Preschoolers May Have Problems with Sleep
Sleep problems do not just plague teenagers who burn the candle at both ends or adults anxious about paying their bills.
Even preschoolers can have trouble sleeping, and experts suspect the main difficulty for children ages one to five is simply a lack of restful slumber, according to a study reported in the journal Sleep.
"Twelve to 15 hours a night is recommended based on best guesses," says Christine Acebo, Ph.D., at Brown University Medical School in East Providence, Rhode Island.
Part of the problem, she explains, is that no rigorous studies have been done to test the effects of various amounts of sleep on young children.
"We don't really know how much sleep they need," she says.
Few young children get the recommended 12 to 15 hours of sleep, Dr. Acebo found.
When she tracked 169 children, ages one to five, she found that the older kids got less than 9.5 hours of sleep in a 24-hour period, including naps. And the one- and two-year-olds got 10.5 to 11 hours in each 24-hour period.
Dr. Acebo found that children in lower-income families spent more time in bed at night, but woke up more frequently during the night than children from higher-income families.
The children from low-income families also tended to have variable bedtimes, which can trigger sleep problems, the researchers found.
She suspects the variable bedtimes could be due to the parents' changing work schedules. They may have to work alternating shifts, for instance.
Besides a lack of sleep, young children often struggle with other conditions, Dr. Acebo says, such as restless leg syndrome, a neurological disorder that typically affects older adults. Restless leg syndrome is characterized by unpleasant sensations in the legs.
Or, children, like adults, can suffer from sleep apnea, in which they have episodes of upper airway obstruction, interrupting breathing, and compromising sleep.
"There are a fair number of kids who have sleep problems such as sleep apnea from enlarged tonsils and adenoids," notes Dr. Acebo.
Some sleep problems may be traced to feelings of insecurity in a child, says another sleep expert, Dr. Rafael Pelayo, at the Stanford University Sleep Disorders Clinic in Palo Alto, Cal.
"We want children to go to bed feeling safe, comfortable, and loved," he says.
If they do not feel that way, it is understandable they may have trouble falling or staying asleep.
Sufficient sleep is crucial not only for proper growth and development, but for a child's behavior, too, as any parent of a crabby preschooler already knows.
On a more scientific level, researchers from Northwestern University Medical School studied the link between adequate sleep and behavior.
They evaluated 510 children, ages two to five, asking parents to report the amount of sleep their child got and then to describe the youngster's behavior the next day.
The result: A lack of sleep during the night or naps translated into next-day behavior problems.
So, what is the experts' advice for parents of preschoolers?
"Keep regularly scheduled bedtimes and have good routines for bedtime," Dr. Acebo says.
Those routines might include a bedtime story or anything else that is relaxing, she says. The point is to ease them to sleep in a relaxed manner.
Dr. Pelayo prefers to give a broader recommendation to parents.
"I don't get caught up in details [such as have your child go to bed at the same time very night] on purpose," he says.
Instead, he emphasizes that parents should make a child feel safe and comfortable and that the household should not be too chaotic. A child will fall asleep more easily if the environment is conducive, says Dr. Pelayo.
He does caution parents not to tell a child she can stay up later and use a later bedtime as a reward for good behavior. That sends the wrong message, he says - that sleep or having to go to bed is punishment.
Another habit that some parents get into is to establish too early a bedtime for the age of the child.
"Sometimes the kids have inappropriate [too early] bedtimes because the parent wants a break, they want earlier bedtimes," says Dr. Pelayo.
Occasional lack of sleep or sleep problems are probably nothing to worry about, says Dr. Acebo. However, if a child aged one to five seems sleepy during the day, outside of his or her regular nap time, then that is "something to tend to," she says.
In these cases, a call or a visit to your pediatrician may be in order, says Dr. Acebo.
Always consult your child's physician for more information.
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Establishing good sleep habits for your child is important.
Newborns do not have a set night/day schedule for the first several weeks of life.
It is best for a newborn not to sleep longer than five hours at a time in the first five to six weeks as their small bodies need frequent feedings.
Older babies and children should have a nap time and bedtime schedule.
Start a quiet time, such as listening to quiet music or reading a book, 20 to 30 minutes before bedtime. TV should not be a part of the quiet time.
After quiet time, follow a bedtime routine such as a diaper change, going to the bathroom, brushing teeth, etc.
Set a time limit for quiet time and the routine so it does not drag on and your child knows what to expect before bedtime.
Say goodnight, turn off the light, and leave the room.
Security objects, such as a special blanket or stuffed animal, can be part of the bedtime routine.
It is important for children to be put to bed awake so they learn to fall asleep themselves.
Babies should not be put to bed with a bottle. It causes problems with tooth decay and ear infections.
Children can easily fall into bedtime habits that are not always healthy habits.
If your child cries, speak calmly and reassure him/her, "You are fine. It is time to go to sleep." Then leave the room.
Do not give a bottle or pick up your child.
Stretch out the time between trips to the room if your child continues. Do not do anything but talk calmly and leave.
Your child will calm down and go to sleep if you stick to this routine. It may take several nights for your child to get used to the new plan.
If your child is used to getting a large amount of milk right at bedtime, start to cut down the amount of milk in the bottle by one-half to one ounce each night until the bottle is empty and then take it away completely.
Sometimes children get out of their routine of night sleeping because of an illness or travel. Quickly return to good sleep habits when things are back to normal.
Sometimes, older children go through a stage or a period of time when they revert back to bad sleep habits or develop new problems in going to sleep.
For older children, if a child gets out of bed, take him/her back to bed with a warning that the door will be shut (not locked) for one or two minutes if he/she gets out of bed. If your child stays in bed, the door stays open.
If your child gets out of bed, the door is closed for two minutes. Your child can understand that he/she has control of keeping the door open by staying in bed.
If your child gets out again, shut the door for three to five minutes (no more than 5 minutes).
Be consistent. Put your child back in bed each time he/she gets out of bed.
When your child stays in bed, open the door and give your child praise (i.e. "You are doing a great job of staying in bed. Goodnight.").
Your child can be rewarded for staying in bed by earning a star on a calendar for staying in bed all night. You can give a special prize for a certain number of stars earned.
Always consult your child's physician for more information.
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