Children’s Sleep: The Routine, the Hours, and the Problems That Are Not Behavioural

A tired child does not look tired. A tired child looks badly behaved.

That is the most useful sentence about children’s sleep, and it explains why sleep problems so often arrive in our office labelled as something else — the tantrums, the inability to concentrate, the meltdown at 5pm, the suspected attention problem. Adults get sleepy when short on sleep. Children get wired, irritable, impulsive and clumsy.

So: the hours, the routine that gets you there, and then the section that matters most — the sleep problems that are not about routine at all, and where more discipline will make things worse.

The hours

Including naps, and there is real variation between children:

Age	Hours
4–12 months	12–16
1–2 years	11–14
3–5 years	10–13
6–12 years	9–12
13–18 years	8–10

Judge by the child, not the table. A child who wakes on their own, is reasonable company in the morning, and holds together until bedtime is getting enough. A child who has to be prised awake, falls asleep in the car at 4pm, or falls apart every afternoon probably is not.

Teenagers are the group furthest from these numbers, and it is not simply late-night phone use. Puberty genuinely shifts the body clock later, so a teenager who cannot sleep at 10pm is not being difficult — and then a 7am school start collects the debt. Most American teenagers are chronically sleep-deprived, and it shows up as mood, grades, and crash risk.

The routine, which is the whole of most of it

Same time, same order, every night. The sequence is what signals sleep, more than any individual element. Bath, teeth, pyjamas, two books, lights out — in that order, at roughly that time, including weekends.

Keep it short. Twenty to thirty minutes. A long routine becomes a negotiation.

Screens off well before bed, and out of the bedroom overnight. The light matters and the content matters more — a game or a video leaves a child alert in a way a book does not. Charge the phone in the kitchen. With a teenager this is the single highest-yield change available and the hardest to negotiate; it works far better as a household rule that includes the adults.

Put them down drowsy but awake. This is the one that matters for night waking. Every child surfaces several times a night; a child who fell asleep being rocked or fed wakes up and needs rocking or feeding again, because the conditions changed. A child who fell asleep in their own bed usually resettles without anyone knowing.

Dark, cool, quiet. Blackout blinds earn their keep here — our summer evenings stay bright long past a reasonable bedtime.

Get daylight into them in the morning. It sets the clock better than anything done in the evening, and outside is better than a window.

Watch the afternoon nap. Napping too late makes bedtime impossible. Most children drop the nap somewhere between three and five, and the transition is a rough couple of months.

Caffeine is in more places than parents count — cola, iced tea, chocolate, energy drinks. It has a long half-life, so an afternoon drink is still working at midnight. Energy drinks are not appropriate for children at all.

Night waking, nightmares and night terrors

Nightmares happen in the second half of the night, the child wakes properly, is frightened, remembers it, and wants comfort. Comfort them. They are normal and they pass.

Night terrors are different and they are often mistaken for nightmares. They happen in the first few hours, the child sits up, screams, may thrash or appear terrified with their eyes open — and is not actually awake. They will not respond to you, and they remember nothing in the morning.

What to do: nothing, mostly. Keep them safe, do not try to wake them, and wait. It is far more distressing for the parent than for the child. They are commonest in preschoolers, they run in families, and being short on sleep makes them more frequent — so the counterintuitive fix is often an earlier bedtime rather than a later one.

Sleepwalking gets the same handling: safety first — stair gates, window locks, a door alarm if needed — and guide them back to bed without waking them.

The problems that are not behavioural

This is the section to read if nothing in the routine is working.

Snoring and obstructive sleep apnoea. The one to think about first, and it is genuinely common in children — most often from large tonsils and adenoids. The signs: snoring most nights, pauses in breathing, gasping, sleeping with the neck extended or in odd positions, sweating heavily in sleep, mouth-breathing, waking unrefreshed. In children it presents as hyperactivity and inattention more often than as sleepiness — which is why it is repeatedly mistaken for ADHD. It is also associated with bedwetting and with poor growth. It is very treatable, and if your child snores most nights, that is the appointment to make.

Restless legs, an evening urge to move the legs, often linked to low iron. Worth a blood test.

Eczema or itching that wakes a child repeatedly. Treat the skin and the sleep follows.

Asthma, which classically coughs at night. A child coughing at 3am several nights a week is a child to bring in — our asthma page covers why the cough can be the only symptom.

Reflux, in a baby or a child who wakes in discomfort after feeds.

Anxiety. A child who cannot get to sleep because of the thoughts in their head does not have a routine problem. Our children’s mental health page covers it.

Constipation and bedwetting both disturb sleep and both go unmentioned unless asked about.

Medication, including some ADHD stimulants and some asthma medicines.

Iron deficiency, which affects sleep in its own right.

Call us if

• Snoring most nights, or any pause in breathing during sleep — do not wait on this one
• Daytime sleepiness in a child who appears to be sleeping enough
• Suspected attention or behaviour problems. Ask us to consider sleep as part of that assessment — it belongs in it
• Waking coughing, or waking breathless
• Night waking that is new, or that started after an illness or a change
• Extreme difficulty settling that a consistent routine has not touched over several weeks
• Bedwetting alongside snoring — those two together point somewhere specific
• A child who is not growing well alongside disturbed sleep
• Sleepwalking with a safety risk
• You are not getting enough sleep yourself. A household running on four hours is a medical issue in its own right, and it is a legitimate reason to ask for help

The Arizona part

Our light and our heat both work against a child’s bedtime, and for months at a time.

Summer evenings stay bright long after a reasonable bedtime, which is a real signal to a child’s body clock that the day is not over. Blackout blinds are not a luxury here, and they do more for a summer bedtime than any amount of negotiation.

Nights do not cool down for months, and body temperature has to fall slightly for sleep to begin. Keep the bedroom genuinely cool overnight and use a fan for air movement — in a Phoenix summer, the thermostat is part of the bedtime routine.

And the household routine inverts. Families here shift outdoor activity to very early morning in summer, which is sensible and which quietly pushes the whole day earlier for the adults while children’s bedtimes stay put. If everyone in the house is short on sleep by August, that is why. Our winter-in-Phoenix page makes the case for using the cool months properly — and they are also the best sleeping weather of the year.

Sources

28. Bedtime habits for infants and children — MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. https://medlineplus.gov/ency/article/002392.htm

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