To Sleep

By Anne Ptasznik on April 08, 2008
Her son’s physician explained that he was having sleep terrors and not to try to wake him. “It’s worse for you than it is for him,” he reassured her. “He won’t even remember he had it in the morning.” One-third of parents or caregivers say that their child’s sleep patterns disturb the family, according to a 2005 National Sleep Foundation poll. Dr. Nicky Cohen, a clinical psychologist, says that there are three main causes for night wakings: nightmares, sleep terrors and learned behaviours. Sometimes parents, and even physicians, have difficulty distinguishing among these. Cohen recently opened a practice in Toronto assessing and treating infants, toddlers and preschoolers with sleep disturbances.

Nightmares

Nightmares are frightening dreams that awaken the child. Cohen says that they are common and a normal part of cognitive development. Nightmares occur during dream or REM (Rapid Eye Movement) sleep, usually towards the end of the night. The child seeks comfort and will respond to the parent, and may also delay returning to sleep. For younger children, nightmares are often related to events such as a dog barking at them. Starting school or seeing a scary movie may be the trigger for older children.

Nightmares peak between the ages of three to six years as children’s imaginations develop along with a growing awareness that bad things happen and they can get hurt. You can help to reduce nightmares by avoiding scary stories right before bedtime. Being held can soothe younger children, whereas older children may need to be verbally reassured. Pretending to spray away monsters can backfire and make them seem real. Ensuring your child gets adequate sleep and has a regular sleep schedule is important.

Sleep Terrors

Sleep terrors, which tend to run in families, are much less prevalent – affecting up to 6.5 percent of all children, according to the American Academy of Sleep Medicine. They usually occur within two hours after the child falls asleep and last between a few minutesto an hour. Although the child may have his eyes open, sleep terrors, like sleepwalking, involve partial arousals during deep sleep. The child appears highly agitated, confused and incoherent. A child may be rigid with fear and parents report being unable to settle them. It’s truly frightening for parents and children.  Triggers can include sleep deprivation, some medications, sleeping in a different environment or feeling stressed. Cohen says night terrors do not stem from or cause psychological problems. Terrors can start at 18 months of age and peak at four to eight years.

During a sleep terror, you can sit beside your child to see whether a soothing touch or calm voice helps. Trying to wake him will only agitate him further and prolong the terror. Avoid next day discussions, as children do not usually recall sleep terrors. Sometimes restarting a dropped nap or setting an earlier bedtime can help. Keep children safe by putting pillows around the bed if they thrash or tend to fall out of bed. If your child sleepwalks, put a bell on his door, a gate on the stairs and locks on the windows. Guide him gently back to bed.

Nightwakings

Night wakings are most commonly caused by poor sleep-onset associations. Both adults and children have normal partial arousals about four to six times per night. If children fall asleep while parents feed, rock or pat them on the back, they associate falling asleep with that condition. Later in the night when they awaken, they cannot recreate these conditions on their own and will cry until the parent soothes them back to sleep.  You can address this problem by training your child to fall asleep independently, Cohen says. Stick to a regular sleep schedule and the routine that cues your child that it is sleepy time. Then put your child into bed awake so he can fall asleep on his own. Babies are adept at learning how to self-soothe, while toddlers and preschoolers can take a little longer. You can still check on your child briefly and sometimes a safe, comforting object helps. Sleep training should not start before four months of age and underlying medical conditions should always be ruled out first.

Dr. Fabian Gorodzinsky, a London, Ontario, paediatrician, says anything that causes discomfort can affect a child’s sleep including eczema itchiness, ear infections, teething, digestive problems, allergies, colds and asthma. Sleep apnea, where the child stops breathing briefly, will not wake the child but can cause tiredness.  If problems persist, talk to your child’s physician or another health-care professional with expertise in this area. And get some sleep!

QUESTIONS AND ANSWERS with Dr. Nicky Cohen

Is it okay for a child to sleep with the light on?

Sleeping with a full light on is not recommended for any age as it could disturb sleep and cause an early morning awakening. A nightlight is fine as it tends not to disturb sleep.

Should parents allow a young child to sleep in their bed after a nightmare?

This can give children the impression that it is not safe to stay in their own bed and encourage them to join you in bed more regularly. It is best to comfort them and let them fall asleep in their own bed.

Should parents allow an older child to sleep in their room or in a sibling’s room, if they don’t want to sleep alone?

This may be a family lifestyle choice, but if parents are concerned about the child not wanting to sleep alone, this can inadvertently reinforce the behaviour. Sleeping with others in the room can also increase wakings.

Should parents encourage stuffed animals as a comfort for kids with sleeping difficulties?

The Canadian Paediatric Society recommends keeping duvets, pillows or stuffed animals out of an infant’s bed. Small breathable blankies can be used with babies and small stuffed animals with older children to comfort and soothe them back to sleep, as long as they do not interfere with breathing or provide a prop to help climb out of bed.

Other Tips?

Encourage your older child to draw and rip up a picture of what is frightening him or to imagine a different ending for a nightmare.mTry hanging up a dream catcher. Finally, keep a sleep journal noting triggers, stressors and strategies that work.


By Anne Ptasznik| April 08, 2008

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