Restless Sleep in Children: Why Your Child Tosses and Turns

You check on your child at midnight and find them sideways in bed, blankets on the floor, one leg hanging off. By morning they've somehow rotated 180 degrees. Is all this movement normal, or is something wrong?

Some restlessness during sleep is completely normal for children. But excessive movement, kicking, or inability to settle can sometimes indicate sleep problems that need attention. Understanding the difference helps you know when to investigate further. AAP

Normal vs. Concerning Restlessness

Normal restlessness:

• Some movement between sleep cycles
• Occasional position changes
• Brief arousals that don't fully wake them
• More movement in light sleep stages
• Settles down in deep sleep

Potentially concerning:

• Constant movement throughout the night
• Can't seem to get comfortable
• Kicks legs repeatedly
• Appears uncomfortable or in distress
• Still tired despite adequate sleep time
• Other symptoms present (snoring, leg discomfort)

Common Causes of Restless Sleep

Environmental factors: NSF

*Temperature:*

• Too warm is the most common culprit
• Children sleep better in cool rooms (65-70°F)
• Being overheated causes restlessness
• Light pajamas and breathable bedding help

*Comfort issues:*

• Uncomfortable mattress or pillow
• Scratchy pajamas or sheets
• Allergies to bedding materials
• Growing out of the bed

*Light and noise:*

• Light disturbs sleep and causes partial awakenings
• Variable sounds can trigger movement
• Even subconscious awareness of disturbances

Behavioral factors:

*Overtiredness:*

• Paradoxically causes worse sleep
• More difficulty staying in deep sleep
• More frequent partial awakenings
• More movement and restlessness

*Irregular schedule:*

• Body clock confusion
• More difficulty settling into deep sleep
• Inconsistent sleep quality

*Screen time before bed:*

• Stimulated brain has trouble settling
• Delayed sleep onset
• Lower sleep quality

Medical causes: AAP

*Restless Legs Syndrome (RLS):*

• Uncomfortable sensations in legs
• Urge to move legs
• Worse at rest and at night
• Often described as "creepy crawly"
• May be called "growing pains"

*Periodic Limb Movement Disorder (PLMD):*

• Repetitive leg movements during sleep
• Jerking every 20-40 seconds
• Child may not be aware
• Disrupts sleep quality

*Sleep apnea:*

• Breathing difficulties cause arousals
• Body movements to open airway
• Restless sleep is a common symptom
• Usually accompanied by snoring

*Pain or discomfort:*

• Ear infections
• Growing pains (actual)
• Headaches
• Digestive issues
• Allergies/congestion

*Anxiety:*

• Mind can't settle
• Hypervigilance even in sleep
• More reactive to disturbances

Restless Legs Syndrome in Children

RLS is often overlooked in children because they can't always describe it accurately. NSF

What children might say:

• "My legs feel funny"
• "I can't get comfortable"
• "My legs want to move"
• "It feels like bugs crawling"
• "My legs hurt" (often diagnosed as growing pains)

What you might observe:

• Can't sit still at bedtime
• Constantly moving legs in bed
• Gets up frequently
• Rubs or massages legs
• Difficulty falling asleep

Risk factors:

• Family history (highly genetic)
• Low iron levels
• ADHD (high co-occurrence)

When to suspect RLS:

• Symptoms are worse at rest
• Symptoms are worse in evening/night
• Movement provides temporary relief
• No other explanation for symptoms

Periodic Limb Movement Disorder

PLMD involves repetitive movements during sleep: AAP

Characteristics:

• Rhythmic jerking or twitching
• Usually legs (sometimes arms)
• Occurs every 20-40 seconds
• Happens during sleep (not falling asleep)
• Child often unaware

How it differs from RLS:

• RLS: awake sensations prompting movement
• PLMD: movements during actual sleep
• Often occur together

Impact:

• Disrupts sleep quality
• Child may not realize
• Results in fatigue despite adequate sleep time

When to See a Doctor

Contact your pediatrician if: AAP

The restlessness is:

• Significantly disrupting sleep
• Accompanied by snoring or breathing issues
• Paired with leg discomfort complaints
• Causing excessive daytime sleepiness
• Getting worse over time

Your child:

• Can't fall asleep due to leg discomfort
• Seems tired despite sleeping enough hours
• Has behavior or attention problems
• Has family history of RLS
• Shows signs of iron deficiency

What You Can Try at Home

Optimize the environment:

• Cool room (65-70°F)
• Comfortable, breathable bedding
• Darkness (blackout curtains)
• White noise for consistent sound
• Remove allergens

Address schedule and habits:

• Consistent bedtime and wake time
• Adequate total sleep opportunity
• Not overtired at bedtime
• Screen-free wind-down period
• Physical activity during the day (not before bed)

For suspected RLS: NSF

• Massage legs before bed
• Warm bath
• Stretching routine
• Ensure adequate iron intake (with doctor guidance)
• Limit caffeine entirely
• Regular exercise

Track patterns:

• Keep a sleep log
• Note what makes it better or worse
• Record associated symptoms
• Share with doctor

Treatment If Needed

For RLS:

• Iron supplementation (if levels low—requires blood test)
• Sleep hygiene optimization
• Leg massage and stretching
• Medication in severe cases

For PLMD:

• Treating underlying causes
• Iron supplementation if appropriate
• Medication rarely needed in children

For sleep apnea:

• Treatment of underlying cause (usually tonsils/adenoids)
• Reduces restlessness as a secondary benefit

What Other Parents Ask

Q: My child moves constantly in sleep but seems well-rested. Is this a problem?
A: Probably not. If your child is getting adequate sleep, wakes rested, and functions well during the day, some nighttime movement is likely normal. Only investigate if symptoms suggest otherwise.

Q: Could my child's restless sleep be causing their behavior problems?
A: Possibly. Poor sleep quality—even with adequate sleep quantity—can cause behavior and attention problems. If your child is restless AND has daytime issues, evaluation is worthwhile. AAP

Q: Is restless sleep related to ADHD?
A: There's significant overlap. Children with ADHD often have sleep difficulties including restlessness. RLS is also more common in children with ADHD. Sleep problems can also cause ADHD-like symptoms. NSF

Q: Should I wake my child when they're thrashing around?
A: Usually no. Unless they're in danger or having a night terror, let them cycle through. Waking them disrupts sleep further. Make sure the environment is safe.

The Bottom Line

Some restlessness during sleep is normal for children. However, persistent excessive movement—especially with leg discomfort, snoring, or daytime symptoms—may indicate a sleep disorder that needs evaluation. Environmental optimization and good sleep habits help many children sleep more peacefully.

Key points:

• Some nighttime movement is normal
• Excessive restlessness may have underlying causes
• Environmental factors (temperature, comfort) are common culprits
• RLS and PLMD are real and underdiagnosed in children
• Snoring + restlessness suggests sleep apnea
• Track patterns and symptoms
• See a doctor if home measures don't help

Clara is here to help you understand your child's restless sleep.