Problems with sleep behaviors in children are very common, and these disturbances can affect not only the child, but the whole family. Sleep is of primary importance at all stages of human development, and in the newborn, is the primary activity other than eating. There is an abundance of different beliefs and lore about childhood sleep disturbance and how to cure it. Sifting through the enormous amount of material on different approaches and opinions about kids' sleep can be daunting for parents. There is not one correct way to deal with your child in regard to sleep. Each child is unique and has his own special set of circumstances and needs. What's important is for parents to identify what they feel comfortable with, and what they feel is best for their child.

Different sleep difficulties tend to cluster around different ages. Before the age of three it is common for infants to have problems going to sleep and nighttime awakening. Nightmares, fear of the dark, and night terrors usually begin to occur between ages 3-6, and sleepwalking usually has its onset after age 6. Sleep problems appearing later and in adolescence are more frequently associated with underlying psychiatric disorders, drug abuse, or medical conditions like narcolepsy. Below, I will offer some general principles and guidelines that I have found to be helpful for parents in making choices about how to handle their child's sleep disturbances.

Should Johnny Be Sleeping In His Own Bed?

There are different philosophies about children sleeping in the same bed as their parents. Western culture expects children to sleep alone from a very early age. In non-Western cultures, families tend to sleep together for a much longer period of time. Parents generally have to decide what works for them and their lifestyle. This issue can sometimes be a source of conflict between parents. I recently consulted with a set of new parents who disagreed about whether their 4-month-old son should be sleeping in their bed. Mom found this convenient for breast-feeding, enjoyed having her son sleep with her, and felt that this was an important bonding experience for them. Dad complained of feeling tired at work the next day and felt frustrated about the lack of sex with his wife. I advise parents that the older a baby is when he is sleeping with his parents, the more difficulty they are likely to experience when making the transition from their bed to the child's own bed. Kids generally love to sleep with their parents. Once used to this they can be quite resistant to changing. It's important for parents to be aware of the impact that this has on their own time for both sexual and emotional intimacy.

Night Wakenings

Infants sleeping alone often wake at night and fall back asleep without the parents being aware of the arousal. Some infants, as most parents know, cry upon awakening and this can become a regular and frequent habit. The concerned parent may rush in to see that the child is okay and to provide comfort. If a healthy baby continuously awakens this can be a source of distress for the parents. One popular intervention is "Ferberizing." This is a method popularized by Dr. Richard Ferber. Basically it involves letting the child continue to cry for increasingly longer periods of time without intervening. The goal is to foster the child's ability to "self-soothe", or put themselves back to sleep. This is effective after a few days for many children. However, some parents don't feel comfortable with what they perceive as a "cold turkey" approach. Parents need to do what they feel comfortable with and often do well with modified approaches. I advise parents to try and not respond instantaneously to the child's awakening and crying. An instant response is likely to be gratifying to the child and increase the likelihood that this behavior will recur. Frequently a baby will cry for 20-30 minutes and then fall back asleep. A timer is often useful to keep track of how long your child has been crying (20 minutes at 2 am can seem like 2 hours). Children often respond rather quickly to methods like "Ferberizing." However, transitions, changes in environment, travel, and illnesses can causes these difficulties to recur.

Mommy, There's a Monster in My Closet!

Around ages 3-5 children commonly experience fears around going to bed and the dark. This is a period of a child's development in which the boundary between fantasy and reality is commonly blurred. Our culture is replete with stories of nighttime visitors like the tooth fairy and Santa Claus as well as stories of monsters and the bogeyman. Children's imaginations are quite vivid, and bedtime can be a particularly scary time for some youngsters. A night-light can help some of those monsters go away. Nightmares also begin to occur at this time. Sometimes these awaken the child in the middle of the night. Listening to your child's fears and concerns while reassuring him is the best response. I recommend trying to avoid bringing your child into your bed for comfort. Your child will certainly welcome it, but this can quickly become a favorite habit.

Night Terrors versus Nightmares

Night terrors start to occur in the 3-5 age range. Night terrors are distinct from nightmares. With night terrors, children will begin to scream and cry in the middle of the night but still be asleep. These episodes are self-limited and it is best to hold the child, not attempt to awaken them, but comfort them until they have settled down again. Night terrors tend to run in families and usually resolve spontaneously. At times the problem will be frequent and severe enough that medication is used.

Bed-Wetting

Bedwetting can be quite embarrassing for older children, who are often fearful of having sleepovers at a friend's house, knowing they could have an "accident". Devices that set off an alarm to awaken the child when he urinates in bed can be quite effective for some. Different drugs have been used to treat this but I generally do not recommend them. Most medicines stop working after a period of time or the problem recurs as soon as the medicine is discontinued. Most children grow out of this problem eventually and parents need to be patient and supportive.

Sleepwalking

Sleepwalking, like night terrors, tends to run in families. This problem emerges more frequently after age 6. A child can get up and walk around while still in a sleep state. At times, the child can open doors and go outside. When the problem is this severe and can possibly endanger the child, medication is used. Generally the child should be led back to bed without attempting to awaken him. Sleepwalking tends to spontaneously resolve.

Summary

The development of regular sleep-wake cycles is vital for the healthy development of children. Each child is unique and varies according to his own unique needs and environment. Both brain function and external factors influence sleep-wake cycles. Parents play an important role in facilitating the development of their child's sleep behavior. Sleep disturbances can be caused by a number of factors. It is important to consult your pediatrician to rule out medical causes for sleep problems. Parents have many tools at their disposal to enhance their child's sleep. The adage "an ounce of prevention is worth a pound of cure" holds particularly true for sleep behavior in children. Maintaining good sleep hygiene, or habits, is the best way to facilitate appropriate sleep behavior for kids.

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