Nonpharmacologic treatments for pediatric sleeplessness
Section snippets
Assessment
To assess for pediatric sleep disorders, a thorough sleep history that reviews a child's or adolescent's entire sleep-wake cycle is essential. This review should include questions about the child's sleep habits (eg, sleep schedules for weekdays and weekends, co-sleeping), bedtime routines (eg, evening activities, bedtime refusal or stalling behaviors, latency to sleep onset), nocturnal behaviors (eg, snoring, pauses in breathing, night terrors, night wakings), diurnal behaviors (eg, difficulty
Common pediatric sleep disorders
There are a number of sleep disorders resulting in sleeplessness that are observed in the pediatric population. Several of these disorders are covered in this section, including bedtime difficulties, night wakings, insufficient sleep, inadequate sleep hygiene, insomnia, and DSPS. For each disorder, a general overview of behavioral interventions is provided. For more detailed coverage on clinical implementation, see Mindell and Owens [14].
Special populations
Children and adolescents with different types of special needs are at an increased risk for sleeplessness. This group includes, but is not limited to, children and adolescents with learning disabilities, cerebral palsy, ADHD, depression, anxiety, developmental disorders (eg, autism), and chronic physical illnesses (eg, epilepsy) [58]. Behavioral interventions are appropriate for special populations, especially when sleep problems are a result of children not having learned appropriate sleep
Summary
Because of the high prevalence of sleep problems in children and adolescents, as well as the profound negative impact that pediatric sleeplessness has on daytime functioning, pediatric practitioners must be aware not only of the causes of sleeplessness but also how to treat sleep problems effectively with nonpharmacologic interventions. This article provided an overview of common pediatric disorders that present as pediatric sleeplessness and are effectively treated by behavioral interventions.
References (76)
A community survey of characteristics of one- to two- year-olds with sleep disruptions
J Am Acad Child Adolesc Psychiatry
(1981)- et al.
Delayed sleep phase syndrome in adolescents
J Adolesc Health
(1988) - et al.
Disturbed circadian core body temperature rhythm and sleep disturbance in school refusal children and adolescents
Biol Psychiatry
(1997) - et al.
Developmental features of sleep
Child Adolesc Psychiatr Clin N Am
(1999) - et al.
Behavioural treatments for sleep problems in children and adolescents with physical illness, psychological problems or intellectual disabilities
Sleep Med Rev
(2000) - et al.
Functional assessment and treatment of sleeping problems with developmentally disabled children: six case studies
J Behav Ther Exp Psychiatry
(1998) - et al.
Restless legs syndrome and periodic limb movement disorder in children and adolescents: comorbidity with attention-deficit hyperactivity disorder
Child Adolesc Psychiatr Clin N Am
(1996) Stress, trauma, and sleep in children
Child Adolesc Psychiatr Clin N Am
(1996)- et al.
Pediatricians and sleep disorders: training and practice
Pediatrics
(1994) - et al.
Sleep habits and sleep disturbance in elementary school-aged children
J Dev Behav Pediatr
(2000)
Incidence of sleep disorders in medical practice: a physician survey
Sleep Res
Sleep problems seen in pediatric practice
Pediatrics
Sleep disorders in children
Health Psychol
Snoring, sleep disturbance, and behaviour in 4–5 year olds
Arch Dis Child
Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive and daytime functioning
Eur J Pediatr
Neurophysiological features and differential diagnosis of sleep apnea syndrome in children
J Clin Child Psychol
Neuropsychological sequelae of obstructive sleep apnea in children
Sleep Res
Acute restriction of nocturnal sleep in children
Percept Mot Skills
The role of sleep disturbances in attention deficit disorder symptoms: a case study
J Pediatr Psychol
Sleep and daytime behaviors in children with obstructive sleep apnea and behavioral sleep disorder
Pediatrics
A clinical guide to pediatric sleep: diagnosis and management of sleep problems
Estimating sleep patterns with activity monitoring in children and adolescents: how many nights are necessary for reliable measures?
Sleep
Evaluating night wakings in sleep-disturbed infants: a methodological study of parental reports and actigraphy
Sleep
Activity-based sleep-wake identification: an empirical test of methodological issues
Sleep
Nighttime sleep-wake patterns and self-soothing from birth to one year of age: a longitudinal intervention study
J Child Psychol Psychiatry
Night waking, sleep-wake organization, and self-soothing in the first year of life
J Dev Behav Pediatr
The sleep patterns of normal children
Med J Aust
Sleep problems of elementary school children: a community survey
Arch Pediatr Adolesc Med
The international classification of sleep disorders: diagnostic and coding manual
Treatment of childhood sleep disorders: generalization across disorders and effects on family members
J Pediatr Psychol
Empirically supported treatments in pediatric psychology: bedtime refusal and night wakings in young children
J Pediatr Psychol
Treatment efficacy in behavioral pediatric sleep medicine
Behavior characteristics and security in sleep-disturbed infants treated with extinction
J Pediatr Psychol
Sleeping through the night: how infants, toddlers and their parents can get a good night's sleep
Treatment of infant sleep disturbance by graduated extinction
Child and Family Behavior Therapy
Reducing nocturnal awakening and crying episodes in infants and young children: a comparison between scheduled awakenings and systematic ignoring
Pediatrics
Handling parents' concerns regarding the behavioural treatment of infant sleep disturbance
Behav Change
Treatment of young children's bedtime refusal and nighttime wakings: a comparison of “standard” and graduated ignoring procedures
J Abnorm Child Psychol
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2020, Sleep MedicineCitation Excerpt :During this time, parents have a key role in shaping infants’ sleep patterns [7], and the parenting behaviors that occur at bedtime appear particularly important for influencing nighttime sleep patterns [8–10]. Previous studies have identified different aspects of sleep hygiene that contribute to improved nighttime sleep in young children [11–14]. This includes the use of consistent bedtime routines, which involves predictable, low-stimulus activities (eg, reading, bath) before lights go out and children fall asleep [11,12,15].
A systematic review and meta-analysis of the prevalence of sleep problems in children with cerebral palsy: how do children with cerebral palsy differ from each other and from typically developing children?
2019, Sleep HealthCitation Excerpt :As with typically developing children, the first-line treatment of sleep problems in children with CP is the promotion of developmentally appropriate healthy sleep practices and behavioral sleep interventions.64 Behavioral sleep interventions prepare the child for sleep and promote appropriate timing, duration, and effectiveness of sleep.65 Pharmacological treatments may be an option for sleep problems not amenable to behavioral interventions.
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2018, Sleep Medicine ReviewsCitation Excerpt :Poor sleep is associated with a range of daytime consequences including cognitive impairments (e.g., memory and attention difficulties), lower academic performance, and more difficulties with behavioural and emotional regulation [3–5], areas in which children with NDD have existing impairments [1]. Moreover, poor sleep may result in increased symptom presentation of the NDD [6–8]. Insomnia (i.e., difficulties falling asleep, staying asleep, or early morning waking) is the most common sleep problem in children with NDD, with more than 85% reported meeting criteria [9].
Timing and variability of postpartum sleep in relation to daytime performance
2013, Physiology and BehaviorCitation Excerpt :If sleep timing is determined to be a modifiable risk factor, the potential significance of these data for informing postpartum interventions is particularly important given that postpartum interventions have been largely ineffective [50]. Current studies have focused on behavioral–educational interventions settings informing postpartum women about the importance of sleep, specifically focused on increasing postpartum total sleep time [50,51]. More recent research has discovered that mothers' total sleep time is preserved, but their sleep is highly fragmented [5], suggesting that it is the fragmentation leading to sleep-related health and daytime deficits.