Pediatric Sleep & Occupational Therapy (Find a Therapist!)
Introduction
If you are considering occupational therapy as a treatment for pediatric sleep difficulties, we want you to be as informed as possible—so we, as OTs, can truly partner to create the best course of treatment for YOU and your child.
In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each family. Below, you’ll find the assessment and treatment options your therapist may use, along with the evidence supporting them.
At the bottom of this page, you’ll find occupational therapists near you who specialize in addressing sleep difficulties.
Please note that this page is for educational purposes and does not substitute advice from your medical provider.
Why to pursue OT for pediatric sleep?
Occupational therapists view sleep as foundational to overall health and well-being.
Sleep has a direct impact on your ability to engage in all other occupations. Occupational therapists can play a vital role in helping individuals improve their sleep by addressing the factors that impact a person’s ability to fall asleep, stay asleep, and obtain restful sleep.
Unlike other, more invasive intervention options for sleep difficulties—such as prescription medications—occupational therapy focuses on healthy sleep habits and routines, environmental modifications, and stress reduction techniques that help promote more restful sleep.
Sleep difficulties, like insomnia, affect a substantial proportion of children (estimates range from 10% to 30%). The percentage of neurodiverse children (like those with autism, ADHD, etc.) with considerable sleep problems is even more staggering at 40–80%.
Related Assessments
Assessments are powerful tools to help us partner in your care. They establish a clear baseline, direct our treatment efforts, and give us a reliable way to track your progress over time. Your team may select some specific measures that fit your unique situation. Here are some examples:
Caregiver Reported Questionnaires
Child Reported Questionnaires
Caregiver Reported Questionnaires1,2, Child Reported Questionnaires3
Clinician Notes for Initial Clinical interview
Questions are non-exhaustive
Use the PEO model to drive clinical questions
Ask questions about the family routine, values, culture around sleep
Understand the sensory input the child received throughout the day and at night that might impact arousal level at night
Also consider the role of the family relationships on sleep (e.g., chaos in the house, caregiver-child relationship, mental health of family)
Possible Goal Areas
Therapy works best when there is buy-in from the patient. It is important that you and your child work with your therapist to set treatment goals that truly reflect what’s important to you.
Goal Bank for Clinicians
Focus on functional goals, rather than impairment-based goals.
Supporting family during bedtime routine to:
Complete a multi-stepped routine with XX supports (e.g., visual schedule, environmental adjustments to support transition)
Work on this could start within the therapy session and then phase to bedtime per caregiver report.
Increase emotional regulation as evidenced by less emotional outbursts/smoother transitions at bedtime
Therapy could provide environmental adjustments to support transitions, provide a calm atmosphere with cues for transition, educate families on emotion regulation tools, teach the child.
Child and caregiver will verbalize agreed upon expectations related to bedtime
Work on this goal could focus on supporting the caregivers in setting up appropriate expectations and providing supports to child during bedtime for success.
Child will engage in a consistent bedtime routine x/x nights per parent report
Therapy focus could support caregivers in executing a consistent bedtime routine/bedtime timing to support circadian rhythm.
Support the child with settling down for sleep:
Child will fall asleep within 20 minutes of initial sleep attempt X/X nights per week per caregiver report.
Engage in activities that support a robust circadian rhythm (e.g., daytime activity, dimming lights in the evening, limit screen time before bedtime, set up consistent bedtime timing, get morning sunlight)
Set up environment to support settling down (e.g., soft blanket, dark and quiet room, routine)
Child will complete the bedtime routine with X support, X/X nights per week per caregiver report.
Engage in sensory activities to identify which activities would decrease arousal level prior to bed (e.g., deep pressure massage, tactile tools for calming, heavy work, inversion or sustained weight bearing).
Build schedule supports and expectations.
Guide caregivers in emotional co-regulation for bedtime.
Treatment Interventions
Occupational therapists view sleep intervention through a holistic lens. They will consider your child’s sleep routines, along with family and neighborhood factors that may impact sleep health.4
Thankfully, OTs have strong evidence to draw from when addressing sleep through behavior change and non-pharmacological interventions.5,6 We can also consider the American Academy of Sleep Medicine for guidance on treatment of bedtime problems and night wakings.7 Further descriptions of possible approaches can be found in Pediatric Sleep Problems: A Clinician’s Guide to Behavioral Interventions.8
Okay, here are some details on what treatment can look like:
Education-based interventions
Education on the importance of sleep, sleep hygiene, and basic environmental and behavioral strategies to support sleep.
Can be based on handouts or videos provided individually or in group sessions across many settings.
Behavioral interventions
Cognitive Behavioral Therapy for Insomnia9
Colorado State offers an online CBT-I training for OTs
Faded bedtime with response cost and positive reinforcement (FBRC-PR)10
Specific training programs:
Sleeping Sound (tested with children with ADHD and autistic children) 12,13
Transdiagnostic Intervention for Youth Sleep and Circadian Rhythms14
Supporting a robust circadian rhythm
Daytime activity
Bedtime timing
Education
Supporting sleep routines and sleep
Consistent routine
Earlier bedtime timing
Considering emotional regulation’s role in bedtime challenges
Emotional regulation and sleep can be addressed in tandem15
Environmental adaptations or tools
Bedtime routine supports (e.g., visual schedule)
Lighting changes to support circadian rhythm
Bed/bedroom changes
Decrease distractions
Only use bed for sleep/naps
Sensory-based tools to decrease sympathetic arousal/support parasympathetic activation (differs per child)
Weighted stuffed animals or blankets
Compression clothing or sheets
Sound machine
Dim night light (red color is best for circadian rhythm)
Essential oil diffusion
There is preliminary evidence that Bergamot essential oil could activate the parasympathetic nervous system (the rest and digest system) for adult females. No research in children.16
This systematic review highlights the work done across multiple essential oils. Of note, two found improved sleep with use of lavender essential oil in adults.17
More Intervention Notes for Clinicians
Interventions should consider the bigger picture of sleep- what impacts sleep and how sleep may be impacting other things. Using the PEOP model can be helpful to develop this bigger picture. There are good resources to use to guide clinical practice, however, many of these interventions have not been trialed in special populations that we see in the OT clinic. It is critical that we apply our knowledge about the specific client and their diagnosis (e.g., person factors, family factors, environment factors) to the existing intervention tools.
Meltzer et al.’s 2022 paper on Pediatric Sleep Health lays out the above domains below are critical to understand when assessing and addressing sleep health in children and youth.4 This can be used alongside the PEOP model too.
Pharmacological interventions
As occupational therapists, we would not guide the use of medication or supplements to support sleep. It is, however, helpful to have a foundational understanding of what medications and supplements children may be on and how that might impact sleep or other occupations. Some resources to use:
NIH’s NCCIH page on Melatonin
American Academy of Child & Adolescent Psychiatry’s Parents’ Medication Guide for Sleep Disorders
Discharge Suggestions
Sleep challenges can change through different developmental stages. Discharge could happen when families are in a good routine and feeling like they are sleeping well generally. Topics to discuss as families are discharged could be:
Tools that the family has learned to support sleep in the event they have a new phase of sleep difficulties
Reiteration of the foundational education that they have learned about sleep and circadian rhythms
Reminder that sleep changes are normal and they can always seek out more support if they have difficulties in the future.
Red Flags
If families have concerns about their child’s snoring or gasping for breath during sleep, referral to get a sleep study and consult with their pediatrician or a pulmonary doctor should be considered.
If there are concerns about falling asleep during the day uncontrollably, refer to their pediatrician.
Discussions with caregivers about managing sleep with medicine or supplements (e.g., melatonin, magnesium) should be done with the care team (e.g., pediatrician).
Education Resources for Clients
Sleep for Kids website by the National Sleep Foundation
Boston Children’s Hospital has a website on sleep
Education Resources for Clinicians
Choosing a Therapist
If you are looking for an occupational therapy professional near you to help address sleep difficulties, you can use the OT Near Me Directory below. We’ve highlighted the professionals who have tagged “Insomnia & Sleep” as a focus area. For pediatric sleep difficulties, look for therapists who have also selected pediatrics as an interest.
Note that cognitive behavioral therapy for insomnia is a specific evidence-based approach with its own certification. Therapists who have this certification typically use the CBT-I credential.
Khadijah Guy
OTD, OTR/L, CLT, DCS
Occupational Therapist
Full Circle Therapy & Wellness
Phoenix, Arizona
Health Promotion, Home Modifications, Insomnia & Sleep, Leadership, Lymphedema, Maternal Health, Pelvic Health, Population Health
Christine Urish
PhD, MS, OTR/L, BCMH, FAOTA, CCAP
Occupational Therapist
Drake University
Des Moines, Iowa
ADHD, Anxiety, Chronic Conditions, Coaching, Dementia, Health Promotion, Insomnia & Sleep, Lifestyle Medicine, Obsessive-Compulsive Disorder (OCD), Prevention, Population Health, Social Determinants of Health
Jamie Boldig
MOT, OTR/L
Appleton, Wisconsin
Aging in Place, ADHD, Amyotrophic Lateral Sclerosis (ALS), Anxiety, Aphasia & Communication Disorders, Assistive Technology, Autism, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Chronic Pain, Coaching, Cognitive Rehabilitation, Dementia, Depression & Mood Disorders, Dystonia, Ergonomics, Fitness, Feeding and Eating, Functional Neurological Disorder (FND), Grant Writing, Hand Therapy, Health Data, Health Policy, Health Promotion, Hippotherapy, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Knowledge Translation, Lifestyle Medicine, Leadership, Medication Management, Multiple Sclerosis, Nature-based, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Osteogenesis Imperfecta, Parkinson’s, Pelvic Health, Prevention, Population Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Seating and Mobility, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Tourette syndrome, Voice & Fluency
Alicia
OTR/L
MaineHealth Behavioral Health at Spring Harbor
Westbrook, Maine
ADHD, Anxiety, Autism, Coaching, Depression & Mood Disorders, Health Promotion, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Leadership, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Trauma & PTSD
Ashley Halle
OTD, OTR/L, CAPS, LRC
Educator
University of Southern California
Los Angeles, California
Aging in Place, Chronic Conditions, Chronic Pain, Coaching, Dementia, Depression & Mood Disorders, Health Promotion, Insomnia & Sleep
Lauralee Gordon
OTR/L
Flow Therapeutics, LLC
Richmond, Virginia
ADHD, Anxiety, Autism, Cerebral Palsy, Chronic Conditions, Cognitive Rehabilitation, Dementia, Fitness, Hand Therapy, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Maternal Health, Multiple Sclerosis, Neurodiversity, Neurorehabilitation, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Parkinson’s, Pelvic Health, Prevention, Rare Diseases, Seating and Mobility, Sexuality/Intimacy, Spinal Cord Injury, Stroke, TBI, Tourette syndrome
Shubhangi Sharma
OTR, Registered OT (BC)
Shubhangi (Shubhi) Occupational Therapy, Coaching and Consulting
Vancouver, British Columbia
ADHD, Anxiety, Chronic Conditions, Chronic Pain, Coaching, Ehlers-Danlos Syndrome, Ergonomics, Functional Neurological Disorder (FND), Health Promotion, Insomnia & Sleep, Neurodiversity, Rheumatic Diseases, Sexuality/Intimacy, Trauma & PTSD
Samantha Valasek
OTD, OTR/L, ADHD-RSP, CTTS
Spectrum Psych LA
Los Angeles, California
ADHD, Anxiety, Autism, Chronic Conditions, Chronic Pain, Coaching, Ergonomics, Health Promotion, Insomnia & Sleep, Lifestyle Medicine, Leadership, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Sexuality/Intimacy, Trauma & PTSD
Salmin Chacha
OTR/L
Occupational Therapist
AL NOOR TRAINING CENTRE
dubai
ADHD, Augmentative and Alternative Communication, Aquatic Therapy, Aphasia & Communication Disorders, Assistive Technology, Autism, Burns, Cerebral Palsy, Chronic Conditions, Chronic Pain, CIMT, Coaching, Cognitive Rehabilitation, Dementia, Depression & Mood Disorders, Developmental Delays, Dystonia, Ehlers-Danlos Syndrome, Ergonomics, Emergency Department, Feeding and Eating, Functional Neurological Disorder (FND), Grant Writing, Hand Therapy, Health Data, ICU/Critical Care, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Knowledge Translation, Lifestyle Medicine, Low Vision Rehabilitation, Maternal Health, Medication Management, Mitochondrial Disorders, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, NICU, Pelvic Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Seating and Mobility, Sexuality/Intimacy, Spinal Cord Injury, Stroke, Swallowing & Dysphagia, TBI, Trauma & PTSD, Vestibular & Balance Rehab
Marlene Handler
MS, OTR/L, TIPHP, CSOT
The Lifted Lotus, PLLC
Brooklyn, New York
Anxiety, Chronic Pain, Ehlers-Danlos Syndrome, Fitness, Health Promotion, Insomnia & Sleep, Maternal Health, Pelvic Health, Sexuality/Intimacy, Trauma & PTSD
Angela Robertson
OTR/L, ADHD-RSP
Occupational Therapy With Angela, LLC
Baltimore, Maryland
ADHD, Anxiety, Autism, Chronic Conditions, Coaching, Cognitive Rehabilitation, Depression & Mood Disorders, Health Promotion, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Lifestyle Medicine, Leadership, Maternal Health, Medication Management, Multi-tiered System of Supports, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Prevention, Trauma & PTSD
Cynthia Kisik
COTA/L
Patriot at Home
Louisville, Ohio
Aging in Place, Amyotrophic Lateral Sclerosis (ALS), Aphasia & Communication Disorders, Assistive Technology, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Chronic Pain, Dementia, Fitness, Grant Writing, Home Modifications, Insomnia & Sleep, Lifestyle Medicine, Medication Management, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, Orthopedics & Musculoskeletal, Parkinson’s, Pelvic Health, Rare Diseases, Rheumatic Diseases, Seating and Mobility, Sexuality/Intimacy, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Vestibular & Balance Rehab
PJ Bhakta
OTR, OTD, PCES, CSOT
Consultant
TheraSolutions Consulting, LLC
Cedar Park, Texas
ADHD, Chronic Pain, Coaching, Depression & Mood Disorders, Ehlers-Danlos Syndrome, Ergonomics, Fitness, Hand Therapy, Health Data, Health Policy, Health Promotion, Industrial Rehabilitation, Insomnia & Sleep, Knowledge Translation, Lifestyle Medicine, Leadership, Maternal Health, Neurodiversity, NICU, Orthopedics & Musculoskeletal, Pelvic Health, Prevention, Population Health, Sexuality/Intimacy, Social Determinants of Health, Sports Medicine & Performance, Trauma & PTSD
Kimberly Eberly
OTR
Balanced Vision, LLC
Aurora, Nebraska
Aging in Place, ADHD, Autism, Drivers Rehabilitation, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Low Vision Rehabilitation, Neurorehabilitation, Vestibular & Balance Rehab
Rebecca Villa
OTD, OTR/L, RYT-200
Student
San Diego, California
Aging in Place, Anxiety, Chronic Conditions, Coaching, Health Promotion, Home Modifications, Insomnia & Sleep, Lifestyle Medicine, Maternal Health, Pelvic Health, Prevention, Population Health, Sexuality/Intimacy, Trauma & PTSD
Stacy Simoneaux
OTR/L, MBA-HA, MOccThySt(Hons),
Occupational Therapist
Seattle, Washington
Aging in Place, ADHD, Anxiety, Autism, Cerebral Palsy, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Dementia, Health Data, Health Policy, Health Promotion, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Leadership, Mitochondrial Disorders, Multiple Sclerosis, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Prevention, Population Health, Social Determinants of Health, TBI, Trauma & PTSD, Tourette syndrome
Hurya Bin sultan
MSc, OTR/L, SIPT, ASI
Educator
King Saud University
Riyadh
Anxiety, Cognitive Rehabilitation, Depression & Mood Disorders, Home Modifications, Insomnia & Sleep, Knowledge Translation, Leadership, Medication Management, Neurodiversity, Obsessive-Compulsive Disorder (OCD), Trauma & PTSD
Monika Lukasiewicz
OTR/L
Occupational Therapist
MollyLu P-LLC
Mesa, Arizona
Aging in Place, Chronic Conditions, Chronic Pain, Coaching, Dementia, Fitness, Health Promotion, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Lifestyle Medicine, Leadership, Low Vision Rehabilitation, Nature-based, Parkinson’s, Prevention, Population Health, Social Determinants of Health, Stroke
Marissa
OTR/L, OTD, AMPS, CEAS, LRC
Educator
True North Occupational Therapy
Nacka
ADHD, Anxiety, Assistive Technology, Autism, Chronic Conditions, Coaching, Ergonomics, Fitness, Health Promotion, Insomnia & Sleep, Lifestyle Medicine
Alana Woolley
OTD, OTR/L
Occupational Therapist
UnityPoint Meriter
Madison, Wisconsin
ADHD, Autism, Health Policy, Insomnia & Sleep, Knowledge Translation, Neurodiversity, Trauma & PTSD
Shaunna Kotka
OTD, OTR/L, CLT-LANA, CMT
Administrator
Open Grounds Inc.
Marina del Rey, California
ADHD, Anxiety, Cancer, Chronic Conditions, Chronic Pain, Cognitive Rehabilitation, Dementia, Depression & Mood Disorders, Dystonia, Ehlers-Danlos Syndrome, Fitness, Health Promotion, Home Modifications, Insomnia & Sleep, Knowledge Translation, Lymphedema, Medication Management, Neurodiversity, Neurorehabilitation, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Parkinson’s, Prevention, Population Health, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Social Determinants of Health, Sports Medicine & Performance, Stroke, TBI, Trauma & PTSD
Melina McSweeny
S/OT
Student
Xavier University
Columbus, Ohio
Dementia, Insomnia & Sleep, Maternal Health, NICU
Destiney Carmichael
OTS
Student
Xavier University
Cincinnati, Ohio
Aging in Place, ADHD, Amyotrophic Lateral Sclerosis (ALS), Anxiety, Assistive Technology, Autism, Burns, Cancer, Cerebral Palsy, Chronic Conditions, Chronic Pain, CIMT, Cognitive Rehabilitation, Dementia, Dystonia, Ehlers-Danlos Syndrome, Fitness, Feeding and Eating, Functional Neurological Disorder (FND), Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Lymphedema, Maternal Health, Multiple Sclerosis, Nature-based, Neurodiversity, Neurorehabilitation, NICU, Obsessive-Compulsive Disorder (OCD), Orthopedics & Musculoskeletal, Osteogenesis Imperfecta, Parkinson’s, Pelvic Health, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Rare Diseases, Rheumatic Diseases, Seating and Mobility, Sexuality/Intimacy, Social Determinants of Health, Spinal Cord Injury, Stroke, TBI, Trauma & PTSD, Vestibular & Balance Rehab
Virginia Padgett
OTS
Student
Xavier University
Verona, Kentucky
ADHD, Anxiety, Autism, Cerebral Palsy, Chronic Conditions, Chronic Pain, Fitness, Feeding and Eating, Home Modifications, Insomnia & Sleep, Intellectual and Developmental Disabilities (IDD), Leadership, Nature-based, Neurodiversity, NICU, Prevention, Postural Orthostatic Tachycardia Syndrome (POTS), Seating and Mobility
Conclusion
Hopefully this article helped you understand what occupational therapy for pediatric sleep difficulties entails.
This article is updated regularly based on newly released research. If you have any research you would like us to consider, please contact us.
OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.
Contributors
Amy Hartman
PhD, OTR/L
I am an occupational therapist and sleep scientist interested in supporting families with sleep and emotion regulation.
Sarah Lyon
OTR/L
Sarah Lyon, OTR/L, is the CEO of OT Potential. Sarah earned her BA from St. Olaf College and her master’s degree in occupational therapy from New York University. Her diverse clinical background spans multiple settings, including critical access, acute trauma, and state inpatient psychiatric hospitals. In 2011, she founded OT Potential to fulfill the industry's need for reliable, high-quality occupational therapy resources and continuing education.
As a recognized content creator, Sarah has collaborated with top healthcare brands like VeryWell Health, WebPT, and MedBridge. She blends her clinical expertise with a talent for creating clear, action-oriented content that empowers practitioners to excel. Passionate about elevating the OT profession, she has been featured on numerous industry podcasts. Sarah ultimately returned to her roots, running OT Potential and raising her family in her hometown of Aurora, Nebraska.
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