Clinical Corner - 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.
Toddlers and preschoolers
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 asleep–especially 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:
Common sleep problems
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.
How to handle nightmares:
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.
How to handle night terrors:
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.
Sleepwalking and sleep talking
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.
How to handle sleepwalking and sleep talking:
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.
Bed-wetting (also called enuresis)
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:
How to handle bed-wetting:
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.
Give it Time
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.