The world of childhood sleep
By Charles Downey
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 cracker or other small snack,
perhaps another story, some prayers, more kisses for mom,
dad, grandmother, grandfather, and even the pets. 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 p.m. or 10:30 or even 11:00, tempers of busy working
parents start to fray, and anger becomes apparent. Adult voices
rise while tears well up in little eyes.
It's bedtime for young children
Many paediatricians 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 new and exciting and young children just
don't want to face sleep.
Experts say five-year-olds are at their manipulative, pleading
best when finding ways to stay up late, past their normal
In one case, a five-year-old created an elaborate bedtime
ritual that involved a ride on a lake in a motorboat. The
child would only fall asleep amidst the roar of the speeding
boat and was then 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, Sleep is absolutely necessary for healthy
One recent study of sleep-deprived persons revealed that the
body's immune defences reduce 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 defence mechanism in our bodies. Alice Carskadon, PhD,
a sleep researcher nd professor at Brown University in Providence,
Rhode Island, studied 39 slumbering children. She found that
kids with poor sleep quality had higher levels of depression,
hopelessness, and low self-esteem.
Other sleep researchers have linked a lack of sleep in young
children to a whole host of daytime woes, including hyperactivity,
behaviour problems, learning difficulties, and that dreaded
condition feared by all parents: the cranky child.
Because many parents work and the whole household rise 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, paediatrician and chairman of graduate
medical education at St. Barnabas Medical Centre in Livingston,
New Jersey. "Children must know that tonight, and tomorrow
night, and the night after that, bedtime is always 8:00 p.m."
Make use of transitional time
Experts recommend using "transitional time." 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 favourite 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.
"Too often, children think of a parent as a 'sleep assistant,'"
says Donald Shifrin, MD, associate clinical professor of paediatrics
at the University of Washington in Seattle, Washington. "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
Instead, parents should think of themselves as "drowsy
assistants" who help set the mood for a good night's
sleep. The American Academy of Paediatrics 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
Other items that can interfere with childhood sleep are a
new sibling, a new teacher or school, fights between parents,
or a divorce or a death in the family. 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 paediatrician showed the wind-blown
parents a better way.
"Establish a bedtime routine when the child is an infant
and stick to it," says Dr. Shifrin. "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, T.V. should be a daytime thing."
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, paediatrician and study co-author.
"Many children who sleep with their parents are restless
and tired during the day."
Is my child's snoring normal?
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.
Once a child does sleep alone, caregivers should hear no snoring
or other wheezing sounds at night.
"Too many people believe snoring is normal," says
Dr. Rafael Pelayo, MD, head of the Paediatric Sleep Disorders
Clinic at Stanford University Hospital in Stanford, California.
"Actually, snoring is a problem of blocked breathing
and can be cured by removing the child's tonsils and adenoids."
If a child is not breathing properly, he or she will tend
to be underweight and may have behaviour problems during the
day. "When I find a five-year-old with night breathing
problems, it's because the parents have brought the child
in due to misbehaviour problems at school," says Dr.
Pelayo. "A child who does not get enough sleep will spend
his days fidgeting, doodling, teasing other children and not
paying attention in school. Sometimes these children are mislabelled
with attention deficit disorder problems."
Many snoring children are also bed-wetters. Nights become
dryer, though, when the snoring is stilled. Snoring youngsters
may also sweat profusely at night and be underweight because
the breathing obstructions force them to expend far more calories.
They usually gain weight after the tonsillectomy. Moreover,
a child's growth hormone is secreted at night, so anything
that disrupts sleep also interferes with proper growth.
Keep a sleep diary
If you think your child may have a sleep problem, the American
Academy of Paediatrics recommends keeping a sleep diary. Adds
Ray Coleman, MD, a Washington, D.C. expert on child sleep:
"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."
Also, consider what happens during the day. Does the child
get a lot of daytime sleep? Is he over stimulated by watching
too much television or playing too many video games?
With over stimulation 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.
"Co-sleeping in a Community Sample of Two and Three Year
Old Children," by D. Madansky, et al. al. Pediatrics,
Vol. 86, No. 2, August, 1990, pp. 197-203.
"Naps in Children: Six months to Seven Years," by
Marc Weissbluth. An excerpt from Sleep: The American Sleep
Disorders Association and Sleep Research Society. To order
reprints, contact Marc Weissbluth, MD, 680 North Lake Shore
Drive, Suite 123, Chicago, IL 60611.
"Sleep Problems in Children: Guidelines for Parents"
is a brochure available from the American Academy of Pediatrics,
Division of Publications, 141 Northwest Point Blvd., P.O.
Box 927, Elk Grove, IL 60009-0927.
"Parent/Child Sleep Guide" and "Sleep Tips
for Teens" brochures are available by sending a self-addressed
stamped envelope to The Better Sleep Council, PO Box 1953,
Alexandria, VA 22320-0534.
National Sleep Foundation