ASK THE DOCTOR

Ask the Doctor: Back-to-School Bedtime Routines

by Bobbi Hopkins, M.D., pediatric sleep specialist and medical director of the Sleep Center at Johns Hopkins All Children’s Hospital

Sleep is a time to rest and recharge, but some children may not get the restful sleep they need. Whether this is because of trouble falling asleep or staying asleep, a lack of rest can lead to a variety of other issues, including poor performance in school and behavior problems. As we head into a new school year, here are some basic bedtime routine ideas to jumpstart good sleep habits. But first, let’s answer the big question…

WHAT TIME SHOULD MY CHILD GO TO BEDEACH NIGHT?

● Elementary aged children should try to go to bed between 7:30p.m. and 9 p.m. ● Middle school aged children should go to bed between 8:30 p.m. and 10 p.m. ● Teens should try to go to bed between 9 p.m. and 11 p.m. Recalling the wake time should allow the child to achieve an age-appropriate amount of sleep.

MORE HELPFUL BEDTIME TIPS FOR BACK-TO-SCHOOL:

SETTING A BEDTIME ROUTINE

● Start the routine at the same time every night. ● Reduce indoor lights to encourage the release of melatonin, which will help your child feel sleepy sooner. Start this around 6 p.m. or when it starts to get dark outside. Think of it as pretending to have no electricity. ● Stop using electronics (TV, tablet, computer, phone) at least one hour before bed. ● Prepare a warm bath before bedtime. Many children may find this soothing. ● Prepare a small, quiet activity such as reading a book or singing a soft song. Be sure to keep the activity short. For example, no more than two short books. ● Be consistent between caregivers. Any change in the routine can disturb your child’s ability to rest. ● Walk your child back to their room with as little interaction as possible to help them settle back into sleep easier if they wake up during the night and come to you. ● Set a wake-up time for when your child is allowed to leave their room. If they wake up earlier, staying in their room will help them fall back asleep instead of getting up to go play or watch TV.

Remember, do not allow bargaining when following a bedtime routine. Children will often ask for “one more hug” or “one more song” to delay going to bed. Though it may be difficult, stick by the rules you have set so your child can be at their best the next day.

Following the same routine every night helps your child mentally prepare for sleep. A bedtime routine can Along with a routine, make sure your child’s room is a relaxing be as simple as a warm bath and a little bit of reading. environment. A TV in the room or having lots of toys in the bed can send mixed messages to the brain about if it is time to play or sleep.

Following the same pattern at the same time every night will create cues for the brain to start getting ready During the day, encourage your child to do homework, play games, to sleep. Use these tips for setting a bedtime routine: talk on the phone and do other activities off of their bed and away from the bedroom. This helps their body associate their bed with ● Consistent bedtime and wake time for two weeks sleep and not with any other activity.prior to school. ● Dimming the light for four hours prior to bedtime and eliminating electronics for one hour prior to bed will help the child go to sleep easier and earlier. Is melatonin safe for kids? ● Exercise during the day, but not during Excellent sleep hygiene and a consistent bedtime and wake time are important the two hours prior to bed. strategies to ensure a good night’s sleep. For children who continue to struggle ● School aged children should not take with difficulty sleeping despite these interventions, low dose melatonin may be naps. considered if recommended by a physician. ● Ensure the bedtime and wake time are Although melatonin is one of the best studied sleep aids for children, there are age/circadian rhythm appropriate. concerns it may impact the release of other hormones. In addition, recent studies note melatonin accidental ingestion or overdose is on the rise for children. If parents and the child’s physician feel melatonin will be beneficial, it is good to have a plan to wean from it over time once the sleep problem has improved.