Children's Sleep

Children's Sleep: A Comprehensive Reference in Nutrition and Natural-Health Context

1. Definition and Overview

Sleep disorders are defined as any disturbance in the sleep timing, quality, or quantity that affects the baseline functional status of an individual. In the pediatric context, this encompasses a broad spectrum of difficulties ranging from problems initiating or maintaining sleep to abnormal nocturnal behaviors and excessive daytime sleepiness. According to the third edition of the International Classification of Sleep Disorders (ICSD-3), there are seven major categories of sleep disorders: sleep-related breathing disorders, insomnia, parasomnia, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, and other sleep disorders.

Epidemiological studies have shown variations in the prevalence of pediatric sleep disorders, but sleep problems are prevalent in approximately 50% of children. The essentiality of sleep in maintaining body health is well known and studied, especially in the pediatric population, as their physical, psychological, and mental functions are still developing. Chronic childhood sleep deprivation is considered a risk factor for impaired mental health, cognition, emotional regulation, immunity, and the development of chronic diseases in adulthood.

Sleep disorders may affect 20–30% of young children, and include excessive daytime sleepiness, problems getting to sleep (dysomnias), or undesirable phenomena during sleep (parasomnias), such as sleep terrors and sleepwalking. Common complaints related to sleep disturbances include difficulty initiating or maintaining sleep, abnormal behavior or movements, snoring or abnormal breathing, and excessive daytime sleepiness.

2. Age-Specific Sleep Requirements

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents, using a modified RAND Appropriateness Method. A panel of 13 experts in sleep medicine and research used this method to develop recommendations regarding the sleep duration range that promotes optimal health in children aged 0–18 years. The expert panel reviewed published scientific evidence addressing the relationship between sleep duration and health, resulting in a total of 864 scientific articles.

The resulting age-specific recommendations are:

• Infants 4 to 12 months should sleep 12 to 16 hours per 24 hours (including naps); children 1 to 2 years of age should sleep 11 to 14 hours (including naps); children 3 to 5 years should sleep 10 to 13 hours (including naps); children 6 to 12 years should sleep 9 to 12 hours; and teenagers 13 to 18 years should sleep 8 to 10 hours per 24 hours, all on a regular basis to promote optimal health.

The Pediatric Consensus Panel found that sleeping the recommended number of hours on a regular basis is associated with overall better health outcomes including improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. The panel found that sleeping fewer than the recommended hours is associated with attention, behavior, and learning problems.

3. Body Systems Involved in Pediatric Sleep

Sleep has been implicated in the optimal functioning of all organ systems — brain, heart, lung, metabolism, immune function, and hormonal balance.

3.1 Neurological and Cognitive Systems

Among the leading theories for the role of sleep are that it provides a time of relative cortical quiescence to allow brain energy stores to rebuild; that sleep allows an opportunity for synaptic pruning which facilitates neural plasticity allowing memory and learning; and that sleep provides an opportunity for the clearance of neural waste products through the glymphatic system, which is activated during sleep.

Chronic sleep disturbances can significantly impair cognitive, emotional, and social functioning, leading to deficits in attention, alertness, and executive function, alongside increased irritability, anxiety, and depression. For pediatric patients, such disturbances pose additional concerns, potentially disrupting developmental processes and quality of life for both children and their families.

3.2 Endocrine System and Growth Hormone

During deep (slow-wave) sleep, there is an increase in growth hormone (GH) secretion. This peak of GH during sleep is essential for growth and muscle development, as well as tissue regeneration and repair. GH has a strong association with brain activity during deep sleep and plays a role in maintaining tissue homeostasis. Furthermore, GH has been identified as being one of the potential mechanisms that link sleep to body composition.

Insufficient or poor quality sleep can have a significant impact on the development, learning, behavior, and overall health of children, including a detrimental effect on their physical and mental well-being. Other effects include difficulties with concentration, increased irritability, growth impairment, weakened immune function, anxiety, and depression.

3.3 Immune System

Proper and adequate sleep enhances immune function and may reduce the likelihood of developing a number of diseases, such as cardiovascular disease, diabetes, and stroke. It has also been found to improve memory and help learning, and to regulate the secretion of growth hormone, which is responsible for the physical development of children and adolescents.

3.4 Metabolic System and Cardiometabolic Risk

Many adverse consequences are associated with child sleep deficiency, including physical outcomes such as obesity, neurocognitive outcomes such as memory and attention, intelligence, and academic performance, as well as emotional and behavioral outcomes including internalizing and externalizing behaviors and behavioral disorders.

Inadequate sleep affects the regulation of homeostatic and hormonal systems underlying somatic growth, maturation, and bioenergetics. Regularly sleeping fewer than the recommended number of hours is associated with attention, behavior, and learning problems. Insufficient sleep is also associated with increased risk of accidents, injuries, hypertension, obesity, diabetes, and depression.

3.5 Circadian Rhythm Regulation

Sleep is regulated by myriad intricate biological mechanisms, including circadian rhythm, sleep neurons, and neurochemical activity. Circadian rhythm governs the body's sleep–wake cycle, while sleep neurons regulate the transition between wakefulness and rest. Neurochemical regulation involves various nervous systems and chemical substances working together to maintain sleep balance.

Melatonin, a hormone produced by the pineal gland, is directly involved in the regulation of circadian rhythms and sleep–wake cycles. From a physiological standpoint, melatonin is synthesized from the essential amino acid tryptophan via the neurotransmitter serotonin, and the endogenous production of melatonin starts at 3–4 months of age and progressively increases throughout childhood.

4. Classification of Common Pediatric Sleep Disorders

4.1 Behavioral Insomnia and Dyssomnias

Obsessive-compulsive disorder, anxiety, depression, and psychophysiological disturbances may lead to insomnia. Substance misuse and drugs such as fluoxetine might also play a role.

4.2 Parasomnias

Non-REM sleep parasomnias typically occur in the transition from the deeper into the lighter stages of sleep, about 2–3 hours after initial onset. The child wakes up agitated and confused or walks while asleep, with no recollection of the event the following morning. Most resolve spontaneously over a matter of months. When non-REM parasomnias become problematic, an underlying disorder such as sleep-disordered breathing or restless legs syndrome is often triggering partial arousals.

4.3 Sleep-Disordered Breathing and Obstructive Sleep Apnea

Globally, estimates suggest that obstructive sleep apnea (OSA) affects approximately 1–5% of children. According to the American Academy of Pediatrics' 2012 guidelines, the prevalence of OSA in the pediatric population is about 1.2–5.7%. The European Respiratory Society's 2016 statement, referring to a meta-analysis of published studies, reports the prevalence of OSA in a range from 0.1 to 13%, among which most studies show a frequency between 1% and 4%.

4.4 Circadian Rhythm Disorders

The delayed sleep phase syndrome typically starts in adolescence, mostly in boys. Patients are habitually unable to fall asleep before 2 or 3 am and prefer to wake in the late morning or early afternoon. They show normal sleep quantity and quality when allowed to sleep freely, but are very sleepy when they have to conform to more conventional sleep–wake schedules. A higher likelihood of HLA DR1 and the occasional familial clustering of delayed sleep phase syndrome suggest a genetic predisposition.

4.5 Restless Legs Syndrome (RLS) and Restless Sleep Disorder

Population-based studies estimate a high prevalence of 2–4% for pediatric RLS, which exceeds other common childhood disorders such as pediatric diabetes (<1%) and seizure disorders (~0.5%). Approximately one-third of children are affected by moderate-to-severe RLS symptoms, impacting sleep and daytime function.

Pediatric restless legs syndrome, a neurologic sleep disorder characterized by an uncomfortable urge to move the legs while at rest, is present in 1.9% of children in general pediatric population surveys and 5.9% of patients in pediatric sleep centers. In addition, restless legs are reported as a comorbid diagnosis in 12% to 35% of children with attention deficit hyperactivity disorder (ADHD).

5. Contributing and Associated Factors

5.1 Developmental and Physiological Factors

Evidence of the etiology of sleep disorders in children is generally limited; however, the proportion of rapid eye movement (REM — active sleep) is greater in infants than in adults. REM is frequently associated with awakenings, and infants with a sleep disorder often need assistance to resume sleep after such arousals.

The duration, quality, and architecture of sleep change over the course of life, particularly in the first 5 years, with a significant impact on the developing brain.

5.2 Neurodevelopmental Conditions

Preschool-aged and school-aged children were more likely to receive a sleep disorder diagnosis than were patients in other age groups, with household income, growth parameters (head circumference and BMI), and comorbid developmental disorders (ASDs and ADHD) also being related to whether a patient received a sleep disorder diagnosis.

The prevalence of sleep disorders tends to be even greater in children with physical or learning disabilities: about 86% of children aged up to 6 years, 81% of children aged 6–11 years, and 77% of children aged 12–16 years with physical or learning disabilities suffer from severe sleep problems.

5.3 Anatomical Factors

Adenotonsillar hypertrophy, neuromuscular disorders, and craniofacial abnormalities such as retrognathia, maxillary hypoplasia, and macroglossia are important predisposing factors. Multiple predisposing factors may coexist, as seen in Down syndrome.

There is also a "congenital–structural" phenotype characterized by a high prevalence of OSA, appearing from the earliest ages of life, supported by morpho-structural abnormalities or craniofacial changes associated with genetic syndromes such as Pierre Robin syndrome, Prader-Willi, achondroplasia, and Down syndrome. Neuromuscular disorders and lysosomal storage disorders are also frequently accompanied by a high prevalence of OSA in all life ages. Early recognition and proper treatment are crucial to avoid major neuro-cognitive, cardiovascular, and metabolic morbidities.

5.4 Iron Deficiency

Although the pathophysiology of restless sleep disorder is not fully established, current research points towards iron deficiency as a main contributing mechanism. Early studies demonstrated that children with restless sleep disorder had low ferritin levels. On average, children with restless sleep disorder were found to have ferritin levels around 20 ng/dL. Nonanemic brain iron deficiency in patients with restless legs syndrome has been identified and defined as ferritin levels lower than 50 ng/dL.

A deficiency of brain iron stores results in a reduction of dopamine production and the clinical expression of RLS. Brain iron stores cannot be directly quantified for clinical purposes but can be evaluated indirectly by measuring serum ferritin.

6. Nutrients, Herbs, and Natural Ingredients

6.1 Melatonin

Scientific Evidence

Melatonin is a hormone produced by the pineal gland and is available over the counter for treating sleep problems in the pediatric population. A systematic review of randomized clinical trials (RCTs) was conducted on MEDLINE; six studies met inclusion criteria. RCTs were conducted in patients from two to eighteen years of age with a DSM-IV diagnosis of autism spectrum disorder (ASD) and/or ADHD in both short-term and long-term RCTs ranging from eight-week to 52-week studies.

The mean difference in the children's sleep disorder showed statistically significant improvement in sleep duration and sleep latency onset compared to placebo. Overall, a high response rate was observed in the melatonin group compared to the placebo in treating sleep problems in children.

In two small randomized trials involving children and adolescents with atopic dermatitis, melatonin supplementation showed positive outcomes. In the first trial, 48 children with atopic dermatitis experienced a greater reduction in the severity of their condition and a shorter time to fall asleep when taking melatonin (3 mg) compared to placebo; no side effects were reported. The second trial, which included 70 children aged 6 to 12 years, found that those taking melatonin (6 mg) had greater improvements in their skin condition and sleep quality compared to those on placebo, with lower levels of serum total IgE and longer sleep duration, with no reported adverse events.

Low certainty evidence supports a moderate effect of melatonin in treating sleep continuity parameters in children and adolescents with chronic insomnia due to primarily medical disorders. The off-label use of melatonin for these patients should never be the first choice of treatment, but may be considered by medical specialists with knowledge of the underlying disorder and if non-pharmacological interventions are inadequate.

Melatonin appears to be effective in treating chronic insomnia in children with ADHD but appears to have minimal effects in reducing core ADHD symptoms.

Evidence strength: Moderate evidence from multiple RCTs supports melatonin's effect on sleep onset latency and total sleep time, particularly in children with neurodevelopmental conditions. Evidence in neurotypical children is more limited. Results in ASD/ADHD populations cannot be generalized to children with other psychiatric illnesses.

6.2 Iron

Scientific Evidence

Iron deficiency is thought to be important in the pathophysiology of restless legs syndrome (RLS), but studies measuring the effects of iron supplementation on RLS symptoms have yielded mixed results. Researchers assessed the relationship between RLS symptoms and serum ferritin in a cohort of pediatric patients and measured the effects of oral iron supplementation on ferritin levels and RLS symptoms. They found that improving low serum ferritin levels modestly improved RLS symptoms in some children but did not lead to statistically significant improvement in children with definite RLS.

Responders to oral iron supplementation showed an improvement in symptoms and also an increased level of ferritin, as early as 2–3 months after supplementation.

There is currently no definitive research evidence for iron efficacy in most children with RLS. A 3 mg to 6 mg elemental iron per kg per day dose for three months could be tried if the ferritin level is <50 µg/L. Sleep hygiene and behavioral strategies are also recommended. Iron supplementation should be safe in the absence of iron metabolism disorders, provided that transferrin saturation and ferritin levels are monitored pre- and post-treatment.

Evidence strength: Preliminary and mixed. Evidence from cohort and retrospective studies supports the relationship between low ferritin and restless sleep/RLS in children; however, controlled intervention trials demonstrating consistent, significant improvement remain limited.

6.3 Magnesium

Scientific Evidence

Melatonin is synthesized enzymatically by the sequential actions of four enzymes and requires Mg (magnesium) and B vitamins as cofactors. This positions magnesium as a nutrient of biochemical relevance to sleep-hormone synthesis.

After 12 weeks of consumption of a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc, most subjects in an observational cohort showed a considerable reduction in symptoms of attention deficit and hyperactivity/impulsivity. Assessment revealed fewer emotional problems and also reduced sleeping disorders. Problems falling asleep in particular decreased during the 12-week nutritional therapy. This was an observational cohort study of 810 children aged 5–12 years, which limits causal inference.

Melatonin, magnesium, and zinc have been studied for their potential roles in sleep regulation, but further research is needed to establish their optimal use in the treatment of insomnia.

Evidence strength: Preliminary. The role of magnesium in pediatric sleep has principally been examined in combination supplement studies and mechanistic (cofactor) research, not isolated pediatric RCTs. Evidence is insufficient to establish independent efficacy in children.

6.4 Zinc

Scientific Evidence

Zinc is a cofactor for enzymes that are important for cell membrane stabilization and in the metabolism of neurotransmitters, melatonin, and prostaglandins.

Iron and zinc supplementation may have benefit in reducing symptoms in children with or at high risk of deficiency. Data demonstrating efficacy of iron, zinc, or magnesium in non-nutrient-deficient populations is lacking.

Evidence strength: Preliminary and largely indirect. Zinc's sleep relevance in children stems primarily from its role as a cofactor in melatonin metabolism, and from combination supplement studies. Isolated zinc intervention trials in pediatric sleep are not yet established.

6.5 Omega-3 Fatty Acids (EPA and DHA)

Scientific Evidence

Recent studies suggest that omega-3 fatty acids may improve sleep in children with clinical sleep deficiencies. Omega-3s might also play a role in melatonin production and neuronal function, which could support sleep onset and maintenance, though more research is needed to fully understand this relationship.

An observational cohort study monitored 810 children from 5 to 12 years of age referred for medical help and recommended for consuming polyunsaturated fatty acids (PUFA) in combination with zinc and magnesium by a physician over a period of at least 3 months. The food supplement used contained a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc. The study objective was to evaluate the nutritional effects of the PUFA-zinc-magnesium combination on symptoms of attention deficit, impulsivity, and hyperactivity, as well as on emotional problems and sleep-related parameters.

Evidence strength: Preliminary to moderate. The best-available pediatric evidence comes from observational and combination-supplement designs rather than isolated omega-3 RCTs specifically targeting sleep. Confounding by co-administered nutrients cannot be excluded.

6.6 Tryptophan

Scientific Evidence

Tryptophan is an essential amino acid that serves as a precursor for the synthesis of serotonin and melatonin, two neurotransmitters involved in sleep regulation. Serotonin plays a key role in mood, anxiety, and sleep–wake cycles, whereas melatonin regulates sleep timing and wakefulness.

Serotonin is exclusively produced from dietary tryptophan, but only a small portion (1–2%) of this dietary tryptophan is converted to melatonin via the serotonin pathway.

Dietary sources of tryptophan include poultry, eggs, cheese, nuts, and seeds.

Evidence strength: The tryptophan–serotonin–melatonin pathway is well-established biochemistry. Clinical evidence from controlled trials specifically examining tryptophan supplementation for sleep in children is sparse; most relevant findings concern adults or are extrapolated from dietary pattern research.

6.7 Tart Cherry (Prunus cerasus)

Traditional Use

Tart cherry has been used as a traditional food across European and North American cultures; its specific use as a sleep aid is relatively modern and arises from phytochemical analyses rather than an extended pre-scientific tradition.

Scientific Evidence

Some foods that are particularly rich sources of melatonin include fruits and nuts, specifically tart cherries, tomatoes, strawberries, almonds, and walnuts. Tart cherries are of particular interest in sleep research because they contain tryptophan, serotonin, and melatonin.

In all available clinical studies on tart cherry juice and sleep, the treatment dose administered to participants corresponded to 200–300 g of fresh cherries per day, whose melatonin and tryptophan content is estimated at 0.27–0.40 µg and 18–27 µg respectively. It is unlikely that the observed benefits of tart cherry juice on various components of sleep health result directly and exclusively from the supply of these specific compounds. Further investigations into possible alternative and/or complementary mechanisms are required. Nonetheless, chronic supplementation with tart cherry juice appears to be a safe and potentially effective dietary strategy to support restorative sleep.

Evidence strength: Preliminary in adults; tart cherry has not been studied in controlled pediatric sleep trials. The adult data are promising but doses of melatonin contained in the fruit are pharmacologically small compared to supplemental doses. Extrapolation to children must be made with caution.

6.8 Valerian (Valeriana officinalis)

Traditional Use

Valerian root has a long history of use in European herbal medicine as a sedative and nervine, documented across medieval European herbalism and more formally in 18th- and 19th-century German and British botanical pharmacopoeias. It has traditionally been prepared as a decoction or tincture of the dried root for nervous unrest and difficulty sleeping in both adults and children.

Scientific Evidence

Valerian and lavender were the most frequently studied plant extracts, and their use has been associated — with conflicting results — with anxiolytic effects and improvements in quality and duration of sleep.

Certain supplements, particularly valerian, hops, and melatonin, could be effective in improving sleep quality and reducing insomnia symptoms through modulation of neurotransmitter systems and regulation of sleep–wake cycles.

The extent to which a fixed plant extract combination can support children suffering from nervous agitation was investigated in a multicenter, prospective observational study in 2008 with 115 children between 6 and 12 years. Assessments of the parents showed a distinct improvement in children who had attention problems, social withdrawal, and/or were anxious/depressive. Based on physicians' assessments, 81.6–93.9% of the affected children had no or just mild symptoms at the end of the observation period concerning nine of thirteen evaluated symptoms, including sleeping problems. The plant extracts were obtained from St. John's Wort herb, valerian root, and passionflower herb.

Evidence strength: Weak to moderate and largely based on combination herbal products. The combination design of existing pediatric studies makes it impossible to attribute observed effects to valerian alone. Adult RCT data show conflicting results. Evidence in children is limited to observational studies.

6.9 Chamomile (Matricaria recutita / Chamaemelum nobile)

Traditional Use

Chamomile has been used as a calming and sleep-promoting herb in European and Mediterranean traditional medicine for centuries, typically prepared as a hot infusion (tea) of the dried flower heads. It has a well-documented history of use for children's restlessness and difficulty sleeping in the German and British herbal traditions, as well as in the Commission E monographs.

Scientific Evidence

Chamomile is one of the most studied herbal teas for nighttime relaxation. The flavonoid apigenin may engage calming pathways without causing heavy sedation.

Although certain supplements, such as valerian, hops, and kava, have shown promise in clinical trials, other supplements, such as German chamomile and cherry, have shown limited evidence to support their efficacy.

Evidence strength: Very limited in children specifically. Most evidence regarding chamomile is from adult studies or animal models. No robust RCTs in pediatric populations have been identified. Its traditional use in children is long-standing, but scientific evidence does not currently substantiate efficacy claims independently.

6.10 Passionflower (Passiflora incarnata)

Traditional Use

Passionflower has been used in North American indigenous traditions and later in European phytomedicine as a nervine and mild sedative, typically administered as a tea or liquid extract. In traditional European herbalism, it has been indicated for nervous restlessness, anxiety, and insomnia.

Scientific Evidence

Passionflower may enhance GABA activity in the brain, which is proposed as one of its mechanisms for sleep support.

A study showed that a composition of valerian, passionflower, and hop improved total sleep time, sleep latency, number of nightly awakenings, and insomnia severity index. This study was conducted in adults.

In the observational pediatric study mentioned above, a fixed herbal combination containing St. John's Wort, valerian, and passionflower was evaluated for safety and effectiveness in the treatment of nervous agitation due to affective disorders in children between 6 and 12 years. After more than 40 years of experience with these plant extracts, the researchers hypothesized a positive impact of the combination on children with nervous agitation.

Evidence strength: Preliminary. Adult evidence is limited and largely from combination products. Dedicated pediatric passionflower RCTs have not been identified. The combination observational study provides weak supporting evidence in children, confounded by co-administered herbs.

6.11 Lavender (Lavandula angustifolia)

Traditional Use

Lavender has been used throughout Mediterranean and European traditional medicine for centuries, principally as an aromatherapeutic agent to promote relaxation and sleep. Applications have included sachet placement near sleeping areas, aromatic baths, and infusions. Its use for children's restlessness and insomnia is described in traditional European herbal records.

Scientific Evidence

Lavender was among the most frequently studied plant extracts, and its use has been associated — with conflicting results — with anxiolytic effects and improvements in quality and duration of sleep.

Many studies are limited by small numbers of participants and, in some instances, inadequate design and sparse use of objective measurements. As noted in a meta-analysis on lavender use for sleep disturbances, a wide range of dosages and types of preparations are often used and most measurement methods are open for interpretation.

Evidence strength: Preliminary and conflicting. Studies in adults show mixed results. Controlled evidence in children is essentially absent. Aromatherapeutic lavender is among the interventions mentioned in the literature on childhood sleep, but robust pediatric trials are lacking.

6.12 Lemon Balm (Melissa officinalis)

Traditional Use

Lemon balm has been used in European traditional herbal medicine as a calming and sleep-supporting herb for centuries, commonly prepared as a tea or combined with other herbs such as valerian and chamomile. Its use in children for nervous restlessness and insomnia is documented in German Commission E literature.

Scientific Evidence

The most commonly used plant extracts for insomnia include valerian, chamomile, and lavender, with lemon balm often studied in combination formulas. Passionflower and lemon balm work well together when sleep disturbance is linked to stress or mental restlessness, according to traditional herbal practice. Independent controlled trials of lemon balm specifically in children are not yet established in the literature.

Evidence strength: Evidence is limited primarily to adult combination-product studies and traditional use descriptions. No high-quality, isolated pediatric RCTs have been identified.

7. Dietary and Nutritional Factors

7.1 The Tryptophan–Serotonin–Melatonin Pathway and Diet

A healthful diet rich in food sources of tryptophan, serotonin, or melatonin may lead to good-quality sleep. The correct functioning of the sleep–wake cycle is promoted by melatonin, exclusively synthesized from dietary tryptophan, via serotonin, obtained from ingested foods. Melatonin is synthesized enzymatically by the sequential actions of four enzymes and requires magnesium and B vitamins as cofactors.

7.2 Micronutrient Deficiency and Sleep

Micronutrient deficiencies, particularly in iron and zinc, have been linked to sleep deficiency, frequent nighttime awakenings, and shorter total sleep duration.

7.3 Meal Timing and Circadian Rhythms

Research has explored how meal timing can influence the body's circadian system. Meal timing is known to regulate the human circadian system. Late-evening high-calorie meals and irregular eating patterns have been proposed to interact with sleep-wake regulation, although dedicated pediatric intervention data on meal timing are limited.

7.4 Caffeine Intake in Children

Excessive intake of caffeine from different dietary sources coexists with unhealthy dietary and lifestyle behaviors and sleep problems.

Children who watch more TV may have shorter sleep, experience fatigue, and higher exposure to food-related advertising, and may have unhealthy eating habits; these factors could motivate higher intake of caffeinated foods and/or beverages.

8. Lifestyle Factors

8.1 Screen Time

Reduced physical activity and increased screen time adversely impact older children's sleep. A systematic review found that reduced physical activity and increased screen time adversely impact older children's sleep, and examined the association between screen time/movement behaviors and sleep outcomes in infants, toddlers, and preschoolers.

8.2 Physical Activity

Current prevention and intervention approaches to address childhood sleep problems include nutrition, exercise, cognitive–behavioral therapy for insomnia, aromatherapy, acupressure, and mindfulness.

8.3 Circadian Hygiene and Behavioral Factors

Children sleep less than they did one century ago. Despite compelling evidence supporting a vital role for healthy sleep in brain maturation, somatic growth, information processing, memory consolidation, learning, and other important neurobehavioral functions, parents and professionals often treat sleep as a tradable commodity.

Low overall prevalence rates of diagnosed sleep disorders in primary care may be attributable to a combination of factors, including primary care providers not asking about sleep and parents not reporting significant sleep problems.

8.4 Obesity and Sleep: A Bidirectional Relationship

Inadequate sleep affects the regulation of homeostatic and hormonal systems underlying somatic growth, maturation, and bioenergetics. Therefore, assessments of the obesogenic lifestyle, including dietary and physical activity factors, need to be coupled with accurate evaluation of sleep quality and quantity, and coexistence of sleep apnea.

Unhealthy sleep indicators, such as short or very long sleep, fragmented sleep, insomnia symptoms, and daytime sleepiness, are robust predictors of obesity in the pediatric literature.

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