Sleep Problems

To first understand sleep problems one must understand the normal sleep pattern.  All humans have many brief awakenings during the night.  This is a protective mechanism which allows us to monitor our surroundings, to assure that they are unchanged from the time we fell asleep.  Adults typically don't remember their awakenings unless something is different.  For example, you may remember awakening recently to find your pillow which had fallen on the floor.

A few simple steps can be started at any time to help prevent or to help solve sleep problems.  Obviously, the earlier you use these techniques, the easier it is to help your child sleep through the night.

1. Develop a night routine.  Following dinner have a schedule consisting of play time, bath, reading of a book, and/or a snack, followed by a consistent bedtime.  Your routine can consist of whatever your family prefers.

2. Put your child to bed or in the crib awake.  A child who falls asleep in a parent’s arms or with a bottle, will cry out during normal awakenings, when the parent or the bottle is no longer there.

3. Consider using a “transitional object” (stuffed animal, blanket, pillow, doll, etc.).  This may ease your child’s anxiety over having to be separated from you.

Some children may require additional help in resolving their sleeping problems.  When a child is unable to return to sleep upon awakening during the night, the cause can usually be traced to one of three reasons: he is hungry and is accustomed to a regular nighttime feeding; he wants you because he has not learned to settle back to sleep without you; or he wants you because he is afraid and has not learned to comfort himself regarding fears. The following suggestions may be helpful:

If your child is accustomed to night feedings beyond the age that is nutritionally necessary (usually 4 months for the full-term infant), night feedings can be gradually phased out.  A child who is fed every 3 hours during the day will want to continue to eat that frequently at night.  Increasing daytime intervals with larger feeds and decreasing the amount fed at night will decrease hunger at night.  If you are giving your child a bottle in bed, stop immediately and replace it with a bottle prior to bed as part of the nighttime ritual.

In order to establish self-consoling skills in your child, reinforcement of his crying must stop.  The most rapid way to stop this behavior is to allow the child to cry until he falls asleep; most children will fall asleep within an hour or two the first night.  He will cry for progressively shorter periods the following nights until he no longer cries while going to sleep or upon awakening. (Usually 5-7 nights).

The technique of graduated extinction is extremely helpful in this situation, both for the child and the parents.  First allow your child to cry for 5 minutes, then go to your child and console him by patting his back and speaking in a calm voice.  Do not pick up your child at any time.  As your child continues to cry, gradually increase the interval at which you enter to console him by 5 minutes.  Again, picking up the child will reinforce the behavior that you don't want.  This technique will show your child that you do hear his cries and that he is protected, yet at the same time, teach him self-consoling skills.  The earlier that you start this technique, the better.  It is much more difficult to do this with an ambulating child who can get out of bed and walk to the parents' room.  Again, all caretakers must do the same behavior for this to work.
For the older child who is waking up with fears or nightmares, firm but calm reassurance is essential in getting her back to sleep.  Hugs and speaking in soothing tones can be effective.  Reminding the older child that she was dreaming may also be helpful.  A night light or leaving the door to her room open will provide reassurance and reduce feelings of isolation from you.

While these suggestions address some of the common sleep problems and their solutions, some problems may need more in-depth recommendations.  If the above suggestions have been followed and your child still has difficulty with sleep, further advice can be obtained through an appointment with one of our physicians.