The Sleep Of America's Children

“We need to focus as much on the sleeping half of children’s lives as we do on the waking half.”

The Forgotten Country

Sleep is the forgotten country and is not getting the attention it merits. It plays out in the home, in the pediatrician’s office, and in school. Sleep is an important factor in the lives of children.
Mary A. Carskadon, PhD

Children aren’t getting enough sleep, and many parents do not identify their children’s sleep problems as an issue that should be addressed. Add to the mix that doctors often aren’t asking enough questions about their young patients’ sleep. These are some of the major findings in the 2004 Sleep in America poll, the first nationwide survey on the sleep habits of children and their parents.

The National Sleep Foundation commissioned WB&A Market Research to conduct a national survey of adults living in the United States who have a child present in their household age 10 and younger. The primary objective of this poll was to describe children’s sleep habits and sleep problems.

“It is clear from the poll results that we need to focus as much on the sleeping half of children’s lives as we do on the waking half. Children are clearly not getting enough sleep,” says Jodi A. Mindell, PhD, who served as Chair of NSF’s 2004 Poll Task Force: “And a remarkable number of children have some kind of sleep problem. We need to help parents to become better educated about positive sleep practices so that their children can get the sleep they need to be able to function at their best during the day.”

The poll results indicate that on average, children get less sleep during a 24-hour period than recommended by sleep experts. For example:

Infants get 12.7 hours, when experts recommend that from 3-11 months they should get 14-15 hours.
Toddlers get 11.7 hours, when 12-14 hours are recommended for children aged 1-3 years.
Preschoolers get 10.4 hours, while it’s recommended that children 3-5 years of age should average 11-13 hours.
School-aged children (1st through 5th grades) get 9.5 hours, but experts recommend 10-11 hours.

(Note: All sleep times are averages.)

Children who get less sleep at night (those in the lower 25th percentile) also tend to have more difficulty falling asleep. They are more likely to change where they are sleeping during the night, take fewer naps during the day, and have more sleep problems overall. They also seem sleepy or overtired during the day, according to their parent or caregiver.

In addition, an overwhelming majority of parents/caregivers say they would change something about their child’s sleep if they could. While most would change their child’s bedtime, one out of five parents/caregivers of infants say they would change the length of time their child sleeps.

“In talking to parents, I now hear from as many parents of school-aged children who are facing sleep problems as I do from parents of younger children. In the past the overwhelming number of questions came from parents of infants,” says Dr. Mindell. “Clearly sleep is a universal problem for parents of children of all ages.”

Other major findings of the 2004 Sleep in America poll:

There is an apparent gap between whether parents/caregivers think their child gets enough sleep and what s/he actually gets. A majority of parents/caregivers says their child gets the “right amount” of sleep; however, comparing the number of hours they think their child should sleep with the number of hours they report the child actually sleeps, it is clear that many children are getting much less.

About one in ten parents/caregivers think his/her child has a sleep problem, characterized by such symptoms as the child not getting enough sleep, taking too long to fall asleep, waking up during the night, appearing sleepy or overtired during the day, and/or snoring. However, in contrast, 69% of all children experience one or more sleep-related problems at least a few nights a week.

Of those who consumer caffeine, nearly three-quarters are school-aged children (73%) and 27% are preschoolers. Consuming caffeine can have a negative impact on children’s sleep. According to the poll data, children who drink caffeinated beverages sleep less than those who don’t.

Another significant finding was the number of children who have television sets in their bedrooms:

Children Who Have TVs in Their Bedroom

Infants: 20%
Toddlers: 18%
Preschoolers: 30%
School-aged: 43%

“Shorter sleep time is associated with more TV watching,” says Mary A. Carskadon, PhD, a member of the Poll Task Force. “It’s impossible to say which is the chicken and which is the egg, but it does raise a red flag about TV sets in bedrooms. The bottom line is that the association with reduced sleep is something parents should consider when furnishing their children’s bedrooms.”

Other findings:

Most parents/caregivers say they get less sleep than they need. A majority say they need between eight and nine hours each night, however, parents/caregivers average about 6.8 hours of sleep a night, slightly less than the 6.9 hours averaged by adults with no children, according to NSF’s 2002 poll.

The sleep habits of children have a direct impact on the adults caring for them. Parents/caregivers whose children get the least amount of sleep are twice as likely to say they sleep less than six hours a night. On average, parents/caregivers lose slightly more than a half-hour of sleep each night because their child awakens them during the night. Parents of infants lose the most sleep—nearly an hour on a typical night.

“Sleep issues are often more difficult to deal with than many other family problems,” says Dr. Mindell. “At night, when everyone is exhausted, patience has decreased, and being consistent is difficult. In addition, one child’s sleep problem can affect not only the parents, but also siblings, so now the whole family is up in the middle of the night.”

Members of NSF’s Poll Task Force expressed some concern about the need for pediatric healthcare practitioners to ask their patients (or their parents) about their sleep. Although many parents or caregivers say their child’s doctor asked them about their child’s sleep (from 38% for school-aged children to 60% for toddlers), fewer have been asked by the doctor if their child snores.

“In 2002, the American Academy of Pediatrics issued guidelines recommending that every child be screened for snoring as part of a regular health exam,” notes Ronald D. Chervin, MD, a Poll Task Force member. “The poll indicates that only 28% of school-aged children are asked about snoring.

“It’s important to understand that sleep apnea affects 1-3% of children, and more subtle problems with breathing during sleep may affect many others among the 10% or more of all children who snore regularly,” he adds. “These disorders could have important consequences on daytime cognition, behavior and development. Therefore, it’s important to discuss warning signs when children visit their doctors.”

“I would like to see physicians spend as much time educating their patients about sleep as they do about other health behaviors, such as adequate nutrition,” says Dr. Mindell. “Pediatric health practitioners should be sending the message to their patients that sleep is important. If children are asked about sleep by their doctor it will help stress that the development of healthy sleep habits is essential.”

“The poll results suggest that sleep is the forgotten country and is still not getting the attention it merits,” adds Dr. Carskadon. “It plays out in the home, in the pediatrician’s office, and in school. Sleep is an important factor in the lives of children.”

For the complete Summary of Findings, go to www.sleepfoundation.org and click on the Sleep in America poll graphic.

NSF Issues A Call to Action

In light of the findings from the 2004 Sleep in America poll, the National Sleep Foundation makes the following recommendations for parents and caregivers:

Make sufficient sleep a family priority. Understanding the importance of getting enough sleep and how sleep affects the overall health of parents and children is the first step towards making sleep a family priority. Parents/caregivers need to determine the amount of sleep each family member needs and take steps to ensure their individual needs are met. Every family member must make a good night’s sleep a regular part of his/her daily schedule.
Embrace good sleep habits. Regular bedtime routines, creating a quiet and comfortable bedroom, and adhering to appropriate bedtime and wake times can go a long way to better sleep. Televisions and computers need to be out of the bedroom and caffeine should not be part of a child's diet.
Learn to recognize sleep problems. The most common sleep problems in children include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping. These sleep problems can be evident in daytime behavior such as being overtired, sleepy or cranky.
Talk to your child's doctor about sleep. Parents/caregivers should discuss their child's sleep habits and problems with their child's doctor, as most sleep problems are easily treated. Healthcare professionals must regularly ask about a child's sleep.