Five things twenty years of working with families have taught me about children's sleep

Averages describe populations, not individual children

If I could change one thing about the way we talk about children's sleep, it would probably be our relationship with numbers. We have recommendations for how much sleep children need at different ages. We have population data showing how sleep changes across childhood. Both are useful. The problem comes when we turn an average or a recommended range into a prescription for the individual child in front of us.

Children vary considerably in how much sleep they need. Large population studies show substantial variation even between children of exactly the same age (Iglowstein et al., 2003; Galland et al., 2012).

In practice, I often find it useful to think about children as having relatively low, average or high sleep needs. These aren't diagnostic categories. They're simply a way of remembering that the amount of sleep that works well for one child may be quite different from the amount that works for another. This matters because sometimes what looks like a sleep problem is actually a mismatch between the amount of sleep a child is being offered and the amount they are capable of sleeping.

A child who isn't tired enough at bedtime may take a long time to fall asleep. A child who is spending more time in bed than they can realistically sleep may have long periods awake overnight or start their day extremely early. Moving naps or bedtime around won't necessarily solve that if we haven't first considered how much sleep the child needs across 24 hours.

The opposite matters too. Some children need more sleep than their peers, and trying to fit them into a schedule designed around an average can leave them struggling. This is why I don't start with how much sleep a child ‘should’ be getting.

I want to know how much they are actually getting, how that sleep is distributed, how they function on it, whether there are signs that they need more or less, and what happens when we make changes.

The numbers give us somewhere to start. The child tells us whether they fit.

The strategy is usually the easy bit

People ask me about sleep strategies all the time. What's the best way to move away from feeding to sleep? How would I approach repeated night waking? What would I do about an early-rising toddler?

My answer is very often ‘it depends’.

I've joked for years that I should have it tattooed somewhere, but I mean it seriously. ‘It depends’ isn't a way of avoiding the question. It is usually the beginning of the assessment.

It depends on the child. Their age, health, development, temperament, sensory needs, feeding, sleep need and sleep pattern may all be relevant. It depends on the family too. What do they want to change? What do they actively want to keep? Who responds overnight? What else is happening in their lives? What support do they have? How much capacity do they have for change at the moment?

And sometimes timing matters as much as anything we put into a sleep plan. A new sibling, starting childcare, illness, a house move or a significant developmental change can alter what feels manageable for both a child and their parents.

My background in health visiting and paediatric nursing has probably shaped the way I think about this as much as my work in sleep. I find it very difficult to look at one part of a child's life in isolation.

Bronfenbrenner's ecological model of human development described children as developing within interconnected systems of relationships and environments (Bronfenbrenner, 1979). I think that is a useful way of approaching sleep too. Sleep is affected by biology, health, feeding, development, relationships, environment and family circumstances. Those factors interact, and their relative importance won't be the same for every family.

Occasionally sleep disruption may also be one of the things that alerts us to a feeding, health or developmental issue that deserves further assessment.

So before I decide how I might change sleep, I want to understand why this particular child might be sleeping as they are. Sometimes that assessment leads to a fairly straightforward sleep strategy. Sometimes it leads somewhere else entirely. And sometimes the conclusion is that this probably isn't the right moment to change anything. That is why assessment comes before strategy in holistic sleep coaching (Hookway, 2026).

The strategy isn't unimportant. We just need to know what problem we're asking it to solve.

A good plan has to work for the people who will actually use it

One of the biggest changes in my own practice over the years has been moving further away from telling families what I think they should do and becoming much more interested in helping them work out what will actually work for them.

There is a clinical part of that. Families come to us because we have knowledge and experience they don't have, and there are times when we need to explain evidence, identify concerns or make recommendations.

But expertise doesn't mean taking over the decision-making.

A family may want fewer night feeds but have no interest in stopping feeding to sleep at bedtime. They may want their child to sleep in their own room eventually but not be ready to make that change now. One parent may be comfortable with a particular approach and the other may not be. A plan may look perfectly sensible on paper and be completely unrealistic at three o'clock in the morning.

Those things aren't obstacles to the plan. They are information we need before we make one.

This is where coaching has become such an important part of the way I work. Instead of beginning with ‘here's what you need to do’, we can ask different questions:

• What is working well at the moment?
• What is difficult?
• What would you most like to change?
• What don't you want to change?
• What have you already tried?
• What happened?
• If things were better three months from now, what would actually be different?

And perhaps one of the most useful questions of all: does the plan we're discussing still feel manageable when everybody is exhausted at three o'clock in the morning?

Solution-focused and coaching approaches have a substantial evidence base across health and other settings, including evidence for effects on self-efficacy, goal attainment and wellbeing. That evidence doesn't mean that coaching guarantees a better sleep outcome, and I don't think we need to pretend it does.

For me, its value is more fundamental than that: the family lives with the decision after I leave. They need enough information to make an informed choice. They need space to decide what matters to them. And the plan needs to reflect their values, resources, limits and goals rather than mine.

That's family-centred care, but it is also good sleep practice.

The sleep questions change as children grow

A lot of professional sleep education concentrates on babies and toddlers. That's understandable. Sleep is an enormous issue for families during those years, and it is often when parents first ask for help.

But children don't stop having sleep difficulties when they turn five. The questions change. Supporting a four-month-old who wakes frequently to feed is very different from supporting a preschooler who needs a parent beside them to fall asleep. And neither is the same as working with an eleven-year-old who lies awake worrying for two hours at bedtime. As children grow, circadian timing changes. Sleep need changes. Development, school, friendships, anxiety, neurodivergence, physical activity, autonomy, technology and family relationships may all become increasingly relevant.

The child's role in the conversation changes too. With a baby, almost all of our work is with the adults caring for them. As children get older, it becomes increasingly important that they are involved in understanding their own sleep and in decisions about what might change.

I've written previously about sleep throughout childhood because I think this developmental perspective matters (Hookway, 2021).

You cannot simply take an infant sleep approach and scale it up for an older child. The assessment has to develop as the child does.

That is why the Holistic Sleep Coaching Program covers sleep from infancy through childhood and adolescence. If we want to support families beyond the baby years, we need to understand what changes and what remains relevant as children grow.

Experience doesn't mean knowing the answer immediately

I've worked with children and families for more than twenty years.

I'm a paediatric nurse, health visitor and IBCLC. I've done a PhD. I've written books, taught professionals around the world and spent an enormous amount of my career thinking about feeding, parenting and sleep. And I still encounter situations I haven't seen before.

I actually think I'm more comfortable with that now than I was earlier in my career. Experience gives you knowledge, of course. You recognise patterns more quickly. You know which questions are likely to be useful. You become better at spotting something that doesn't quite fit.

But experience also teaches you how variable people are. No amount of training can give you a protocol for every child and every family you will ever meet. Sometimes new information changes your formulation. Sometimes something you expected to work doesn't. Sometimes you need another professional's perspective. Sometimes you need to go away and read.

Being able to say ‘I don't know yet’ is not the opposite of expertise. Knowing what to do next is part of expertise. This is one of the reasons supervision is such an important part of our training. Every week, coaches bring real cases to supervision and we think them through together. We look at what they have noticed, what they may have missed, what else might need assessing and what options the family has.

Sometimes I know immediately what I want to ask.

Sometimes somebody else in the room sees something I haven't.

Sometimes the discussion sends all of us away to look something up.

That's what clinical learning looks like. A qualification gives you knowledge and a framework. Working with families teaches you how complicated applying that knowledge can be. You shouldn't have to do that part alone.