Is Your Child Getting Enough Sleep?

Lynn Smith: Today we're diving into one of the most elusive dreams of parenting sleep. While babies tend to get all the attention when it comes to sleep schedules, bedtime challenges for parents tend to get even more complex as kids get older. Whether you have a preschooler whose nighttime routine slowly morphed from a sprint into a marathon, or a teen who can't shut down before midnight, this episode has insights for you. We'll get into what's normal, how much sleep kids need, and signs they're getting too little or too much sleep. We'll also take on the topic of sleep aid supplements like melatonin and magnesium, which seem to be everywhere these days.

We're joined today by two parents whose families are in the throes of sleep time conundrums, as well as Dr. Stan Sonu from the Children's Strong4Life team. Dr. Sonu will draw from his experience as a pediatrician and a dad to answer questions he often hears from parents. Whether you captain a ship with toddlers, teens or both, this episode offers insights from you don't want to miss.

Tina, I want to start with you. Because your kids are close in age to where mine are now, young elementary schoolers, I can attest sleep is the most important thing, and waking them in the morning, especially after they're coming off a summer break, is killing me. What does sleep look like for you these days?

Tina Byrnes: Like many listeners today, I am a working mother. My daughter Ella is 6 years old in first grade. My son Mason is about to be 8 years old in second grade. Mason was always a perfect sleeper. First child, we thought everything was great and then came Ella. Both never wanted to be in the crib. Mason left the crib at 15 months, Ella at 12 months and got into big kid beds. The journey was completely opposite. Mason had no problem sleeping through the nights, for the most part. Ella found out quickly she could leave the bed fast forward. Now she's 6. She's still leaving the bed in the middle of the night. We have challenges whether it's I'm thirsty, it's too dark, or it's not light enough. I'm scared of the dark. Don't close the door. You name it.

Lynn Smith: Tina, you make a good point. You think you've got it down with one of your children, then the second one or third or however many come in and just throw everything out the window. Kelly, you're joining us for a little bit of insight into the world of parenting teens, especially when it comes to sleep, because they seem like they can sleep all day long. They start to go until noon. Tell me about your experience.

Kelly Thompson: I have three kids. I have Naomi, who's 18, just started her senior year. Charlie is 15, just started his sophomore year. Kate is 13, just started eighth grade. It's a little bit hectic around our house. They were all pretty good sleepers, honestly, when they were babies. I don't recall sleep ever being an issue for us, for me personally, but not for the kids. Once they hit puberty, there was a massive shift and Naomi could not see settle down before 11 p.m. She didn't sleep late. She would wake up at 9 a.m. Charlie, same thing. He would get in bed at a decent hour, 10 p.m., but he would not fall asleep. Now he doesn't fall asleep until like 2 or 3 a.m. on the weekends. He sleeps until the afternoon. Kate is the same way now that she's hit puberty.

Lynn Smith: Really throws you for a loop, right? You thought you had it down. Dr. Sonu, I'm going to guess none of this surprises you for all ages. Tell us a little bit about the trends you see.

Dr. Sonu: Thanks for having me again. It was interesting to hear, Kelly and Tina, both of your accounts and what you're experiencing. You're not alone. I'm sure you've thought of everything under the sun to try to optimize sleep for your children. Sleep is extremely important. As a society, we chronically undervalue sleep. We tend to run on this rhythm of chronic sleep deprivation.

The challenges, the sleep regression patterns or the change in onset of sleep that you see in adolescence, a lot of that can be normal physiologic change as children transition into puberty. Certain rhythms, normal natural sleep, wake cycles, those shift a bit. We have research that demonstrates that there's nothing wrong necessarily with that shift. It's just a normal part of development. The question is, how then do we pivot or adapt to those changes that our children experience? Tina, to your earlier point, I have a son who's 10 and a daughter who's 6. My son, like your son, was great at sleeping. My daughter is a great, very different story. Even within the same family, even if you have a routine that worked for one child, every child is different. For sleep, that's especially true. Differences in your children's temperament can be somewhat connected to their tendency or their patterns around sleep.

Lynn Smith: You talked about a sleep deficit from what I understand. Please clear this up. It's not like you can have a great night's sleep the next day, and it makes up for two hours the day before, which is why as parents, we get really concerned. Is that true?

Dr. Sonu: That's generally true. When we're sleep deprived, we feel that most when we're awake. Unless we are operating on high speed, high octane the entire day, chances are we are going to feel like we need to take a nap. The most inopportune time for naps is right around that supper, you know, 4, 5 to 7 p.m. window. I hear in my clinic that a lot of teenagers come home from school, and they just need to crash for an hour. They get back up, maybe eat supper and then do their homework. We kind of create strong currents for families to have to swim against when it comes to sleep.

Lynn Smith: That's such a good point. Sports in general, we get home at 10 p.m. We have to turn around to be up at 7 a.m. We hear it's important for us to get sleep. You're reiterating this, but what is it about it that makes it so important and how does that change as our children grow?

Dr. Sonu: What we know from short-term and medium-term studies is that when children don't get that recommended amount of sleep consistently over time, behaviors develop that can be associated with ADHD—hyperactivity, impulsivity or other cognitive deficits can show up. If you have a young toddler who's just not getting good sleep, or a young child, first grader, second grader, consistently not getting good sleep, then they're tired during the day, which lowers their threshold for a tantrum or some kind of behavioral challenge. Think about how many of those children might be mislabeled as ADHD or having some kind of behavioral problem that then puts them on this path of needing to see a counselor or perhaps medication down the road. The root cause might be a sleep pattern. Most parents have routines, but how often or consistently that routine is implemented, that's a different question.

Lynn Smith: We've experienced that with my son where he just needed his adenoids out. He wasn't sleeping because he couldn't breathe. Then he was having behavioral issues. It was just the knowledge we needed in order to be able to make the decision to have something serious like surgery. I want to ask you about sleep hygiene. We don't mean taking a shower before bed--how dark it is in the room, noise machines. With my first, we were obsessed with the darkest room, cold and a sound machine. To this day, he cannot sleep anywhere but his room. My youngest can sleep anywhere. It's habits that we give them early on. How much does that affect them, and what should we be doing?

Dr. Sonu: The research isn't necessarily a home run, but there is a strong signal that things like sleep hygiene and sleep routines do work now. They work better for younger children. I would say even up until fifth grade, things like sleep routines and sleep hygiene work. Sleep hygiene includes all the things you mentioned. A really important one that we should ask our children about is the temperature of the room. Sometimes if the ventilation in that room isn't great, some parents will get a small desk fan and just have that running, not pointed it directly at their child because that can cause other problems, but just have the air circulating in the room. Considering dietary discretion, make sure children aren't coming home from school and getting a drink with caffeine in it or tons of sugar.

Lynn Smith: Even staring at your phone. For teens, how much is that affecting them?

Dr. Sono: That's the big one and the hill that many parents find themselves battling their teens. The teenage brain is growing and increasingly peer oriented. Maintaining social ties is so important. We can all imagine going back to our teenage selves and you have school. You get through class. You may have a sport practice in the afternoon. You have dinner. You do your homework. Then, at 9:30 or 10 p.m., when all is done, if you have an ability to talk with your friends, chat with them, see what's going on in social media, there's a very strong current or pull to want to socialize. Socializing is one of the greatest ways to help our brains release dopamine.

Socializing feels good. It activates the reward circuits in our brain. At the end of the night, when we want to be winding down, a lot of teens are ramping up because then they're reaching out and texting their friends to see what's going on. That ramping up delays their onset of sleep by some time. Now, I bring that up not to say we shouldn't let them socialize. We have to be willing to work with our children, especially our teenagers, to find a balance that is healthy and right for them.

Lynn Smith: Kelly, I'm curious, do you experience this with your teens and what is the effect of their lack of sleep? What do you notice about them?

Kelly Thompson: I don't know that I experience it necessarily from the socialization standpoint, but I definitely experience it from the natural routine of the day. They go to school. They get home. They have all kinds of sports practices. We prioritize family dinner. The majority of us will be eating together, sometimes late at night. Then there's shower and then they have homework. We've done a pretty good job of making sure that they don't have their phones in their rooms, that they don't have their computers in their rooms after a certain period of time. They do have homework, particularly my Charlie, my sophomore, and Naomi, my senior. They have a ton. We struggle with whether they stay up late and do their homework or go to bed and get up early to finish their homework? It's a net effect. They either lose it at the beginning or they lose it at the end. They're great kids. I don't know if when they give us attitude it's because they are tired or if they're just being teenagers. We definitely see it. It's hard and we worry about it a lot.

Lynn Smith: Tina, what about you for the littler ones? They're not on their phones, but I know with my boys I can barely get them to wind down. What are the effects of lack of sleep for you?

Tina Byrnes: I think about my husband. We're going through the routine of getting them ready for bed and all of a sudden he wants to wrestle my son or play chase with my daughter, right? We're halfway through the routine. We're settling down, and now they're not ready to go to bed. Ella, my tough sleeper, often says sleep is boring. Do kids sometimes need less sleep than other children? Perhaps we're forcing her to go to bed at a time that we should change. When they do not get the right amount of sleep, it's temper tantrums, not wanting to go to school or having bad days at school. It certainly adds up.

Lynn Smith: Dr. Sonu, Tina makes a great point in that maybe they don't need to go to sleep if they don't seem tired. Is that true?

Dr. Sonu: Every child is different, even within the same family. That's why we have ranges of recommended sleep durations. I'm not strict about them in my clinic because within a family, inexplicably there could be a wide range between the children. You pay attention to the behavior of your child the day after they get that less amount of sleep. If they're regulated and flexible and can handle transitions, and you see their threshold for tantrums is high, then maybe they truly don't need as much sleep. Sleep deprivation can also stack. I wouldn't make a sweeping judgment after one or two days, but I would try it out for a week or two and then see.

There's a kind of intervention that is quite underutilized and it's called the fading out method. If you have a child who your desired bedtime is 8:30 p.m., but they're going to sleep consistently at 11:30 p.m., and you've tried your best and have been consistent with the sleep routines, this approach suggests that one night we allow the child to go to bed when they naturally start to feel more tired and sleepy. If that ends up being at 11 p.m., we allow that to happen. Over a span of several weeks, we gradually, in 15-minute increments, increase the bedtime or make it earlier. Instead of 11 p.m., now it's 10:45 p.m. We do that for a couple weeks. Then, we move it to 10:30 p.m. That process might seem slow and drawn out, but it works and there's evidence to support it. There's less conflict doing it. It requires a lot of mutual trust between the child and parent.

Lynn Smith: I've struggled because my 6 year old will wake up and, especially during the school year, say, “I'm so tired. Please let me sleep.” Sleep to me is number one because I've been told this is when their brain develops. This is when they grow. Sometimes, I'll have them be late for school just because I want him to get that kind of sleep. Is there too much sleep? Is there any such thing?

Dr. Sonu: The reason too much sleep can be concerning is that it may be a signal of something else going on that's not directly related to sleep. To this day, under recognized causes of too much sleep or inappropriate sleepiness despite adequate sleep is anxiety and depression and sleep. Unusual sleep patterns or erratic sleep patterns or too much sleep may be the first clue that there is something going on.

Lynn Smith: What about bed sharing and co-sleeping? We were very aware with babies of the dangers that could happen with a little infant in bed with adults. As they get older, we know they shuffle down the hallway and ask, “Can I sleep with you?” I'll admit I'm guilty of this. They're not little for long, and I say, “Yes, you can.” What do we need to know about co-sleeping?

Dr. Sonu: Lynn, this is where it gets real now.

Lynn Smith: My mom tells me no, but I'd rather Dr. Sonu tell me. I think Tina is asking for a friend.

Dr. Sonu: I'm an AAP member and follow the guidelines that most pediatricians in the United States follow. At the same time, I'm a human being and a father. There's a realist part of me that shows up. The AAP certainly has very clear guidelines on safe sleep for infants, but there's no language around when the recommendation against co-sleeping is released. Generally speaking, after the child is walking, which is around 12 months, and they have a bit more gross motor development is when I hear parents co-sleeping more.

Lynn Smith: It's more of a philosophical question than it is a medical question.

Dr. Sonu: Exactly. Where I'll land with them is if this arrangement leads to more net sleep, then it's working for you. If having a conventional sleep routine, process and hygiene and having the kids stay in their room the whole night is not working and you've really given it a fair shot, then do what works. Our six year old, 80 percent of the time, will sleep the whole night in her room. Maybe, 20 percent of the time, I'll wake up, and she's at the foot of our bed or squished in between me and her mom. Sometimes she has a dream or after she uses the potty, she wants to come snuggle with us. We don't have any strict rules against that in our household.

Lynn Smith: That's great to know.

Tina Byrnes: We probably created a terrible routine where we introduced melatonin to Ella because she couldn't go down. She wasn't tired, but in the middle of the evening, around 2 a.m., the melatonin's wearing off. She's awake, and pitter patter down the hallway. Here she comes. Our new rule was don't wake mom and dad. You can come into our bed and sleep, but we need sleep. We tried to introduce the walk back method, where we would get up, walk her back to her room. She'd pitter patter back down the hallway, we'd do it again. We found in the long run, to your point, it was affecting all of us instead of just Ella not sleeping. This new method of her coming in and not waking us has worked, but now we're on year two of it. How do we break it?

Lynn Smith: I would love to hear the answer to this one. I also want to get your thoughts on melatonin. Let's start with how you break those routines.

Dr. Sonu: Routines are easy to slip into, hard to break. The only way that I found to help parents break routines is have a new intention. It might not be a big shift, but it may be a conversation you have before bedtime. Say, “You're older now and things might not be as scary for you as they were when we started this pattern. Let me walk you back and see if you can do it.” Not in a way that's forcing it, but offering it to her to say, “You want to try it again and see how she feels?” There's no harm in asking, “Do you want to try it? I think you're ready.” That could be one strategy.

For waking up in the middle of the night, coming into your bed again, if this is working for her, and she's doing well at school, in her relationships and still acting like herself, then if it's okay with you, ride the wave.

Lynn Smith: Maybe this is something she needs emotionally?

Dr. Sonu: That's an under recognized part too. Lynn, Melatonin is interesting because there is data that has found a benefit in giving melatonin to help children sleep. The data seems to be strongest in children with a neurodevelopmental problem, or may be neurodivergent, maybe they have autism, some with ADHD. It hasn't been as promising for the average child. It's an interesting finding. We don't really know why some children respond to it and others don't.

Melatonin is a hormone that our brains produce, naturally in our bodies. The way it's regulated is by when our eyes see light, natural light in the morning. Natural light is what helps to synchronize our melatonin production in the brain. These studies have found that when you give melatonin 30 minutes to an hour before a child's bedtime, if they have autism, they tend to have less delayed sleep onset. They go to bed more quickly, and they can stay asleep. The risks of taking melatonin are fairly low. The theoretical risks do suggest that melatonin, because it's a hormone, may have some activity in some of the hormone pathways in our bodies in the long run. We just don't know. We just don't know its effects on puberty and development in adolescents.

Lynn Smith: Is it the same for magnesium because that is pitched as more natural and relaxing than melatonin?

Dr. Sonu: Magnesium is an interesting one because there has been some signal in the adult population that it can help with sleep onset. Unfortunately, there is no sound data in children that it works or is safe. One study looked at the effect of giving vitamin D and magnesium to children with ADHD and found that they had less behavioral problems. It didn't specifically comment on sleep. Magnesium does have known side effects. At higher doses, specifically, it can cause some GI upset, diarrhea is a big one. It relaxes our smooth muscle, even around the heart. It can lower our blood pressure in excess amounts. It can lower our blood pressure to dangerous levels.

Lynn Smith: Instead of allowing your children to come out in the middle of the night, some parents choose to lock their kids in the room and say, “You're staying in the room, and that's it.” What's your take on that?

Dr. Sonu: That's a hard one. I don't love the practice. I understand it. Can it work? I have heard cases where it has done the job but at what cost? To what end? Being locked in a room with no way out can be conceivably terrifying and scary, especially for a young child. It's a tough balance to justify or put on the other side of the scale without knowing the exact circumstances that people are in. I don't advise it. I think it can send confusing messaging to the child. We want them to know we're here no matter what, day or night. If you feel scared, we got you. They're safe.

Tina Byrnes: I'm so glad to hear this because I did this with Mason. When he was between 2 and 3, he realized he could get out of his bed, and we locked his room for three nights. It was the hardest thing as a mother to hear him pounding on the door, and then it was over. He sleeps through the night now. The challenge is absolutely real when you hear them knocking on the door.

Lynn Smith: Same applies for the “Cry It Out” theory, which killed me. They were sleeping but to what end? I'd like to get into sleeping on breaks from school, then getting back into the routine of school— whether that's summer or holidays or whatever it is. In our house, you can stay up until 11 p.m., because you need to be able to just have fun and sleep in. Then, you have to get back on track. What are some strategies around that?

Dr. Sonu: The simplest method is a graded transition back. If you've got a week or two ahead of you, ideally you've got two weeks every few nights, move that bedtime forward 15 minutes from wherever they're at, but stick to it. Set a hard morning wake up time. That's the other piece that's important to get this schedule, this transition, moving. Some parents ask me, “How long when it comes to weekends? How late should I let my child sleep in, if they're going to bed at this time during the week and waking up at 6 or 7 a.m. during the week?” I ultimately say, “Do what works for your family.”

In general, if you want a loose recommendation, don’t let them go beyond two hours during the school year. If they're waking up at 7 a.m., we really don't want them waking up beyond 9 a.m.

I know some teenagers who hear this will want to throw darts at me for saying that. It's a general recommendation. Do what works for your family, but that helps to mitigate some of the difficulty sleeping on Sunday night, which is where we see a lot of problems.

Kelly Thompson: That definitely applies to us right now. They sleep late in the day, late in the morning. I use the term “morning” very loosely. Sometimes it travels to the p.m. hour. They've been so sleep deprived during the week. Am I doing them justice by Letting them sleep in until noon on Saturday? The flip side is, what time do they go to bed? They don't go to bed until 1 or 2 a.m. We end up in this vicious cycle.

And another thing I wanted to ask you goes back to sleep hygiene. We take away screens. They don't do anything. If their body clock, their body rhythm isn't going to sleep, should they be reading a book? If they're reading a book, are they reading an actual book and then a light is on, or are they reading a Kindle in front of a screen, or do they just lay there? We struggle with that.

Lynn Smith: What are your thoughts on that?

Dr. Sonu:First, I applaud you for negotiating screens out of the room before bedtime. You're leading the way for us, Kelly, and I'll come take notes from you when my kids are older.

Kelly Thompson: There's no winning there. I'll just tell you that right now. It's a constant battle.

Dr. Sonu: I know it's a struggle. There's some research that says that blue light seems to suppress melatonin secretion. There's a physiological reason why we don't want our children or teens looking at a screen in a dark room that's bright because it may actually delay their onset of sleep. On the flip side, reading a Kindle, having a soft light, reading a book, I'm green light for all those things. Now, can a scary book wake someone up? Sure, but on average, will it do that? I don't think so. If I have a teenager who's willing to read a book as opposed to browsing Snapchat, 100 out of 100 times, go ahead.

Lynn Smith: Is there anything that is a significant factor that we have control over, like diet or exercise? Getting them a huge amount of exercise and making sure they have a full meal before they go to bed, can that improve sleep?

Dr. Sonu: Exercise is overlooked when it comes to sleep. The recommendation is 60 minutes of exercise a day, which I don't think is a reality or realistic for most families, but exercise can help regulate sleep wake cycles very effectively. They need to be somewhat tired and exhausted and have exerted themselves for that to help. Exercise within two hours of bedtime, that can be activating. Paradoxically, we're veering into things that we can't control necessarily, like practice times that end at 9 p.m. You have to find ways to adapt to those schedules. You might not get good sleep that night, but the next night maybe you can catch up.

Diet is interesting in that the one thing that we certainly advise is avoiding caffeine after 4 or 5 p.m. Avoid anything with caffeine or high-sugar beverages. Outside that, the general guidance is a healthy balanced diet that includes fiber, fruits, veggies, whole grains, some protein and maybe some dairy. A balanced diet is an optimal diet for sleep.

Lynn Smith: As we wrap up, Tina, Kelly, you've offered great perspective from a parent's point of view, the challenges, the moments of weakness so relatable to so many of us. Dr. Sonu, I think I speak for all parents when I say we appreciate how you balance your experience as both a physician and as a dad. As we close out, what's the one thing you want parents to remember when it comes to sleep?

Dr. Sonu: The one thing I would love to leave parents with as they think about sleep for their school-age child or teenager is that sleep is one of the most important, yet underappreciated, modifiable factors that can greatly impact our health—especially in childhood with development related to the brain and behavior. If it's been a while or you haven't ever thought about your child's sleep quality or their patterns in hygiene, now's a good time to revisit it. It shouldn't be a sleep routine that only works for the parent or is inconvenient for the parent and only works for the child. It should be a mutually agreed upon thing. If there are still problems, try to be open to the possibility that something else might be going on in teenagers. Like we mentioned before, a sleep problem might be the first signal of an underlying mental or emotional issue that needs attention. In general, no matter what we're going through, life just feels a little bit less stressful and overwhelming when we get good sleep.

Lynn Smith: I hope you enjoyed this fun change up to our usual format as much as I did. Big thanks to all the staff members who took time to share these great insights with us. For more sleep resources from the Children's Strong4Life team, head to choa.org podcasts. We're going to link to a wealth of resources to help get your family back on track. I'm Lynn Smith and this has been Hope and Will, a parenting podcast from Children's Healthcare of Atlanta.

This podcast is for general informational and educational purposes only. It is not to be considered medical advice for any particular patient. Clinicians must rely on their own informed clinical judgments when making recommendations for their patients. Patients in need of medical or behavioral advice should consult their family healthcare providers.