Behavioral insomnia in Children

Sleep problems are prevalent in infants, children, and adolescents. Approximately 25% of children experience difficulties with some aspect of sleep.Moreover, 27% of children are sleeping less than the recommended amount for their age. Although the prevalence of sleep disorders is high, it is crucial to note that rates vary greatly depending on the specific sleep disorder. For instance, behavioral insomnia, the most common sleep disorder, has a very high prevalence rate (20%–30%), whereas the prevalence rates are much lower for disorders such as sleep apnea,sleep related movement disorder, and parasomnias such as night terrors.

What is Behavioral insomnia in Children (BIC)?

Behavioralinsomnia is one of the most common sleep disorders found in children. It is estimated that approximately 25% of children will experience it at some point in their childhood. Behavioral insomnia is characterized by difficulty falling asleep or maintaining sleep leading to poor sleep quality and duration. BIC is very similar to poor sleep hygiene practices in adults, where the ability and opportunity to sleep are present, but poor practices lead to sleep loss. There are two main types of behavioral insomnia: sleep-onset association and limit-setting.

Symptoms of Insomnia in Children

Generally, children need more sleep than adults. This varies somewhat based on age. When sleep is needed, a child will simply fall asleep and get it. It is best to optimize the amount of time in bed overnight to meet these sleep needs. Younger children may take 1-2 naps during the day to get adequate rest. By the age of 4 or 5, most children will stop taking daytime naps. Children who do not sleep enough begin to have problems during the daytime. Children become cranky, refuse to cooperate with simple requests, and suffer from complete meltdowns. Older children may begin to have problems at school, with poor attention, and impaired school performance. Beyond simply being unable to fall asleep, other aspects of behavior and even growth spiral out of control.

Diagnosis and Treatment

The diagnosis of BIC relies on report of parent or caregiver, as opposed to the self-reported complaints in adult insomnia. Adult insomnia is generally treated with sleep restriction and stimulus control. And these concepts are important in children as well, however for treatment of BIC parental teaching about behavior management such as limit-setting, extinction, and operant theory is additionally needed.

How to Improve Insomnia in Children

The two types of behavioral insomnia can improve quickly with education and observation of consistent rules. In some cases, further assistance may be needed. It can be very helpful to discuss concerns with a pediatrician or even a pediatric sleep specialist. Children with special needs may require additional support. In some cases, melatoninmay be used as a sleep aid. If you are struggling, make sure to get the support that you need so that everyone in the house can sleep better.

Giving your child a consistent routine will help them understand expectations that you have of them, and that they can expect from you. Consistency is the key in establishing bedtimes, and behavior will often fall in line in a short amount of time. Children's sleep habits should always be discussed with their pediatrician. Typical discussions should include regularity of sleep and duration, bedtime resistance and sleep onset delay, night awakenings, and any potential sleep disorders such as snoring. Parents concerned about their children's sleep habits should record their sleep activity in a sleep diary that includes intended bedtime, sleep-onset, and duration of sleep, amount and duration of awakenings.