Pediatric Sleep & Occupational Therapy (Find a Therapist!)

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.

A quick note on why to pursue occupational therapy for sleep difficulties

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%.  

Therapist-recommended assessments for sleep difficulties

Occupational therapists assess individual sleep patterns, environments, and daily routines to identify factors contributing to a person’s sleep problems. 

As you can see below, multiple different components can be involved in evaluating sleep difficulties. That’s partly because several areas of overall body function can be affected—especially within the context of everyday life.

Assessments also serve as a point of comparison for tracking an individual’s progress and response to treatment over time. An accurate and thorough baseline allows your therapist (and you/your child) to discern how much the interventions are helping. Your therapist may perform certain assessments at various intervals over the course of therapy.

Members of the OTPotential Club can log in to see these assessments broken down in more detail.

Caregiver-reported questionnaires

  • PROMIS Sleep Disturbances and Sleep Related Impairment measures—two versions, one for early childhood (ages 1–4) and one for childhood (ages 5–17)
  • Children’s Sleep Habits Questionnaire1
  • Pediatric Sleep Practices Questionnaire2

Child-reported questionnaires

  • Child Sleep Self Report3

Setting Goals for OT Sleep Interventions 

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.

Occupational Therapy Treatment Interventions for Sleep 

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program. 

Occupational therapists take a unique approach, considering intervention at the person, environment, and occupational level.

Possible 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

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)

Choosing an occupational therapist for pediatric sleep difficulties

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.

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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 drop it in the comments. 

Therapists who would like more detailed information on sleep therapy best practices can join us as members of the OT Potential Club.

Article by

Sarah Lyon, OTR/L, is the CEO of OT Potential and is on a mission to bridge the gap between research and real occupational therapy practice.

References

Here’s the science backing the assessments and treatment outlined above. 

References

  1. Owens JA, Spirito A, McGuinn M. The Children’s Sleep Habits Questionnaire (CSHQ): Psychometric Properties of A Survey Instrument for School-Aged Children. Sleep. 2000.
  2. Meltzer LJ, Forrest CB, de la Motte A, Mindell JA, Bevans KB. Development and Validation of the Pediatric Sleep Practices Questionnaire: A Self-Report Measure for Youth Ages 8–17 Years. Behav Sleep Med. 2021.
  3. Meltzer LJ, Avis KT, Biggs S, Reynolds AC, Crabtree VM, Bevans KB. The Children’s Report of Sleep Patterns (CRSP): A Self-Report Measure of Sleep for School-Aged Children. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2013.
  4. Meltzer LJ, Williamson AA, Mindell JA. Pediatric sleep health: It matters, and so does how we define it. Sleep Med Rev. 2021.
  5. Magee L, Goldsmith LP, Chaudhry UAR, et al. Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and Meta-analysis. JAMA Pediatr. 2022.
  6. Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Child Adolesc Psychiatr Clin N Am. 2020.
  7. American Academy of Sleep Medicine. Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. Sleep. Published online October 1, 2006.
  8. Meltzer L. Pediatric Sleep Problems. American Psychological Association. 2015.
  9. McCrae CS, Chan WS, Curtis AF, et al. Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study. Autism Res. 2020
  10. Sanberg SA. Bedtime Fading with Response Cost for Treatment of Sleep Disturbances in Children with Autism Spectrum Disorder. University of Nebraska Medical Center. 2017.
  11. Moss AHB, Gordon JE, O’Connell A. Impact of Sleepwise: An Intervention for Youth with Developmental Disabilities and Sleep Disturbance. J Autism Dev Disord. 2014.
  12. Hiscock H, Sciberras E, Mensah F, et al. Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial. BMJ. 2015.
  13. Papadopoulos N, Sciberras E, Hiscock H, et al. Sleeping Sound Autism Spectrum Disorder (ASD): a randomised controlled trial of a brief behavioural sleep intervention in primary school-aged autistic children. J Child Psychol Psychiatry. 2022.
  14. Harvey AG. A Transdiagnostic Intervention for Youth Sleep and Circadian Problems. Cogn Behav Pract. 2016.
  15. Sesso G, Guccione F, Pisano S, et al. Emotional Dysregulation and Sleep Problems: A Transdiagnostic Approach in Youth. Clin Pract. 2024.
  16. Watanabe E, Kuchta K, Kimura M, Rauwald HW, Kamei T, Imanishi J. Effects of Bergamot (Citrus bergamia (Risso) Wright & Arn.) Essential Oil Aromatherapy on Mood States, Parasympathetic Nervous System Activity, and Salivary Cortisol Levels in 41 Healthy Females. Forsch Komplementärmedizin Res Complement Med. 2015.
  17. Sattayakhom A, Wichit S, Koomhin P. The Effects of Essential Oils on the Nervous System: A Scoping Review. Molecules. 2023.

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.

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