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Causes of sleep disorders in children and their treatment. The underlying causes of sleep disturbances and nightmares in children The child has disturbed sleep, what to do?

Caroline Tedke, University of South Carolina Medical College, Charleston, South Carolina

Sleep disorders are common in children. It is necessary to distinguish between cases where polysomnography reveals disorders (eg, parasomnias, apnea and narcolepsy) and cases where the problems are behavioral in origin and the polysomnography is normal. Parasomnias (night terrors, somnambulism and enuresis) are caused by immaturity of the central nervous system and often resolve with age. Obstructive sleep apnea syndrome (OSA) in children is often not diagnosed on time, although it can be successfully treated surgically. Behavioral sleep disorders can be treated with proper parental coaching. Doctors can provide significant assistance to such families by recommending effective techniques to parents. ( American Journal of Family Medicine 2001;63:277-84 )

Sleep problems in children are often a concern for parents. A child who does not want to go to bed or wakes up frequently during the night often causes very big problems in the family. Sleep disorders in children, confirmed by sleep laboratory data, are in principle similar to disorders in adults. However, problems, which are defined as a sleep pattern that is unsatisfactory to the parent, child or doctor, are more common in children. Determining sleep behavior disorder is quite difficult due to significant differences in sleep patterns at different ages. So, for example, it is not abnormal if a two-month-old baby often wakes up at night, but the same would be a pathology for a two-year-old child. To understand the complexity of the problem, one can also consider the large differences in tolerance to sleep problems, which vary significantly between families.

Normal sleep in children.

Sleep in very young children differs significantly from sleep in adults. Infants under 6 months of age spend 50% of their sleep in the inactive REM stage, compared to 20% in adults. Sleep in babies begins through the initial active REM stage, while in adults the first REM phase appears no earlier than 90 minutes from the moment of falling asleep. The active REM phase often recurs in infants, creating shortened sleep cycles. Before 6 months, restful REM (also defined as restful or uncertain sleep) cannot be subdivided into EEG stages known as mature sleep patterns. After 6 months, an infant's sleep architecture begins to resemble that of an adult. After an initial "settling" period, which usually lasts 10 to 20 minutes, there is a transition from NREM Stage 1 to Stage 3 or 4. The child may return to Stage 1 and repeat the cycle. After one or two cycles of NREM sleep, REM sleep occurs after 60-90 minutes. The first third of the night is mostly deep sleep (NREM Stages 3 and 4). In the second half of the night, stage 2 NREM and REM sleep predominate. In newborns, the total sleep time is evenly distributed between the day and night periods. Nighttime sleep gradually consolidates into one continuous episode by the first year of life. The amount of daytime sleep gradually decreases over the first three years of life. By age four, most children no longer need short naps during the day. The need for nighttime sleep also decreases, so that during adolescence it is comparable to the need for adults.

Scope of the task.

Parents of young children are eager to learn more about what they can expect from their child's nighttime sleep routine. The studies carried out yielded different results because they were conducted on different populations and used different terminology and data processing methods. Typically, the incidence of night awakenings was estimated to be 100% in newborns and dropped to 20-30% in six-month-old infants. Once an uninterrupted night's sleep has been achieved, some children may begin to wake again during the night - this is often the result of social factors rather than maturational problems. Night awakenings are more common in early childhood. Research has shown that approximately one in three children under 4 years of age continue to wake up during the night, requiring parental intervention to get them back to sleep.

Parasomnias

Parasomnias are sleep disorders that are characterized by an abnormal polysomnogram. They are episodic in nature and reflect immaturity of the central nervous system (CNS). Therefore, parasomnias are more common in children than in adults and usually disappear with age. Parasomnias tend to run in families. These disorders are paroxysmal, predictable in their occurrence in a particular sleep cycle, are not responsive to external influences, and are characterized by retrograde amnesia. Diagnosis is often made solely on the basis of a thorough history. Additional diagnostic tests are rarely required.

Pavor nocturnes or night terrors

Pavor nocturnus or night terrors occur approximately 90 minutes after falling asleep, in stage 3 or 4 NREM sleep. The child suddenly sits up and begins to scream uncontrollably. It may take up to 30 minutes for him to calm down and fall back to sleep. This is accompanied by tachycardia, rapid breathing and other signs of autonomic activation. Night terrors usually occur in children between the ages of 3 and 8 years. They must be distinguished from nightmares (Table 1). Night terrors are more likely to occur during periods of stress or overwork. Despite their frightening nature, parents need to make sure they are self-limiting. We must try to find out if there is any stressful situation in the child's life and make sure that the child has opportunities for rest and recovery. Children whose night terrors do not resolve on their own and whose episodes are extremely disruptive may be given diazepam (Valium).

Table 1. Comparison of night terrors and nightmares

Sleepwalking and dream-talking

During sleepwalking (somnambulism) and sleep-talking (somniloquy), the child sits up in bed with his eyes open, but with the so-called “blind gaze.” Activities can range from resting aimlessly in bed to actually walking around the house. Speech is unclear and rarely intelligible. These disorders occur in school-age children, more often in boys than in girls, and are often also accompanied by enuresis. Sleepwalking children can be injured and parents need to take steps to avoid dangerous situations such as falling from balconies or stairs. Sleeping rooms for such children should be on the ground floor, with windows and doors securely closed. During an episode of sleepwalking, parents should interfere minimally and refrain from shaking him or yelling at him. This type of sleep behavior usually resolves with age and usually does not require special intervention other than the precautions noted above. Another method is the so-called “scheduled awakenings”. Parents keep a diary, record the time when sleepwalking occurs over several nights, and then begin to wake the child 15 minutes before the expected time. In this case, you need to make sure that the child is fully awake for at least 5 minutes. Using this method eliminates sleepwalking in 80% of children.

Nocturnal enuresis

Nocturnal enuresis or bedwetting is one of the most prevalent and persistent problems in children. Enuresis is classified as primary if the child has never previously been “dry” in bed and secondary if it occurs after the child has been able to hold back urination for at least a year. Primary enuresis is much more common and is unlikely to be a consequence of pathology.
The etiology of primary enuresis is most likely multifactorial. Often primary enuresis is associated with a family history. The ability to contain urine is closely related to the maturity of the nervous system and a child who is developmentally delayed at the age of 1-3 years is much more likely to be enuretic at six years of age. Enuretic children were found to have lower functional bladder capacity (the volume of urine the bladder is able to hold) than non-enuretic children, although true capacity did not differ. And finally, enuresis is considered by most researchers to be a parasomnia, since it is observed only in the stages of NREM sleep. However, despite the subjective opinion of parents, enuretic children are no more difficult to wake up than others.
In most cases, if a thorough history, general and neurological examination shows no symptoms of other disorders, no additional diagnostic tests, including urinalysis, are required. As a rule, even before the first visit to the doctor, parents are already taking some measures, in particular, limiting evening fluid intake, waking up the child so that he goes to the toilet before the parents themselves go to bed. Although doctors sometimes resort to drug treatments, such as imipramine (Tofranil) and, as a follow-up, desmopressin (DDAVP), numerous studies have shown the superiority of wetness signals in terms of effectiveness, lack of side effects and low recurrence rates. These devices are available through pharmacies or can be ordered online. There is also "continence training" (bladder training), which involves a number of techniques that are, however, beyond the scope of this article (see Sheldon).

Obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSA) is thought to affect 1-3% of children. Symptoms include snoring and labored or mouth breathing during sleep. Parents of infants with severe OSA may experience difficulty feeding their child. OSA in children is often caused by adenotonsillar hypertrophy. Other causes include craniofacial pathology, obesity, and neuromuscular diseases. A high percentage of allergic diseases has been reported in children with snoring and OSA.
In adults, airway obstruction is transient and often very severe. In children, if the cause is adenotonsillar hypertrophy, the obstruction is permanent, but less pronounced. Children are less likely to experience hypersomnolence (daytime sleepiness) than adults, but they also often experience enuresis, excessive sweating, and developmental delays. OSA. There is clear evidence of OSA in a certain percentage of children experiencing learning difficulties and behavioral problems, including attention deficit hyperactivity disorder. The diagnosis of OSA is made in a pediatric sleep disorder laboratory using overnight oximetry and polysomnography. Most of these children experience significant improvement after tonsillectomy. The latter is not indicated if the cause of OSA in the child is another pathology (craniofacial anomaly, neuromuscular diseases, obesity). In these cases, and also if tonsillectomy surgery does not bring a satisfactory result, treatment with CPAP, a device that creates positive air pressure in the upper respiratory tract, can be prescribed. This technique is usually used in adults, but has also been shown to be effective and safe in children.

Narcolepsy

Narcolepsy is not common in childhood, although it can occur in adolescents. The main symptom, as in adults, is increased daytime sleepiness. Obviously, this can create difficulties in the learning process. Cataplexy or hypnagogic hallucinations are much less common in children than in adults. At first, the child begins to experience difficulty waking up in the morning. Upon awakening, there may be some confusion, and the child may even be aggressive in words and actions. Diagnosis can be quite difficult; initial polysomnography may be normal. If the diagnosis remains in doubt, repeated polysomnography is indicated. These children may benefit from regular short naps during the day. Sometimes drug stimulation may be required. Because it is a lifelong condition with increased mortality, children with narcolepsy should be monitored by a sleep specialist.

Secondary sleep disorders

Secondary disorders are much more common than primary ones and are characterized by normal polysomnography data. Disturbed sleep patterns are often temporary, but can cause serious problems in the family if they continue for a long time. The most common secondary sleep disorder is night awakenings and reluctance to fall asleep at the appointed time, which is most often observed in children just starting to walk and in general in the preschool period. Although 95% of newborns cry after waking up at night and require parental attention to fall back to sleep, by the age of one year, 60 to 70% of children can actually fall back to sleep on their own. The concept of sleep associations is important. A child who goes to bed awake and learns to fall asleep using comfortable measures is usually able to self-soothe if he suddenly wakes up in the middle of the night. Conversely, a child who falls asleep with the help of a parent, such as rocking or simply physical presence, may have difficulty falling asleep on his own after waking up in the night. In such cases, parents can be advised to change behavior, stop rocking the child, etc., wait longer than usual when the child cries after waking up, until the child gradually learns to calm down and fall asleep on his own.

Colic and night awakenings.

Colic in children is often a real scourge for young parents. While colic is not a sleep disorder in itself, infants with colic have shortened total sleep duration. Sleep problems can sometimes continue after colic has passed with age - because the measures that parents used to stop crying attacks (rocking in arms, in a stroller) can interfere with the development of a normal sleep pattern. An infant over 4 months of age who continues to wake during the night is considered a “trained night cryer.” These babies calm down quickly after being held. One way is to recommend that parents gradually increase the time intervals of “ignoring”; another way to stop a child’s crying is “cold turkey.” Either method leads to difficulties for several nights, but ultimately helps in “training” the child to fall asleep independently (Ferber). Another method that is also effective and more readily accepted by some parents is “scheduled wake-ups.” In this case, parents wake up the child at a certain time, shortly before the child is expected to wake up on his own. Once the frequency of spontaneous awakenings decreases, the length of the interval between “scheduled awakenings” may increase until the spontaneous awakenings stop.

Disorders of sleep initiation and maintenance

Disorders of initiating and maintaining sleep (DIMS) are most often found in preschool children due to the characteristics of psychological development and the difficulties inherent in this age. Sometimes parents have difficulty setting firm limits or agreeing with the child’s demands - “one more glass”, “one more fairy tale”. In such cases, parents are advised to perceive such attempts to delay bedtime calmly but firmly, ignoring the child’s protests. You can avoid further confrontation by telling your child that the door to his room will be open while he is in bed, but will be closed (not locked) if he tries to get out of it. One recommended technique is called a "bed passport" - a card with the child's name written on it that can be exchanged without penalty for one short exit from the bedroom per evening and then returned to the parent for the rest of the evening. For children who have difficulty falling asleep, it may be helpful to develop a predictable routine - 3 or 4 components, lasting 20 to 30 minutes, for example, a story, a song, a drink, a back massage; Constant use of this procedure is very effective. The procedure can be shifted in time earlier, until the desired time.

Sleep problems in older children.

In adolescence or a little earlier, sleep problems become more pressing again. As parental supervision wanes and educational and social demands increase, sleep may begin to become more and more inconsistent. Sometimes there is a delay in the onset of falling asleep, a decrease in sleep time and increased daytime sleepiness. In some cases, such children may develop delayed sleep phase syndrome. This means that they cannot sleep at night and cannot stay awake during the day. This condition may represent a form of school avoidance. Treatment consists of strict control of the time of falling asleep, which gradually shifts towards the evening. A summary of sleep problems and suggested measures is presented in Table 2.

Table 2. Sleep disorders at different ages.

Age Sleep disturbance Recommendations
0 – 4 months Night awakenings and eating are age appropriate
4 – 12 months Night awakenings, night nutrition requirements Systematic ignoring, “scheduled awakenings.” Increasing the feeding interval, reducing the volume of food, and the duration of feeding
2 – 4 years DIMS Predictable procedure and conditions for falling asleep, reward system, setting limits
3 – 6 years Night terrors “Scheduled wake-up”, sometimes drug treatment
6 – 12 years Nocturnal enuresis “Humidity signals”, training, drug treatment
8 – 12 years Somnambulism Precautions, "scheduled wake-up"
Teenagers Delayed sleep phase syndrome.

Narcolepsy

 Setting restrictions, gradually shifting sleep to an earlier time.

Contact a somnologist
Any OSA Contact a somnologist, possible surgical treatment

Co-sleeping

Co-sleeping is a term that refers to parents and children sleeping in the same bed. Many experts frown upon the practice due to concerns about possible sexual harassment or infringement of personal autonomy. However, statistical studies do not reliably confirm these concerns. Co-sleeping is especially popular in a number of cultures and is believed to promote a sense of security and love in a child. Regardless of the above, it can be argued that the frequency of co-sleeping is much higher, since parents may simply not talk about it or even hide it for fear that the doctor will frown on it. According to various sources, 33-55% of preschoolers and 10-23% of schoolchildren sleep in the same bed with one of their parents. It is impossible not to take into account the likelihood of dramatic consequences not related to sleep disturbances themselves. Recently, a special commission in the United States published a report that over 8 years described 515 deaths of children sharing beds with adults. Approximately every fourth death was caused by mechanical compression of a child by an adult. Three quarters of the cases were caused by mechanical problems with the bed or mattress, which led to strangulation and suffocation of the child.

How to improve and normalize your sleep pattern.

Due to the prevalence of sleep disorders in children, the pediatrician or family doctor should pay attention to this aspect during each of his visits or examinations by asking parents (Table 3). The doctor should tell parents about the importance of healthy sleep in a child, no less important than normal nutrition or dental growth. If you have any sleep problems, you need to take a thorough history and look for other medical problems, such as chronic diseases, respiratory problems, seizures, recurrent ear infections, and medications. It is very effective for parents to keep a diary of their child’s sleep throughout the week. Parents need to be taught how to develop bedtime rituals and how to behave at night in the event of a particular problem.

Table 3. Questions for parents to assess their child’s sleep

Each visit should include questions:

If in response to a question the parent indicates problems
What time do you put your child to bed?
What usually happens in your house before dinner and falling asleep?
What do you usually do 60 and 30 minutes before falling asleep?
What happens when the lights turn off?
When a child cries, how do you respond? How fast?
Does the baby get a bottle or be handled when falling asleep in the evening?
Is the baby given a bottle or handled when waking up at night?
How many times does a child wake up at night?
How do you or the other parent react?
How quickly does a child fall asleep again?
What time does your child wake up in the morning?
Does the child play quietly on his own before falling asleep or does he wait for someone to approach him?
Does the baby sleep in a cradle or in a bed?
Are the conditions in the child's room conducive to falling asleep?
Does your child ever sleep in bed with you?
Does your baby sleep with a toy, stuffed animal or favorite blanket?
Does your child fall asleep during the day? How often? How long?

“He sleeps like an angel,” the parents say, looking at their sleeping baby. But what to do when you have to be touched less and less, spending most of your time trying to put your child to sleep? What to do when all the fairy tales have been read, all the songs have been sung, but your beloved child, as they say, has no sleep in his eyes? And this happens almost every day, month after month?

In fact, this problem, unfortunately, is not uncommon. Every fourth child of preschool age experiences regular or recurrent problems with sleep, and parents, forced to look for ways to solve the problem, experience chronic lack of sleep. Insomnia (from the English insomnia - “insomnia”) has become one of the most common problems in our time, especially relevant for children.

At first glance, it may seem that insomnia in children does not have any serious consequences other than disrupting the daily routine of the whole family. But in fact, insomnia can have a detrimental effect on the child’s health.

The fact is that while the child is sleeping, his body is most actively producing somatropin – a hormone responsible for growth and development in childhood. A lack of sleep slows down the production of hormones, so children who sleep poorly grow more slowly and often experience problems with weight and even mental and psychological development. Therefore, sleep in infancy is especially important.

In addition, due to insomnia the nervous system does not have time to recover because she has to work constantly. At the same time, brain activity slows down: the child thinks worse, reacts late to changes in the environment and questions addressed to him. He is able to perform simple everyday actions “automatically,” but when he needs to change the usual algorithm or move on to another activity, it causes stupor. This condition negatively affects studies, communication with friends, and can even be dangerous.

With prolonged insomnia, both well-being and psyche suffer: the child becomes lethargic, irritable, restless, whiny, and often complains of headaches, dizziness and lack of appetite. This condition can lead to more serious diseases, so insomnia must be actively combated.

Causes and treatment of sleep disorders in children

Insomnia is a disorder that requires careful treatment. But before starting it, it is necessary to find out the reasons that led to childhood sleep disorders.

Conventionally, there are several groups of causes of insomnia: psychological, physiological and related to the environment. Insomnia can be caused by one or more reasons, and these may differ slightly in children of different ages.

Thus, sleep disturbances in children under one year of age are usually caused by imperfections in their nervous system: circadian rhythms are still being developed in infancy. Therefore, if a child is healthy, cheerful, active and “confuses day with night,” staying awake at night and sleeping heavily during the day, then this is the reason. However, there are more serious causes of insomnia in infants:

  • too warm and dry air;
  • noisy or unusual environment;
  • too bright light;
  • problems with the stomach and intestines;
  • diaper rash;
  • teething;
  • ear infections;
  • encephalopathy.

In this case, the child sleeps poorly both day and night, often wakes up, is capricious, and cries frequently and loudly. It is necessary to observe the baby: it may be necessary to change the environment in the room where the child sleeps, and also be sure to show him to the doctor to rule out any diseases.

In the future, new causes of insomnia may be added. After a year Children learn new motor skills and actively explore the world around them. Intense and varied activities overload the nervous system so much that the child has difficulty falling asleep.

In addition, the child begins to try adult food, and unusual food can cause gastrointestinal disorders and diathesis. A baby at this age cannot yet regulate his sleep independently, so it is necessary to develop a daily bedtime ritual and also establish a healthy, nutritious diet, eliminating overeating at night.

Preschool age is often marked by the first nightmares - children 3–6 years old they listen to fairy tales, watch cartoons and TV shows, and the actively developing brain processes the impressions received into unimaginable fantasies. As a result, the child begins to be afraid of the dark, afraid to fall asleep, does not sleep soundly and often wakes up screaming and in tears.

In addition, when children begin to attend kindergarten, the risk of catching a cold or becoming infected with helminths increases significantly: at this age, children may suffer from insomnia due to a sore throat, stuffy nose or itching. Such problems should be solved comprehensively: strengthening children's immunity, treating diseases in a timely manner and regularly taking tests. In addition, it is necessary to limit the child’s viewing of television, and select fairy tales and cartoons more carefully, excluding scary plots and frightening characters.

In children of primary and secondary school age The psychological causes of insomnia come to the fore: the beginning of school is almost always accompanied by stress due to a change in environment, and then other problems may arise. Fear of tests and exams, problems with academic performance, conflict with the teacher, quarrels with friends are the most common causes of insomnia in children aged 8–10 years. In addition, family problems, moving, a change of environment, and even the death of a pet often cause sleep disturbances.

If insomnia is caused by such reasons, it is necessary to direct all efforts to create a favorable atmosphere in the family and psychological support for the child. It is important to pay attention to the grades: perhaps your son or daughter needs additional classes. It is advisable to talk with your child more often about topics that concern him, and try to make him feel a friendly attitude. If insomnia is accompanied by headaches, appetite disturbances, fainting, sudden mood swings, visual disturbances, the child should be immediately shown to a pediatrician and neurologist, and, if necessary, to other specialists.

In addition to all of the above, insomnia can be caused by very serious neurological disorders, diseases of the cardiovascular and nervous systems, as well as endocrine disorders. Therefore, even if the child does not have any health problems other than difficulty sleeping, consultation with a specialist is mandatory in any case.

Medicinal and homeopathic treatment of insomnia

It happens that it is enough to create a favorable atmosphere in the room, establish a daily routine, or even have a frank heart-to-heart talk with the child for sleep to improve again. But if the child still cannot fall asleep for a long time, often wakes up, or does not sleep at all, treatment may be required.

The main thing to remember is - Under no circumstances should you treat a child with drugs chosen independently or on the advice of friends! Any incorrect use of medications can lead to the most dire consequences. In addition, sleeping pills for children are strictly prohibited: they have a large number of side effects and have a detrimental effect on the brain and nervous system. Any treatment should only be prescribed by a doctor.

The use of medications in children under 3 years of age is strictly contraindicated. From the age of 3, a child can be prescribed drugs such as Persen (strictly in tablets), Alora or Tenoten. These preparations based on plant extracts have a relaxing and calming effect, actively combat irritability and anxiety, and help normalize sleep.

Homeopathic remedies , even despite their plant origin, should not be used independently. The duration of use and dosage are prescribed exclusively by a specialist. Basically, all homeopathic medicines are allowed for children from 3 years of age, with the only exceptions being “Valerianahel”, the use of which is permissible from 2 years of age, and “Sleep-norm”, which has no age restrictions.

Safer ways to normalize sleep in children are to use decoctions plants such as:

  • motherwort;
  • chamomile;
  • mint;
  • hop cones;
  • oregano;
  • Melissa;
  • valerian root.

It may be equally useful massage with essential oils of these plants and aromatic pillows. However, they should be used with caution in children under 3 years of age.

Treatment of insomnia, even with the help of medications, will not be effective if you do not create a comfortable physical and psychological environment for the child. To do this, it is important to adhere to the following recommendations:

    1. It is imperative to follow a daily routine. Children, especially infants, are very conservative: the slightest change in the usual routine or disorderly routine unsettles them and prevents them from falling asleep. Therefore, it is important to develop a bedtime ritual. For a baby, this may be the “bathing - feeding - sleeping” pattern. For older children - “washing - a glass of warm milk - reading a fairy tale - sleep.” The most important thing is to perform the ritual daily and strictly at the same time.
    2. It is important to create the correct microclimate in the room - it has been proven that for comfortable sleep you need an air temperature of approximately 16–20 degrees and a relative humidity of at least 50%. Be sure to ventilate the nursery before bedtime and, if necessary, use a humidifier.
    3. Particular attention is also required to the baby’s nutrition – it should be complete and varied. Be sure to include lean meat, dairy products, and whole grain bread in your diet - they contribute to the production of the sleep hormone melatonin and the amino acid tryptophan, which is beneficial for brain activity. It is advisable to eat more vegetables and fruits, especially tomatoes and bananas, which contain potassium and magnesium that are beneficial for the nervous system. The main thing is that the child is not allergic to these products.

  1. You should not feed your child tightly right before bed or give him sweets: this leads to insomnia and can provoke scary dreams.
  2. The child’s activities during the day should be active: spend more time outdoors, play, and do physical exercise. After such stress, sleep is usually healthy and sound.
  3. An hour before bedtime, it is necessary to set the child up for rest: dim the lights and loud sounds, switch to quiet games, otherwise overexcitement will prevent him from falling asleep.
  4. Does your child have nightmares and wake up screaming and crying? You should definitely reassure the baby, ask him about what he is dreaming, and explain the safety of dreams. You should not put your child to bed immediately after this: the impressions from sleep will remain strong for a long time. It’s better to talk to him, read a fairy tale, drink warm milk with honey and stay close until sleep takes over. If a child is tormented by nightmares, it is better to leave a small night light in the room: soft light will not interfere with sleep and will allow the child not to experience horror when falling asleep and waking up.
  5. If the baby does not sleep and does not show signs of illness, you can try to bathe him in a cool bath: after swimming enough, the baby will get tired and fall asleep.

If a child does not sleep well, you should not take it lightly and dismiss the problem: consultations with competent specialists, as well as the attention and care of parents will help quickly establish healthy sleep, and as a result, ensure normal growth and development for the baby.

: how to improve baby's sleep. Eva Farber, a consultant on the upbringing and care of children under 3 years old, dealt with “baby sleep” at the traditional online festival of the Neufeld Institute.

Eva talked about 7 myths about sleep in babies and shared natural solutions that will help your child fall asleep faster and sleep more peacefully, and you will remain a support for him not only during the daytime, but also at night.

If you, as a parent or professional, need support, inspiration, fresh ideas and expert advice regarding baby sleep, you can read our resource on how to improve your baby's sleep and find all the answers.

7 Myths About Baby Sleep

We present to your attention 7 ridiculous myths related to children's sleep.

The child needs to be taught to sleep

Of course, this is not true; children are perfectly capable of sleeping on their own. While still in the womb, babies sleep 90% of the time. They get used to this routine and eventually sleep peacefully. It is necessary to let the child understand that there is nothing terrible in the dream, he will wake up, after sleep the morning will come and he will see his family again.

Some babies sleep through the night for a week or two after birth. But most people sleep more during the day and less at night at first.

Children should immediately be taught to fall asleep separately

We are afraid of harming the child physically or emotionally while sleeping together, but in reality, we are often thinking about ourselves. Mothers don’t want to get involved with their children at night either; it’s more comfortable when he lies in the crib and you can rest peacefully and sleep in any position.

If we forcibly place a child alone, it will emotionally hurt him, alienate him and can cause the trauma of being “unnecessary.” But it is worth saying that there is an increased risk of suffocation and falling from an adult bed. If you breastfeed frequently and want to keep your baby close, you can choose a bedside crib.

You should not accustom your child to his parents' bed, otherwise he will not wean himself

This is a big mistake, the baby needs maternal care and warmth at a basic level.

These are evolutionarily determined feelings; without tactile contact, the child does not feel that he is protected, that he is safe.

The stomach must rest at night, GV interferes with the quality of sleep

GW, on the contrary, strengthens the baby’s nervous system, feeding soothes, and sleep improves. If you do not feed your baby at night, serious problems with his gastrointestinal tract and sudden weight loss may begin.

Babies typically lose 10% of their weight in the first couple of weeks at birth, so they should be fed at night. In addition, if they sleep more during the day than at night, you can wake them up so that the break without food is no more than 4 hours.

The child should sleep all night without waking up

There will be no continuous sleep for 10-12 hours, but the child can sleep peacefully for his 5 hours. It is normal that a baby’s sleep is intermittent, as nature intended; until 4-6 months, the baby’s sleep is free.

Attachment to the breast acts like a sleeping pill on the baby; he needs to make sure that his mother is nearby and calm down. This is how the child checks whether he is safe, awakening occurs for the purpose of contact.

The child needs a routine

It is difficult to impose a regime on a small child; it will give nothing but resistance. It is enough to know the approximate amount of sleep your baby needs, this comes with experience.

Monitor his behavior and needs, try to have at least some kind of schedule, but all actions should not be scheduled down to the minute.

The child does not need a routine

There should be no extremes, everything is individual. Children need to understand the rhythms of when it is day and when it is night.

You need to focus on the nature of your baby’s sleep and help him sleep when it’s time. The ideal option is for the child to go to bed at the same time.

How to improve your baby's sleep

Many factors influence the quality of a child's sleep; to ensure your baby sleeps soundly, you need to follow a specific plan.

Sleeping conditions - The sleep conditions in which he sleeps are of great importance for the baby's peace of mind. Certain external factors create favorable and comfortable conditions for a newborn to sleep. Here are the points that must be followed:

  • where your child sleeps (with you or in a separate room)
  • lighting (dark or light)
  • temperature (comfortable or cool)
  • sounds (a pleasant melody can be played in the baby’s room, which calms and lulls you to sleep)

Sleep habits - It will be easier for you to lull your baby to sleep if he has developed certain sleep habits that will give him signals that it is time to go to bed. Here are the habits you need to develop:

  • usual blanket
  • soft pillow
  • a certain pose
  • touch mom's hair
  • feeding
  • humming
  • stroking

Going to bed - To put your child to sleep, follow daily rituals, a sequence of actions before going to bed, which will help the baby calm down and get ready for rest. These actions will give you the opportunity to throw out the remaining energy. Here's what you can do before putting your baby to bed:

  • bathing baby
  • wiping baby
  • swaddling
  • rocking
  • less games before bed and new experiences
  • routine and peace of mind

Also, it is necessary to feed and drink the baby before bed, pay attention to the baby’s fatigue, hug and carry him in his arms before bed.

Up to 3 months, the baby sleeps as much as 16 hours a day. But not all at once. Newborns usually sleep 1 to 2 hours at a time. By 6 months, many babies sleep 6 hours a day.

Use these tips to help your baby sleep through the night:

  • When your baby is fussy at night, wait a minute or two and you will see your baby calm down and go back to sleep.
  • Be careful during night feedings or diaper changes. Try not to wake her up too much.
  • Be active and play during the day to keep your baby from oversleeping. This may gradually help your child sleep more at night.

Why a child may not fall asleep

There are many reasons for a baby that does not allow him to relax and fall asleep peacefully. Here are the main ones:

  • Incorrect daily routine and number of hours of sleep
  • Violation of the usual schedule, for example, during vacation
  • Negative associations for sleep, the child may remember that he will soon be left alone, because his mother will put him to bed and go on business
  • A sharp change in activity before bedtime, activity, games, fun
  • Incorrect sleep atmosphere: loud music, bright lighting, noise, people talking
  • Late bedtime at night, when sleep has passed and the child is alert again
  • Health problems: colic, teething, allergies
  • Lack of attention and care, the child may not have enough time spent with parents, he may be bored and not want to fall asleep
  • Early relocation to a big bed, the baby may not be ready, the best age for such a castling would be 2.5-3 years, but not earlier.

Also, there may be psychological fears that will keep the baby tense and prevent him from falling asleep.

  1. The fear of separation from the mother is often the main obstacle to the baby falling asleep easily and getting quality sleep. Often the mother falls asleep with the child at lunchtime and then leaves. He may wake up and get scared and start to worry. If this situation is repeated, the conditioned reflex and reaction are reinforced. The child is afraid that he will be left alone.
  2. Anxiety becomes more active in the evening - the child becomes more agitated and fearful. These conditions can lead to: enuresis, bruxism, muscle spasms, nightmares and pacing.

Now you know 7 myths about baby sleep and how to help your baby fall asleep.

(teeth grinding), shuddering, initiation disorder (difficulty falling asleep). If sleep disturbances recur regularly, you should not let the process take its course and wait until it “outgrows.” Firstly, rest during night sleep must be complete in order to restore the child’s body and psyche before the start of a new day. Secondly, disturbances often signal diseases of internal organs and nervous disorders.

When turning to a pediatrician or somnologist for help, you need to analyze and systematize cases of violations in order to give the doctor a detailed description of the problem.

The most common causes of sleep disturbances in infants:

  • Feelings of hunger;
  • Temperature discomfort.

These are natural problems that go away over time. Parents, not getting enough sleep with their child, tend to exaggerate their importance under the influence of their own nervous tension. But, if insomnia is systematic, and there are no visible objective reasons, it is an anxiety syndrome.

Preschoolers have high emotional sensitivity. Difficulties due to getting used to kindergarten, quarrels between parents, watching programs for adults, and an excessive amount of cartoons create information and emotional overload. At this age, it is important to have a routine; the number of impressions (even positive ones) needs to be measured.

Excitement, which children are unable to overcome on their own, interferes with sleep and gives rise to night terrors and nightmares.

Is it time to see a doctor?

It is worth paying special attention to shuddering in your sleep. Perhaps intrauterine development occurred with disturbances, and hypoxia was diagnosed at birth. Convulsive syndrome may be a manifestation. Timely diagnosis increases the likelihood of a positive prognosis.

When a baby breathes through his mouth in his sleep, even in the absence of respiratory diseases, breathing is irregular and interrupted, this is a reason to visit an otolaryngologist.

We may be talking about hypertrophy (enlargement) of the adenoids or tonsils. Violation of the parameters of the upper respiratory systems and the mode of operation of the respiratory muscles provokes short-term cessation of breathing in children. Against this background, infants become drowsy, have difficulties with development and learning. Children under one year old who are breastfed have problems eating. Consultation with a specialist is necessary.

The baby grinds his teeth in his sleep - this often indicates the formation of an incorrect bite. You need to visit a dentist (orthodontist).

Uncontrollable urination at night (enuresis) may continue until age 6.

If there are signs that a child is lagging behind his peers in terms of height and weight, there may be a delay in the development of the central nervous system and the formation of awakening reflexes. The cause of involuntary urination during night sleep in children is stressful situations and illnesses. In addition to inflammation of the urinary tract, disturbances in the structure of the genitourinary system may occur. The process is accompanied by painful sensations. In this case, it is necessary to start treatment.

  • Note to parents:

Treatment

The decision on the methods of drug therapy is made by the doctor. He is responsible for diagnosis and prescribes medications. The herbal preparation Persen is recommended from the age of three. During the first year of life, soothing herbal teas (fennel, mint, valerian) are used. Humana's Sweet Dreams tea can be consumed by babies as young as two weeks old.

– one of the most widely used sedatives. Used to stabilize the psycho-emotional state of preschoolers and young schoolchildren. It is often recommended to use it in combination with Magne B6. Some doctors recommend Citral medicine, which contains bromine. It is prohibited to overestimate the period of use prescribed by the doctor. The child’s state of nervous excitement will be suppressed, but apathy may develop, and the likelihood of side effects is high.

For fans of homeopathy

Homeopathy is used in pediatrics, especially for the treatment of infants. Pain and nervousness when teeth appear are relieved with homeopathic suppositories. Nott's and Domirkind's medications help restore disturbed sleep in infants. From the age of 5, Bayu-Bai drops are useful, which alleviate children's syndrome. Additionally, they have anti-inflammatory and analgesic effects. Teenagers who have a depressive syndrome come to the aid of Epam drops, which help restore nerve cells.

When do worms bother you?

Preventive measures

For sleepwalking, sleep talking, nightmares and fears, drug treatment is not necessary. Doctors' advice will mainly concern a healthy lifestyle. Measures to normalize a child’s night sleep:

  • Compliance with the regime;
  • Sufficient amount of fresh air;
  • Comfortable bed, pillow;
  • Proper eating and sleeping habits;
  • Positive emotional background.

The process of preparing the baby to fall asleep is important. It is advisable to discuss problems with peers, an exciting event or a new impression in a confidential conversation, without putting pressure on the child, explain what happened and reassure the child.

  • Be sure to read:

Before going to bed, avoid watching TV, physical and emotional stress. Baths with infusions of pine needles, mint, lemon balm, and lavender are useful for children. Dim lighting, reading books at night, discussing the past day and planning a new one contribute to a calm transition to sleep. Reasons why you shouldn’t exclude all noise and abuse your household to create ideal conditions: the monotonous sounds of a washing machine from the bathroom or a quietly working TV from the next room are more soothing than absolute silence.

If a little one suffers from night terrors and wakes up in a confused state, screams and cries for 10-30 minutes without responding to attempts to calm him down, doctors advise waking him up a few minutes before such a moment occurs.

This happens in the first phase of deep sleep (the first half of the night, an hour or two after falling asleep), at the moment of transition to the REM phase with dreams. The most common reasons: refusal of proper routine and daytime sleep. Periods of emotional stress become too long for the child. We need breaks from active games and switching to quiet activities.

Important: when there are constant scandals in the family, neither traditional medicine nor homeopathy will help. But only the normalization of the communication environment.

As a pediatric neurologist, every day in my work I deal with various manifestations of sleep disorders. I often see worried mothers who are very depressed because the baby is not sleeping well.

Indeed, a child's good sleep indicates his health. And if a child sleeps restlessly, often wakes up, and cries, this alarms the parents, and they seek help from a doctor. Parents of small children are especially often worried, because not being doctors, they cannot be sure of the health of the little person whom you cannot ask: “What happened? Does anything hurt? What did you dream about?” At first, parents may also doubt their child’s neurological health: “Is poor sleep evidence of more serious problems?” A pediatric neurologist can assess the baby’s health status and dispel the parents’ fears and help with effective advice.

Let's look at the main reasons for poor sleep in children:

  • Emotional overload
  • Somatic problems
  • Neurological problems

Physiological characteristics of a child's sleep

At the physiological level, a child's sleep differs from an adult's sleep. Children sleep differently than us, their sleep is more superficial, more sensitive, and this is the norm.

As you know, sleep consists of alternating phases - slow and fast. In children, most of the sleep is REM sleep (and in adults, REM sleep is only 25%). During this phase, the mother can observe how the child’s eyeballs move quickly under closed eyelids, at which time the child dreams. Muscle tone is lost (except for the muscles of the eyes and nasopharynx), the child cannot move, as nature intended. If the possibility of movement remained, people would make all the movements that they dream about.

Creating conditions for sleep

In order for a small child to sleep better, no matter how strange it may sound, you should not isolate him from extraneous noise. If the baby hears in his sleep the quiet background of a working washing machine, the calm muffled voices of his parents, he will get used to these sounds and will not be afraid of them in his sleep, and accordingly, he will sleep better, and the parents will be able to continue doing their usual things without fear of waking up the baby .

Before going to bed, it is necessary to ventilate the room in which the child sleeps well. Fresh air will help your baby sleep better. Sleeping in the open air is very beneficial, as it increases the body's resistance to colds. Older children benefit from walks before bed.

For a good night's sleep, how comfortable the pillow and blanket are is also important. The baby should not be too hot or cold while sleeping, so the blanket should be appropriate for the season and the general temperature in the room. If a child's feet are cold, he will fall asleep faster in socks. For older children, you need to pay attention to the selection of the pillow, in particular its height. It is also important how the child sleeps on the pillow: the edge of the pillow should rest on the neck, and the shoulders and upper back should lie on the mattress - this is the most physiologically correct position.

Sleep duration

Everyone knows that the smaller the child, the more he should sleep. However, the duration of sleep is individual for everyone; it often depends on temperament and psychophysiological state.

The table shows daily sleep norms depending on age:

1-2 months- 18 o'clock
3-4 months- 17-18 hours
5-6 months- 16 hours
7-9 months- 15 hours
10-12 months- 13 o'clock
1-2 years- 13 o'clock
2-3 years- 12 o'clock

As a child ages, the duration of periods of wakefulness increases; this is associated with an increase in brain performance. Some children, due to their individual characteristics, require less sleep than their peers; if a child sleeps a little less, but feels and behaves well, parents should not worry.

You can understand that your baby has grown up and needs a different sleep schedule by the following signs: the child falls asleep very slowly, wakes up early after a nap, remains active during all periods of wakefulness

Sweet dream with mom

A few decades ago in Russia, many believed that a child should sleep separately from his mother. Immediately after giving birth, the baby was taught to sleep in his own crib, which often exhausted both the baby, who did not want to sleep away from his mother, and the mother, who was also sleep-deprived.

Modern psychologists and neurologists agree that sleeping together with a mother is not a child’s whim, but a normal physiological need. The baby is born a completely helpless creature (unlike many animals), and for a long time his life is completely dependent on his mother. Being close to mom means survival, so children feel uncomfortable if mom is not around. Mother's smell, mother's warmth, tender hugs, accessibility of the breast - all this creates the most favorable conditions for the full psychological development of the child and, of course, affects the quality of sleep. After all, psychological stability is the key to good sleep, both for children and adults.

If the baby wakes up, frightened by something in a dream, the mother will quickly calm him down, he will not have time to scream, and, consequently, the quality of sleep will be preserved.

Don’t be afraid to spoil your child; up to 1.5 years old he can calmly stay in his parents’ bed, this will only benefit him. Such children grow up calmer, more balanced, and more self-confident. After all, they receive the necessary amount of maternal love at the age when it is most necessary, when the foundations of his physical and psychological health are laid. Later, at the age of 1.5 to 3 years, he is already “big” and will gladly move to his own bed.

Individual characteristics of the child

In rare cases, a child may be healthy and sleep restlessly due to his individual characteristics. In my practice, there have been cases when a mother went to the doctor with a complaint about the child’s poor sleep, but an examination, additional examinations, and consultations with medical luminaries confirmed the child’s health. Such cases are rare, but they do happen, and here, unfortunately, you just have to wait for the child to “outgrow” this condition. But most often, if the child is neurologically healthy, the cause of poor sleep should be sought in somatic problems or the child’s excessive emotionality. Which is what we will talk about next.

Emotional overload

Emotional overload is the most common cause of poor sleep not only in children, but also in adults.

If your child is overstimulated or overtired, falling asleep can be a long and painful process. Therefore, parents should monitor their child’s activities before bedtime; it is not advisable to watch TV, play computer games, or encourage active, noisy games with peers or parents. Overfatigue can also be caused by the child being overly busy during the day, which happens quite often among today's preschoolers and schoolchildren.

If your child has trouble falling asleep, first of all, analyze what the child does before bed to see if there are any factors that can overstimulate his nervous system. For example, maybe dad works all day and comes only when the child is put to bed. Waiting for dad to return from work, communicating with him before bed can excite the baby and disrupt the mood for sleep.

The emotional state of the mother is very important for a child’s good sleep. If a mother is nervous for any reason, this will definitely affect the baby’s condition. Analyze your behavior, do you get irritated over trifles, do you splash out your negative emotions when communicating with your child? An uncomfortable psychological situation in the family, strained relationships between mom and dad or other relatives with whom you live in the same apartment can also upset the emotional balance of an impressionable baby.

Laying procedure

In order for your baby to fall asleep, it is advisable to adhere to a certain bedtime procedure. If every evening before bed your child performs the same actions, for example, putting his toys away, watching “Good Night Kids,” brushing his teeth, this nightly ritual will help him get ready for sleep. After putting him into bed, mom can read him a story, kiss him and wish him a “good sleep.” If your child is afraid of being in the dark, it is better to leave the night light on.

When putting small children to bed (up to one year old), I also advise you to adhere to a small ritual, this could be singing a lullaby or reading a fairy tale, don’t worry if the baby doesn’t understand you yet, at this age the main thing when putting them to bed is monotony of speech. One of my patients (a university student) read notes to her one-year-old baby before bed - and the baby fell asleep faster, and the mother prepared for exams.

I do not recommend rocking your baby to sleep for a long time; sleep during rocking is not deep, and besides, the child gets used to it very much and the mother becomes hostage to motion sickness. If your baby sleeps well at the breast, you can feed him while lying in bed, and this may become a better ritual for him. Don't try to immediately put him in a crib; let him fall asleep more deeply.

Somatic problems

Somatic problems are diseases not associated with disorders of the nervous system. To exclude somatic disorders, it is necessary to consult a pediatrician.

If your baby has a tummy ache, don't expect him to sleep well. The reason for this may be gastrointestinal colic or spasms. But, as a rule, gastrointestinal disorders cause temporary sleep disturbance - only for the period of exacerbation.

The most common cause of persistent sleep disorder in the first year of life is rickets - a disorder of phosphorus-calcium metabolism due to vitamin D deficiency. In the initial stages of rickets, there is always an increase in neuro-reflex excitability; this symptom can be clearly detected from 3-4 months, in some cases even earlier - from 1.5 months. The child develops anxiety, fearfulness, irritability, and sleep is noticeably disturbed. Children often startle, especially when falling asleep. Sweating increases, especially during sleep and during feeding. The face and scalp sweat the most. Prescribing an appropriate dose of vitamin D by a doctor leads to an improvement in the condition.

Neurological problems

Sleep disorders that are caused by disruption of the child's central nervous system can be of epileptic or non-epileptic origin. Only a neurologist can determine the nature of the disorder, so if you have any suspicions, you should consult a doctor.

What should alert a mother and serve as a reason to contact a neurologist:

  • Nocturnal enuresis (in children over 4 years old)
  • Sleepwalking, sleep talking
  • Nightmares

Separately, I would like to dwell on nightmares of epileptic origin. In this case, the mother notices that the child’s night terrors are repeated as if according to the same scenario. During such a nightmare, the child may have a frozen look, his limbs may tremble, and at the same time there may not be a bright emotional coloring of the night terror. In the morning, such children are always lethargic, depressed, and feel bad.

In conclusion, I would like to repeat that in most cases, sleep disorders do not require serious medical intervention, and disappear without a trace after the mother herself stops being nervous and adjusts the child’s sleep-wake schedule. But if the baby continues to sleep restlessly, it is better to entrust the solution to this problem to the doctor.