BACKGROUND: The aim of the study was to investigate the frequency and predictors of sleep problems and the need for parental night-time attention in children with physical disabilities. METHODS: A questionnaire on sleep problems and need for parental night-time attention was completed by 505 parents of children with physical disabilities aged 1-16 years (mean 9 years 3 months) with moderate to severe motor disabilities. General characteristics of the children were analysed by frequencies and cross-tabulations. Logistic regression analysis was used to identify factors associated with sleep problems and the need for parental night-time attention. RESULTS: The results showed a high prevalence of sleep problems, which in general were chronic. Currently 48% of the children had sleep problems, of which 23% estimated the problems to be serious. About one-third (37%) needed parental night-time attention every night, and 10% needed help five times or more. No significant differences were found between younger children and school-aged children regarding sleep problems and the need for parental night-time attention. Having pain [odds ratio (OR) = 3.4] was associated with sleep problems, as was having problems eating and drinking (OR = 3) and the diagnosis of cerebral palsy (OR = 2.5) (P < 0.05). Children with muscular dystrophy (OR = 68.5), cerebral palsy (OR = 26.7) and 'other diagnosis' (OR = 18.5) were more likely to need support at night than were children with spina bifida, P < 0.001. Pain (OR = 7.6) was also associated with need for support at night, P < 0.001. CONCLUSIONS: The prevalence of sleep problems and need for parental night-time attention is high among children with physical disabilities. This in turn affects the whole family, and paediatric caregivers must keep this in mind. Besides certain diagnoses, the results suggest that children who have pain should be prioritized.