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JAMA Pediatrics Patient Page
September 28, 2020

Current and COVID-19 Challenges With Childhood and Adolescent Sleep

Author Affiliations
  • 1Department of Pediatrics, University of Florida College of Medicine, Gainesville
  • 2Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
JAMA Pediatr. 2020;174(11):1124. doi:10.1001/jamapediatrics.2020.2784

The coronavirus disease 2019 pandemic has disrupted life for all, causing school closures and changes in daily schedules.

The pandemic has significantly altered normal sleep patterns for children and teenagers. While similar to summer vacation sleep laxity, children and families need to adjust sleep schedules to be well rested and arise appropriately to start their day.

Sleep is a key component of healthy living when bodies and brains rest and recharge. If children and teenagers do not get enough sleep, they can be irritable and have behavior changes, attention difficulties, and memory problems. Inadequate sleep increases the risk of high blood pressure, obesity, depression, and diabetes.

The American Academy of Sleep Medicine recommends children aged 3 to 5 years get 10 to 13 hours of sleep daily, those aged 6 to 12 years get 9 to 12 hours of sleep, and teenagers get 8 to 10 hours of sleep. Signs of too little sleep include difficulty getting up in the morning, falling asleep during the day (outside appropriate napping age), longer weekend sleep, yawning, or poor behavior. With relaxed schedules, children and teenagers may be going to bed later and sleeping later. With a return to more regular schedules, families may need guidance to reset sleep times.

First, establish a daily routine for all family members with set times for waking up, meals, school or work, recreation, and bed. School-aged children and adolescents can help create their schedules, but parents must provide healthy boundaries.

Second, stick to a consistent evening routine including a regular bedtime. Avoid caffeinated drinks, including soda, tea, and coffee drinks. Establish an electronics turn off time at least 1 hour before bedtime, and store them outside the child’s room. This means no cell phone, TV, computer, tablet, or handheld gaming systems. Sleep disruption increases just by having electronic devices in the room, even if they are not being used. Electronics emit blue light that stimulates wakefulness, as do after-bedtime snacks and drinks. Finally, keep sleep spaces dark and cool, but a night-light is OK.

If bedtime has been later than usual, it may take a few weeks to gradually move bedtimes and rise times earlier because it is easier to stay up later than to go to sleep earlier. Set a wake-time goal, and gradually move bedtime earlier by 10 minutes every 3 to 4 days. Once a child can fall asleep within 30 minutes of bedtime, move bedtime 10 minutes earlier the next night. With each step, move up the wake time. It is important to avoid napping; the sleepiness that builds during the day helps children fall asleep at night. If a nap is inevitable, limit it to 20 minutes.

Consider contacting your pediatrician if you are having trouble moving your child’s sleep-wake schedule around or for other sleep behaviors such as snoring, gasping, kicking, or sleeping too much. These could be signs of a different health problem.

Adjusting sleep schedules can be challenging at first and will take time to implement. Sleep is a critical part of health for children and adolescents, so make sleep a consistent priority and your child will benefit from this for years to come.

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Article Information

Published Online: September 28, 2020. doi:10.1001/jamapediatrics.2020.2784

Conflict of Interest Disclosures: None reported.