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Helping children to get a good night’s sleep – Sleep Factsheet

This factsheet aims to identify the “optimal” sleep conditions and practices, which will support

getting the the best night’s sleep possible for children (and adults!). Sleep plays a vital role in a

child’s growth, health and development. During sleep the brain is at its most active and our bodies

are repairing and preparing for the day ahead.

Our body works on a 24 hour cycle known as the circadian rhythm. This cycle can be broken into two

parts; sleep and wake. This sleep-wake cycle is partially driven by our internal body clock and

reinforced by external factors such as light and dark. To find out more about how sleep works please

look at our factsheet “How sleep works - Children’s sleep”

The key to successful sleep is reinforcing internal and external cues which will anchor and regulate

the sleep- wake cycle and in-turn the circadian rhythm and body clock. Having a regular bedtime

routine and and best conditions to aid sleep and sleep onset will lay the foundations for a good night

sleep for babies, children and adults.

Bedtime routines and preparation is often referred to as “sleep hygiene.”

The environment One of the most important parts of helping towards a good night’s sleep is getting the environment

right. Parents should always use safe sleeping practices for every sleep episode with their baby and

child. For further information please see our leaflet on “Safe sleeping practices.”

Light and Dark

The sleep – wake cycle is partially driven by light and dark it is important to get this right in the

bedroom. Dark promotes the production of melatonin (the sleep onset hormone) and light inhibits

it. A dark room is needed to promote sleep onset, in contrast a bright environment supports the

setting of the body clock for day.

Blackout blinds/curtains are really helpful in blocking out light in a bedroom and promoting a good

sleeping environment. These are particularly useful during lighter months, when the sun sets late

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and rises early. Ideally the curtains/blinds should be shut and ready before the child goes into their

room. This will mean that the room is dark and ready and is less likely to interfere with the

melatonin levels.

Often a completely dark room is not practical and may increase child anxiety,(1) so a small very dim

night light can be used. These should be placed somewhere safe, away from curious toddlers.

Parents reading a story as part of a bedtime routine should use a low wattage light bulb in a lamp or

a dimmed central light, rather than bright light.

Televisions/Computers/Mobile Phones and Tablets

Melatonin is essential to aid sleep onset. This hormone is very light sensitive. (2) Televisions,

computer, mobile phones and tablets all emit a “blue light” even with screens turned to lowest

settings inhibit melatonin production. (3) Avoiding having these devices in children’s bedrooms will

help promote the best environment for sleep. Ideally it is best to avoid exposure to television and

any light expelling devices in the 90 minutes before bedtime. (4,5)

Noise

Keeping noise levels to a minimum are more conducive with a good night’s sleep. This allows the

brain to focus on sleep, rather than external sounds. (6) In many households noise levels may not be

able to be controlled, such as traffic noise or airports. These sounds will be familiar sounds to the

baby/child and will not have an impact on sleep as they will become background sound.

Using white “background” noise can be calming for some children and aide sleep onset. If this is

used to help sleep, it will need to be present throughout the night, as it will become a sleep

association. (7). White noise can come from objects such as a fan, blowing towards a wall, or a

detuned radio; these can be placed somewhere safe in the bedroom or just outside the door.

Temperature

Unlike many adults, babies and children do not need to be very warm to sleep. Overheating has

been identified as increasing the risk of sudden infant death. The best ambient room temperate is

around 16-20 Celsius. (8) Duvet covers, cot bumpers and pillows are not advised for babies less than

one year. (9) Having a bath before bed raises the child’s body temperate, which then drops when

they come out. Research has suggested that the drop in temperature before bed helps increase

melatonin production. (10).

Babies under 1 year

Where to sleep? - Parents should always follow safe sleeping practices. The safest place for babies

up to 6 months is in a cot by the mother’s bed. This has shown to reduce the risk of cot death and

encourages “responsive” parenting.(8,9,)

Sleeping position - Babies should always be placed on their backs to sleep this has demonstrated to

be the safest position and reduces the risk of sudden infant death (8,9). The lullaby Trust advises

that until a baby can roll from “front to back” they should be repositioned onto their backs during

the night if found on their front(8).

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Moses basket - Often in the early day’s babies will sleep in Moses basket. It is usually not long before

they grow out of them. These are perfect for helping a new baby feel safe and snug. Always have a

new mattress.

Cots - There are a huge variety of cots available from the traditional cot to a bed/cots. It is important

that whatever is chosen is safe and meets safety standards. There should be no horizontal bars

which could allow the older baby to climb out. Any cots with moveable sides or adjustable heights

should be safe and all the mechanisms, working and out of reach of the baby/toddler.

Duvets and pillows - It is not advised that babies under a year should have duvets, pillows or cot

bumpers as these can all increase temperature and increases the risk of sudden infant death. (8,9)

Using one sheet and cellular blankets are the safest way to keep a young baby warm at night.

Mattresses - should always be new for each baby. They should fit snugly into the cot or Moses

basket, with no gaps. They should be firm and meet the safety guidelines. (8,9,10)

Babies and children over a year

Moving into a bed -There is no recommended age for the transition from cot to bed, however, if a

baby or toddler is at risk of climbing out of a cot or getting to big these are often be natural

indicators that the time is right. Most children by the age of 3 have moved into a bed.

Moving into a bed can be an exciting time for children and gives them the feeling of independence.

However, some children find the change more challenging and it is important to prepare them for

the transition. When they are in their new bed it is not uncommon for them to fall out in the first

few weeks. Using safety measures such as a bedside or spare mattress on the floor can reduce the

risk of injury and reduce anxious parents!

The bedroom – The bedroom environment should be a place where the child feels safe and happy.

Having familiar toys and books around them will help this. However, there can be a fine line

between an over stimulating bedroom and a calm relaxed environment. It is a good idea to put away

tempting and stimulating toys in the bedroom before expecting a toddler to sleep.

Teenagers

Many teenagers use their rooms as mini bedsits and increase the amount of time that they spend in

there. This can confuse the body clock as there is not a clear cue in the transition from day to night.

Teenagers these days often will be watching television, using computer, tablets and mobile phones

late at night. These devices will interfere with melatonin levels which in turn affect sleep onset.

Naturally, teenagers sleep phase becomes later as they get older, and research suggests that they

produce melatonin later than they did as children. (11) There is evidence that suggests that many

teenagers are not getting enough sleep as they are late to bed, but still have to rise early for

school/college commitments. This can lead to sleep deprivation, which in turn has detrimental

impacts on health, memory and learning. (12)

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Preparation for sleep

The bedtime routine

The most important part of preparation for sleep is the bedtime routine. Having a structured and

regular routine will help set the body clock for night and day and will also send messages/cues to the

brain and body to get ready for sleep. For children it helps them predict what is going to happen

next and is the foundation for a good night’s sleep. (13)

Bedtime routines can be put in place from an early age. Research has shown that babies under one

month can recognise the differences between day and night. (14) A bedtime routine can be up to 45

minutes.

For older children, planning the bedtime routine together with parents, can give them a sense of

control and engage them in preparing for sleep. This positive interaction will help with settling to

sleep. (15).

It is important the routine fits in with family life and timings are appropriate for the amount of sleep

the baby or child needs. Therefore if the child needs 11 hours sleep, working out what time is best

for going to sleep and waking up.

It is often a good idea to plan the routine and who is going to be involved. This means that it will be

consistent and will strengthen the links with going to sleep.

A bedtime routine should be calm and relaxing, it can be a time that to spend time together with a

baby or child.

Every family will have their own unique routine which suits them and their children.

An example of a bedtime routine –

Quite play downstairs – A bath and into night clothes – Into their bedroom – short story time –

Cuddle and then to sleep.

A good bedtime routine helps develop positive associations with sleep.

Appropriate Sleep Associations

Having good sleep associations will help a child stay asleep through the night. Getting it right – it is

important that when a baby or child goes to sleep, that they are able to fall asleep on their own with

minimum external cues. This is often referred to as self-settling. Any external cues or associations

with falling asleep will need to be reproduced if they wake during the night. The aim is to help the

child learn to self-settle from an early age. (7).

There are many good sleep associations which can be part of an effective bedtime routine. These are

sleep cues, which can be reproduced easily during the night so when the child wakes they are able to

settle back to sleep easily.

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Sleep associations to avoid:

Rocking to sleep – If baby is rocked to sleep at the start of the night; when they wake during

the night they will seek to be rocked to sleep again, as they will associated the holding and

rocking motion with sleep.

Sleeping/lying next to children - If a parent lies next to a child to aid sleep onset, when the

child wakes during the night this will need to be repeated.

Dummies - Dummies are commonly used to help sleep and often become a strong sleep

association. Dummies can become problematic if they baby is unable to replace it

themselves. This will mean that parental intervention is needed to do this and both baby

and parent wake up fully.

Sleep associations to try:

Using a safe, soft toy to cuddle at night.

Having a safe small nightlight.

Having familiar pictures on the walls for the child to look at as they drift to sleep.

Encouraging self-settling is key to helping a baby and child sleep through.

Starting good habits early on will help prevent sleep difficulties occurring.

Wake up time

The body clock works on a 24 hour cycle, known as the circadian rhythm, which is driven by light

dark. Setting a regular bedtime anchors the circadian rhythm at one end and the opposite is setting

the body clock in the morning. Regardless of what time a child or baby went to sleep it is important

to anchor this morning point. This sets the cycle for the day ahead.

Eating and Drinking

Like adults babies and children need to go to bed neither feeling hungry or over full as both can

impact on sleep. Timing milk feeds and the last meal is important. It is advised that not to have a

large meal less than two hours before bed. It has also been suggested that late eating can increase

the risk of obesity. (16) Many babies and young children enjoy a milk feed before bed and often as

part of the bedtime routine. Caffeine and any stimulating drinks should also be avoided in the two

hours before bed.

Night time feeding – Young babies need to be fed through the night for normal growth and

development. Usually around 6-12 months babies will start weaning, resulting in dropping night

feeds.

Exercise

Getting enough exercise is important for many reasons for babies and children. Many studies have

concluded that regular exercise enhances the quality and quantity of sleep in both adults and

children. (17)

Day time Napping

Babies and young children need day naps and these are essential to growing and development and

also count as part of their overall sleep requirements. Very young babies will spend much of the day

asleep. As the child becomes older, fewer naps are required and they will become shorter. There is

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mixed research suggesting what age to stop day time napping, however over the age of three having

late afternoon naps can impact on the night sleep. (18)

GETTING A GOOD NIGHTS SLEEP WITH YOUR CHILD Getting the best night’s sleep for your child is all about establishing consistent routines and

promoting the best environment ready for sleep.

Preparation.

o Eating - Try and avoid meals close to bedtime as it is difficult to sleep with a full

tummy. It is best to leave a gap of at least two hours.

o Hunger- Contra to the above, a hungry tummy can also prevent sleep. So having a

milky drink can often help prevent a hungry chid.

o Drinking – Drinking milky drinks before bedtime will help sleep whereas caffeine

drinks or additive drinks such as cola, chocolate, tea and coffee may stimulate your

child.

o Napping during the day. -Some younger children need to “recharge” and nap,

however, prolonged or late afternoon naps could impact on night sleep.

o Activity - Doing exercise or stimulating activities during the day may help the child be

tired for bed. Beware of stimulating activities 1- 2 hours before bed as this could

keep them active all night!

Prepare the bedroom.

o A quiet environment helps the child to settle and recognise it is bedtime.

o The temperature should be a comfortable level.

o The room should be dark. Using blackout blinds can help.

o Using a low level night light can be reassuring for children who don’t like complete

darkness.

o No blue lights! Televisions, computers, mobile phones and tablets all deliver a blue

light. This blue light switches of “sleep hormone” melatonin. So ideally remove all

blue lights from the bedroom, or make sure they are switched off at least 1 hour

before bed.

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Plan a bedtime and wake up routine.

o Set a regular bedtime routine. This will regulate the body and reinforce message

that sleep is about to happen. This can include:

Bath or wash (did you know that after a bath your temperature drops and

this can help your body produce melatonin!)

Brush teeth

Story time / relax time in the bedroom

A bedtime mantra as you tuck them in “Night Night, We love you, see you in

the morning.”

o Encourage your child to fall asleep in their own bed alone each night. This will help

them to settle back to sleep if they wake during the night

o Visual support. Using visual aids/social stories and books can all help support a good

bedtime routine

o Wake your child at the same time every morning. This helps set the body clock.

Opening the curtains to let the light in will help get rid of any of sleepy melatonin.

o Clear messages. It is important to give consistent messages to your child at bedtime

and night time that it is now time to sleep. When you have tucked your child into

bed, you should always leave the bedroom completely. Keep verbal interaction,

physical contact and eye contact minimal if you need to return to your child during

the night.

And a few more tips.

o A bedroom for sleeping - As far as possible their bedroom should be used just for

sleeping. This will help promote good sleeping habits.

o Troublesome sleep – Many children at some point will go through a time where they

have problems with their sleep. Making changes to a child’s sleep can take time and

commitment. Stick with it and give consistent messages.

o Sleep diary. - Keeping a sleep diary is a perfect way of recording your child’s sleep.

By looking at it you can often work out what to do next.

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o Get help and support – If you are having problems with your child’s sleep, talk to

your health visitor, school nurse or health professional.

(19, 20, 21)

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