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David Baxter PhD

Late Founder
When Your Child Struggles With Sleeplessness
July 20, 2004
By E.J. Mundell, HealthDay

TUESDAY, July 20 (HealthDayNews) -- It's 2 a.m. and for the third night this week your 3-year-old scrambles into your room, fretting that he can't get back to sleep.

As a parent, you assumed that your child's frequent nighttime awakenings would end with infancy. So what's going wrong?

Not to worry, say pediatric sleep experts. Sleeplessness in young children -- from toddlers to pre-teens -- is a common phenomenon linked to overstimulation and poor bedtime habits, both of which are relatively easy to change.

In young children, "probably the most common thing we treat we'd describe as 'settling problems' -- difficulty falling asleep, nighttime awakenings. They may be as common as 25 percent," said Dr. Carol Rosen, medical director for Pediatric Sleep Services at Rainbow Babies and Children's Hospital in Cleveland. She said most parents can help their kids sleep better at night by teaching them to drift off on their own.

Because they are busy growing physically and processing unfamiliar neurological data, children need a lot more sleep than adults. Experts estimate the average baby sleeps 16 to 20 hours a day, while toddlers average about 13 hours a day, naps included. Total daily sleep time declines gradually with age.

But sleep has lots of competition for a child's time in today's hyperactive world.

"Ours is a 24/7 society," said Dr. Judith Owens, a pediatric sleep expert at Brown University Medical School, in Providence, R.I. "There are many more competing priorities for sleep now than there were 50 years ago, ranging from the Internet to TV to social activities, things like hockey practices that are held at 8 o'clock at night."

In fact, American children may be counting sheep almost as often as their parents do, according to a recent survey from the National Sleep Foundation.

According to the survey of almost 1,500 parents, almost two-thirds of American kids under the age of 10 don't get the sleep they need, 30 percent experience problem nighttime awakenings on a regular basis, and about a third have serious trouble waking up for school each morning.

Sleep requires that the mind and body be relaxed, so one way to ensure that children sleep well is to turn off TVs and computers and put an end to "roughhousing" or physical play during that crucial hour before bedtime, the sleep experts said.

"These are all stimulating activities that occur at a time when children should be preparing themselves psychologically, mentally, physically for that transition from wake to sleep," Owens said.

Ideally, the last half-hour before sleep time should be devoted to some type of soothing parent-child interaction, such as reading. "Turn off the TV and read, listen to music, talk -- do things that aren't going to stimulate a child and make it harder for them to fall asleep," Owens advised.

But experts agreed that kids, especially toddlers, can also become too dependent on intimate parental contact.

"The most common mistake that parents make that leads to sleep disruption is that the parents are too intimately involved in the child's transitioning to sleep," said Dr. Gerald Rosen, a pediatrician at the Minnesota Regional Sleep Disorders Center in Minneapolis. "Particularly in the toddler age, if they learn to transition to sleep with intimate contact with their parents -- rocking, bottle, breast -- then when they have a normal nighttime awakening, some of those kids aren't able to transition back to sleep quickly without re-instituting the same triggers."

No two children are alike when it comes to sleep, however, and parents have to pay attention to their child's "natural sleep-wake rhythm," Rosen said. A strategy that works well for one child might prove ineffective for another.

Daytime distractions can keep kids awake at night, too. Caffeine lurks in colas and other soft drinks, and it has a much more stimulating effect on children than adults, experts said.

And, like adults, children can also toss and turn at night because of stresses in their lives. In school-age children, there's often "anticipatory anxiety about school or social relationships," Owens said. "We see a lot of 9-, 10-, 11-year-olds who come in and they just can't fall asleep because they're worried about stuff."

Talking over problems with kids can often help restore sound sleep patterns.

All of the experts agreed, though, that the leading cause of problem sleep in young children is irregular bedtimes.

"The analogy that we draw for families is that if you have a child that's going to bed three or four hours later on Friday and Saturday night, it's like they're getting jet lag," Owens said. "Come Monday morning they're not going to be in very good shape."

Sticking to a set bedtime helps kids set their own internal circadian clock, helping them wake up refreshed and ready to tackle the day.

Added Rosen: "The pattern kids sleep best at is if they have a regular time that's the right time, and they make the transition from wake to sleep in an environment that's not overly stimulating."

More information
Learn more about children and sleep at the National Sleep Foundation.
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