Sweet Z-z-z-z-z's: The World of Childhood Sleep
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Sweet Z-z-z-z-z's: The World of Childhood Sleep

sleeping child Healthy child development requires sufficient slumber. So, when a young child fails to fall asleep at an appropriate hour, both parents and child suffer.

Ideally, it starts with a yawn and maybe a story somewhere in the early evening.

But all too often, it progresses through successive glasses of water, a graham cracker or other small snack, perhaps another story, some prayers, more kisses for mom, dad, grandmother, grandfather, and even the pets. Then comes yet more water and two or three suddenly remembered anecdotes from a busy day.

Bedside lamps, night lights, and hallway lights are turned off and on so much they blink like Christmas tree decorations. The bedroom is alternately too hot, too cold, too stuffy, and too filled with scary monsters lurking in closets and under beds. The bedroom door is opened and shut more times than an exit door on a rush-hour bus.

Around 10 pm or 10:30 or even 11:00, tempers of busy working parents start to fray, and anger becomes apparent. Adult voices raise while tears well up in little eyes.

It's Bedtime for Young Children

alarm clock Many pediatricians report the number one complaint among parents and caretakers of five-year-old children is bedtime and its associated rigors. Yet you really can't blame the kids; life is so new and exciting that young children just don't want to face the sandman.

Experts say five-year-olds are at their manipulative, pleading best when angling for ways to stay up past their normal bedtimes. And parents sometimes respond to that manipulation in ways that give children more control over adult behavior than might seem appropriate.

For example, one five-year-old would only fall asleep on the family motorboat. After a nightly ride on the lake, he was carried back onto the dock, into the family bus, back home, out of the car and, finally, into his own bed and deeper into the land of nod.

Why Fight It? Is Sleep That Important?

However they get them, those z-z-z-z-z's of childhood slumber are more than just sweet. They are absolutely necessary for healthy young development.

One recent study of sleep-deprived persons revealed that the body's immune defenses nap after lost sleep. The good news is that a sound night's sleep restores those cells to their former levels of effectiveness.

Researchers think that sleep, like fever, may represent a basic defense mechanism in our bodies.

While observational studies don't allow researchers to say whether poor sleep quality is a cause or a result of depression and low self esteem, other sleep researchers have linked a lack of sleep in young children to a whole host of daytime woes. These include hyperactivity, behavior problems, learning difficulties, and that dreaded condition feared by all parents: the cranky child. Sleep disturbance and behavior disorders are likely associated in children, even if it is rarely possible to say with certainty which causes which.

Make Use of Transitional Time

child in bath Because many parents work and the whole household rises early, bedtime is more important than ever. "To get kids to go to bed on time, the caregiver must be consistent," says Arthur Maron, MD, pediatrician and chairman of graduate medical education at St. Barnabas Medical Center in Livingston, New Jersey. "Children must know that tonight, and tomorrow night, and the night after that, bedtime is always 8:00 pm." But merely knowing the rules may not change children’s behavior unless parents are imaginative in their techniques for enforcing bedtime.

One useful technique recommended by experts is the effective use of "transitional time" between normal evening activities and bedtime. Quiet, low-key activities such as bedtime stories, prayers, singing, warm baths, cuddling, and quiet talk make for good transitional time. Many children have a favorite teddy bear or toy they associate with bedtime each night.

Wrestling and other roughhousing, exciting videos or shoot-'em-up television shows just before bed should be discouraged. On the other hand, exercise is very important for creating the kind of fatigue that leads to good nightly sleep. For a variety of reasons, many children do not get adequate opportunities for exercise during daylight and early evening hours. Increasing exercise—thought not in the transition hours—may be a good technique to improve sleep for some children.

And don't forget the warm bedtime glass of milk—especially if followed by a good tooth brushing.

Don't Be a Sleep Assistant

The average five-year-old needs about 11 hours of sleep daily, several hours of which can be spent napping. Remember the motorboat boy? It's a perfect scenario of what not to do. Eventually, a kindly pediatrician showed the wind-blown parents a better way.

"Establish a bedtime routine when the child is an infant and stick to it," says Donald Shifrin, MD, associate clinical professor of pediatrics at the University of Washington in Seattle. "It's far easier to deal with a little fussiness now than a power tantrum later. And, don't use television as a transitional device. For young children, TV should be a daytime thing." "Too often, children think of a parent as a 'sleep assistant,'" says Dr. Shifrin. "If you develop a bad habit like lying down with the child to get him to sleep, it will be a requirement from then on. Every time that child wakes, he expects to see mom or dad there with him."

Instead, parents should think of themselves as "drowsy assistants" who help set the mood for a good night's sleep. The American Academy of Pediatrics recommends waiting several moments when a child calls out from bed. The idea? Give the child a chance to fall asleep on her own each time she calls out. Then, stop farther from the child's bed every time you go to her room. Soon, you can just answer from an adjoining room.

Jimmy Wants to Sleep With Us. Is That Okay?

Another destroyer of restful childhood sleep is something scientists refer to as "co-sleeping." That's when young children make a habit of crawling into bed with mom and dad in the wee hours.

One study has approved of an occasional (once a month or so) session of bed sharing. But children who get into the habit of sleeping with their parents may suffer chronic sleep problems and attendant daytime woes. The co-sleeping study of 303 families was first reported in 1990 at the University of Massachusetts Medical School in Worcester, Massachusetts. Young children who routinely slept with their parents more than once a week proved 10 times more likely to dislike sleeping alone and up to four times more likely to resist going to bed. The study suggests that habitual bed sharing makes it more difficult for a child to get a full night's sleep.

"Co-sleeping is a hard habit to break once parents start," says Deborah Madansky, MD, pediatrician and study co-author. "Many children who sleep with their parents are restless and tired during the day." To get children to sleep solo, experts say to offer a morning reward when the child spends the night in his or her own bed.

Keep a Sleep Diary

If you think your child may have a sleep problem, the American Academy of Pediatrics recommends keeping a sleep diary. Ray Coleman, MD, a Washington, D.C. expert on child sleep, offers this advice, "Record for the doctor where the child sleeps, what time he was put to bed, how long it takes him to fall asleep, the time he gets up in the morning, the time and length of naps, if he woke up at night, what you did to comfort him, changes or stressful events in the home, and even the time the caretakers went to bed." Stressful events worth considering in a sleep diary include a new sibling, teacher, or school, fights between parents, divorce, and a death in the family.

Also, consider what happens during the day. Does the child get a lot of daytime sleep? Is he overstimulated by watching too much television or playing too many video games? Record some of this information in a sleep diary which you may wish to show to your child’s pediatrician.

With overstimulation and other factors in check, bedtime does not have to be the day's most difficult event. And there's certainly no need to rush out and buy a speedboat to lull a young child to sleep.

RESOURCES

American Academy of Pediatrics
http://www.aap.org

The American Academy of Sleep Medicine
http://www.sleepeducation.com/

The National Sleep Foundation
http://www.sleepfoundation.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References

American Academy of Sleep Medicine. International classification of sleep disorders. 2nd ed. Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine; 2005.

Madansky D, et. al. Co-sleeping in a community: sample of two- and three-year-old children. Pediatrics. 1990;86:197-203.

Parent/child sleep guide. The Better Sleep Council website. Available at: http://www.bettersleep.org/.

Sleep problems in children: guidelines for parents. American Academy of Pediatrics website. Available at: http://www.aap.org/.

Sleep tips for teens. The Better Sleep Council website. Available at: http://www.bettersleep.org/.

Weissbluth M. Naps in children: 6 months-7 years. Sleep. 1995;18:82-87.



Last reviewed March 2008 by J. L. Chang, MD, FAASM, D, ABSM

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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