• Making Bedtime Easier

Introduction

What parents want to know about sleep for children (and for themselves): the where and when and why and most of all, how much.

Real Life Stories

Sleep and bedtime routines are the topics that come up most often when groups of parents of children of all ages get together. Here are some of their descriptions of some bedtime problems:

• My baby can't decide whether it's day or night.
• Elissa comes out of bed at least five times before she gets to sleep.
• Jimmy has more energy than he's had all day when it's time to go to bed.
• We let Scott fall asleep in front of the television set, 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 two hours because the motion of the car seems to lull her.
• Spencer falls asleep right away if I'm in his bed with him.
• And so on...

Sleep: a closer look

What's a normal sleep pattern?
As with most behaviors, what's normal varies, even in infancy. As infants develop they gradually spend less time sleeping and more time awake and tuned in to their surroundings. Infants sleep in short spurts and don't differentiate between night and day, so they seem to be awake more 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. By 6 or 7 months most babies reach the milestone their parents have been eagerly anticipating - they begin to sleep through the night and will require only two or three short naps during the day. By 8 or 9 months about 2/3 of all infants sleep six to eight hours, and by 12 months most babies get a good night's sleep.

At 1 and 2 years of age, most children sleep about fourteen hours a day altogether. 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.

Sleep strategies established early on will promote smooth sleeping habits as the child grows. As children try to figure out the world, familiar bedtime routines provide valuable structure and predictability.

What can interfere with sleep?
Anxiety about separation, which may first occur at about 8 months of age, can be a factor. A child usually has the security of his mother's or a 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.

Since going to sleep represents a time of separation from the family, even older children may feel lonely at night. The child may not have learned how to soothe himself and to gradually make the transition to sleep.

A child with sleep problems may have established certain associations with falling asleep and may have become accustomed to such habits 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 which 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 from a child who may not receive enough emotional support during the day.

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.

What to do

In the early years, to help the newborn sleep for longer periods, gradually stretch out the periods between feeding. Sometimes waking the baby shortly before you go to bed to give him a last feeding, may increase the number of hours of sleep. Encourage the baby from the earliest age to learn to go to sleep by himself.

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. Also keep the baby active during the day so she's tired at bedtime. Let her nap in her swing, infant seat, or carriage, so that her bed or crib is associated with night time sleep. 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 her 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 awake. 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 expectable 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 or is sick or in pain, he needs consolation, but 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, reassure him, and provide a favorite toy, and he may go back to sleep. 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 Richard Ferber, M. D., author of Solve Your Child's Sleep Problems. Dr. Ferber advises parents to:

• let the child cry for five minutes, then go in for a couple of minutes to reassure him and pat him on the back, without picking him up,
• repeat the process during the night, by lengthening the interval that you allow your baby to cry. Move from five minutes to ten and then to fifteen.
• continue to return and comfort the child every fifteen minutes until he falls 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 an easy system to adhere to. The first night it could take two hours of revisiting to get the baby to sleep. The second night it might take less time, and so on. But parents have to stick to the system. If they can't tolerate some crying and they pick up their baby, they're conditioning him to think that they'll eventually pick him up if his crying persists.

Some experts don't agree with this technique. 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 or 10 months of age when a child may be experiencing separation anxiety, his sleep may be affected and he may need extra support.

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.

Most 3-year-olds have given up naps but may still need a quiet time after a busy or an overstimulating day. Because a child's bedroom or sleeping area is a space for relaxing and sleeping it's not a good idea to use it as a place for time out. The preschooler will probably need bedtime rituals as a way of winding down. The rituals are important, but don't make the mistake of prolonging them. Singing or playing soft lullaby tapes will help the child drift off.

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.

Lying down with the child may be helpful initially, but doesn't help the child develop her own strategies for falling asleep.

Giving a ten-minute warning time helps ease the transition to bedtime for some children. Be sure to praise a child when she settles down comfortably.

Warning Signs

Although time, understanding and interventions solve most sleep problems, some may persist. Among the common sleep problems:

Nightmares: It is the rare child who doesn't have a nightmare at some time. Most dreams are easily forgotten and every child has an occasional bad dream. Many children, however, have nightmares that are frightening and disturbing to them. Nightmares usually occur late in the night as the periods of REM sleep grow longer. The child usually awakens from the nightmare and is well aware of what has happened. Depending on how frightened she is, she may call out frantically for her parents, come into her parents room, or go back to sleep. In the morning, she'll usually be able to recall the bad dream.

Nightmares may occur often and become more intense when a child is under stress. Children's tolerance for frightening experiences vary. There is no cause for alarm if a child has occasional nightmares, which are most common between the ages of three and eight. Times of change, such as moving, starting school, or adjusting to a family change, can trigger nightmares.

For occasional nightmares, hugs and reassurance are the best response. Identifying and reducing the stress the child is experiencing is also helpful. Simple solutions often work. If a child is frightened about staying in the dark, a night-light can be the solution. Trying to talk her out of the danger of a monster or a ghost is usually not successful. Avoid violent movies, television programs and books. Choose stories in which people successfully conquer their fears in the end. If a child has recurring nightmares and becomes fearful and irritable during the day, consultation with a professional can be helpful.

Night terrors are easily confused with nightmares. Night terrors are not bad dreams; a child during a night terror is not dreaming. Night terrors usually occur shortly after the child falls asleep, within the first three hours. When a child has a night terror, she may scream and thrash in bed, kicking or punching, with eyes wide with fear. She doesn't respond to questions and may even hit or push an adult away. Most night terrors last between thirty seconds and five minutes. Once the terror ends, the child soon goes back to sleep and will not remember the event the next morning. Some children seldom have attacks, others have them often. Night terrors are not thought to be indicators of emotional disturbance, but are probably related to a temporary delay in the maturation of the brain, and as the child shifts from one stage of sleep to another, there is some interference. Night terrors usually occur when a child is around eighteen months old, and are more common in boys than girls.

Night terrors run in families. Stress and excessive fatigue are also thought to be factors. Children usually outgrow these attacks as they mature. During an attack the parents' main concern should be that the child not hurt herself. Stay in the room and intervene if you think she's in danger, but otherwise don't restrain her. A brief nap during the day can be helpful. Some parents have found that waking the child up prior to the time when the attacks generally occur may prevent the attack. For persistent night terrors, a physician may prescribe an anti-anxiety medication for a short period.

Sleepwalking occurs when the brain has difficulty in making the transition from non-REM to REM sleep, the sleep stage in which dreaming occurs. Sleepwalking usually happens sometime during the first three hours of sleep. Some children get up and walk aimlessly around the house, for a few seconds to thirty minutes. The child's eyes are usually open she'll seem in a daze, and in the morning usually will not remember the incident. Some children just sit up in bed and although they seem to be awake, they're actually asleep. Sleepwalking runs in families; other causes include fatigue and sleep loss. The problem usually surfaces during the preschool and elementary school years and is outgrown by adolescence. Sleepwalking is not a sign of an emotional illness; of more concern is the risk of injury. Children have been known to fall down stairs, bump into objects or even leave the house. Therefore it's important for parents of children who may sleepwalk to make sure the house is safe, such as locking doors, placing gates at stairs, etc. For some children, a brief late afternoon nap and reducing stress is helpful. In severe cases anti-anxiety medication may change the sleep pattern.

Questions & answers

How do we know if a child is getting enough sleep?

There are individual differences in the amount of sleep that children need. Pediatricians say that on the average, children between 2 and 3 need about twelve or thirteen hours of sleep including naps; 4 and 5-year-olds need about ten to twelve hours. If your child is getting several hours of either more or less sleep than is the average for her age, she may have a sleep problem. Does she seem well rested or cranky during the day? Is her behavior and her mood different when she has more sleep? Changes in her sleep routines may be necessary.

Why is getting to bed such a long, drawn-out process for some children?

For children bedtime means separation from parents and the activity of the day, moving away from excitement and stimulation into the darkness and loneliness. Especially for children who have not learned how to get themselves to sleep, prolonging bedtime routines is a way of fending off isolation. But remember every child needs limits and will benefit from knowing there are firm boundaries on bedtime routines.

If you just let your child cry it out, won't this make bedtime even scarier?

Sometimes letting the child cry it out gives him the opportunity to learn to fall asleep on his own. But for some children it can be a traumatic experience. If this happens and your child seems frightened, stay at her side until she dozes off. Just be there, and eventually when she's more relaxed and secure you'll be able to leave her while she's still awake.

My baby doesn't just have difficulty sleeping. He's fussy and hard to soothe when he's awake. Is this the way he's going to be? Is it my fault? Am I doing something wrong?

Babies are born with different temperaments. Some cry a lot, some are quiet, some sleep on a fairly regular schedule, others wake at irregular hours. Some babies are constantly wriggling; others lie in their cribs quietly for long periods of time. Some babies are born with a tendency toward certain moods and styles of reacting to people in specific ways. This style of reacting to the world is called temperament. Some children quickly establish routines; some react slowly, and others are often fussy and irregular in their feeding and sleeping habits. No matter what the child's temperament, harmony between mother and child is what's important. Tuning in to your child's specific temperament is what's basic in getting him to establish regular habits.

Don't you avoid a lot of problems if you let your child sleep in your bed?

Recently, there's been a lot of interest in the idea of the "family bed," which is common in many cultures. Some parents feel secure and close when they have their babies and small children sleeping with them. A problem with this arrangement is that it's difficult to decide when to move the child to his own sleeping area. Those who advocate babies sleeping by themselves feel this arrangement helps the baby learn to soothe himself and to fall asleep on his own. Each family has to decide what works best for them.

About the Authors

Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.

References

Solve Your Child's Sleep Problems
R. Ferber 1986
Simon and Schuster

The Sleep Book for Tired Parents
R. Huntley 1991
Parenting Press

Crying Baby, Sleepless Nights: Why Your Baby is Crying and What You Can Do About It
S. Jones, M. Thompson, & L. Ziedrich (Ed.) 1992
Harvard Common Press

Sleep Thieves: An Eye-Opening Exploration into the Science and Mysteries of Sleep
S. Coren 1997
Free Press