For most children, sleep problems are intermittent or temporary and often do not require treatment.
(See also Overview of Behavioral Problems in Children.)
Normal Sleep
About two-thirds of infants are able to sleep through the night on a regular basis by age 6 months (1). Later in the first years of life, children may experience periods of night-waking, often associated with illness or other changes in routine. With maturation, the amount of rapid eye movement (REM) sleep increases, with increasingly complex transitions between sleep stages. For most people, non-REM sleep predominates early in the night, with increasing REM as the night progresses. Thus, non-REM phenomena cluster early in the night, and REM-related phenomena occur later. Differentiating between true sleep (REM or non-REM)–related phenomena and awake behaviors can help direct treatment. Sometimes non-REM sleep phenomena during childhood are associated with emergence of migraine later in life (2).
If a child is sleeping in their parent's (or caregiver's) bed, it is important for clinicians to determine whether the parent views the child sleeping with them as a problem because there is much cultural variation regarding sleep habits (3, 4). The American Academy of Pediatrics suggests that infants sleep in the same room as parents but not on the same sleep surface; this is thought to decrease the risk of sleep-related infant death, a subset of sudden unexpected infant death (SUID) (5).
Normal sleep references
1. Stanford Medicine Children's Health. Infant Sleep. Accessed April 23, 2025.
2. Pavkovic IM, Kothare SV. Migraine and Sleep in Children: A Bidirectional Relationship. Pediatr Neurol. 2020;109:20-27. doi:10.1016/j.pediatrneurol.2019.12.013
3. Mindell JA, Sadeh A, Wiegand B, et al. Cross-cultural differences in infant and toddler sleep. Sleep Med. 2010;11(3):274–280. doi:10.1016/j.sleep.2009.04.012
4. Willoughby A, Alikhani I, Karsikas M, Chua XY, Chee MWL. Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study. Sleep Med. 2023;110:155-165. doi:10.1016/j.sleep.2023.08.010
5. Moon RY, Carlin RF, Hand I; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME AND THE COMMITTEE ON FETUS AND NEWBORN. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022;150(1):e2022057990. doi:10.1542/peds.2022-057990
Nightmares
Nightmares are frightening dreams that occur during REM sleep. A child having a nightmare can sometimes awaken fully and vividly recall the details of the dream.
Nightmares are not a cause for alarm, unless they occur frequently. They may occur more often during times of stress or even when the child has seen a movie or television show containing frightening content. If nightmares occur often, parents can keep a diary of the child's activities during the day before a nightmare occurs, particularly close to bedtime, to see whether they can identify the cause.
Night Terrors and Sleepwalking
Night terrors are non-REM episodes of incomplete awakening with extreme anxiety, usually occurring in the first few hours after falling asleep; they are most common between the ages of 3 and 8.
The child screams and appears frightened, with a rapid heart rate and rapid breathing. The child seems unaware of the parents’ presence, may thrash around violently, and does not respond to comforting. The child may talk but is unable to answer questions. Usually, the child returns to sleep after a few minutes. Unlike with nightmares, the child cannot recall these episodes in detail. Night terrors are dramatic because the child may scream and may be inconsolable during the episodes.
About one-third of children with night terrors also sleepwalk (the act of rising from bed and walking around while apparently asleep, also called somnambulism). About 13% of children (peak at age 10) have at least 1 episode of sleepwalking (1).
Night terrors and sleepwalking almost always stop on their own, although occasional episodes may persist for years. Usually, no treatment is needed, but if a disorder persists into adolescence or adulthood and/or is severe, treatment may be necessary. In children who need treatment, night terrors may sometimes respond to a sedative or certain antidepressants. There is some evidence that children with disrupted sleep associated with periodic leg movements often respond to iron supplementation (2, 3), even in the absence of anemia. If children snore and thrash, evaluation for obstructive sleep apnea also should be considered.
Night terrors and sleepwalking references
1. Petit D, Pennestri MH, Paquet J, et al. Childhood Sleepwalking and Sleep Terrors: A Longitudinal Study of Prevalence and Familial Aggregation. JAMA Pediatr. 2015;169(7):653-658. doi:10.1001/jamapediatrics.2015.127
2. Leung W, Singh I, McWilliams S, et al. Iron deficiency and sleep—A scoping review. Sleep Med Rev. 2020;51:101274. doi:10.1016/j.smrv.2020.101274
3. Peirano PD, Algarin CR, Chamorro RA, et al. Sleep alterations and iron deficiency anemia in infancy. Sleep Med. 2020;11(7):637–642. doi:10.1016/j.sleep.2010.03.014
Resistance to Going to Bed
Children, particularly between the ages of 1 and 2, often resist going to bed because of separation anxiety, whereas older children may be attempting to control aspects of their environment. Young children often cry when left alone in bed, or they climb out and seek their parents.
Another common cause of bedtime resistance is delayed sleep onset time. These situations arise when children are allowed to stay up later and sleep later than usual for enough nights to reset their internal clock to a later sleep onset time. Moving bedtime a few minutes earlier each night is the recommended intervention for resetting the internal clock, but, if needed, brief treatment with a nonprescription sleep aid, such as an antihistamine or melatonin, can help children reset their clock.Another common cause of bedtime resistance is delayed sleep onset time. These situations arise when children are allowed to stay up later and sleep later than usual for enough nights to reset their internal clock to a later sleep onset time. Moving bedtime a few minutes earlier each night is the recommended intervention for resetting the internal clock, but, if needed, brief treatment with a nonprescription sleep aid, such as an antihistamine or melatonin, can help children reset their clock.
When parents stay in the room at length to provide comfort or take children out of bed, resistance to going to bed may be exacerbated. In fact, these parental responses reinforce night waking, in which children attempt to reproduce the conditions under which they fell asleep. To avoid these problems, a parent may have to sit quietly in the hallway in sight of the child and make sure the child stays in bed. The child then establishes a sleep-onset routine of falling asleep alone and learns that getting out of bed is discouraged. The child also learns that the parents are available but will not provide more stories or play. Eventually, the child settles down and goes to sleep. Providing the child with an attachment object (such as a teddy bear) is often helpful. A small night-light, white noise, or both also can be comforting. Some parents set limits by giving the child a "sleep pass" that the child can turn in for one time out of bed.
If the child is accustomed to falling asleep while in physical contact with a parent, the first step in establishing a different bedtime routine is to gradually lessen the contact from full body to a hand touching the child to a parent sitting next to the child's bed. Once the child is regularly falling asleep with a parent next to the bed, the parent can leave the room for increasing durations.
Awakening During the Night
All people awaken multiple times each night, and most fall back to sleep each time with no intervention. Children often experience repeated night awakening with difficulty falling back to sleep after a move, an illness, or another stressful event. Sleeping problems may be worsened when children take long naps late in the afternoon or are overstimulated by playing before bedtime.
Allowing the child to sleep with the parents because of the night awakening reinforces the behavior. Also counterproductive are playing with or feeding the child during the night or scolding or punishing the child for night awakening. Returning the child to bed with simple reassurance is usually more effective. A bedtime routine that includes reading a brief story, offering a favorite doll or blanket, and using a small night-light (for children > 3 years of age) is often helpful. To prevent arousal, it is important that the conditions under which the child awakens during the night are the same as those under which the child falls asleep. Parents and other caregivers should try to keep to a routine each night so that the child learns what is expected. If children are physically healthy, allowing them to cry for a few minutes often allows them to settle down by themselves, which diminishes the night awakening. Extended crying is counterproductive, however, because parents may then feel the need to revert to a routine of close contact. Some parents of children aged 3 to 10 years use a red light/green light clock that indicates to the child when it is acceptable to get out of bed (1).
Sleep is sometimes disrupted by restless legs syndrome, and a few children, particularly those who thrash and snore, may have obstructive sleep apnea. Children with restless legs syndrome may benefit from iron supplementation, even if they do not have iron deficiency anemia. Clinicians should also consider an evaluation for sleep apnea for children who thrash and snore.
Awakening during the night reference
1. Mindell JA, Meltzer LJ, Carskadon MA, Chervin RD. Developmental aspects of sleep hygiene: findings from the 2004 National Sleep Foundation Sleep in America Poll. Sleep Med. 2009;10(7):771-779. doi:10.1016/j.sleep.2008.07.016