BEDTIME BATTLES – TEACHING YOUR CHILD GOOD SLEEP HABITS

Teaching your child good sleep habits is the best gift you can give them and yourself. Find out how much sleep your child needs, and when to worry about their night-time habits.

There’s nothing quite like the joy, or the exhaustion, that comes with parenting. It starts as soon as you bring your baby home. All you want to do is sleep,  but your newborn is awake every few hours for a feed or just to be held. Will we eventually establish good sleep habits? Should we resign ourselves to years of sleeplessness until the time when our young teenager struggles to drag himself out of bed in the morning?

“Absolutely not,” says Ann Richardson, author of Toddler Sense and co-author of Baby Sense and Sleep Sense (Metz Press). Teaching your child good sleep habits is the best gift you can give them and yourself, but keep your expectations in pace with each phase of your child’s development.

Cape Town-based sleep consultant, Erica Lotter, adds that your child’s health, nutrition, routine and social, emotional and physical development, are relevant too.

Sleep 101

Children have different needs, so the average amount of sleep recommended for each age and stage serves as a rough guideline.

Newborns

Expect: They should sleep 16 to 20 hours a day. Their nutritional needs mean that they will wake up every couple of hours. By six to eight weeks, they will drop one feed and get a good “core” sleep – their first real stretch of sleep. Richardson advises limiting “awake” times to around 45 minutes between naps to avoid sensory overload. Put them down to sleep while they are still happily awake. If they have a clean bill of health, there is no such thing as too much sleep.

Sleep Disorders: Their neurological systems are too immature to filter out sensory input, so they will become fussy and will struggle to fall asleep if they are overstimulated. An immature digestive system may be prone to problems, such as lactose intolerance and reflux, which can affect sleep.

Tips:

  • Signs of over-tiredness include fussiness, bouts of crying, loss of eye contact, turning the head away from you, flailing limbs, clawing the face, back arching, making fists, sneezing, yawning, hiccupping, blueness around the mouth, clumsiness and eye-rubbing.
  • Rock and cradle them if they need it – they can’t self-soothe yet.
  • Non-nutritive sucking, on fingers or dummies, may help them sleep.
  • Swaddle them up until they are a year old, with their hands to the mouth or towards the midline. This counteracts the startle reflex and maintains their temperature when you transfer them from your arms to the cot.

Three to six months

Expect: Tracy Hogg, author of Secrets of the Baby Whisperer (Vermillion), recommends 15 to 18 hours of sleep, with two to three naps, from now until 18 months. Your child may sleep through, for about eight hours, or wake for only one feed. The startle reflex settles and your child will self-soothe with fingers or hands in the mouth. Sensory input is filtered better and the amount of time spent awake will lengthen.

Sleep disorders: Babies may need help falling or staying asleep.

Tips:

  • Hogg says babies thrive on predictability and routine.
  • Avoid overstimulation. When your baby starts yawning, take him to bed. His eyes may remain open, but he’ll stare at nothing for several minutes until he nods off.
  • Your baby should be able to fall asleep unassisted, but should not be left to cry. Part of sleep training involves checking that your baby has no health problems. Watch awake times to avoid overtiredness. Swaddle and introduce solids from four months if your baby appears hungry when awake during the night.
  • Richardson says don’t wake your baby for a late evening feed, in the hope that they’ll sleep longer thereafter.
  • This is their core sleep.

Six to 24 months

Expect: There should be no more night feeds; your baby can go 10 to 12 hours without food. Hogg says two naps, or one long one, is sufficient. Lotter adds that children go through huge developmental milestones during this period. Their brains need sleep to help them develop and thrive.

Sleep disorders: If your child still needs your help to fall or stay asleep, you need to start sleep training. A lack of sleep can cause irritability, crying, poor eating and may affect the growth hormone, which is secreted during sleep.

Tips:

  • Make sure your child’s nutritional needs are met during the day.
  • Low iron levels will affect your child’s sleep, eating habits and may compromise their immunity. Check with your paediatrician about a supplement.
  • Dr Richard Ferber, director of the Center for Pediatric Sleep Disorders in Boston, advocates the controversial “cry it out method”, which has become known as “Ferberising”. He says children should be able to self-soothe and fall asleep independently. His mode of sleep training involves putting your child to bed, while still awake, and leaving them for gradually longer periods if they cry, until they are able to sleep independently. But Lotter says, “Sleep training doesn’t have to be a lengthy and emotionally difficult process. Expect your baby to be resistant to changing what he’s used to. Remain consistent, reassuring, determined and loving, but don’t leave him feeling abandoned.”

Toddlers from two to four years old

Expect: Your toddler should go to bed early and sleep for 10 to 12 hours. They’re early risers, so you will be too. They’ll enjoy one or two day naps, and older toddlers will need some quiet time during the day once they’ve dropped their naps.

Sleep disorder: Your toddler needs you or a bottle to fall asleep. Night bottles compromise your child’s daily calorie intake and will rot their teeth. Toddlers and older children can suffer from restless leg syndrome, growing pains, nightmares, sleepwalking and night terrors. Too little sleep interferes with their learning and affects their moods. It can cause a failure to thrive and altered immunity.

Tips:

  • If your child is climbing out of the cot, he may have to move to a big bed.
  • Richardson says magnesium syrup can help with growing pains and cramps, while an iron supplement helps with eating, sleeping and immunity. She also recommends deworming twice a year.
  • The American Association of Pediatrics advises no TV before the age of two. TV and electronics an hour before bed is too stimulating and can cause nightmares.
  • Routine is fundamental for good sleeping habits.
  • Your child should be eating all the food groups and only drinking water at night.
  • A “sleep friend”, such as a blankey or a soft toy, may prove comforting.

From preschool to pre-teenager

Expect: Dr Alison Bentley, a sleep clinician based at Wits University, stresses the importance of a bedtime routine. Preschoolers need 10 hours of sleep, primary school children need about nine hours, and pre-teenagers should average between eight and ten hours a night.

Sleep disorders: Day sleeping is actually a sign that something is up, so monitor their sleep habits. Your child should not be wetting the bed from the age of five or six, so seek professional help if this occurs. Dr Bentley advises consulting a medical professional if you suspect your child has any other sleep disorders (see box).

Tips:

  • Don’t over-schedule extramurals as it can stress and overstimulate them, making it difficult for them to fall asleep.
  • From the foundation phase, more quiet time before bed is appropriate – reading and listening to story tapes helps them self-soothe.
  • Avoid colourants, flavourants and preservatives. Opt for a low-GI diet, packed with fresh foods and omega oils.
  • Later to bed doesn’t mean later rising. It just increases the cycle of overtiredness, which affects their moods, concentration at school, appetite and health.
  • Limit electronics, especially an hour before bedtime and never allow them to be used in their bedroom.
  • Provide a bedside light.
  • Physical exercise helps with their moods, stress, appetite and sleep.

Sleep disorders to watch out for

Bentley says most childhood sleep disorders are behavioural, meaning they’re learnt and can be unlearnt, unless they’re parasomnias such as sleep terrors, somnambulism, enuresis, apnoea and narcolepsy. Intervention from the parent with a therapist or physician will help.

  • ADHD More than 40 percent of people with ADHD have significant sleep disturbances, and conversely, poor sleep can cause children to have ADHD-like symptoms, such as poor attention, irritability, distractibility and impulsiveness.
  • Apnoea and snoring Get treatment as this can affect your child’s breathing, which impacts on their growth and learning. Often the tonsils and adenoids are removed.
  • Bedwetting/enuresis This can be treated with behavioural methods, the teaching of continence skills and sometimes even medication, but first rule out emotional stress as a possible cause.
  • Delayed sleep onset If their circadian or biological rhythm is out; they will want to go to sleep later in the evening and wake up later in the morning. Professional intervention is needed.
  • Growing pains Joburg-based paediatric rheumatologist, Dr Gail Faller, says this happens only at night and occurs in the legs. A calcium and magnesium supplement taken after an active day can help.
  • Insomnia If your child has difficulty falling asleep or can’t go back to sleep, they need a professional assessment. Possible causes include stress, depression and ADHD.
  • Night or sleep terrors Your child appears awake, screams, thrashes and is inconsolable, but remembers nothing the next morning. Although it’s unsettling, children usually outgrow it.
  • Nightmares Try a night light and avoid frightening TV programmes, computer games or stories. Gently console them and they’ll resettle.
  • Restless leg syndrome A neurological disorder where the sufferer struggles with uncomfortable pins and needles, or pain, in their legs at night. It may present as insomnia.
  • Sleepwalking or somnambulism It is not advised to wake a sleepwalker. Rather make their environment safe and guide them back to bed. Children usually outgrow this condition.

Daniella Renzon