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Sleep

Children vary in the amount of sleep they need, right from the start. It is normal:

  • For a baby who has been sleeping through the night to wake up crying at odd hours
  • For a toddler to wake at midnight and want to talk and play
  • For a young child to be ready to start the day at 5am
  • For a child frightened by a bad dream or just feeling lonely to creep into your bed with you.

Problems start because most children need less sleep than their parents want them to have. If we're honest we want children to sleep all night for our sake, not theirs. We need the rest for them. It's impossible to keep going 24 hours a day. You can't make a child go to sleep but you can encourage 'good' feelings about going to bed.

Prevention of sleep problems

Many parents have sleepless nights as it is very common for pre-school children to be wakeful. Sleep problems can be treated in a variety of ways. What suits one parent may not be right for another. Here are a few suggestions about how you might be able to prevent problems occurring.

Between 4-6 months

  • Try to start a simple short pre-bedtime routine which is relaxing and calming.
  • Make sure that during the 15 minutes prior to going sleep your child does the same things in the same order every night.
  • If this includes looking at a book, having a drink beside the cot and saying goodnight to a few toys in the same order, this routine can be done on holiday or wherever you are. Make sure the toys you use are small.
  • Try to work towards encouraging your baby to fall asleep independently of you.
  • Avoid letting your baby fall asleep anywhere that he or she is not going to spend the whole night, for example the settee.
  • Avoid rocking, feeding to sleep, musical mobiles or light shows.
  • Try to discourage waking by making a clear difference between day and night, keep lights low, don't play, don't change nappies or move the baby out of the bedroom unless it is necessary.

Over 6 months

Try to avoid your baby napping during the day before 9am and after 4pm. A baby who had previously had a good night's sleep regularly, may develop a wakeful pattern after if routine is broken by a holiday or by a period of illness. If this happen and you are sure your baby is well; you can discourage waking by using 'controlled crying techniques'. [link to item below] The age that a baby will respond to this technique varies but it is usually around 6-9 months.

Toddlers

The most important thing is that bedtime is a happy, relaxed time not punishment time. Boisterous romps just before bedtime don't exhaust children but make them more excited. Time spent quietly together makes a child feel happy and secure. A child who feels cheated out of this attention can make countless more demands after bedtime. Routine, especially about going to bed, is really important. However, when you have been through the bedtime routine, try to make it clear that there are no more excuses to bring you back.

Young children

Lying in bed before going off to sleep and waking early can be made more enjoyable by having:

  • Toys, books or a bag of oddments nearby to keep a wide awake mind interested for a while.
  • A snack and a drink to keep him.
  • A small light or landing light on all night if your child is frightened of the dark.

Talk about this fear. Don't say how silly your child is but talk about someone you know who felt the same fear and who has now got over it. Some children wake in the night in terror of nightmares. Lots of cuddles and reassurance from you are the best thing. Firm 'no nonsense' handling helps a child. If there is begging to crawl into your bed and you don't mind, let your child stay. Maybe you'd prefer a short struggle – then back to bed. Maybe a drink and then being tucked up again will do the trick. BUT don't be playful – or they'll want more. As long as you've checked that there's nothing wrong, don't feel guilty about sending your child back to bed.

Controlled crying techniques

Do this together with making sure that your baby has a strict pre-bedtime routine and that he or she falls asleep independently of you.

1. When your baby wakes attend to his or her needs using the minimum verbal and physical contact possible.

Ideally:

  • Don't give a drink or feed
  • Don't take the baby out of the bed or cot
  • Don't put on the light
  • Do make the baby comfortable, gently and calmly
  • Do say 2-3 comforting words
  • Do stroke or pat the baby 2-3 times
  • Do leave the room.

2. Time the interval before returning (you may choose to wait for anything between 1-5 minutes depending on what you know about your baby).

3. Re-enter the room and carry out steps a-d again.

4. Time an increased interval before returning and repeat steps a-d again.

5. Continue to repeat this until your baby goes to sleep.

Be prepared for the problem to get worse for a night or two before it gets better. If you are unsure how to proceed, or are not entirely confident please do seek further help, which your health visitor will be happy to give. It is better for the problem to start confidently with a good technique than to confuse your baby with a half-hearted attempt. The controlled crying technique does not suit everybody. Your health visitor will be happy to discuss alternative methods with you.

Top tips for a good night's sleep

1. A good meal at teatime will prevent your child from waking with hunger

2. Some children kick off bedclothes so make sure your child is dressed warmly enough. Cold is a stimulant and will make a child more wakeful.

3. Avoid overheating. The child should not be so hot that s/he sweats, particularly if unwell.

4. Have a set routine at bedtime as much as possible. The last hour should be quiet. Exciting play, physical activity, exciting or frightening television programmes should be avoided during this wind down period.

5. A ritual of a bath or wash, drink, story, bed is suitable. Do not allow your child to over-extend this ritual, set a reasonable time limit.

6. Your child should be taken lovingly to bed, tucked in and goodnight said.

At this point, the day is finished and your child is expected to stay in bed, reading a book or playing with a toy if not sleepy. Your child may cry or get out of bed or come downstairs after being put to bed. It helps if parents use the following approach at this time:

Take your child back to bed without speaking or looking at him or her. Avoid eye contact. You are, in fact, trying to put your child back in bed whilst also ignoring him or her. Show no emotion. Do not tell your child off, show affection or any other emotion, tut, sigh or use physical gestures such as pushing, pulling or cuddling. Tuck your child in, whisper something like 'cuddle teddy' and leave. If your child refuses to lie down or continues to cry use the 'disappearing chair routine'.

Sometimes children may wander out of their room at night. A stairgate across their bedroom door will help to emphasise your rule that children should try and stay in their own room at night. This can be taken away later. A child in a cot will be attracted by the sights and sounds coming through windows and doors. They will know that they are missing out on all the interesting things going on while you are trying to get them to sleep. To encourage sleep it can be helpful to Position the cot away from windows and doors.

You may feel worn out as you try to establish a sleeping pattern with your child. This day to day struggle can be very difficult and stressful for the whole family and for your relationship with your partner. You may need to give yourself a night off and ask Grandparents or trusted friends to look after your child at night. Some children have more energy than others and they wake up wanting something to do.

It can help to make sure that there are toys in easy reach so they can amuse themselves when they wake up without waking you. Some children also take time to settle. Some favourite soft toys can help as a comfort. When you are trying to change your child's sleeping pattern if may be helpful to let your neighbours know. If your child cries and complains then they are prepared and you have less to worry about.

The disappearing chair routine

This can be used for the child who tries to keep you with them at bedtime, or who wakes during the night.

1. Put your child to bed with their usual routine.
2. Sit in a chair beside the bed reading a book (pretend if necessary). If your child is very upset you may need to sit on the bed.
3. Don't speak or look at your child.
4. If your child tries to get out of bed or sits up gently return him or her to the lying down position.
5. Every night the distance between you and your child should be increased. When the chair is outside the bedroom door you have completed the programme.

This process can take as long as you and your child need - several days to several months. Be prepared for the problem to get worse for a night or two. In some cases this just means that your child is testing you to see if you are really serious.

Making a new sleep routine is best started on a Friday night so that you are not under pressure and can outlast your child's attempts to sabotage the new routine.

This is only an outline. Each child is different and changes may need to be made before the routine is successful.

Nightmares

Sudden Partial Wakings

Behaviour - Extended periods of crying, sobbing, moaning with wild thrashing.

Typical age - 6 months – 6 years, occasionally in older children.

What to do

  • Go in to the bedroom to ensure your child does not injure him/herself.
  • Let the episode run its course.
  • Keep your distance. Don't forcibly help.
  • Only hold your child if s/he recognises you and wants to be held.
  • Do not shake or try to wake your child.
Watch for the relaxation and calm that signals the end of the episode. You may then help your child lie down. Don't make your child feel strange or different.

General suggestions

  • Make sure that your child gets enough sleep. Consider an earlier bedtime. Restart a nap if it was stopped without good reason.
  • Make sure that sleep and daily routines are fairly regular and consistent.
  • Professional advice may be considered if events are frequent and if they began around known stresses, or if significant and persistent stresses are present.

Calm Sleepwalking

Typical age - At any age from the time the child learns to crawl or walk.

What to do

  • Talk quietly and calmly to your child. S/he may follow your instructions and return to bed.
  • If your child does not seem upset when you touch him/her, you should be able to lead him/her back to bed calmly. Your child may want to stop at the bathroom.
  • Nothing will be gained by waking your child, who is unlikely to remember the sleepwalking in the morning and is not in any distress.
  • If your child wakes after the episode (which older children and adolescents commonly do), they will probably be embarrassed.
  • Do not make any negative or teasing comments.
  • Don't make your child feel peculiar or strange.
  • Treat the sleep walking in a matter-of-fact way.

General suggestions

  • For young children ensure adequate sleep and a normal schedule.
  • Occasionally, this will help older children as well.
  • Make the environment as safe as possible to avoid accidental injury.
  • Floors should not be cluttered, objects should not be left on stairs, and hallways should be lit.
  • If your child's walking sometimes goes unnoticed put a bell on the bedroom door so that you will be aware of it
  • If your child tries to leave the house an extra chain lock out of reach should be installed.
  • If your child sleeps in a bunk bed, the bottom bunk is safer.
  • Consider professional help.

Agitated Sleepwalking

Typical age - Middle childhood through adolescence.

What to do

If the agitation is marked, restraint will only make the event more intense and longer lasting. Keep your distance. Hold only if your child is starting to do something dangerous. Remember your child is unlikely to be in distress even though it may appear that way. When calm, treat your child as you would a calm sleepwalker.

General suggestions

Same as for calm sleepwalking.

Night Terrors

Behaviour - Screaming, look of panic and fear, possibly wild running. The child may cry out, talk, moan in a seemingly nonsensical way, and may have a glazed expression.

Typical age - Most commonly reported between the ages of 3 and 8.

What to do

  • Wait for the screaming to subside and then simply let your child return to sleep. S/he will be able to relax quite quickly and will have no memory of the night terror.
  • Do not try to wake your child.
  • Do not embarrass your child if he/she fully wakes.
  • If there is wild running and risk of injury, you may have to intervene, but be careful; both of you could be injured.
  • Talk calmly and block access to dangerous areas, but holding may be very difficult and can lead to even wilder behaviour.

Try to stay calm yourself. The most difficult aspect of a night terror is the fact that the child's sudden arousal, characteristic of night terrors, also wakes you up with alarm and without warning. It is you who is more likely to be in distress, not your child.

General suggestions

  • Your child may be safer sleeping on the ground floor.
  • If there is a threat of, or actual window breakage, consider replacing glass with an unbreakable type.
  • Use the same general precautions as for sleepwalkers.
  • Consult your GP for possible use of medication, especially if there is wild running.
  • If medication is used, it should be viewed as a temporary solution used mainly for protection.
  • Professional help should be considered. This is the case even if psychological factors seem minimal but arousals are frequent, intense and dangerous.
  • With all these behaviours talk to your child during the day and listen out for any worries.

Nightmares and night-terrors: how to tell them apart

Nightmares tend to happen during the latter half of the night, whereas night terrors happen in the first third. Nightmares are long, frightening dreams, which wake the sleeper and can be remembered in vivid and intense detail. A night terror is not a dream but an unusual awakening. Sleepers do not remember the night terror as they might a dream, they remember either nothing at all or a single frightening image.

Night terrors are a different biological phenomenon from nightmares. They can be considered a minor abnormality in the brain's sleep-wake mechanism, resulting in unusual arousals. They occur at a different stage of the sleep cycle, usually deep sleep, not REM sleep.

Both nightmares and night terrors can be influenced by stress or a difficult period in the family. Night terrors are likely to be worse with sleep deprivation or extreme tiredness, which is why it can help to keep to a regular bedtime routine.

Nightmares, like dreams, can be an opportunity to express and figure out the conflicts and worries of everyday life. Children may fear retaliation for their own angry impulses for example, which is why it can help to let your child know that their difficult feelings are perfectly normal and acceptable (even if some of the behaviours they show are not).

Your child may not recognise you or allow you to comfort after a night terror but can be consoled after a nightmare. Nightmares can be associated with daytime depression, whereas night terrors are associated with sleepwalking. After a nightmare your child might be frightened to go to bed or to sleep. After a night terror he/she will not have this fear.