Jenna Henderson, ND
A comprehensive look at the rising rates of childhood insomnia, its long-term health effects, and integrative strategies—from circadian regulation to nutrient support—for improving sleep in kids and teens.
Abstract
Sleep troubles are becoming increasingly common in children and teens, and they’re more than just a nightly frustration. Pediatric insomnia is linked to issues with mood, focus, growth, immunity, and long-term metabolic health.
In this timely article, Dr. Jenna Henderson explores the root causes of childhood sleep disturbances and offers a range of naturopathic strategies to restore healthy rest. From circadian rhythm support and lifestyle changes to key nutrients like magnesium and vitamin D, this piece equips practitioners with practical, whole-child approaches to improving sleep, without over-relying on melatonin.
Whether you’re treating toddlers, school-aged kids, or adolescents, this guide offers thoughtful, evidence-informed tools to help your patients (and their parents) reclaim restful nights.
Pediatric insomnia is increasingly becoming a concern for parents and teachers. As many as 1/3 of pediatric patients are affected.1 There appear to be many contributing factors, including artificial light, poor diet, and a lack of physical activity. It’s also common with many conditions, such as autism, ADHD, and depression. Chronic pain, obstructive sleep apnea, and restless leg syndrome may also be contributing factors. Sleep trouble can cause daytime sleepiness, poor attentiveness in school, a lack of emotional regulation, and poor memory. Still, it can also impact growth and maturation during this critical time in life.2
Some concerns about insomnia are readily apparent in childhood, while others are setting the stage for health concerns later in life. Infants sleeping less than the recommended amount had a much greater risk for quality-of-life issues later in childhood. Optimal sleep for children seems to follow a U-curve, with excessive sleep also being associated with health concerns.3
Too little sleep is linked to an increased risk of falls and accidents for toddlers.4 Teenagers with sleep issues have more accidents, self-harm, substance abuse, and suicidal ideation than those with good sleep habits.5 Hypertension, insulin-resistance, obesity, and a higher waist circumference are observed in children with sleep trouble.6 Better sleep was associated with a healthier immune profile as measured by cortisol, cytokines, immune cell counts, and CRP.7 In children who slept longer than 8 hours, there was an increase in bone mineral density content.8
In Traditional Chinese Medicine (TCM), the sleep/wake cycle is governed by the kidneys. The vital energy of the kidneys also controls growth and development. This makes sense from a Western medical perspective, as melatonin causes a surge of growth hormone at night.9 Many conditions of the kidney, such as Minimal Change Nephrotic Syndrome, are associated with insomnia. This is especially true with advanced kidney disease.10 (Diabetics don’t always show this pattern as it’s a systemic condition and not a disease of the kidney.)
Ayurveda also stresses sleep as part of an overall healthy lifestyle, which helps balance the doshas of vata, pitta, and kapha. Regimented sleep patterns for children set them up for conscientiousness in their health habits. This is part of an overall healthy lifestyle for both dietary habits and sleep. Interestingly, a new study led by researchers at Columbia University and the University of Chicago found that eating more fruits and vegetables during the day was associated with sleeping more soundly later that night.11
There are various types of insomnia: onset insomnia, where it’s hard to fall asleep, maintenance insomnia, where it’s hard to stay asleep, and non-refreshing sleep, where the individual doesn’t feel refreshed even after an adequate amount of sleep. For infants, there may be a dependence on specific stimuli, objects, or settings to fall asleep or return to sleep after awakening, such as parental presence, co-sleeping, or feeding at the time of sleep onset. Older children and teens often have a disruption of the circadian rhythm, staying up late and sleeping late.
How much sleep do children need? This varies with age. According to the Cleveland Clinic:
Newborns (0 to 3 months) should sleep 11 to 17 hours, including naps.
Babies (4 to 12 months) should sleep 12 to 16 hours, including naps.
Toddlers (12 to 24 months) should sleep 11 to 14 hours, including naps.
Preschoolers (2 to 5 years) should sleep 10 to 13 hours, which may include a nap.
School-aged kids (6 to 12 years) should sleep 9 to 12 hours.
Teenagers (13 to 18 years) should sleep 8 to 10 hours.12
Different experts may give slightly different values, but there is little emphasis on individual differences within this population. Parents may think it’s not a problem if the child is not a good sleeper, but sleep requirements are never described as being different for each child. If the child isn’t sleeping, there’s generally a reason for it.
Some children have the correct number of hours of sleep, but are on a very late sleep schedule. In practice, working with parents of children with chronic kidney disease, the parents often don’t see a problem with children or even toddlers getting to sleep well past 10 p.m. This may be dismissed as an idiosyncrasy, and the child is “just a night owl.” This seems to be an increasingly modern pattern, contrasting with more traditional agrarian societies that were generally kept to an earlier sleep schedule. TCM also emphasizes the quality of earlier sleep over a late sleep schedule.
What is an appropriate bedtime for children?
This also varies with age, but there are guidelines from the National Sleep Foundation.
Infants: 6 to 7 p.m.
Toddlers: 7 to 7:30 p.m.
Preschoolers: 7 to 8 p.m.
School-aged kids: 8 to 9:30 p.m.
Teenagers: 9 to 10:30 p.m.13
Although there may be some variance in chronotype, with some children naturally gravitating toward earlier or later schedules, delayed sleep-wake phases are generally associated with worse health outcomes. For many, this is a form of onset insomnia and is associated with poor daytime cognitive function, anxiety, and depression.14 Interestingly, elevated levels of folate are associated with the morning-type preference, while high concentrations of vitamin B6 are associated with the night-owl preference.15
Some sleep phase delay is expected in puberty, but adolescents do not do well staying up past midnight. Multiple studies in children have shown decreased levels of melatonin at puberty, when sex hormones increase.16 In other mammals, high melatonin play a role in suppressing sex hormones during the non-breeding season.17 Melatonin is also used to suppress precocious puberty, a condition believed by many to be associated with artificial light.18
A decline in deep sleep usually begins around age 11 to 12 and continues until approximately age 16.5. Girls with early puberty are more likely to have delayed sleep timing, whereas boys with early puberty have delayed sleep timing.16
Addressing Insomnia in Children
Consistency in Sleep Schedule: Keeping to a routine is important for children. It’s easy for them to get off track on the weekend. The more they stick to a consistent schedule, the easier it will be. Arising later or napping to make up for missed sleep may make sleep onset harder in the coming days.
Physically getting into bed early is suitable for most children. However, if they have chronic insomnia and don’t fall asleep within 20 minutes, it may be helpful to allow them to get up and read a book. Lying in bed trying to force sleep can be an exercise in futility and a source of frustration. Reading a traditional print book is preferable to engaging with electronic media, which is too stimulating.19
Model Good Sleep Habits: A 2024 study found that poor sleep quality in mothers was linked to sleep problems in children. The study surveyed 102 children and adolescents (6-17 years), 92 mothers, and 69 fathers. Poor sleep quality of mothers was associated with their children’s sleep quality, even when other variables were factored in. The sleep quality of fathers did not have an impact on the children.20
Bright Light Therapy: This technique is used in sleep clinics to regulate the circadian rhythm. Full spectrum light signals from the back of the eye to the brain that it is daytime and time to wake up. This external cue can help keep the body’s internal time clock aligned. This is good to do for 20 to 30 minutes around 7 a.m., when there is usually an increase in cortisol. Sunlight is good for bright light therapy, and the sun is not overly intense early in the morning. A soft gaze toward the sun can be helpful, but a bright light box is also valid for overcast days and during the winter months.21
Exercise: Children may not feel tired if they haven’t had adequate physical activity. A 2018-2019 study of overweight children looked at the effect of a mobile physical activity application. Children who used the application had significantly less insomnia and better sleep quality.22
Overexcitement: High levels of dopamine can make sleep difficult.23 The release of this feel-good hormone that comes from playing video games makes the experience particularly addictive. As the developing brain is not mature in executive function, parents need to regulate their child’s screen time.24
Likewise, television and movies in the evening can be overly stimulating, making a parasympathetic state more difficult. This mainly includes watching the news, as the images presented can be pretty disruptive before bed.
Magnesium: Before trying melatonin, it’s good to address issues with basic nutrients. Many people have concerns over magnesium depletion due to the poor quality of soil used in agriculture. RBC magnesium is better for assessing nutritional status than serum magnesium, but children are rarely given any test. Supplemental calcium, not paired with magnesium, can make one functionally low in this mineral.
It’s difficult to find studies specifically addressing childhood insomnia and magnesium. Adult studies do indicate that magnesium, particularly magnesium threonate, improved sleep quality (especially deep/REM sleep stages), improved mood, energy, alertness, and daily activity and productivity.25
Vitamin D: An increasing number of studies are showing the link between vitamin D and sleep. Low vitamin D levels have been reported to be associated with shorter sleep duration, and adequate levels of vitamin D seem to be necessary for the maintenance of sleep, reducing the number of nocturnal awakenings. A 2018 study from China suggests that vitamin D status could be a potential biomarker of insomnia in children.26
Vitamin D appears to work through several mechanisms involved in sleep, including affecting the serotonin and dopamine pathways. The influence of vitamin D is seen early. Newborns with better vitamin D have better sleep. Their vitamin D status starts with the vitamin D available to the fetus. For this reason, addressing vitamin D deficiency during pregnancy can give the child a good start.27
In practice, vitamin D supplements are best given early in the day, as this is “the sunshine vitamin”. Patients with insomnia seem to do better taking this supplement with breakfast or lunch, rather than later in the day.
Melatonin: As the sleep hormone is released in response to darkness, dimming lights in the evening encourage the release of endogenous melatonin.
Before supplementing melatonin in children, I usually start with 2 oz. of cherry juice in the evening on alternating nights. The very low dose of melatonin contained in cherries is often enough to help with insomnia in children. A schedule of alternating nights helps ensure that supplementation does not inhibit endogenous production of melatonin.
Supplementing melatonin in children should be approached with caution. Often, they may need increasing amounts to achieve the desired effect, but starting with minimal doses is key.
Insomnia can be a persistent condition in children, but building good habits can ensure better health outcomes over their lifetime.
Dr. Jenna Henderson’s naturopathic practice, Holistic Kidney, is dedicated to the unique needs of renal patients. A kidney patient herself since 1993, she has experienced all stages of kidney disease firsthand, including 20+ years on dialysis. In practice, she has found that addressing insomnia is key to improving health outcomes and quality of life. She is a graduate of the University of Bridgeport College of Naturopathic Medicine and holds a CT state license.
Dr. Henderson has lectured extensively across the U.S. to doctors, kidney patients, and kidney professionals, and has been published in several journals.
Holistic Kidney does telemedicine with patients on six continents. Dr. Henderson works with all stages, including chronic kidney disease patients, patients on dialysis ,and those with a transplanted kidney. In her practice, she helps patients sort through often conflicting information to understand what is appropriate for their individual needs and stage of kidney function.
References
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