Clinical
Corner Ð Sleeping Problems with Children
Sleep problems are very common among children during the first few years
of life. Problems may include a reluctance to go to sleep, waking up in the
middle of the night, nightmares, and sleepwalking. In older children,
bed-wetting can also become a challenge.
Children vary in the amount of sleep they need and the amount of time it
takes to fall asleep. How easily they wake up and how quickly they can resettle
are also different for each child. It is important, however, that as a parent
you help your child develop good sleep habits at an early age. The good news is
that most sleep problems can be solved.
Newborn infants have irregular sleep cycles which take about 6 months to
mature. While newborns sleep an average of 16 to 17 hours per day, they may
only sleep 1 or 2 hours at a time. As children get older, the total number of
hours they need for sleep decreases. However, different children have different
needs. It is normal for even a 6 month old to wake up briefly during the night,
but these awakenings should only last a few minutes and children should be able
to go back to sleep easily on their own. Here are some suggestions that may
help your baby (and you) sleep better at night:
1. Try to keep him/her as calm and quiet as possible. When feeding or
changing your baby during the night, avoid stimulating him/her too much.
2. Don't let your infant sleep as long during the day.
3. Put your baby into the crib at the first signs of drowsiness. Ideally it is best to
let the baby learn to relax herself to sleep. If you make a habit of holding or
rocking him/her until they fall asleep, h/she may learn to need you to get back
to sleep when h/she wakes up in the middle of the night.
4. Avoid putting your baby to bed with a pacifier. Your baby may get
used to falling asleep with it and have trouble learning to fall asleep without
it. Pacifiers should be used to satisfy the baby's need to suck, not help a
baby sleep.
5. Begin to delay your reaction to infant fussing at 4 to 6 months of
age. Wait
a few minutes before you go in to check a crying baby. They will probably
settle themselves and fall back to sleep in a few minutes anyway. If baby
continues to cry, check on him/her, but avoid turning on the light, playing,
picking up, or rocking them. If crying continues or begins to sound frantic,
wait a few more minutes and then recheck the baby. Once your baby realizes that
you are not going to run in and comfort them, they will begin to fuss less and
simply return to sleep. This is an important time for new parents to support
each other in learning to be patient.
Many parents find their toddler's bedtime one of the hardest parts of
the day. It is common for children this age to resist going to sleep,
especially if there are older siblings who are still awake. Remember toddlers
and preschoolers usually need 10 to 12 hours of sleep each night.
Following are some tips to help your toddler develop good sleep habits:
1. Make sure there is a quiet period before your child goes to bed. Establishing a
pleasant routine that may include reading, singing, or a warm bath. A regular
routine will help your child understand that it will soon be time to go to
sleep. If parents work late hours, it may be tempting to play with their child
before bedtime. However, active play just before bedtime may leave the child
excited and unable to sleep. Limit television viewing and video game play
before bed.
2. Try to set a consistent schedule for your child and
make bedtime the same time every night. The consistency is important.
3. Allow your child to take a favorite teddy bear, toy, or special
blanket to bed each night.Such comforting objects often help
children fall asleepÐespecially if they awaken during the middle of the night.
4. Avoid letting your child sleep with you. This will only make
it harder for them to learn to settle down and fall asleep when they are alone.
5. Try not to return to your child's room every time he/she complains or
calls out. A child will quickly learn to take advantage of your
"caring" if you always give in to their requests at bedtime. When
your child calls out, try the following:
For a young child, many things can interrupt a good night's sleep. As a
parent, you may be able to prevent some of them.
Nightmares are scary dreams that usually happen during the second half
of the night, when dreaming is most intense. This may occur more than once a
night. After the nightmare is over, your child may wake up and can tell you
what occurred. Children may be crying or fearful after a nightmare but will be
aware of your presence. They may have trouble falling back to sleep because
they can remember the details of the dream.
Night terrors are more severe or frightening than nightmares, but not as
common. They occur most often in toddlers and preschoolers. Night terrors occur
during the deepest stages of sleep, usually within an hour or so after a child
falls asleep. During a night terror, children usually cannot be awakened or
comforted. Night terrors may also cause the following:
Night terrors may last for as long as 45 minutes, but are usually much
shorter. Children seem to fall right back to sleep after a night terror, but
they actually have not been awake. Like nightmares, night terrors may occur
more often in times of stress or may relate to difficult feelings or fears.
However, unlike a nightmare, a child does not remember a night terror.
Keep in mind that night terrors do not always indicate serious problems.
Your child will be more likely to have night terrors when they are overly tired
and during periods of stress. Try to keep your child on a regular sleep
schedule or increase the amount of sleep to prevent night terrors. Night
terrors usually disappear by the time a child reaches grade school.
Like night terrors, sleepwalking and sleep talking happen when a child
is in a deep sleep. While sleepwalking, your child may have a blank, staring
face. They may not respond to others and be very difficult to awaken. When your
child does wake up, they will probably not remember the episode. Sleepwalking
children will often return to bed by themselves and will not even remember that
they have gotten out of bed. Sleepwalking can be common, and tends to run in
families. It can even occur several times in one night among older children and
teenagers.
Sleepwalking and sleep talking are more likely to occur when your child
is overly tired or under stress. Keeping your child's sleep schedule regular
may help prevent sleepwalking and sleep talking.
Nighttime bed-wetting is normal and very common among preschoolers. It
affects about 40% of 3 year olds and may run in families. The most common
reasons your child may wet the bed include the following:
Most importantly, don't pressure your child. Bed-wetting is usually
beyond a child's control and they may only become sad or frustrated if they
cannot stop. Set a "no-teasing" rule in the family. Make sure your
child understands that bed-wetting will get better in time.
It is also common for children to grind their teeth during the night.
Though it produces an unpleasant sound, it is usually not harmful to your young
child's teeth. It may be related to tension and anxiety and usually disappears
in a short while.
Handling your child's sleep problems may be a challenge and it is normal
to become upset at times when a child keeps you awake at night. Try to be
understanding. A negative response by a parent can sometimes make a sleep
problem worse, especially if it is associated with a stressful situation like
divorce, a new sibling, a tragedy in the family, problems at school, or some
other recent change in your child's life.
If the problem persists, there may be a physical or emotional reason
that your child cannot sleep. Keep in mind that most sleep problems are very
common, and with time and your help, your child and you will overcome them.