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Children - Healthy Sleep Practice

Amount of sleep guidelines, sleep inequities, babies and toddlers sleep, children sleep, teenager sleep, persistent sleep problems, suggestions for practice

Background Information


Research tells us that sleep is important to children’s growth, development, health and mental wellbeing. Among children, poor sleep is linked to poorer emotional regulation and mood, increased likelihood of developing a mood or anxiety disorder and increased risk of having suicidal thoughts (Truong, 2024).

Sleep is made up of sleep cycles, which consist of periods of light and deep sleep. When we go to sleep at the start of the night, it takes around 20 minutes to pass from light into deep sleep. We then spend some time in deep sleep, coming up into light sleep again. This is called a sleep cycle. In adults, a sleep cycle lasts about 90 min. In children aged six months to 18 months, sleep cycles last about an hour.  In newborns, sleep cycles are even shorter. It is normal for children to wake when a sleep cycle comes to an end, when they are in light sleep (RCH, 2023a).

Good sleep generally includes:

  • feeling satisfied after sleep

  • having appropriate timing of sleep

  • having enough hours of sleep (over a 24-hour period)

  • falling asleep relatively easily; and

  • being alert during waking hours (i.e. not dozing or nodding off) (Truong, 2024).

The Queensland Children’s Hospital (2024) recommends the following as a guideline children and teenagers’ healthy sleep: 


Recommended sleep hours per 24-hour period

          Infants: 4 to 12 months

                  12 to 16 hours (including naps)

          Toddlers: 1 to 2 years

                  11 to 14 hours (including naps)

          Pre-schoolers: 3 to 5 years

                  10 to 13 hours (including naps)

          Grade-schoolers: 6 to 12 years

                  9 to 11 hours

          Teens: 13 to 18 years

                  8 to 10 hours

Sleep-related behaviours that can have a positive effect on children’s sleep health include a consistent sleep schedule and bedtime routine, and parent–child interactions at bedtime, such as reading a bedtime story. Conversely, the use of electronic devices before bedtime, at bedtime and overnight and consuming caffeine can have a negative effect on a child’s sleep health (Truong, 2024). 

What are sleep inequities?

There is an emerging body of evidence (largely international) that indicates that children’s sleep patterns and problems are influenced by their individual, family and school circumstances, and by their neighbourhood and community context. For example, research suggests children from lower family socioeconomic backgrounds are more likely to have sleep problems than those from higher family socioeconomic backgrounds.

Sleep inequities (also known as ‘sleep disparities’) are a type of health inequity. Health inequities are differences in health status between population groups (e.g. by gender or racial/ethnic background) that are caused by social, environmental and structural factors that are unfair or unjust (Truong, 2024).

What contributes to sleep inequities?

Examples from the emerging research on determinants of sleep inequities among children include:

  • Experiences of discrimination    Primary carer and child experiences of racial discrimination are associated with more sleep difficulties such as having trouble getting to sleep.

  • Family socioeconomic and educational background         A systematic review of 46 studies found that higher household income and/or higher parental education were associated with fewer sleep problems and higher sleep quality.

  • Living in a disadvantaged neighbourhood             A study of 1,280 in the United States found that kindergarten children from disadvantaged neighbourhoods experienced later bedtimes than children from more advantaged areas (Truong, 2024).

Babies and Toddlers

(Source: RCH, 2023)

Struggling to fall asleep and waking up many times through the night is very common in babies and toddlers. It can be very distressing and exhausting for their parents and caregivers.  Caring for babies and toddlers with sleep challenges can be exhausting and it is important parents seek support for themselves through family, friends, their GP and their community.  Information on how much sleep to expect in babies and toddlers can be found at: and 

Sleep in babies younger than 6 months

Babies less than 6 months usually wake regularly during the night. They need regular feeds overnight, and they need time for their body clocks to adapt to the differences between daytime and nighttime (circadian rhythm). Behavioural sleep interventions in babies younger than 6 months old are not recommended as there is no evidence  behavioural sleep interventions are beneficial for these babies in these early months, so it is important to respond to your baby’s cues when they wake.

Sleep in babies and toddlers aged older than 6 months

Sleep associations

Every family and every child are different. Some children naturally settle and fall asleep more easily than others, who may need help to fall asleep. It is common for parents and caregivers to soothe or settle their child to sleep using techniques such as feeding, patting, rocking or holding the child until they fall asleep in their arms. If a child is used to getting help from their parents to fall asleep, this can become a habit, called a sleep association. Specific preference to one parent or caregiver can also be a sleep association.

Sleep associations are usually not a problem in the first few months of life. However, at around 4-5 months of age, babies start to realize that their parents are still around even if they cannot see them—‘object permanence’ develops and babies may start to cry out for their parent at the end of each sleep cycle.  Babies who do not need help to fall asleep at the start of a night or nap may be able to soothe themselves back to sleep. However, babies who have sleep associations are likely to need help from their parents to fall back to sleep.

Sleep associations are not a problem for all children and families.  For those who need more support around children’s sleep the following strategies may help promote good sleeping habits (from Sleep with Kip, 2024).

  • A calming bedtime routine: Try to do the same things each night, choosing calm and enjoyable activities to help the child wind down. e.g. dinner, bath, quiet play or reading, then into bed.

  • Regular sleep and wake times (within 30 minutes)

  • Avoid daytime naps (for children five and over).

  • A calm, quiet sleep environment: The child’s sleep environment should be relaxed, peaceful, and relatively dark. It should be the same at bedtime and throughout the night, with the same lighting and no music unless it will play all night.

  • A media-free bedroom: Avoid watching electronic screens such as computer games, iPad and TV for at least one hour before bed.

  • Get morning light: Getting natural light during the morning by opening the curtains or going outside helps keep the body clock on the right track.

  • Avoid caffeine from late afternoon: Caffeine is in chocolate bars and cola, tea and coffee.

  • ·Encourage exercise (but not just before bed): Avoid exciting, high-energy activities, such as playing outside or running around, just before bed.

Other strategies to keep in mind include:

  • Screen time or high-energy play in the hour or two before bedtime may make it harder for children to fall asleep. Instead, have some quiet time before the child is put to bed (e.g. having a bath and bedtime story).

  • Feeding a child immediately before bedtime can become a sleep association. Instead, try to time the last feed for at least half an hour before bed. Consider giving this feed outside the bedroom if the child associates feeding with going to sleep.

  • If dummies have become a sleep association, there may be ways to help the child replace the dummy. More information can be found at 

  • Letting the child hold a comforter (e.g. a soft toy or small blanket) can be helpful, but this should not be done for babies under seven months of age as it can be a choking or suffocation hazard.  

  • Actions such as patting or rocking the child to sleep are OK for newborns, but older children can form a sleep association with these actions. Try to cut down on these actions if this is the case.

  • Begin to put the child into the cot awake at bedtime as this can help them to learn to settle themselves to sleep.

  • Try to leave the room and go back for brief but regular checks until the child is asleep. If this is too distressing, sit quietly on a chair in the bedroom until they fall asleep. Gradually move the chair out of the room over time.

  • Be consistent in your behaviour, and set limits. Each family is different.

  • If co-parenting, try to share the child’s bedtime routine and strategies with one’s partner so there is consistency for the child.

More tips to promote healthy sleep routines can be found here


(Source: RCH, 2018)

Many families have problems getting their children to bed, especially preschool and primary school-age children. Many children will use excuses to avoid going to bed such as 'I need to go to the toilet' or 'I just need to tell you something', which can often delay sleep time significantly.  It is not unusual for children to have night-time worries or fears, which can prevent them from getting to sleep easily.  Whatever the cause of the bedtime problems, it is important that the family decides on (and sticks to) clear rules about a bedtime routine. Praising a child and reinforcing good behaviour will also help to improve bedtime problems. 

Strategies to improve bedtime behaviour

Be clear about what the child needs

Adults need to decide what is reasonable bedtime behaviour and be clear about the behaviours expected. Setting limits often benefits children in more ways than just improving sleep, as they feel secure and contained.  Explain (without a lengthy discussion) the new rules to the child during the day. Don't leave it to tell them for the first time when they're stalling at bedtime. Expect some resistance. Children probably do not want to change, so things may get worse briefly before they get better.

Implement a consistent bedtime routine

  • Have a predictable, enjoyable routine with calm activities such as a bath or a set number of stories.

  • Avoid stimulating activities, such as watching TV, running around or computer games.

  • Have a set bedtime that has already been explained during the daytime.

  • Try to avoid negotiating with the child at bedtime and do not enter into a battle if they protest. Calmly remind them of the new rules and continue. Remember, this is what they need.

  • Put the child to bed and leave the room while they are still awake.

  • Be consistent and stick to your routine.

Dealing with resistance

If the child calls out:

  • Calmly tell the child it's time to sleep.

  • Do not enter into a discussion. 

  • f they get upset, return to reassure them but be brief and limit what is said.

If your child comes out of their room:

  • Calmly return them to bed, while holding their hand. Remember, this is not punishment, but be firm.

  • For some children, any attention (even a parent getting angry with them) is better than sleep, so limit what is said. Be calm, repetitive and boring, and do not enter into a discussion.

  • If they get out of bed again, return them to bed again. Repeat as many times as is necessary. 

Positive reinforcement

  • Praise the child first thing in the morning for things they did right the night before. The idea is to focus on success, not on failure.

  • Consider rewarding them for sticking to the rules (e.g. sticker charts work well, even in older children).

  • For children who are very resistant or struggling with the new routine, break the process down into different parts and reward your child for each part (e.g. a sticker for getting into bed, staying in bed and sleeping through the night). 

Strategies to deal with night-time worries

Some children have difficulties getting to sleep because they are worried or anxious, and they start to think too much about their worries when they go to bed.  During the day talk to the child about what is worrying them (e.g. fear of the dark, or monsters). Parents should give the child the message that they have confidence in them to deal with their worries.

It's important to stick to the child's bedtime routine, even if they seem very worried or upset.  Setting limits and being gentle but firm will help the child to feel safe. Giving in to a child's requests may give him or her the message that there really is something to worry about.  

A night-light can be helpful for children who are scared of the dark as long as it does not stop the child from falling asleep.  Security objects (e.g. a soft toy or favourite blanket) can help the child feel safe and more relaxed at night (don't use with children under six months old).

Teach relaxation techniques.

  • Breathing exercises: Ask the child to breathe deeply into their tummy or imagine they are blowing big bubbles, or blowing out candles on a birthday cake.

  • Muscle relaxation: Concentrating on tightening then relaxing the muscles (starting with the feet and moving up to the muscles of the face).  This can distract the child and help them relax. 

  • Positive imagery: Otherwise known as 'going to a happy place', children use their imagination to create a happy place they can visit in their minds, when they are in bed.   

When to seek help

  • If sleep problems are causing parents and children significant problems, the  GP or paediatrician should be consulted.

  • If the child wakes frequently during the night because of their own loud snoring, see the GP as the child may have obstructive sleep apnoea (OSA).

  • Some children suffer from a more general anxiety that affects them during the day as well, and they may need further treatment. See the GP, who may refer you to a psychologist.


(Source: Raising Children Network, 2022a)

Why teenagers need sleep

Teenagers need sleep to:

  • maintain good physical health

  • regulate appetite and stay at a healthy weight

  • maintain energy levels

  • maintain good mental health, build resilience and reduce stress

  • learn, concentrate and remember things well

  • maintain healthy social relationships.

Lack of sleep can make it harder for the teenager to behave well, regulate emotions, pay attention, do well at school, and get along with others. Being tired all the time can even contribute to mental health issues like anxiety and depression.

Most teenagers need 8-10 hours of sleep each night. Some need as little as 7 hours or as much as 11 hours.  It’s very common for children in the early teen years to start wanting to go to bed later at night and get up later in the morning. This is because they start to secrete melatonin later at night than they did in earlier childhood, which affects their circadian rhythms. Also, as their brains mature during puberty, children can stay awake for longer.

Helping teenagers get the sleep they need

Waking, sleeping and napping routines

  • Keep wake-up times on school days and weekends to within 2 hours of each other. This helps to keep the body clock regular.

  • Get out of bed when they wake up in the morning, rather than staying in bed.

  • Spend the hour before lights out avoiding screens and doing relaxing activities like reading, listening to music or having a warm shower.

  • Keep daytime naps to no more 20 minutes, and make sure the nap is in the early afternoon.

Sleep environment

  • Avoid the use of electronic devices in the hour before bed.

  • Put electronic devices in family rooms overnight.

  • A quiet, dimly lit space is important for good sleep.

Good health and nutrition

  • Have a satisfying evening meal at a reasonable time. Feeling hungry or too full before bed can make it harder to get to sleep.

  • Get as much natural light as possible during the day, especially in the morning. This will help the body produce melatonin at the right times in the sleep cycle.

  • Have a healthy breakfast to kick-start their body clock. This helps the body feel ready for sleep at night.

  • Avoid caffeine – in energy drinks, coffee, tea, chocolate and cola – especially in the late afternoon and evening.

  • Do some physical activity during the day but avoid intense exercise in the hour before bed.

Worries, fears and anxiety

  • Talk about worries during the day.

  • Write down anxious or sad thoughts well before bedtime. For each thought, add a possible solution.

  • Try some mindfulness exercises, breathing exercises or relaxation exercises to calm an anxious or active mind before sleep.

  • Be a healthy sleep role model for the teenager – for example, by winding down before bed, reducing screen use before bed, relaxing and managing stress, and reducing the use of caffeine before bedtime.

Signs of teenage sleep problems

Signs that a teenage child has sleep problems might include difficulties with getting to sleep, staying asleep and getting out of bed in the morning.  If a child has sleep problems, they might also feel tired during the day or have trouble remembering things or concentrating.  The child might be able to solve some sleep problems by getting into the good sleep habits described above. But if persistent problems with sleep are affecting the child’s wellbeing, schoolwork, relationships or mental health, it might be time to see a GP.

Working with teenagers on sleep problems

If teenagers have sleep problems, they need to be involved in solving their own sleep issues

  • Get the child’s input by asking what makes it hard for them to get to sleep or what keeps them awake. Then the child might be able to choose a daytime or evening habit that they think will help. For example, if they don’t feel tired, they might focus on doing more physical activity each afternoon.

  • It’s a good idea to praise the teenager when you notice they’re trying to make changes to sleep patterns or trying out strategies you’ve discussed.

  • After-school activities like sport, music or part-time work can cut into your teenager’s sleep time or make it harder to unwind before bed. If this is the case, you might need to talk about it. For example, your teenager might be able to reschedule some activities, so they don’t interfere with sleep.

  • Young people should avoid alcohol and illegal drug use completely. These substances have a bad effect on sleep, mental health and wellbeing. They can also harm young people’s developing brains.

Persistent Sleep Problems

(Source: Raising Children Network, 2022b)

What are persistent sleep problems?

Persistent sleep problems affect a child’s ability to sleep or settle over a long period.  Not all sleep problems are persistent. A sudden change in your child’s sleep might be a short-term sleep problem, rather than a persistent one.  You can sort out many short-term sleep problems by encouraging good sleep habits as outlined in the above material. Persistent sleep problems continue even after the introduction of better sleep habits and other lifestyle changes.

Behaviour-based persistent sleep problems

Some persistent sleep problems are related to behaviour. These problems can happen at bedtime or during the night.  Behaviour-based persistent sleep problems include the child:

  • calling out and getting out of bed

  • not wanting to sleep in their own bed

  • having trouble getting to sleep because they help them settle

  • waking up often during the night and needing help to get back to sleep

  • feeling very anxious

  • sleeping at irregular times – for example, going to sleep much later on some nights.

These persistent sleep problems can sometimes be managed with behaviour strategies to reduce the behaviour that’s causing the problem. For example, if the child gets out of bed at night, it can help to minimise the amount of talking and eye contact given to the child each time they are gently returned to bed.

Medical conditions and persistent sleep problems

Some persistent sleep problems might need some kind of medical treatment. They include:

  • Sleep apnoea      Children with obstructive sleep apnoea stop breathing when they sleep.  Symptoms include snoring, struggling for breath while asleep and daytime tiredness.  Treatment depends on the cause.  Children should be taken to the GP if they have sleep apnoea symptoms.

  • Insomnia               Insomnia is a problem with getting to sleep, staying asleep or waking up too early.  Insomnia treatment includes changes to sleep habits, cognitive behaviour therapy and medical treatments.  A GP should be consulted if sleep problems are affecting children’s wellbeing, schoolwork or relationships.

  • Restless leg syndrome   A condition where people feel an irresistible need to move their legs, often at night in bed, making it hard for people to get to sleep.  Treatment varies and depends on the diagnosis of its cause.  Lifestyle changes or medicines may be suggested

  • Nightmares          Nightmares are bad dreams that can wake children up and leave them feeling scared and upset.  Be patient and reassure that everything is OK.  Think about what’s happening in the day to trigger nightmares, e.g. stress and trauma.  See a GP if worried.

  • Night terrors      Night terrors are when children get very agitated while deeply asleep.  They don’t hurt children, and they won’t remember them in the morning.  Don’t wake children during night terrors.  Wait for the terrors to finish and then help them settle.

  • Narcolepsy           Narcolepsy is a lifelong condition where a child or adult cannot stay awake during the day because of overwhelming feelings of tiredness, and keeps falling asleep.  This can cause serious problems with the daily routine.  Medicines and lifestyle changes can help manage the symptoms.

  • Delayed sleep phase        This is present when a child’s bedtime and wake time are later than the bedtime and wake time needed for schoolwork or other daily routines.  A treatment plan might include making changes to sleep habits, taking melatonin supplements and using light therapy.

How persistent sleep problems affect children and their families

If a child has a persistent sleep problem, they might have daytime problems like:

  • behaviour problems – for example, younger children being overactive or older children being sleepy

  • poor memory

  • trouble with concentrating or understanding instructions

  • more tiredness during the day

  • the need for more naps

  • inability to wake up for school or work

  • irritability and anger

  • mental health issues like childhood depression, teenage depression, childhood anxiety or teenage anxiety.

Ask for help from family and friends or parenting helplines (e.g.

Getting assistance for persistent sleep problems

The first step is talking with a GP about getting an assessment of the child’s sleep.  Below are some examples of persistent sleep problems at different ages.

In toddlers and preschoolers (2-5 years), common persistent sleep problems include:

  • night-time fears like fear of the dark

  • the need for something or someone to go to sleep with – for example, a bottle of milk in bed or a parent

  • bedtime resistance – for example, calling out and getting out of bed

  • nightmares and night terrors

  • sleep apnoea

  • sleepwalking.

In school-age children (5-8 years), common persistent sleep problems include:

  • night-time fears like fear of the dark

  • poor sleep habits – for example, caused by having a screen-based device in the bedroom

  • nightmares and night terrors

  • sleep apnoea

  • sleepwalking

  • teeth-grinding

  • anxiety – either general anxiety or anxiety about not getting enough sleep.

In pre-teens (9-11 years), common persistent sleep problems include:

  • poor sleep habits – for example, caused by having a screen-based device in the bedroom

  • anxiety, including being anxious about getting enough sleep

  • sleep apnoea

  • insomnia

  • delayed sleep phase.

In teenagers (12-18 years), common persistent sleep problems include:

  • poor sleep habits – for example, caused by having a screen-based device in the bedroom

  • anxiety, including being anxious about getting enough sleep

  • sleep apnoea

  • insomnia

  • delayed sleep phase

  • restless leg syndrome.

Suggestions for Practice

How can social workers support and encourage sleep health?

Truong (2024) provides general guidance about how social workers, and other health practitioners, can go about encouraging sleep health, remembering that sleep health can promote children’s mental health and wellbeing. Social workers can do this in several ways:

  • Use the material above, and other sources, to learn about the importance of good sleep to children’s mental health and wellbeing, and the different factors that affect sleep health in children.

    • Recommended sleep hours

    • Be aware of the factors that can lead to sleep inequities and explore these with parents (e.g. experiencing discrimination, socioeconomic situation, educational background, living in a disadvantaged neighbourhood)

    • Issues specific to babies and toddlers (e.g. sleep associations, screen time, calming bedtime routine, morning light, exercise during the day)

    • Issues specific to children (e.g. set limits, consistent bedtime routine, approach to getting out of bed, positive reinforcement)

    • Issues specific to teenagers (e.g. include them in the conversation and solution, routines, health and nutrition, dealing with worries during the day)

    • Be aware of the potential sleep problems for different ages.

  • Speak with children and their parents about their sleep related behaviours, routines and habits, e.g. number of hours of sleep, how long it takes them to fall asleep and if they sleep through the night.  Share relevant information and strategies similar to the above with parents and families.

  • Refer the parents or carers of children with suspected sleep disorders to a GP or other relevant professional for further assessment and treatment. 

Some key factors around healthy sleep that apply across most age groups include the following (drawn from Raising Children Network, 2023).

  1. Set up a bedtime routine           A regular bedtime routine starting around the same time each night encourages good sleep patterns. A bedtime routine of bath, story and bed can help younger children feel ready for sleep. For older children and teenagers, the routine might include quietly chatting with you, turning off digital technology, having a shower, listening to music or reading, and turning out the light.

  2. Relax before bedtime                  Encourage relaxation before bedtime, e.g. reading a book, listening to gentle music or practising breathing for relaxation.

  3. Keep regular sleep and wake times     Keep bedtimes and wake-up times within 1-2 hours of each other each day. This helps to keep the internal body clock in a regular pattern. It’s good to do this on weekends and during holidays, as well as on school days.

  4. Keep (older) children’s naps early and short  If a child is having bedtime struggles at night, try to keep any nap to no longer than 20 minutes and no later than early afternoon.

  5. Make sure your child feels safe at night              If a child feels scared about going to bed or being in the dark, you can praise and reward your child whenever they’re brave. Avoid scary TV shows, movies and computer games.  A night light can help. 

  6. Check noise and light in your child’s bedroom                 Check whether the child’s bedroom is too light or noisy for sleep. Blue light from televisions, computer screens, phones and tablets suppress melatonin levels and delays sleepiness. Bright light in the hour before bedtime can have the same effect on young children.  If the child uses a night-light, choose a dim, warm-coloured globe, rather than a bright, white, cool-coloured globe.

  7. Avoid the clock              If a child is checking the time often, encourage the child to move the clock or watch to a spot where they can’t see it from bed.

  8. Eat the right amount at the right time                  Make sure a child has a satisfying evening meal at a reasonable time. Feeling hungry or too full before bed can make it harder for your child to get to sleep. In the morning, a healthy breakfast helps to kick-start the child’s body clock at the right time.

  9. Get plenty of natural light in the day   Encourage the child to get as much natural light as possible during the day, especially in the morning. Bright light suppresses melatonin. This helps the child feel awake and alert during the day and sleepy towards bedtime.

  10. Avoid caffeine              Caffeine is in energy drinks, coffee, tea, chocolate and cola. Encourage the child to avoid these things in the late afternoon and evening, and don’t offer them at these times.

  11. Monitor physical activity level              Ensure ther child is engaging in physical activity to a level that makes them tired enough to want to sleep of a night.  Normal daily activity may be sufficient for most, but otherwise, supplement this with regular, organised activities.

Supplementary Material / References

From Truong, 2024

The following is a range of resources related to child sleep health:

From RCH, 2023 – Babies and Toddlers

From RCH, 2018 – Children

From Raising Children Network, 2023 – Teenagers


Queensland Children’s Hospital. (2024). Healthy sleep

Raising Children Network. (2022a). Sleep and teenagers: 12-18 years.

Raising Children Network. (2022b). Persistent sleep problems in children and teenagers

Raising Children Network. (2023). How to sleep better: 10 tips for children and teenagers

RCH: Royal Children’s Hospital Melbourne.  (2018). Bedtime problems: Children

RCH: Royal Children’s Hospital Melbourne. (2023). Sleep problems: Babies and toddlers

Sleep with Kip. (2024). Clinically validated sleep strategies

Truong, M. (2024). Sleep health and sleep inequities in children.  Emerging Minds.


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