Most children sleep for a stretch of at least 5 hours by age 3
months but then have periods of night waking later in the first years of
life, often when they have an illness. As they get older, the amount of
rapid eye movement (REM) sleep increases, and it is during this phase
of the sleep cycle when dreams, including nightmares, occur.
Families vary in their attitudes about children sleeping with
parents and other sleep habits. Experts recommend that infants sleep in
the same room as their parents but not in the same bed (bed-sharing).
Bed-sharing is thought to increase the risk of sudden infant death syndrome
(SIDS). It is important that parents be open with each other about
their preferences to avoid stress and avoid sending mixed messages to
their children.
For most children, sleep problems are intermittent or temporary and often do not need treatment.
(See also Overview of Behavioral Problems in Children.)
Nightmares
Nightmares are frightening dreams that occur during REM sleep. A
child having a nightmare can awaken fully and can vividly recall the
details of the dream. Nightmares are not a cause for alarm, unless they
occur very often. They can occur more often during times of stress, or
after a child has seen a movie or television program containing
frightening or aggressive content. If nightmares occur often, parents
can keep a diary to see whether they can identify the cause.
Night Terrors and Sleepwalking
Night terrors are episodes of incomplete awakening with extreme
anxiety shortly after falling asleep. They occur in non-REM sleep and
are most common between the ages of 3 and 8. The child screams and
appears frightened, with a rapid heart rate, sweating, and rapid
breathing. The child seems to be unaware of the parents' presence, may
thrash around violently and does not respond to comforting, and may talk
but be unable to answer questions. Usually, the child returns to sleep
after a few minutes. Unlike with nightmares, the child cannot recall
these episodes. Night terrors are dramatic because the child screams and
is inconsolable during the episode. About one third of children with
night terrors also sleepwalk (rising from bed and walking around while
apparently asleep, also called somnambulism). About 15% of children
between the ages of 5 and 12 have at least one episode of sleepwalking.
Night terrors and sleepwalking (see Parasomnias)
almost always stop without treatment, but occasional episodes may occur
for years. Usually, no treatment is needed, but if these disorders
continue into adolescence or adulthood and are severe, treatment may be
necessary. Children who need treatment for night terrors sometimes
respond to a sedative or certain antidepressants. However, these drugs
are potent and can have side effects. Sleep sometimes is disrupted by restless legs syndrome, and a few children, particularly those who thrash and snore, may have obstructive sleep apnea.
A doctor may recommend iron supplements for children with restless legs
syndrome, even if they do not have iron-deficiency anemia, and may
suggest an evaluation for sleep apnea for children who thrash and snore.
Resistance to Going to Bed
Children, particularly between the ages of 1 and 2, often resist going to bed due to separation anxiety,
whereas older children may be attempting to control more aspects of
their environment. Young children often cry when left alone in their
crib, or they climb out and seek their parents. Another common cause of
bedtime resistance is a delayed sleep start time. These situations arise
when children are allowed to stay up later and sleep later than usual
for enough nights to reset their internal clock to a later sleep start
time. It can be difficult to move bedtime earlier, but brief treatment
with an over-the-counter antihistamine or melatonin can help children
reset their clock.
Resistance to going to bed is not helped if parents stay in the
room at length to provide comfort or let children get out of bed. In
fact, these responses reinforce night waking, in which children attempt
to reproduce the conditions under which they fell asleep. To avoid these
problems, a parent may have to sit quietly in the hallway in sight of
the child and make sure the child stays in bed. The child then
establishes a routine of falling asleep alone and learns that getting
out of bed is discouraged. The child also learns that the parents are
available but will not provide more stories or play. Eventually, the
child settles down and goes to sleep. Providing the child with an
attachment object (like a teddy bear) is often helpful. A small night
light, white noise, or both also can be comforting.
Awakening During the Night
Everyone awakens multiple times each night. Most people, however,
usually fall back to sleep on their own. Children often have repeated
episodes of night awakening after a move, an illness, or another
stressful event. Sleeping problems may be worsened when children take
long naps late in the afternoon or are overstimulated by playing before
bedtime. Sleep sometimes is disrupted by restless legs syndrome, and a few children, particularly those who thrash and snore, may have obstructive sleep apnea.
A doctor may recommend iron supplements for children with restless legs
syndrome, even if they do not have iron-deficiency anemia, and may
suggest an evaluation for sleep apnea for children who thrash and snore.
Allowing the child to sleep with the parents because of the night
awakening reinforces the behavior.
Playing with or feeding the child during the night, spanking, and scolding also are counterproductive measures. Returning the child to bed with simple reassurance is usually more effective. A bedtime routine that includes reading a brief story, offering a favorite doll or blanket, and using a small night-light (for children who are older than 3) is often helpful. To decrease the likelihood of the child awakening, it is important that the conditions and location under which the child awakens during the night are the same as those under which the child falls asleep. Thus, although a child may be allowed to settle down in another location (for example, in another room with the parents), the child should not be fully asleep when placed in the crib or bed. Parents and other caregivers should try to keep to a routine each night, so that the child learns what is expected. If children are physically healthy, allowing them to cry for a few minutes often allows them to settle down by themselves, which will diminish the night awakenings.
Playing with or feeding the child during the night, spanking, and scolding also are counterproductive measures. Returning the child to bed with simple reassurance is usually more effective. A bedtime routine that includes reading a brief story, offering a favorite doll or blanket, and using a small night-light (for children who are older than 3) is often helpful. To decrease the likelihood of the child awakening, it is important that the conditions and location under which the child awakens during the night are the same as those under which the child falls asleep. Thus, although a child may be allowed to settle down in another location (for example, in another room with the parents), the child should not be fully asleep when placed in the crib or bed. Parents and other caregivers should try to keep to a routine each night, so that the child learns what is expected. If children are physically healthy, allowing them to cry for a few minutes often allows them to settle down by themselves, which will diminish the night awakenings.
0 Comments