Typical sleep requirements vary with age. A newborn sleeps an average of 16 to 17 hours per 24 hours and this decreases with age to 12 to 13 hours in toddlers, 11 to 12 hours in pre-schoolers, 10-11 hours in school going children and 9 to 9 1/2 hours in adolescents. In addition, at the onset of puberty, adolescents develop an approximate 2-hour phase delay and a decrease in daytime alertness in mid puberty.
In a newborn, sleep periods of 3 to 5 hours in bottle fed babies and 2 to 3 hours in breast fed babies are separated by 1 to 3 hours awake. An infant typically takes a mid morning and early afternoon nap and the former drops out by 18 to 24 months. Most children do not need naps by 3 to 5 years old.
What is enough sleep?
There is an inter-individual variation in sleep requirements as well as tolerance to insufficient sleep. Enough sleep is the amount of sleep required for the child to feel well rested and function normally. Insufficient sleep is inadequate sleep relative to sleep need. Some signs of insufficient sleep in children include excessive daytime sleepiness, mood disturbances, behavioural problems, poor concentration and learning problems.
What are the common sleep problems in childhood?
Sleep problems are common in childhood. Approximately 25% of all children experience some type of sleep problems at some point in childhood, ranging from transient sleep disturbances e.g. Behavioural sleep disorders to more serious primary sleep disorders e.g. Obstructive sleep apnea hypopnea syndrome (OSAHS).
Some of these early childhood sleep disturbances may persist into later childhood in at risk individuals e.g. head banging in children with neuro developmental delay or resolve and resurface in adult life e.g. OSAHS. Many of these are disorders are preventable with education and anticipatory guidance of parents or are treatable.
Sleep-Onset Association Disorder (SOAD) is a condition characterized by reliance on specific stimulation or objects for initiating sleep or returning to sleep following an awakening e.g. rocking, breast feeding or bottle feeding.
Limit Setting Sleep Disorder is a condition whereby there is inadequate enforcement of bedtime limits by the caregiver resulting in the child stalling his bedtime or refusing to go to bed.
SOAD, Limiting Setting Disorders, Night Time Fears, Rhythmic moving disorders e.g. head banging are conditions that may result in bedtime struggles and delayed sleep onset times.
Parasomnias e.g. Confusional Arousals, Sleep Walking, Night Terrors are part of a spectrum of disorders resulting from arousal from deep sleep. Most children outgrow these problems.
Obstructive Sleep Apnoea Hypoventilation Syndrome (OSAHS) is a condition whereby there is intermittent obstruction or prolonged partial obstruction of the airway resulting in disruption of gas exchange and thus reduced oxygen or raised carbon dioxide in the blood. Early diagnosis and appropriate treatment is necessary to prevent complications of disease.
BEARS sleep screening algorithm
B= Bedtime problems
Any problems going to bed, falling asleep at bedtime?
E= Excessive daytime sleepiness
Any sleepiness / tiredness during the day? In school? Any naps?
A= Awakenings during the night
Any awakenings at night? Any sleepwalking or nightmares? Any trouble getting back to sleep?
R=Regularity and duration of sleep
Any regular bedtime and wake time? What are they on school nights? weekends? How much sleep? Is it enough?
S= Sleep-disordered breathing.
Any snoring or difficulty breathing at night?
Dr Jenny Tang
MBBS (S’pore), MMed Paediatrics (S’pore), MRCP (UK), FAMS, FRCPCH (UK)
SBCC Baby and Child Clinic, Asthma, Lung, Sleep and Allergy Centre, Gleneagles Medical Centre
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