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Sleep Disorders

4 Year Old refuses to sleep



I have a 4 year old son that refuses to sleep. He gets up at 7am everyday whether he needs to or not and doesn`t take any naps. Every night is a battle to get him to go to sleep and we usually win around midnight. This is starting to get extremely hard on us adults especially when I have to get up at 5:30 am. We have even stop his allergy medicine for a while to see if that might be the problem but no luck. Is this normal for a 4 year old to get 7 hours of sleep a night?



It sounds like you have a lot on your hands and you are correct to seek help. The short answer is no, 7 hours of sleep is not sufficient for a 4 year old. Children this age should be sleeping 11-13 hours per night and, the fact that your child is only sleeping 7 hours, suggests that further evaluation is needed.

Children who have difficulty falling asleep at night need further investigation. Issues which should be explored include:

- caffeine intake during the day

- snoring during night

- family history of insomnia

- family history of restless leg syndrome

- family history of ADHD or psychiatric disorders

While a number of different possible causes may be responsible for your child's problems, it’s possible your child may have what is called a "limit setting" sleep disorder. This type of problem typically occurs in children ages 3-6 years old. This is a time when children are often requested to begin to control their own urges (for example going to the bathroom or going to bed), but still require parental guidance. As this transition to some form of independence occurs, it is very easy for bad habits to develop. This may include the development of poor sleep habits. These often accompany the transition from sleeping in a bed requiring adult help to get out of (i.e. a crib or bed with rails) to a bed where the child now has the freedom to get out of bed as they please.

Many factors need to be considered in this type of situation and involvement of both the child and parent(s) is required to make changes for the better. A number of different approaches may be considered. Strict limit setting with avoidance of caffeine may be helpful initial strategies.

Your child should be evaluated carefully by a physician to make sure there are no underlying physical or psychological abnormalities. In order to determine what treatment strategy(s) might work best for your child and family, you should discuss this matter with your Pediatrician.

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Response by:

Mark   Splaingard, MD Mark Splaingard, MD
Clinical Professor of Pediatrics
College of Medicine
The Ohio State University