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. 

1. 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.

2. Optimize the Sleep Environment

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. 

3. 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.

4. 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.

5. 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.

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.

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

Devina is an autistic occupational therapist 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 strategies that empower children to thrive.You can learn more about Devina's credentials, lived experience, and approach here. 

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. Reviewers praise it 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. Available in eBook, paperbook, and audiobook versions so you can learn the way that works for you!

Devina is an AOTA approved professional development provider and also shares her knowledge through expert-led webinars, where she delivers practical guidance tailored to the needs of caregivers and professionals. Stop by her store here to explore her latest resources, workshops, CEUs and training sessions designed to help children succeed in their behavioral development journey!