Sleep from six to twelve
School age sleep looks settled from the outside. Underneath, this is the age when snoring starts to matter, when legs ache at bedtime, and when a child who cannot switch off gets labelled as difficult. Here is what is ordinary and what is worth asking about.
How much sleep school age children actually need
Children aged 6 to 12 need 9 to 12 hours in 24. The range is wide on purpose. It comes from a consensus of sleep physicians rather than from a trial, so it is a guide, not a target to hit exactly.
Aged 6 to 12
Across 24 hours. American Academy of Sleep Medicine consensus statement, endorsed by the American Academy of Pediatrics (Journal of Clinical Sleep Medicine, 2016).
Do not get it
37.5 percent of US children aged 6 to 12 slept less than recommended in the National Survey of Children's Health, 2016 to 2019. Parents reported the hours, so treat it as an estimate rather than a measurement.
Why three hours wide
Children of the same age genuinely need different amounts. Where your child sits in the range matters less than whether they wake rested and get through the school day.
The child who cannot fall asleep
Lying awake at bedtime is common at this age, and it is not evidence that you have done something wrong.
In a population study of 700 children aged 5 to 12, about one in five had insomnia symptoms as reported by a parent, and the rate was highest in girls aged 11 to 12 at just under a third (Sleep Medicine, 2014). A Norwegian study that used diagnostic interviews rather than questionnaires found lower figures, between 7.5 and 12.3 percent across ages 8 to 14 (BMJ Paediatrics Open, 2020). The gap between those two numbers is mostly a difference in how the question was asked.
Behavioural treatment, often called CBT for insomnia, is the usual first step and it is a reasonable one. It is worth knowing what the evidence behind it actually covers. The practice parameter that established these methods studied children up to 4 years and 11 months (Sleep, 2006). In school age children there are only two randomised trials, and a pooled analysis of six trials, most of them in teenagers, found children fell asleep around 19 minutes sooner while total sleep time and daytime sleepiness barely moved (Journal of Clinical Sleep Medicine, 2018).
Snoring is not just noise
About 7 in 100 children snore on most nights, and 1 to 4 in 100 have obstructive sleep apnea confirmed on a sleep study (Proceedings of the American Thoracic Society, 2008).
Tonsils and adenoids are at their largest relative to the airway between about two and eight years, which is why this age group is where breathing problems in sleep tend to show up. Where a child has apnea and enlarged tonsils, surgery is the recommended first treatment (American Academy of Pediatrics guideline, Pediatrics, 2012).
What surgery does and does not do is worth understanding before you are asked to decide. In a trial of 464 children aged 5 to 9, surgery improved breathing, behaviour, symptoms and quality of life, and sleep studies returned to normal in 79 percent of the children who had surgery. The question the trial was actually built to answer, whether surgery improves attention and executive function, came back negative (New England Journal of Medicine, 2013). A second trial in milder disease found the same pattern (JAMA, 2023).
The finding that gets left out of most conversations: 46 percent of the children who did not have surgery had normal sleep studies seven months later anyway. A watchful approach is a real option for some children, and the decision belongs with your child's own clinician.
- Snoring on most nights, not just with a cold
- Pauses in breathing, gasping, or snorting
- Breathing through the mouth while asleep
- Very restless sleep, or sleeping in odd positions
- Morning headaches
- Bedwetting that returns after your child was dry
- Daytime sleepiness, or trouble focusing and sitting still
Growing pains, or restless legs
An uncomfortable, restless feeling in the legs at bedtime that improves when your child moves is not the same as growing pains, and it has a name.
In a survey of 10,523 families, 1.9 percent of children aged 8 to 11 met the criteria for restless legs syndrome (Pediatrics, 2007). Two details from that study are useful at home. Around 8 in 10 of the affected children had a history of what the family called growing pains, and more than 7 in 10 had at least one parent with the same symptoms. If this sounds familiar in your own childhood, mention that to the clinician.
Iron is where the conversation usually goes next, and this is where the evidence is softer than it sounds. The current guideline suggests iron for children with restless legs when iron status is appropriate, but rates that recommendation as conditional with very low certainty (Journal of Clinical Sleep Medicine, 2025). A ferritin level under 50 is the threshold most often quoted. It was carried across largely from adult data, and an international task force concluded that the evidence in children is insufficient to set one (Sleep Medicine, 2018).
Please do not start iron on your own. It needs a blood test first, and too much iron is harmful. This is a conversation for your child's clinician.
Screens in the evening
Screens are the first thing most families are told to cut, and the evidence is weaker than the confidence behind that advice.
A review of 67 studies in children and young people aged 5 to 17 found that 90 percent reported a link between screen use and worse sleep (Sleep Medicine Reviews, 2015). Almost all of those studies simply observed children at one point in time. Participants were randomly assigned in only three, all of them in teenagers. We could find no randomised trial in children aged 6 to 12 showing that cutting screens improves their sleep.
The largest careful analysis, of 50,212 children and young people, found around 3 minutes less sleep for each hour of screen time, accounting for under 2 percent of the difference between children (Journal of Pediatrics, 2019). The author's own point is that this is small next to something like an early school start.
None of that makes screens harmless. It does change where to aim. A device in the bedroom overnight, notifications left on, and something exciting in the last half hour are worth changing. Counting total hours is probably not the lever it is sold as.
Melatonin at this age
Melatonin has become ordinary in family medicine cabinets. In a survey of US parents, 18.5 percent of children aged 5 to 9 and 19.4 percent aged 10 to 13 had used it in the previous month, and preteens who used it had been doing so for a median of 21 months (JAMA Pediatrics, 2023).
Two things are worth knowing before it becomes routine in your house. The first is what is in the bottle. When researchers tested 25 melatonin gummies, 22 were inaccurately labelled, with actual content ranging from 74 to 347 percent of what the label claimed, and one containing no melatonin at all (JAMA, 2023).
The second is how much it does. Pooling eight randomised trials in children and young people with long standing insomnia, melatonin brought sleep forward by about 18 minutes and added about 30 minutes of sleep, with certainty rated low to very low. The authors were direct that it should never be the first choice in this group (EClinicalMedicine, 2023).
The American Academy of Sleep Medicine advises parents to treat melatonin like any other medicine, keep it out of reach, talk to a pediatric health professional before giving it, and choose a product carrying the USP Verified Mark (health advisory, 2022).
Tired, or not paying attention
Sleep and school performance are linked, and the size of that link is smaller than most headlines suggest.
A meta-analysis covering ages 8 to 18 found that daytime sleepiness predicted school performance better than either sleep quality or sleep duration did, and all three effects were small (Sleep Medicine Reviews, 2010). More hours in bed does not straightforwardly produce better grades.
The overlap that matters more clinically is with attention. Pooling 18 studies, children with sleep disordered breathing and children with ADHD symptoms looked considerably alike, a medium sized relationship (Sleep Medicine Reviews, 2014). That does not mean breathing problems explain most attention difficulties, and the two randomised surgical trials found no attention benefit from surgery. What it does mean is that a child being assessed for attention problems is worth asking about snoring first.
Worth mentioning at your next visit
None of these mean something is wrong. All of them are worth saying out loud to your child's clinician rather than waiting to be asked.
- Snoring most nights, or pauses in breathing
- Legs that ache or feel restless at bedtime
- Taking longer than about 30 minutes to fall asleep, most nights
- Waking in the night and being unable to settle again
- Sleepiness during the day, or falling asleep at school
- A change in mood, attention or behaviour alongside a change in sleep
- Melatonin used for more than a few weeks
- Headaches in the morning
Have another child at a different age?
What is normal at eight months is not normal at eight years. Each age has its own page.
Where this comes from
- Paruthi S, et al. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine, 2016;12(6):785 to 786. Source of the 9 to 12 hour range.
- Claussen AH, et al. Short sleep duration: children's mental, behavioral, and developmental disorders and demographic, neighborhood, and family context. Preventing Chronic Disease, 2023;20:220408. Source of the 37.5 percent figure, National Survey of Children's Health 2016 to 2019.
- Calhoun SL, et al. Prevalence of insomnia symptoms in a general population sample of young children and preadolescents. Sleep Medicine, 2014;15(1):91 to 95.
- Falch-Madsen J, et al. Prevalence and stability of insomnia from preschool to early adolescence. BMJ Paediatrics Open, 2020;4(1):e000660.
- Aslund L, et al. Cognitive and behavioral interventions to improve sleep in school-age children and adolescents: a systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 2018;14(11):1937 to 1947.
- Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proceedings of the American Thoracic Society, 2008;5(2):242 to 252.
- Marcus CL, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012;130(3):576 to 584.
- Marcus CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. New England Journal of Medicine, 2013;368(25):2366 to 2376. Source of the 79 percent and 46 percent figures.
- Redline S, et al. Adenotonsillectomy for snoring and mild sleep apnea in children: a randomized clinical trial. JAMA, 2023.
- Picchietti D, et al. Restless legs syndrome: prevalence and impact in children and adolescents. Pediatrics, 2007;120(2):253 to 266.
- Winkelman JW, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 2025;21(1):137 to 152.
- Allen RP, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome in adults and children. Sleep Medicine, 2018;41:27 to 44.
- Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Medicine Reviews, 2015;21:50 to 58.
- Przybylski AK. Digital screen time and pediatric sleep: evidence from a preregistered cohort study. Journal of Pediatrics, 2019;205:218 to 223.
- Hartstein LE, et al. Characteristics of melatonin use among US children and adolescents. JAMA Pediatrics, 2023.
- Cohen PA, et al. Quantity of melatonin and CBD in melatonin gummies sold in the US. JAMA, 2023;329(16):1401 to 1402.
- Edemann-Callesen H, et al. Use of melatonin in children and adolescents with idiopathic chronic insomnia: a systematic review, meta-analysis, and clinical recommendation. EClinicalMedicine, 2023;61:102048.
- American Academy of Sleep Medicine. Health advisory: melatonin use in children and adolescents. Adopted 2022, published in Journal of Clinical Sleep Medicine, 2022;18(12):2857 to 2859.
- Dewald JF, et al. The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Medicine Reviews, 2010;14(3):179 to 189.
- Sedky K, et al. Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: a meta-analysis. Sleep Medicine Reviews, 2014;18(4):349 to 356.
This page provides educational and informational content on pediatric sleep health for general purposes only. Nothing here constitutes medical advice, a clinical diagnosis, or a substitute for professional medical consultation. Parents and caregivers should consult their child's physician before changing care or treatment. In a medical emergency, contact your local emergency services immediately.
FREE DOWNLOAD
Where should we send your melatonin guide?
Melatonin is one of the most common things parents reach for once a child is past infancy, and one of the least understood. This guide covers what it does, what it does not do, and what to ask your clinician.
The Sleep Health Organization
Sleep is simple. Physician-led Pediatric Sleep Education and Certificate of Training. Every clinician. Every family.