Sleep in Young Children with Heart Defects

By the time they are toddlers (ages 1 and 2), most children can:

• Fall asleep on their own once they are sleepy

• Wake briefly during the night, and then put themselves back to sleep

• Sleep through the night most of the time

• Nap 1-2 times a day at regular times

• Go to bed at the same time every night

• Wake up at about the same time every morning

By the time they are preschoolers (ages 3 and 4), most children can:

• Fall asleep on their own once they are sleepy

• Wake briefly during the night, and then put themselves back to sleep

• Sleep through the night most of the time

• Nap once a day at a regular time

• Increasingly get through a whole day without a nap

• Go to bed at the same time every night

• Wake up at about the same time every morning

Many families are frustrated by how their child with a heart defect sleeps.

It is not clear if children with heart defect have more sleep problems than other children. However, it is clear that families need help in order to feel better about how their children with heart defects sleep.

Sleep problems affect the whole family, and they often need a family solution.

Families often report that their child with a heart defect:

• Has trouble falling asleep

• Needs to sleep in the parent’s bed or room

• Wakes many times during a night

• Asks to eat or drink during the night (even when a doctor says they do not need this)

• Does not nap regularly

• Needs certain things in order to sleep (example: being rocked, being held, a song, a bottle)

Families with a sick child are understandably scared for their child’s safety. They often remain scared even when a doctor tells them there is little or no danger. These worries are normal and natural, and they are a sign of how much parents love their children.

Many parents worry when their child with a heart defect is sleeping. They may fear that the child will stop breathing, or will have a medical emergency. They may not not be able to relax when the child is out of their sight or hearing.

As a result, parents may:

• Keep the child sleeping in their room

• Have the child sleep in their bed

• Check on the child many times during the night

• Wake the child during the night

• Always respond if the child makes a sound

• Provide the child with whatever they ask for at night

• Not allow the child to cry

Any safe sleep practice is fine, as long as everyone in the family gets enough sleep and feels good.

However, if a family is stuck in a sleep pattern that does not feel good, or that results in too little sleep, they may want to make a change.

If a parent feels very scared when their child is asleep, they should ask the doctor if their child is at risk. If there is a risk, they can work with their doctor to make the risk as low as possible.

A parent who spends a lot of time worrying might want to ask for a referral to a therapist. A therapist can usually help parents to calm their worries while their child is sleeping. Then, the parent can get sleep as well as the child.

Babies and children often learn to fall asleep under certain conditions. For example, they might learn to sleep when they:

• Are rocked in a chair

• Have a special blanket or lovey

• Are drinking from a bottle

• Are breastfeeding

• Are listening to a parent sing

• Are in a parent’s bed

• Have a sound machine on

These are called “sleep associations,” because the child associates, or connects, certain conditions with going to sleep.

Sleep associations are helpful when they are safe, and when they work well with a family’s goals and schedules.

Sleep associations can be a problem if they:

• Are not safe

• Do not meet a family’s goals

• Disrupt the family’s schedule

• Make people frustrated or overwhelmed

• Mean anyone is not getting enough continuous sleep

Sleep associations are problems for many (but not all!) families when:

• Family members get up and switch beds through the night (“musical beds”)

• Someone is sleeping in a place that does not work for everyone (example: the parent sleeps on the child’s floor, or the child sleeps in the parent’s bed)

• The parent has to go through a routine to get the child back to sleep many times over the night

• A parent has to go to bed at the same time as a child

• A bedtime routine feels too long and is not pleasurable

• A parent needs to provide food and drink for the child overnight, even though a doctor says the child does not need to eat or drink at this time

Preventing unhelpful sleep associations is easier than breaking ones that are already established.

Families can prevent unhelpful sleep associations by making sure their child learns to fall asleep in a way that will work for the family long-term.

Remember, if a child needs something to fall asleep at bedtime, they will likely need the same thing to fall back asleep in the middle of the night.

When caregivers teach a child to sleep at home, they should think about:

• Where the child will sleep

  • Which room?

  • What kind of sleeping space? (own bed, shared bed, crib)

• Conditions in the room

  • Room-darkening shades?

  • Nightlight?

  • Sound machine?

  • Music?

  • Fan?

  • Humidifier or dehumidifier?

  • Mobile?

  • Door(s) open or closed?

• Comfort items

  • Pacifier?

  • Blanket(s)? (if over 18 months)

  • Pillow(s)? (if over 18 months)

  • Soft toy? (if over 18 months)

  • Bottle?

  • Breastfeeding?

• Bedtime routines

  • Story?

  • Singing?

  • Rocking?

  • Drink? (cup, bottle, breastfeeding)

  • Bath/shower?

  • Brush teeth?

• How the child will actually fall asleep (after they are sleepy)

  • On a lap?

  • In their own bed?

  • In someone else’s bed?

  • On a chair, floor, or couch?

Families should pick bedtime practices that will work for them for months or years.

Remember: unless a doctor advises differently, children 18 months and younger should always sleep:

• on their back

• on a firm mattress

• in their own bed

• without any pillows, soft toys, bumpers, or loose blankets

Families should talk with their doctor about their child's individual risk for SIDS.

If a child already has an unhelpful sleep association, families can gradually move away from the association. For example:

• If a child is used to being rocked to sleep, the parent could rock the baby until they are very sleepy, and then put them in bed

• If a child is used to being held on a lap to sleep, the parent could put their arms around the child while the child lies in bed

• If a toddler expects a bottle in the middle of the night, the parent could give a pacifier dipped in formula

• If a child is used to being in the parent’s bed, the child could first move to a cot next to the bed, and then later into their own room

Changing a child’s sleep habits can be hard to get used to. At first, the child might become upset. They might cry. Changing habits slowly helps a child feel more comfortable.

Some parents worry that their child with a CHD should not be allowed to cry. Parents should ask their doctor to make sure they feel safe changing sleep habits.

Most children will get used to a new sleep habit within a few days. Then, they will be happier when everyone in the family gets better sleep.

“Sleep hygiene” means the behaviors and conditions that lead to better sleep. Families can help their children by using good sleep hygiene.

Good sleep hygiene means:

• Go to bed and wake up at the same time every day

• Avoid screens before bed

• Keep the bedroom dark and cool

• Consider white noise or calming music

• Use a consistent bedtime routine

• Save the bed for sleep, not other activities

• Get exercise during the day

Sleep hygiene is important for adults as well as for children. When the whole family practices good sleep hygiene, usually everyone gets more and better sleep.

Healthy sleep is critical to the physical and mental wellbeing of everyone in the family. Caregivers can and should seek help if their family is struggling to get enough high-quality sleep.

This content was reviewed by a psychologist at Boston Children's Hospital .

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.