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Sleep problems

What are sleep problems?

Sleep problems occur when your child has difficulty settling down to sleep. They can also include small episodes of sleep or sleep interruptions. The constant night interruption can lead to baby irritation and parental fatigue. When your baby has trouble sleeping, it can be a hard time for the entire family. You can make bedtime less problematic and more enjoyable by learning some healthy sleeping tips.

Healthy sleep patterns

Your doctor may advise you of the average number of hours of sleep your child needs. Still, every child’s sleeping patterns are different. On average, newborns up to 6 months of age sleep 16 hours a day. Some babies sleep as little as 11 hours and some others sleep as much as 20 hours. Older babies (6 months to one year) sleep about 14 hours a day. Toddlers sleep between 10 and 13 hours. Pre-schoolers sleep between 10 and 12 hours.

Types of sleep problems

Difficulty settling down to sleep

It is very common for babies, toddlers and young children to have trouble falling asleep. Up to one in three children show an unwillingness to go to sleep.

Separation issues and co-sleeping

In many families, parents choose to sleep in the same bed as their babies and small children. The Canadian Paediatric Society does not recommend co-sleeping. Some parents say co-sleeping can help in maintaining regular breastfeedings. But it may disrupt the parents’ sleep, cause tension in the parents’ intimate relationship or cause your baby to become dependent on you to fall asleep. There is also an association between co-bedding and crib death (Sudden Infant Death Syndrome).

Night awakening

Night awakenings occur when a child wakes up in the middle of the night and cannot settle back to sleep. Often the child will cry or call out for their parents or get out of bed. This is common. Many parents allow the child to sleep in the parents’ bed for the rest of the night. This may lead to dependency on the parent to resume sleep. The child should be reassured and brought back to his bed. The child eventually learns self-soothing strategies.


Nightmares are dreams that bring about fear or anxiety. Nightmares are very common. They occur in as many as one in two children.

Night terrors

Night terrors are different from nightmares. Night terrors are characterized by a child appearing to waken in horror. The child often screams in panic but usually does not remember what led to their feelings of fear.


Sleepwalking occurs in about 15 per cent of all children. It occurs most often in children aged four to 12 years. Sleepwalking children usually walk around the house aimlessly. They appear unco-ordinated, often do not make sense or start urinating in some place other than the toilet. A bell hung on the child’s door or on the front door may provide reassurance that you will hear your child sleep-walking.

Healthy sleep habits

Newborns and young children seem to fall asleep easily when they are held or rocked. Newborns fall asleep very easily when sucking on a nipple or pacifier.

Develop a consistent nap and bedtime routine

Children respond well to routine. Your child will likely respond well to a fixed nap and bedtime routine. Naps for toddlers should be, at most, two hours and should end before 4 pm.

Your child’s bedtime will depend on their age and energy levels. Bedtime routines can include:

  • giving a bath
  • putting on pajamas
  • offering a breastfeed or bottle
  • dimming the lights
  • nighttime cuddling, stroking, singing
  • storytime

Afterward you can put the baby in the crib or the young child in bed. You can kiss the child goodnight and leave the room. Maintaining a consistent bedtime routine will help your child settle down more easily.

Create a welcoming sleeping environment

Keep the room dark and quiet. Nightlights are not recommended. Instead, keep the light on in the hallway with the door ajar. This will allow the child to go to the bathroom without fear of the dark and will allow you to use a closed door as a motivation to get the child back in bed should they begin to use delay tactics to go to bed at night.

Your baby should sleep on their back, toward the bottom of the crib. When they are old enough to roll from front to back there is no need to reposition them. There should be no blankets or crib bumpers or other soft materials that may block a baby’s breathing. They should wear a sleeper that is warm enough to make a blanket unnecessary.

When your child becomes aware of separation at bedtime, you may give them a blanket or a stuffed animal to offer a sense of comfort. Do not give these items during early infancy as these may be risk factors for crib death.

Your baby should learn to fall asleep by themselves. If they were to wake up and find you gone, the whole process of soothing to sleep may be required several times a night.

React to infant crying when appropriate

Respond to the cries of newborns and babies in their first few months of life. The crying is a way to express a need.

As for seven- or eight-month old babies, it is entirely normal if they cry before falling asleep.

It is alright to let your baby cry a little before settling down. However, if your baby has grown accustomed to having you around when falling asleep, you can try to reduce this dependency by gradually lessening your time in the bedroom. One approach is to lay your child down, leave for a few minutes, return and stay until the child sleeps. Every evening, stay out of the room for a little longer. After about five to seven days your baby will learn to sleep alone.

Recognize your child’s delaying tactics

Once your child understands the bedtime routine, they can manipulate the situation. Toddlers and young children are particularly skillful at prolonging the bedtime routine. They will ask for water, another story or a cuddle. Parents and caregivers should return the child to bed immediately. Warn the child there will be consequences if the behaviour is repeated. Consequences can include closing the door or not offering stories at the next bedtime.

Key points

  • Sleep problems can lead to baby irritation and parental fatigue.
  • Develop a consistent nap and bedtime routine.
  • Create a welcoming and appropriate bedroom.
  • Slowly decrease the amount of time you spend with your child before they fall asleep.

Mark Feldman, MD, FRCPC​