A Letter to the Nurturing Center Whose Baby Doesn't Sleep Well

One of a parent's most treasured moments is to look in on a child who is sleeping peacefully. The value of sleep can be measured by your child's natural energy, smiling face, and happy nature during the daytime. Sleep is a vital part of how a child's body and mind grow and develop. Behavior or developmental problems can arise when a child does not sleep well. A child's sleep problems can also turn an entire family's life into a bad dream. The sleepless nights and unwanted stress that result can often be avoided. As a parent, your role is to help your child start healthy sleep habits that will last the rest of his life.

There is not one set way for every child to sleep. Your child may sleep in the following ways:

• Alone
• In a room with other siblings or parents
• In the same bed with someone else

The key is to begin a consistent pattern that helps your child get a good night's sleep. This pattern also needs to carry over into naps during the day. You also need to be able to detect any sleep problems your child may have. Then you can take the steps needed to help him get better sleep. If your child has a problem with sleeping, be sure to talk to his doctor about it.

Children's sleep is a subject that puzzles many parents. A young child's need for sleep is so much different from that of adults. But did you know that by six months of age, a child can sleep at least nine hours at night? This may sound like a miracle to some frustrated parents. All children sleep for different lengths of time - some shorter and some longer. But most children do have the ability to sleep through the night.

I. Problem Signs

Signs that your child has a problem with sleep might include the following:

• You spend too much time "helping" your child fall asleep.
• Your child wakes up many times during the night.
• Your child's behavior and mood are affected by poor sleep.
• You lose sleep as a result of your child's sleeping patterns.
• Your child's poor sleep hurts your relationship with your child.
• Your child constantly tosses and turns during sleep.

Most of the sleep problems in children are very common. They can be corrected quickly once you detect them and learn what to do. Normally you can solve the problem with a little guidance and some common sense. Talking with other parents and with your child's doctor can also give you some good tips. For more rare or severe problems, you may want to talk to a sleep specialist.

II. Bedtime Routine

Preparing for bed can be scary for many young children. They are afraid of being alone and away from their parents. As a parent, it can be hard for you to be apart from your child as well. It is natural for you to want to comfort your child and keep him close to you. Putting him to bed may be hard at first, but a consistent bedtime routine can be one of the richest ways for you and your child to spend time together.

Plan a bedtime routine that is close to the same time every night. Change clothes, wash up, brush his teeth, and prepare the bed. Then set aside from10to 30 minutes for special quiet time with your child. Read a book, sing songs, or play a quiet game. The activity should not be very active. Avoid doing things like jumping, running, or wrestling. You should also keep from telling scary stories.

Your child needs to know the limits for this time. Make sure that you do not exceed them. Giving in to requests for extra juice or for another story will begin bad habits. It will teach your child that bedtime can always be put off. A good routine will make the evening more relaxed, calm, and quiet.

III. Three Common Sleep Problems In Young Children

1. Needing Help to Fall Asleep & Go Back to Sleep

"I'm exhausted. I have to rock my child to sleep every night and for every nap. If she wakes up during the night, she won't go back to sleep until I rock her again."

"The only place my child will nap is in the car. I have to drive around town to get him to fall asleep. Sometimes we end up staying in the car for an hour or two."

Many parents have felt these same frustrations. Tired and weary, they will do anything to get their child to go to sleep. While these solutions work in the short term, they begin bad patterns that can last much longer. The child learns to connect or "associate" going to sleep with a person or activity.

Many adults have their own sleep "associations." Maybe you must have a certain pillow in order to be able to fall asleep. If the pillow is missing, you toss and turn as you try to go to sleep. The same is true when you wake up during the night. If you find your pillow is not in the bed, you will begin to look for it so you can easily go back to sleep. You "associate" your pillow with falling to sleep.

If your child refuses to go to sleep unless you are with them, you "become their pillow." This is what is going on with the child who needs to be rocked, nursed, or held to fall asleep. The child who needs a car, stroller, or swing to fall asleep has learned to associate sleep with these movements. In these cases, when the other person or action is missing, your child is unable to fall asleep. This problem is called "sleep-onset association."

It is normal for adults and children to wake up a number of times during the night. It occurs most often during the deep stage of sleep when we dream. Adults tend to be unaware of waking up and quickly go right back to sleep.

Young children respond in a much different way. They may feel very insecure when they wake up. As a result, they cry, scream, and do what they can to get someone's attention. The natural response from parents is to comfort the child. They may feel that they need to "help" their child return to sleep. They do this by feeding, rocking, holding, or lying down with the child.

As they do so, the child learns that this "help" pattern will always occur to assist him in going back to sleep. Many young children are then unable to fall asleep without the help of a parent. They depend on the parent, instead of finding comfort in a blanket or stuffed animal. Knowing this can create stress for the parents. They naturally want to comfort their baby. But at the same time, they want and need him to learn to sleep well by himself.

How Can My Child Learn to Go to Sleep Without My Help?
Parents need to know that a baby really can fall asleep on his own once he is given the chance to do so. This does not mean that you should ignore your baby's cries. You must always make sure that your child is safe. You also need to know if he is crying because he is hungry, sick, or wearing a dirty diaper.

Young children often have teething pain, colds, or ear infections that wake them up from sleep. In these cases, you may have to get up and tend to their needs. Newborns and young infants in particular will require a lot of attention through the night. They will need frequent feedings and diaper changes. But once your child is six months old, he should be able to sleep through the night on his own.

To correct your child's sleep problem, you must teach him to fall asleep with a new set of associations. He must no longer depend upon a response from you. The child must learn to make these new connections during all times of sleep. This includes naptime, nighttime, and after waking up at night. It is best to begin this learning process at night. Some parents, however, will choose to do it during naptime.

During this learning process you should expect your child to cry at first. You must keep in mind that you are not abandoning your child. If you are organized and consistent in this process, you can have success. You will be able to encourage and reassure your child, while also helping him fall asleep on his own.

A Plan that Works
This plan will help a child learn to sleep on his own when he is between six months and three-years-old. After your quiet bedtime routine, place the child in his crib or bed. He can be awake or drowsy. Say "goodnight" and leave the room, making sure that the room still has a little bit of light. If your child is still crying after a waiting period of two minutes, return to the room. Don't turn on any lights or pick your child up from the crib or bed. Also don't hug your child or give in to new requests for juice or another story.

You can comfort your child with words and by gently patting him on the back. After one or two minutes, leave the room again. Do not stay for a longer amount of time. Stay away from the room for a waiting period of five minutes. If your child is still crying after that time, return to the room to comfort him again. After one or two minutes, leave the room. Use the following chart to see how long to wait before returning to the room for each additional time. Be sure to never stay in the room for more than about two minutes at a time.

Plan for Helping a Child Fall Asleep on His Own
(The following chart represents only one example. Waiting times can vary from child-to-child. Only you can determine the correct amount of time to wait before responding to your child's crying. Some children can tolerate less, others more. It is most important to be consistent, regardless of the waiting time chosen.)

Wait Periods	1st Time	2nd Time	3rd Time	4th Time +
Night 1	2 minutes	5 minutes	10 minutes	15 minutes
Night 2	5 minutes	10 minutes	15 minutes	20 minutes
Night 3	10 minutes	15 minutes	20 minutes	25 minutes
Night 4	15 minutes	20 minutes	25 minutes	30 minutes
Night 5	20 minutes	25 minutes	30 minutes	30 minutes

+ Same wait period for all additional times that they may wake up

The goal is to gradually help the child get used to falling asleep without your help. He will become more secure as he learns that you are still nearby even when you are not in the room. He learns that he can get you if he needs you, but he should not need you to go to sleep. This process can be extremely hard for the parents. Counting the minutes while listening to your child cry can be heart-wrenching. In fact, it is likely to be harder for the parents than for the child. But this plan is the key to helping your child learn a healthy sleeping pattern. When you don't remove your child from his crib or bed, you are helping him learn to fall asleep alone.

All of the caregivers who tend to the child at night must be committed to this plan. This includes parents, grandparents, and other siblings. Everyone will be tempted to pick up the child to get him to stop crying. But you have to be consistent for it to work. You will hinder the plan if a caregiver decides to pick the child up or give him a pacifier "just this one time."

Your child should improve at falling asleep after several nights if you are consistent. You may want to start the plan on a Friday night. This will get the nights when you sleep the least out of the way before the workweek begins on Monday. If your child does not improve after five nights on this plan, then make sure that everyone who tends to the child at night is following the plan correctly. It is also possible that your child just needs more time to fully adjust to the change. Being persistent and not giving up will pay off.

A Plan for Older Children
Sometimes older children have trouble sleeping because they are scared. They might have had a bad dream or seen a scary movie that makes them afraid to go to sleep alone. Often parents will lie down next to the child to help him fall asleep. This process can be hard to break once the child becomes used to it. The following plan should be helpful. This method is called "desensitization." It should also be used consistently to help the child take naps and when he wakes up at night.

Explain to your child that you will stay with him until he falls asleep. Also tell him that instead of lying in bed, you're going to sit in a chair right next to the bed. For several nights allow your child to fall asleep with you sitting next to the bed. Then, move the chair farther away from the bed and closer to the door.

Over the course of several nights, gradually move the chair closer and closer to the door. Eventually the chair should be moved out of the room. The door may be left open for a child who does not get out of bed.

Depending on the child, this process may take from one to three weeks. For the older child, you can also use rewards to encourage him in the process. This kind of "positive reinforcement" will motivate him to fall asleep on his own again. You can give him small prizes or make a chart with star stickers to show his progress. Always be sure to praise him verbally for trying and for improving.

2. Nighttime Eating/Drinking Disorder

"My child is hungry during the night. I feel like I have to give him more to eat (or drink) all night long. I'm exhausted."

This complaint is a sign of excessive nighttime feeding. This is often a problem for infants and young children. It is normal for a newborn to eat every couple hours. But once a child is a few months old, several feedings during the night can be more than he needs. Even one nightly feeding after a child is six or seven months old is probably not necessary.

Children who become hungry during the night can wake up many times. They will then be unable to return to sleep without being fed. A child who is used to being fed several times during the night may learn to feel hungry at those times even when food is not needed. The parent's task is to teach the child to feel hungry at a better time of the day.

A child who is at least five or six months old should not need to drink more than eight ounces of fluid during the night. A child at this age should not need to nurse more than once or twice or for longer than two to three minutes at a time. A quick way to tell if your child is taking in more fluid than needed is to check his diaper. If your child has a soaked diaper whenever he wakes up at night, then he may have a nighttime eating/drinking disorder.

You can end the habit of unnecessary feedings at night. Start by gradually reducing the frequency of feedings. This is a much better idea than stopping them altogether.

For an infant who feeds every hour and a half at night, the parent should do the following:

• Wait at least two hours between feedings the first night.
• Wait 2 ½ hours between feedings the second night.
• Gradually increase the time between feedings each night until all nighttime feedings are eliminated.

This process may take one to two weeks. If your child takes a bottle, you can also try gradually decreasing the amount of milk at each feeding by one ounce per night.

3. Limit-Setting Problems

These problems usually begin after a child is two-years-old. This is when your child refuses to go to bed, stalls, or makes it hard for you to leave the bedside. Limit-setting problems can occur at bedtime, naptime, or when your child wakes up during the night.

Parents need to assert that they are the ones who decide when it is time for bed. This should be a regular time each night. It should not vary from night to night, depending on how active or alert the child seems.

Children can get very creative when they want to stay up longer. They may ask for one more hug, a tissue, a drink of water, another story, to have the light turned off or on, or to "tell you something important." It can be hard to know when their requests are real and when they are only a delay tactic. You need to be firm and consistent when you respond to the delays. Giving in to them will only encourage the behavior. Parents need to give their children well-defined limits.

An older child who sleeps in a bed may have the problem of getting out of bed many times during the night. In this case, a gate can be placed in the doorway or the door can be closed until you are sure your child is staying in the room. Gates are better than doors until your child is too big. With a gate, children are still able to see out of the room. A closed door can frighten some children. For a child who has learned to climb over a gate, you should use a taller gate or simply begin closing the bedroom door. The gate or door should be kept closed all night. You can tell your child that you will gladly open the door again when he or she stops trying to leave the bedroom.

You should avoid going into the room to comfort your child. Instead, stand on the other side of the gate or closed door and speak to your child in a calm voice. Wait for gradually longer periods of time before responding to the child. If you are using a gate, you should be out of the child's sight. When closing the door, you will want to respond quicker at first. The purpose is not to frighten the child. Wait only a few seconds the first time and gradually work up to a few minutes.

A child will sometimes fall asleep on the floor near the gate or door during this learning process. For older children, a warning that you will close the door may motivate them to stay in bed. This will only work if you follow through with the warning by actually closing the door if they get up.

Parents need to understand the importance of setting limits during the day and at night. A reward system may also help to reinforce a child's good behavior. It is also wise to discuss your bedtime routine with babysitters and other caregivers. You want them to be able to stick to your routine and your limits when you are not home at bedtime.

IV. Tips To Help Your Child Sleep Better

1. Set a consistent bedtime routine and stick to it.
2. Set and establish a consistent morning wake-up time.
3. Establish a setting in your child's bedroom that is calm and relaxing.
4. Interact with your child at bedtime. Don't let a TV, video, or computer take your place.
5. Do not allow children to watch anything that is not right for their age. This applies during the day and at night. Be aware of images that may frighten them.
6. Do not let your child fall asleep while being held, rocked, fed a bottle, or while nursing.
7. Do not allow your child to have foods or drinks with caffeine at bedtime. This includes chocolate and sodas. Try not to give him any medicine that has a stimulant at bedtime.

Remember:
A child who sleeps well will fall asleep easily and wake rarely during the night. He is also more likely to be happier and healthier overall. The better the child sleeps, the happier the entire family will be.

It is also important for you to understand that many sleep problems in children are both common and natural. They are not a result of poor parenting. They are also not a sign of a serious physical or mental problem with your child. If your child continues to have problems, be sure to talk them over with a doctor.

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A Letter to the Nurturing Center Whose Baby Doesn't Sleep Well

Source: https://www.uclahealth.org/sleepcenter/sleep-and-children

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