What to know about behavioral insomnia in children (BIC)
Insomnia is a persistent difficulty with falling or staying asleep at night. BIC, which affects about 25 percent of children, is a type of pediatric insomnia that encompasses three behavioral disorders: sleep-onset association, limit-setting and combined BIC.
“Sleep-onset association, most common among infants and toddlers, is a behavioral disorder in which the child has learned to fall asleep only under specific bedtime conditions (e.g., while being rocked, cuddled or nursed),” explains Douglas Li, MD, UCLA pediatric pulmonologist and sleep medicine specialist. “If the child wakes up during the night, he or she is often not able to fall back asleep (‘self-soothe’) unless those same conditions are available.”
In contrast, children experiencing limit-setting BIC explicitly refuse to go to bed or attempt to delay bedtime with persistent requests – asking for “one more story” or another trip to the bathroom. The third type of insomnia, combined BIC, occurs when a child exhibits both: reliance on a sleep aid and defiance around bedtime.
Sleep is an integral part of a child’s physiological health and development. “To promote optimal health, children 3 to 5 years old need 10 to 13 hours of sleep per day and children six to 12 years old need nine to 12 hours of sleep per day,” Dr. Li says. If your child is not getting enough sleep, talk to your pediatrician about treatment strategies. A BIC diagnosis is based on the child’s symptoms and medical history. Factors that can cause or compound BIC include, but are not limited to, inconsistent bedtime routines and inadequate parental limit-setting, stress, caffeine, or co-existing medical disorders.
“While treatment may vary depending on the type and severity of the insomnia, most cases can be resolved with proper sleep hygiene practices that establish a regular sleep-wake cycle,” Dr. Li says. Medications are not typically recommended as a first-line treatment for childhood insomnia; they are usually only used in special circumstances.
Practice good sleep hygiene
- Establish a routine sleep schedule that promotes independent sleeping (without parent in room)
- Avoid stress at bedtime
- Use your bed for sleeping only (no games, phone, TV or homework)
- Avoid heavy meals late in the evening
- Restrict caffeine intake 4-6 hours before bedtime
- Exercise regularly
- Maintain a dark, quiet and cool room
Symptoms of poor sleep
If left untreated, insufficient sleep can lead to physiological and behavioral problems, including hyperactivity, inattention, diminished memory and recall, aggression and excessive daytime sleeping. “Poor sleep is also associated with increased risk of cardiovascular complications, diabetes and mood disorder,” says Dr. Li.
If you’re concerned that your child may have behavioral insomnia, please contact UCLA Health’s Division of Pediatric Pulmonology and Sleep Medicine at (310) 825-0867.