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Comprehensive Health Care for Infants, Children & Young Adults
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SLEEP – A PART OF OUR LIVES

We all experience a daily pattern of awake and asleep periods. Interestingly, these begin even before we are born. Sleep, as we know it, is a grouping together of 60- to 90-minute cycles of sleep. During a cycle, we are in one of two states of sleep – either rapid eye movement (REM) sleep or non-rapid eye movement (non-REM) sleep. The way to best remember these two terms is that either our eyes are moving underneath closed eyelids (REM sleep), or our eyes are at rest (non-REM sleep).

Below is a brief discussion of each of these states of sleep. You need to understand the difference between them so you can act in ways that benefit your child, yourself, and your household routine.

When Your Child Is In Deep Non-REM Sleep

During the deepest stages of non-REM sleep, your child's body is relaxed and his or her mind is fairly free of thoughts or dreams. Breathing is slow and regular. Your child is difficult to awaken at this time and won't easily be disturbed by the noises of normal household activities.

When Your Child Is In REM (Dreaming) Sleep

During REM (dreaming) sleep, your child's eyes are closed, but, as mentioned before, bursts of rapid eye movements occur under the closed lids. You may see your child's hands, legs, or muscles in the face twitch. During the early months, sucking may occur. Even though your child can awaken more easily from dreaming sleep than from deep, non-dreaming sleep, he or she usually can learn over time to fall back to sleep alone.

Your Sleepy Newborn

Generally, your new baby sleeps a total of about 16 hours a day. But, as you've noticed, your newborn isn't able to sleep more than a few hours at a time. Your baby goes through about seven different asleep/awake cycles each day. These cycles are fairly evenly spaced over 24 hours.

Your 3- to 5-month old Baby

By 3 or 4 months of age, your baby probably will sleep a little less – about 13 to 15 hours daily. This sleep may occur in four or five periods, with most of them during the night. Even though many babies this age briefly awaken at night, they can quickly go back to sleep by themselves. So, when you say that your baby now "sleeps through the night," you really mean that you are no longer aware of his or her wakings and now you can sleep through the night!

Your 6-month old Baby

Your baby will sleep a total of over 14 hours by this age, with about 12 hours at night. Your baby probably welcomes a 1- to 3-hour nap both in the morning and in the afternoon.

Between 6 months and One Year

Your baby reduces total daily sleep by about a half an hour during this time. However, he or she probably still wants two daytime naps.

One Year

Around the first birthday, your child probably will sleep a total of about 14 hours a day. Your child may still be taking two naps a day, but within a few months he or she likely will be taking only one.

Two Years

By 2 years old, your child probably is still napping once a day. The total amount of time your toddler sleeps during the night and day is about 13 hours.

Three Years and Older

Your 3-year old probably will start napping inconsistently now and soon will not nap at all. Nighttime sleep will be a little less than 11 hours by school age.

YOUR BABY AND DAILY SCHEDULES

All of us do well when we have reasonable and consistent times for the events of our daily lives, including sleep. As your child grows, a regular schedule makes him or her – and you – feel comfortable and leads to good behavior from your child.

The Daily Schedule and Feeding

Your Baby's First Weeks

Your baby may take 6 to 10 weeks to settle into a 24-hour schedule that you can count on. Schedules that you develop for feeding your baby affect your baby's pattern of daily sleep. Early on, expect to feed your baby every 2 to 4 hours, day and night. Breastfed babies require more frequent feedings. These feeding schedules can be tiring for mothers, so they must learn to rest when their baby does.

When Your Baby Is 3 To 4 Months Old

As your baby reaches 3 to 4 months of age, you'll probably know when he or she wants to wake up, play, feed, and sleep. Some babies seem to be able to satisfy their sucking urge during feeding. Others seem to want to suck constantly, including  their thumb or finger.

If you offer a pacifier, use only a commercially made one that meets safety standards and doesn't have a cord. Only use it when your baby is awake. If a baby loses grip on a pacifier after falling asleep, he or she may not find it upon wakening and will cry. A hand or finger is always available.

If your baby is healthy and gaining weight at this age, you probably do not have to feed him or her every few hours through the night. These frequent night feedings can start a habit of the baby's wanting to be fed or wanting to suck just to go back to sleep. Extra feedings also mean more wet, uncomfortable diapers for your baby. Probably by 6 months, nighttime feedings should not be necessary.

Babies should never be put to bed with a bottle. They could accidentally choke.

Changing Night To Day

Some young babies sleep a stretch of time during the day and take only short naps at night. To turn this pattern around, parents can wake their baby a bit earlier each day until the baby goes to bed for the night at a reasonable time. Some children are "larks." They wake early in the morning full of energy and want to go to sleep early when nighttime comes. "Owls" are children who are at their best in the late evening. They never seem tired at bedtime, but they're hard to wake up in the morning.

Researchers do not know if these children are born to be larks or owls, or if children learn the pattern in their early years. Parents can help these children adjust to the comfortable schedule of a family. With larks, parents can try keeping their child up a bit later each evening until the time the child wakes in the morning is more acceptable. With owls, parents can wake the child early each morning until an earlier bedtime is possible.

When the child adjusts to going to sleep and to waking at the appropriate times, the parents need to follow this pattern every day – even on weekends. And they need to plan unrushed bedtime routines.

BEDTIME RITUALS WITH YOUR GROWING CHILD

As your child becomes a toddler, you will start to develop a bedtime ritual together. You'll want this to be about 10- to 30-minutes of pleasant time. Your child will look forward to bedtime and find it easier to accept the separation from you as you leave the room.

TV usually isn't suitable for the last activity before bed because, even though you're in the same room, you are not actually relating to each other. Reading a story to your child or doing other quiet activities together is more appropriate.

It's certainly okay if your child has a special stuffed animal, doll, toy, or blanket. What comes to everyone's mind is Linus and his blanket or Christopher Robin and Winnie-the-Pooh. Your child can have a comforting object to fall asleep with when others leave the room. This can help your child accept separation without fear. You can also leave a nightlight on.

Consistency in a routine is important as your child prepares for bed and falls asleep. Both parents can take turns with these bedtime rituals. Your child should feel comfortable with either parent putting him or her to bed. Both of you just have to agree that you'll tell your child when the time is almost up and that you must leave. Then, leave.

If Sleep Disturbances Continue

Although all babies wake occasionally during the night, by 5 or 6 months of age only some babies cry and need to be comforted at these times. That they wake during the night isn't the concern – all children do – it's that they don't go back to sleep by themselves. Those who can't go back to sleep alone must learn to do so.

What Parents Can Do

Parents don't have to wait to see if this pattern will change by itself. Instead, you can use a "progressive approach" to help yourr child learn to fall back to sleep by himself or herself. You wait a bit longer to go into your child's room each time your child wakes and cries. You should reassure your child briefly but do not try to get him or her back to sleep. Your child must learn to fall asleep while you are out of the room. In order to succeed, you must be committed to following this approach and must be consistent in your actions.

If your child is older than 5 or 6 months and cries at bedtime or wakes up during the night, refer to the chart on this page. It shows the number of minutes you should wait before going into your child's room. You'll stay only about 2 or 3 minutes in the room each time, be reassuring, but try not to hold, rock, or feed your child.

Chart: Learning To Fall Asleep With Proper Associations*

Number of Minutes for Parents to Wait

Before Going Into the Child's Room Briefly

 

At First

If the Child Is Still Crying

Day

Wait

Second Wait

Third Wait

Following Waits

1

5

10

15

15

2

10

15

20

20

3

15

20

25

25

4

20

25

30

30

5

25

30

35

35

6

30

35

40

40

7

35

40

45

45

*Adapted from Ferber R: Solve Your Child's Sleep Problems. New  York: Simon & Schuster Inc. 1985, Figure 5, p 78.

For example, on the first day you will wait 5 minutes before going into your crying child's room. You'll spend several minutes in the room. If your child cries after you leave the room, you'll wait 10 minutes before going in again. Every time after that you'll wait 15 minutes – until your child falls asleep and you no longer have to go into the room.

If your child wakes up during that night, you will again start waiting for 5 minutes before going into the room – and so on, for that first day. If your child is still awake by a reasonable time in the morning, you will get your child up and start the day.

You can follow this same approach at naptime each day as you do at night. However, if your child is still awake after an hour, the nap will be ended.

If your child cries the second night, you will wait for 10 minutes at first before going into the room – then 15 minutes, then 20 minutes as often as necessary. You'll continue this progressive approach until your child learns to fall asleep alone. It sometimes surprises parents that their child settles into a comfortable sleep routine in just a few days. Both parents and child have learned a good nighttime routine – to everyone's benefit.

Medical Reasons for Sleeplessness

Some children may have different sleep patterns caused by physical reasons. A child may have a skin problem, such as eczema, that causes annoying itching. Asthma may bring difficulty in breathing. Or fluid may collect in the middle ear. Also, a child's sleeping may be disturbed by a medicine that is being taken.

Parents should discuss any concerns about their child's sleep with their doctor. The doctor will help the family explore possible reasons for the sleep disturbance and recommend ways to correct it.

Sleep Like a Baby

Your baby undergoes many changes as he or she grows and develops. By understanding how your baby's sleep patterns change, you can respond appropriately to your child and help the development of good lifetime sleep habits. Bedtime can be an enjoyable time for you and your child. When your child sleeps well, you have helped to add another building block to self-confidence and maturity.