When a child has difficulty falling or staying asleep, consequences may include problems with mood, attention and behavior. Such difficulties can result in academic decline, disciplinary action, missed school, social malfunction and/or family discord. In addition, parents may lose sleep when their child receives insufficient rest.

The pediatric insomnia program at Comer Children's provides care for infants, toddlers, school-aged children and adolescents with sleep difficulties. Specially trained clinicians work with infants and children who have behavioral insomnia, as well as adolescents with delayed sleep phase syndrome, inadequate sleep hygiene (e.g., late electronics use, excessive caffeine intake or late homework that delays bedtime) and/or insomnia.

Signs & Symptoms of Insomnia

Insomnia is defined as the perception or complaint of inadequate or poor-quality sleep because of one or more of the following:

  • Difficulty falling asleep
  • Non-refreshing sleep 
  • Waking up frequently during the night
  • Waking up too early in the morning

Symptoms of insomnia may include:

  • Anxiety or frustration about sleep
  • Attention, concentration or memory problems
  • Daytime sleepiness 
  • Low energy or fatigue 
  • Waking up un-refreshed

Most children with insomnia fall into one of three diagnostic categories: sleep onset association type (children need to be with a specific item or person to fall asleep), limit-setting type (children refuse or stall bedtime) or combined type.

Diagnosing Sleep Difficulties in Children

During an initial evaluation, a patient and his/her family will meet with program director Lisa Medalie, PsyD, CBSM. We will discuss symptoms and rule out underlying medical factors that may contribute to sleep problems. All families will be asked to fill out sleep logs that track the quality and length of the patient's rest each night. Based on the initial assessment, our team may also ask some children to wear an actiwatch — a portable device about the size of a wristwatch that records and stores information about body movements over a period of time. Information collected from the sleep log and/or actiwatch will be used to properly diagnose sleep issues and create treatment plans.

Treatment for Sleep Problems

If an insomnia diagnosis is confirmed, our team will work with your family to establish treatment goals and create an individualized care plan. Behavioral plans for insomnia will vary based on a child's age and the type of sleep difficulty. We often recommend the use of evidence-based interventions in younger children while adolescents may benefit from cognitive behavioral treatment. In some instances, melatonin (an over-the-counter sleep aid) or other sleep medications may be helpful.

Our team will discuss all treatment options with your family. We aim to empower you by providing knowledge about sleep medicine and behavioral interventions. We work closely with patients and their families, often meeting weekly or bi-weekly, to encourage motivation and adherence.