Information for Parents and Carers

This page is for parents and carers about sleep problems that children and young people may experience when they have a health problem or have stayed in hospital. It explains some things that may help improve your child’s sleep.

Sleep

Sleep is an important part of a child’s development. Not getting enough sleep can affect many things including: concentration, mood and behaviour. Sleep problems can have a big impact on the whole family.

The effect of health problems on sleep

Usual sleep patterns can be disrupted when a child or young person has a health problem or has to stay in hospital. Often the sleep pattern will return to normal when your child is getting more well or when your child returns home. Sometimes sleep patterns may not return as quickly as you may like, particularly if your child has ongoing pain or discomfort related to their health or if they have been in hospital a long time. Having to take medication at specific times may affect sleep. Speak to your child’s medical team about their sleep routine and how medicine that needs to be given could be made to fit in with this. Sometimes this can be tricky as some medication may affect the sleep routine.

Developing sleep skills

A poor or inconsistent bedtime routine can have a big impact on sleep. Parents and carers can help children to sleep by supporting them to develop good sleep skills. Important aspects of developing sleep skills include helping children to feel safe and secure at night time and helping children to learn how to sooth themselves off to sleep. Some children learn sleep skills and habits very quickly. For others this can be more challenging.

Sleep routine

A good sleep routine should aim to be the same every night. Sometimes family life or your child’s health needs may interrupt this, for example, a stay in hospital or a special event like a family party.

It is important to return to the usual routine as soon as possible.

A good routine should include:

Time for your child to calm down from the day’s activities before sleeping.
Sleep cues, things that let your child know it is time for sleep.

Sleep for young children

(18 months to 5 years) Sleep problems which young children experience usually occur in three main areas:

Your child may not want to go to bed and be up into the early hours making demands, for example, asking for drinks or to stay up and watch television.
Not falling asleep in their own bed.
Night waking, for example, calling out or getting up in the night and coming into parent’s bed.

Strategies to help young children

Set up a good sleep routine

A sleep routine for a young child may look something like this:

5.30pm: Last meal of the day. No caffeine drinks such as cola, with or after evening meal.

6.00-6.30pm: Play time or watch television. Try to keep this play calm by avoiding activities that involve lots of physical activity or running around. This time is to encourage your child to “wind down after their daytime activity”.

6.30pm: Bath time. A warm bath will increase your child’s body temperature and it can help your child feel sleepy. Then dress your child in their pajamas.

It is then time for:

Final drink
Clean teeth
Bedtime story
Settle themselves to sleep (with no adult present)

Sleep diary

The first step to understanding your child’s sleep pattern is to keep a record of it. This diary should be for at least a week. A sleep diary should record the following things:

What are your child’s sleeping times?
How long did it take them to get to sleep?
How many times did they wake up in the night?
How long did each awakening last?
How long did they sleep in total?
Did they do any exercise shortly before going to bed?
What activity were they doing before bed?
Did they take any naps during the day or evening?
Has anything happened in the day or previous weeks which may have had an emotional impact on your child?

Sleep Plan

It might be useful to consider a sleep plan or a behaviour reward programme for your child. In order to decide the best approach to help your child it is important to understand the reason for the sleep problem and to help your child with any worries or anxieties they may be

experiencing. If your child is still of an age where they have a health visitor it may be useful to discuss this with them or with your GP.

Sleep for school age children

(Age 5-11 years)

Many of the strategies for children under five years old will be helpful for school age children. It will be important to:

Have a clear and consistent bedtime routine (suitable bedtimes will change as children become older).
Keep a diary to identify possible problem areas.
Consider setting up a reward chart. Give small rewards for agreed specific goals for sleep.
Children of school age naturally begin to have more worries, for example, about school or friends. This may affect their sleep. Talk to your child about any worries they have.

Relaxation

Teaching your child relaxation skills or using a relaxation CD can help sleep.

Try taking long deep breaths through the nose. Count to five as your child breathes in, then breathes out slowly for the count of five.
Progressive muscle relaxation. This involves tensing and relaxing muscles in turn (see our guide on relaxation for more information on this).
Imagery. Encourage your child to imagine themselves somewhere they find relaxing. Help them to build this picture by including all their senses, sight, sound, smell, touch and taste (See our guide on relaxation for more information).

Sleep for young people (Teenagers)

Often young people may experience issues with sleeping by sleeping more or less than usual. This can sometimes be a sign of low mood or worries. It is important to remember that at this stage of development teenagers require more sleep than adults. Puberty and hormone changes can also affect sleep.

Young people may be tempted to stay up late at night doing other activities, for example, using the internet, watching television or finishing homework. It might be useful to help your child plan “wind down time” before bed. Often mobile phones and computers keep teenagers alert and so it might be useful to limit these.

The tips below for parent and carer sleep may also help young people.

Parent and Carer sleep

Having a child with a health problem or who has had to stay in hospital for treatment can be stressful and worrying. Parents and carers may experience difficulties with their own sleep at times.

Having better sleep can help you cope better and make you more able to support your child.

Sleep can be affected by:

Anxiety – This can make our bodies more tense and alert, causing difficulties with falling or staying asleep.
Worried thoughts – If you are experiencing worried thoughts at night, it can make it difficult to ‘switch off’ and thus harder to fall asleep.

Our surroundings can impact on sleep. If you are away from home, for example, on a ward or in other hospital accommodation, sleep can be affected by things such as:

Disrupted routines – for example, reduced levels of physical activity or unpredictable sleeping times.
Changes in diet – for example, more caffeine or different foods.

Sleep tips for your own or your teenager’s sleep:

Set up a routine for going to bed. Try not to do anything too active for 90 minutes before bed. Set aside this time for relaxing.
Try to go to bed at the same time every night.
Don’t try too hard to sleep; this can have the opposite effect. Say to yourself ‘my body will sleep when it is ready, relaxing in bed is still resting’.
However, if you can’t get to sleep after half hour of being in bed, get up and relax in another room, then go back to bed. Try not to lie in bed for a long time if you are unable to sleep. This gets your body into the habit of being awake in bed.
Try counting backwards from 99 to distract from worries about sleeping or other things.
Keep a pen and paper by your bed. When worries come into your mind, write them down and make a deal with yourself to sort these things out as best you can tomorrow when you are rested.
Tell yourself there is nothing that you can do about these worries at the moment because it is time to sleep.
Try keeping your eyes open in the dark for as long as you can, this can help to bring on sleep as your eyes naturally want to close.
Avoid caffeinated drinks such as tea, coffee, hot chocolate or fizzy drinks in the evening.
Try not to nap during the day, even if you feel tired. This can disrupt your sleep pattern for the evening.

Sleep while staying in hospital

While your child is staying in hospital their usual sleep routine may become disrupted due to the daily schedule of the ward. Wards can be a strange place to sleep with machines makes noises and ward staff moving around to make essential checks on your child and other patients.

Things that may help while you are in hospital include:

Routines – Try to establish some kind of consistent routine around sleep. It may not be possible to have the same routines as at home but having a set bedtime and making time for calm play and reading a bedtime story can be very useful.
Usual comforters – If possible bring in items from home that your child associates with sleep, for example, their favorite pajamas or soft toy. Ask nursing staff if you can bring in your child’s own pillow or bedding. In some cases due to medical care or infection risk this may not be possible.
Unfamiliarity, noise, light or discomfort may affect ability to sleep.
Day and night cues – Hospital wards are often well lit and sometimes it can be difficult to tell what time of day or night it is. Ask nursing staff where possible if it will not compromise your child’s care to turn down the lights at night and increase the lighting during daytime hours. For older children you may consider using a sleep mask which can be used to cover their eyes and increase darkness.

Sleep after returning home from hospital

Sometimes after a stay in hospital children may experience disturbed sleep, they may even experience nightmares or bad dreams. Dreams can be a way for children and adults to deal with their worries and work out ways of managing them.

If your child is waking in the night due to distressing dreams then they need to be comforted and made to feel safe. It can be useful to remind children where they are and that you are with them. In the morning you could consider getting your child to draw or talk to you about their dream.

Often dreams can seem very real for children. They may feel that they are re-experiencing things that have happened to them. If you are concerned about this see our guide to trauma symptoms. Usually nightmares

resolve quickly. If this does not happen you can seek help. Consider contacting your child’s health visitor, GP or medical team.

Important points to remember

It can take several weeks for good sleep routines to work properly. Once you have set a routine, be consistent and stick with it. If you continue to be concerned about your child’s sleeping, speak to your child’s GP or medical team.

Summary

It is common for children to experience sleep problems. Having a health problem or a stay in hospital can have an impact on a children’s sleep. Having a consistent sleep routine is important in developing good sleep skills. Keeping a sleep diary and teaching your child relaxation skills can help resolve sleep difficulties. If you have ongoing concerns about your child’s sleep you can contact your child’s health visitor, GP or medical team for advice. Parents may also find that their sleep is affected by their child’s health condition, using some of the sleep tips in this leaflet can help with this.

This has been produced by the Department of Psychology in Healthcare. Clinical Psychologists are based at the RVI and Freeman Hospitals. If you have any further concerns about the issues discussed, please discuss these with your GP or medical team.