How well does your child sleep?

There are many challenges that parents face in nurturing their children. One of the most common challenges is disturbed sleep. It is estimated that 25 percent of healthy, “normal” children experience sleep disturbance.

Children who suffer from physical ill health or who have handicapping conditions show a higher rate of difficulty with sleep. For them, this figure can be as high as 60 percent. Medication and physical condition play a part.

Parents often have major sleep deficits in trying to cope with a child who either:
› will not settle to sleep without them
› will not sleep without disturbance in the night
› has an antisocial sleep pattern

“Sleep is as essential to a child as good nutrition”. This 16th century quote comes from Thomas Phaire’s The book of the child, the first book of Paediatric Medicine. Of all the issues that parents find challenging today, sleep rates amongst the top three. When you are away from your usual support system, disturbed sleep is twice as difficult to cope with.

Sleep is important to allow the brain to rationalise the events of the day, to consolidate learning, to rest and repair, and to grow. It is while we sleep that growth hormone is released.

Sleep is thought to be affected to some extent by our genes. If our parents or grandparents have a sleep disorder, the probability that our children may develop a similar disorder is greater. For example, Narcolepsy often recurs in families.

Sleep is also a learned behaviour

We used to only work during daylight. When dusk came it was safer for man to sleep. As we developed as a civilisation, our sleep / wake pattern altered. We have electric lighting, so there is no need to retire to bed when it gets dark.

Our children are born into this lifestyle. We expect them to wake and sleep when we do. We know that even infants, demonstrate a basic rhythm to waking and sleeping. It has been recently demonstrated that from about 60 days (two months) babies have a rudimentary sleep pattern. This is some weeks before there is a real feeding pattern emerging.

From the age of two to four months our children learn to sleep at appropriate times. Until a child is about six years old, they have a very flexible circadian rhythm (body clock). Their natural inclination is to follow the pattern of our ancestors, sleep at night and wake in the daytime. As parents, we have a profound effect on setting that circadian rhythm.

Common sleep problems

Sleep disorders are complex and some children experience more than one simple sleep disorder. Resolving these issues takes time. It is also very important to correctly identify the sleep disorder and to differentiate between a sleep disorder and a physical or mental health problem.

The nature of a sleep disturbance varies with the age of the child. In the first few months of life night waking is not uncommon. We expect this, but, by six months of age, a healthy mature baby should no longer physically require a night feed and should be able to sleep for ten to eleven hours at night.

A baby who is slow to settle may have reflux, or colic, or may simply never have learned to self soothe to sleep. If we develop a habit of holding or rocking baby, until soundly asleep, baby thinks he / she can only sleep when such pre-conditions are present.

A toddler may resist bed time or have night terrors, or nightmares. This can become a vicious circle. These events are most frequent when there is already a sleep deficit and they are themselves causes of sleep deficit. 

Finding a way to break this cycle can be difficult. Providing reassurance to a small child, who lacks the vocabulary to express their concerns, can be very frustrating. A school aged child may still have nightmares or may have anxieties about school or family. Again, these concerns may not be expressed but may result in night waking.

There are over 30 recognised and classified Parasomnia’s (partial arousals) such as sleep walking, sleep talking, Bruxism (tooth grinding), some of which start to become apparent at this age.

Psychiatric disorders and some medical conditions, can co-exist with sleep disorders. Children who have chronic health problems and are on some types of medication may experience sleep disorders. It is estimated that 60 percent of children with handicapping conditions and / or pervasive developmental disorders also have sleep disorders.

Circadian Rhythm disorders

Circadian Rhythm disorders are not uncommon. This can be demonstrated in two ways:

› Delayed sleep

Those children, who go to bed but cannot get to sleep for some time are sleepy when they need to wake up and go to school. They find concentrating in class difficult and may require work to reset their body clock.

› Early Wake Phase

Other children may wake far too early in the morning and be unable to return to sleep. Regular waking at 3am, 4am, 5am, following a bed time of 7pm or 8pm does not allow enough time for a full and restorative sleep.

Since the circadian rhythm is set at aged six and work after this to alter poor patterns is more difficult, it is obviously best to identify and alter poor sleep patterns before this. Parents often become angry and frustrated with children who experience delayed phase / early sleep phase disorders and do not fully appreciate that these can be resolved.

Physiological changes at puberty can result in sleep disorders. Sleep is a very important, biologically complex, process which man cannot thrive without.

How to encourage good sleeping habits in our children

Observe good Sleep Hygiene principals. Have a fixed bed and wake time. The earlier in your child’s life that this is established the more likely your child will accept and adopt it. Fixed sleep and wake times help to set the circadian rhythm.

In the last hour before bedtime, quiet play, reading a story, drawing and listening to music are soothing and will help your child to wind down. You may want your child to talk about their day so that they can empty their head of concerns about school or friendships. Listen to your child.

This last hour is theirs. If you can give them your undivided attention, you will improve your relationship and increase your child’s trust in you. Your child will be calmer and more amenable to bed time.

Develop and maintain a short 20 minute pre-bed routine. This should consist of three things which are always done in the same order, at the same time of night, no matter where in the world you are. This will cue your child that bedtime is not far away.

If your child still naps, try to have these naps completed by 3pm to 3.30pm. (If your child is on a 7pm bedtime - 7am wake time. If bed and wake time are later then extend the time of the last nap accordingly). Naps are very important and should never be eliminated in the hope that the more tired your child is, the more likely they will not wake in the night. This is not how it works.

If you have concerns about your child’s sleep, do seek appropriate advice. Most sleep disorders, once correctly identified, can be successfully treated using behavioural techniques.