How Occupational Therapy Can Treat Children with Sleep Problems

Are your patients getting enough sleep? If your child is having sleep problems, considering occupational therapy for kids might be a good idea. Children regularly sleeping the number of recommended hours by the American Academy of Pediatrics is associated with better health, including: improved attention, behavior, learning, working memory, emotional regulation, quality of life, and mental and physical health.¹

Typical Sleep Development ^{2, 3}

• Newborns: Sleep during the first few months of life occurs at any time depending on the newborn’s need to be fed, changed, and nurtured. Newborns may sleep anywhere from 10.5 to 18 hours each day with periods of one to three hours of awake time intermixed.
• Infants 4-12 months: Nine to 12 hours of sleep at night with two to three 30 minute to two-hour naps during the day is recommended for infants. By nine months, 70-80 percent of infants will be sleeping through the night.
• Children 1-2 years: Toddlers need 11-14 hours of sleep each day with naps decreasing to once per day and lasting one to three hours.
• Children 3-5 years: Preschoolers should sleep 10-13 hours each night and most children will forego naps at the end of this age period.
• Children 6-12 years: Children ages 6-12 should get 9-12 hours of sleep each night.

Sleep is a primary occupation of children until the age of five. It is crucial for homeostatic balance, and if left untreated, sleep deprivation can lead to more serious health issues.⁴ Sleep deprivation can impair safety and performance in daily tasks. Poor sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression.¹ Most studies have demonstrated a negative association between sleep duration and obesity. Shorter sleep periods align with an increased risk for children becoming overweight. Two analyses found that for each increased hour of sleep, the risk of obesity or becoming overweight decreased. ¹

Children that regularly sleep less than the recommended amount of hours may exhibit attention, behavior, and learning problems. Decreasing a child’s sleep by only one hour can have a negative effect on emotions, behavior, and cognitive skills, all of which play an integral part to a child’s ability to perform in school. ⁴ Insufficient sleep can lead to many academic problems by limiting planning and organization skills needed for problem solving, by worsening mood and behavior, reducing focus and attention, and hampering both long-term and working memory. It has also been found that people who regularly get poor sleep are more socially rejected than those that appear and feel well rested. At UC Berkeley, researchers discovered that sleep-deprived people feel lonelier, disengage, and avoid eye contact with others. This behavior also makes them appear socially unattractive to others. ⁵

Children sleeping at least 10 hours each night report less health complaints, while children with less than 8 hours of sleep report increased ADHD behaviors.¹ It is harder for sleep-deprived children to retain new information, and children with ADHD are specifically at higher risk.⁶

When treating a child for sleep issues, you may not think to prescribe occupational therapy; however, sleep/rest is one of the eight areas of occupation treated by occupational therapists. Occupational therapists use their knowledge of sleep physiology, sleep disorders, and sleep promotion practices to evaluate and treat the complications of insufficient sleep or sleep disorders on daily activities. When occupational therapists evaluate clients, they assess issues including sleep preparation, participation, latency, duration, maintenance, and daytime sleepiness. They also look at the impact of sleep on work, school, and other life events, the influence of pain and fatigue, psycho-emotional status, and troubles in other areas such as vision, balance, strength, skin, and sensory systems.⁷ Occupational therapists work together with the child’s healthcare team to identify possible contributors to a child’s sleep issues.  These include, but are not limited to, daily routines, nap schedules, and the bedroom environment as well as considering how physical, cognitive, sensory, and emotional disturbances may be impacting sleep. ⁸

Occupational therapy for kids is based on first educating parents and caregivers on the misconceptions and expectations of sleep and addressing factors that may exacerbate poor sleep quality. Establishing a predictable and smooth routine is an important step in treating a child with sleep problems. Setting regular wake and sleep times while modifying the bedroom environment, including noise, light, temperature, and bedding, helps the child wind down and prepare for sleep. Occupational therapists also focus on increasing coping skills and self-regulation to facilitate the child’s capacity to relax for sleep onset. ⁷

Sleep can be complex due to the environmental, physiological, psychological, and sensory aspects. Because sleep is so important and can have a serious impact on daily activities, from self-care to academics to social skills, it is key that children receive appropriate care from professionals, like occupational therapists, that are well trained to consider all of these factors. Consider prescribing occupational therapy for kids when they show signs of restlessness and sleep problems.