Preschoolers and Sleep: Expert Advice

How to handle naps, bedtime power struggles, and more.

From the WebMD Archives

You take your 3-year-old to the playground with the hope that running her ragged will tire her out by 8 p.m. and allow you to enjoy a relaxing evening and maybe sleep in a bit. But the plan backfires. Your rambunctious kid is still bouncing off the walls at 9 p.m., finally falls asleep later that night, and then wakes up full of energy and ready to play at 6 a.m.

Sound familiar? Parents may think getting through the night with a newborn was tough, but getting a preschooler to sleep can be a challenge that leaves even the most patient moms and dads exasperated. When preschool children don't get enough sleep it can affect their mood, behavior, eating habits, and ability to focus during the day.

"Kids are like their parents -- they're not getting enough sleep," said Richard Kravitz, MD, a pediatrician and director of the Pediatric Sleep Medicine Program at Duke University School of Medicine in Durham, N.C. "How many times have you seen 3-year-olds out to dinner with their parents at 10 o'clock at night? But kids are not little adults and kids need more sleep than adults. You want to have good sleep hygiene, which means good quantity and good quality."

So how do you know if you have good sleep hygiene? "You know your kid is getting a good night's sleep if they get up happy and refreshed, ready to go," Kravitz says.

Establishing Good Sleep Habits -- to Nap or Not to Nap?

According to the National Sleep Foundation, children aged 3-5 need about 11 to 13 hours of sleep every night. In addition, many preschoolers nap during the day, with naps ranging between one and two hours per day. Children often stop napping after five years of age.

Experts say every preschooler is different -- some kids will stick with their nap routines from their infant days and other kids will start to refuse napping when they reach the preschool years. The trick is to be consistent, stay calm, and make sure your preschooler gets at least 11 hours of sleep per night and down time or naps -- if napping is needed -- at the same time every day.

"Up until 2-3 years of age, most children will take two naps per day," says Christine Briccetti, MD, a pediatrician at the Johns Hopkins Children's Center in Baltimore. "The typical preschooler will take only one nap, usually in the afternoon and lasting one to two hours. Many children this age will no longer nap at all. Naps are not necessary if your child does not get cranky or over tired. However, if your preschooler does not nap, he or she will still benefit from daily quiet time.

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Nixing Their Nap

If your child refuses naptime, don't worry. Kids in this age group don't necessarily need a nap every day, but they should have predictable down time, which means time scheduled at the same point in the day every day for simply resting.

"This is the time of day when you take away stimulation," says Wendy Sue Swanson, MD, pediatrician and author of the Seattle Children's Hospital blog "Seattle Mama Doc." "This time is still restful for a child. It's not restorative sleep, but it's important downtime."

Experts agree what's most important is to establish sleeping routines and be consistent. Preschoolers thrive on schedules.

Getting to Bed

Many parenting books will recommend warm baths or a bedtime story to help your preschooler fall asleep, but this doesn't always work. Often times, a preschooler who refuses to go to bed is a preschooler who is overtired.

Setting an earlier bedtime or starting quiet time earlier on to help preschoolers transition to bedtime might help. Keeping them up later does not, Briccetti says.

"When children become overtired they get cranky, which can increase the bedtime struggles," she says. "Parents will sometimes react by keeping them up later to try to tire them out, which exacerbates the problems. Offer rewards for nights without struggle, but try not to scold or punish your child if they are resistant. Remember, you have control over when your child goes to bed, not when he or she falls asleep. If they are unable to fall asleep quickly, the rule should be that they have to remain lying quietly in bed."

Some preschoolers continue to co-sleep with their parents, a practice that is common among some cultures. The American Academy of Pediatrics recommends against parent-infant bedsharing because of the risk of Sudden Infant Death Syndrome (SIDS). The risk of SIDS declines after the first year, but if a young child co-sleeps with his parents on a long-term basis, it may become difficult to get him to sleep independently.

"The older the child gets the more difficult it can become to encourage him or her to sleep in their own room," Briccetti says.

Parents often think toddler beds help preschoolers adjust to sleeping on their own or out of a crib.

Experts recommend that if a child is big enough to climb out of a crib or is toilet-training, then it's time to transition to a regular bed. Some children can transition directly from a crib to a regular twin-sized bed, so a toddler bed isn't always necessary.

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Sleeping Through the Night

Preschool-aged children have active imaginations, so it's no surprise they awaken easily during the night either from bad dreams or just because they're frightened. Experts say what can help make bedtime less scary and more manageable is to ensure that the child's nighttime sleep environment is one that is quiet, dark, and without a TV.

"We know children will naturally wake up a few times during that night, just like adults do," Swanson says. "We get ourselves back to sleep so quickly you don't even remember."

But it's unusual for preschool children to frequently get up in the middle of the night or want to get out of bed. If you're up with your child in the middle of the night, you can soothe him back to sleep, but do not offer snacks or comfort food in the middle of the night. "Do not reward this behavior," Swanson says.

What's critical is that children maintain their sleep architecture, a term experts use to describe the different stages of sleep, which include the rise and fall of brainwave activity levels and eye movement as people move through phases of sleep.

One of the most restorative phases of sleep is delta wave sleep, the deepest kind of sleep where you don't move a muscle. Parents have often seen their kids conked out, stone-still in their car seats snoozing away. That's delta sleep.

Children who have healthy sleep habits also have solid sleep architecture. "Children who are chronically sleep deprived have changes to their sleep architecture," Swanson says. And that can affect their abilities to get a good night's sleep.

WebMD Feature Reviewed by Laura J. Martin, MD on June 09, 2010

Sources

SOURCES:

Richard, Kravitz, MD, pediatrician and director of the Pediatric Sleep Medicine Program, Duke University School of Medicine. 

Infant and Children Sleep Apnea Awareness Foundation.

National Sleep Foundation.

American Academy of Pediatrics.

Christine Briccetti, MD, pediatrician, Johns Hopkins Children’s Center, Baltimore. 

Wendy Swanson, MD, pediatrician; author of the Seattle Children’s Hospital blog “Seattle Mama Doc."

Anderson, S.  Pediatrics, March 2010; vol 125: pp 420-428.

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