• Facebook
  • Twitter
  • Tumblr
  • LinkedIn
  • LOGIN
  • DONATE NOW

  • Home
  • About
    • Mission
    • Annual Report 2019
    • History
    • For the Media
    • Board of Directors
      • Peter S. Jensen, MD
      • Alan Axelson, MD
      • Deborah Buccino, MD
      • Wynford Dore
      • Seth J. Finkel, JD, LL.M.
      • Steve Holsenbeck, M.D.
      • Robin Hulshizer, Esq.
      • Laura A. Jones, JD
      • Robert Marshall, Esq.
      • Matthew Raimondi
      • Charles G. Ray, M.Ed.
      • Elizabeth Reagan
      • Erica Rubach
      • Marley Spector
      • Judith Warner
    • Staff
    • REACH Faculty
      • PPP Faculty
      • CATIE Faculty
    • Donors and Funders
  • Services
    • For Healthcare Organizations
      • Staff Training
        • Patient-Centered Mental Health in Pediatric Primary Care
          • Training dates
          • How to schedule a course
          • Sites trained
          • What our trainees are saying
          • Faculty
        • Child/Adolescent Training in Evidence-Based Psychotherapies (CATIE)
          • How to schedule a training
          • Sites trained
          • What our trainees are saying
          • Faculty
        • Parent Empowerment
          • How to schedule a training
    • For Primary Care Practitioners
      • Patient-Centered Mental Health in Pediatric Primary Care
      • Adult Behavioral Health in Primary Care
      • Course Dates and Registration
      • What our trainees are saying
    • For Mental Health Practitioners
      • Child/Adolescent Training in Evidence-Based Psychotherapies (CATIE)
      • Dr. Greene’s Approach
    • REACH Scholarship
    • REACH Video
    • Online Courses
  • Get Involved
    • Donate
    • Volunteer
      • Opportunities
      • Application
  • Help for Families
    • Advocating for Your Child
    • Child Mental Health: Fact vs. Fiction
    • Helpful Resources
    • REACH-Trained Practitioners
  • Trainees & Alumni
    • PPP Trainees & Alumni
      • Rating Scales
  • Newsletters
  • Contact Us

Home Newsletters Why Can't This Kid Sleep?

Why Can't This Kid Sleep?

  • Print
  • Email
photo of a sleepy boy rubbing his eyes

Alana, age 17, comes in complaining that she is tired all the time and struggles to stay awake during school.

Or perhaps it's six-year-old Miko, whose mother tells you that Miko avoids going to bed and often gets up in the middle of the night. Miko says he doesn't feel sleepy, but his teachers say he is often inattentive and sometimes quarrelsome.

The most common sleep problems among young patients are these and other forms of insomnia or insufficient sleep, according to REACH faculty member Robert Kowatch, MD, a pediatric sleep expert and professor of psychiatry at Ohio State University Medical Center/Nationwide Children's Hospital. 

Fortunately, in most cases the diagnosis is straightforward, and treatment often consists of behavioral techniques for parents and cognitive behavioral therapy for adolescents.

Sleep problems can be divided into two broad categories, with some overlap:

  • Excessive daytime somnolence, particularly in teens, is most often caused by insufficient sleep. Other less common causes include sleep apnea, narcolepsy, and sedating psychiatric medications.
  • Insomnia, the inability to sleep, can be the primary diagnosis or may be secondary to other conditions, such as depression or restless legs syndrome/periodic leg movements during sleep.

The differences in diagnosis and treatment between teens and younger children can be fairly pronounced. For this issue, we asked Dr. Kowatch how to deal with children like Miko. Next month, he'll tell you how to deal with teens like Alana.

"Younger children usually can't tell you whether they have symptoms of disorders like snoring or restless legs syndrome," said Dr. Kowatch. "But those issues are uncommon enough that we wouldn't order a sleep study unless it's indicated by factors other than insomnia." One risk factor is a family history of restless legs or sleep apnea. Another is a diagnosis of autism spectrum disorder or ADHD, which are associated with higher incidence of periodic leg movements during sleep.

"For most children ages 2 to 6, the problem is behavioral," said Dr. Kowatch. To assess the issue, pediatric primary care providers can ask parents about the child's nighttime behavior.

  • What time is bedtime?
  • What is the pre-bedtime routine?
  • Does the child follow this routine easily or disrupt it with "curtain calls" -- just one more story or drink of water?
  • Where does the child fall asleep -- in his own bed or the parents'?
  • Does the child stay in bed? How many times a night does she get up? What happens when she does?

"We call this a limit-setting sleep disorder," said Dr. Kowatch. It's the parents who need to set the limits. Dr. Kowatch recommends the process known as "Ferberizing," after Richard Ferber, MD, author of Solve Your Child's Sleep Problems. Parents of young children should:

  • Stick to a consistent bedtime routine
  • Try bedtime "fading": Set as the temporary bedtime the hour at which the child can fall asleep naturally, even if that's 10:30 pm. After a few nights, put the child to bed 15 minutes earlier. Repeat until the desired bedtime is reached.
  • Gently but firmly put the child back into his own bed if he gets up in the night
  • Use a sticker chart to reinforce the desired bedtime behavior

Children who feel anxious and want adult attention get what they need when caregivers lovingly impose consistent boundaries. "The parents need some coaching," said Dr. Kowatch. "If necessary, you can refer them to a mental health specialist for sleep behavioral therapy. Many families need just a couple of sessions to develop these tactics."

When the child's behavior doesn't fit the limit-setting profile, clinicians may want to assess risk factors for physical issues such as narcolepsy, apnea, and restless legs. Children with sleep apnea typically snore on most nights and are tired or irritable during the day. Clinicians may also screen for underlying mental health disorders such as depression or anxiety.

Next month: How to diagnose and treat the sleepy teen

Details
Last Updated: January 22, 2019
January 22, 2019
|
Author: The REACH Institute
|
Pediatric primary care, Child mental health, Sleep disorders
  • Prev
  • Next

Filter by Category

  • ADHD
  • Anti-racism
  • Anxiety
  • Assessment & screening
  • Child mental health
  • coding
  • Cognitive behavioral therapy
  • College transition
  • Culturally responsive
  • Depression
  • Foster care
  • Grief
  • High-risk children & youth
  • Medication
  • Parents
  • Patient communication
  • Pediatric primary care
  • School refusal
  • Sleep disorders
  • Suicide
  • Trauma
  • Show All Categories

Filter by Date

  • May 2018
  • June 2018
  • July 2018
  • September 2018
  • October 2018
  • November 2018
  • January 2019
  • February 2019
  • March 2019
  • April 2019
  • May 2019
  • June 2019
  • July 2019
  • September 2019
  • October 2019
  • November 2019
  • January 2020
  • February 2020
  • March 2020
  • April 2020
  • May 2020
  • June 2020
  • July 2020
  • September 2020
  • October 2020
  • November 2020
  • January 2021
  • Show All

Contact Us

The REACH Institute
404 5th Avenue
3rd Floor
New York, NY 10018

Phone: 212-947-7322
E-mail: info@thereachinstitute.org

Stay Connected to REACH

Put your e-mail and click Submit.

Copyright 2021 The Reach Institute