All About Sleep

Sleep — or lack of it — is probably the most-discussed aspect of baby care. New parents discover its vital importance those first few weeks and months. The quality and quantity of an infant's sleep affects the well-being of everyone in the household — it's the difference between being cheerful, alert parents and members of the walking dead.
And sleep struggles rarely end with a growing child's move from crib to bed. It simply changes form. Instead of cries, it's pleas or refusals. Instead of a feeding at 3:00 AM, it's a nightmare or request for water.
So how do you get your child to bed through the cries, screams, avoidance tactics, and pleas? How should you respond when you're awakened in the middle of the night? And how much sleep is enough for your child?
How Much Is Enough?
It all depends on your child's age. Charts that list the hours of sleep likely to be required by an infant or a 2-year-old may cause concern when individual differences aren't considered. These numbers are simply averages reported for large groups of children of particular ages.
There's no magical number of hours required by all kids in a certain age group. Two-year-old Sarah might sleep from 8:00 PM to 8:00 AM, whereas 2-year-old Johnny is just as alert the next day after sleeping from 10:00 PM to 5:00 AM. Still, sleep is very important to a child's well-being. The link between a child's lack of sleep and his or her behavior isn't always obvious. When adults are tired, they can either be grumpy or have low energy, but kids can become hyper, disagreeable, and have extremes in behavior.
Most kids' sleep requirements fall within a predictable range of hours based on their age, but each child is a unique individual with distinct sleep needs. Here are some approximate numbers based on age, accompanied by age-appropriate pro-sleep tactics.
Babies (up to 6 Months)
There is no sleep formula for newborns because their internal clocks aren't fully developed yet. They generally sleep or drowse for 16 to 20 hours a day, divided about equally between night and day.
Newborns should be awakened every 3 to 4 hours until their weight gain is established, which typically happens within the first couple of weeks. After that, it's OK if a baby sleeps for longer periods of time. But don't get your slumber hopes up just yet — most infants won't snooze for extended periods of time because they get hungry.
Newborns' longest sleep periods are generally 4 or 5 hours — this is about how long their small bellies can go between feedings. If newborns do sleep for a while, they will likely be extra hungry during the day and may want to nurse or get the bottle more frequently.
Just when parents feel that sleeping through the night seems like a far-off dream, their baby's sleep time usually begins to shift toward night. At 3 months, a baby averages 5 hours of sleep during the day and 10 hours at night, usually with an interruption or two. About 90% of babies this age sleep through the night, meaning 6 to 8 hours in a row.
But it's important to recognize that babies aren't always awake when they sound like they are; they can cry and make all sorts of other noises during light sleep. Even if they do wake up in the night, they may only be awake for a few minutes before falling asleep again on their own. It's best if babies learn early to get themselves to sleep, so let your baby try.
If a baby under 6 months old continues to cry for several minutes, it's time to respond. Your baby may be genuinely uncomfortable: hungry, wet, cold, or even sick. But routine nighttime awakenings for changing and feeding should be as quick and quiet as possible. Don't provide any unnecessary stimulation, such as talking, playing, or turning on the lights. Encourage the idea that nighttime is for sleeping. You have to teach this because your baby doesn't care what time it is as long as his or her needs are met.
Ideally, your baby should be placed in the crib before falling asleep. And it's not too early to establish a simple bedtime routine. Any soothing activities, performed consistently and in the same order each night, can make up the routine. Your baby will associate these with sleeping, and they'll help him or her wind down. You want your child to fall asleep independently, and a routine encourages babies to go back to sleep if they should wake up in the middle of the night.
6 to 12 Months
At 6 months, an infant may nap about 3 hours during the day and sleep about 11 hours at night. At this age, you can begin to change your response to an infant who awakens and cries during the night.
You can give babies at this age 5 minutes to settle down on their own and go back to sleep. If they don't, you can comfort them without picking them up (talk softly, rub their backs), then leave — unless they appear to be sick. Sick babies need to be picked up and comforted. If your baby doesn't seem sick and continues to cry, you can wait a little longer than 5 minutes, then repeat the short crib-side visit.
After several days, your baby should find it easier to get back to sleep on his or her own. But if your 6-month-old continues to wake up five or six times each night, talk to your doctor.
Between 6 and 12 months, separation anxiety becomes a major issue for some babies and may cause them to start waking up again. But the rules for nighttime awakenings are the same through a baby's first birthday: Don't pick up your baby, turn on the lights, sing, talk, play, or feed your child. All of these activities encourage repeat behavior.
If your baby wakes up crying at night, you can check in to make sure he or she isn't sick or in need of a diaper change. You can pat your child lovingly on the back or belly. Using a pacifier or thumb sucking can also help children of this age learn to calm and reassure themselves. If your baby continues to cry, you can institute the 5-minute visit pattern.
From ages 1 to 3, most toddlers sleep about 10 to 13 hours. Separation anxiety, or just the desire to be up with mom and dad (and not miss anything), can motivate a child to stay awake. So can simple toddler-style contrariness.
Note the time of night when your toddler begins to show signs of sleepiness, and try establishing this as his or her regular bedtime. And you don't have to force a 2- or 3-year-old child to nap during the day unless yours gets cranky and overly tired.
Parents sometimes make the mistake of thinking that keeping a child up will make him or her sleepier for bedtime. In fact, though, kids can have a harder time sleeping if they're overtired.
Establishing a bedtime routine helps kids relax and get ready for sleep. For a toddler, the routine may be from 15 to 30 minutes long and include calming activities such as reading a story, bathing, and listening to soft music.
Whatever the nightly ritual is, your toddler will probably insist that it be the same every night. Just don't allow rituals to become too long or too complicated. Whenever possible, allow your toddler to make bedtime choices within the routine: which pajamas to wear, which stuffed animal to take to bed, what music to play. This gives your little one a sense of control over the routine.
But even the best sleepers give parents an occasional wake-up call. Teething can awaken a toddler and so can dreams. Active dreaming begins at this age, and for very young children, dreams can be pretty alarming. Nightmares are particularly frightening to a toddler, who can't distinguish imagination from reality. (So carefully select what TV programs, if any, your toddler sees before bedtime.)
Comfort and hold your child at these times. Let your toddler talk about the dream if he or she wants to, and stay until your child is calm. Then encourage your child to go back to sleep as soon as possible.
Preschoolers sleep about 10 to 12 hours per night, but there's no reason to be completely rigid about which 10 to 12 hours they are. A 5-year-old who gets adequate rest at night no longer needs a daytime nap. Instead, a quiet time may be substituted. Most nursery schools and kindergartens have brief quiet periods when the children lie on mats or just rest.
A 5-year-old child may still have nightmares and trouble falling asleep some nights. You can prepare a "nighttime kit" that includes activities to pass the time and relax your child. It might include a flashlight, a book, and a cassette or CD player and story tape or CD. Use the kit together, then put it in a special place in your child's room where he or she can get to it in the middle of the night.
School-Age Children and Preteens
Kids ages 6 to 9 need about 10 hours of sleep a night. Bedtime difficulties can arise at this age from a child's need for private time with parents, without siblings around. Try to make a little private time just before bedtime and use it to share confidences and have small discussions, which will also prepare your child for sleep.
Children ages 10 to 12 need a little over 9 hours of shuteye a night. But it's up to parents to judge the exact amount of rest their children need and see that they're in bed in time for sufficient sleep.
Lack of sleep for kids can cause irritable or hyper types of behavior and can also make a condition like attention deficit hyperactivity disorder (ADHD) worse.
Adolescents need about 8 to 9.5 hours of sleep per night, but many don't get it. And as they progress through puberty, teens actually need more sleep. Because teens often have schedules packed with school and activities, they're typically chronically sleep deprived (or lacking in a healthy amount of sleep).
And sleep deprivation adds up over time, so an hour less per night is like a full night without sleep by the end of the week. Among other things, sleep deprivation can lead to:
*decreased attentiveness
*decreased short-term memory
*inconsistent performance
*delayed response time
These can cause generally bad tempers, problems in school, stimulant use, and driving accidents (more than half of "asleep-at-the-wheel" car accidents are caused by teens).
Adolescents also experience a change in their sleep patterns — their bodies want to stay up late and wake up later, which often leads to them trying to catch up on sleep during the weekend. This sleep schedule irregularity can actually aggravate the problems and make getting to sleep at a reasonable hour during the week even harder.
Ideally, a teenager should try to go to bed at the same time every night and wake up at the same time every morning, allowing for at least 8 to 9 hours of sleep.
Establishing a Bedtime Routine
Here's a summary of a few ways that may help your child ease into a good night's sleep:
* Include a winding-down period in the routine.
* Stick to a bedtime, alerting your child both half an hour and 10 minutes beforehand.
* Allow your child to choose which pajamas to wear, stuffed animal to take to bed, etc.
* Consider playing soft, soothing music.
* Don't give your baby or toddler a bottle (of breast milk, formula, or any sugar-containing drink) to aid sleep. This can cause a serious dental problem called "baby bottle tooth decay" because the fluids tend to pool in the child's mouth.
* Tuck your child into bed snugly for a feeling of security.
* Encourage your older kid or teen to set and maintain a bedtime that allows for the full hours of sleep needed at this age.
There isn't one sure way to raise a good sleeper, but every parent should be encouraged to know that most kids have the ability to sleep well. The key is to try, from early on, to establish healthy sleep habits.

Reviewed by: Steven Dowshen, MD
Date reviewed: November 2007

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