5 Sleep Foundations Every Pediatric OT Should Know

Research shows that nearly half of all children struggle with sleep, and the numbers are even higher for the populations occupational therapy practitioners serve. Childhood sleep problems are a public health epidemic occupational therapists are uniquely qualified to address. Unfortunately, this is also an area where many occupational therapy practitioners feel unprepared to effectively help. As an occupational therapy practitioner, honing your sleep expertise can transform bedtimes, accelerate goals, and restore peace for families. Here are five foundational approaches to guide your next intervention. 

Author: Devina King, Occupational Therapist and Certified Autism and ADHD Specialist. Last updated: 11/29/2025

Table of contents

• Start with a compassionate assessment

• Optimize the sleep environment and sleep hygiene

• Introduce co regulation techniques

• Address breathing and posture

• Support gradual independence

• AOTA approved pediatric sleep CEU

• A free tool to help

• Want more support

• FAQ

Start with a compassionate assessment

A thorough pediatric occupational profile with a focus on sleep is important. According to AOTA a common barrier occupational therapists encounter is that parents can have shame around sleep. This survey also found that many occupational therapist's aren't evaluating sleep, less are writing sleep goals, and a majority of therapist report the did not get enough occupational therapy sleep education. You can read AOTAs survey on how occupational therapists assess and address the occupational domain of sleep here. Many parents may not even realize their child has sleep problems and falsely screen their child out if you just ask "How's their sleep". Thus, it's important to know how to have these conversations and what questions to ask. Before suggesting bedtime tweaks, develop a holistic view of each child’s sleep:

• Combine caregiver interviews with simple tracking tools and clinic observations
• Create a safe space for families to share frustrations without judgment
• Identify patterns in overall daily and bedtime routines, environment, sensory differences, and coexisting conditions

This groundwork reveals where small shifts can unlock big changes.

Optimize the sleep environment and sleep hygiene

Most parents want to know how to make bedtime easier and how to get better sleep at night. Good sleep hygiene practices are key for good sleep. Neurodivergent children may need more than a dark room and a white-noise machine. Focus on key sensory elements:

• Calibrate light levels to match wind-down cues
• Manage noise with flexible sound options
• Balance room temperature and tactile comforts

A few strategic tweaks and sleep hygiene techniques help anchor circadian rhythms and reduce nighttime restlessness. For sleep hygiene interventions to work they must be practical, meaningful, and adapted to the individual's sensory profiles. For example,  I used to listen to Metallica to help me sleep. Instrumental metal songs played quietly may help some kids with ADHD sleep while others may need complete silence. 

Introduce co-regulation techniques

Parents and caregivers are your greatest allies in sleep support. Teach them to:

• Use gentle, attuned presence at bedtime transitions
• Layer calming signals—voice, touch, visuals—to ease into sleep
• Reinforce small wins to boost family confidence
• Provide daytime and bedtime sensory diets

These co-regulation skills build trust and smooth the path to independence.

Address breathing and posture

Evidence supports that common interventions in the scope of occupational therapy can be incredibly important for those with sleep apnea (even while waiting for sleep studies). Subtle airway or posture issues can fragment sleep without obvious signs. In your sessions, you can:

• Screen for oral motor or core stability concerns
• Offer simple exercises that encourage better nighttime breathing
• Integrate playful activities that double as clinic-to-home tools

A targeted focus here often translates to fewer night wakings.

Support gradual independence

Moving a child into their own bed requires both structure and flexibility. Consider:

• Short, coached intervals in the child’s sleep space
• Consistent yet adaptable bedtime cues
• Positive reinforcement that honors neurodivergent needs

A clear roadmap lets families celebrate progress at every step.

AOTA approved pediatric sleep CEU

To dive deeper into evidence-based assessments, pediatric sleep questionnaires, sensory-smart routines, adapted CBT-I strategies, and respiratory and core strengthening exercises, and more explore the full occupational therapy sleep CEU Supporting Pediatric Sleep for Behavioral Regulation.

Led by an expert, neurodivergent instructor. In just two hours, you’ll earn 0.2 AOTA CEUs and gain 16 downloadable resources designed for children 0-18 with various conditions. Equip yourself with the complete toolkit to transform sleepless nights into restful ones for your clients and their families.

If you’re an occupational therapist supporting neurodivergent children who struggle with state transitions to sleep check out my AOTA approved sleep CEU.

You can learn how to use technology to help with state transitions (between wakefulness and sleep and sleep and wakefulness) here how to help sensory seekers transition to being ready to rest here and more strategies to help prevent or respond to bedtime meltdowns here.

A free tool to help

To make this easier, I created a Bedtime Support Plan For Sensory Seeking Children. It’s a printable guide that helps you choose activities that match your child’s current state and gently support them toward rest.

It’s flexible, regulation-first, and emotionally literate. You can use it to build a bedtime routine that actually works for your child’s body and brain.

Download the Bedtime Support Plan For Sensory Seeking Children.

Want more support?

If you’re ready to go deeper, I’ve created a low-cost digital companion called the Regulation-First Bedtime Toolkit.

The Regulation-First Bedtime Toolkit helps caregivers calm chaos, connect with their child, and build a sensory-smart nighttime routine that actually works. Developed by a pediatric occupational therapist with real-world experience. It’s only $9 and includes:

Get the Toolkit here.

You’re not doing bedtime wrong. You’re navigating a nervous system that needs support, not shame. And you’re doing it with love, even when it’s hard.

FAQ

Why is sleep such an important focus for pediatric occupational therapists?

Nearly half of all children struggle with sleep, and the numbers are even higher for neurodivergent populations. Sleep impacts regulation, learning, and family well being, making it a critical domain for occupational therapy practice.

What does a compassionate assessment involve?

It means creating a safe space for families to share frustrations without judgment, combining caregiver interviews with tracking tools, and identifying patterns in routines, environment, sensory differences, and coexisting conditions. This holistic view helps uncover hidden sleep challenges.

How can the sleep environment be optimized?

Adjust light levels to match wind down cues, manage noise with flexible sound options, and balance temperature and tactile comforts. Sleep hygiene must be practical and adapted to each child’s sensory profile.

What role does co regulation play in bedtime?

Parents and caregivers provide calming signals through voice, touch, and visuals. Gentle presence, layered cues, and sensory diets build trust and help children transition more smoothly into sleep.

Why should occupational therapists address breathing and posture?

Subtle airway or posture issues can fragment sleep. Screening for oral motor or core stability concerns and offering playful exercises that support better breathing can reduce night wakings and improve sleep quality.

How can gradual independence be supported?

Use short coached intervals in the child’s sleep space, consistent bedtime cues, and flexible routines. Progress should be celebrated step by step, honoring neurodivergent needs.

How can occupational therapists support children with sleep apnea?

Occupational therapists can screen for subtle airway and posture issues that may fragment sleep. They address oral motor skills, breathing patterns, and core stability through playful, functional activities. These interventions complement medical care and help children regulate better during the day and night.

What role does posture play in sleep apnea management?

Poor posture can contribute to airway collapse during sleep. OTs assess alignment and core strength, then provide exercises that improve breathing mechanics. Activities such as yoga poses, animal walks, or stability ball play strengthen muscles needed for better nighttime breathing.

Can occupational therapy help while families wait for a sleep study?

Yes. While medical evaluation is essential, OTs can provide immediate support by teaching breathing exercises, adjusting sleep environments, and coaching families on regulation strategies. These steps often reduce night wakings and improve sleep quality while awaiting formal diagnosis.

How do sensory interventions connect to sleep apnea?

Children with sleep apnea may also have sensory sensitivities that worsen bedtime struggles. OTs adapt sleep hygiene practices to each child’s sensory profile—adjusting light, sound, and tactile input—so the nervous system is calmer and breathing is more efficient.

What caregiver strategies can OTs teach for sleep apnea?

OTs guide caregivers in co regulation techniques such as gentle touch, rhythmic breathing cues, and consistent bedtime routines. They also provide education on positioning, pillow use, and monitoring signs of disrupted breathing. This empowers families to support children safely at home.

How does occupational therapy complement medical treatment for sleep apnea?

OTs do not replace medical care but enhance it. They collaborate with physicians, sleep specialists, and families to integrate behavioral regulation, sensory supports, posture training, and respiratory control. This holistic approach improves adherence to medical recommendations and overall sleep outcomes.

What evidence based interventions can OTs use for sleep apnea?

Occupational therapists can implement respiratory control strategies such as diaphragmatic breathing, paced breathing, and oral motor strengthening. They also use evidence based interventions like core stability programs, sensory diets for regulation, and adapted CBT‑I strategies. These approaches are grounded in research and tailored to each child’s developmental and sensory profile.

About Devina King, B.A. Psy, MSOTR/L, ASDCS, ADHD-RSP

Devina is an autistic occupational therapist, parenting coach, author, and credentialed autism and ADHD specialist with over 17 years of experience working with children, specializing in behavioral regulation and neurodivergence. As both a clinician and a parent, she combines professional expertise with personal experience parenting neurodivergent children who previously struggled with behavioral disorders. This unique perspective allows her to bridge the gap between science and real-world application, offering compassionate, evidence-based behavior treatment strategies that empower children to thrive.

You can learn more about Devina's credentials, lived experience, and approach here. 

Publications

Devina has written many books. Her book From Surviving to Thriving: The Art and Science of Guiding Children to Develop Behavioral Regulation available on Amazon here, provides actionable insights for parents, educators, and professionals looking to support children in building essential self-regulation skills. Devina is an AOTA approved professional development provider. Reviewers praise her works for her comprehensive, refreshing and practical, compassionate approach that takes complex psychological concepts and evidence based approach and breaks it down into concepts anyone can understand and apply. Devina has been included in publications such as this article in Psychologist Brief available here and this article in Doctors Magazine available here. Stop by her store here to explore her latest resources, workshops, CEUs and parent coaching sessions designed to help children succeed in their behavioral development journey!