Nonpharmacological interventions for sleep disorders in children

INTRODUCTION An estimated 20-30% of children will experience sleep problems during the first three years of life (1-4). Although parents and professionals wish that sleep problems would simply “go away” as the child matures, research suggests they can be highly persistent, lasting even into adulthood (5-8). Although certain pediatric sleep disorders clearly demand medical attention (e.g., obstructive sleep apnea, narcolepsy), the majority call for clinical assessment and intervention skills that behavioral specialists are well-suited to provide. Principles of learning (e.g., reinforcement, extinction, shaping, fading, stimulus control) that have been shown successful in reducing daytime behavior problems can be highly effective in alleviating many forms of pediatric sleep disturbance (9). The purpose of this article is to review nonpharmacological interventions for pediatric sleep disturbance; namely, bedtime resistance and night waking, circadian rhythm disorders, and the parasomnias. We then review briefly a rapidly emerging literature on behavioral interventions to promote adherence with continuous positive airway pressure (CPAP) for sleeprelated breathing disorders.