Sleep is on every parent’s mind. The American Academy of Pediatrics estimates that sleep problems affect 25 to 50 percent of children and 40 percent of adolescents. UC Davis pediatrician Lena van der List comes to the rescue to answer some frequently asked questions to help parents (and their children) sleep through the night.
Children gradually need less sleep. By the time they are adolescents, they should get about nine hours of sleep per night.
There’s a range of sleep that individuals need. Every child may not be right on the average. Sleep can be affected by the child’s temperament.
Younger children usually take two naps per day: one in the morning and one in the afternoon. Usually by around 2 years of age, they are only taking one nap per day. As children get older, they grow out of taking routine naps. By around age 5 years, most children stop taking routine naps.
It takes a while for the baby to distinguish between day and night. This usually happens around two months of age.
This doesn’t start until the baby’s nighttime feedings get spaced out. Starting around four months of age, a typical baby can go six hours between feedings during the night. By six months, most children sleep through the night.
No; it’s coincidental. Some parents start to introduce solid foods at four months of age, around the time that children naturally start to sleep for longer periods at a time. But the American Academy of Pediatrics recommends that parents start their children on solid food after six months of age. Pediatricians endorse exclusive breastfeeding, if feasible, for the first six months of life.
We recommend that babies sleep in the same room as the parents for the first six months of life, and ideally for the first year. Put the baby’s crib or bassinet in the parent’s bedroom close to their bed. This can decrease the risk of sudden infant death syndrome (SIDS) by as much as 50%. Plus, room sharing will make it easier to feed and comfort the baby.
One of the causes may be separation anxiety, which starts at around eight months of age. At an early age, if children don’t see something or someone because it’s covered up or in the next room, they think it’s actually gone. In psychology, it’s called object permanence.
If the parent puts the child down for sleep and then leaves the room, the child might experience separation anxiety. Then, the child might be so upset that they cry until the parent returns. Sometimes, parents might decide to sleep in the same room, or have the baby fall asleep in their bed, then transfer the child to their crib, but the child needs to learn how to sleep on their own.
Older children and adults have rapid eye movement (REM) and non-REM sleep cycles every 90-110 minutes. But the newborn sleep cycle is about half of that, every 50 minutes. REM sleep is relatively active, and sometimes the baby smiles, sucks, frowns or the arms and legs might twitch a little. At the end of the sleep cycle, sometimes there is a brief arousal. But it’s important to remember that the baby is not actually awakening. Sometimes parents think that this behavior is their baby waking up and then they pick them up and create a real awakening.
This usually occurs in kids around 2 years of age and can be a real problem. The toddler may call for one more of something. One more book read to them. One more glass of water. This can happen when parents are not setting limits. The increased attention that parents pay to the child actually reinforces this behavior. It’s important to be consistent with bedtime rules. Establish a routine and to stick to it. And then no back-sliding, like rewarding them by responding differently on weekends, for example, because this will just spill over into the next week.
No parent wants to hear their child cry. It sounds like they are suffering, and we want to help when children cry. On the other hand, children need to learn to go to sleep on their own. We recommend that sleep training start at around four to six months. It’s important that children get comfortable falling asleep on their own before the separation anxiety phase, which starts at around eight months of age. At bedtime, parents let their children cry for a bit. It’s difficult and parents need to be consistent and patient.
It’s different for every child and parent. Perhaps start with two minutes to start to allow the child to self-regulate, with gradually increasing times for the following nights. Then for the 4 to 12 month-old child, the parent can return and pat or sing to them.
For those older than 8 or 12 months, we recommend that the parent returns to the room to show them they are still there. But don’t be entertaining. Just reassure them that you are present and don’t lift them out of the crib. Maybe sit in a chair, then leave. Sometimes this takes a lot of work.
The Ferber Method was recommended by physicians years ago. This involved letting your child cry at bedtime for gradually increasing periods before responding, so that eventually the child falls asleep. Parents would increase the waiting period while the child is crying a minute per night. Add an additional minute of waiting to reassure them that you are present every night.
No, no study has shown that the Ferber method harms children. There is just concern about prolonged distress in the child. It usually takes a week or two, but sometimes it only takes a few days. It can be difficult to listen to the child cry, and difficult to resist going in to soothe them. Before starting this, everyone in the family should be prepared and consistent with following this method.
If parents are consistent with their sleep training and limit setting, these problems should resolve generally in less than three weeks. But if untreated, these problems can last for years. It’s important to address this early.
Parents should talk with their pediatrician. Most pediatricians have a lot of experience in this area.
Check with your pediatrician regarding any sleeping medication. Seeing a specialist is a good idea to consider in some difficult cases. Some of these issues relate to behavior and parent-child interaction. A pediatrician specializing in child development might be the next step. Also, there are pediatric sleep medicine specialists who might be a helpful resource.