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Pediatric Sleep Difficulties


Childhood sleep disorders are one of the most common pediatric health concerns and can lead to a significant impact on children’s overall health and well-being. Approximately a quarter of all children and one-third of adolescents experience some type of sleep problem or have significant sleep complaints. Some of the most commonly reported behavioral symptoms of pediatric sleep problems (and those frequently seen at our clinic) include: 

  • Bedtime fears/anxiety
  • Bedtime resistance/refusal
  • Delayed sleep onset (difficulty falling asleep)
  • Difficulty waking in the morning 
  • Poor sleep maintenance (frequent nighttime wakings)
  • Circadian rhythm difficulties (significant shift in desired sleep schedule)
  • Poor sleep habits 
  • Undesired co-sleeping or bed-sharing 
  • Difficulty tolerating positive airway pressure (for children with Obstructive Sleep Apnea)
pediatric sleep issues

These bedtime struggles may develop due to a number of factors including medical illness, comorbid psychological difficulties such as anxiety, OCD, and ADHD, irregular sleep schedules, and limit-setting inconsistencies. The impact pediatric sleep difficulties can have on both child and caregiver is significant, and typically leads to poor emotional or behavioral outcomes in a number of areas including: 

  • Memory and/or learning difficulties
  • Decline in academic performance 
  • Difficulty with concentration 
  • Heightened frustration response and lower emotional control 
  • Increase in disruptive or aggressive behaviors 
  • Decrease in parent-child relationships 
  • Greater prevalence of accidental injuries 

The good news is that childhood sleep disorders are considered very treatable due to the development of highly effective behavioral interventions. At Anxiety Specialists of Atlanta, we have a team of highly experienced specialists who focus on utilizing evidence-based behavioral strategies for the treatment of these sleep and anxiety-related conditions. 


Childhood insomnia can present in a number of different ways, though the diagnosis always includes some difficulty with falling asleep or staying asleep that results in an insufficient “total sleep time”. The child’s sleep disturbance then often leads to sleep loss for other family members, which can disrupt overall family functioning. The term “Behavioral Insomnia of Childhood” includes three common diagnoses:

Sleep-Onset Association Type: This type occurs when children resist or appear unable to fall asleep without the presence of a specific item or person. This type can also include the inability to get back to sleep after awakening. 

Limit-Setting Type: This is the clinical term for excessive bedtime delaying. Children with this type of behavioral insomnia tend to stall going to sleep by various means, including screaming or crying, asking for extra hugs/kisses, and finding new items or tasks needing completion prior to bedtime. 

Combined Type: As stated in the name, this type involves a combined presentation of both limit-setting and sleep-onset symptoms. 

Cognitive Behavioral Therapy (CBT) has been shown to be the most effective non-medical treatment for pediatric insomnias in several studies. Treatment following this approach at Anxiety Specialists of Atlanta often includes the use of effective CBT-informed strategies including behavioral extinction, positive routine development, bedtime fading, graduated exposure, stimulus control, and behavioral management techniques.  


Parasomnia is a general term used to indicate distressing or undesired activities that either occur during or are exacerbated by sleep. These can include difficulties such as recurring nightmares, sleepwalking, night terrors, etc. Our team at ASoA frequently assists parents in differentiating and normalizing these struggles, which are often highly distressing to parents and disruptive to a family’s nightly routine. This is typically followed by effective behavioral strategies targeting specific parasomnia, such as contingency management, sleep hygiene, scheduled awakenings, replacement behavior changes, and circadian rhythm schedule adjustments.   


At Anxiety Specialists of Atlanta, we believe in providing scientifically proven treatments with the goal of managing conditions through a Cognitive Behavioral approach. Treatment begins with a thorough evaluation to conceptualize the primary contributors to your child’s sleep difficulties and recommendations are always tailored to address the specific sleep problems your child is experiencing. Caregivers often play a key role in establishing and maintaining changes in their children’s sleep, so for this reason, parents are almost always intimately involved in treatment. 

Melatonin, outside of its more known form as a pill or gummy, is actually a naturally developed hormone that helps us regulate our own internal sleep clock. Many people also use extra melatonin taken externally to improve their ability to fall asleep, and children have seen some benefit in its use for shifting “off schedule” circadian rhythms and assisting with developmental difficulties at night. However, a word of caution in the increased use of melatonin is warranted, due to growing reports of melatonin overdose at poison control centers and emergency rooms. We at Anxiety Specialists of Atlanta recommend that parents speak with a healthcare professional prior to initiating the use of melatonin or any sleep-inducing supplement for their children. Unlike other over-the-counter medications, melatonin is not under FDA oversight and the content in its supplements can vary widely. Further, many sleep problems that drive parents to seek supplemental support can be even better managed with therapeutic behavioral strategies. 

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