Do you have trouble putting your child to sleep?
Maybe you could use the help of an occupational therapist. Bedtime problems and frequent night walking’s are very common in young children. Roughly 20%-30% of infants, toddlers and preschoolers have trouble getting the amount of sleep they need for their development there exists an abundance of research linking sleep disruption and/or insufficient sleep with negative effects on a child’s cognitive development. For example, if a child has trouble sleeping he or she may exhibit undesirable consequences such as chronic irritability, poor mood, difficulties with attention and concentration, difficulties with learning and memory retention as well as lower immune function. The reason for bedtime resistance and night time walking in young children is influenced by a myriad of biological, environmental and social factors such as the child’s bedroom, sleeping arrangements and parenting styles1. Other reasons may be sleep apnea, insomnia, bed wetting, or circadian rhythm sleep disorder. You may want to consult a physician to rule out any medical condition that may be troubling your child’s sleep. However if there are no medical abnormalities causing breathing obstructions, pain or visceral dysfunction, an occupational therapist can help you discover strategies and ways to get your child to fall and stay asleep.
TYPICAL SLEEP PATTERNS/CIRCADIAN RHYTHMS /SLEEP-WAKEÂ CYCLES IN CHILDREN:
NEWBORNS (0-3MONTHS)
Newborn babies, sleep pretty much all day and their sleep-wake cycles have much to do with their need to feed and have their diaper changed. Newborns sleep on average 10.5 to 18 hours a day on an irregular schedule. It is not uncommon for the newborn to only be awake one to three hours at a time. They usually have multiple naps a day lasting from a few minutes up to several hours. When asleep, it is normal for the infant to appear restless (twitching their arms and legs, smiling, and sucking).
INFANTS (4-11 MONTHS)
By 6 months, many babies sleep through the night, some may or may not need a feeding. By 9 months, 70-80 % of infants will sleep through the night without waking. Babies normally need 9-12 hours of sleep per night and take 1 to 4 naps of thirty minutes or more during the day. As they age they will need fewer naps.2
TODDLERS (1-2 YEARS)
Toddlers require approximately 11-14 hours of sleep within 24 hours. When they reach about 18 months of age their naptimes will decrease to once a day lasting about 1 to 3 hours. Parents should try to avoid naps close to bedtime as they may interruption the child’s ability to fall or stay asleep.
PRESCHOOLERS (3-5 YEARS)
Preschoolers usually need about 11-13 hours of sleep each night and most no longer require a nap after they’ve reached five years old.
SCHOOL-AGED CHILDREN (6-13 YEARS)
Children aged six to 13 need 9-11 hours of sleep and no longer need naps during the day.
If your child isn’t getting the amount of sleep he or she needs for their age, they may be suffering from a form of child insomnia. Insomnia is a sleep disorder, which characterized by difficulty falling and/or staying asleep. When insomnia occurs in childhood it is called behavioral insomnia of childhood, which can be categorized into two subtypes; the limit-setting-type and the sleep-onset-type.
If your kid exhibits bedtime problems such as bedtime stalling and bedtime refusal ( verbal protest, crying, clinging, refusing to go to bed, getting out of bed, attention seeking behavior, and multiple requests for food, drinks and stories) your child may have behavioral insomnia of childhood, which can be characterized as the limit-setting-type. This may occur when parents demonstrate difficulties enforcing bedtime limits appropriate for the child.
When the child has difficulty staying asleep, he or she might night walk or wake up crying, which is the sleep-onset-type of behavioral insomnia of childhood? This type of insomnia is where the child relies on sleep onset associations (external cues) such as rocking, feeding and parental presence to fall asleep. Once awaken, these children are unable to self-sooth and fall back asleep, they then require parental assistance to return to sleep. Sleep-onset-insomnia is usually problematic when the child cries for a long time, protests and gets out of bed frequently and for a prolonged period of time.
WHAT CAN YOU DO TO HELP YOUR CHILD SLEEP?
There exists many strategies and treatments to help your child get the sleep he or she needs. There are 5 proven treatments
or methods to help put your child to sleep. They are : the extinction method also known as the cry it out method, the graduated extinction method, positive bedtime routines, scheduled awakenings and parent education and prevention. An occupational therapist can help the family discover which treatment would best suit them. They may also look into or evaluate to see if there are no other factors which may be contributing to the child difficulty sleeping, such as sensory, developmental or environmental issues. Often the family only needs 1-3 treatments or sessions in order to implement the strategies or solutions.
A. EXTINCTION:
Is when the parent puts the child to bed at a designated time and then ignores the child until a set time the next morning. (The child is still monitored, but the parents ignore all behaviors related to stalling and refusal such as crying, tantrum, and parent calling)
B. GRADUATED EXTINCTION:
Is where parents are typically instructed to ignore bedtime crying and tantrums for a specific period of time. Then the parent will check –in on the child. The duration or intervals between check-ins as well as the duration of the check-ins themselves will gradually decrease. Check-ins will vary depending on child’s age and parents tolerance to their child’s crying.
C. POSITIVE ROUTINES:
A positive routine involves the parents developing a set bedtime routine characterized by quiet activities that the child enjoys. This extinction and graduated extinction methods, where the child is supposed to be in bed and a certain hour and woken up at a certain time in the morning. Furthermore daytime naps are discouraged, with the exception of age appropriate naps.
D. SCHEDULED AWAKENINGS:
Is where the parent awaken and console their child approximately 15-30 minutes before a typical spontaneous awakening. When using this strategy, parents must establish a baseline of the number and times their child spontaneous awakens during the night. Only then can pre-emptive awakening be scheduled. Then parents are asked to spread out or gradually increase the time between awakening their child.
E. PARENT EDUCATION PROGRAMS:
Include preventative information, such as how to establish positive bedtime routines, various methods to put your child to sleep such as how to handle your child and how to deal with your child when he or she wakes up in the night. They also prone putting your child to bed when he or she is drowsy but not awake to help them develop self-soothing strategies. They may also provide information about typical sleep patterns in children in order to better inform the parents to what is normal or atypical and when to seek help from a professional.
SLEEP TIPS
- Observe baby’s sleep patterns and identify signs of sleepiness (eye rubbing, yawning…).
- Put child in the crib or bed when drowsy, not asleep.
- Encourage night time sleep: Newborns can be encouraged to sleep less during the day by exposing them to light and noise, and by playing more with them in the daytime. As evening approaches, the environment can be quieter and dimmer with less activity.
- Develop regular daytime and bedtime schedules.
- Create a consistent and enjoyable bedtime routine.
- Establish a regular “sleep friendly” environment.
- Encourage baby to fall asleep independently and to become a “self-soother.”
- Maintain a daily sleep schedule and consistent bedtime routine.
- Make the bedroom environment the same every night and throughout the night.
- Set limits that are consistent, communicated and enforced. Encourage use of a security object such as a blanket or stuffed animal.
- Have a relaxing bedtime routine that ends in the room where the child sleeps.
- Child should sleep in the same sleeping environment every night, in a room that is cool, quiet and dark – and without a TV or other electronics.
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