Putting Children’s Sleep Problems to Bed
Of all the things that people discuss with their doctors, few have as great an impact on the immediate well-being of a family than the sleep patterns of a child.
Infants, toddlers, and older children who sleep poorly can lead to overtired, stressed-out parents that may lead to a cycle of dysfunction. Nonetheless, few families make it through the early years without having to face the challenges of getting unwilling children to initiate and maintain sleep. As with all parenting issues, there is an abundance of advice available on this subject. The trick is sifting through it to find what works for your child and for your parenting style.
Practically every baby wakes frequently during the night in the early months of life. Aside from confusion around day vs. night cycles, there is also the small stomach and high rate of metabolism, which results in the need for frequent feedings. Most babies are physiologically able to sleep through the night by 4 months of age; however, several factors play a role in whether or not families achieve this goal.
Babies that sleep with the parents, in the same bed, may be more likely to wake frequently and require assistance to get back to sleep. Feeding for this purpose sets up an expectation that meals will come at frequent intervals, and a pattern is started. Co-sleeping parents are more likely to hear and respond to minor sounds, possibly disturbing a sleeping baby that may never have awakened if left alone. Evidence indicates that co-sleepers also have a higher incidence of suffocation due to adult bodies or bedding.
Similarly, exhausted moms who fall asleep after providing a short “snack” of breast milk may be awakened again when an unburped and unsatisfied baby fusses, distended and hungry. Instead, I recommend getting out of bed, nursing the baby completely on one side, taking the time to burp the baby, and then repeating the process on the other breast.
Perhaps the best advice I ever received on this came from a lactation consultant at NewtonWellesley Hospital after I had my third child. Rather than using a finger to “unplug” a sleeping newborn from the breast, she told me to leave her on until she spontaneously came off. This includes babies that seem to be asleep but are still latched on. By giving her the chance to finish completely on each side, she is able to get the “hind milk” which is known to have a higher fat content and thus satisfies the baby longer. This whole process may take up to 45 minutes but the investment is worth it if it helps the baby sleep for a longer stretch before waking up poor Mom and Dad again. Taking the time to diaper a baby at this time also saves you from another unnecessary wakening later on.
By four months, most babies have the ability to fall asleep on their own and sleep for at least a 6hour stretch, but may need to be taught how to do so. There are many authors with several different theories about how best to do this, but parents will ultimately do what feels best for them.
The American Academy of Pediatrics recommends putting babies to sleep on their backs when they are drowsy but awake and using a consistent bedtime routine. At the same time every night, go through a 20-30 minute series of activities that helps your child to know that bedtime is here. A typical routine might be a warm, soothing bath, reading a few books, and then listening to a favorite song while drifting off to sleep. Using the same song every night can do wonders for a resistant sleeper. Offer the same blanket or toy to hold onto and before long your child will start asking for it by name. Look for signs of fatigue like, rubbing the eyes or droopy eyelids, to figure out when is the best time to put your child to bed. Then try to be consistent about the bedtime, thereafter. Say goodnight, turn down the lights and leave the room. Consistency is everything and be strong because children sense when we are unsure of ourselves and grab the opportunity to keep you in the room. Busy yourself for five minutes doing laundry or cleaning up from dinner and by then any fussing is likely to have stopped. For those infants that have not soothed themselves, go back into the room and comfort them ideally without picking your baby up. Try to increase the amount of time between these visits and limit your time in the room to one minute.
Once your baby can escape from the crib, it is time to move to a toddler or ordinary bed. While this is critical for safety, it unfortunately introduces a new set of nighttime challenges.
Motivating toddlers to stay in their beds is tricky but various forms of rewards may be effective. Some offer the reward of leaving the door open when the child stays in bed but closing it if he gets out. For preschoolers, rewards such as a desired toy or privilege can help achieve the desired result. Also, the peer pressure of knowing that their classmates can do it may motivate a 3 or 4 year old to stay in their own bed all night.
As we proudly watch our children develop their cognitive and intellectual skills we are continuously amazed by the complex physiology, which occurs at bedtime. Somehow, preschoolers require large amounts of food and water precisely at bedtime. If these requests are firmly and consistently denied, they will be extinguished in a matter of days. If they are even intermittently granted, however, they will continue to plague you for months to come. Be sure they eat and drink all they need at dinnertime, before starting the bedtime routine. Remarkably, their memory also improves at this time. Remember that teaching your children to comfort themselves at bedtime will give them the building blocks for a lifetime of autonomy and independence.
Ronda Rockett, MD is a family practice physician affiliated with Newton-Wellesley Hospital. A mother of three, Dr. Rockett is accepting new patients at her practice Family Care Associates at 173 Worcester St. in Wellesley. She can be reached at 781-235-7900.
