Sleep is not negotiable. We all need it, and children need lots of it. And usually we don’t feel our best when we don’t get enough. The benefits of sleep are numerous – both physical and psychological. Parents are often aware of how they feel when sleep deprived. Even if your child is sleeping well now, you can probably recall the days when he wasn’t! However, parents sometimes forget to consider the impact that loss of sleep can have on their child and how children may be feeling when they don’t get enough sleep. Like adults, many children who do not get enough sleep display signs of sleep deprivation during the day such as irritability, sleepiness, and difficulty concentrating.
Several years ago, in the first nationwide study of its kind, 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. It was found that 76% of parents reported that they would like to change something about their child’s sleep. It was estimated that some parents lose up to 200 hours of sleep a year due to their child’s nighttime wakings and that many children are getting less than the recommended number of hours of sleep a day based on their age. Additionally, many parents/caregivers reported that they get less sleep than they need, with 50% of all parents/caregivers reporting that their sleep is disturbed during the night, at least twice a week, on average, due to their child awakening them. However despite a large majority of parents being dissatisfied about their child’s sleep, the study found that many (52%) doctors don’t ask about children’s sleep habits.
Many parents face challenges regarding their child’s sleep, whether it be stalling and resistance going to bed, night wakings, early morning wakings or daytime sleep problems (just to name a few). Usually these problems translate into less sleep – for everyone – as a result. The following are tips for parents who are looking to make some positive changes in their children’s sleep habits.
1. Establish a consistent and appropriate sleep schedule for your child. Having a predictable bed time will be helpful in getting your child to fall asleep at night more easily and quickly. Similarly a regular wake time is important as it sets the “start” button for the day. A child’s wake time is important in setting a child’s naptime as well as her bedtime. Research has shown that children (and adults) who go to bed at roughly the same time each night, have less difficulty falling asleep than those who don’t have a regular bedtime. Most young children do well with a bedtime between 7:00-8:30pm. Watch for your child’s tired signs and don’t keep her up. If you miss the “window of opportunity” when your child falls asleep most easily, you may have greater difficulty getting her to bed.
2. Make sufficient sleep a family priority. Understanding the importance of getting enough sleep and how sleep affects the overall health of you, as parents, and your children, is the first step towards making sleep a priority for your family. Parents need to determine the amount of sleep their children need and take steps to ensure that each child’s individual sleep needs are met. Parents should strive to make a good night’s sleep a regular part of each family member’s daily routine.
3. Create a predictable and calming bedtime routine. A bedtime routine is important to help your child wind down before bed and signal to her that bedtime is approaching. Children learn that when certain things happen, for example, a bath, pajamas, books and songs, it means that ‘sleepy time’ is coming. Many parents of toddlers and preschoolers report frustration with bedtime resistance. Children of this age are notorious for “curtain calls” – also known as repeated requests - at bedtime. If this is happening in your home, develop an appropriate bedtime routine and stick to it. Be sure to incorporate everything (within reason) that your child needs to have done before falling asleep. Develop a simple bedtime checklist with your child. Checking off the items as you complete them can be helpful. Be careful not to reinforce multiple requests at bedtime. Once you are firm and consistent, your child will quickly learn the new rules.
4. Ensure that your child gets adequate day sleep if she still needs a nap. Most children need to nap until between 3-5 years of age. Sometimes parents drop their child’s nap prematurely for social or other activities. Parents are encouraged to take their child’s lead and maintain the nap as long as the child still needs it. However if napping is preventing your child from going to bed at a reasonable time at night, it may be time to reconsider the nap. Rather than dropping the nap entirely, as a first step, parents can move the nap earlier in the day, or limit the nap to 1 hour, for example.
5. Introduce a transitional object. Many children can benefit from having a transitional object such as a “blankie” when they sleep. If your child is still in a crib, a blankie should be small enough (e.g., 8” by 8”) so that it cannot wrap around her face or neck area. Also, blankies used in cribs, should be breathable, meaning that fresh air can circulate in/out of them. Things that can arouse a child, and prevent her from falling asleep, or wake her if she rolls on it (such as a stuffed animal) are best left as daytime toys and out of the crib.
6. Have your child fall asleep independently. Most healthy full-term babies who are 3-4 months of age and older, can start to learn to fall asleep independently. This is an important life-long skill that we all have to learn. The earlier that parents allow for the development of this skill, the easier it is for children to learn. Falling asleep independently is most easily learned at bedtime (nighttime) when the drive to sleep is relatively stronger than compared to daytime sleep periods. While it is never too late to learn, it is generally an easier and quicker process for younger children. However before 3 months of age, babies should not be left for more than 5 minutes to cry, and possibly even less depending on the intensity of their cry.
The importance of a child learning to fall asleep on her own at night is related to her ability to sleep through the night. This is because children who fall asleep under certain conditions (e.g., with parental presence, being fed, bounced or rocked) at bedtime, often need these same conditions re-established upon waking at night in order to return to sleep. These children (“signalers”) will call or cry out to get the help they need to return to sleep. This may happen several times a night, as we all have several periods of brief arousal throughout the night. However children who have learned to fall asleep independently, without parental intervention, usually return to sleep on their own following periods of partial arousal. These children (“self-soothers”) will return to sleep, often without their parents being aware that they were briefly awake.
7. Respond to your child appropriately and consistently during the night. Once a child has acquired the skill of falling asleep independently at night, she will likely start applying the skill following night wakings. However if night wakings continue to be inappropriately or inconsistently reinforced, they may continue. So develop a plan and stick to it. Consistency is key. For young infants who still need nighttime feeds, scheduled feeds initiated by parents can be helpful.
8. Make sure your child’s sleeping environment is conducive to sleep. Most children sleep best on their own, in their own sleep space. Research has shown that children and adults who co-sleep usually do not sleep through the night as everyone is disturbed by each others noises and movements. As well, parents are more likely to reinforce night wakings due to close proximity. Children, like adults, sleep best in an environment that is on the cool side of comfortable, quiet, and dark. White noise and room darkening shades can be helpful. Research has shown that children who have a computer or television in their room, sleep less on average, than children who don’t.
9. Practice safe sleep hygiene. Ensure that the area where your child sleeps is safe and that your baby is always put on her back to sleep to decrease the risk of sudden infant death syndrome (SIDS). While room sharing for the first few months may be a protective risk factor against SIDS, sleeping in the parental bed (bed-sharing) is not considered to be the safest place for young children to sleep. This is because many parents do not use guard rails to protect against accidents such as falls off the bed. Also soft materials on beds such as blankets/duvet covers and pillows are not recommended for young children due to safety concerns. Parents are encouraged to speak with their child’s physician regarding safe sleep practices. For additional information, the Canadian Paediatric Society website (www.caringforkids.cps.ca) has helpful handouts for parents on healthy and safe sleep habits for children.
10. Get some sleep yourself! With research showing that many adults get less sleep than they need, make sleep a priority for yourself! The better rested we are as parents, the better able we are to effectively parent and cope with the many challenges we face during the day. Often it is helpful for adults to have a bedtime routine and some wind down time before bed. Having shifts with your spouse if you have a young infant who is still waking at night can be helpful.
Parents are encouraged to pay attention to sleep problems in their children and to follow-up with their child’s physician or other health care professional with training in this area. While the more common sleep disturbances in young children include difficulty falling asleep, bedtime stalling, nighttime wakings, sleep terrors, and nightmares, other problems such as trouble breathing while sleeping, including pauses in breathing, snoring, and restless legs also require discussion with a medical professional.
While sleep disturbances are one of the most chronic behavioural problems in children, often times these problems are easily solved through behavioural interventions. Though the anticipation of trying to deal with these issues can be overwhelming – especially if you are sleep deprived to begin with – usually the anticipation is actually worse than tackling these problems.
Pleasant dreams!
Dr. Nicky 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 5 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. Dr. Cohen has held various research and clinical positions at the Centre for Addiction and Mental Health, the Hospital for Sick Children, and the University Health Network (Toronto General Hospital). More information about Dr. Cohen’s work can be found at: www.kidsleep.ca.