Early morning waking in children: understanding it and what to do

What counts as waking too early?

An occasional early morning is nothing to worry about. Cleveland Clinic puts the problem at a child who is up and active before 6 a.m., repeatedly, and notes that a one-off early morning is normal. Some toddlers also wake on their own around 5:30 or 6 a.m.: Australia's Raising Children Network says there is little to do about this except shift bedtime and wake-up time together.

Total sleep gives a benchmark. The Sleep Foundation gives 11 to 14 hours per 24 hours, naps included, for ages 1 to 2, and 10 to 13 hours for ages 3 to 5 (sleep needs by age covers these ranges). France's Réseau Morphée, on Santé.fr, cites an average of 12 hours for ages 3 to 5. A 3 year old put to bed at 8 p.m. and up at 5 a.m. has slept nine hours overnight: with a one-hour nap, that barely reaches the bottom of the range, well below that average.

The most common causes

Cleveland Clinic lists five causes: a bedtime that is too early, a bedtime that is too late, naps that are too many, too long or too late, a bedroom that is too distracting, and a habit of waking early. Pediatric sleep specialist Craig Canapari (Yale-New Haven Children's Hospital) adds light sensitivity, which is strong in many early risers, too little total sleep, sleep associations, a body clock that naturally runs early, hunger or a wet diaper, and a sleep regression.

Naps cut both ways. Santé.fr (Réseau Morphée) recommends placing the nap in the early afternoon and notes that a late nap makes falling asleep harder in the evening; Ameli advises waking the child if the nap runs long. Child naps covers timing and length by age.

The calendar matters too. According to the American Academy of Pediatrics, at the autumn clock change younger children may wake earlier than usual, and children usually adjust within about a week (the clock change explains how to ease it). Santé.fr adds that children's sleep problems most often stem from a change in their surroundings, and sometimes from an illness (reflux, asthma, ear, nose and throat infections) or anxiety.

Bedtime too late or too early: how to decide

Putting a child to bed later in the hope of a later wake-up generally does not work, notes Raising Children Network: they may still wake early, on less sleep. The data point the same way. In a study by Mindell and colleagues of 841 children from birth to 36 months tracked through an app, wake time barely varied from 5 to 36 months, while a later bedtime went with a shorter night. In 24 infants aged 6 to 24 weeks tracked by actigraphy (Adams and colleagues), each hour of earlier sleep onset lengthened the night by about 34 minutes, while wake-up came only about 8 minutes earlier.

The reverse also happens. If bedtime is before 7:30 p.m. and the child wakes early, Cleveland Clinic suggests moving it later by about 10 minutes a night. Craig Canapari proposes the same 10 minute step up to a 30 to 60 minute shift, then waiting a week or two before judging the effect. A child who goes to bed late and exhausted, on the other hand, benefits from an earlier bedtime, in steps of 15 minutes every few days according to Raising Children Network.

Naps: adjust before dropping

According to Raising Children Network, a child has two naps at 12 months, then one, or none, by around age 3. Cleveland Clinic places a toddler's two naps around 11 a.m. and 3 p.m., the move to a single nap around age 2, and the end of napping between ages 3 and 5 for most children. A nap that slips late in the afternoon or runs long can be enough to bring the next morning's wake-up forward.

If the last nap goes past about three hours, Craig Canapari suggests capping it at two hours and making sure the child is awake by 4 p.m. If the child resists napping, he considers dropping it. Once the nap is gone, Raising Children Network suggests a rest period at the same time of day.

What helps

A bedroom as dark as possible is the first adjustment: Craig Canapari recommends blackout blinds. In the evening, Ameli advises reducing noise and light in the room, and notes that a night light can reassure a child; the bedroom environment goes through temperature, noise and light.

A fixed wake time, weekends included, gives the day a structure. The American Academy of Pediatrics recommends the same wake time on weekdays and weekends, and bright light when it is time to get up. Ameli advises against sleeping in to make up for a bad night, and Cleveland Clinic caps weekend wake-ups at one hour later at most.

To push the wake time later, Craig Canapari advises moving the time you get the child up gradually, without aiming too far at once. A clock that shows by light when it is OK to get up ("OK to wake") suits children from around age three: set it first about ten minutes after the current wake time, then push it later every day or two. Cleveland Clinic adds not to use a phone as the alarm clock.

Light affects the daytime rhythm as much as the night one. Santé.fr (Réseau Morphée) recommends enough exposure in the morning and limited exposure in the evening, especially screen light. The American Academy of Pediatrics adds that natural daylight helps reset a child's body clock, and advises dimming the lights before bed.

In the evening, the American Academy of Pediatrics recommends turning off all screens at least an hour before bedtime and keeping them out of the bedroom. Ameli advises against screens before age 3. Cleveland Clinic adds a calm routine (story, song, dimmed lights).

What can keep the waking going without meaning to

According to Craig Canapari, bringing the child into the parents' bed when they wake before 5 a.m. teaches them to expect that comfort. A child who needs an adult to fall asleep will ask for the same thing at an early waking, and teaching independent sleep at bedtime can reduce these wakings. Cleveland Clinic recommends keeping the bedroom for sleep rather than play.

A habit of waking early comes undone slowly: Cleveland Clinic recommends patience with sleep habits that are already set, and puts the time needed to change a bedtime and wake time at about three weeks.

When to see a doctor

If adjusting bedtime and wake time changes nothing after several weeks, Cleveland Clinic advises talking to the pediatrician. Craig Canapari recommends the same for wakings at 4 or 5 a.m. or earlier, especially with irritability during the day. Santé.fr recommends seeing a doctor when a sleep problem lasts more than a week, rather than waiting until the child and parents are exhausted.

Nighttime snoring and changes in breathing are signs to report. Ameli lists breathing pauses followed by a loud breath, restless sleep, and, on waking, a child who is tired, hard to wake, breathes through the mouth or has a headache. Some children need an ear, nose and throat evaluation or a sleep study (Cleveland Clinic). The guide on sleep apnea in children describes these signs.

Santé.fr generally discourages sleep-promoting medicines for children, herbal ones included, and Raising Children Network notes that sleep medicines are not usually the solution. The pediatrician remains the person to talk to about next steps.