Monthly Archive

Pediatric Therapy Corner: Help for Problem Sleepers

By: Lindsey Biel, OTR/L
Coauthor, Raising a Sensory Smart Child
© 2011, Lindsey Biel, OTR/L. This article is printed here with the express permission of Lindsey Biel
Sensory issues can have a huge impact on sleep. An auditory sensitive child may have trouble filtering out sounds, whether it’s traffic outside, the TV down the hall, or even the sound of a sibling breathing in the next bed or next room. A tactile defensive child may be disturbed by the pajamas, sheets, pillow, blanket, or the firmness of the mattress. The room may be too warm, too cool, too bright, too dark for your child to relax and sleep. Happily, fairly simple changes can make a big difference!
Establish predictable bedtime routines
Have your child go to bed and wake up at the same time every morning, seven days a week. It’s tempting to let kids stay up late and sleep late on weekends and vacations, but this confuses the body’s internal time clocks and can disrupt sleep well beyond the weekend or holiday.
For kids who struggle with transitions and have a hard time going to bed, start your bedtime routine up to an hour in advance. Develop a sequence for getting ready for bed such as brushing teeth and washing face, talking about the day’s events, reading a book,and then lights out. Build in some variety so your child doesn’t get too rigid about bedtime rituals. You may always read a book, but you can read different books throughout the week from the library. It may be very comforting for kids to have a social story about the bedtime routine and, for some, to have a picture schedule for each step.
While we may assume that evening activities should be calm and quiet, some children actually require intense vestibular and proprioceptive input before they can settle in for the night. You may find that your child falls asleep more easily if, for example, he starts his routine by jumping on his mini-trampoline or climbing a few flights of stairs and then brushes his teeth and so on.
A bath is often soothing for kids before bed because the water provides deep pressure. If your child does not drink bath water, try adding Epsom salts to the bath since the magnesium helps relax muscles and induce sleep. However, some kids are overstimulated by a bath just before bed. If this is the case, have them bathe earlier.
Many kids and adults self-soothe orally. If your child craves chewing gum, sucks his thumb, bites himself, or puts nonfood objects in his mouth frequently, he may benefit from an oral comfort such as a Chewy Tube, Ark Grabber, Kid Companion, or a Dr. Bloom’s chewable jewel. You’ll find these and more at>toys & equipment>oral comforts.
Make the room, clothing, and bedding comfy
Use a night light if your child prefers one, but consider whether your child needs the room to be completely dark. You may need to install black-out shades or double-pane windows. Minimize environmental noise by keeping the house relatively quiet, using a white noise machine or CD, a fan, or actually soundproofing the room. Make sure the room isn’t too hot or too cold. Do what you can do to fix vibrations from an air conditioner or a clanging radiator. Use a humidifier if the air is very dry.
Make sure the mattress is not lumpy, too hard, or too soft. Most kids prefer all-cotton bedding and cotton or polar fleece pajamas with tags and labels removed and without elastic waistbands and cuffs. Speak with your occupational therapist about using a weighted blanket at bedtime.
If your child is smell-sensitive, take out the garbage before bedtime and air out lingering cooking smells. Use unscented laundry detergent and in general, avoid fabric softener because it leaves a residue.
Other strategies
Eliminate or reduce daytime naps because they often interfere with nighttime sleep.
Avoid having your child associate the bedroom with fun, wakeful activities. Reserve the bed for sleeping only.
Consult with your doctor if your child is taking medicine such as antihistamines and mood stabilizers and his sleeping habits have changed. Avoid products containing caffeine such as chocolate, hot cocoa, ice tea,Coke/Pepsi/Mountain Dew, Midol, Excedrin Migraine up to six hours prior to bedtime.
Ask with your pediatrician about giving your child melatonin before bed. Research so far shows this dietary supplement to safe help regulate sleep-wake cycles in children with autism.
Finally, use these sleep strategies to help yourself too. A well-rested caregiver is the best person to help a sleepy kid get a good night’s sleep!
This Week’s Featured Author: Lindsey Biel, M.A., OTR/L
Lindsey Biel, M.A., OTR/L is a pediatric occupational therapist based in New York City. She is the coauthor of the award-winning Raising A Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Processing Issues, with a foreword by Dr. Temple Grandin, published by Penguin Books. She is the co-creator of the Sensory Processing Master Class DVD program, along with Drs. Brock and Fernette Eide as well as a contributing writer for Autism Asperger Digest Magazine. She is a popular speaker, teaching workshops to parents, teachers, therapists, and other professionals across the country. Please visit her website at

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