Nothing ruins a good night's sleep like a child. Whether you're concerned about your teenager's dark under-eye circles or your toddler is the cause of your own, here are some of the most common sleep issues children have and how we can help them, so everyone is well rested.
Most parents learn the hard way that sleep is terribly underrated. Before you had a kid, sure, you thought you cared about sleep, but it wasn't the most precious, elusive, one-thing-you-would-kill-for activity it becomes after the child is born. At the same time, infants, toddlers, school-age kids, and teenagers don't seem to appreciate sleep at all, even though it's critical for their development. While every child is different and we can't cover as much as the entire books written on this subject, we've learned a few lessons over the years and tapped a couple of sleep professionals for advice on this most important subject.
First, watch Samuel L. Jackson read this now-classic bedtime book.
Back? Then lets get these kids to go to sleep already.
The "Will I Ever Sleep Again?" Phase: Birth to One-Year Old
Newborns and infants need to feed every few hours because their tiny stomachs can only hold so much food. This is directly at odds with our need to sleep throughout the night. Unless you can afford to have someone else nurse your child, there's no way to escape the round-the-clock feeding. Here's what you might be dealing with during this most sleep-deprived time:
- The baby wakes up screaming every few hours. That's actually by design (see stomach capacity above). If you have a partner or other help, it's really important you tag team to make this more bearable -- switch who has to get up every other feeding. (If you're breastfeeding, that means the mum has to pump "extra" milk to skip the feeding, which also sucks. There are ways to increase your milk supply, but it's still a labour of love.) Also, remember the mantra: "Sleep whenever the baby sleeps," and to hell with everything else.
- After the feeding, your baby won't go back to sleep. Babies don't know when it's nighttime or daytime -- and they don't care. You, warm and loving caregiver, come to nustle at 3AM? It's time to play and keep you here! Try to be as boring as possible as you try to help the baby get back to sleep. Specifically: in the middle of the night, keep the lights off and be as subdued, quiet, and quick as you can.
- You fall asleep while breastfeeding. That's not a problem, that's a solution! Seriously, if you're breastfeeding, lying down to feed is one of the best ways to sneak in some rest.
- Your baby won't go to sleep or nap when she's supposed to. First, check the obvious. Does the diaper need changing? Are you putting the baby down in a sleep-conducive environment (the same sort of the things we adults need for better sleep)? Is the baby overstimulated (eg., a full day of activities and then playing horsie right before nap time)? Has the baby skipped a nap or stayed up too late? Dr. Sears offers several suggestions for helping a baby who is refusing to nap, including wearing your baby in a carrier or napping with him.
- Your baby is not sleeping through the night. This may be the most important milestone, perhaps, and parents' biggest question: When will my baby finally sleep through the night? Most infants will let you get a full night's (seven or eight hours uninterrupted) sleep starting by three months of age, according to the American Academy of Pediatrics -- but every baby is different. If your baby is not complying, you could try adding more active play during the day and setting up a more consistent bedtime ritual (e.g., bath, song, story, bed). One thing that will not help is skipping naps; it sounds like it would make sense to keep babies up as long as possible so they'll sleep longer at night, but naps are essential to the child's growth, moods and nighttime sleep. The average baby from six-to-nine months old needs two naps a day; over-stimulation and skipping naps can cause shorter naps, fighting bedtime, and night wakings. Dr. Karp's Happiest Baby 5 S's system could help your baby get to sleep faster and sleep longer: swaddle, place the baby on her left side for sleep, and soothe with shushing sounds, swinging, and something to suck on. Also, know that "sleeping through the night" could mean anything -- 7pm to 7am or 10pm to 6am -- but take what you can get, parents!
- Your baby keeps waking up. Starting around eight months and well into the toddler stage, kids can start developing separation anxiety. This means that while great at sleeping through the night, he or she resists going to bed and wakes up more often looking for you. It's probably the roughest time, when your child is crying for you and you're not sure if you're supposed to let them "cry it out" or go and console the child. Sleep expert Nitun Verma says it's like pulling a band-aid: do it the quick and harsh way or pull it off slowly but extend the experience; both are painful. It's pretty much up to you to decide which method to use. Dr Verma assures me it's harder on the parents than on the babies, really.
One special case is if your baby has colic. It's a special issue, but one that can seriously affect your sleep. Scott Siege, a board certified pediatrician and the medical director for Baystate Medical Practices - Quabbin Pediatrics in Ware, MA, says colic is generally diagnosed in kids from about two weeks to four months of age as excessive crying due to no identifiable underlying causes. Crying because of formula intolerance, for example, shouldn't be explained as colic, because there's an identifiable cause. Doctors try to treat the causes before attributing the crying to colic. However:
Once the diagnosis of colic is made the first steps are reassure, reassure, reassure. I think it is helpful to understand that the baby is really OK and that it really might not be possible to stop the crying and that this is OK. I recommend that parents develop a routine to quickly assess the baby for a cause when crying starts. This can be "hold, rock, shush, check diaper, feed, etc.". If nothing helps then you might have to accept that the baby is going to cry and the parent must avoid becoming overwhelmed by it. I reassure parents that if they are overwhelmed they can place the baby in a safe place, like a crib, and walk away. This seems horrifying to many parents (and may be to your readers), but a parent can really benefit from a time to relax and then go back to their baby in a better mood which makes them a much better parent at that moment.
Amazingly, colic frequent resolves over a short period of time, leaving that lovely baby the parent always expected to have.
That may be the most important message for all parents in this age range: This will pass (and, looking back, all too quickly). Try to stay patient and loving, but consistent as well. This will help teach your child the important skill of putting him or herself to sleep independently.
The "What Happened to Your Nap?" Phase: Ages 1 to 6
In the previous phase, you have to just try to survive sleep deprivation and avoid instilling bad sleep habits if possible. Past the infancy stage, it's all about setting a consistent bedtime routine, according to Dr Verma (just like it is with us adults). This is easier said than done.
- Set up a bedtime routine. As with adults, avoid digital screens during the wind-down time. Instead, dim the lights, cuddle your child, and grab a book. WebMD recommends the four Bs: bath, brushing teeth, books, and bed, with the routine. When I asked my seven-year old how parents could help their kids get to sleep, she mostly echoed those suggestions, adding her own conditions, of course: "Snuggle with mum all night, read the longest book you have, hear a story that goes on and on until the kid is asleep." More qualified experts say the routine should last between 30 minutes and an hour before the kid should be asleep. (Kids need around 10 to 11 hours of sleep plus naps for the first three years, then about 10 to 12 hours for big kids, according to Babycenter.)
- Start the routine early enough. You can't actually control how long your child sleeps, but you should try to start the routine at around the same time each day. If your child is showing signs of being frequently overtired, try moving the routine start time 30 minutes earlier.
- Stay consistent. Everyone in the family has to maintain the routine, which is hard if parents' schedules are irregular. This is also a time when toddlers start toddling out of bed and older kids start negotiating to stay up longer -- just 10 more minutes pleeeeease! Try to stick to the plan (perhaps even have a sticker chart or a drawing of the routine in the bedroom), because doing the same steps each night actually can help the child fall asleep more easily by giving her body cues it's time to induce sleep.
- But don't stress it. Dr Verma says if you're stressing to get the kids to go to sleep on time, they'll pick up on it and it'll only make matters worse.
Other issues that might arise at this time are bedwetting, which Dr. Sears can help you troubleshoot, and nighttime fears, for which the National Sleep Foundation offers advice (I like the "flashlight tag" and "monster spray" ideas).
The "Ohhhh, Nice to Meet You Again, Sleep" Phase: Ages 7 to 12
As they get older, kids get better at sleeping well. (Or so I'm told.) At this age, it's mostly a matter of maintaining the bedtime routine and practicing good "sleep hygiene".
- Maintain the bedtime routine. The routine will likely change when your kid gets older and he's able to put himself to bed, but the basics of going from active to quieter activities, and unplugging from video games and TV still apply.
- Limit after-school activities. Extra-curricular activities are important, but too many of them coupled with lots of homework can push the bedtime later and later. Kids this age still need about 10-11 hours of sleep a day, although the average is only about 9 hours.
- Don't let weekends throw you off. Sleeping in on the weekends doesn't help anyone catch up on sleep and can, instead, throw off our internal clocks. A policy of staying up late "because it's the weekend" could jeopardize your child's sleep the following week, so try to avoid that if you can.
The "Wake Up, Sleepyhead" Phase: Ages 13+
Most teens don't get enough sleep. They need as much as nine hours, but it's nearly impossible for them to get that. This is because teens' circadian rhythms get temporarily reset, so they become night owls -- falling asleep later and waking up later, Dr. Verma says. With most schools' early start times and more homework than even parents can handle, it's a terrible situation. Author David K. Randall, quoted at Brain Pickings, illuminates [emphasis mine]:
Biology's cruel joke goes something like this: As a teenage body goes through puberty, its circadian rhythm essentially shifts three hours backward. Suddenly, going to bed at nine or 10 o'clock at night isn't just a drag, but close to a biological impossibility. Studies of teenagers around the globe have found that adolescent brains do not start releasing melatonin until around eleven o'clock at night and keep pumping out the hormone well past sunrise. Adults, meanwhile, have little-to-no melatonin in their bodies when they wake up. With all that melatonin surging through their bloodstream, teenagers who are forced to be awake before eight in the morning are often barely alert and want nothing more than to give in to their body's demands and fall back asleep. Because of the shift in their circadian rhythm, asking a teenager to perform well in a classroom during the early morning is like asking him or her to fly across the country and instantly adjust to the new time zone -- and then do the same thing every night, for four years.
There are only a few things we can do to help:
- Blue light therapy. Blue light, we've seen before, can boost alertness. So blue lightbulbs or lamps in the morning could help your teen adjust more easily. (The wavelength most studied for helping night owls is 470nanometers, Dr. Verma says.)
- Reserve the bed for sleep only. Advise your teen to have a good bedtime routine (yes, still!), which could include reading, but preferably not in bed, says Dr. Siege: "The act of getting into bed can be used as a final trigger for the brain to say 'I am going to sleep now,' so getting into bed should be reserved for the actual moment when one is going to be actually going to sleep." Good advice for adults too.
- Ban screens the hour before bed. Encourage your teen to keep the cell phone out of the bedroom (don't laugh, anything's possible!).
- Avoid stimulants. Per Dr. Siege: "Caffeine, alcohol, tobacco, and of course other recreational substances can interfere with proper sleep and should be avoided by those struggling with insomnia."
- Push your school district to have later start times. Studies have shown that schools that tried later start times had better-performing students. Not only that, those districts had fewer car accidents caused by teenage drivers. 29 states have at least one district that has moved the start time later, and you can join the national movement to push back middle school and high school start times at Start School Later.
- Set a bedtime. Even if it's 11:30, if you, the parent, set a bedtime for your teen, it could mean better sleep, according to one study. NPR reports that's because it gets the message across that parents feel sleep is important. Yes we do.
Thanks to Dr Verma and Dr Siege for offering their expertise. Dr Nitun Verma, MD is a specialist in sleep medicine and the Medical Director of the Washington Township Center for Sleep Disorders in Fremont. He has also create a survey where you can compare your sleep with others here. You can follow him on Twitter at @nitunverma.
Dr Scott Siege is a board certified pediatrician and the Medical Director for Baystate Medical Practices -- Quabbin Pediatrics, as well as the Chair of Pediatrics and President of the Medical Staff at Baystate Mary Lane Hospital, both in Ware, MA. He is also the proud father of 15-year old twins (a boy and a girl) and of a 10-year old boy. He adds: "My daughter was one of the worst colic cases I have ever known. She required being held from 7 pm to 4am to keep her from crying. This lasted for several weeks. Her twin brother slept through the night at just a few weeks of age. Go figure. Her colic disappeared between 3 and 4 months of age - virtually overnight. Happily my kids all sleep well now."