Sign of Sleeping Problems

By: Suzanne Dixon,
M.D., M.P.H.
Augus 6, 2009

Every parent has some degree of trouble getting a child to go to bed and stay in bed. Struggles over sleep are the most common concerns we hear about on the Web site and the ones I’m asked about most frequently in the clinic. Here we look at sleep from the child’s perspective and then explore some sleep problems and solutions for parents.

Routine Is Everything

Children behave the best around any issue when they see a pattern they can rely on. A regular bedtime and a standard routine for settling down for the night help kids understand what’s expected. If the time, the place, or the routine changes all the time, then anxiety, confusion, and room for negotiation may creep in. Although some kids rely on regularity more than others do, all children benefit from a bedtime routine.

A good bedtime routine for just about any young child lasts about 30 minutes. It can include a bath, a snuggle, a story, or a song. If the routine lasts longer than that or becomes too elaborate, kids wind up rather than settle down. But a routine under 30 minutes makes most young kids feel pushed to bed.

If weekend and weekday bedtimes vary by more than an hour, expect trouble on Monday. For best results, try to stick to a single schedule all week. This plan is tough for families who like to sleep in on the weekends, but my experience suggests that having at least one parent get up with the kids on Saturday and Sunday morning will make life go more smoothly overall.

Children should sleep in the same place every night if possible. Switching locations — sleeping in different beds, on the floor, on the couch — makes it difficult for kids to get into a good pattern. If kids are in a joint physical custody situation (which I don’t recommend for young children), do your best to be sure the routine and some of the physical features, such as the pillow or blanket, are the same in each place. Parents in different households need to coordinate bedtime routines so that they are providing pretty much the same structure.

From a child’s perspective, going to sleep is a separation: from parents, from siblings, from toys, from the exciting events of the day, and from whatever is continuing to go on in the household. Why would he readily give all this up — especially when it means going into a dark room where monsters may lie under the bed, ghosts could float outside the window, or snakes might slither under the sheets? No child goes to bed without some struggle and adjustment. And no child sleeps in his own bed by himself without a lot of prompts, learning, and firm rules that don’t change.

Sleep Is Separation

For parents, too, this is a separation. Although most parents say that they are ready to let go of their child at the end of a long day, many really struggle with this. They give their child mixed messages, only partially enforce the routine, and can’t handle the discipline needed to enable their child to sleep on his own. As parents, we have to recognize and deal with our own tough issues about separating and being apart before we can solve any of our children’s concerns.

Many cultures allow young children to always sleep with an adult next to them, and there is no harm in that. In fact, many families swear by the concept of the family bed. However, co-sleeping works only if everybody really agrees to the concept and everyone’s needs for some independence and privacy are met in other ways. Most families in Western societies think that children should sleep in their own bed from infancy onward. Either way, it’s best to discuss this issue openly with your partner. Most parents bring their kids into bed with them sometimes, when the kids are sick, scared, or under pressure. That’s fine, of course, but remember that your child won’t gladly go back to his own bed without clear direction and support from you, his parents.

Head Banging and Body Rocking

Many children will use these rhythmic, repetitive behaviors to settle themselves to sleep at bedtime or during the night to get back to sleep. This is most common in the first year of life and usually disappears before age 2. They hit hard, from a few minutes to half an hour or more, but they are extremely unlikely to hurt themselves. You can’t stop this behavior, but you can make things more quiet and comfortable:

• Move the crib away from the wall.
• Put rubber carpet protectors under the crib’s legs to cut down movement and noise. Put the crib on a thick carpet, too.
• Pad the crib up over the top. Secure the padding very well so it won’t slip and trap your child underneath or serve as a step stool out of the crib. Keep the ties less than six inches.
• Don’t go into your child’s room to check if you know she’s developed this habit. Your presence may reinforce this behavior as an attention-getter rather than a self-comforting habit.

Endless Drinks of Water

The toddler who bounces up like a ball after going to bed needs to be put back to bed with, at most, a single sentence of explanation. No discussions or negotiations, no more time watching TV. Silently put him back in bed, tuck him in, and leave. At first, you may repeat this process a hundred times before he stays put, especially if you’ve been loose about enforcing bedtime guidelines in the past. Be prepared for a struggle to establish this new routine. One drink of water is okay. One trip to the potty is enough.

Getting Into Parents’ Bed

If you really don’t want your child to share your bed, silently put him back into his own bed, a hundred times if necessary, with no talking and no discussion. If you let him climb into your bed in the morning and go back to sleep, he won’t understand what’s different about doing the same thing in the middle of the night. For a child who is stressed by separation or has been co-sleeping with his parents for a long time, I recommend placing a sleeping bag on the floor of your room and giving him rewards for moving closer and closer to his own room. This staged approach helps with the separation, which is hard for everyone.

Nightmares

Nightmares, or bad dreams, are a sign of an active mind putting life’s experiences in order. Although children can have a nightmare any time during the night, as a child gets older, he will dream toward morning, as adults do. We all use dreams and nightmares to handle stress, adjustments, and pressures. Children have the capacity to dream as soon as they learn to talk. Young children usually can’t remember their dreams, even the ones that awaken them. And since dream content isn’t that important, don’t push to get it. If a child is stuck with the same dream over and over for weeks, however, ask a health professional to help figure out the source of stress. Don’t go after the monsters in the closet; just provide simple reassurance. If you take the monsters too seriously, it’s hard for a kid to be sure they aren’t there, under the bed.

Night Terrors

These are abrupt partial awakenings that generally occur before midnight in children ages 2 to 6 years. Children are flushed, sweaty, and unresponsive to comfort. Night terrors are scary to parents because their child looks so wild-eyed and thrashes around. But they don’t mean anything, and a child will have no memory of the event in the morning. He won’t respond to your comfort measures, either. Keep him safe from injury as he moves around his bed and room. He’ll grow out of this. You or your spouse may have had night terrors when you were youngsters, as they run in families.

Dealing With Night Terrors

• Make the environment safe. Remove hazardous or breakable items around your child’s bed. Cover the floor with something soft — a rug or blanket if there isn’t any carpeting.
• Keep the atmosphere calm. Keep the light down, and turn off any radio or TV in the area.
• Don’t try to calm or soothe your child with words or hugs. She won’t respond, and restraining some children will only make it worse. Don’t shake or slap her.
• Wait until your child falls back asleep before you leave the area.
• Avoid overtiredness. Your child may need an earlier bedtime or even a brief afternoon nap.

Sleepwalking and Sleep Talking

Both of these conditions are partial awakenings and run in families, increase in frequency and degree during times of stress and overtiredness, and are more common in boys. Young children particularly may also have these when no special stress is present. Most kids outgrow these conditions by adolescence. Don’t take the nighttime talk too seriously, as the content won’t make much sense. And don’t tease a sleepwalker or talker too much, as self-conscious kids may worry that they are revealing secrets or be reluctant to stay over at another child’s house. Reassure your child that he’s normal and that his sharp mind and lively imagination are just keeping him going at night. He won’t remember a thing in the morning.

Dealing With Sleepwalking

• Clear the floor of all objects, including throw rugs, and remove breakables from the bedroom.
• Install a bell on the bedroom door so you know when your child leaves her room.
• Install gates at stair entrances.
• Move your child off the top bunk, if that’s where she sleeps. Consider a first-floor bedroom if she doesn’t already have one.
• Lock or block off the kitchen or other areas that have hazardous items available.
• Be sure all glass in windows, cabinets, and shower doors is shatterproof.

Source: Pampers

Editor’s Note: We would like to know what you think? dan@youngchronicle.com