Helping Children Sleep Well and Cope with Nightmares
So often, when children start kindergarten, by mid-afternoon, many of them look EXHAUSTED. It’s a long day to learn to adapt to! And if they were used to taking naps, it can be a huge adjustment. When I see a child having behavioral difficulties, one of the first questions I ask families is about sleep habits. Oftentimes, sleep disturbances can be at the root of behavioral difficulties during the day. It seems so basic and simple that we often overlook this area.
Why is sleep important?
Getting enough sleep is extremely impactful for children’s development. According to the CDC (2018), six out of ten middle schoolers don’t get enough sleep and seven out of ten high schoolers don’t get enough sleep. In addition, children and adolescents who don’t get enough sleep have a higher risk of a variety of issues including obesity, diabetes, injuries, poor mental health, and problems with attention and behavior (CDC, 2018; Paruthi, Brooks, D'Ambrosio, 2016; Owens, 2014; Lowry, Eaton, Foti, McKnight-Eily, Perry & Galuska, 2012; Fitzgerald, Messias & Buysse, 2007).
How much sleep do children and teens need?
The American Academy of Sleep Medicine (AASM) recommends that children six to twelve years old get nine to twelve hours of sleep each night and teens need eight to ten hours of sleep each night. They report that getting enough sleep regularly contributes to “improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health” and not getting enough sleep is "associated with an increase in injuries, hypertension, obesity, and depression, especially for teens who may experience increased risk of self-harm or suicidal thoughts.” (Paruthi, Brooks, D'Ambrosio, 2016).
What can help my child sleep at night?
A few seasons in my life I have struggled with my own sleep as an adult and my children have had time periods where they struggled with their sleep. Here are some tips my family has found to be helpful! Please note, this is not medical advice.
The American Academy of Pediatrics (AAP) recommends turning off screens an hour before bedtime and to avoid having screens (phones, computers, tablets, TVs) in the bedrooms (2016). So, a good first step is to remove both work and electronic devices from all of the bedrooms.
Having a predictable bedtime routine is so helpful for kids. AAP has published a free online resource on bedtime routines called “Brush, Book, Bed” (2014). You can use this simple nighttime visual schedule to help your child follow a routine. If you're looking for other visual schedules for the day, check out this other free visual nighttime schedule I created for you.
I created this free nighttime visual schedule for you! Just subscribe to my free resource library at the top of this page.
This schedule has four steps. When the child completes the task they flip it up to the done portion and it velcros shut:
Brushing teeth time
Reading, singing or snuggling time
Make a relaxation habit a part of your bedtime routine. Lots of children find it helpful to use a few breathing techniques like Unicorn Breath and Buddy Breath from my book, Skills for Big Feelings, before going to bed.
for children too! If you are looking for more relaxation apps, check out this post. I also have a free printable list of apps and resources for anxiety available in my Free Resource Library. For access, just scroll to the top of this page to subscribe!
Model good sleep habits for your children because as Gordon Neufeld writes, "children do not experience our intentions, no matter how heartfelt. They experience what we manifest in tone and behavior.”
Some people can be very sensitive to light, so pay attention to light sources. You can get room-darkening shades or curtains and consider one of these Smart Sleep alarm clocks. I have this alarm clock and I absolutely love it! You can dim the time so the numbers show little light during the night, and you can make the alarm slowly mimic the sun by getting increasingly brighter before the alarm sound goes off. It helps me wake up less groggy. This is really helpful for me because I use room darkening shades and am very sensitive to light. You can also consider using an eye mask or a weighted eye pillow. I have this one, filled with lavender, and it is lovely!
Consider a weighted blanket. I use one but don't use it all year long. I do love it and find it very soothing to fall asleep with. If you are going to buy one for a child, make sure you figure out what weight they need, as the blanket should be a certain percentage of their body weight. An occupational therapist can help you figure out the right weight blanket to buy.
Notice what temperature feels comfortable – the research says that “the thermal environment is one of the most important factors that can affect human sleep” (Okamoto-Mizuno & Mizuno, 2012). Many people find cooler temperatures more comfortable to sleep in.
Limit caffeine intake. I know this is tough, but at least limit caffeine intake in the afternoon and evening if you can’t cut it out.
Consider using aromatherapy. I made a lovely linen pillow spray that helps with sleep and if I am traveling I put 1 drop of Atlas Cedarwood, 1 drop of Lavender, and 1 drop of Clary Sage on a cotton ball and put it underneath my pillowcase. You can also use a kid-safe sleep blend with a diffuser or a pre-diluted roll on blend. Essential oils are powerful so please be sure to consult with a certified aromatherapist before using essential oils with children or pets!
According to John Hopkins University (n.d.), the impact of aerobic exercise during the day is similar to taking a sleeping pill! So, increasing physical activity during the day is also important.
Many people take melatonin to sleep, but did you know that dark or tart cherry juice has melatonin in it, and other constituents that help with sleep? According to research by Losso et. al. (2019) "tart cherry juice is an effective treatment for insomnia. It has no adverse events as demonstrated in our study as well as in prior studies by others.”
TLDR: Sleep Tips:
Turn off screens 1 hour before bedtime
Avoid having work or any screens in bedrooms
Have a predictable, structured bedtime routine and use a visual schedule
Model good sleep habits
Pay attention to light sources and consider room darkening shades/curtains, an eyemask, special alarm clocks, etc.
Ensure a comfortable room temperature
Use a weighted blanket
Limit caffeine intake
Increase physical activity during the day
Consider dark or tart cherry juice
Why is my child having trouble sleeping?
Kids can have a range of different sleep issues like not wanting to sleep in their own bed, having nightmares, having trouble falling asleep, struggling with staying asleep throughout the night, or medical issues that can impact sleep. I’ll talk more specifically about how to help your child who is afraid of the dark, and some of my favorite resources for helping children cope with bad dreams and nightmares!
How to Help a Child Who is Afraid of the Dark
If you are a parent or work with kids, you know that many children are afraid of the dark and often talk about their fears of seeing scary things in the dark.
Beth Palumbo, LCSW, RPT/S is the owner of Daybreak Center for Therapy in Kennesaw, Georgia and came up with this awesome psychoeducational arts-based intervention to help children who are scared of the dark.
Beth starts with some psychoeducation by teaching kids about pareidolia.
So what is Pareidolia?
Beth explains it to kids as being "how our brains make sense out of things we see.” And then she gives them an example such as, “Have you ever seen the front of a car that looked like a face?” They always say yes, and then they work together to brainstorm other fun things that look like faces.
Then, Beth puts some black paint splotches on paper, folds it in half, and opens it back up. She shows the children how the black splotches turn into an image. Then they work together to find as many different pictures in the image as they possibly can. She reminds them that this is Pareidolia and that this is what their brain does at night when it’s dark! Children love to learn this big, strange word and can use that as positive self-talk when they are feeling fearful!
I am so grateful that Beth shared this useful intervention and allowed me to share it with you. This sounds like a great transition to a perspective-taking activity too!
How do I stop my child from having nightmares?
I remember in elementary school I had a recurring nightmare (or maybe it was a night terror?) of a bald man wearing a face mask and coming after me with a chainsaw. This is something I had forgotten about until I was doing my clinical rotation to become an RN, and when I observed my first orthopedic surgery and I saw the medical equipment they used, it hit me right away!
As a kid I remembered arguing with my Mom and resisting going to sleep because the nightmares were so terrifying to me. This is not uncommon behavior as nightmares can cause bedtime anxiety in many children. When I think back about that nightmare, it was probably related to an orthopedic surgery I had at about 2 years old. I’m not sure exactly what happened during the surgery, but clearly, some part of my psyche was traumatized from that experience!
I was recently re-reading Levine’s Waking the Tiger: Healing Trauma and the stories in that book reminded me of how impactful medical trauma can be on a person. When I was studying to obtain my B.S. in art therapy, I externalized my childhood recurring nightmare and personified the surgeon with a drawing. I wish I still had it to share with you, but to be honest, it was a pretty creepy drawing!
How to Deal with Children's Nightmares or Bad Dreams
Follow the steps above about sleep tips, including having a predictable, relaxing bedtime routine.
Let the child take a special transitional object to bed like a stuffed animal or blanket.
Avoid behavior such as checking under the bed or making a monster spray, as this can inadvertently reinforce the fearful beliefs.
If your child wakes up in the middle of the night, don’t ask them what happened in their nightmare unless they bring it up first and they want to discuss it in the middle of the night. If they do, it is important to validate their feelings. In that moment you want to reassure them that they are safe and help them fall back to sleep as quickly as possible.
Take a look at the environment and remove anything that could inadvertently be giving scary imaging or messages like video games, tv shows, websites, etc. You'd be surprised, many movies that don't seem scary to us as adults can be triggering for children.
Lastly, I recommend reading these two books with your child: The Dream Director by Krysten Taprell and Neon the Ninja: Activity Book for Children who Struggle with Sleep and Nightmares by Dr. Karen Treisman.
The Dream Director
The Dream Director is a picture book written and illustrated by Krysten Taprell of The Therapist Parent. This book empowers children to become the director of their dreams. I've always found that any way you can help children move toward having an internal locus of control is so impactful and so I found this book to have such an empowering concept for children struggling with nightmares.
I love the idea of framing dreams as movies in your head and giving kids more control. There are some great techniques in this book for kids to use to help them cope with their nightmares. Kids will find the concept of making the dream funny especially useful! The reframing is so powerful here: "You don't need to be asleep to control your dream" you can even "close your eyes and imagine the new ending" (Taprell, 2021). Please note this is available on Amazon or at the Book Depository.
Neon the Ninja
I was so impressed with this book that I even bought a Neon stuffed animal and had it shipped from the UK! Neon the Ninja is very thorough and has a full-color storybook for the kids and then a robust guide for adults and clinicians with activities and interventions.
Topics covered include how children experience nightmares, the content of nightmares, nightmares as sensory experiences, CBT and the cycle of avoidance, thinking traps, post-traumatic nightmares or nightmares in the context of relational and developmental trauma.
The storybook section of this book normalizes that everyone has nightmares or bad dreams sometimes and that “Neon has a whole treasure box full of ninja tricks to get rid of those sneaky nightmares, to make them teeny tiny, and to keep them far, far away” (Treisman, 2019, p. 17). I love that the book teaches the concept that nightmares lose their power when the child wakes up and that even though nightmares FEEL scary they aren’t real and can’t hurt us. These are really empowering concepts to teach children.
The activities are well suited for child therapists and have many ideas to work on nightmares with children! There are arts and crafts projects, quizzes, a nighttime diary, psychoeducation about different types of bad dreams, activities to learn how to make nighttime feel more calm and positive, activities to help kids understand nightmares etc.
My favorite activities from Neon the Ninja: Activity Book for Children who Struggle with Sleep and Nightmares include:
Changing the story of your nightmare
Exploring safe, calm, relaxed, and happy feelings
Positive thoughts before bed
Relaxation, mindfulness, yoga, and breathing exercises
Here are a couple of short excerpts from the book Neon the Ninja: Activity Book for Children who Struggle with Sleep and Nightmares, shared with permission from Dr. Treisman.
How Children Can Experience Nightmares
By Dr. Treisman
Having a sound knowledge of nightmares and bad dreams is important as it can support you to find ways both to validate the children’s experience, and to explain it to them in words that make sense to them.
As you have probably experienced in your own dreams, nightmares feel very real, intrusive, overwhelming, and scary. Often children will feel very alone, out of control, and trapped in a nightmare. This experience is even scarier for a growing child who has not yet developed a cognitive framework to explain the nightmares, or to even recognise that they are nightmares, and are not real. They may not have the knowledge and experience to realise that the nightmare will go away.
To a child, nightmares are often a new and unfamiliar experience, which is why it is important that their experiences and feelings are empathised with, understood, supported, named, and validated by a caring, attentive, and safe adult; before going on to explore and learn that nightmares are not real. The more children understand and can make sense of something, the less confusing, powerful, overwhelming, and scared they will feel.
Nightmares are very common, and the vast majority of us have them at some time. They are very normal and, in many ways, expected part of child development. Children have very active imaginations which can manifest in dreams, yet so much of the emotional territory they encounter in a nightmare is new and unfamiliar.
For most children, nightmares are harmless, and will naturally fade without intervention or without too much attention. Indeed, many children will have a nightmare but will not remember it the next day, or will be fairly easily soothed at the time of awakening.
For others, nightmares can be a recurring problem - maybe a nightmare every night, or even several nightmares within a single night. For children experiencing problematic nightmares, night time can become very distressing, and in turn affect the child’s sleep pattern (this cycle will be explained further below.)
However, there are ways to help alleviate nightmares, and many of the activities described in this book should help (Treisman, 2019, p. 102).
Getting to Know your Child’s Nightmares
By Dr. Treisman
Before you can respond to and address nightmares, it is important to try to assess them - to explore and understand them - first. The approach and intervention should match and be tailored to the reason - there is no ‘one-size-fits-all’.
Below I’ve included some questions which I commonly explore in a clinical context to help me with this. For professionals using these questions, these should be integrated within a wider whole-child and trauma-informed assessment.
What is the child’s bedtime routine, including the hour before bed?
What does this look like or involve?
Has this always been the case, or have there been any changes, or different experiences of nighttime previously?
When did the nightmares start?
Why might the nightmares have started at that time?
Were there any triggers, changes, transitions, experiences, or incidents which co-occurred at that time?
How frequently do the nightmares occur?
Where and when do the nightmares occur? (It can be helpful to visually track, map out, chart, and/or diaries the patterns of the nightmares. See Activity 19 for help with this.)
What triggers, hotspots, patterns, and variables are there (e.g. environmental, sensory, autobiographical, physical, cognitive, relational, emotional, situational) which make the nightmares bigger, smaller, absent, present, etc.?
What happens in times when the nightmares are absent or less frequent/intense/distressing?
What is different and why?
How can these times when the nightmares are absent or less intense be magnified, increased, and celebrated?
Is the child able to recall the content of the nightmares?
Is the content the same each time or is there a common theme or feeling? (For example a feeling of being trapped, a theme of being lost, etc.) You can use Activity 20 to help with this.
Are there any links, associations, explanations, or ways you can make sense or recognize the content of the nightmares?
What does the child think about, worry about, or talk about before bed?
How are they feeling emotionally before bed?
How are they feeling in their bodies before bed?
What is the child’s expressed worries or fears?
Do you suspect other worries or fears?
What is the impact of the nightmares on the child and on those around them?
What does the child do differently as a result? (For example try to stay awake, play with their phone, wake up the other children, sleep in their carers’ room, etc.)
What do you think the nightmares or themes within them may be communicating?
What function are they serving?
What might the story behind them be?
What might be underneath their surface?
What are the child’s sense-making, meaning-making, attributions, and explanations about the nightmares?
How are these similar or different to other surrounding people’s conceptualizations of the nightmares?
What strategies/interventions have been tried already?
What bits of these were helpful or less helpful or less helpful and why?
Once you have read through these questions and given them some thought, try to reflect on what you have learned.
Have you noticed anything?
Has anything surprised you?
You may find it helpful to visually capture your reflections of these in a poster, a spider diagram, a visual map, or a diary.
If there are gaps or more questions which have emerged, how might you hold these in mind, or further and gently explore them? (Treisman, 2019, p. 111-113)
I am so excited to check out the other books in this series from Dr. Treisman including: