Why the run of the mill sleep advice isn't working for your child

If you've tried the routine, the earlier bedtime, the sleep training method a friend swore by, and the sticker chart, and your child is still waking overnight or fighting sleep at 5, 6 or 7 years old, it's worth asking a different question. Not "what technique haven't we tried yet" but "what's actually driving this."

As an Occupational therapist experienced in paediatric and infant sleep quality, I see this pattern often. A family arrives having tried nearly everything, and the thing that's usually missing isn't effort or consistency. It's that nobody has looked underneath the sleep problem to what's maintaining it.

Short term fixes and long term problems are different things

Most sleep advice is built for short term, situational sleep disruption. A new sibling, a house move, teething, an illness. For these, a bit of structure and consistency genuinely helps, and there's good evidence behind that. 

However, research and my extensive clinical experience points to a range of predisposing factors that can quietly sit underneath long-standing sleep difficulty, in ways a bedtime routine alone won't touch. When a sleep problem has been going on for months or years rather than weeks, it's often because something at the root hasn't been identified or addressed yet, not because the family hasn't been consistent enough.

Why root causes matter more the longer sleep has been hard

There's a reasonable body of research suggesting sleep problems in children are frequently layered. What starts as one contributing factor can, over time, create secondary habits and associations that make the original issue harder to see. A large narrative review of paediatric sleep disorders describes several predisposing factors that increase the risk of sleep difficulty becoming chronic, and notes that once a sleep problem is established, treating only the surface behaviour without addressing what's underneath it tends to have limited or short-lived results.

This is also why sleep training methods that work well for one family can fail completely for another at any age, even when applied exactly as instructed. If the method targets a behaviour without addressing the root cause behind it, the nervous system or body has no reason to stop pushing back. I see this often in my work combining occupational therapy, infant reflux support and orofacial myofunctional therapy. A sleep issue that looks purely behavioural on the surface sometimes has a physical, sensory or developmental thread running underneath it that a generic routine was never going to resolve.

A dysregulated or disrupted sleep pattern is the nervous system and body doing exactly what they're built to do under the circumstances they're in. The work is in understanding those circumstances properly, not pushing harder on the same surface-level strategy.

Why this shows up so clearly in childhood

Research estimates that a notable proportion of preschool and school-aged children experience regular difficulties falling or staying asleep, and unlike infancy, where some disruption is expected and often resolves on its own, sleep difficulty that persists into these years is more likely to be tied to something ongoing rather than a developmental stage the child will simply grow out of.

Research also links persistent childhood sleep problems to broader impacts on emotional regulation, behaviour and daytime functioning, which is often what brings a family to seek support in the first place, not just the sleep itself, but everything that's become harder around it. 

What looking at root causes actually looks like

In practice, this isn't about a single missing technique. It's a process of looking at the whole picture, the child's temperament, their sensory experience of their body and environment, their nervous system state, any physical or developmental factors, and the family's own capacity and patterns, rather than applying a generic method and hoping it holds.

Many parents notice that once they understand what's actually maintaining their child's sleep difficulty, the day to day approach starts to make more sense, even before anything changes overnight. That shift in understanding is often the real turning point, more than any single strategy.

Where to go from here

If this is resonating and you suspect there's more going on for your child than a routine can fix, this is exactly the kind of work we go through inside The Sleep Membership and my 1:1 consultations. Rather than another one-size-fits-all method, it's built around understanding what's actually driving your child's sleep, sensory profile, temperament, nervous system regulation and more, so the approach you take is shaped around your child rather than a generic script.

Sources referenced: Cohen, J. F. W., et al. (2024). Sleep-related disorders in children: a narrative review. Pediatric Discovery. UpToDate. Behavioral sleep problems in children. Turnbull, K., et al. Behavioral sleep problems and their potential impact on developing executive function in children. PMC.