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Sleep problems — children
Children's sleep problems aren't smaller versions of adult sleep problems.
A clinical overview of behavioral sleep issues in children from infancy through adolescence — and how the practice approaches them differently than adult care.Pediatric sleep is its own clinical territory. What works for adults isn’t usually appropriate for a child. Pediatric treatments are developmental, adapted by age, and account for the family system around the child. Dr. Shelby’s pediatric work uses evidence-based behavioral approaches calibrated to each stage of childhood, in coordination with the child’s pediatrician where appropriate. If Dr. Shelby feels that the child would benefit from additional anxiety work specifically with a child psychologist, she will provide appropriate referrals.
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Why pediatric sleep is different
A child's sleep problem is usually three problems at once.The child's sleep affects the parents' sleep.
When an adult comes in with insomnia, the patient is the patient. The treatment targets the patient's behavior, thoughts, and sleep environment. When a child comes in with a sleep problem, the situation is fundamentally different. The child's sleep affects the parents' sleep. The parents' exhaustion affects how they manage bedtime. The bedtime management affects the child's sleep. The system is recursive, and the treatment has to address all of it.
The other complication: not every “sleep problem” in a child is the same kind of problem. Some are developmental — a phase that will resolve. Some are behavioral — patterns that need intervention. Some are medical — sleep apnea, restless legs, or other conditions that require pediatric sleep medicine evaluation. The clinical work, often, starts with figuring out which category applies before any treatment begins.
What this looks like by age
How sleep problems present differently across childhood.Pediatric sleep problems are stage-specific. The clinical question is never just “what sleep problem does this child have?” — it's always also “what does sleep look like at this age, and where does this child sit inside that range?”
Infants (0–12 months)
Night wakings, difficulty self-soothing, day-night confusion, and the broader question of how and when to support sleep consolidation. Treatment is developmentally cautious and varies based on the child's age, feeding status, and parental goals. The first six months are largely about gentle behavioral foundations; the second six months are when more structured behavioral approaches become appropriate.Toddlers (1–3 years)
Bedtime resistance, night wakings, transitions out of the crib, fear of the dark, and the emergence of bedtime stalling behaviors. The treatment focuses on consistent routines, parent-managed limits, and gradual independence. This is often the stage where families have been managing on exhaustion for the longest and need the most structural support.Preschool and Early School-Age (3–7 years)
Bedtime fears, nightmares, night wakings, bedwetting that affects sleep, difficulty separating at bedtime, and behavioral resistance. The treatment integrates anxiety-focused work appropriate to the developmental stage with continued behavioral structure.School-Age (7–12 years)
Difficulty falling asleep, anxiety about school, screen-related sleep disruption, and the emergence of insomnia patterns. The treatment begins to incorporate cognitive elements — children at this age can engage with thought-pattern work in a developmentally appropriate way.Adolescents (13–18 years)
Significant delayed sleep phase (the natural biological shift toward later sleep timing that begins to impact school), insomnia, nightmares, anxiety-related sleep disruption and the interplay between mental health concerns and sleep. Treatment is tailored to the presenting problem, from light therapy and sleep-wake scheduling to CBT-I or other modified versions that are appropriate. The work often involves the adolescent directly with parental support, not parental control.Did you know
Common adult sleep beliefs worth reexamining.A useful threshold
When children's sleep problems warrant evaluation.Many sleep difficulties in children are developmental and resolve on their own. Others persist and respond to behavioral treatment. A small number are medical and require pediatric sleep medicine evaluation.
Sleep problems have persisted for at least four to six weeks despite reasonable behavioral consistency at home.
Daytime functioning is affected — behavior, attention, mood, school performance, or growth concerns.
Snoring, pauses in breathing during sleep, gasping or choking, or restless sleep — any of which can indicate potential pediatric sleep apnea and warrant evaluation from a pediatric sleep medicine physician. Appropriate referrals will be provided.
Bedtime is consistently taking more than 45 minutes, occurring nightly, with significant distress.
Parents are running on chronic sleep deprivation and the family system needs support.
You're considering medication for the child's sleep and want a behavioral evaluation first.
Meeting any one of these is a reasonable signal to seek a pediatric behavioral sleep evaluation. Snoring or breathing concerns warrant evaluation from a pediatric MD sleep medicine specialist and referrals will be provided.
Treatment approach
Behavioral, developmentally appropriate, in coordination with the pediatrician.Pediatric sleep treatment uses behavioral approaches calibrated to the child's developmental stage. For younger children, the work is often parent-directed — coaching parents through the structural changes that the child needs from them. For older children and adolescents, the work involves the child directly with parental support.
The practice coordinates with the child's pediatrician when relevant and refers to pediatric sleep medicine physicians when medical evaluation is warranted (suspected sleep apnea, complex parasomnias, persistent issues that don't respond to behavioral work).
Dr. Shelby's book The Essential Guide to Children's Sleep is a useful starting point for parents who want to understand the framework before scheduling a consultation.
Learn more about the children's sleep book
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No referral required. The call is used to understand what you're experiencing and to determine whether the practice is the right fit. If it's not, you'll get a referral to someone who is.Schedule Consultation