Q: What’s the best way to cope with a toddler who wakes several times a night?
A:When young children are waking during the night, two things usually need to be addressed: the way they are falling asleep and the way you respond to their wakings.
Night wakers typically associate certain conditions with falling asleep. We sometimes call these negative associations because a child cannot do them on his own — such as nursing, drinking a bottle, being rocked or lying down with a parent. Meanwhile, positive associations are available to the child throughout the night — such as white noise, a blankie or a pacifier (so long as the child is able to put it in his mouth by himself).
Partial wakings at night are normal for children (for adults too) — they usually happen three to eight times a night. But for a child who doesn’t fall asleep on his own, these arousals often turn into full awakenings, and he may need to repeat his bedtime routine to go back to sleep. Learning to fall asleep without negative associations will help resolve this problem.
Some toddlers fall asleep independently, but get up because their parents reinforce the wakings by feeding or bringing them to their bed. Changing your response and sticking with it can help. For example, if you stay calm and don’t offer a bottle or back rub, your toddler will probably find night waking less appealing.
Q: How much sleep do kids actually need?
A: The following table provided by the US National Sleep Foundation gives recommended hours of sleep for young children. Of course, some will need less or more — your child’s mood and behaviour is the best gauge of this. If you have concerns she is sleeping too little or too much, speak with her physician.
RECOMMENDED HOURS OF SLEEP BY AGE GROUP AGE RECOMMENDED HOURS
Infants 3-12 months 14-15 hours
Toddlers 1-3 years 12-14 hours
Preschoolers 3-5 years 11-13 hours
School-agers 5-12 years 10-11 hours
-Source: National Sleep Foundation
Q: Why do doctors say that children older than six months don’t need to be fed during the night? What if they really seem hungry?
A: Many paediatricians agree that healthy, full-term infants do not need to be fed during the night after six months of age. This guideline is probably tied to the time when children typically start eating solid foods.
Parents often report that their child seems hungry when he wakes at night. He probably is hungry — but out of habit because he’s used to getting a portion of his daily calorie intake at night. I recommend weaning off the nighttime feeds gradually over a few days or weeks. Children often start eating more during the day to make up for not eating at night.
In some cases, children will need to continue nighttime feeds after six months of age (for example, if they’re not gaining weight as expected or are not yet eating solid foods regularly).
Q: Should I be worried about a child who sleepwalks?
A: Parents often worry that sleepwalking is caused by an underlying psychological problem, or that it results in psychological harm. But the consensus, based on the research, is that neither worry is founded. Experts estimate that up to 40 percent of children sleepwalk at some point. It usually happens early in the night — one to three hours after a child falls asleep. It’s most common between ages eight and 12, but often begins between four and six. Most kids outgrow it by adolescence.
We do not fully understand why people sleepwalk. But we usually come by it honestly — 80 to 90 percent of children who sleepwalk have a family member who does too. Not getting enough sleep is a common cause, and stress, a full bladder, illness or even noise can also trigger sleepwalking. Sleepwalkers may be clumsy and do strange things, such as urinating in a closet — yet have no memory of it the next day (unless woken when it’s happening). If your child is sleepwalking, gently guide her back to bed. Disturbing her can make her agitated and prolong the episode.
To keep your sleepwalker safe, clear the floor and use safety locks on windows and doors. Hanging a bell over her door will alert you if she leaves her room.
Q: How do I know when my child is ready to stop napping?
A: Most children are down to a single nap, usually after lunch, by 12 to 18 months of age. Kids typically drop the final nap between ages three and five. There are two main signs that a child may be ready for this.
First, it will take him longer to fall asleep, or he will stop falling asleep altogether, at nap time. You might try a later nap because as kids get older, they need to be awake longer to increase their drive to sleep. Most preschoolers need to be awake for seven or eight hours before a nap.
A later bedtime (after 8:30 p.m.) may also be a sign that your child no longer needs a nap. Try limiting nap time to one hour; if he still has difficulty falling asleep at night, you can probably drop the nap. When you do this, your child will likely need an earlier bedtime.
Q: Is there anything parents can do to help prevent early wakings?
A: Early waking (before 6 or 6:30 a.m., depending on the child’s bedtime) is a common parental complaint, and can be tricky to resolve. But there are things you can try.
First, consider installing room-darkening shades and a white-noise machine to block sunlight and noise. If heavy diapers are waking your child, give her less to drink in the last few hours before bed (and offer her more earlier in the day).
Sometimes putting a child to bed late — possibly in the hope of getting her to sleep longer — can have the opposite effect. A good bedtime for most young children is between 7:30 and 8 p.m. or, if she is still napping, closer to 8:30 p.m.
Giving your child a “morning signal” for when it’s time to get up can be helpful. I often recommend attaching a night light to a timer. Children as young as two can learn that they can get up when the light is on, and that they must return to sleep when it’s off.
Q: When I put my four-month-old to bed, he starts to cry and rolls over onto his tummy. Do I need to keep rolling him over to make sure he sleeps on his back?
A: The Back to Sleep campaign recommends that until a child can roll onto his tummy, he should sleep on his back, as this position is associated with a decreased risk of sudden infant death syndrome (SIDS).
Once a child can roll onto his tummy on his own, he is probably safe sleeping in this position. Unless there is a medical reason for him not to sleep this way, it is not necessary to keep repositioning him.
Q: I’ve read about transitional objects, but am not sure what they are. Should all parents give them to their kids? Is a pacifier a good transitional object?
A: Transitional objects are things children use to comfort and soothe themselves at bedtime and during naps. I am a big advocate of them.
A pacifier is a great transitional object if your child can use it on her own, including in the dark. Blankies are a good option for many children. Just be sure that if your child is still in a crib, the blankie is small enough that it cannot wrap around her face or neck, and that it’s made of breathable material. Check with your child’s physician if you have concerns.
Q: If I don’t sleep-train my child, am I doing her a disservice?
A: Good sleep — both in quality and amount — is as important as good nutrition. Sleep deprivation has been shown to affect both physical and psychological functioning.
The goal of sleep training is to help your child develop the skill of falling asleep independently. It typically involves checking on your child briefly and at gradually increasing intervals, offering her words of reassurance, but not picking her up or soothing her for longer than a minute. Some lucky parents have kids who fall and stay asleep without major fussing — they never need to sleep-train. And although parents whose kids do have problems are often told their children will outgrow them, this is usually not the case. Research has shown that sleep problems are among the most chronic behavioural problems in children, persisting even into adulthood.
While sleep training can be controversial, most experts agree on its benefits. It improves sleep for the whole family and helps with children’s behaviour, learning and physical development. Parents have reported that children have a greater sense of security after sleep training. There’s evidence that it eases anxiety and depression for moms, and gives marriages a boost. And there is no evidence that sleep training results in psychological harm.
Sleep training is often easier and quicker the younger the child is, but you should wait until your baby is at least four months old, and be sure she is healthy, before trying it. It’s also a good idea to rule out any medical causes for sleep problems before you start sleep training.
It’s worth noting that sleep training may not be something all parents are comfortable doing. You need to decide what works best for your family.
Q: My two-year-old was never a good sleeper and I received a lot of advice to do “whatever works.” I have been co-sleeping with him, but he is still waking. I would like him to sleep in his own room and wonder how I can make this change gradually?
A: “Gradually” is key when it comes to changing where a toddler or preschooler sleeps. You might start by sleeping with him in his room, ideally on a mattress on the floor. Introducing a transitional object can also be helpful.
Once he’s more comfortable sleeping in his own room, you can move out step by step. Start by sitting near his bed, then move farther away over the course of a few weeks. If he wakes during the night, try doing what you do at bedtime (for example, sitting by the door) to help him fall back to sleep. The final step is having him fall asleep independently (brief checks are OK).
During this process, your child will probably get out of bed several times. Silently lead him back. You might try using a reward chart to reinforce positive behaviour, or involve him in setting up his new big-boy room — he can help pick out new sheets and pyjamas, for example.
Parents should be aware of potential co-sleeping risks, including accidental smothering and children falling off the bed: See caringforkids.cps.ca and click on Pregnancy and Babies, then on Safe Sleep for Babies.