A panel of pediatric specialists led by the American Academy of Sleep Medicine (AASM) has released sleep recommendations for children between 4 months and 18 years. The recommendations are summarized in the following table.
Sleeping the number of recommended hours on a regular basis is associated with better health outcomes, including improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health.
Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts.
Regularly sleeping more than the recommended hours may be associated with adverse health outcomes such as hypertension, diabetes, obesity, and mental health problems.
The panel focused on seven health categories with the best available evidence in relation to sleep duration: general health, cardiovascular health, metabolic health, mental health, immunologic function, developmental health, and human performance. Consistent with the RAND Appropriateness Method, multiple rounds of evidence review, discussion, and voting were conducted to arrive at the final recommendations. The recommendations have been endorsed by the American Academy of Pediatrics, the Sleep Research Society, and the American Association of Sleep Technologists.
A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.
UBC sleep specialist and nursing professor Wendy Hall, the only Canadian member of the panel, explains how the guidelines were developed and why getting enough sleep is critical to good health.
Why are these guidelines important, and why now?
Lack of sleep is a growing trend and AASM saw a need for updated, evidence-based recommendations for adequate sleep. Most parents and care providers don’t really know how much sleep children should be getting. In fact, some studies suggest that less than 1% of children receive science-backed interventions when they have sleep problems because so few people are educated about sleep.
Our panel examined how sleep impacts different aspects of health, such as cardiovascular, developmental, mental, and metabolic, as well as longevity, immunology, and life performance.
These new AASM guidelines focus specifically on children, were developed by pediatric specialists, and are based exclusively on pediatric studies.
How does insufficient sleep affect children’s health?
While most of the evidence that we have is associative, not cause and effect, it’s pretty persuasive.
Sleep deprivation in infants is linked to problems with emotional regulation during the day, and possibly with obesity once they reach 3 years of age. Toddlers who lack sleep have difficulty focusing and retaining language. They might show more aggressive, less prosocial behavior. Among 3- to 5-year-olds, lack of sleep is associated with memory consolidation and language development difficulties, and with a lesser quality of life.
Children aged 5 to 12 years who get less than 9 hours of sleep have significantly increased odds of obesity, while 13- to 18-year-olds are more likely to suffer athletic injuries if they sleep less than 8 hours. Other studies suggest sleep-deprived adolescents and teenagers show higher levels of cellular inflammation and insulin resistance.
How do we safeguard children’s sleep?
For school-aged and younger kids, bedtime should be no later than 9:00 p.m. Even older kids do better if they go to bed before 9:30 p.m.
Sleep routines are critical for kids of all ages. Reading a book, telling a story, singing a song, or getting into a toothbrush routine help kids settle into sleep better. Banning electronic devices from the bedroom also helps.
Follow good sleep hygiene and keep children’s bedrooms dark, cool, and quiet.
Parents who are concerned that their child is sleeping too little or too much should consult their health care provider for evaluation of a possible sleep disorder.
1. Fitch K, Bernstein S, Aguilar M et al. The Rand/UCLA appropriateness method user’s manual. Santa Monica, CA: Rand, 2001.
2. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12:785-786.