William Tucker, OTR/L

As occupational therapists, we understand that sleep is not simply a period of rest—it is an essential occupation that supports a child’s development, learning, emotional regulation, sensory processing, and participation in daily life. When children do not get enough sleep, the effects are often felt throughout the entire family. A poor night of sleep can impact attention, behavior, mood, and overall functioning for both children and caregivers.

When children are running low on sleep, they may appear hyperactive, irritable, anxious, inattentive, or emotionally dysregulated. Improving sleep can often lead to improvements in many areas of daily functioning.

Many sleep difficulties can be improved through consistent sleep hygiene practices. Sleep hygiene refers to habits, routines, and environmental factors that support healthy, restorative sleep. Below are evidence-informed strategies that parents can use to help their children develop healthier sleep patterns.

Create A Consistent Sleep Schedule

One of the most important sleep hygiene practices is maintaining consistent bedtimes and wake times every day of the week.

Many families allow later bedtimes and sleeping in on weekends, but this can disrupt a child’s internal body clock and make it more difficult to fall asleep during the week, especially for children who already have a difficult time falling asleep.

Predictability helps children feel secure and signals to the brain that sleep is approaching.

Use The Bed Primarily For Sleep

Children often spend time in bed watching videos, playing games, or engaging in other stimulating activities. Over time, the brain may stop associating the bed with sleep.

Keeping the bed only a place for sleep strengthens healthy sleep associations and supports quicker sleep onset.

Create A Comfortable Sleep Environment

The sensory environment of the bedroom can significantly affect a child’s ability to fall asleep and stay asleep.

Consider:

Room temperature
Noise levels
Lighting
Bedding comfort
Clothing textures

Some children may become uncomfortable due to overheating, tangled blankets, or sensory sensitivities.

A weighted blanket may be beneficial for some children who often seek deep pressure. A strong sign of this is if they frequently request tight hugs or like to be squeezed generally. A common guideline is that a weighted blanket should be no more than approximately 10% of the child's body weight, though parents should consult with their healthcare provider or occupational therapist regarding individual needs.

Reduce Stimulation Before Bed

High levels of stimulation close to bedtime can make it difficult for children to transition into sleep.

Activities To Limit Before Bed

Television
Video games
Tablets and phones
Vigorous physical activity

Create a calming "wind-down" period during the hour before bedtime. During this time, encourage:

Reading
Coloring
Listening to calming music
Gentle stretches
Quiet family interaction

Reducing stimulation allows the nervous system to gradually shift into a more restful state.

Pay Attention To Sensory Input

Many children, particularly those with sensory processing differences, benefit from intentional sensory regulation strategies before bed.

Dim the Lights

Bright overhead lighting can signal wakefulness to the brain.

Reducing visual input helps support natural melatonin production and prepares the body for sleep.

Use Calming Scents

Some children find comfort in familiar, pleasant smells.

If your child enjoys certain scents, consider:

Lavender
Vanilla
Scented lotions
Body wash or shampoo with preferred calming scents

A consistent scent can become part of the bedtime routine and serve as a cue that sleep is approaching.

Use Calming Music

Music can be a powerful sensory tool. Create a consistent bedtime playlist that may include:

Instrumental music
Soft guitar
Lullabies
White noise

Playing the same songs or sounds in the same order each night helps create predictable sensory cues associated with bedtime.

Incorporate Physical Activity During The Day

Regular physical activity often supports better sleep later in the evening. Encourage movement throughout the day including:

Outdoor play
Sports
Playground activities
Family walks
Active games

While exercise is beneficial, try to avoid highly stimulating physical activity immediately before bedtime.

Modify Challenging Self-Care Tasks

Certain hygiene tasks, such as hair brushing, tooth brushing, or bathing, can be highly aversive for some children. To avoid high stimulation before bedtime, complete difficult self-care tasks earlier in the bedtime routine. Follow them with a preferred calming activity or positive parent-child interaction. This allows children time to regulate before lying down to sleep.

Teach Relaxation Skills

Relaxation techniques can help children calm both their bodies and minds before sleep.

Strategies May Include:

Deep breathing
Slow belly breathing
Gentle rocking
Rhythmic movement
Deep pressure input
Guided imagery
Progressive muscle relaxation

Practice these skills during calm moments in the day before expecting children to use them independently at bedtime.

Children are more likely to access relaxation tools when they have practiced them regularly.

Manage Worries Earlier In The Day

Many children experience racing thoughts or worries at bedtime.

Schedule a designated "worry time" earlier in the day. During this time:

Encourage children to talk about concerns
Problem-solve together
Write worries in a journal
Create plans for handling challenges

This helps prevent bedtime from becoming a time dedicated to worry and rumination.

Put Children to Bed Drowsy but Awake

If your child is not sleepy at bedtime, consider temporarily delaying bedtime in small increments (approximately 30 minutes) until your child falls asleep more readily. Once sleep onset improves, gradually move bedtime earlier until the desired schedule is reached.

During the extended awake time, focus only on calming, low-stimulation activities.

Night Wakings

If children wake during the night, parental responses should be reassuring but minimal.

Keep Check-Ins "Brief and Boring"

The goal is to communicate:

"You are safe."
"I am here."
"It is time to sleep."

Avoid lengthy conversations, bright lights, games, snacks, or stimulating interactions that may unintentionally reinforce waking.

Consider Security And Comfort Objects

Transitional objects can provide emotional comfort and support independence at bedtime.

Examples:

Favorite stuffed animals
Blankets
Special pillows
Parent shirts or sweatshirts with familiar scents

These items can help children feel safe and secure when caregivers are not immediately present.

Track Sleep Patterns When Problems Persist

If sleep difficulties continue despite consistent intervention, gathering information can be extremely valuable. Keep a sleep diary that records:

Bedtime
Wake time
Night wakings
Daytime naps
Physical activity
Food and caffeine intake
Behavioral observations

Patterns often emerge that can help identify contributing factors and guide intervention.

Final Thoughts

We recognize that healthy sleep is foundational to a child's success in everyday occupations, including learning, play, self-care, social participation, and emotional regulation. While there is no single strategy that works for every child, a combination of consistency, sensory awareness, predictable routines, and supportive environmental modifications can significantly improve sleep quality.

Remember that meaningful change often occurs gradually. Start with one or two strategies, practice them consistently, and build from there. Small adjustments to a child's sleep routine can have a profound impact on their overall well-being—and on the well-being of the entire family.

List of strategies:

Keep bedtime and wake-up times within 30–60 minutes of the usual schedule, even on weekends
Establish a predictable bedtime routine that occurs in the same order each night
Aim for routines that are calming, simple, and repeatable
Encourage quiet activities outside of bed before bedtime
Use the bed for sleeping and not for activities
Keep the bedroom cool, quiet, and comfortable
Observe signs of discomfort such as kicking off blankets, sweating, or constantly repositioning
For children who seek deep pressure, weighted blankets may be beneficial when used safely and appropriately
Reduce stimulating activities before bed
Encourage wind-down activities
Use lower lighting in the evening
Use lamps or warm ambient lighting instead of bright overhead lights
Consider dimmers when possible
Use a consistent common and preferred scent around bedtime
Use consistent calming music around bedtime
Make sure to get plenty of exercise during the day
Put challenging self-care tasks earliest for evening routine
Practice relaxation techniques with your child
Have “worry time” earlier in the day
Put kids to bed when they are drowsy, and gradually change bedtime earlier until desired regular time
If your child wakes at night, keep interactions brief, concise, and boring before sending them back to bed
Blankets, special pillows, or stuffed animals can help as security items
If sleep problems are persistent, keep a log of activities before bedtime, during night hours, and after waking to watch for patterns

Sleep Hygiene for Children: An Occupational Therapist’s Guide for Better Sleep