CHAPTER 11

SLEEPING PROBLEMS

Establishing satisfactory sleeping patterns may happen early and easily. However, sleeping patterns may not establish early or may establish but then be disrupted. Abnormal patterns of sleeping, once established, may be difficult to break, especially if the cause of the sleeping problem is not dealt with. Sleeping difficulty is often associated with medical problems as has been described in the discussion of Eustachian tube Irritation [ETI] babies.

To understand an infant’s sleeping issues we need to accept that different families have different expectations of their children’s sleeping. Parent’s expectations depend on family experience, cultural acceptance and child rearing ideas of individual parents.

Cultural differences as to where and how families sleep must be respected. There is no right or wrong. There is only what a family is comfortable with.

I believe that as long as the parents wake in the morning feeling refreshed and the children wake happy and appear to have had adequate sleep, that the sleeping arrangements are acceptable.

Some families enjoy having everyone in the household sleeping together, usually on one large mattress on the floor. Other families prefer to have several children sleep together in one large bed. Nowadays it is common for many parents to expect children to each have their own room and sleep in their own bed. In the days when large families lived in smaller homes with several children sharing a room or even a bed, there seemed to be less problems with children not wanting to stay in bed. It is often better for young children to share a room when they are young—for company and security, and then move to separate rooms when they are older and have more desire for privacy.

Some parents move from one bed to another during the night, going into the child’s bed when they wake, rather than trying to resettle the child in his own bed. Some have the child come into the parent’s bed as the quickest way to get back to sleep. Sometimes the father will move into the child’s bed to ensure he has adequate sleep before going to work. Some mothers see no problem with getting up several times a night to a child, where others are shattered if woken even once during the night.

Parent’s expectations must be respected unless they are unrealistic. An explanation of what can be expected, related to the child’s development helps parents understand, if their expectations are not realistic.

Parents have enormously different tolerance of children waking during the night. Some parents are ‘night owls’ and sleep lightly and may get up several times during the night and just wander around the house, perhaps have a drink then go back to bed—and still wake in the morning refreshed and relaxed. Others need at least eight hours of undisturbed sleep or they will be tired and not function well the next day.

It is useful to enquire about both parents sleeping needs and their sleeping patterns. Usually the children’s sleeping needs will follow one or the other parent, and the child’s sleep needs are often established by two years. Sometimes there is a suspicion, even earlier, that the child actually needs less sleep than average. Depending on the pattern the child develops, they may need to go to bed early and wake early or they find it difficult to settle to sleep until late and prefer to sleep later. They may need more or less sleep than expected for their age, but wake happy.

In early infancy, if the infant’s sleep is disturbed because of medical problems [e.g., ETI], the problems need to be resolved before seven or eight months of age for a more satisfactory sleeping pattern to develop spontaneously. If the sleeping pattern is not established by seven or eight months, it is likely to need specific measures to establish a satisfactory pattern….


SUMMARY

Sleeping problems are very common in infants and young children. Households do not function well if the family’s sleep needs are not met.

Understanding children’s sleeping requires an understanding of the normal pattern of sleeping.

To prevent sleeping problems developing, and in treating sleeping problems, it is necessary for children to learn to fall asleep by themselves, without rocking or physical contact with a parent. Without learning this ability, children will want or need the same situation to be present each time they wake—including if they wake when the sleep changes from a deeper to a lighter phase.

Infants with Eustachian tube Irritation are especially prone to sleeping problems as they have discomfort when lying down and this changes the threshold at which they wake.

Sleeping problems may be difficulty falling asleep, difficulty remaining asleep or difficulty resettling after waking.

Changing infant’s and children’s sleeping patterns is not always easy as the infant is happy with the situation and does not have any reason to want to change.

I do not agree with using ‘controlled crying’ or even ‘controlled comforting’ as I believe that children should always go to bed relaxed and happy. There are long term implication for using these techniques including children losing trust, being insecure and having difficulty establishing long term relationships.

Changes should not be attempted until the child’s medical problems have been resolved. If the child is less than seven or eight months old when these problems are sorted out, the sleeping problem will often resolve spontaneously, within a few days or weeks. If older than seven or eight months the problems may not resolve spontaneously and need specific intervention to correct.

Changing settling and sleeping patterns needs to be done gently and subtly so that the child is not aware that changes are occurring. This may take several weeks but can be achieved more quickly with a low dose of long acting sedative [usually Vallergan forte], although many doctors do not approve of this technique.

If using sedation, the dose and timing are important, as is the need to slowly establish good routines. Vallergan forte is only available on prescription, must be used under medical supervision, and there are strict criteria for its use, including not giving if the child is unwell or in conjunction with some other medications.

Other habits that the child has developed for settling may have to be sorted out, including drinking during the night and the use of a dummy.

Parents have specific ideas of what is acceptable sleeping for their infants and children—depending on their beliefs and their own sleeping needs. Listening to parents is always important and their instincts must never be ignored.


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