The sleep of children and adolescents

Source: 📒 The sleep of children and adolescents

📜🔗LINK

Number of pages: 16

1. Analytical summary

Development, life rhythms and sleep debt

The report shows that sleep structures the brain, cognitive and emotional development of the child from fetal life, through the complementary role of REM sleep and slow sleep in synaptic maturation, memory consolidation, and emotional regulation. The authors document the specific vulnerabilities of the perinatal period (impact of maternal sleep disorders on DOHaD and the child's subsequent mental health), early childhood (the role of napping in learning), and adolescence (phase delay, 'social jetlag', chronic deprivation). They describe the interactions between sleep, physical activity, eating behaviours, screens, and neurodevelopmental disorders (ADHD, ASD, dyslexia, intellectual disability), as well as the bidirectional links with mental health (depression, suicide risk).

Pathologies, early detection and prevention levers

The document details the main sleep disorders in children and adolescents (insomnia, central hypersomnias, notably narcolepsy, obstructive sleep apnoea syndrome – OSAS – and circadian rhythm sleep-wake disorders), emphasising their frequency, underdiagnosis, and neurocognitive and psychosocial impact. It proposes practical management strategies (insomnia annex), structured public health recommendations (systematic screening in primary care, free multilingual parental education programmes, sleep education in schools, limiting screen time in the evening, adjustments to school hours) and three 'shock measures': sleep check-ups at 6 months and 6 years, a digital curfew after 8 pm before the age of 15, and starting classes at 9 am. The report is part of the interministerial roadmap 'sleep' 2025–2026 and the evolution of nutrition-physical activity policies, elevating sleep to a major public health determinant.

2. Key points of the document

1. The sleep debt in children and adolescents is massive and multifactorial, combining biological phase shift, inappropriate social rhythms, increased screen use, and reduced napping, with documented effects on learning, mood, metabolism, immunity, and suicide risk. (p. 3–7, 10–11)

2. Sleep disorders during pregnancy and early childhood, through the concept of DOHaD, are a major determinant of the child's subsequent mental and physical health, which justifies the systematic integration of sleep into prenatal and postnatal monitoring and the health record. (p. 3–4, 8–10)

3. Sleep disorders are particularly common in neurodevelopmental disorders (ADHD, ASD, learning disabilities, intellectual disability), where they exacerbate behavioural and cognitive difficulties, but also represent a therapeutic lever (for example, the effectiveness of melatonin in ASD). (p. 5–6)

4. The report proposes a clear structure for the management of childhood obstructive sleep apnoea (definition of phenotypes, indications for polysomnography or polygraphy, thresholds for AHI, the role of adenotonsillectomy and associated measures) and central hypersomnias (diagnostic criteria for narcolepsy, metabolic and educational implications, therapeutic options). (p. 8–9)

5. Public health recommendations are highly operational: systematic sleep screening in paediatrics and general medicine, free and multilingual parental education programmes, integration of sleep into school curricula and professional training, creation of a national observatory and targeted calls for proposals on 'sleep and learning' / 'sleep and ADHD/autism'. (p. 9–10)

3. Action points for local stakeholders

1. Integrate a systematic module of questions about sleep (duration, regularity, night awakenings, screens, naps, daytime sleepiness) in all follow-up consultations (PMI, general medicine, paediatrics, school health) and record this data in the health booklet, particularly before and after 6 months, at the start of nursery school and at 6 years old. (p. 3–4, 9–10)

2. Co-construct, at the level of municipalities and education authorities, projects on the "culture of sleep" in primary schools and colleges: maintaining proper nap spaces in nursery schools, educational sessions on sleep, parent-school workshops, a charter for screen use after 9 pm, and experimenting with starting classes at 9 am for secondary school students. (p. 4–5, 7, 10)

3. Develop free, digital, multilingual parental education tools on young children's sleep (short videos, fact sheets, webinars), supported by local authorities, family allowance funds, perinatal networks, and associations, in alignment with the future national offer recommended by the report. (p. 9–10)

4. Structure local pathways for vulnerable children (neurodevelopmental disorders, obesity, multiple traumas, unaccompanied minors, situations of violence) systematically including a sleep component (identification, advice, referral to a paediatric sleep centre or a CRMR if necessary), in connection with child mental health centres, specialised educational services, child protection services, and specialised associations. (p. 5–6, 9)

5. Establish sleep as a priority theme for CLS/CLSM and ARS projects, coordinating actions with the inter-ministerial roadmap 2025–2026 (public information, conducive sleep environment, identification in prevention assessments) and with the guidelines of PNNS 5 on active lifestyles and sleep. (p. 2–3, 10–11)

4. Additional references

🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the topic of SLEEP ➡️🔗https://pratiquesensante.odoo.com/blog/tag/sommeil-129

1. Ministry of Health – "Inter-ministerial roadmap for promoting quality sleep and preventing its disorders 2025–2026"https://pratiquesensante.odoo.com/blog/politiques-10/promouvoir-un-sommeil-de-qualite-pour-tous-une-feuille-de-route-2025-2026-5000

5. Cross-sectional analysis – values of Pratiques en Santé

• Literacy: The report provides simple numerical benchmarks (sleep durations by age, the role of naps, recommended screen times) but is overall written in expert language, requiring mediation for audiences with low health literacy. (p. 3–5, 9–11)

• Empowerment: The beneficiaries (children, adolescents, parents) are not described as co-actors, but the emphasis on parental education, sleep education in schools, and enhancing parents' knowledge opens up potential for family empowerment. (p. 4–5, 9–11)

• Participation: Co-construction is mainly scientific (experts, learned societies, GSEA) and institutional; the direct participation of young people or families is not specified in the report. (p. 2, 13–15)

• Community health: The text mentions key living environments (family, school, childcare structures, communities) and clearly situates itself within a logic of social and environmental determinants of sleep, but does not detail formalised community approaches. (p. 3–7, 9–11)

• Ethics: Issues of cultural or social bias are only implicitly addressed; however, the report notes the increased vulnerability of certain groups (neurodevelopmental disorders, obese children, unaccompanied minors, victims of violence) and stresses the need for enhanced screening and support. (p. 5–6, 9)

• Human rights: Equal access to quality sleep and care is underlying (mandatory visits, free and multilingual programme, integration into public policies) but the explicit reference to human rights or non-discrimination is not developed. (p. 9–10)

• Intersectorality: The report is part of the interministerial roadmap (Health, Education, Employment, Housing, etc.) and advocates for partnerships between the health system, schools, and national public policies. (p. 2–3, 10)

• Partnership: Collaboration models are implicit (Academy – SFRMS – INSV – academic experts; links with ministries and ARS), but not formalised in the form of protocols or field partnership charters. (p. 2, 10, 13–15)

• Combating discrimination: The document mentions certain situations of vulnerability (TND, MNA, violence) without explicitly addressing systemic discrimination; the principle of non-judgment appears indirectly through the emphasis on training professionals and adapting tools for parents. (p. 5–6, 9–11)

6. Evaluation of the reliability of the resource

• Scientific relevance: The report is supported by the National Academy of Medicine and a group of recognised experts (paediatrics, sleep, child psychiatry, epidemiology) and is based on an extensive bibliography, including numerous review articles and longitudinal studies published since 2018, as well as work from 2023–2025 on DOHaD, TND, and psychiatric risks. (p. 3–8, 11–12, 14–15) The positions are consistent with recent national roadmaps and recommendations (sleep roadmap 2025–2026, PNNS 5) and with published epidemiological data.

• Operational relevance: The recommendations are directly transposable on the ground (systematic identification, standardised messages to families, thresholds and actions to take for the main disorders, practical annex on insomnia) and linked to public policy measures (mandatory visits, digital curfews, school hours). (p. 8–10, 16) However, implementation requires local adaptation (available resources, school organisation, social constraints) and a translation into communication tools suited to varying levels of literacy.

7. MCQ – 5 questions

Part 1 — MCQ without answers

Question 1 (p. 3–4):

In early childhood, what main role is attributed to paradoxical sleep?

a) The regulation of body temperature

b) The maturation of neural networks and synaptic connections

c) The secretion of growth hormone

d) The reduction of appetite

Question 2 (p. 4–5):

What major change regarding naptime at school is described in the report?

a) Its systematic extension until the age of 8

b) Its gradual removal in hospital nurseries

c) Its reduction or even premature removal in certain schools for organisational reasons

d) Its regulatory obligation in all large sections of nursery school

Question 3 (p. 5–6):

In children with autism spectrum disorder, what biological characteristic of sleep is frequently observed?

a) Increased melatonin secretion

b) An absence of paradoxical sleep

c) A decrease in melatonin secretion and circadian rhythm disorders

d) A systematic increase in deep slow sleep

Question 4 (p. 8–9):

According to the report, at what apnoea-hypopnoea index (AHI) is severe obstructive sleep apnoea (OSA) discussed in children?

a) AHI ≥ 3 events/hour

b) AHI ≥ 5 events/hour

c) AHI ≥ 10 events/hour

d) AHI ≥ 15 events/hour

Question 5 (p. 9–10):

What 'shock measure' is explicitly recommended by the Academy for adolescents?

a) Ban homework after 6 PM

b) Delay the start of lessons to 9 AM

c) Make napping mandatory in secondary school

d) Impose a screen-free day each week

Part 2 — Commented correction

Question 1:

✅ Correct answer: b) The maturation of neural networks and synaptic connections

📝 Explanation: The report highlights that REM sleep, which is very present in newborns, promotes the formation and strengthening of synaptic connections and the programming of sensory-motor circuits. Source: p. 3–4.

Question 2:

✅ Correct answer: c) Its premature decrease or elimination in certain schools for organisational reasons

📝 Explanation: The text indicates that the practice of napping has significantly decreased and that some schools eliminate it too early, for organisational reasons, without considering the physiological needs of children. Source: p. 4–5.

Question 3:

✅ Correct answer: c) A decrease in melatonin secretion and circadian rhythm disorders

📝 Explanation: In ASD, the authors describe frequent sleep disorders with insomnia, circadian disorganisation, and decreased melatonin secretion, which partly explains the difficulties in falling asleep and night awakenings. Source: p. 5–6.

Question 4:

✅ Correct answer: c) AHI ≥ 10 events/hour

📝 Explanation: The report adopts the classification of the severity of OSA in children; an AHI ≥ 10 events per hour defines severe OSA, while lower values correspond to mild or moderate forms. Source: p. 8–9.

Question 5:

✅ Correct answer: b) Shift the start of lessons to 9 am

📝 Explanation: Among the three proposed shock measures, the report recommends shifting the start of classes to 9 am, in relation to the phase shift of adolescents and their sleep debt. Source: p. 10.

8. Frequently Asked Questions (FAQ)

1. Why is sleep considered a major determinant of child and adolescent health?

   Sleep influences brain development, memory, emotional regulation, metabolism, immunity, and mental health, from fetal life and throughout childhood and adolescence. Insufficient or poor-quality sleep increases the risk of anxiety, depression, learning disorders, obesity, and cardio-metabolic complications. (p. 3–4, 11)

2. What are the recommended sleep durations for young children?

   The Academy recommends informing families that children need 11 to 14 hours of sleep before the age of 3 and 10 to 13 hours between the ages of 3 and 6, with naps maintained according to individual needs until around the age of 6. These guidelines should be included in the health record and discussed during consultations. (p. 9–10)

3. How to identify insomnia in a child during a primary care consultation?

   The report proposes a structured annex: identifying the age, duration and frequency of the disorders, bedtimes and night awakenings, conditions for falling asleep, associated symptoms, and sleep hygiene. It encourages looking for a somatic cause, assessing the psychological and family context, and then implementing behavioural measures before considering any medication options. (p. 8, 16)

4. What links exist between neurodevelopmental disorders and sleep disorders?

   Children with ADHD, ASD, learning difficulties, or intellectual disabilities frequently experience sleep disorders (insomnia, fragmentation, circadian disorders), which exacerbate their attentional, emotional, and behavioural difficulties. Sleep appears both as an early marker and a therapeutic lever, particularly through sleep hygiene, behavioural interventions, and, in some cases, melatonin. (p. 5–6)

5. What to do in the case of an adolescent with a significant phase delay and daytime sleepiness?

   The report describes the phase delay syndrome, common in adolescence, characterised by very late sleep onset, difficulty waking up, and improvement during periods without constraints. Management relies on sleep education, regular schedules, reducing screens in the evening, physical activity, and morning light, possibly combined with CBT, low-dose melatonin, and light therapy. (p. 6–7)

6. How can schools help improve students' sleep?

   The report emphasises the importance of maintaining naptime in nursery, promoting a sleep culture in schools (sleep education programmes, teacher awareness) and limiting screens in the evening through coordinated messages. It suggests experimenting with starting classes at 9 am to reduce adolescents' sleep debt and improve their academic performance and well-being. (p. 4–5, 7, 10)

7. When should a child be referred to a paediatric sleep centre or a CRMR?

   Specialist referral is recommended in cases of suspected central hypersomnolence (narcolepsy), moderate or severe OSA, persistent sleep disorders despite first-line management, or in the presence of complex comorbidities (severe neurodevelopmental disorders, respiratory conditions, craniofacial malformations). CRMRs and specialised units offer polysomnographic evaluation, accurate diagnosis, and therapeutic education programmes. (p. 8–9, 14–15)

9. Rewriting in Easy-to-Read Language 

Title

Sleep of Children and Adolescents

Context and Issues – Easy-to-Read Version

Sleep helps children's brains grow well.

It also helps with memory, mood, and physical health.

Lack of sleep makes children irritable and tired.

They concentrate less well at school.

Screens in the evening, lack of movement, and unbalanced meals damage sleep.

Children with disabilities, ADHD, or autism have even more sleep problems.

Operational inputs – easy-to-read version

The report offers simple advice for better sleep.

Parents and professionals should ask questions about sleep at every age.

Naptime should be maintained in nursery for children who need it.

Screen time in the evening should be limited, especially after 8 p.m.

For teenagers, the Academy suggests that classes start at 9 a.m.

The report also calls for more training and specialised care facilities.

Key points – easy-to-read version

• Sleep is important from pregnancy for the health of the baby.

• Young children need a lot of hours of sleep and naps.

• Screens in the evening cause later and poorer sleep.

• Some children have sleep disorders and need to see specialists.

• The state wants to make sleep a priority, like nutrition and physical activity.