The following blog is based on a paper I presented at the International Child Trauma Conference in August 2025. 

I have always believed that the way a child sleeps tells us something profound about how safe they feel in the world. For children in out-of-home care (OOHC), those who have been removed from their families due to abuse, neglect, or chronic instability, night-time is often not a place of peace. It’s a battlefield. A place where memories echo, bodies tense, and the nervous system refuses to rest. 

Sleep is not simply a biological function; it is an act of trust. To sleep well, a child must feel safe enough to let go of control. Yet for children whose earliest experiences were filled with danger or unpredictability, letting go can feel like the most unsafe thing of all. 

Research paints a stark picture. Up to 90% of trauma-exposed children experience sleep impairment in the aftermath of traumatic events (Hambrick & Perry, 2009). These disruptions are not just occasional bad nights. They often become chronic patterns, difficulty falling asleep, nightmares, night terrors, and constant hypervigilance. And while professionals in OOHC systems often focus on behaviour management or educational outcomes, the humble act of sleep remains one of the most overlooked and yet essential ingredients in a child’s recovery (McLean, 2016). 

The brain that cannot switch off

Sleep plays a central role in emotional processing and brain development. It is during sleep that the brain consolidates memories, regulates stress hormones, and prunes neural connections. But for children whose bodies are wired for survival, the brain struggles to switch from fight-or-flight to rest-and-repair.

When trauma occurs early and repeatedly, especially within attachment relationships, the hypothalamic–pituitary–adrenal (HPA) axis, the brain’s stress-regulation system, becomes dysregulated (Gunnar & Quevedo, 2007). The result? A body that is perpetually on alert, flooded with stress hormones that make relaxation nearly impossible. The amygdala, the brain’s alarm system, becomes overactive, while the hippocampus, responsible for contextualising memories, becomes impaired (Teicher & Samson, 2016). 

In this state, bedtime can feel like danger time. The stillness, the dark, the absence of movement, each can trigger memories of past fear. Children might fight sleep not out of defiance, but out of instinct. Their bodies are whispering: Stay awake, it’s not safe yet. 

Sleep becomes fragmented, shallow, and filled with distressing dreams. And because deep sleep is when emotional memories are integrated and neural connections are strengthened, the lack of it keeps trauma memories raw and unprocessed. It becomes a vicious cycle, trauma disrupts sleep, and disrupted sleep prevents recovery. 

The out-of-home care context: When night feels unsafe

Children in OOHC, whether in foster, kinship, or residential care, experience sleep problems at much higher rates than their peers (Dozier et al., 2006; Meltzer et al., 2012). Their nights are often characterised by restlessness, resistance to bedtime, or fear of sleeping alone. 

Placement instability only compounds the problem. Each new bed, each new carer, each new set of rules can reignite the nervous system’s alarm. Predictability, which is key to healthy circadian rhythms, is often disrupted. And in the absence of a consistent, emotionally attuned caregiver, the night can feel like an echo of every past separation. 

These sleep difficulties are not trivial. They are linked to attention deficits, aggression, anxiety, and poor school performance (Becker et al., 2018). But all too often, the behaviours we see during the day, irritability, defiance, inattention, are interpreted as “acting out” rather than as the exhaustion and dysregulation that flow from broken nights (McLean, 2015). 

When a traumatised child cannot sleep, it is not because they won’t. It’s because they can’t. 

The role of attachment and co-regulation 

In healthy development, bedtime is not just a routine, it’s a relationship. Through gentle, predictable caregiving, stories, songs, soothing tones, children learn to downshift from wakefulness to rest. This process of co-regulation builds the foundation for self-regulation later in life (Schore, 2001). 

For children with disrupted attachment histories, bedtime can trigger feelings of abandonment or fear. Being left alone in the dark may echo early experiences of neglect or threat. A child’s resistance to bedtime, then, is not simply defiance, it’s the nervous system saying, I don’t feel safe enough to fall asleep. 

This is where carers play an extraordinary role. The caregiver’s own regulation, patience, and predictability become the external scaffolding for the child’s fragile nervous system. When carers understand that a child’s refusal to sleep is a survival response rather than misbehaviour, their response shifts from control to compassion. 

McLean and colleagues (2019) developed the 4C model of healthy sleep: Calm, Connection, Consistency, and Comfort to guide carers in creating emotionally attuned routines. But this approach only works if carers themselves are supported. Chronic sleep disruption affects them too, often leading to burnout or secondary trauma. Supporting carers’ wellbeing, therefore, is not peripheral, it is part of the intervention. 

Listening to the night: Assessment as empathy 

Despite how central sleep is to development and recovery, it often remains invisible in assessment frameworks. A trauma-informed assessment of sleep requires more than a checklist, it requires curiosity. 

Instead of merely asking “What time does the child go to bed?”, practitioners should ask: 

What happens in their body when the lights go out? 

What fears or memories are triggered by the dark or by being alone? 

What helps them feel safe? 

Quantitative tools like the Children’s Sleep Habits Questionnaire are useful, but qualitative exploration provides the emotional context that transforms data into understanding. In some cases, sleep diaries, caregiver narratives, and even wearable sleep trackers (actigraphy) can help map the patterns. But the most important insight often comes from simply listening, to the child’s story of night-time. 

When we approach sleep assessment this way, we are no longer managing behaviour. We are witnessing survival strategies. 

Restoring rest: A healing-centred approach 

Effective intervention must address sleep as a multi-layered phenomenon—biological, emotional, relational, and environmental. A healing-centred approach includes: 

Predictable routines: Familiar bedtime patterns, soft lighting, and sensory cues that signal safety. 

Trauma-focused therapy: Approaches such as narrative therapy or trauma-informed CBT for insomnia help children reframe bedtime as safe. 

Sensory regulation: Weighted blankets, rhythmic movement, and soothing soundscapes can help children with sensory sensitivities or neurodiverse profiles regulate before sleep. 

Systemic stability: A child cannot rest if they are unsure where they will wake up or who will be there. Consistency in placements and carers is fundamental to rebuilding trust. 

Trauma-informed care means recognising that safety is not created by telling a child “You’re safe now,” but by showing them, night after night, that they truly are. 

Policy and practice: Sleep as a measure of healing 

If sleep is such a profound indicator of safety and recovery, it must be embedded at every level of policy and practice. Every placement assessment should include a sleep history, not just about routines, but about fears, night-time triggers, and previous coping rituals. 

Carers and staff must receive ongoing training in understanding the sleep–trauma connection, and reflective supervision to process the emotional toll of supporting children through difficult nights. 

Policymakers should recognise that sleep outcomes are not “soft” indicators. They are measurable reflections of a child’s wellbeing and relational security. Funding must support evidence-based sleep interventions and trauma-informed training for carers. When systems treat sleep as a core developmental need rather than an afterthought, they signal to children that their comfort, peace, and rest truly matter. 

The profound message of a sleeping child 

When a child finally sleeps peacefully in care, it is more than rest, it is a revelation. It means that, in that moment, their body has decided the world is safe enough to let go. Their nervous system, long trained for survival, has found a brief home in calm. 

Sleep, then, is not a small issue. It is the ultimate barometer of felt safety, trust, and healing. To prioritise sleep is to tell the child: You deserve peace. You deserve comfort. You deserve to dream again. 

In this light, tending to a child’s sleep is an act of profound care, a radical shift from behaviour management to relational repair. When we help a child rest, we are not just soothing the night. We are rebuilding their faith in the world and perhaps, one night, as they drift into deep, untroubled sleep, we can know that healing is quietly underway. 

As you move through your day, pause and consider the children in your care: How do they sleep? What does their night-time tell you about their sense of safety, trust, and belonging? Even small shifts, a predictable routine, a listening ear, a steady presence, can transform night-time from a place of fear into a space for healing. In attending to their sleep, we are not just helping them rest; we are helping them reclaim their right to feel safe in the world. 

References 

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