Sleeping like a baby

Sleep is probably one of the most discussed—and debated—aspects of child rearing. Expectant parents anticipate disaster in terms of their newborns’ sleep patterns and their own sleep deprivation. Dr. Geary answers the question, "how much sleep is the right amount?"


What’s important for your child’s sleep (and yours too)


Studies have shown that children, from elementary school to high school, get about an hour less sleep each night than they did 30 years ago, a deficiency that can have an impact on their cognitive abilities. The brain grows to 85% of its full adult size (volume) by age 3 years. And it is continuously developing in complexity (connections). Much of that development happens when you are asleep, so lost hours of sleep can have an exponential impact on the developing child. Sleep deprivation can lead to attention and behavioral issues in children, and it can affect their memories and their emotional well-being. And many of the characteristics typically attributed to adolescence—moodiness, depression, irritability and self-esteem issues—are exacerbated if not generated by chronic sleep deprivation.


How Much Sleep Do Children Need?

Sleep is probably one of the most discussed — and debated — aspects of child rearing. Expectant parents anticipate disaster in terms of their newborns’ sleep patterns and their own sleep deprivation. Parents of children from toddlers to teens suffer from bedtime battles and worry that their kids are just not getting enough hours of deep sleep.


How much sleep is the right amount?

That depends on the child’s age, and temperament. Two children of the same age who get the same number of sleep hours may behave and feel very differently, simply because one needs more sleep than the other. But there are certain guidelines to help you navigate this complex aspect of child-rearing. From newborn to six months: Before three months of age, babies internal clocks are malleable. Ideally this is the time to establish a routine. Once they are over about 10 pounds body weight, they have enough glycogen storage capacity to maintain a stable blood sugar level for 5-6 hours. This means that you can adjust their sleep cycle to sleep at night!! This allows you to finally get some sleep yourself!! Ideally, a baby gets 7-8 feeds spaced 2-3 hours apart to start. As the baby grows, and becomes a more efficient eater, the goal should be to always increase the volume not the frequency of feedings. From six to twelve months: At six months, babies average about 11 hours of sleep at night, and may nap for about three hours during the day. By this time, it should be possible for the baby to self-settle if they wake up during the night. Ideally, as the parent, you would allow them to whimper a bit, but fall back asleep on their own without your intervention.


From one to three years: Children of this age range may start to put up a real fight at bedtime. This is a different kind of challenge than earlier months: now the child is not only verbal, but also mobile! So sleep hygiene also requires sleep safety, especially if they can climb out of the crib! They need between 10 and 14 hours of sleep. Some toddlers may need daytime naps, but for others a short quiet time may be all that is needed.


From four to nine years: By the age of five, many children no longer need naps. However, if they have begun a school program, they often return home quite exhausted, and an after school nap, if relatively short, is beneficial. The average sleep requirement for this age range is about 10 -12 hours of sleep per night.


Pre-teen and Teenagers: These days, puberty is beginning earlier and earlier. Along with the concomitant changes in their bodies, these kids are also dealing with increasing social pressures and stress. If your preteen child is particularly irritable or hyperactive, it just might be due to sleep deprivation. If your teen is moody or aloof the same may be true. This age group usually needs between nine and ten hours of sleep a night. They rarely get it, however. They stay up later at night and get up earlier. And then they attempt to compensate by sleeping all weekend. While this may seem reasonable, it does not help their bodies establish good sleep hygiene, and often the “catch-up” time does not recalibrate them fully for the following week ahead. Ideally, try to get them to go to bed at the same time every night and wake up at the same time every morning even on Saturdays and Sundays. Good luck with that!


How to Help Your Child Get the Sleep She Needs

Sometimes bedtime battles are so exhausting you can only fall into bed yourself. But here are a few suggestions:

● Don’t wait until your baby is asleep to put her to bed. Put her in her crib when she’s drowsy but still awake. This will help her learn to self-soothe when/if she wakes up in the night. Children who fall asleep with a bottle of milk, juice, or any sweetened liquid in the mouth can suffer from “baby bottle caries,” which are cavities in their front teeth from drinking a bottle of sugary substances before sleep.

● If your infant wakes up crying, take a few minutes before you respond. If the crying continues, check on him, but don’t turn on the light, don’t pick him up, or attempt to comfort him. Try hard not to give him a bottle. Just say a few comforting words, and be sure they are the same words every night: for example “ Mom is here, but it is sleepy time. Good night”. The more consistency and the less stimulation he gets, the quicker he will learn to go back to sleep.

● If your toddler cries or calls out to you during the night, wait several minutes before you respond. If you go into the room, don’t turn on the light. Reassure your child that he is safe, that you are there but that it’s bedtime. If he calls out again, wait a longer time before responding and try speaking to him softly without entering the room again. Probably the most valuable sleep aid you can provide is to establish a bedtime routine.


Children are reassured by schedules: they like knowing what to expect. Create a 30-40 minute pre-bedtime ritual that signals to the child that bedtime is coming:such as reading a story or listening to soft music, or simply getting in bed for a back rub.

 

Natalie W. Geary, MD pediatrician and mother of three.

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