundation 819 Second Street S.W.www.rls.org Rochester, MN 55902-2985 References

28. National Sleep Foundation The National Sleep Foundation is an independent nonprofit organization dedicated to improving public health and safety by achieving public understanding of sleep and sleep disorders, and by supporting public education, sleep-related research and advocacy. 1522 K Street, NW Suite 500 Washington, DC 20005 202-347-3471 Website: www.SleepFoundation.org ©2003