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Sleep and the young child: All about sleep for parents of young children — the where, when, why and most of all, how much

by Anita Gurian, PhD

Toddler-age boy laughing in bed

 

Real Life Stories

Sleep and bedtime routines are perhaps the number one cause of hand-wringing when parents of young children get together. Here's how some real parents describe their children's bedtimes:

  • My baby can't seem to tell the difference between day and night.
  • Elissa jumps out of bed at least five times before she gets to sleep.
  • When it's time for bed, Jimmy has more energy than he's had all day.  
  • We let Scott fall asleep in front of the television, but he wakes up when we carry him to his own bed.
  • Sometimes we're so desperate to get Carrie to sleep that we drive around for an hour because the motion of the car seems to lull her.
  • Spencer falls asleep right away as long as I'm in his bed with him.

Sleep: a closer look - What's a normal sleep pattern?

As with most behaviors, what's normal varies. During the early months babies sleep at all times of day and night. As infants develop they gradually spend less time sleeping and more time awake and tuned in to their surroundings. Because infants sleep in short spurts and don't differentiate between night and day, they seem to be awake more often than they really are. They sleep erratically because they spend twice as much time as adults in the rapid eye movement (REM) stage of sleep. During this REM phrase, which accounts for half of their sleep time, babies wake easily and tend to twitch, jerk, suck, make noises and flutter their eyes.

Sometime between 3 and 4 months of age, babies settle into the rhythm of a sleep-wake pattern based on a 24-hour cycle. They sleep about 15 hours a day, two-thirds of which is at night. By 6 or 7 months most babies reach the milestone their parents have been eagerly anticipating — they begin to sleep 12 hours through the night and will require two or three short naps during the day. By 12 months most babies get a good night's sleep and need about one nap during the day.

At 1 and 2 years of age, most children sleep about fourteen hours a day altogether. Then, from age three to adolescence, children need gradually less and less sleep. They seldom nap after the toddler period and nighttime sleep slowly decreases from about twelve hours in the preschooler to about ten hours in the preadolescent. However, according to a National Sleep Foundation Sleep in America poll, seven out of 10 children experience some kind of sleeping problem. It's important to establish strategies, sometimes called "sleep hygiene," early on to promote smooth sleeping habits as the child grows.

Encourage good sleep habits right from the start

Help the newborn sleep for longer periods by gradually stretching out the time between feedings. Sometimes waking the baby to give her a last feeding shortly before you go to bed may increase the number of hours of sleep. At about 6 to 8 weeks a more regular cycle emerges during which the baby sleeps more at night and stays awake more during the day. Encourage the baby from the earliest age to learn to go to sleep by herself.
 
At about 3 or 4 months of age, when the baby settles into a 24-hour sleep cycle, help her differentiate between day and night activities. During the day keep the house light and don't bother about keeping everyone quiet. Don't encourage long naps; they may interfere with nighttime sleep. Keep the baby active during the day so she's tired at bedtime. If she naps more than three or four hours at a time, wake her.

Follow daily activities with a calming bath, gentle rocking and lullabies before bed. At night use the opposite strategy from what was done during the day. When you put the baby in her bed, keep the lights dim and pull down the shades. If you feed her during the night, don't make it a playtime. Put her back in her crib when she's sleepy, but still awake, so she will associate bed with the process of falling asleep. The point is to let her learn to fall asleep on her own, in her own bed, not in your arms. You're setting the stage for expected routines and consistency.

If a baby over 5 or 6 months of age wakes at night, give him a little time to see if he settles down on his own. Sometimes a drink of water or a bottle will help. If he cries because he is sick or in pain, he needs consolation, but otherwise before rushing in, ask yourself what the meaning of the cry might be. If you do go in, don't pick him up. Talk, pat, and  reassure him, and he may go back to sleep. 

As the baby grows, continue to make bedtime special

Make sure the child's room helps her feel safe and secure with some familiar, beloved things around her. Help her wind down before actual bed time. Spend some special quiet time with her with a few soothing activities.

Keep nighttime care as calm and low-key as possible. When your child needs attention or feeding during the night, use dim lights, a soft voice and gentle movements. This will send the message that it's sleep time  — not play time.
 
Establish a regular bedtime routine. Quiet activities such as bathing, brushing teeth, changing into pajamas, cuddling, singing, playing quiet music or reading will help her relax and soon she will associate these activities with sleep.

Give her time to settle down. She might fuss or cry before finding a comfortable position and falling asleep. If the crying doesn't stop, speak to her in a calm voice and stroke her back. Your reassuring presence might be all she needs to fall asleep.

Expect her to move around frequently at night. Babies often wriggle, squirm and twitch in their sleep. Unless you think that she might be hungry or uncomfortable, wait a few minutes to see if she falls back asleep.  

Encourage the baby to sleep in her bed. Sharing a parent's bed can make it harder for the baby to fall asleep on her own. If you'd like to keep the baby close, consider placing her bed in your bedroom.

What can interfere with sleep?

Anxiety about physical separation from parents, which may first occur at about 8 months of age, can be a factor. A child usually has the security of a parent or caregiver's presence during the day, but when he is on his own at night he may become anxious. Although separation anxiety is a normal developmental phase, some children experience it with great intensity. If you are nearby to reassure him, he will settle back to sleep. To help prevent separation problems at night, when your child is between four months and a year old, give him a transitional object (a blanket, doll, or other favorite thing) that will soothe him and may help him fall asleep.

A child with sleep problems may have established negative associations with falling asleep and/or habits such as falling asleep in a parent's bed, long and protracted bedtime routines, falling asleep with a parent or in front of the television set, etc. Some children imagine scary or violent images that may be triggered by television shows, news stories, or things they may have overheard as they drift off. They may complain that they can't sleep because of monsters or robbers. Every child has some anxieties and may have occasional nightmares. A child may insist on elaborate rituals; another may demand that a parent lie down with him, that he be read to, sung to, rocked. Resistance to going to sleep may be used as an attention-getting mechanism.

When children have persistent problems in falling asleep

Babies
Pediatric sleep experts have different opinions on the best way to help babies learn to soothe themselves and fall back to sleep on their own.

The Ferber Method
If his cry signals "I want attention now" and it goes on for more than five or ten minutes, you may want to follow the advice given by children's sleep expert Richard Ferber, M. D. He advises parents to:

  • Prepare the baby for sleep with nighttime rituals.
  • At bedtime, leave the child in bed and leave the room.
  • Return at progressively increasing intervals to comfort the baby when he cries — without picking him up. For example, on the first night, some scenarios call for returning first after three minutes, then after five minutes, and thereafter each ten minutes, until the baby is asleep.
  • Each subsequent night, return at intervals longer than you did the night before. For example, the second night may call for returning first after five minutes, then after ten minutes, and thereafter each twelve minutes, until the baby is asleep.
  • The rationale for this method is that if you continue this pattern every night, you will condition your baby to expect to be left alone, and he will learn to calm himself and fall asleep.

This system works for many parents, but it is not easy to adhere to and has been criticized by other experts. They point out that it's too difficult for many parents; some may feel guilty if their baby's been ill or if they've been away at work all day. Sometimes there are sound reasons for not letting a child cry. For example, at about 8 to 10 months of age when a child may be experiencing separation anxiety, his sleep may be affected and he may need extra support.

Modified Ferber Method
In this approach one parent goes in to the crying child every five to ten minutes (rather than waiting longer and longer each time) until the child eventually falls asleep. The idea is that the child will need less and less time each night to get back to sleep, until they finally sleep through the night.

After going through the child's bedtime ritual, put him down and rub or pat his back, play a lullaby, wind up a musical toy, or turn on some kind of "white noise." If he cries, wait five to ten minutes and then go in briefly, to reassure him. Don't give a bottle or pick him up and play with him. Keep checking every five to ten minutes as long as he cries. You can expect it to take about a week before he will fall asleep alone without too much fuss.

Other sleep experts recommend helping the baby to learn to sleep alone in his own time. Attachment parenting, for example, encourages co-sleeping, rocking, or nursing the baby to sleep, thus encouraging positive sleep associations. (Doctors disagree on whether co-sleeping is safe.) Others recommend the middle ground, such as picking up the baby as many times as needed to get him to sleep.

Finding that fine line between comforting your child and setting limits is another one of those difficult jobs most parents face. Relax and the right combination will evolve.

In the preschool years
Most 3-year-olds have given up naps but may still need a quiet time after a busy or over-stimulating day. Because a child's bedroom or sleeping area is a space for relaxing and sleep, it's not a good idea to use it as a place for time out. The preschooler will probably still need bedtime rituals to help her wind down. The rituals are important, but don't make the mistake of letting your child draw them out.

Once she's in bed, make sure she knows you expect her to stay there. Reassure her that she's safe and that you're nearby. If she cries out, first see if she can calm herself before you respond. If she needs you, offer reassurance, tuck her back in bed and encourage her to return to sleep.

A bedtime chart can be helpful for some children. Make a chart that shows a picture of every part of the bedtime routine (bath, pajamas, brushing teeth, etc.) and check off each step. Lying down with the child may be helpful initially, but it doesn't help the child develop her own strategies for falling asleep.

Giving the child notice that it's 10 minutes until lights out helps ease the transition to bedtime for some children. Be sure to praise a child when she settles down comfortably.

School-age children
By the time kids are in school, many factors can contribute to sleep problems – over-scheduling of activities, homework, inconsistent bedtimes, television, and for older kids, cell phones and being on the Internet, can all lead to later bedtimes. Families with two working parents are apt to keep their kids up later to have some family time together.

Poor sleep in the later childhood years is usually not an isolated problem and is likely to be a manifestation of other stresses, such as moving, changes in families, worry about school achievement, peer concerns, etc.

Signs of not-enough sleep include difficulty waking in the morning, daytime sleepiness and sleeping longer on weekends and vacations.

While it's harder to generalize about sleep problems and their causes as kids get older, here are a few pointers. Some of the same concepts used with preschoolers still apply:

  • Encourage bedtime routines — even in older children (and adults), they help prepare the body and mind for sleep.
  • As much as possible, have kids maintain a consistent schedule. If  you let children stay up later and sleep later on weekends, make sure it's no longer than an hour past their usual weekday time.
  • When it starts getting to be bedtime, try cultivate a quiet, calm atmosphere in your home. Avoid bright lights once homework is put away. If the TV is on, keep the volume low.
  • Discourage kids from doing homework and other activities in bed — and if possible, or in the case of sleep problems, even in the bedroom. Beds and bedrooms are for sleeping. Associating bed with potentially stressful activities like studying can make it harder for some kids to sleep.
  • Adpot a "no electronics" policy for at least a half hour before bedtime. TV, loud music, texting, video games can wind kids up.
  • For the above reasons, don't put a TV in your child's bedroom. You may also need to make sure kids don't keep cell phones in their bedrooms overnight. Preteens and teens have been known to stay up late texting well after the lights have gone out.
  • Include in your child's bedtime routine a chance to say goodnight. Even as children get older, a parent's reassuring presence and a hug are a good end to a busy day.

The costs of not enough sleep

Several studies point to the academic costs of not getting enough sleep and show an associated drop in standardized test scores, in both school readiness and elementary school achievement. In terms of brain function, the tiredness caused by lack of sleep results in a drop in the executive functions of the brain. The executive functions are responsible for focusing attention, planning, and organizing, factors important to basic learning. According to researchers, adequate sleep is important for the developing brain to have time to organize itself and consolidate the day's learning. Other studies have linked poor sleep or lack of sleep to obesity in children and teens.

According to experts, adults in many parts of the world don't sleep enough. Instilling good sleep habits in children can help lead to a lifetime of better rest, and better physical and mental health.

Revised and updated, August 2012

Resources

The Baby Sleep Book
By William Sears    
Little Brown, 2005

Solve Your Child's Sleep Problems: New, Revised and Expanded Edition
By Richard Ferber   
Touchstone, 2006

The Happiest Baby Guide to Great Sleep
By Harvey Karp
William Morrow, 2012

Secrets of the Baby Whisperer
By Tracy Hogg
Ballantine Books, 2005

National Sleep Foundation: Children and Sleep

The American Academy of Sleep Medicine: Your Sleep

Sleep Medicine Reviews (scientific journal)