Preschool: Ages 2-4
PILLAR FOUR: SLEEP
The National Sleep Foundation recommends that preschool-age children get 10 to 13 hours of sleep each night; however, as few as eight hours and as many as 14 hours may be appropriate.
Preschool age is when children learn bedtime routines. Offer guidelines that can help parents make the transition to sleep less of a challenge for both them and their child. For example:
- Parents should establish consistent routines, such as dinnertime, bath time, brushing teeth, and reading books.
- Parents should resist protests from a crying child no matter how difficult.
- Parents might consider minimizing the duration of the bedtime routine.
- Parents can use comforting objects like blankets and stuffed animals when putting the child to bed.
Parents also need guidance with the following bedtime issues:
Prolonged bedtime routines. These occur when the routine extends longer than usual because the child attempts to delay bedtime because they fear separation. Parents often exacerbated the situation by feeling guilty about leaving a fearful or crying child. Parents need to understand that allowing this period to draw out makes exiting the child's bedroom even more difficult.
Nightmares. Children can experience dreaming as young as 1 year old. However, nightmares occur in children by ages 3 to 6. Nightmares often happen during rapid eye movement (REM) sleep early in the mornings. Children still have a clear recollection of their bad dream when they wake up and feel anxious and frightened. They are often hesitant to return to sleep after a nightmare but respond well to consoling.
Night terrors. These can occur in toddlers but are more common in preschool-age children. There is often a family history of night terrors, or other sleep-related issues, like sleepwalking or talking in one's sleep. Night terrors are characterized by arousals (not awakenings) and often happen after an hour to an hour and a half of sleep. Common traits include extreme fear and panic, along with screaming and shrieking, sweating, and heart racing. Children should NOT be forced awake in these situations, but instead protected from any potential bodily injury. Parents should allow the terror to run its course (most last about 10 minutes), and the child should subsequently be allowed to fall back asleep. Children do not recall the events, as they occur during deeper sleep stages.
Soothing an awakened child
Parents should always console their child in his or her bedroom. This reinforces the room as a place of safety and warmth. Avoid removing the child or allowing him or her to sleep in the parents' bed, which can be detrimental to the regular sleeping routine.
Look out for Obstructive Sleep Apnea (OSA)
OSA is a disorder in which a sleeping person experiences either partial upper airway obstruction for prolonged periods or complete upper airway obstruction intermittently. Among children, OSA is most common in children ages 2 to 6 as this is when tonsils and adenoids are largest relative to the size of the oropharynx.
Children with OSA frequently snore with periodic pauses or gasps in their breathing. Snoring can disrupt their sleep and cause problems with attention, concentration, and daytime sleepiness.
Always screen children for snoring during wellness checks. Refer any child who snores three or more nights per week and has any OSA symptoms to a sleep medicine physician/sleep lab, or a pediatric ear, nose, and throat physician. A polysomnography—a test used to diagnose sleep disorders—can diagnose OSA.