Feature/General
Sleep Habits Important to Establish
By Rachel Tribble, Athens Regional Medical Center
August 2004

Sleep is a precious thing. A well-rested child wakes up happy, smiles and has a pleasant disposition throughout the day. But more than 100 million Americans of all ages have trouble sleeping. Long-term difficulties can cause problems in development and behavior and cause undue stress to the entire household.

An important key to quality sleep is establishing routines for both naps and nighttime. Newborn babies average 16-18 hours of sleep a day generally spread into five episodes. By two months of age, nearly 50 percent of infants sleep or rest quietly for at least five hours during the night. By six months, many babies can sleep as long as nine hours at night. By the end of one year, most children are down to one long sleep period at night and a morning and afternoon nap, altogether about 12-14 hours of sleep a day.

Generally, parents should set aside 10 to 30 minutes to do something special with their child before bed. The activity should not be stimulating (jumping, running, wrestling), nor should it include scary stories. The child needs to know the time limits and they will not be exceeded. Giving in to requests for extra juice, milk or another story can teach children that bedtime can be postponed. The longer bedtime is postponed, the more likely it is for tension, anxiety and arguments to develop.

According to Joe Granato, R.EEG T./RPSGT, Manager of Athens Regional Medical Center’s Sleep Disorders Center, many common sleep problems in children and adults can be corrected once they are identified. The Center, accredited in November 2003 by the National Board of Sleep Medicine, treats children as young as 10. Specialty centers treat children younger in age.

Granato says solutions to sleep disturbances are often a matter of a little guidance and common sense. He says children should always feel they are sleeping in a safe, nurturing environment. They should also be taught to sleep independently.

Children who sleep with pacifiers, for example, should be encouraged to fall asleep with a favorite toy or blanket instead. When a pacifier falls out of the child’s mouth, they often wake up and are unable to get themselves back to sleep.

The following are recommendations from the American Sleep Disorders Association to help children sleep soundly:
• Follow a consistent routine.
• Establish a relaxing setting at bedtime.
• Don’t substitute television-watching or videos for personal interaction at bedtime.
• Screen television programs, videos and computer games for age-appropriate material.
• Avoid letting the child fall asleep with a bottle or while nursing, being held or rocked.
• Avoid food and drinks containing caffeine (chocolate, sodas, etc.)

Granato says people, regardless of age, should stay on the same sleep schedule instead of going to bed at different times and in different sleeping conditions and environments.
“ All humans experience brief awakenings during their sleep, but adults generally do not remember them,” he said. “When parents see their child awaken, they often pick up the child, interrupting this very normal process.”

According to Granato, sleep disturbances can range from infants being fed too much during evening hours to social stresses in school-aged children. Medications (both prescription and over-the-counter) may also cause disruptions in sleep.

“ If sleep difficulties persist or there is a medical concern, your child may be experiencing problems such as serious otitis, or gastroesophageal reflux,” Granato says. “Respiratory difficulties may be due to enlarged tonsils, maxillofacial abnormalities or obesity.”

He says all sleep disturbances should be monitored and addressed by parents, and when necessary, brought to the attention of the child’s pediatrician. Parents can often help medical professionals by sharing observations about their child’s sleep patterns. In fact, many sleep centers will ask parents to log their child’s sleeping and waking patterns for a week or two before their visit. Specialists may need to know when the child goes to bed, when they get up, as well as how often and at what time of night sleep disturbances occur.

The following signs may indicate a problem with your child’s sleep:
• Too much time is spent “helping” the child fall asleep.
• Your child wakes up repeatedly throughout the night.
• The child’s behavior and mood are affected by poor sleep.
• Parents lose sleep as a result of the child’s nighttime patterns.
• Poor sleep causes the parent-child relationship to suffer.

Once infants mature to toddler age, sleep periods become very stable and sleep disturbances usually subside, Granato says. They begin sleeping more like adults with only brief awakenings.
“ Parents are responsible for establishing consistent routines that encourage restful sleep,” Granato says. “By enforcing nighttime and naptime rules, they are helping create positive sleep habits for their child.”