Keeping Kids Healthy by Dr. Sally Robinson
As any parent of a small child can tell you, their child’s poor sleep can leave the entire family with brain fog and irritability. It sometimes appears to parents that the less sleep their child gets the less they need.
Insomnia is common in both children and adults. In children, it can be difficult going to bed, difficulty staying in bed, difficulty maintaining sleep, or awakening too early. Insomnia occurs in about 20-25% of children and 25-35% of adolescents.
In children with chronic medical conditions, both psychiatric and neurodevelopmental disorders, it is even more prevalent (80%). Treating the behavior and learning problems are less successful until the sleep issues are resolved. Dr. M. Cecilia Melendres discusses sleep problems in Contemporary Pediatrics, March/April 2026. Insufficient nighttime sleep in children and adolescents has been shown to have deleterious effects. Physical, neurocognitive and behavioral consequences have been associated with poor sleep. Lack of sleep affects a child’s neurocognitive functioning, including attention, memory, and academic performance.
When there are concerns about behavior or school performance the first part of the evaluations is to determine the family’s sleep hygiene. Most of us have heard about sleep hygiene. In our society of multiple devices, multiple commitments, and multiple social upheavals good sleep hygiene isn’t easy but could benefit the entire family.
Dr. Melendres suggests the following for good sleep hygiene: First, the bedroom should be cool, dark, and quiet. The bed should be used only for sleeping. Second, a regular bedtime routine should be observed, including a quiet wind down time of 1-2 hours before bed. Electronics should be off at this time. No rough play or strenuous activities in the 2 hours before bed. Third, sleep schedule should allow for the recommended amount of nighttime sleep and should be similar on weekdays and weekends (6-12 years, 9-12 hours, 13-18 years, 8-10 hours). Fourth, Exposure to light in the morning and being active during the day. Fifth, no caffeine intake after lunch and finally, avoid naps, unless it is age appropriate.
Obtaining good sleep hygiene can be difficult unless the entire family is playing by the same rules and, most likely, the hardest part is turning off devices. Cognitive (behavior) therapy can be obtained that is appropriate for all ages. Behavior therapy has been shown to lead to improvement in sleep onset and in the frequency and duration of night awakenings. These evidence-based therapies train children to fall asleep independently by modifying parental response, adjusting sleep schedules, and establishing consistent routines.
Improved sleep can be so helpful in improving thinking skills and behavior that is felt that obtaining good sleep should be obtained before medication is prescribed. The first interventions should be obtaining good sleep hygiene, age-appropriate behavior therapy, and management of conditions or external factors that affect sleep before medications are tried.
Sally Robinson, MD Clinical Professor
UTMB Pediatrics - Children's Complex Care
Also see: Pediatric Primary Care