Counting Sheep and Getting Sleep for Young Children with T1D and Their Parents

Every parent of a young child knows that bedtime can often be an uphill battle. You’ve heard it all—he’s not tired yet, she wants you to read her one more storybook or he wants to stay up for just another five minutes. Throwing bedtime diabetes management into the mix can make getting your child to bed at a certain time even more challenging—and diabetes-related needs or worries overnight can make it hard to get a full night’s sleep. However, consistent routines at bedtime and plans for overnight care can help smooth the overnight hours.

The amount of sleep that a young child needs varies, depending upon age and development. According to the National Sleep Foundation, sleep recommendations depend on a child’s age.

Hours of sleep recommended…

• toddlers: 11-14 hours (including daytime naps)
• preschoolers: 10-13 hours
• older school-age children: 9-11 hours

By the age of 3-4 years, most children stop taking their afternoon naps, and so parents might need to move bedtime earlier to ensure kids get the 10-13 hours they need. Sleep is critical for children’s growth and development, and it is also equally important for your own health and well-being. It’s recommended that adults get at least seven hours of sleep a night—which can be tough for any parent of a young child! Though prioritizing sleep won’t eliminate all stress, it can definitely help you manage your daily tasks and challenges better, including managing your child’s diabetes.

Here are our top before, during and after bedtime tips to help both you and your child with diabetes get to sleep and stay asleep:

Daytime/Before Bedtime

• During the day, try to spend some time outside with your child. Giving your child the time to be active and play during the day will make getting to sleep easier at night. For adults, try to fit in physical activity every day, even if just for 20-30 minutes.
• Try to avoid caffeine (commonly found in soda or chocolate), especially after dinner or as a bedtime snack. For adults, also try to avoid nicotine and alcohol.
• Start to limit high-energy activities (rough play, playing outside) about an hour before bedtime.
• It is also important to limit technology within 30-60 minutes of bedtime—try to minimize time in front of any bright screen. Dim the lights, and try to engage your child in quieter activities like reading a book together, drawing, or listening to music.
• Establish a consistent “bedtime” and “wake-up time” and do your best to stick to it, even on weekends. If you know your child needs more time to quiet down and adjust to bedtime, try to build in extra time when getting ready for bed.

At Bedtime

• Establish a routine that works well for your child and family. Your child can help you create a bedtime ritual that includes both diabetes management tasks and other more calming activities (like reading a bedtime story or sharing favorite parts about each family members’ day).
• For adults, try to use a relaxation strategy before going to sleep, like mindful breathing, to quiet the mind and reduce overnight worries about your child’s diabetes.
• Create the right sleeping environment—your and your child’s bedrooms should be dark, quiet, comfortable and cool. Sometimes a “bedtime buddy” or other type of transitional object/stuffed animal can be comforting for children and can make the transition easier.
• Diabetes management can sometimes take longer than expected—persistent out-of-range glucose values that won’t budge, surprise site changes and the like can delay bedtime. Build some buffer time into the evening diabetes management routine to allow for the predictably unpredictable diabetes-related needs at bedtime.
• Stay patient. Many children misbehave at bedtime and diabetes management challenges can add to the stress—keep your frustration in check by taking a deep breath, saying a positive mantra to yourself, or switching off with other caregivers with the goal of remaining calm.
• If your child has been having out-of-range blood glucose values overnight, talk to your care team to look at those patterns and discuss how to adjust the evening diabetes care plan.

After Bedtime and Overnight

• Make sure your child knows what to expect during the night and when it is OK for your child to come out of his/her room or call for you. Praise your child for letting you know if he/she doesn’t feel well overnight, but try to limit your interactions at that time to diabetes management (and treatment if needed) and then back to bed, to avoid other reasons for being out of bed. Provide reassurance that he/she will now be OK and can go back to sleep.
• Occasional overnight finger checks or use of remote blood glucose monitoring can help parents keep an eye on diabetes overnight without your child getting up too often. If needed, you can encourage your child to stay in his/her bed or bedroom all night by providing a small incentive in the morning: stickers or small prizes given first thing in the morning can work well for young children.
• If you routinely check blood glucose levels overnight, consider sharing this responsibility with another caregiver, if possible, in order to get a full night’s sleep every few nights.
• It may be time to check in with your child’s diabetes team to see under which circumstances an overnight blood glucose (BG) check is mandatory, and when it may be OK to not check BG overnight.

Some children require additional support to fall asleep on their own, or stay in their own bed/bedroom for the entire night, but the good news is sleep challenges can usually be managed! As you learn more about your child’s unique blood glucose patterns, you will also learn more about what routines are best for you and your family. If you have any questions or concerns, be sure to talk to your child’s diabetes care providers about both your child’s sleep and your own sleep, and do what you can to make sure that you are each getting enough restful sleep every night. Sweet dreams!

For further information, check out theses resources:

Weissbluth, M. (2005). Healthy sleep habits, happy child: a step-by-step program for a good night’s sleep. New York, NY: Ballantine Books.

Mindell, J. A. (2005). Sleeping through the night: how infants, toddlers, and their parents can get a good night’s sleep. New York, NY: HarperResource.

Bedtime Apps: Breathe, Calm, Smiling Mind

 This work is funded by NIH DP3DK103998 and R01DK102561

Marisa E. Hilliard, PhD, is a pediatric psychologist and behavioral scientist whose work focuses on clinical care and research with young people with type 1 diabetes and their families. Her passion is promoting resilience, and her research focuses on how youth and families overcome the challenges of diabetes to maintain good quality of life, adhere to treatment recommendations, and have optimal diabetes control. She is especially interested in transitional times in diabetes management, such as adjusting to life with a new diabetes diagnosis, how family diabetes management shifts across childhood and adolescence and how teenagers prepare to manage their diabetes as young adults. Dr. Hilliard is an Assistant Professor of Pediatrics at Baylor College of Medicine, in the Psychology Section of Texas Children‘s Hospital in Houston, Texas.

Randi Streisand, PhD, CDE, is a child health psychologist and received her doctorate in clinical psychology from the University of Florida. She completed her internship at Brown University and a fellowship at the Children’s Hospital of Philadelphia before joining the faculty at Children’s in 2000. Dr. Streisand is also professor of psychology & behavioral health, and pediatrics at Children’s National Medical Center, is director of Behavioral and Community Research in the Center for Translational Science, and serves as director of Psychology Research for the institution.  Dr. Streisand is currently NIH funded with research efforts related to childhood diabetes. Her work focuses on adherence to diabetes management, parent and child adjustment and managing diabetes in young children. She has multiple publications in the area of child health, and specifically related to childhood diabetes.

Caitlin Shneider, BA, is a clinical research assistant with Dr. Randi Streisand at Children’s National Medical Center in the Center for Translational Science. She graduated with honors in Biopsychology, Cognition and Neuroscience from the University of Michigan in 2016. Caitlin is currently working on a multi-site NIH funded intervention trial for parents of young children with type 1 diabetes. Her past research experiences include family psychosocial functioning after pediatric liver transplantation and food allergies in young children. Caitlin plans to pursue a doctorate in clinical psychology with a particular interest in pediatric psychology.

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