Insomnia in children is not uncommon. Many children have sleeping problems some time in their lives. Children who won't fall asleep or have irregular sleeping patterns can give much frustration to their tired parents. The most common sleep problems with infants, toddlers and preschoolers is sleep onset association disorder sometimes caused by the habit of parents and children sleeping together.

This problem occurs when the child wake up when the parent which she has associated with falling asleep is not present. The child learn to rely on the parent to fall asleep and thus lack the soothing skills necessary to settle back to sleep. Parents often describe a child who insists on being nursed to sleep or on having a parent lie alongside until he or she falls asleep. Parents are often unaware that their well-meaning habits have created the difficulty.

Management of sleep-onset association disorder involves two critical elements. First, you must gain an understanding of your child’s “brain clock" or typical time of sleep onset and morning awakening. It might be helpful for you to keep a sleep log to accomplish this. Then, you must undertake a period of training the child to shift from wake to sleep independently. Making this transition requires that parents put the child to bed when he or she is drowsy but still awake--in other words, at a time that coincides with natural sleep onset rather than at an arbitrary hour they have chosen as bedtime.

Even when timing is optimal, most children protest when their bedtime routine is changed. Parents vary in their ability or willingness to allow their child to cry for brief intervals during this period of training. Simply allowing infants to cry themselves to sleep is unnecessary and potentially harmful, particularly in babies with daytime symptoms of separation anxiety.

Nighttime snacks and drinks, with the exception of water, should be avoided, because these can exacerbate nocturnal arousals from a physiologic standpoint and negatively affect dental health.

During the middle-childhood years, short sleep requirement, sleep-onset anxiety, and obstructive sleep apnea are commonly encountered problems. In these cases, making a sleep chart is very helpful both for parent and doctors if the problem becomes persistent.

When dealing with sleep-onset insomnia caused by anxiety, physicians will ask about daytime complaints, fears, or worries, which may suggest a more pervasive anxiety problem warranting referral to a children's mental health professional.

Exposure to frightening media events and a history of stressful events such as a death in the family or the arrival of a new sibling should be explored. More severe stressors, such as enduring sexual abuse or witnessing family violence, are considerations in some cases.

A simple but common cause of sleep-onset insomnia in children is rumination on issues of the day at bedtime. This problem can often be settled with a small amount of extra attention and conversation with a parent at bedtime.