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Part 4: Keeping Your Child Healthy  >  The A-Z of Childhood Illnesses  >  Sleep and Sleep Problems

SLEEP AND SLEEP PROBLEMS

Treat this important feature as a guide and act as per your instincts with regard to the needs of your child and the rest of your family. 

We will discuss the following points:

  • The duration of sleep differs at different ages and from child to child.
  • A few sleepless nights are normal in the first months of your child’s life. After about 3 months of age, most babies settle down to a schedule convenient for you and the family.
  • While older children may sleep in a separate room, your young infant will sleep better with you.
  • Close relatives, specially the father, should be involved in helping the baby to sleep well.
  • Most sleep problems are temporary.


Duration Of Sleep

The duration of sleep varies from child to child. If your child is joyful and active the whole of the next day, you can be sure that he had a good sleep the night before. If he is irritable and not his usual self, he either had inadequate sleep or has some other emotional or physical problems.

A newborn baby seems to sleep most of the 24 hours of the day, except when he is hungry, wet or uncomfortable for some other reason. As he does not yet know the difference between day and night, he may sleep more during the day and less at night. While this may not be convenient for the mother, she will then herself choose to sleep more during the day while the child sleeps, and learn to feed the baby in a lying position (safe in breastfed babies) in bed without having to get up to feed. People at home should support her by restricting visitors.

Some babies may demand extra attention. They are rather fussy and can give anxious moments to an unprepared mother. Most (but not all) babies seem to sleep better after their morning massage and bath, especially if they are swaddled (wrapped up).

In the second month, the baby is more awake and, after about 6 weeks, may start responding when you try to catch his attention. Around 3 months of age, the pattern of sleep is more likely to change, and most babies sleep for longer hours at a stretch during the night. They are more awake during the day and may have a nap for an hour or two in the morning and again in the afternoon. This pattern continues until the first birthday. They may then have a nap only in the afternoon until the age of 3, when they may stop having a nap during the day. At this age, most children will sleep for about 10 to 12 hours at night.

Teenagers need 9 to 10 hours of sleep each night. Sleep deprivation can affect academic performance.


The Difficult First Months
To understand the basis of this statement, you should have some idea about ‘light sleep’ associated with rapid eye moments (REM) and ‘deep sleep’, also called non-REM sleep. 

A newborn’s sleep period begins with drowsiness, leading to light sleep, and followed by deep sleep. Rapid movement of the eyes and dreaming mark light sleep. Up to the age of 3 months, half a baby’s sleep time comprises of light sleep. Compared to this, toddlers, older children and adults have deep sleep for upto three-fourths of the total sleep period. So if a small baby below 3 months sleeps for 16 hours, he has deep sleep for 8 hours. For the other 8 hours, he is in light sleep. Older children who sleep for 12 hours may have light sleep for only 3 hours. A baby is likely to wake up more easily from a light sleep. A mother may put a child passing through this stage of sleep down on the bed with the impression that he has gone to sleep, but he is likely to get up soon after and start crying because he has not yet gone into a state of deep sleep. Therefore, it is important that we continue to give the child body contact till he crosses the barrier of light sleep and moves into the realm of deep sleep.

Also, as mentioned earlier, babies are not yet able to distinguish between day and night. Therefore, they may sleep more during the day but bother Mom more during the night.

And then, in the mother’s womb, all the needs of the foetus were met promptly. Hunger was satisfied, warmth assured. There were familiar heart sounds to entertain. After he is born, the baby needs about 3 months to understand that his demands should be reasonable and that Mom also needs rest. And so most babies would have their mothers dance to their tune for the first few months.

The good news is that those mothers who respond promptly to baby’s needs in the first few months are rewarded in the long run. As they grow older, babies thus reared are quieter, calmer and more secure compared to babies who are left to cry. They start trusting people around them, which helps in personality development.

The so-called three months’ colic (discussed under Crying) is another problem that bothers quite a few babies in their early months.

Once you know about these possible factors that may make life difficult for you and your baby, you will be able to cope with such a situation with the right frame of mind. This may also send signals to other members of the family to give you a helping hand as often as possible.

Listen to well-wishers’ advice but follow your own instincts. Cry if you feel like. Do not feel ashamed to ask for help if required. But have patience. A crying child is indicating that he needs you. If you fulfill his needs, you will start understanding him better. You will learn to discriminate more quickly whether his cry is for a feed or for comfort. In due course of time, this approach will help you to quickly pick up the cues that he gives you — even cues related to his readiness in such areas as bladder training, inculcation of healthy habits or to make him learn to choose between right and wrong.

A breastfeeding mother finds it easier to cope with this difficult period. The three months’ colic is less frequent in breastfed babies compared to those who are artificially fed. The body contact which breastfeeding automatically provides helps the baby feel more secure in the arms of the mother. Suckling during breastfeeding also helps in increased production of a hormone called prolactin, which has a calming effect on the mother and helps arouse the mothering instinct in her. This hormone is produced in greater quantity during sleep. So a mother who feeds her baby during sleep is able not only to provide immediate gratification to the hungry or fretful baby, but help herself as well by providing more prolactin. 

After having made the point that a crying baby should not be left crying, I must sympathise with mothers who have to spend sleepless nights in this process. The following guidelines might be found helpful:

  • Get into the habit of sleeping while the baby sleeps, as mentioned earlier.
  • Do not switch on the lights when the child gets up at night. The idea is to gradually let him learn that nights are meant for sleeping and not for playing. Feed him in a supine position if he is hungry. Pat him to sleep if he is just squirming. Give him body contact if he has moved away from you.
  • Do not get up to burp the child. Raise him while you are lying down. Let him lean against you to burp. If he does not oblige, do not worry. Quite a few babies can manage without burping. If you are still concerned, let him lie on his right side; in this position, the child is more likely to burp on his own.
  • If a child has wet his diaper, see if he can remain asleep without it being changed. After the first few weeks, quite a few babies can tolerate a wet diaper without getting upset and without getting diaper rash. If the baby does get annoyed or if the whole bed gets wet, try putting a double diaper on him. Tie it firmly. This may work. If not, keep such diapers handy which do not need to be pinned and can be tied easily in the dark. The important rule is not to spend too much time in changing the diaper so that both you and the baby can go back to sleep as soon as possible.
  • All noises do not wake up a child. Many babies sleep quite well with some background music or human conversation. Of course, sudden loud noises may startle them, especially if they are in a period of ‘light sleep’.


Where Should Your Child Sleep?

Decide with your husband what will work best for you and your baby. Do not blindly follow the textbooks that exhort that children should sleep in a separate room right from an early age.

The baby can sleep next to you in your bed or in a cradle or in a cot kept in your room or in an adjacent room. Toddlers can sleep on a mattress in your room or in a bed in an adjacent room. Older children can sleep in a bed or on a mattress in an adjacent room.

I believe that a baby who sleeps in his mother’s bed soon after birth has less sleep problems and behavioural problems later in life. In the hospital, you should insist that your baby sleeps next to you and is not kept away in a nursery with other babies. You can, if you want, ask for a cot that can remain near your bed. The baby can be placed in it as per your convenience. Most mothers have been found to sleep better with the baby in their rooms once they understand that this helps in bonding with their baby. Of course, you can always seek help from the nursing staff as and when required. 

If allowed, it is, of course, a real boon to have a close relative in attendance. Most modern hospitals encourage such an arrangement.

After going home, many mothers have found the following sleeping arrangements quite practical: The baby sleeps in your bed until he is one year old. In the second year, he sleeps on a mattress spread on the floor by the side of your bed. After he is 3, he sleeps in a separate room, on his own, or along with his older brother or sister, in separate beds.

Teenaged siblings of the opposite sex should sleep in separate rooms.

The above arrangements are based on the knowledge that children develop separation anxiety if they are separated from the mother figure. Between one and a half years and 3 years, they learn that the mother is around somewhere even if she is not to be seen. Hence, it is important to give enough body contact to the child in his first year of life, meet his needs (vocalised mostly by crying) promptly, help him build trust in you and gradually wean him from your bed to another convenient sleeping arrangement in your room and then to another room, preferably adjacent to yours.

Once the child is shifted to his room, he can be brought to your room if he is not feeling well or if he feels scared for some reason. But he should soon be placed back in his room.

Ideally, the older child should be taken to his room for sleeping by the mother or the father. You may read to him or tell him a story. Many mothers find it helpful to say a small, simple prayer together. The child is gently lulled to sleep. Older children are likely to go into a ‘deep sleep’ rather soon and can be left properly covered. Some children are happier if a dim light is kept switched on all through the night.

If you want the child to go to sleep early, see that he does not sleep during the day. If he is in the habit of doing this, take him out during those hours to an interesting place or a garden for a few days to break his habit of sleeping during the day.

In your bed, the infant can sleep between you and a wall. Otherwise, you can get bed-railings that can protect the child from falling down. For a very small infant, raising the edge of the mattress by putting a pillow underneath it serves the purpose.

Do not worry that you will smother the baby as he lies in your bed. This can only happen if the parent(s) are intoxicated or heavily drugged.

Another reason to have children older than toddlers sleep separately is to avoid them being unwitting witnesses to their parents’ conjugal relations. Psychologists report that children who watch adults having intercourse either can become terrified or can develop undue curiosity about the same. Moreover, children have to graduate from the parents’ room to another room to prepare themselves for moving into the outside world.


Support From Others 
Graciously accept the help of your husband, mother and mother-in-law, or indeed any good relative and friend in helping to take care of your baby and relieve you. Let the child bond with your husband, and with his grandparents. Allow the baby to sleep with a close relative or a maid during the day; this will make it easier for the child to sleep with such a person when the mother is not well or when the child must be weaned away from the mother during the night. 


Most Sleep Problems Are Temporary
Yes, this is true, except perhaps with babies whose needs for attention in infancy were not met. Children who do not get attention from their mothers cry themselves hoarse at first, but finally give up and become withdrawn. People may feel that the child has settled down, without realising that instead his personality has been stunted.


Work With Family Routines
Although it is ideal that a child goes to bed early, this routine may have to be changed if the father comes home from work late in the evenings and again leaves for work early in the morning. A child must spend time with his father. In such a case, it may be essential to make the child sleep during the day or allow him to remain asleep for a longer time in the morning. The presence of the father definitely helps in prevention as well as in management of common sleep problems.


Common Sleep Problems

  • Getting up too frequently at night
  • Nightmares
  • Night terrors
  • Sleep walking


Getting Up Too Frequently At Night
Most problems associated with sleep can be prevented by caring parents who promptly attend to the needs of the child during the early months of his life and keep a watch on the factors that may contribute to sleep disturbances.

Breast milk is digested fast and so a child may demand frequent feeds in the early months. Parents who do not appreciate this fact may allow the child to cry unnecessarily. Flies and mosquitoes can be a nuisance. A mosquito net may be helpful. Extremes of temperature must be taken care of. If a heater is used in a room, a kettleful of water should be kept on the boil all through the night to maintain the humidity of the room. Otherwise, the child’s nasal secretions dry up, causing discomfort. If the child has a stuffy nose, it should be cleaned and nose drops used as detailed in Common Cold. Physical discomfort in the form of a wet diaper or during teething can add to the discomfort. Excessive activity during the day may also delay the onset of sleep. Any sickness must be attended to, especially ear infection and itching associated with eczema or threadworms, which come out from the anus at night and cause itching over the buttocks. Certain stimulating drugs and caffeine can be responsible for difficulty in sleeping.

Children who slept well in the early weeks of life may suddenly give the mother sleepless nights around the age of 3 weeks, 6 weeks and 3 months. During these periods, some babies have growth spurts when they need to suckle more often to meet their normal demands of milk. On such occasions, you should not presume that your milk is not enough and that you must add artificial milk. This temporary phase passes as you let the baby suckle more often. 

Some mothers give the child a heavy meal at night or a feeding bottle in the hope that he will sleep better. This is not desirable and often does not work. Outside milk given in the early months of life can lead to rapid development of infections and allergic diseases. A heavy meal may come in the way of the child going to bed soon.

Consult your doctor if you have tried everything and you still feel that your child has problems sleeping. If he certifies that the child is normal, do consider the possibility that your child may need more body contact.

He may need to breastfeed for many more months and may have to sleep longer in your room compared to other average children.

Any emotional factor at home or school should be attended to. Don’t allow children to watch violent and scary movies on television.


Nightmares

These are seen mostly in preschool children. A child has a scary dream and then he gets up crying. He is fully awake and appears afraid. He may recount the dream and once reassured, go back to sleep.


Night Terror
The child, again a preschooler, suddenly sits up in bed crying. He is not fully awake and is not aware of your presence. He screams as if terrified. He may be sweating and have a very fast heart rate. No effort on your part calms him down. Fortunately, he settles down after 15 to 30 minutes and goes back to deep sleep. When he gets up, he does not remember anything about the whole episode. 


Sleep Walking

This is seen mostly in children of school going age. While sleep walking, the eyes appear glazed. They may mumble something that may be difficult to comprehend. Generally, they do not hurt themselves, but care should be taken to prevent injury. Most such children are otherwise normal and the condition disappears in a couple of months. In rare cases, it may continue to adulthood. No treatment seems to help. Homoeopaths claim to be able to treat this condition.

In general, most sleep problems are sorted out by common sense, by listening to the child and by attending to his needs.




7 March, 2016

 
Part 4
The A-Z of Childhood Illnesses

Abdominal Pain
Abrasions or Scratches
Acute Glomerulonephritis
Acute Nephritis
Acute Watery Diarrhoea
Addictions
Adenoids
AIDS
Allergies
Anaemia
Anorexia (Poor Appetite)
Asthma
ADHD
Autism
Backache
Bed-Wetting (Enuresis)
Birth Deformities
Bites and Stings
Bleeding
Bone, Joint and Muscle Injuries
Bowlegs and Knock-Knees
Breathlessness
Bronchiolitis
Burns
Calcium Deficiency
Cancer
Cardiac Pulmonary Resuscitation
Cerebral Palsy (CP)
Chickenpox
Choking
Circumcision
Cleft Lip and Palate
Common Cold
Congenital Heart Disease
Constipation
Convulsions or Fits or Seizures
Cough
Croup
Crying
Cuts
Dengue Fever
Diabetes Mellitus
Diarrhoea, Dysentery ...
Diphtheria
Down's Syndrome
Earache, Ear Infections ...
Electric Shock
Encephalitis
Eye Problems
Fears
Foot Problems
German Measles (Rubella)
Glands in the Neck ...
Headache
Head Injury
Hepatitis
Hydrocephalus
Hypertension
Hypospadias
Influenza (Flu)
Jaundice
Joint Disorders
Kala-Azar
Leptospirosis
Limp and Pain in the Legs
Malaria
Malnutrition (Undernutrition)
Measles
Meningitis
Meningomyelocele
Menstrual Problems
Mental Retardation (MR)
Mouth To Mouth Breathing
Mumps
Nephrotic Syndrome
Nose-Related Problems
Obesity
Pneumonia
Poisoning
Poliomyelitis
Premature Baby
Prolapse of the Rectum
Rabies
Rheumatic Fever
Rheumatoid Arthritis
Rickets
Short Child
Skin Conditions
Sleep and Sleep Problems
Sore Throat (Pharyngitis)
Splinters
Stammering
Stridor (Noisy Breathing)
Teething and Care of Teeth
Tetanus (Lock Jaw)
Thrush
Thumb-Sucking
Tics
Torticollis
Tracheoesophageal Fistula
Tropical Eosinophilia
Tuberculosis (TB)
Typhoid
Umbilical Problems
Undescended Testis
Urinary Infection
Vaginal Discharge
Vomiting
Wheezing
Whooping Cough (Pertusis)



Part 4
Keeping Your Child Healthy
Choosing A Paediatrician
Proper Use of Medicines
Home Remedies
A First Aid Kit
The A-Z of Childhood Illnesses
Psychological Concerns
Managing A Hospital Stay
Emergencies
Prayer And Your Child's Health
The Role of Nature Cure
Homoeopathy
Ayurveda and Child Care
Congenital Heart Disease FAQ
 
Guide to Child Care
Home
Introduction
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand
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