Is anxiety keeping you awake?

The effects of the COVID-19 pandemic have hit children hard. As a pediatric sleep medicine physician, I’ve noticed the impact it’s had on children’s sleep. Constant change and routine disruptions have led to many children experiencing feelings of anxiousness.

A child who feels anxious may struggle to fall asleep. They might describe their thoughts as racing or feel afraid to go to bed. Once in bed, they may seek out a caregiver, asking for a cup of water, one more hug/kiss or to sleep in a parent’s bed or on the couch.

When they do fall asleep, anxiousness can cause them to remain in shallow stages of sleep, awakening more often – sometimes for good, especially halfway through the night or later, as their now-lowered sleep pressure makes it difficult to fall back asleep.

If this sounds like your child, talk with them to determine what’s going on. Are they uncomfortable at night? Do they feel restless? Children are very good at telling you if they can’t shut their brain off. Try to determine if these thoughts are positive or negative. An anxious child isn’t struggling to fall asleep because they’re excited about tomorrow’s events. They’re worrying about something that already happened or will happen.

Set aside 15-20 minutes earlier in the day. I call this “worry time” or “processing time.” This is your child’s safe space to talk about less positive things. We tend to shy away from negative conversations because we want to be optimistic, but we all have stressors. In fact, the more exciting things we do, the more we have to worry about.

Model the conversation for your child (“Something didn’t go well for Mommy today at work, and I’m feeling frustrated. I don’t know what I’m going to do about it, but I can’t do anything today. I’ll come up with a plan tomorrow.”) By showing them you worry about things, too, they may be more open to sharing their feelings.

It’s impossible to take all of your child’s worries away, but providing them with concrete tools to manage anxious thoughts such as worry/processing time can make all the difference.

Implementing a dependable bedtime routine can also help your child relax before bed. This series of steps that happen in the same order every night can be very grounding to a child.

Consider incorporating mindfulness and relaxation practices into the routine. Together with your child, tense your forehead, nose and chin, feeling each body part as you do that. Take a deep breath in, expanding your diaphragm. This activates your parasympathetic, or “rest and digest” nervous system. When that’s on, your sympathetic nervous system (“fight or flight”) can’t be activated. By changing your breathing, you’re relaxing your body.

Examine your child’s bedtime. Is it too early? If they’re well rested during the day and are waking up at their usual time, you may need to adjust bedtime. The National Sleep Foundation offers bedtime recommendations based on age.

If you’re concerned about your child’s sleep or mental health, reach out to your pediatrician. Many things get better with time, but remember you have support around you to help you navigate your child’s ages and stages.

Dr. Innessa Donskoy is a pediatric sleep medicine physician at Advocate Children’s Hospital.