Sleep problems in children and adolescents

Adequate sleep is essential for development and wellbeing. Sleep requirements change with age—Recommended sleep times for healthy children and adolescents gives recommended sleep times for healthy children and adolescents.

Table 1. Recommended sleep times for healthy children and adolescents
[NB1]
Age	Recommended sleep time (hours)	Not recommended sleep time (hours)
0 to 3 months	14 to 17	less than 11 or more than 19
4 to 11 months	12 to 15	less than 10 or more than 18
1 to 2 years	11 to 14	less than 9 or more than 16
3 to 5 years	10 to 13	less than 8 or more than 14
6 to 13 years	9 to 11	less than 7 or more than 12
14 to 17 years	8 to 10	less than 7 or more than 12
Note: NB1: Individual sleep requirements vary; if a child sleeps more or less than the recommended duration for their age group but is not distressed or impaired, they may be receiving adequate sleep. Adapted with permission from Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 2015;1(1):40-3. URL

Over a third of children and adolescents experience sleep problems. Daytime sleepiness is the most recognisable symptom of sleep problems and can present differently in children and adolescents to adults (eg behavioural or learning problems). The Raising Children website provides comprehensive information on sleep in children and adolescents.

Behavioural sleep problems are common in children and adolescents—see the Australian Sleep Association website for assessment and treatment advice.

Other causes of sleep problems in childhood and adolescence include:

parasomnias—commonly nightmares, sleep terrors, confusional arousals, and sleepwalking and rarely, rapid eye movement (REM) sleep behaviour disorder
delayed sleep–wake phase disorder—particularly common in adolescents
obstructive sleep apnoea
comorbid anxiety or depression
restless legs syndrome and periodic limb movements of sleep/wakefulness—seek specialist advice if suspected.

If a child or adolescent has difficulty sleeping, first-line therapy is good sleep hygiene; see the Raising Children website for advice.

If a child or adolescent does not respond to treatment, seek specialist advice (eg paediatrician, sleep specialist, child psychiatrist).

Although melatonin is widely used for sleep problems in children and adolescents, high-quality evidence of benefit and long-term safety data are lacking. There is also little evidence to guide dosing, choice of formulation and timing of administration. Melatonin should only be used for sleep problems in children and adolescents with specialist advice (eg paediatrician, sleep specialist, child psychiatrist).