New insights into managing paediatric sleep disturbances improve routines and address medical causes

Paediatric consultant Ikram Rabea Ayad highlights that most sleep problems in children are temporary and manageable, emphasizing routine, cultural variations, and medical assessments to promote healthier sleep patterns.

Paediatric sleep problems are often temporary and manageable, according to paediatric consultant Ikram Rabea Ayad, who said most babies begin sleeping for longer stretches of around five hours by about three months of age, although night waking can still happen, especially when a child is unwell or their routine changes.

Ayad also stressed that sleep habits vary across families and cultures, but medical guidance recommends that infants sleep in the same room as their parents on a separate surface, not in the same bed. The advice reflects concern that bed-sharing is linked to a higher risk of sudden infant death syndrome.

For many children, the most common sleep difficulty is a nightmare. These usually occur during rapid eye movement sleep, leaving the child frightened but able to remember the dream. Ayad said they become more concerning only if they happen very frequently, and she noted that stress or exposure to scary or violent content can make them worse.

Night terrors are different. They tend to happen during non-REM sleep and are most common between the ages of three and eight. During an episode, a child may scream, sweat, breathe quickly and appear terrified, yet remain unaware of a parent’s presence. Ayad warned that waking the child can make matters worse and said most children settle back to sleep within minutes and remember nothing the next morning. She added that some children who experience night terrors also sleepwalk, which usually fades with age.

Resistance to bedtime is another common issue, especially in toddlers. Ayad said children between one and two years old may resist sleep because of separation anxiety, while older children may do so to test limits. She advised against turning bedtime into a bargaining exercise, and said allowing very late nights can shift a child’s body clock and make it harder to return to a normal routine. The NHS and the American Academy of Pediatrics likewise recommend a consistent, calming bedtime routine to help children settle more easily.

Ayad said repeated night waking can stem from illness, stress, long late-afternoon naps or too much activity before bed. She also pointed to medical causes such as restless legs syndrome and sleep-disordered breathing, including sleep apnoea. In some cases, a doctor may check iron levels and recommend supplements if needed. Ongoing snoring, laboured sleep, daytime sleepiness or changes in behaviour should prompt a paediatric review.