Establishing healthy sleep habits in young children is vital for optimal functioning for them and, of course, for us as parents. It is difficult to do what we need to do and parent at our best when we are sleep deprived. Also, poor sleep in children often results in negative consequences to daytime behaviour, mood, learning, and physical development.

 

Recommended Sleep by Age

 

Young children need lots of sleep! While some children need more or less sleep than others, the table below provides a range of recommended sleep by age.

 

    Age               Night                              Day                                   Total

 

0-3 months                         —  unpredictable, varies widely –

 

3-6 months       11-12 hrs                   3-4 hrs  (in 3-4 naps)                  14-16 hrs

                                                           

6-9 months       11-12 hrs                   2-3¼ hrs (in 2-3 naps)                13-15¼ hrs

                                                           

9-12 months     11-12 hrs                   2-3 hrs (in 2 naps)                      13-15 hrs

                                                           

12-18 months   11-12 hrs                   1½-3 hrs (in 1-2 naps)                12½-15 hrs

                                                           

1.5-2 years        11 hrs                      1½-3 hrs (usually 1 nap) 12½-14 hrs

           

2-3 years           11 hrs                      1½-3 hrs (in 1 nap)                     12½-14 hrs

                                               

3-5 years           11-12 hrs*                0-2 hrs (0-1 nap)                        11-13 hrs

                                                           

 

*Children may sleep longer at night after they drop their nap

 

Source: modified from The Sleepeasy Solution, 2007

 

Establish Good Sleep Habits (Early!)

 

It is important for parents to start establishing healthy sleep habits early. This will help ensure that your child gets the sleep he/she needs. Also, it is easier to establish good habits early on than to correct bad habits as children get older. This is because habits (including “bad� habits) become very ingrained and more difficult to change.

 

Develop a sleep schedule

Developing a sleep schedule is important. In early infancy, a sleep schedule can be flexible. By 3-6 months of age, a sleep schedule should include a regular bedtime and wake time and naps at approximately the same time each day. Most young children do well with a bedtime of 7:00-8:30pm - depending on their age and, if napping, when their last nap ended.

Learning how to fall asleep independently

The most important aspect of getting children to fall asleep quickly and sleep through the night is to have them learn to fall asleep independently without parental assistance. Children need to learn this at bedtime so that when they have arousals during the night, they will know how to return to sleep on their own.

 

Research has shown that teaching an infant to fall asleep

independently can prevent the development of future sleep problems.

 

Between 6-12 weeks of age, parents can experiment with putting their baby down to sleep when they are drowsy but awake. However, babies younger than 3 months should not be left to cry for more than 5 minutes (or less, depending on the intensity of the cry). At 3 months of age (full-term and healthy), a child can learn to fall asleep on his own. The younger the skill is learned the better. It is much easier to teach a 3 month old how to fall asleep on his own, compared to a 1 or 2 year old – who has never learned the skill.

 

Address night wakings

If your child is waking at night, first ensure that she is falling asleep independently. If night wakings persist, ask yourself “what is she waking for?� Things that typically maintain a child waking are nighttime feeds, co-sleeping, and various types of “parental responding�. Most infants who are 6 months of age (full-term) who are gaining weight as expected don’t need to be fed during the night. Developing a plan to gradually eliminate night feeds and other things which are keeping her waking is often necessary. Like most aspects of parenting, consistency is key!

 

Establish a bedtime and nap routine

A well established bedtime and nap routine is important. The routine should be calming and predictable. The last part of the routine (at least) should take place in the child’s room. The lights should be low and it is important to avoid ‘dozing’ during a bedtime and nap routine as this can decrease the drive to sleep and lead to difficulty settling when it is time for the child to fall asleep. Snacks and t.v. time (if parents wish) should be done prior to the start of a bedtime routine.

 

Maintain an environment conducive to sleep

A child’s crib and bed area should be all about sleep and toys and mobiles should be removed. The optimal sleep environment includes a temperature on the cool side of comfortable and little to no light or noise. White noise (a constant and even sound) in a child’s room and in the hallway outside his room can help to block external and household noise, and is also believed to be soothing for young children.

 

Common Causes of Sleep Problems

The 2 most common causes of sleep problems are: 1) not falling asleep independently and 2) inappropriate and inconsistent responding, especially during the night. Other things that can cause or worsen sleep problems are greater cognitive awareness (becoming more alert), reaching new developmental milestones, and a poorly timed sleep schedule.

 

 

What is Sleep Training?

Sleep training includes a child learning how to fall asleep independently (self-soothing to sleep) and appropriate and consistent responding, on the part of the parents. Also important in a sleep training plan is developing an age-appropriate and well-timed sleep schedule and ensuring that the sleep environment is safe and conducive to sleep.

 

Safe Sleep Practices - Health Canada & Canadian Paediatric Society Guidelines
The Back to Sleep Campaign advocates placing infants on their back to sleep (when first placed in the crib) until 12 months of age. The back to sleep position, until a child can roll or move to his side on his own, is associated with a reduced risk of Sudden Infant Death Syndrome (SIDS). According to the guidelines, however, children do not need to be repositioned during the night or nap, once they can roll or move to another position independently. Young children should sleep on a firm flat surface in their crib for all sleep periods. Room-sharing in the first 6 months may protect against SIDS.

 

Health Canada and Canadian Paediatric Society guidelines state that soft and non-breathable materials including blankets, bumper pads, stuffed animals, infant positioners, pillows, and pillow-like items should not be in a crib. These objects can prevent air circulation around a child’s face and lead to suffocation. Rather than covering a young child with a blanket, a sleep-sack or wearable sleeper-blanket is recommended for cooler months (see http://www.halosleep.com/ for wearable sleeper blankets).

 

The guidelines also outline that an adult bed is “not the safest place for a baby to sleep�. This is because young children can be suffocated by an adult, can fall off a bed, and can become trapped between the mattress and wall or headboard. Also, soft materials on a bed are a risk factor for overheating and suffocation. High risk groups to co-sleep with children are those who have consumed alcohol, taken sedating drugs, and those who are sleep deprived – all which can lead to decreased responsiveness. Avoid overheating your child. Being overheated is a risk factor for SIDS and can also lead to discomfort during sleep.

 

Medical Problems and Sleep

Parents should speak to their child’s physician if they have any concerns regarding his/her sleep. Also, before starting a sleep training plan, parents should consult their child’s physician to rule out any medical cause of their child’s sleep disturbance. Common medical problems that can disrupt a child’s sleep include gastroesophageal reflux disease, ear infections, and sleep apnoea - which is often characterized by loud snoring and pauses in breathing during sleep.

 

Recommended Readings 

 

 

The Sleepeasy Solution: The Exhausted Parent’s Guide to Getting Your Child to Sleep – from Birth to Age 5. (Jennifer Waldburger & Jill Spivak, 2007)

Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good Night’s Sleep (Revised Edition). (Jodi A. Mindell, 2005)

 

Pleasant dreams!Dr. Nicky Cohen, C. Psych.
Practice in Clinical and Counselling Psychology
491 Lawrence Avenue West, Suite 203
Toronto, Ontario M5M 1C7
Tel/Fax: 416.783.3900
www.kidsleep.ca

©Dr. Nicky Cohen 2012

 

Parenting your Child to Sleep: Sleep problems in children - How common are they and what parents can do

Parental reports of sleep problems in young children are very common. Research shows that approximately 30% of infants, toddlers and preschoolers experience sleep problems. Other findings suggest that these problems are even more common. Several years ago, the National Sleep Foundation’s Sleep in America poll investigated sleep habits of children (infants to 10 year-olds) and their parents/caregivers living in the United States. They found that 46% and 36% of toddlers and preschoolers, respectively, still wake at night and that 43% of toddlers and preschoolers fall asleep with a parent (or other adult) in the room at least a few nights a week. It is not surprising that 76% of parents surveyed reported that they would like to change something about their child’s sleep.

Reports of children’s sleep problems are not new. Documentation from as far back as the 16th century by Thomas Phaire details sleep problems during childhood and their implications for the family. In the first English textbook of paediatrics (1545), Phaire describes 39 paediatric “maladies� (illnesses or disorders) that he believed to be particularly common in children (4 of which were problems related to sleeping).

Sleep problems in children are not only very common, they are also often the cause of significant distress to the child and parents. They can negatively affect family life and are a source of parental concern, stress and conflict. Consequences of inadequate quantity or quality of sleep are numerous – both for the child and parents. Poor sleep can cause a variety of mood, behaviour, cognitive, and physical changes. If sleep problems persist, these changes can intensify as sleep debt accumulates (increases) over time.
 
Since the scientific approach to children’s sleep problems began in the 1980’s, much information of practical value has emerged. Unfortunately, this knowledge is not sufficiently well known to the general public or by many health care professionals. The result is that many opportunities for helping parents with their child’s sleep problems are missed or inadequately addressed.

Many parents are also unaware that sleep problems in their children can often be prevented or effectively treated, even in cases where the problems seem serious or persistent. In addition to this lack of awareness, a common but incorrect assumption is that not much can be done to address sleep problems in children.

Behavioural interventions for bedtime stalling, problems falling asleep independently, night wakings, early morning wakings, and daytime sleep difficulties exist. These treatments have been shown to be very effective, sometimes with surprisingly quick results, even when the problems have been long-standing in nature.

Before a treatment plan is implemented, a detailed assessment of the problem should be done to identify the underlying cause(s) and contributing factors. Although medical causes of sleep problems are uncommon, it is suggested that parents speak with their child’s physician before implementing a sleep training program.

It is recommended that specific behavioural interventions be combined with principles of good sleep hygiene. In all cases this should include discussion of an age appropriate bedtime/naptime routine, self-soothing, nighttime feeds (if necessary or if weaning is required), safe sleep practices, recommended hours of sleep, and a well-timed sleep schedule (depending on the age of the child). As well, the rationale and specific guidelines for implementing a sleep training program should be outlined.

Sleep training programs differ from child-to-child and depend on the age of the child and the presenting problems. However, the focus of many treatment plans address bedtime routines, ways in which a child is falling asleep, and how they are being responded to at bedtime and during the night.

Sleep training methods are highly effective if both 1) an appropriate plan has been developed (e.g., the right choice of treatment is made, all factors that are contributing to the problem are addressed) and 2) the plan is carried out properly. The effectiveness of such methods should be evaluated only after such a plan is fully implemented. It is not uncommon for parents to feel that they have carried out a similar treatment plan, however with careful inquiry, the wrong choice of treatment was made, or the plan was not carried out properly.

While a common myth is that sleep problems are inevitable in the first few years of life, the fact is that good sleep habits can be encouraged from an early age and that most babies can learn to sleep well starting from a few months of age. Regardless of the age of your child, it is never too late to make positive changes!

Pleasant dreams!

Dr. Nicky Cohen, C. Psych.
Practice in Clinical and Counselling Psychology
491 Lawrence Avenue West, Suite 203
Toronto, Ontario M5M 1C7
Tel/Fax: 416.783.3900
Email: dr.nickycohen@kidsleep.ca

Dr. Cohen is a Registered Psychologist in private practice in Toronto. She received her Ph.D. in Clinical Psychology from York University and developed an interest in parenting issues related to children’s sleep disturbances after having her first child 7 years ago. She is active in the community disseminating information on healthy sleep practices and increasing awareness of the importance of making sufficient sleep a family priority. More information about Dr. Cohen’s work can be found at: www.kidsleep.ca.

©Dr. Nicky Cohen 2010