Infants Sleep Problems

Normal Sleep Development in Children

As children grow and develop, their sleep patterns undergo significant changes. One of the most prominent shifts occurs during the first 6 months of life, as infants transition from having approximately 5-6 episodes of sleep throughout the day to consolidating their sleep, with more extended periods of rest at night. Concurrently, daytime naps decrease. Most infants master sleeping for at least 5 consecutive hours with minimal disruptions during this process. However, difficulties in this phase can manifest as trouble falling asleep and multiple nighttime awakenings.

In addition to changes in sleep duration, the architecture of sleep also transforms during early development. Newborns spend roughly 50% of their sleep time in the REM (rapid eye movement) stage, amounting to approximately 8 hours a day. Yet, within the first two years, this proportion declines to 20-25% and remains relatively constant as the child continues to grow.

Another notable change in children’s sleep occurs during the preschool years and continues into adolescence as bedtime is postponed, and the total sleep time decreases. This trend accelerates during puberty, often leading to insufficient sleep, especially among adolescents.

Global studies indicate that children today are generally sleeping less than in previous decades, making them more susceptible to sleep deprivation. It’s important to understand that various factors can disrupt sleep, including medical, physiological, environmental, and psychological issues. Any condition causing physical discomfort or pain, such as reflux, milk allergy, skin problems, teething, headaches, or colds, can adversely affect sleep.

Regulation of Sleep and Wakefulness

Two primary mechanisms oversee the sleep-wake cycle: the “sleep-dependent” process (S-process) and the “sleep-independent” process (C-process), related to circadian rhythms. The S-process increases the urge to sleep the longer one has been awake and the shorter the previous night’s sleep. Similarly, this process is akin to feeling hungrier with increasing time since the last meal. The C-process governs 24-hour physiological rhythms.

Sleep Problems and Difficulties in Children

Sleep difficulties, especially struggles with falling asleep and frequent nighttime awakenings, are common in young children, affecting approximately 20-30% of children from infancy to school age. Approximately 25-50% of infants and toddlers over 6 months of age continue to experience nighttime awakenings. Furthermore, these difficulties often persist into school age, leading to cognitive, emotional, and behavioral challenges, impacting areas like memory, learning, mood regulation, and overall quality of life. These sleep problems can also affect parents, potentially leading to maternal depression and marital strife.

Numerous factors contribute to sleep issues in children, including biological, circadian, developmental, environmental, and behavioral elements. Parents’ beliefs and perceptions about their child’s sleep are essential factors that influence the development of sleep difficulties. For instance, parental misconceptions about sleep expectations and development can lead to counterproductive behaviors.

It’s also crucial to consider the cultural context as living arrangements or environmental factors, like sharing a room with siblings, can affect sleep. Recognizing and addressing these factors is vital to improving sleep outcomes.

Assessing Sleep

Evaluating sleep problems can involve clinical assessment by a professional, objective methods like sleep laboratory tests or actigraph devices, and subjective approaches such as self-administered questionnaires and sleep diaries. Clinical tests, like sleep laboratory assessments, are necessary when there are suspicions of sleep-disordered breathing, sleep movement disorders, unexplained fatigue, or epileptic seizures.

Treatment of Sleep Problems in Children

To address sleep difficulties in infants and toddlers, various therapeutic strategies exist. Many children learn to rely on specific conditions, such as the presence of parents or particular soothing techniques, to fall asleep. Over time, this reliance can lead to difficulties falling back asleep independently when they wake up at night. Behavioral interventions and parent education are typically effective in guiding parents on establishing good sleep habits and promoting self-soothing behaviors in children.

These interventions often lead to improvements not only in sleep but also in overall child behavior, anxiety reduction, family communication, and parental well-being. Such interventions focus on helping parents understand their role in maintaining or resolving sleep problems and facilitating behavioral changes in both parents and children.

Parent Education for Sleep Improvement

Parent education provides general principles for preventing and addressing sleep problems in children. Key recommendations include:

• Maintaining regular sleep and wake times.
• Establishing a consistent bedtime routine with enjoyable and relaxing activities, including alone time with parents.
• Creating a comfortable sleeping environment with a dark, quiet room.
• Setting clear boundaries and bedtime rules.
• Ensuring the child sleeps in their own bed without constant location changes.
• Managing the child’s physical activity while avoiding vigorous exercise close to bedtime.
• Exposing the child to daylight, particularly in the morning and early afternoon.
• Avoiding caffeine consumption before bedtime.
• Restricting daytime naps for school-age children.
• Seeking professional advice if the child experiences issues like snoring, restless sleep, nighttime awakenings, anxiety, or the need for an adult’s presence to fall asleep.
• Encouraging the child to use a safety or transitional object while lying down.
• Placing the child in their bed while drowsy but not fully asleep.
• Gradually decreasing the time between check-ins if the child is crying at bedtime.
• Gradually moving away from the child’s room once they fall asleep independently.
• Consistently applying these principles.

Please click here for preliminary children’s sleep assessment questionnaire