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Sleep issues.
We all talk about it. There are a million parenting memes about it.
Did you know that sleep issues affect up to 50% of our kids? Sleep problems can be the underlying cause of other issues for our kids, including behavioral or learning problems.
But what is normal sleep?
I have found that parents all feel somewhat differently about how much sleep is appropriate for their children. A great guide for proper sleep is one of my favorite websites, healthychildren.org. You can find a ton a reliable information on this site.
Here is what they say about sleep [1]:
Toddler (1-3 years): 10-16 hours total, with one nap daily on average
Age 3-5: 11-15 hours a day, about half of them may no longer nap
Kindergarten: they are down to 9-13 hours.
So how do we tease out the cause of sleep problems?
Sleep issues can have such an impact on our child’s behaviors that if I have a parent come to me with behavioral or ADHD concerns, one of the first things I say is “Tell me about their sleep”.
Usually I ask parents if their child snores significantly, like wake-the-dog-up snoring. I also ask if they are restless sleepers. Do they have trouble falling asleep, staying asleep, or both? These are quick screens for signs and symptoms of underlying problems.
Sleep apnea is a blockage of the airway that can be caused by enlarged tonsils and adenoids among other reasons in kids. This typically shows up between ages 2-8 [2]. These kids may snore loudly, have restless sleep, have pauses in their breathing while sleeping, and can suffer from sweating or bedwetting [2]. During the day, the signs include behavioral issues and difficulty concentrating. If your child has these symptoms, you should visit your pediatrician.
tAnother topic that comes up is Restless Leg Syndrome (RLS) where a kiddo feels the need to move his legs during the night and rest is actually uncomfortable. These kids can have ADHD-like symptoms and growing pains. This would also warrant a visit to your pediatrician. At home in the meantime, you can decrease exposure to caffeine or nicotine. Also, RLS is much more likely if a first degree relative also has it [2].
However, for a lot of our children, the issues falls more in the category of Behavioral Insomnia of Childhood.
Well, what do we do about that?
Here is what I tell parents:
Set a daily bedtime and try to be as consistent as possible, even on the weekends.
Have a simple bedtime routine. If you choose to sing a song, make it a good one (make sure its in your vocal range), because you may be singing “You Are My Sunshine” every day for 6 years (not that I mind the least little bit, Malli Marie).
Daytime routines are important too, including regular meals and (if applicable) nap times.
For older kids (think Pre K through 1st -2nd grade), limiting electronics several hours before bedtime, encouraging physical activity during the day, and having a set wind-down period (snack, bath, reading that does not involve a screen) can all help encourage good sleep hygiene.
There are several “sleep training” techniques for infant and toddlers and just like everything else in parenting... you have to choose which is right for you. Sleep training does not imply that you ignore your child or their needs, but it does mean setting boundaries related to sleep time. You are also teaching them skills for self soothing.
This is the one I used personally and that I usually recommend: After your typical bedtime routine (bottle, bath, book, song, etc., or for older kids: snack, bath/shower, reading), put your child to bed sleepy, but awake. Check in at scheduled intervals. I tell parents that if the child fusses or cries, after you walk away, check in at 30 seconds, then 1 minute, then 2 minutes, etc. and increase that timeframe each night. In this situation, you are supposed to go to your child if they are crying, saying soothing words and comfort them, but stay for one minute only. I also usually add to not to pick the child up. You are essentially trying to show your child that you love them, you are here for them, but setting the tone that night time is for sleeping. Everyone may be getting better sleep within a few nights!
Before you start a plan, really think about what works well for your family and your goals as a parent and, as always, if you are having difficulty or you are concerned about other problems, sit down with your pediatrician.
We are always happy to see you and happy to help!
Sweet dreams!
[1] Healthy sleep habits, how many hours does you child need?. American Academy of Pediatrics. 11/16/2020. https://www.healthychildren.org/English/healthy-living/sleep/Pages/healthy-sleep-habits-how-many-hours-does-your-child-need.aspx
[2] Carter, K.Hathaway N., Lettieri C., Common Sleep Disorders in Children. AM Fam Physician. 2014 Mar 1;89(5):368-377. https://www.aafp.org/afp/2014/0301/p368.html