Article written by Dr Jenny Tang, Paediatrician – Special Interest in Paediatric Asthma, Lung, Sleep & Allergy

1. A child spends 40% of his childhood sleeping
Sleep is the primary activity of the brain during early development. Sleep is very important in childhood and directly impacts mental and physical development.

2. A newborn infant has 50% of Rapid Eye Movement (REM) sleep (Dream sleep)
The proportion of REM sleep decreases over time to 25% in adulthood. REM sleep has been shown to help developing brains mature, and is also important for memory and consolidation of learning. Disorders that reduce REM sleep e.g. sleep apnoea, may result in cognitive dysfunction.

3. Teenagers need as much sleep as young children i.e. about 9.5 hours
Studies have shown that teenagers need about 9.5 hours of sleep but most get 7 to 7.5 hours. This is due to a variety of factors, such as shift in the internal clock, early school start times, social and school obligations. Chronic sleep deprivation will result in impaired mood, behavior and cognitive function.

4. 30 – 50% of children have some form of sleep problem in childhood
These include very common problems like behavioural insomnia e.g. sleep association disorder, recurrent night awakenings, limit setting disorder; chronic sleep deprivation and parasomnias e.g. sleepwalking, night terrors; to the less common like sleep apnoea, narcolepsy, restless legs syndrome and periodic limb movement disorder. It is therefore important to actively screen for and manage sleep problems in children.

5. Most children do not need a night feed by 4-6 months of age and sleep through the night by 9 months of age
Studies suggest that 70-80% of infants sleep though the night by 9 months.

Physiologically, infants 4-6 months do not need a night feed. Frequent feeding though the night may result in a persistent requirement for night feeds with conditioned hunger, increased wetting and recurrent nighttime awakenings.

6. Rocking and nursing / bottling your child to sleep may result in recurrent night time awakenings
Allowing your child to fall asleep in a ‘sarong’, rocker or while nursing, feeding from the bottle may result in a sleep onset association disorder, where the child is a ‘signaler’ vs. a ‘self soother’. The child having learnt to fall asleep only with the required intervention (e.g. rocking or nursing), will cry during a normal night time arousal until original sleep onset conditions are re-established. Putting the child in bed drowsy but awake allows the child to learn to fall sleep on her own.

7. Nightmares are common in children
Studies have shown that approximately 75% of children report experiencing at least one nightmare. It is virtually universal and is part of normal cognitive development, peaking at 3-6 years of age. Reducing anxiety, stress, sleep deprivation and exposure to frightening or over stimulating images, especially before bedtime, can reduce incidence of nightmares.

8. Sleepwalking and sleep terrors are a neurodevelopmental phenomenon
Parasomnias e.g. sleepwalking and sleep terrors are common. Up to 15-40% report experiencing sleepwalking and or sleep terrors during childhood. This arises out of slow wave sleep and in most children spontaneously resolves following puberty. This is a result of a dramatic decrease in slow wave sleep at puberty. Sleepwalking and sleep terrors are neither indicative of a psychological issue nor result in psychological harm.

9. Habitual snoring in children may indicate the presence of sleep apnoea
Habitual snoring – i.e. snoring on most days of the week- is uncommon in children, occurring in 6-10% of children of which up to 30% may have sleep apnoea. All children with habitual snoring should be evaluated for possible sleep apnoea.

10. Prevention is better then ‘cure’
Studies have shown that increasing parental knowledge, and awareness of childhood sleep and sleep problems, is effective in reducing the prevalence and impact of sleep problems in early childhood. This can be done by parental education in antenatal or early postnatal classes.

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