Trauma-Informed Sleep Supports: How to Help Your Child When Traditional Sleep Supports Are Not Enough


Monday January 3, 2022


Sleep is vital to a child’s healthy development, and there are many simple, practical ways parents and caregivers can support healthful sleep. But what happens when stress and traumatic experiences affect a child’s sleep? Paediatric nurse and child life specialist, Cindy Pilchuk, offers practical trauma-informed sleep supports to aid children’s coping and restorative sleep.


A young girl sucking a pacifier rests with her head on a pillow. Her eye is swollen from recent treatment.

There is a definite link between children who have experienced trauma and loss, and sleep issues, even when the child is out of the traumatic situation and living in a safe and loving environment.

Nighttime and bedtime can be very anxious for a child who has experienced trauma simply because there are no other distractions (no electronics, friends, or activities).  The body is slowing down, and the child is left with BIG emotions that can trigger their alarm systems to high alert, and this can be very difficult for the child to manage, especially alone.  For these children, bedtime needs to be viewed as an opportunity for connection and safety.

It is important to stick with the sleep hygiene practices you have established, as they will help support your child even into adulthood.  However, a child who needs more support with sleep needs sleep routines and practices that are trauma informed.  The trauma needs to be comforted and cared for; from there, healthful sleep will follow.

“Reducing stress as well as increasing psychological safety and sensory comfort will allow the body to focus energy on other areas of healing and development”

Support Your Child’s Coping

As caregivers, we want to do our best to support our children, especially if sleeping is a problem that disrupts the whole family.  Here are some trauma informed strategies you can use to help your child cope with their nighttime anxieties.

Step 1: Begin with You, the Caregiver

Take some time to think about and imagine your child’s early experiences – this includes both your child’s experiences with medical procedures and what their sleep has been like from early on.  Remember, the best way to support a child to cope with their trauma is to develop a relationship that provides them safety.  This first step will help you gain insight into their experiences, and develop empathy and compassion, helping to better understand the motivation behind their behaviours at bedtime.

Step 2: Allow Your Child to Regress

This step might sound a little strange, but this will require you to respond to any signs of distress your child exhibits at bedtime and throughout the night.  Just like a small baby, this might include hugs and cuddles, rocking, lying down beside them, singing a lullaby or reading a story.  I know, just when you thought you were past this stage…  Believe me, in the long run, showing your child you are there for them day and night with love and support will build a strong foundation within your relationship.  This will support your child to achieve healthful sleep and be more resilient.

The goal here is to provide comfort and soothing, so your support becomes predictable and your child experiences feelings of safety and security, calming the alarm system within their brain.  You need to meet your child where they are at.  Children who have experienced trauma at a very early age can often get stuck there, impacting their coping and emotional development.  Allowing them to regress meets them where they are stuck, provides them with a feeling of safety and comfort, then moves them forward in their journey.

During this time, you might feel quite exhausted.  You can prepare for this by letting family and friends know what you are doing, adjust your schedule so you have some downtime, and prepare meals you can put in the freezer for nights when you are just too tired to cook.

Step 3: Uncover Your Child’s Bedtime Needs and Verbalize Them

Your child is resisting sleep, asking for one more hug, or one more sip of water, or for their blanket to be adjusted, or maybe even having a full blown tantrum…  When this happens, it is really important to not get caught up in these behaviours, rather focus on the emotions behind it, and acknowledge your child’s experiences.

The goal here is to validate your child, to let them know you understand where their behaviour is coming from, and why it is occurring, and to reassure them that you will work on these issues together.  The focus is on the problem that can and will be supported, rather than focusing on the child themselves.

A young boy cuddling a soft toy rests with his head on a pillow. His eye is swollen from recent treatment.Maybe lying down alone in the quiet makes your child remember a medical treatment they had and elicits a fear response.  Maybe they fear separation from you.  You can verbalize this by saying: “I see you are upset, I see you want me to stay with you.  I am here.  I will stay with you for X minutes until you are settled.  I will then come back and check on you before I go to sleep”.

Your child can cope with their trauma through repetitive and predictable experiences of safety.  This will move them from fear to safety and co-regulation with you, and from there move them towards self-regulation and sleeping independently.

How Visual Impairment Affects Sleep and the Circadian System

Waking and sleep are regulated by two main biological processes – the circadian system and homeostatic process. Although these two processes work separately, they interact together to influence the timing, quality, and duration of sleep and wakefulness

Sleep/Wake Homeostasis

This is the body’s internal drive towards balance between sleep and wakefulness.  Very simply put, it is the drive that tells us the longer we are awake, the sleepier we feel.

The Circadian System

The circadian system is cyclical changes in the body – internally generated biological rhythms that occur within a 24 hour period.  These biological rhythms include sleep and wake cycles, alertness, body temperature cycle, daily cycle of hormonal secretion, and blood pressure regulation.

These cycles are driven by a light-dark cycle within the external environment.  Darkness makes us feel sleepy, light makes us feel alert.  Other cues that affect the circadian system include meal times, changes in temperature, noise, physical activity, and bedtime.  Level of sleepiness and recent sleep do not directly influence the circadian system.

Disruptions to the circadian rhythm due to visual impairment may not be well understood by professionals who do not have expertise in the field.  Treatment and support needs to focus on understanding the cause of the sleep disturbance as a circadian rhythm desynchronization.  Providing someone with visual impairment stimulants to keep awake, and night-time hypnotics does not solve the problem.

Although light is the most powerful indicator for circadian rhythm, it is not the only one.  Focus needs to be given to time cues that can aid synchronization of the circadian rhythm with the sleep-awake cycle.

A female toddler dressed in a sunny yellow outfit with blue trim is asleep in a red wagon, parked alongside a wall. Her bald head rests on what looks like the back of a large honey coloured bear, and small toys are scattered around her feet.The timing of sleep, sleep hygiene, exercise, carbohydrate intake, social interaction, and olfactory cues play an important role in supporting the circadian clock. Therefore, maintaining a regular and predictable schedule will benefit children and adults with visual impairments.

Melatonin is also an important biochemical needed for sleep, where under a normal light/dark condition, melatonin is produced only at night or in dark conditions. You can speak to your healthcare provider for more information on melatonin, and whether it may benefit your child.

Sleep, Photosensitivity and Retinoblastoma provides more information on how visual impairment affects sleep.

Activities to Help Your Anxious Child Sleep

The goal here is to support your child to feel safe and secure so they can cope with their trauma experience and anxieties, leading to healthful sleep.

The Check-In

Where your child sleeps is really a decision you need to make as a family.  There is no right or wrong answer if you choose for your child to sleep in their own room or co-sleep in your bed.  However, where your child falls asleep is where they stay asleep.  One strategy for you to support this is the check-in.

In this strategy, you collaborate with your child to set a regular time to check-in on them as they fall asleep.  For example, every five minutes for four times – you would check in with your child in their bed, not saying anything, but just being present so your child knows they are not alone.

If your child needs a kiss or a back rub, you can do that, but your child knows after 2 minutes you will leave again, to return in another 5 minutes.  You can increase the time between check-ins every 4-5 days.

Fact Check Your Fears and Walk Out the Worry Door

Tamar Chansky is an excellent resource for supporting children with anxiety.  She has many books, resources, and her own blog available to caregivers.  Here you will find two amazing activities you can do with your child before bed to promote calm and healthful sleep.  The activities include: Fact check your fears for accuracy, and Walk out the worry door.

Massage

Boomerang Health explains how regular massage can help support your child’s healthy sleep, and how you can incorporate it into your bedtime routine.

On WE C Hope’s blog earlier this year, Morgan Livingstone CCLS provided 7 infant massage tips for improved summer sleep.  She showed how massage can help in specific practical ways to support sleep during sultry summer months, whether or not a child is receiving cancer care.  Read her

Mindfulness and Deep Breathing

Discover mindfulness techniques parents and children can use to ease daily tension.

Learn more about breathing for wellness – including the body’s reaction to stress, and how we can use our breath to restore calm fast.  This article includes practical breathing tools for both adults and children.

Family Calm Down Activities

A young girl of 7 or 8 years old lies on her side in a hospital bed, snuggling under and hugging a bright pink plush blanket. Her patchy short hair indicates that she is receiving chemotherapy. A radio lollipop sticker is just visible on her top, catching and reflecting the light.

About the Author

Cindy Pilchuk is first and foremost a mother to three perfectly wonderful, imperfect children who are her inspiration and hope.  After that, she is a Registered Nurse and Certified Child Life Specialist. She holds a Master’s of Science degree in Child Life and Pediatric Psychosocial Care.

Cindy has focused her entire 23 year career thus far supporting children and families to cope with stress.  She has a particular interest in early brain development and attachment, and how stress and trauma effects early brain development and behaviour.  For the past 13 years, she has worked as a public health nurse in the Child Health and Development division at Toronto Public Health.

Cindy Pilchuk
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