Sleep problems are common in childhood and may be temporary, intermittent or chronic. The commonest sleep problem in young children is sleeplessness, including difficulty settling or waking and not going back to sleep. Other sleep problems include nightmares, night terrors and excessive daytime sleepiness.

Commonest causes of sleep problems

Common causes of sleep problems in the young child include:

• Discomfort: colic, wet nappy, incorrect temperature of the room (excess heat or cold).
• Inappropriate napping i.e. excessively long daytime naps in the 2-3 year-old toddler.
• Presence of parents in the same room (may disturb the child through coughing, snoring, talking etc.)
• Over-anxious parents who are constantly checking on the child.
• Over-fatigue. This can delay sleep, indeed many over-tired children appear irritable and cross and over-active rather than sleepy.
• Personality. Children who demonstrate difficulty establishing a regular night-time routine may also show general fussiness and irritability as a personality characteristic. In contrast, children who are placid tend to sleep more.
•  Disabilities. Sleeplessness is also more common in children with learning difficulties and children with chronic physical illness.

Other causes of sleep problems include anxiety, fear and worry. Some young children feel removed from their parents' love at night and their sleeplessness may be caused by separation anxiety.

This is particularly so between the ages of 18 and 30 months when children are going through a phase of increased dependence on their parents. If separation or divorce has occurred such anxiety may understandably be heightened. Another cause of separation anxiety may be the child's first attendance at pre-school or school.

General worry/anxiety related to any other area of the child's life such as family life, school life (including teasing/bullying), friends (breaking up of friendships, rows etc.), school performance may also manifest itself in sleep disturbance.

Some young children develop a fear of going to sleep at night as they become more aware of death. This fear is heightened if they have experienced a recent death in the family or in their close circle of friends. Older children may have transient night-time fears of noises, break-ins, thunder, being abducted etc. and these anxieties may interfere with their sleep.

Children today are exposed to so much more through TV coverage that they can and do experience very real fears for themselves or for family members. Some children express their fears overtly while others disguise them and they may manifest in sleep problems or delaying tactics around bedtime or pleas to sleep in the parents' bed or indeed attempts to come into the parental bedroom after the parents themselves are asleep.

Most children experience nightmares at some time i.e. bad and frightening dreams. The child wakes and usually remembers the dream content quite vividly. He is lucid when he wakes and can usually be reassured, comforted and settled back into sleep.

Night terrors usually have their origin in the pre-school years. The child wakes from deep sleep, appears terrified, confused and disorientated and seems not to recognise you. He may appear to be hallucinating i.e. talking to people who are not there. He is sweating, breathing rapidly, has a rapid heart rate, his pupils are dilated. The disturbance may last up to 15 minutes but eventually subsides. The child then goes back to sleep and usually has no recollection of the event. Night terrors are usually self-limiting and tend to occur in the 4-12 age group.

Nightmares and night terrors are sometimes accompanied by sleep walking when a child may be at risk of injury and so appropriate precautions need to be taken.

Are you encouraging your child's sleep problems?

It is very easy for sleep problems to become habitual before parents even realise what is happening and by then, it may be equally as difficult for tired parents to break the habit or know how to change it.

Understanding sleep problems and their possible underlying causes will give you a good foundation in learning how to deal with your child's sleep disturbance and recognise where you are encouraging them. You also need to appreciate the need for regular bedtime routine.

• Put your child to bed with an air of certainty. Over-anxious parents who repeatedly and constantly visit their children to check on them often disturb them. In turn, the children learn to stay awake expecting the first visit and they then pick up on the parental anxiety.

Also, once your child discovers that he can cause a lot of fuss and attract attention to himself around bedtime causing the whole household to be in turmoil, he will continue to be difficult and demand this attention. It is therefore important not to get into a tussle with him about lying down or going to sleep because inevitably in such a situation the child will always win!

Clearly it is important to satisfy yourself if your child cries out that he is not in pain or discomfort but you should be wary of rewarding wakefulness by giving too much attention; quickly reassure your child and settle him back down.

• You and your partner should take turns at putting your child to bed as difficulties can arise in the event of the one parent who puts him to bed not being available.

• Do not use bed for threats or punishment because this will inevitably cause your child to associate bed with punishment. This, then is at total variance with your desire for him to go to bed, settle and snuggle down to sleep quickly at the appropriate time.

• Avoid tears if at all possible and do not rush your child; if he senses that you are trying to get rid of him, then inevitably he will act up.
  

Establishing a bedtime routine

The rapidity with which children form habits must be recognised. Decide on a bedtime and be firm and consistent. Although managing the sleeping habits of a young baby may prove difficult, it will be good for all the family if you try and establish some sort of bedtime routine. Between three and five months is the best time to start, depending on the child. The following points will help.

• Do keep the hour before bed enjoyable, happy and loving. Follow the same routines with bath-time, pyjamas, getting teddy etc. so that your child knows bedtime is approaching.

• Do not get your child into the habit of being rocked, stroked or sung to sleep. While this is harmless on occasion, it can quickly become a habit.

• Do not allow your child to become over-tired and make sure your child gets adequate sleep, even at weekends.

• From about 12 months, you can introduce a book at bedtime to help settle your child.

While there is much to be said for reasonably fixed routine and a fixed bedtime, you cannot be totally rigid in this regard; expect to adjust to the needs of your child at a particular time and at a particular age. The more relaxed and happy the child is by day, the easier it will be to settle him down at night and with a good pre-bed routine - this will mean a more peaceful night for all.

Should parents be concerned about sleep problems?

Difficulties getting to sleep, nightmares and night terrors are quite common among healthy toddlers. They tend not to persist for long. However, in the event of on-going problems and concerns, or where the sleep disturbance is affecting your child's performance at school or relationships within the family, you should speak with your family doctor.

 He or she can advise you on simple measures and discuss referral to an appropriate professional, paediatrician, child psychiatrist, psychologist etc. for further assessment and intervention as appropriate or necessary. In most cases, however, reassurance of parents and child is all that is needed.