Why does my child have a sleep difficulty? Research suggests that at least two thirds of children and young people with developmental difficulties have a sleep problem at some point. Your child developing a sleep routine may have been disrupted by time spent in hospital, periods of illness, or physical discomfort during the night e.g. from bedwetting. If your child is experiencing anxiety perhaps as a result of a significant life event (e.g. change of school) he/she is likely to experience disrupted sleep. Children with a learning disability may have difficulty learning to distinguish between day and night, and picking up the routines associated with bedtime/sleep. Research has also indicated that children with Autism Spectrum Disorders may not produce enough of the sleep hormone melatonin which is necessary for feeling drowsy at night. The sleep history questionnaire on pages 7-8 of this booklet is there to help you identify why your child currently has a sleep difficulty. Keeping a sleep diary for 14 consecutive nights (page 9) will give you additional information regarding your child s current sleep habits. If your child protests when you leave the room allow them to grizzle for no longer than five minutes (do not allow them to become hysterical) then return and re-settle them before leaving the room (whilst they are sleepy but awake). Repeat this process whenever they get out of bed during the night. You may have to return your child back to bed several times a night (e.g. fifty times) for this technique to work. Your feelings Parents of children and young people with developmental difficulties have reported experiencing distressing feelings such as anger, sadness, and anxiety regarding their child s difficulties. These feelings can be overwhelming, and make it extremely difficult for you to follow a bed-time routine or start sleep training. Before you use the sleep training techniques outlined in this booklet it might help for you to discuss your feelings with a health professional or trusted friend. How much sleep does my child need? Below is a table with the average number of hours sleep a child needs in 24 hours, however this is only a guide your child may need less or more hours sleep. To find out how many hours sleep your child needs to be rested complete the sleep diary on page 9. On the days that your child is rested he/she should wake easily in the morning looking refreshed.
Information Leaflet number: 536 (19/04/11) Author/Contact: Susannah Lewis Clinical Psychologist How To Help Your Child To Sleep Better Advice For Parents Of Children And Young People Who Have Learning Disabilities Or Autism Review 2014
seizures of any kind, or has difficulty breathing seek advice from a health professional before using the technique outlined. Gradual Withdrawal This involves gradually decreasing how physically close you are to your child when they are settling to sleep. This technique teaches your child to fall asleep on his/her own and weans them off the need for your presence in order to fall asleep. The following are steps to implement the gradual withdrawal technique. 1) Pick a night to begin the plan; the first night may be disrupted so you may wish to opt for a Friday night. 2) Follow your child s usual bed-time routine 3) When it is time for your child to settle to sleep tell them that it is bed-time, sit on the edge of the bed do not talk to your child or make eye contact with them, if they attempt to get up lie them back down gently without talking to them. Stay sitting on the edge of the bed until they have fallen asleep. If your child wakes during the night follow the same procedure, go into their room and check that they are not uncomfortable or frightened, then lie them back down to sleep (without making eye contact or talking to them). Stay in the room until they are asleep. Do this every night for at least four nights (or until they are settling easily) and then follow the guidelines below regarding where you should sit when settling your child at bed time and during the night. Week 2 Sit beside your child s bed on a chair Week 3 Move the chair to the middle of the room Week 4 Move the chair to the door Week 5 Sit outside of the room Rapid Return The rapid return method involves immediately returning your child back to bed as soon as they get out of bed. It gives your child the nononsense message that they will simply be returned to their bed if they get up during the night. If your child gets out of bed once you have left the room or during the night check that they are not uncomfortable or frightened then calmly and quietly return them back to bed without talking to them or making eye contact, put them back into bed then leave the room. Childs age Average number of hours sleep required in 24 hours 6-23 months 13 hours 2-3 years 12 hours 3-5 years 11 hours 5-9 years 10.5 10-13 years 10 hours 14-18 years 8.5 hours Day time napping If your child is school age he/she should not be allowed to nap during the day. If your child is pre-school age and napping during the day but is not able to settle to sleep at night you might need to cut back on their day time naps. Use the sleep diary to work out how long your child is awake for during the night and how long they are napping for during the day. Then cut back their naps accordingly, for example if your child is awake for an hour during the night and naps for two hours during the day cut their day time napping down to an hour. The timing of day time naps is also important, if you child naps later in the afternoon this may interfere with his/her ability to settle to sleep at night. If you are cutting down on your child s napping times it might help to have strategies ready to keep them awake. If you child is beginning to fall asleep at a time when they need to be awake give them a drink and a snack, and do a physical activity together such as walking to the shops or playing in the garden. Try to avoid sitting down activities such as travelling by car or watching television during these times. How can I help my child to sleep better? Below is information regarding your child s sleeping environment, eating and drinking before bed, bed-time routine, and settling to sleep. Following the advice will help your child to develop good sleep habits. Your child s bedroom It is very important that your child s bedroom is a calm and restful environment with minimal light. Darkness helps the body to produce the hormone melatonin which encourages sleep. If your child is anxious in a completely dark room use a small night light that emits minimal light.
A bedroom should be simply decorated with plain colours/fabric, thick lined curtains or a blackout blind and no television. If you keep toys in your child s bedroom put them away in boxes at bedtime to give your child the clear message that it is time for sleep not play. If your child has a computer in the bedroom switch it off at bed-time. Eating and drinking Avoid giving your child food or drink that is high in sugar or caffeine (e.g. fizzy drinks, sweets, tea, and coffee) in the four hours before bed as these encourage wakefulness. If your child needs a drink before bed time give them milk or water. It is advisable not to give your child anything to eat if they wake during the night (as this may become a habit). If they need a drink during the night give them a few sips of water. Sensory sensitivity If your child has autism s/he may be particularly sensitive to touch, sights, smells, or sound. Your child may be woken by very slight sounds, a thick carpet and well fitted bedroom door could help with this. Turning off all electrical equipment in the bedroom will also reduce unnecessary noise, or earplugs may be useful. Touch sensitivity is extremely common in children with autism, labels on bedclothes and different materials can be uncomfortable. Some children with autism find a sleeping bag or weighted blanket more comfortable than a duvet. Also consider if smells in the room or smells coming from other parts of the house might disturb your child. What time should I put my child to bed? Use the sleep diary to work out how many hours sleep your child needs, and then determine a wake time that fits in with you and your child s routine. Then work out at what time your child needs to go to bed. It is very important to have a consistent bed time to encourage your child to get into a regular sleeping pattern. Bed-time routine In order to promote restful sleep and to help your child to understand that it is bed-time it is important that he/she has a calming and consistent bed-time routine. Particularly make the last 30 minutes before bedtime a regular routine. Include activities such as having a bath and getting changed for bed and having a story. Older children may like to read a book before settling. Avoid watching television or using a computer at this time as it can interfere with sleep. Try to keep the order and timing of the activities about the same each night. If you need to change your child s bed-time routine you can prepare them for this using communication aids such as PECS symbols, or a social stories book, or photographs. Settling your child to sleep In order to help your child to develop good sleep habits he/she needs to be put to bed in his own bed/cot with you leaving the room whilst he/she is sleepy but awake. If you train your child to fall asleep on their own in their own room at bed-time they are much more likely to be able to settle themselves back to sleep if they wake during the night. How can I manage my child s settling problems / night time waking? Below are techniques that you can use to train your child to settle to sleep on his/her own at bed-time and during the night. Before you begin to use these techniques seek support from a Health Professional such as your Health Visitor or School Nurse. As the techniques involve your child learning new sleep behaviours all those caring for your child need to consistently use the techniques for them to work. When settling your child off to sleep try to be as calm and boring as you can do not reward your child s night-time waking with lots of attention (do not talk to your child, do not make eye contact, do not put lights on). Be Consistent, be Calm, be Boring! Your Child s Physical and Mental Health Before using the techniques to treat settling problems or night time waking it is important to establish that your child s sleep is not being disturbed by physical discomfort or emotional distress. If your child has recently experienced a distressing life event e.g. change of school and/or is exhibiting signs of emotional distress e.g. clingy behaviour, excessive crying, irritability then consult a health professional. If your child has recently undergone surgery, has
Sleep History Questionnaire The following questionnaire will help you to identify why your child currently has a sleep difficulty. 1) Has your child ever slept through the night? If yes when? When did your child s sleep problem start? Are you able to leave them to fall asleep on their own? 3) Waking during the night: during a usual night how many times does your child wake and for how long? What was happening in your child s life then? (For example changes in routine such as a holiday, illness, time spent in hospital, separation from a parent) please describe: What do you do to settle them to back to sleep when they wake during the night? 2) The following questions relate to your child s current sleep behaviour Bed-time routine: What does your child do in the hour before you put them to bed? Are there any problems with this? 4) Waking in the morning: at what time does your child wake in the morning? Do you have to wake them up? Do they appear well rested? Settling to sleep: Does your child fall asleep in his/her own bed/bedroom at bed-time? 5) Day-time napping: how often does you child nap during the day? At what time? How long do they nap for and where do they nap? Describe the environment (e.g. light off? Curtain closed?) What do they need fall asleep with (e.g. teddy, blanket?) 6) Managing your child s sleep problem: what have you tried so far to manage your child s sleep problem, what was the outcome?
+ SLEEP DIARY Day Time naps: What time? What did your child do in the hour before bed? Time taken to bed, any problems here? What time did your child fall to sleep? Waking during the night; What time? What did you do? Time your child woke in the morning, did you have to wake them?