Laramie Pediatrics, pc

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Sleep Problems in 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 and our office can help.

Infants
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 her as calm and quiet as possible. When feeding or changing your baby during the night, avoid stimulating her or waking her up too much so she can easily fall back to sleep.

2. Don't let your infant sleep as long during the day. If she sleeps for large blocks of time during the day, she will be more likely to be awake during the night.

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 her until she falls asleep, she may learn to need you to get back to sleep when she wakes up in the middle of the night. This may interfere with her learning to settle herself and fall asleep alone.

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 settle herself without it. Pacifiers should be used to satisfy the baby's need to suck, not help a baby sleep. If your baby falls asleep with the pacifier, gently remove it before putting her in bed.

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 her, because she will probably settle herself and fall back to sleep in a few minutes anyway. If she continues to cry, check on her, but avoid turning on the light, playing, picking up, or rocking her. If crying continues or begins to sound frantic, wait a few more minutes and then recheck the baby. If she is unable to settle herself, consider what else might be bothering her. She may be hungry, wet or soiled, feverish, or otherwise not feeling well.

6. Ideally, by a few weeks of age a baby should sleep in a separate room from his parents.

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. However, remember toddlers and preschoolers usually need 10 to 12 hours of sleep each night. If your child's sleeping time does not approach this level, talk to your pediatrician.

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. 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.

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
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:

• Go to the child as quickly as possible.
• Assure her that you are there and will not let anything harm her. Allow the child to have the bedroom light on for a short period to reassure her.
• If your child is fearful, comfort and calm her.
• Keep in mind that a nightmare is real to a young child. Listen to her and encourage her to tell you what happened in the dream.
• Once the child is calm, encourage her to go back to sleep.

Night terrors
Night terrors are more severe or frightening than nightmares, but not as common. They occur most often in toddlers and preschoolers. Night terrors come out of 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:

• Uncontrollable crying
• Sweating, shaking, and fast breathing
• A terrified, confused, and glassy-eyed appearance
• Thrashing around, screaming, kicking, or staring
• Child may not realize anyone is with him
• Child may not appear to recognize you
• Child may try to push you away, especially when you try to restrain him

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:

• Remain calm. Night terrors are usually more frightening for the parent than for the child.
• Do not try to wake your child.
• Make sure the child does not injure himself. If the child tries to get out of bed, gently restrain him.
• Remember, after a short time, your child will probably relax and sleep quietly again.
• If your child has night terrors, be sure to explain to your baby-sitters what they are and what to do.

Keep in mind that night terrors do not always indicate serious problems. Your child will be more likely to have night terrors when he is overly tired and during periods of stress. Your child can become overly tired when he give up a daytime nap, wakes up too early, or his nighttime sleep is interrupted. Try to keep your child on a regular sleep schedule or increase the amount of sleep he gets to prevent night terrors. Night terrors usually disappear by the time a child reaches grade school. If they do persist, talk to our office.

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. She may not respond to others and be very difficult to awaken. When your child does wake up, she 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. If you have concerns or the condition persists, talk to our office.

How to handle sleepwalking and sleep talking:

• Make sure your child doesn't hurt herself while sleepwalking. Clear the bedroom area of potential hazards that your child could trip over or fall on.
• Lock outside doors so your child cannot leave the house.
• Block stairways so your child cannot go up or down.
• There is no need to try to wake your child when she is sleepwalking or sleep talking. Gently lead her back to bed and she will probably settle down on her own.

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:

• A bladder that has not yet developed enough to hold urine for a full night.
• Your child may not yet be able to recognize a full bladder and wake up to use the toilet.
• Stress. Changes in the home, such as a new baby, moving, or a divorce can lead to a sudden case of bedwetting for a child who has been dry at night in the past.

How to handle bed-wetting:

• Do not blame or punish the child for bed-wetting.
• Have your child use the toilet and avoid drinking large amounts of fluid just before bedtime.
• Until your child can stay dry during the night, put a rubber or plastic cover over the mattress to protect against wetness and odors. Keep the bedding clean.
• If your child is old enough, involve him in handling the problem. Encourage him to help change the wet sheets and covers. This will help teach responsibility and avoid the embarrassment of having other family members know about the problem every time it happens. Do not, however, use this as punishment for the child.
• Talk to our office about other approaches to bed-wetting, such as rewards for younger children or alarm devices for the older child.

Most importantly, don't pressure your child. Bed-wetting is beyond a child's control and he may only become sad or frustrated if he cannot stop. Set a "no-teasing" rule in the family. Make sure your child understands that bed-wetting is not his fault and it will get better in time.

Teeth grinding

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. However, it may reappear with the next stressful episode.

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.

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