Having a child with slee problems can be quite a problem for parents. Not only does the parents have to worry about the child's problem, but the parents find themselves having to do extra duty themselves. A sleep problem for a child is a sleep problem for the parents.

As with adults, sleep problems in children can be caused by one or more factors. Illnesses can cause sleep problems by making the child uncomfortable or agitated. If breathing or coughing occurs or if bones and joints ache, if there's stomach problems, it's tough to sleep. Depression and anxiety can also cause sleep problems. And then there are also individual differences between people -- some children just don't seem to need as much sleep as others.

Some good questions to ask yourself if you believe your child has a sleep problem:

1. When your child does get to sleep, how much sleep does s/he seem to need to be in good spirits and function well the next day? Without interventions, does he or she get enough sleep to feel fine and function fine the next day? Do other members of the immediate or extended families seem to just do fine without much sleep?

2. Do others in your immediate or extended families have or have they had sleep problems or problems with anxiety or depression?

3. Is the problem getting to sleep, awakening often and early or both? How about when the sleep problems first started?

4. How many nights a week does the sleep problem occur? How many nights each week do you believe it would occur if you didn't do something like give a med or read a story or stay in the room till the child falls asleep? How many nights each week does sleeplessness actually occur in spite of interventions (like reading, sleeping with, etc.)?

5. If it's not every night that sleeplessness seems to be a problem, is there a pattern associated with the day of the week, a particular activity or some other variable in the child's life? (That is, is it always on a night before school, a few nights after a visit to dad's, on the nights before tests, on the nights you eat a particular food, etc.)

6. Is there any history of traumatization? (That is, has your child been abused or has your child witnessed abuse or death or bloody accident, etc.?)

7. Have you experienced any significant loss or traumatization that might make you anxious about your child's welfare or your own?

8. Are sleeping conditions conducive to sleep? (That is, is there a little brother that coughs all night, is there a firehouse or police station next door, are there people talking and laughing in the next room?) How about when the sleep problems first started?

9. Have you ruled out any illnesses that might be causing sleep problems? How about when the sleep problems first started?

10. Is your child on a medication that might be causing sleep problems? How about when the sleep problems first started?

11. Is there television watching or story telling going on in your child's life that might be causing anxiousness? How about when the sleep problems first started?

12. Is there a history of nightmares? How often, how many?

13. Is there caffeine drinking or sugar eating going on in the hours just before bed? How about when the sleep problems first started?

14. Is there any reason for the child to worry about anything that may or may not happen after s/he goes to bed? How about when the sleep problems first started?

15. Is there napping going on during the day? How about when the sleep problems first started?

16. What does your child do when s/he can't get to sleep? What is the parental response to the sleeplessness of the child?

17. How much of a problem is this for your child, versus how much of a problem is this for you?

18. What possible benefits to the child are there to having the sleep problem? What possible benefits to the parents are there?

19. What do others see as contributing to the sleep problems your child is experiencing? Have you really thought about and ruled out these possibilities?

20. Is it possible that for one reason or another a bad habit got started?

Some ideas to think about and maybe try, depending on the answers to the questions above:

Individual differences in sleep needs. If it seems like your child functions quite well with the sleep he or she gets, in spite of the fact that it seems to you to be too little sleep, maybe this is just an individual difference. If you know of others in your family that don't seem to need much sleep, this is probably some gene at work. Check with your pediatrician to be certain, but you're probably going to need to deal with this by finding things for your child to do in bed at night that are restful, quiet and absorbing -- absorbing enough that it keeps the attention while waiting for sleep but not so absorbing that it keeps your child awake beyond when he or she would have fallen to sleep. Nintendo-type stuff is too engaging. You'd likely often find your child still at the controls when you get up in the morning. Think books or music. One child I worked with could lay in bed and entertain himself quietly for hours with any household utensil. Imagination practice is good for kids and so is developing quiet, patient skills. Drugs can help knock a kid out for a night but that's not a good a learning experience as learning quiet patience.

Anxiety, depression, disorders.    There are a variety of psychological situations that are more habit than disorder which can lead to sleep problems, many of which will be addressed below. However, sleep problems can also be caused by anxiety, depression or other fairly serious psychiatric disorders. If there is a history of sleep disorders, anxiety and/or depression in the family gene pool, then there could be good cause to get a consultation from your pediatrician. There are many medications that can help with biological and psychiatric disorders (i.e., depression and anxiety). Most research shows that the best way to address these is with both medication and counseling.

Life would be much simpler if everything that happens was caused by one cause, but unfortunately there can be many causes in complex interaction causing what seems like one problem. Even if there is a biological or psychiatric component, if there have been efforts to soothe or compensate a young anxious mind, there can also be a habit or other psychological component that should probably be addressed at the same time (see the section on habits below).

Difficulty sleeping can occur because of something on a child's mind that he or she is not comfortable talking about. This can be because he or she has been exposed to or has experienced something scary or weird (horror movie, traumatic event, molestation). It is especially difficult to get kids to talk about things they think will be dismissed or will cause them to be told they're bad or stupid. It is also especially difficult to get a child to talk about things that they think will hurt or harm their parents.

Difficulty sleeping can also occur because of a medication or change in schedule or diet.

Regular elements, routine and sleep.    If sleeplessness doesn't occur every night, it is sometimes very helpful to ask yourself what the difference might be due to. Sleep happens best when it is in a routine that is followed. Is the routine out of whack? Sleep is also tough when excited about something.

If the problem is the routine, either get more routine in your routine OR just get used to it -- your child will have a tough time sleeping when the routine needs to different. That means the next day may be tougher -- emotionally and behaviorally -- and it means you should probably try to be more patient with your child and have somewhat lower expectations. This is all the more important if your child's lack of sleep translates to lack of sleep for you, too. OR, you may be able to find something that helps get him or her asleep and make that a routine part of non-routine nights. A hypnosis or relaxation tape/CD focused on getting to sleep or focused on just relaxing might help a lot.

If you are anxious about something significant, your child may well be anxious too. Most parents live in denial about how much their kids are soaking up from their parents' thoughts and worries. If a parent is a little worried and not making an effort to at least pretend not to be worried at all, his or her child or children may be anxious in the extreme. Children may be very anxious but also anxious about parents finding out about the anxiety because they don't want their parents to be concerned, angry or more anxious than they already are. Children pick up on parental anxiety and a little, "You don't have to worry," is usually totally inadequate in allaying fears.

If a child has been traumatized -- if he or she has been frightened in any way about his or her safety or ability to be safe -- there may be significant anxiety which can cause sleep difficulties.

In either of the above situations, it's a good idea to consult a psychotherapist that works with children if the sleeplessness is more than just once in awhile. Even if you feel that your child may have picked up on mild anxiousness on your part, if sleeplessness is happening a few nights a week or more often your child may be experiencing significant anxiety because of the way his or her child's mind magnified and/or imagined things. A good psychotherapist can help you identify what the anxiousness is about and can help you find ways to convey to your child that things are really okay or at least are going to be (even if you don't really believe that, it's important to children to believe it).

If sleep conditions are not conducive to sleep, it's a no-brainer why there's no sleep. What many parents might miss is that first there may be problem sleep conditions which are understandable but then a bad habit develops that lasts long after the sleep conditions become more optimal. If a bad habit develops, it's just a matter of changing the habit (see the section on habits below).

If an illness may be causing a sleep problem, consult your pediatrician. If there was an illness that caused a sleep problem but the illness is passed but the sleeplessness has not, consider the possibility that you have a habit going on now (see the section on habits below).

Kids can be very anxious about elements of tv shows or stories -- elements that parents may have felt were funny or interesting. Kids think differently than adults do. They deal with information differently and they may have reactions or assumptions that an adult can barely imagine possible. And, to make it a little more complicated, kids don't really pay attention to their own thinking as well or as much as adults do, so things can bother them that they have trouble understanding. Kids may have very little insight into what makes them anxious, or may have difficulty verbalizing their fears even if they have an awareness of them. Kids can be fascinated but deeply frightened by stories with monsters, murders and mayhem and such. If sleeplessness occurs, ask yourself what was on tv and what stories they may have been reading or may have been told.

Adding to the complexity, a child may be anxious about something they watched, read or heard and be sleepless for a few nights before they resolve the issue (with or without help from parents), and then -- having developed a taste for late nights or the special interventions parents implemented -- they may have a habit to deal with after that (see the section on habits below).

A nightmare or two every once in awhile is normal (though that doesn't mean they're not really scary). If nightmares persist, consult your pediatrician or a psychotherapist that works with kids. This could mean there is something bothering your child that can be causing or may cause emotional/psychological harm.

Sometimes this can be happening without parents' awareness. Sometimes it can just be an oversight. Some kids are much more sensitive to caffeine or "energy foods." If there is food or drink intake happening along these lines in the hours before sleep, you might try experimenting with restricting these. Even if you stop caffeine drinking, etc., you still may have a habit to deal with. It can be fun to be up late. If you think you have a habit to deal with after restricting intake of food and drink, see the section on habits below.

Is there a concern that monsters will come with the lights out or that burglars may invade the house or that Dad will possibly beat up Mom when the lights go out? If these kinds of problems are causing sleeplessness, reassure your child, get a night light, get therapy and stop fighting. If there are anxieties about monsters or loss of parents, hypnosis tapes/CDs can help -- as can home-made tapes/CDs you make yourself for your child to listen to in bed at night.

Under these circumstances you might think you have a habit after awhile. However, sleep problems related to anxiousness don't turn into habits like opportunities to stay up late or nights with disturbances that keep kids up unless you've been routinely doing things to soothe and distract your child that may be sorely missed for awhile if they are withheld. Generally speaking, though, under conditions of anxiousness it's good to recognize that being fearful can itself become habitual in a complex way. In addressing anxiousness, it's important not to pressure the child unduly or miss what he or she is saying about his or her concerns. Reality is in the mind of the beholder.

When napping is taking place, it's easier to do without sleep at night and it's harder to get to sleep and stay asleep. Sleep needs change. If your child naps during the day and then is unable to get to sleep and sleep through the night, the possibility that your child is no longer in need of a nap could be considered. Once you adjust this schedule, there still may be a habit left to deal with, depending on how fun it was to be unable to sleep nights (see the section on habits below).

The answers to these questions are very telling. If there is anything fun or otherwise rewarding going on instead of sleeping, maybe the fun is the important issue. A child who finds that he or she is accepted in Mom's and Dad's bed or who finds that Mom will come in and sleep in his or her room -- or who gets a bowl of ice cream or a new CD -- "to help" him or her get to sleep is likely to find staying awake a way better idea than going to sleep. The fix is to withdraw these supports without making the child feel anxious that if he or she has a problem, Mom and Dad won't help. The problem rewards need to be gradually withdrawn and the habit needs to be dealt with (see the section on habits below).

Here again, like the question above, is telling information. If the sleeplessness is not a problem for your child, it's not likely to be something your child will want to work on changing. If sleeplessness is not a problem for your child, working on sleep will be. If it is a problem for you, you'll need to make the situation a problem for your child before much will change. You can do this by reducing rewards for staying awake and offering rewards (be reasonable, now) for getting to sleep and staying asleep. Once you have a motivated child, you can work on the problem as a habit (see the section on habits below).

By now, if you've gone through the questions above, this may seem redundant. It's good to go over again, though -- especially with regard to what might be the reward for the parent. Though Mom and Dad may say that they are very concerned about a child's sleeplessness, there may be underlying things going on for one or both that create and unconscious tendency to subtle sabotage their children's sleep efforts. If Mom and Dad are having struggles but they cooperate on the sleep problems of their child, everybody may consciously or unconsciously be motivated to keep the sleep problems happening. This underlying benefit from the sleep "problems," by the way, can be obvious or subtle. It would be obvious if Mom and Dad never really could talk without fighting except with regard to the kids' problems. It might not seem so obvious if Mom and Dad are actually uncomfortable sleeping together and (coincidentally) sleep problems in a child keeps them from going to bed together or even sleeping together.

It is a good idea to really think through the benefits from sleeplessness problems in children. Directly discuss and address benefits to your child that may get in the way. Directly deal with but unless you really think you have a very good reason to do so, do NOT discuss with your child the underlying parental motivations that may be in play.

Once you've uncluttered the situation vis-a-vis the rewards to the various players, you likely will have a habit to deal with (and again, see the section on habits below).

This is just a good check on the various issues discussed above. Often we don't see things because we are too enmeshed in them (we can't see the forest for the trees). Though obviously one has to make the final decisions him- or herself, it's usually good to take into account what others are seeing and saying.

Habits can be broken with a little work. The longer a habit has been happening, the more work there is to do. The more rewarding the habit is, the more work there is to do. The more rewarding the habit is to anyone in the household, the more work there is to do.

When you work on a habit, the work is not done just because a few days go by without seeing it.   Old habits die hard. Old habits recur -- usually during tough times when you can't really pay attention. It's not mischief or oppositionalism in a child nor is it in a relapsing adult. It's just a fact of life that old behaviors and attitudes keep coming back. You have to keep working on sustaining new habits and behaviors until the new ones are old ones.

To work on a habit, rely on a plan. Sometimes mindless reacting actually accomplishes everything that might have been hoped for from well thought-out logical strategizing. However, it is more likely that thinking through a problem and developing a well thought-out strategy that can be practically implemented will work better.

some examples of dealing with sleep habit problems in kids

Dealing with an 8 year old's habit of not going to sleep or waking early and getting up.

First there needs to be an agreement with your child that the sleep problem is a problem for both of you and something that needs to be worked on. (It doesn't have to be whole-hearted.)

Then decide on a reward program that gives a little reward (be reasonable) for the first night of successful, appropriate sleep, and a little reward then for two additional nights of successful, appropriate sleep, and then a little reward for every five. There should be a little reward for the child (i.e., a hotwheels car, a new Barbie outfit), and a little reward for the parent(s) involved in working on this (i.e., a new DVD or CD), though the frequency for parent's rewards could be at a less frequent schedule (i.e., for every seven nights or every fourteen). (Note: behavior programs in my experience work better if rewards are for numbers of accomplishments, not necessarily number of accomplishments lly avoiding .)

Keep track of nights with a calendar or hand-drawn chart. Use happy faces, stickers or whatever seems fun to indicate good nights. Don't put anything for problem nights -- just blank.

Convey an attitude to your child (and to other kids and other adults -- especially if your child is anywhere around) that this will be okay, that both you and your child can handle this. Convey a sense that you have every faith that its mostly a done deal, its just a matter of time and effort.

Explain to your child and others in the household that this will take awhile and might be tough some nights and that dealing with this may involve both progress and setbacks at times.

If you believe that sleep problems are more an interest in staying awake to avoid missing any fun, a stern attitude with rewards for good behavior might work best.

If you believe that sleep problems are more an anxiousness about being alone, being in the dark, being away from parents, etc., a gentle, reassuring, patient attitude with rewards for little heroic accomplishments might work best.

If reinforcing fun elements are abruptly removed, don't be surprised if there are some nights with crying and other upset. You might explain to your child some ideas for coping with loss of fun things, and commiserate that you know very well how frustrating it is to have to give up some fun.

Consider gradual rather than abrupt withdrawal of reinforcing elements if anxiousness is involved. If your child has been sleeping with parents in their room, then it might work best to have a parent stay in the child's room at bedtime for a limited amount of time -- perhaps up to half an hour at first -- and then gradually withdraw the parent (each night the parent stays a little further from the bed until one night is just outside the room then the next night down the hall, and then the next night just somewhere else in the house.

If there is considerable anxiousness or just to help, any audio tapes or CDs that you believe might be relaxing and soothingly entertaining to your child -- hypnosis tapes/CDs, relaxation tapes/CDs, stories for kids, soft and quiet music, etc. -- might help to distract from feelings of anger or anxiety.

Recognize that when changing attitudes and fears or behaviors, old habits die hard. Like weeds, even when you think you eradicated them, they surprise you by growing back when your back's turned. It's just a matter of getting back to work if you find an old bad habit is back in town.

Dealing with a 4 year old's habit of not going to sleep or waking early and getting up.

First, if you can, get an agreement with your child that the sleep problem is a problem for both of you and something that needs to be worked on. (It doesn't have to be a whole-hearted agreement.)

Then decide on a reward program that gives a little reward (be reasonable -- a sticker on a sticker chart or a happy face on a happy face chart may be plenty) for the first and every subsequent night of successful, appropriate sleep -- for the foreseeable future or at least for a few months. There should be a little reward for the parent(s) involved in working on this, too (i.e., a new DVD or CD), when the child has had a dozen or so good nights.

If you use a sticker chart or a happy face chart to indicate good nights, don't put anything for problem nights -- just leave those boxes blank.

Convey an attitude to your child (and to other kids and other adults -- especially if your child is anywhere around) that this will be okay, that both you and your child can handle this. Convey a sense that you have every faith that its mostly a done deal, its just a matter of time and effort.

Explain to your child and others in the household that this will take awhile and might be tough some nights and that dealing with this may involve both progress and setbacks at times.

If you believe that sleep problems are more an interest in staying awake to avoid missing any fun, a stern attitude with rewards for good behavior might work best. It is good to remember, though, that even angry young children can become frightened and possibly traumatized by experiences when they become scared about getting help and can't seem to get any. Like most of parenting, you have to "play it by ear."

If you believe that sleep problems are more an anxiousness about being alone, being in the dark, being away from parents, etc., a gentle, reassuring, patient attitude with lots of excited praise for little heroic accomplishments might work best.

If reinforcing fun elements are abruptly removed, don't be surprised if there are some nights with crying and other upset.

Reassure your child that you do care about fears and upsets he or she may have, but that you are in charge and you know best.

Consider gradual rather than abrupt withdrawal of reinforcing elements if anxiousness is involved. If your child has been sleeping with parents in their room, then it might work best to have a parent stay in the child's room at bedtime for a limited amount of time -- perhaps up to half an hour at first -- and then gradually withdraw the parent (each night the parent stays a little further from the bed until one night is just outside the room then the next night down the hall, and then the next night just somewhere else in the house.

Any age-appropriate audio tapes/CDs that you believe might be relaxing and soothingly entertaining to your child -- hypnosis tapes/CDs, relaxation tapes/CDs, stories for kids, soft and quiet music, etc. -- might help to distract from feelings of anger or anxiety.

If the problem is anxiousness that comes out as apparent worry about the whereabouts and safety of parents consider making an audio recording -- using your voice and if possible the voice of your spouse. You can use a cheap tape recorder and a cheap tape and if you speak clearly and carefully the quality will be fine -- it's your voice that is the important aspect of this tactic.

Make a tape recording yourself to help your child get to sleep. Here are some ideas:

The quality of the recording. Quality is not a particular concern as long as it's good enough for your child to understand your voice and know that it is your voice speaking. A cheap recorder and a cheap tape will do. The issue is having one or both parents' voices on the recording saying soothing, comforting things and telling stories.

The materials you need

- 1 or 2 children's books that would be appropriate to read to your child (total around 20 min.)
- 1 tape player
- 1 tape 90-100 min.
- 1 or 2 parents and their voices

Start. Start the tape with a statement about how the tape is to help your child get to sleep feeling you watching over and making sure he or she is safe. (e.g., "This recording is so you can hear me speaking to you as you fall sleep. This is so you will know that no matter where I am I am connected to you and thinking about you and watching over you and keeping you safe. And you can feel me loving you and helping you to sleep while you listen to me tell you stories.")

Pauses. Have a little pause of silence about 5 or so seconds long in between ideas or stories.

Add a little story of being together in the future. Add a little story of your own about the future that includes 1) how someday when you child is an adult and successful, 2) your child will be taking care of you, and 3) you, your child and everyone else important and close to your child will all live together. (e.g., "Can you imagine how it will be when you're grown up and you're a [prince/princess/millionaire banker/famous teacher/famous doctor/etc.] and you're living in your [castle/big house] and you have another big house right inside your [castle/house] where [I/your mom and I/your dad and I] live and you can take us out to dinner every night because you are so rich...") Make a sort of a game of coming up with a new fantasy every once in awhile that strongly implies that you will all be together with your child in the future. Ironically, plans for the future make one feel more secure today. To a four year old, a story about being together in adulthood can be very comforting of fears about the stability of the connection with parents today. (And don't worry about keeping such a promise. As soon as your child enters into adolescence he or she will be sure to tell you that the story about being together over the years is NOT going to happen.)

Add a story of being connected by a strong energy. Add a little story of how there is an invisible powerful beam of energy made out of love and caring connecting your heart and your child's (and perhaps your spouse's heart and your child's) that is connected no matter how far apart you are. (e.g., You know, you may not have realized, but did you know that there is a very special, invisible beam of energy that connects my heart to your heart no matter where you are, no matter where I am, no matter how far apart we are? Can you imagine? -- a really strong beam of energy made out of love that's invisible and it can stretch to anywhere and twist and turn and connect even through walls and mountains and even when you're asleep and I'm doing something or I'm asleep."

Then read the children's story/stories. Then read one or two children's stories.

Keep adding up to 20-25 minutes so you have five minutes or more empty tape at the end so the tape player won't click off just as the stories are done.

Copy your tape when it's done. If you have the resources, make a copy of your tape when it's done. Put away the original and use the copy. If you want to do all of the above again, let it to be to make a different tape, not to make a replacement for a tape that the darn tape player ate.