BEHAVIORAL SLEEP PROBLEMS IN CHILDREN (BEHAVIORAL INSOMNIA) AND EFFECTIVE METHODS OF THEIR MANAGEMENT

Abstract

Sleep problems with behavioral origins occur in 20 to 30 percent of children and are especially common in children with medical, neurodevelopmental, or psychiatric disorders. Insomnia related to learned sleep onset associations is most common in infants and toddlers and is characterized by prolonged night waking, requiring parental intervention to restore sleep. It occurs when the child learns to associate falling asleep with specific experiences, such as being rocked or fed. Insomnia related to inadequate limit-setting is a disorder most common in children who are preschool-aged and older and is characterized by active resistance, verbal protests, and repeated demands at bedtime. Guidance to parents about healthy sleep practices helps to prevent sleep problems and is also an important first step in treatment. An integral part of the bedtime routine is the institution of a bedtime and sleep schedule that ensures a developmentally appropriate amount of sleep. A consistent nightly bedtime will help to set the circadian clock and enable the child to fall asleep more easily. Treatment of primary insomnia in older children and adolescents usually involves behavioral interventions that resemble those used in adults. Establishing a consistent sleep schedule is also important for older children and adolescents for whom poor sleep hygiene is a common cause of sleep problems. Pharmacologic therapy for the treatment of childhood insomnia is not a first-line treatment and should always be combined with behavioral therapy.