Special Topics in Development:
Sleep Issues

 

 

Getting kids to sleep definitely makes the top 5 list of parental concerns.  Often it ranks in at #1 simply because it can become the issue that totally topples a household.  Exhausted parents square off against exhausted children -- film at 11:00.

It's obvious that helping children develop good sleep patterns, early on, helps everyone in the family have better days together.  Children are generally better behaved and more cooperative when well rested.  Parents generally sleep better when their children sleep soundly.  Well rested parents are more patient, more fun, and better at working family challenges through in a positive manner.  And there is less tension in the household when bedtime proceeds in a smooth and predictable fashion. 

But just as important, as your children grow, getting a good night’s sleep will help them do better at school.   For example according to a study published in the May 2000 issue of Developmental Psychology, a journal published by APA (American Psychological Association), chronic sleep deprivation in 6th graders may cause “adverse cognitive, behavioral and emotional consequences”.  In other words, it’s harder to learn when you’re half asleep, and harder to handle the increasing complex social situations and conflicts that come with middle school.  But how can we help kids lay the foundation of good sleep patterns now?

 

 Be Kind Unwind

One of the biggest problems kids can develop at the end of the day is how to unwind.   Children can become emotionally over-stimulated (from a big day, too much sugar, being over-tired, highly emotionally charged events, etc.) and then it is hard for them to fall asleep.   It almost seems like they sense that in order to go from that over energized, slightly manic state to the restful state the precedes sleep  they will have to pass through that really uncomfortable state of being back in touch with their over-tired and uncomfortable part of themselves.  Physical discomfort, anxiety, etc. are all things they may be trying to avoid through continuing to choose more stimulating activities. 

So we may need to help them learn how to unwind and self-calm.  Warm bath, massage, cuddling, nursing/feeding, lullabies – all work especially well for infants.   In addition some people like to try playing tapes or CDs of nature sounds, heart beat, ocean sounds, etc.  And many of these techniques will still appeal to preschool aged children, along with story time, having a special stuffed animal to cuddle, etc.   (Note that warm milk at bedtime must be followed by brushing teeth!)

As children grow it’s important to remember that they must have down time during the day, so that they can process their day through role play, art, and imaginative play.  They may also want quiet time to talk with you about their day.  Telling you about their day builds connections (if you try to really listen) and helps them process both exciting and troubling events.  (Try to use “reflective listening” skills rather than give too much advice.)  However don’t make a habit of waiting until bedtime to talk about the day’s troubles!  It’s not a great time for us to bring things up, as children are tired and vulnerable, and their minds open to suggestion.  And bedtime will go quicker if we make space for this earlier in the day.  However, if something is really troubling your child at bedtime, it may be quicker to take 5 or 10  minutes to be a good listener, than to brush them off and spend the whole evening fighting a kid who keeps getting out of bed and etc.

 

Further Ways to Help Get Them to Bed:  

  • Keep to a consistent schedule.  This helps a child develop a sense that "this is how things are", that the bedtime routine is just part of life -- rather than something you are arbitrarily imposing.  This helps to avoid power struggles.  Plus, with a regular schedule their bodies will begin to release melatonin at a predictable time each night, helping them feel sleepy and relaxed.  This puts biology on your side.

  • Don't give in to the temptation to let your child stay up late "until they seem sleepy"  Most young children become more energized as they move into that overtired and overwhelmed state.  The more exhausted they are, the more they will fight sleep.  And the more likely they will be plagued by anxieties, either at bed time or during the night. 

  • Have a routine that follows a predictable order  – for example:  pajamas, tooth brushing, story, lights out.  This helps kids know what to expect.

  • Let your child know ahead of time before changing activity.   “It’s getting close to bed time.  15 more minutes (of current activity or etc).”   “Okay, 5 more minutes until bed.   Time to finish up.”  This is a help to all young children, who invariably have difficulty with transitions.  But it helps reduced frustrations and tensions in older children as well.  Plus, it conveys and invites more mutual respect.

  • For young children, break jobs into small steps.  Rather than “Go get ready for bed,” try “Okay, let’s put some toothpaste on your toothbrush.”  Etc.

  •  Make the bedtime routine an enjoyable part of the day – a toothbrush they helped pick out at the store, pajamas that are comfortable and pleasing, a favorite blankie and cuddlies, plus cuddly one-on-one time together with you for stories and/or lullabies. 

  • Put a positive spin on it.  Rather than “It’s time to go to bed now,” try “All right, it time to get pajamas on and get ready for story time!  Which stories are we going to read tonight?”  Let this be your special time together.  Give yourself, as parent, permission to relax and unwind.

  • Keep a special basket of library books on hand.  Tired of reading the same old stories over and over at bedtime?  Make it more fun for yourself by helping your child select some quality library books that you too may enjoy.  Then rotate these as needed so that story time doesn't doesn't become too dull, for either of you.  Accommodate a very young child's need for repetition by mixing a repeated book in with a fresh one! 

  • Make the end of the bedtime routine predictable too!  For example, if reading stories, pick them out and agree together which ones will be read – before you begin.  “Okay, these 3 board books?  All right, which one first?  ….Okay time for our last story.”

  • If your child typically struggles with settling down at the end of the routine, be sure to discuss expectations at the outset.  “Okay, after we read the last story, then what do we do?”   There may still be some initial struggles.  But be kind and consistent.  And always review the rules ahead of time.

  • Use all the positive parenting techniques you already know:  Try to stay calm and centered.  Acknowledge the child’s desires.  Restate boundaries.  Keep your sense of humor.  Don’t take it personally!

  • Work with your spouse to be on the same team!  Consistency is a key ingredient to success!

  • Learn not to sweat the little stuff.  If sleep issues are a major crisis in your home right now, give yourself and your whole family a break.  Let the dusting, the laundry folding, and the vacuuming wait. And don't freak out if Junior is trotting around the house till noon in his pajamas (and you are too), or if you're both eating most of your meals out of a can or the freezer.  Just rest your body.  Keep your sense of humor.   And know that this too shall pass.  The benefits of keeping calm and coasting through the present dilemma with mental and physical reserves in tact far outweigh other considerations.  After all, 20 years from now your child will not remember if your home was clean or messy.   But the smiles and compassion you shared will leave a mark that will last a lifetime.

 

 


 

Additional Suggestions
From the
American Academy of Pediatrics:

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. His sleep patterns will adjust accordingly.

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. Make sure the object is safe. A teddy bear may have a ribbon, button, or other part that may pose a choking hazard for your child. Look for sturdy construction at the seams. Stuffing or pellets inside the stuffed animal may also pose a danger of choking.

4. Make sure your child is comfortable. Check the temperature in your child's room. Clothes should not restrict movement. He may like to have a drink of water, have a night-light left on, or the door left slightly open. Try to handle your child's needs before bedtime so that he doesn't use them to avoid going to bed.

5. Try to avoid letting your child sleep with you. This will only make it harder for him to learn to settle himself and fall asleep when he is alone.  

6. Try not to return to your child's room every time he complains or calls out. A child will quickly learn if you always give in to his requests at bedtime. When your child calls out, try the following:

  • Wait several seconds before answering. Your response time can be longer each time to give your child the message that it is time for sleep. It also gives him the opportunity to fall asleep on his own.

  • Reassure your child that you are there. If you need to go into his room, do not stimulate the child or stay too long.

  • Move farther from your child's bed every time you reassure him, until you can do this verbally without entering his room.

 


 

 

A Note About the Family Bed: 

Please remember that while the American Academy of Pediatrics advises against letting your child fall asleep in your  bed, many families from a variety of cultures do let children sleep in their bed without difficulty.  In fact, in some cultures, it is considered cruel to force young children and especially infants to sleep alone!  

Nonetheless within our own culture, children who sleep separately do not grow into deeply troubled individuals!  So have a sense of humor about the dramatic advice offered by both camps and just do what works best for you own family.   If you are a light sleeper, or an anxious one, who would find it that much harder to get a good night's sleep with a baby in the bed, then don't choose a family bed.  If you sleep better with baby cuddled close, go for it!

Be aware too that some families choose the middle path.  That is, baby sleeps in a bassinet nestled against the bed so that mom or dad can easily reach over a hand to comfort.  But there are no worries about rolling over on baby, about baby falling out of bed, or etc.   Some families further extend the practice into toddlerhood by placing a crib mattress on the floor (only good if you don't have a cold, drafty bedroom floor). 

Just be advised that when you seek to transition your child to sleeping more independently, you will likely need to do so in gradual increments.  It takes a while for a new way of falling asleep (in a different bed and room) to become comfortable, for it to feel safe and familiar.  You may need to sit on your child's bed and hold his or her hand for a time to provide that feeling of safety.   (Some parents find they need to lay next to the child initially.)   Over time, make your stay shorter and shorter -- until it's just a good night kiss. 

 

 

 

 

Articles

 

Children's bedtime routines: Sound sleeping advice

Sleep is an important part of your child's daily routine.  Regular and adequate sleep not only gives your child energy and motivation for the day ahead, but also can enhance his or her learning abilities and decrease many behavioral problems. On the flip side, lack of sleep can have a serious effect on concentration, memory, physical performance and decision making.   Read More...

 

 

Childhood Sleep Apnea

This useful article gives a good overview of the problem and includes links for more information on specific related issues.

 

Are You Preventing Your Baby From Sleeping Through The Night?

 

 

Nightmares and Night Terrors

Learn how to distinguish and handle the two, and when to call you doctor.

 

 

Perpetually tired teens: Breaking the cycle of late nights and drowsy days

Adolescents are notorious for staying up late at night and being hard to rouse in the morning. You may wonder what happened to that alert youngster who was always up with the sun and in bed by 9 p.m.  You'll be reassured to know that your son or daughter is following a normal pattern. During teens' high school years, when they often have to be at school before 8 a.m., their biological clocks undergo a change that makes it hard for them to fall asleep before 10 p.m. or even 11 p.m.   Read More ...

 

 

Reducing the Risk of SIDS
 

 

 

 

Useful Links

 

Insomniacs

This rapidly expanding U.K.  site contains over 100 articles and is expanding by around 10 new articles each month -- each written by professional journalists or experts in the field of sleep and sleep related disorders.

 

Sleep Disorders & People with Cancer

A collection of articles on the topic from CancerLinks.com

 


 

 

Books
On
Getting Kids to Sleep

 

Solve Your Child's Sleep Problems
Richard Ferber, M.D.

First published in 1985, this book is has been highly acclaimed by some, criticized by others (especially those supporting a "family bed" approach"). Describes Ferber's approach for teaching children (including infants) to fall asleep and sleep through the night on their own. Method depends on allowing child to remain allow for small set increments of time, which gradually increase each night. The idea is to reassure the child that the caregiver has not "gone away" permanently, while gradually weaning the child of the parents' presence in his/her bedroom. (Except for intial "tucking in".)

Ferber's approach provides a humane alternative to the "just let 'em cry it out" advice of earlier generations. Best suited for parents for whom rocking, cuddling, or nursing the child to sleep is simply not working out, and who are "losing it" from lack of sleep!

If you are having difficulties with sleep routines or middle of the night wakings, you will want to read this book and then evaluate for yourself whether it's the approach you want to go with.

 

 

 

The No-Cry Sleep Solution for Toddlers and Preschoolers: Gentle Ways to Stop Bedtime Battles and Improve Your Childs Sleep
Elizabeth Pantley

Presents a method of gradually steering your baby toward a full-night’s sleep.

A breakthrough approach for a good night's sleep--with no tears

There are two schools of thought for encouraging babies to sleep through the night: the hotly debated Ferber technique of letting the baby "cry it out," or the grin-and-bear-it solution of getting up from dusk to dawn as often as necessary. If you don't believe in letting your baby cry it out, but desperately want to sleep, there is now a third option, presented in Elizabeth Pantley's sanity-saving book The No-Cry Sleep Solution.

Pantley's successful solution has been tested and proven effective by scores of mothers and their babies from across the United States, Canada, and Europe. Based on her research, Pantley's guide provides you with effective strategies to overcoming naptime and nighttime problems. The No-Cry Sleep Solution offers clearly explained, step-by-step ideas that steer your little ones toward a good night's sleep--all with no crying.

Tips from The No-Cry Sleep Solution:

  • Uncover the stumbling blocks that prevent baby from sleeping through the night

  • Determine--and work with--baby's biological sleep rhythms

  • Create a customized, step-by-step plan to get baby to sleep through the night

  • Use the Persistent Gentle Removal System to teach baby to fall asleep without breast-feeding, bottlefeeding, or using a pacifier


 

 

Sleeping Through the Night, Revised Edition: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep
Jodi A. Mindell, Ph.D., HarperCo 

Right after "Is it a boy or a girl?" and "What's his/her name?," the next question people invariably ask new parents is "Are you getting any sleep?" Unfortunately, the answer is usually "Not much." In fact, studies show that approximately 25% of young children experience some type of sleep problem and, as any bleary-eyed parent will attest, it is one of the most difficult challenges of parenting.

Drawing on her ten years of experience in the assessment and treatment of common sleep problems in children, Dr. Jodi A. Mindell now provides tips and techniques, the answers to commonly asked questions, and case studies and quotes from parents who have successfully solved their children's sleep problems.

Unlike other books on the subject, Dr. Mindell also offers practical tips on bedtime, rather than middle-of-the-night-sleep training, and shows how all members of the family can cope with the stresses associated with teaching a child to sleep.



About the Author

Jodi A. Mindell, Ph.D., is associate director of the Sleep Disorders Center at The Children's Hospital of Philadelphia. She holds a Ph.D. in clinical psychology, is professor of psychology at Saint Joseph's University, and is the author of numerous publications on pediatric sleep disorders. She lives with her family in Rosemont, Pennsylvania.

 

 

Healthy Sleep Habits, Happy Child

 

 

 

 

 

 

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