Is lack of sleep causing my child to act up during the day?
If your child is not getting enough sleep, it is likely impacting his or her behavior during the day. Likewise, children with daytime behavior problems are more likely to develop certain sleep problems. When it comes to sleep and behavior, parents are faced with the classic question of “which came first, the chicken-or-the-egg?” There is now strong evidence pointing to a bi-directional relationship between sleep and daytime behavior problems in children, meaning sleep affects behavior and behavior affects sleep.
So, what is a parent to do? It is tempting to conclude that sleep is the sole “cause” of a child’s behavior problems. In reality, children’s daytime behavior is influenced by many factors, of which sleep is just one (albeit an important one). Another influence on a child’s sleep duration and daytime behavior is parents’ ability to set and enforce effective behavioral limits. Young children who struggle to follow simple parent instructions often display problems not just during bedtime, but throughout the entire day. Instructional noncompliance (not following directions) tends to drag out most daily demands, from getting through the morning routine to mealtime behaviors, and even public behavior during shopping and dining.
Here are few things to consider if your child is having behavior problems or “meltdowns” during the day.
Sleep may play a more prominent role in your child’s behavior if:
- There is evidence (beyond behavior problems) that your child is not getting enough sleep, or is routinely sleepy during the day. Examples include struggling to remain awake or falling asleep during the day (outside of scheduled nap times). Some situations are more likely to reveal underlying sleepiness, such as watching a movie in a dark room or riding in a car. Another “red flag” implicating sleepiness as a contributor to behavioral disintegration is falling asleep when placed in time-out. Unfortunately, identifying daytime sleepiness is not an easy task in younger children who do not necessarily show it in their outward appearance.
- The behavior problems tend to cluster around the same time each day, especially in the mid-to-late afternoon.
Sleep may play a less prominent role in your child’s behavior if:
- There is no evidence that your child is sleepy beyond disruptive behavior
- Behavior problems occur sporadically throughout the entire day, including times when your child is clearly alert and happy before the disruptive event.
- Your child’s behavior is relatively unremarkable in certain settings or with some caregivers (e.g., child frequently displays behavior problems at home but rarely at daycare – or vice versa).
In addition to insufficient sleep duration, medical problems such as sleep apnea, periodic limb movements, eczema or Gastroesophageal Reflux Disease (GERD), can negatively impact daytime behavior by impairing a child’s sleep quality.
In summary, poor sleep certainly plays a role in the expression of daytime behavior problems, but children with daytime behavior problems are more likely to display sleep problems (especially bedtime refusal). The relationship between sleep and behavior is clearly bi-directional. If you are the parent of a child with sleep and behavior problems, there is no reason to lose sleep trying to figure out which came first. Talk to your primary care physician, behavioral health provider, or a pediatric sleep specialist, because there are evidence-based interventions to address both.