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 “My
child wakes up frequently at night”, “my child resist going to
his bedroom when it is his bedtime”, “my child feels sleepy
and tired in the daytime”, “my child refuses to sleep in his
room” these are some examples of the common complaints we hear
from parents. Most parents complain about the sleep pattern of
their children and may wonder what sleep pattern is normal for
their children. Sleep problems during night in children affect
the parents more than their children. That results in sleep
deprivation and tension in the parents which leads them to
adopt wrong behaviors and patterns that may perpetuate the
problem.
Sleep in children is a dynamic process that is evolving and
changing as the child is older. During their growth, children
may learn good or bad sleep habits. Once these habits are
established, they may continue for months or years.
The First Year of Life:
Newborn infants sleep an average of 16-18 hours daily divided
into 4-5 periods. By two months, the baby sleeps more at night
giving the parents sometime for rest. Although sleeping time
shifts gradually toward night sleep, the baby continues to nap
during the daytime. Between ages 3-6 months, the baby needs
around 3 naps daily, and that changes gradually to 2 naps per
day from age 6-12 months and 1 nap around the first birth day
with a total sleep time of 12-14 hours. Unfortunately, an
increase in nighttime wakings is common in the second half of
the first year. This problem may persist into the first and
second years of life. The good news is that children usually
outgrow these problems with no medical or developmental
problems.
These are some hints that can assist the parents helping their
baby adapting a regular sleep schedule in the first year.
• Train your baby to consider nighttime as sleep time and day
time as a wake time. This can be done by confining playing and
entertaining the baby to the daytime only.
• Help your baby learning the association between bed and
sleeping. This can be achieved by taking the baby to his bed
at bedtime and resisting the temptation to let him sleep in
the living room or the parent’s arms.
• Lights should be low in the bedroom
• If the baby wakes up at night, do not show him attention. If
he starts crying, be calm and reassure him, or change the
diaper if necessary. Do not turn on lights, keep conversation
and noise to minimum and do not loose your temper. If you give
the baby a lot of attention on awakening and crying, he will
be conditioned to that and will use that behavior as a way of
attracting the parent’s attention.
• Infants fed large quantities at night not only show
continued wakings, but frequent wakings, often three to eight
per night. By 6 months, all full-term healthy normally growing
babies have the capacity to obtain satisfactory nutrition
during the day only. If your baby wakes up frequently for
feeding, consult your pediatrician to adopt a plan for gradual
reduction in night feeding
Toddlers and pre-schoolers:
At age two, the child sleeps for an average of 12-13 hours
with 1-2 hours of nap time and 11 hours of night sleep. During
this age children starts to have better sleep schedule and
circadian rhythm. The main sleep problems at this age are;
refusing to fall asleep independently, bedtime crying and
middle of the night tearful awakenings.
A useful strategy at this age includes:
• Always let the child know when it is almost time for bed.
• Avoid exciting activities before bedtime
• Make the child’s room attractive by having attractive
blanket and linen in addition to a
favorite toy as he is falling asleep
• Bedtime routines are important like telling a story
• Resist requests for one more story or another drink
• Be consistent from night to night
• Teach the child that you do not have to stay in the room
until he falls asleep but assure
him that you will be around
• Like adults, children at this age may have some awakenings
at night, however, they should gradually learn how to go back
to sleep. Therefore, if the child cries (and you know that
this is his habit and nothing serious has happened to him),
wait for five minutes before going to his bed and when you go
stay only briefly. Do not pick the child up. Keep the
conversation to minimum, then leave even if the child is still
crying. If crying continues, wait for 10 minutes before going
back. Stay briefly and leave again. If the crying still
continues, wait 15 minutes before returning and so on.
• If the child won’t stay in bed use the door closing
approach. Either the child stay in bed or the door will be
closed. Do not lock the child in; that is too scary. Simply
hold the door closed for a minute before opening it and
restarting the rule.
A parent’s coming and going will provide reassurance and show
the child that the parent is not going away forever. Although
allowing the child to cry during the learning process is
stressful for the parents, experts say it is not
psychologically damaging to the child.
School age (6-12):
In general, by age 6 most children no longer need naps, and
sleep time is reduced to about 11 hours. Sleep time of the
10-year-old averages 10 hours. During these years, the sleep
problems of early childhood usually subside and most children
sleep soundly at night and are fully alert in the daytime.
Like adults, some children are early birds or morning people
and others are night owls or evening people. The major sleep
problems at this age group is related to bedtime rather than
sleep. The commonest problem is bedtime resistance. A child
may push back bedtime to watch TV, play or do homework. Poor
sleep in this age group can result in some concern during
daytime. Insufficient sleep can make the child irritable or
cranky. The child may fall asleep or fail to pay attention in
the class.
Here are some tips that may assist the parents helping their
children to have better sleep.
• Enforce early bedtime. Although bedtime can be different
from one child to another, the
bedtime that results in sufficient sleep (for your child)
should followed regularly.
• The child’s bedroom should be comfortable and attractive
• The child’s bedroom should have no TV, computer games or
distracting toys. A
favorite toy can be allowed to sleep with the child.
• Teach your child to develop rituals before sleep like going
to the bathroom, brushing
teeth, etc.
• Start teaching your child the sleep prayers.
When to seek help?
The above was a guide to parents to help their children
developing good sleep habits and patterns. However, children
may have sleep disorders that need assessment by a specialist
and hence medical treatment. If a child’s sleep poses
difficulties for the child or other family members or if your
child has any of the below complaints, it is time to see a
healthcare provider:
Snoring, inappropriate daytime sleepiness (like sleeping in
the class after good night sleep), inability to sleep at
night, frequent awakenings at night, sleep walking or
nightmares.
Dr. Ahmed
BaHammam
Director Sleep Disorders Center
King Khalid University Hospital
Associate Professor, College of Medicine, King Saud University
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