Occupational Therapy’s Role in Child Sleep

By: Anna McTish OTD, OTR/L

How many times in your clinical experience have you heard a parent state “He/She just won’t sleep!”? I have probably heard it 2,345 times since the beginning of my career. Naively, however, I never used to prioritize sleep in my treatments (unless it was a parent goal) or list sleep as a major catalyst for other concerns occurring with these kiddos. That is…until now. Six months ago, I became a Mom and low and behold… “She just won’t sleep!”.

We all know what it is like to function with little sleep (nearly impossible). Can you imagine being a child whose body is working double time to develop AND being utterly exhausted due to lack of sleep? No wonder these kids are having such a hard time. Lack of sleep challenges your development, behavior, cognition, registration/sensory awareness, play skills, and (believe it or not) sleep itself!

My recent exhaustion led me to research what occupational therapists can do for kids that “just won’t sleep”. You can guarantee this resource has become a staple for my treatments. See below:

  1. We can help families develop a bedtime routine because consistency is KEY
    1. Visual/picture cues/schedules for bedtime routine. Make the schedule concise and the steps easy to follow.
    2. Sensory components of bedtime routine:
      1. heavy work or deep pressure (wheelbarrow walk/animal walk to complete bedtime checklist, deep squeezes on arms/legs prior to sleep)
      2. sustaining tactile play (theraputty, bean bin, rice bin)
      3. calming sensory techniques (bath, calming scents, calming music, low light)
    3. Make sure toileting routines are taken care of before bedtime, if possible.
    4. Talk about any worries or concerns the child might have prior to going to sleep; this might help alleviate some anxiety.
    5. Keep routines as consistent as possible throughout the week, even on weekends.
  2. We can help families explore their daytime routines and make changes as necessary
    1. Is the child over-stimulated/under-stimulated during the day? If so, we can suggest sensory techniques to keep them regulated throughout the day.
    2. Is the child taking naps? They might be sleeping too much or not enough during the day. Help families develop a nap routine.
    3. Does the child seem hungry or thirsty at night? If so, we can suggest ways to increase food and liquid intake during the day to decrease the need at night OR provide a snack or water beside the bed.
    4. Recommend (during the warm months) spending more time outside for increased Vitamin D and increased sensory input.
  3. Help families regulate their child’s sensory system during sleep:
    1. Lycra bed sheets or weighted blankets for sustained proprioceptive input
    2. Loose or tight-fitting pajamas depending on the preferences of the child
    3. Night light or completely dark depending on the preferences of the child
    4. Explore whether a lovey is hindering or helping their sleep
    5. Provide white noise to decrease external noise from environment or family members
    6. Regulate the room temperature

Additional Resources:






OT For Kids NT (2019, October 29). Sensational Sleep. Retrieved from http://www.otforkidsnt.com.au/sensational-sleep/

Heffron, Claire (2016). “Sensory-Friendly Tips for Kids Who have Trouble Sleeping”. Retrieved from https://theinspiredtreehouse.com/sensory-smart-sleep-tips-kids/

Picard, M. (2017). Occupational Therapy’s Role in Sleep. Retrieved from https://www.aota.org/About-Occupational-Therapy/Professionals/HW/Sleep.aspx

Quint, Nicole (2017). “Sleep in Pediatric Occupational Therapy Practice: A Family-Centered Approach.” Retrieved from: www.occupationaltherapy.com/articles/sleep-in-pediatric-occupational-therapy-4018.

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