Sleep consultants often get asked by concerned parents the following question: “Is my child’s sleep normal?’ (The answer is ‘yes’ most of the time. Their sleep habits and patterns might not be ideal for the family, and things can be tweaked and optimized – that is where a sleep consultant can help.
This post will look at how I assess a child’s sleep.
The example in this post is based on my work with a mum whose daughter had the typical toddler bedtime battles – as she described it. This mum was distressed about her daughter’s emotional outbursts and attempts to delay bedtime.
Sleep needs
Sleep needs vary across the lifespan, and decrease with age. Newborns need as much as 14 to 17 hours of sleep in 24 hours, while healthy older adults only need about 8 (Hirshkowitz et al., 2015, Galland et al., 2012)). Of course, some people exist outside the range of what is considered normal, some will thrive on less sleep and some will need more than what is required by most people of the same age. Young children’s sleep can suffer during the time of some developmental changes, so it is important to establish how long their sleep patterns have been problematic.
When looking at a child’s sleep pattern, to determine whether there are any sleep issues, it is important to look at the total amount of sleep in 24 hours, the number and length of naps, the timings, and the wakings, as well as sleep latency.
Circadian rhythm
Sleep is influenced by many factors, such as genetic tendencies, culture, environment and biology. Our habits- exercise, diet and sleep hygiene all have an impact on our circadian rhythm – our internal body clock. Our daytime habits influence our circadian rhythm- if they are consistent then they positively reinforce our circadian rhythm. Consistency when it comes to waking times, bedtimes and mealtimes as well as exposure to broad-spectrum daylight is something parents should strive for to help regulate their children’s circadian rhythm.
Hormones
When looking at sleep, the two important hormones that affect our circadian rhythm are cortisol and melatonin. Melatonin -the sleep hormone- begins to be secreted when light levels begin to fall. Very young babies don’t produce their melatonin, however, there are ways to help them develop a rhythm using social cues, and exposing them to 12-hour intervals of light and darkness. Their circadian rhythm will emerge around 3 months of age. Cortisol is secreted in an opposite pattern to melatonin. Cortisol levels are high in the morning, while melatonin levels are low so the drive to fall back to sleep is relatively low too.
Body temperature
Body temperature is influenced by our circadian rhythm (and it also influences our circadian rhythm). A child might wake up early because he is cold, as our body temperature is the lowest during the early hours of the morning. It is not uncommon for toddlers to wake up during those hours due to cold especially if they have kicked off their blanket earlier in the night.
Sleep pressure
Aside from the circadian rhythm, the other mechanism that influences sleep is homeostatic sleep pressure. The longer we go without sleep, the higher the pressure gets, as the level of the chemical, adenosine increases. In the absence of melatonin, it is sleep pressure that allows young children to nap during the day. If the sleep pressure is low, we will struggle to fall asleep. When looking at a child’s sleep pattern we ideally want to see naps spaced out during the day in a way that allows for enough sleep pressure to build, and the same applies for bedtime. Literature tells us that for children aged 2-2.5 years, it is normal to nap only once. With the nap being halfway through the day ideally. My client’s child is 24 months old and has one nap. For a child her age it is normal to have about 10-13 hours sleep during a 24-hour period, with the daytime nap being up to two hours long, and night-time sleep being anywhere between 10 and 13 hours.
The dilemma
My client‘s daughter naps for 1.5 hours and sleeps for 9 hours during the night. Her night-time sleep is therefore slightly shorter than average, however, she has an ideal sleep latency and sleeps through the night with hardly ever waking. Sleep onset latency refers to the time it takes to fall asleep. The ideal time to fall asleep is 15-20 minutes (Hookway, 2023). Children with very short sleep latency often wake up more frequently between sleep cycles. Looking at my client’s sleep diary tells me that her child’s sleep latency of 15-20 minutes is ideal, not too short, and not too long. Her nap could be better placed, as she is awake for 8 hours between waking in the morning and her lunchtime nap, while she only has 5.5 hours’ worth of sleep pressure built before bedtime. However, since her sleep latency is normal, and she is in a good mood and not unhappy in the morning either this pattern might work fine for her. Her total amount of sleep in 24 hours is 10.5 hours- which is considered normal for her age. Her wake at 5 am could be due to feeling cold, or it might be that 9 hours of nighttime sleep is enough for her.
When trying to determine whether the child is getting an adequate amount of sleep it is useful to observe their mood during the day. If they are content and happy, then the answer is probably yes. She is happy and content, apart from the emotional outbursts at bedtime. It is possible that changes in her sleep timings would have a positive effect on that but equally, it is also possible that her behaviour at bedtime is more about not having a full love tank/ delaying things to get more time with her mum who she hasn’t seen all day, and less so about sleep needs. Her 5 am waking might improve if her nap and bedtime routine is optimised (there is also wake-to-sleep and dramatic awakening, as well as other techniques the mum can try), but it might be that 9 hours of sleep is adequate for her and that these techniques won’t make much difference.
What happened
The mum tried several techniques related to early morning awakenings -as that was something she also really struggled with- before we found something that worked well for her daughter. As for the bedtime battles- we worked on connection, filling up her child’s love tank and optimising the bedtime routine.
The result- less tears, more smiles 🙂
If you would like to find out how I could help your little one’s sleep please feel free to reach out via email!
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