Frequent waking, crying at night, taking ages to fall asleep, waking very early. Parents of children with CP often say they can’t remember the last time they slept through the night. It’s not just about tiredness. Sleep affects a child’s behaviour during the day, their muscle tone, their learning – and the whole family’s strength.
It’s a common problem
Newman and colleagues (2006) studied children with cerebral palsy and found sleep disorders in about one in four. Problems were more common in, among others, children with active epilepsy.
The good news is that sleep problems often have specific causes that can be identified and addressed.
Possible causes
In a child with CP, there are often several causes of poor sleep at once. The most common:
- pain – hips, constipation, reflux, teeth, rubbing from orthoses. In a child who can’t speak, pain is easy to miss. More in the article on hip pain
- muscle tone and spasms – these increase with tiredness, pain and cold, and can wake the child
- inability to change position – a child who can’t turn over lies in one position for hours. Over time it becomes uncomfortable, but they can’t change it themselves
- epilepsy – night-time seizures and anti-seizure medication can affect sleep
- reflux – can get worse when lying down
- breathing problems during sleep – snoring, pauses in breathing, restless sleep
- circadian rhythm disorders – especially in children with visual impairment, whose body clock is less strongly “set” by light
- medication – some can be stimulating or cause daytime sleepiness
- simple discomfort – too hot, too cold, a wet nappy, uncomfortable clothing
Where to start
A sleep diary
For 1-2 weeks, write down:
- when your child falls asleep and wakes up
- how many times they wake at night and for how long
- what helps them get back to sleep
- daytime naps
- medications and their timing
- anything that might matter: pain, seizures, fever, constipation
A record like this makes the conversation with the doctor much easier. Often it reveals a pattern that wasn’t visible before.
Talking to the doctor
Take the diary to your paediatrician or neurologist. The doctor can assess pain, reflux, epilepsy and medications, among other things. If your child snores, has pauses in breathing or clearly struggles to breathe at night, a sleep study may be ordered.
Sometimes the doctor considers treatment to support sleep, such as melatonin. That decision is always made by the doctor.
What you can do at home
- a regular daily rhythm – similar times for getting up, meals and going to sleep, weekends included
- daylight in the morning, darkness in the evening – helps set the body clock
- a calm bedtime routine – the same order of activities, fewer stimuli, dimmed lights
- warmth – cold increases muscle tone. A warm bath in the evening can help
- comfortable positioning – symmetrical, supported, suited to your child. More in the article on sleep positioning
- position changes at night – a child who can’t turn over on their own needs help. Clinical guidance suggests a child shouldn’t stay in one position for more than eight hours (Paleg and Livingstone, 2022)
Positioning and sleep
Night-time positioning is often associated with protecting the hips. But it has another side: a comfortable, stable position can help a child sleep more peacefully. On the other hand, poorly fitted positioning can make sleep worse.
That’s why with any solution it’s worth watching how your child sleeps and introducing it gradually. There’s little research on this, which I describe in the article on night-time positioning. There’s no point protecting the hips at the cost of nights when nobody in the house sleeps.
Your sleep matters too
Months of sleep deprivation are a real burden on a parent’s health, patience and family relationships. If possible, share night-time duties, accept help from family, or use respite care. Looking after yourself isn’t selfish – it’s what makes it possible to keep looking after your child.
Key points
- sleep disorders affect about one in four children with CP
- there are often several causes at once: pain, muscle tone, inability to change position, epilepsy, reflux, breathing, body clock
- a sleep diary is the best starting point for talking to the doctor
- snoring and pauses in breathing should always be reported
- a regular daily rhythm, a calm routine and comfortable positioning help
- a child who can’t turn over on their own needs help changing position
This article is for educational purposes only and does not replace consultation with a doctor or physiotherapist. The causes and treatment of sleep problems are assessed by the doctor, individually for each child.
References
- Newman CJ, O’Regan M, Hensey O. Sleep disorders in children with cerebral palsy. Developmental Medicine & Child Neurology. 2006;48(7):564-568.
- Paleg G, Livingstone R. Evidence-informed clinical perspectives on postural management for hip health in children and adults with non-ambulant cerebral palsy. Journal of Pediatric Rehabilitation Medicine. 2022;15(1):39-48.