How to Help a Child Who Is Having Trouble Falling Asleep

A child's sleep patterns change with age. Learn about these sleep patterns and how to help a child who is having trouble falling sleep. See more pictures of getting more sleep.

New parents are commonly concerned with how to help a child who is having trouble falling asleep. When a child loses sleep, you can be sure the parent does, too. An experienced parent once said, "If you sleep like a baby, you don't have one." If you can relate to that statement, you're probably a parent. And you probably already know that parenting a child and getting a good night's sleep can sometimes be mutually exclusive. The arrival of a baby generally means the departure of uninterrupted nights and lazy mornings of sleeping in, at least for a while. And even after those first few months of nighttime feedings, you are still likely to be called upon in the middle of the night to chase a monster from under a bed, give a drink of water, or take a temperature every now and then.

Sacrificing sleep for a child's sake is, for most of us, a part of being a caring and concerned parent. And some disruptions just come with the territory. That said, there are some tricks and techniques you can try to help you and your child get the sleep you both need, whether during the early, exhausting months of your child's life or later, when sleep problems may crop up. First of all, it helps to have a better sense of the sleep requirements of children at various ages.

On the next page, learn about a newborn's sleep needs and how those needs change as your baby grows.

Understanding a Newborn's Sleep Needs

Understanding a newborn's sleep needs is important for parents who want to foster healthy growth and happiness in their baby. Should your newborn be sleeping so much? When, oh, when, will your baby start sleeping through the night? If your toddler resists your attempts to put him down for the night, does it mean you're putting him to bed too early?

Understanding the typical sleep needs and quirks at various ages may help allay some of your worries and help you encourage your child to get the sleep he needs. The chart on the next page shows the average sleep needs of children at various ages to give you some insight. It's important, however, to keep in mind that children are individuals just like adults are. Some children may need more or less than these averages, and the amount of sleep they require at any particular time may be affected by a variety of factors in addition to age, such as growth spurts, changes in routine, illness, and stress.

To broaden your understanding, let's take a look at various stages in childhood and how patterns of sleep and wakefulness change.

Birth to Six Months

In the beginning, most babies sleep most of the time -- and that's what they're supposed to do. Along with eating, sleeping is essential for healthy development. Although some babies sleep only 10 hours a day, and some as many as 23, the average is about 17 hours, equally divided between day and night. What's more, periods of wakefuless and alertness are very brief and irregular at first. By three months of age, babies typically sleep about 15 hours -- 10 at night and 5 during the day. By six months of age, the average is about 14 hours -- 11 during the night and 3 during the day.

However, it is important to remember that there is great variability in sleep patterns among individual babies. So don't be alarmed if your baby is awake and alert more or less than these averages during the early months. Also, keep in mind that babies tire rather easily. Even if your baby is sleeping many hours each night, she may still not be able to go more than a few hours without a nap during the day.

There is no set age at which all babies routinely begin sleeping through the night. At first, sleeping is tied closely to feeding -- babies will tend to fall asleep when they're full and wake up when they're hungry. It isn't until about three to four months of age that being tired generally takes priority over being hungry. It is also at about three or four months that babies can stay awake for relatively longer stretches. They become considerably more active during the day, so they are likely to remain asleep throughout the night. Therefore, although your baby may start sleeping through the night -- or at least for longer stretches at a time -- somewhat earlier or later, you can reasonably expect to see this beginning to happen somewhere between three and four months of age.

Six Months to One Year

During the second half of the first year, the sleep needs and patterns of babies become even more variable. On average, babies tend to sleep about 13 hours a day during this period. The normal range, however, can be anywhere from as few as 9 hours to as many as 18. Typically, babies will sleep approximately 10 to 12 hours during the night and take two naps during the day. The naps may last as little as 20 minutes or as long as a couple of hours. If your baby's sleep needs were on the high end in the first six months, the same will likely be true during the second half of the first year, and vice versa.

You can try to influence your baby's schedule by determining the length of naps and the timing of meals, but usually the baby will sleep when he's sleepy and eat when he's hungry. With babies, the need for longer naps is often associated with a rapid growth spurt. Depending on your child-raising philosophy, you can remain flexible or try to alter the baby's schedule to better fit in with the family's schedule.

If, say, he's going to sleep at night only an hour or so later than you'd like him to, you can probably try to work around his schedule. However, if he's going to sleep two to three hours later than you'd like, you'll probably want to try shortening one of his daily naps. If the baby is sleeping too long at one nap time, you might shorten the next one. He may or may not be cranky the rest of the day. Likewise, he may fall asleep more easily at the preferred bedtime, or he may be overly tired and cry and fuss at you longer. You'll probably have to do a little experimenting.

You might also try to stimulate and play with him more during awake periods; this may help him use up enough energy so that he's tired enough to fall asleep when you want him to. You don't, however, want to overstimulate or excite the baby just before bedtime, since this defeats your purpose. Your baby will need a little quiet time before he can fall asleep.

What to do if your baby wakes you up at night because he's wet and then doesn't want to go back to sleep? Try changing his diaper just before you go to bed; that may help him get through the night. You might also try double-diapering, using plastic pants, or using a disposable diaper with extra absorbency to help him feel more comfortable and allow you both to sleep through the night. Although your baby's skin needs exposure to air to stay healthy, the heavier diapering or use of plastic pants only at night may be OK. You might also try adding a blanket or using a sleeper to keep him warmer; it could be the cold, more than the dampness, that wakes him. When you do change him, be as brief as possible. Let him know it's time for sleeping. If he cries once his diaper has been changed, it's OK. If you allow him to keep you awake just to play, you reinforce his awake time, and he'll expect the same treatment in the future.

On the next page, learn about a child's sleep needs in the second year of life.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

A Child's Sleep Needs in the Second Year

A child's sleep needs in the second year, now that he or she is a toddler, probably will decline very little and very gradually. By the end of the toddler stage, your child may be sleeping only an hour or two less during any 24-hour period than she did at the beginning of this stage. Most toddlers manage to continue sleeping through for 11 or 12 hours at night, so the reduction in sleep time most likely will come at the expense of daytime naps.

At one year of age, most toddlers will still require two naps a day, but by two-and-a-half, many get by with only one. The transition is not always smooth, and your toddler may experience an awkward period at around 18 months of age -- two naps may be too much, yet one won't quite be enough.

You can get clues about the number and length of naps that are appropriate from your child herself. Chances are, when your toddler is tired, she will take her blanket and head for her bed, tell you she wants a nap, or simply stop what she's doing and fall asleep. In such cases, you should let her nap. If, on the other hand, she's happily and busily playing, you can probably let her skip a nap. If you find that she's unbearably cranky for the rest of the day, that she is so tired and irritable later on that she can't fall to sleep that night, or that you simply need some quiet time for yourself, you could try to encourage her to take a nap the next day. If she's not sleepy, encourage some quiet playtime -- with or without you -- instead.

Likewise, if she's not ready to sleep when it's time for her to go to bed at night, put her in her bed and allow her to play quietly until she falls asleep. Make it clear to her, however, that once you put her to bed at night, she's to stay there until morning, whether she spends the whole time sleeping or not. Other tips for helping your toddler get and stay asleep at night include establishing a bedtime ritual and providing a transitional object, both of which you'll read about later in this chapter.

You may find that, even after weeks or months of sleeping through the night, your toddler starts waking up and crying in the middle of the night for no apparent reason. Your toddler may be experiencing separation anxiety -- she may need to check to be sure you are really still there. These unhappy awakenings will eventually stop. In the meantime, however, for your own well-being as well as your toddler's, you need to keep short the amount of time you spend with her when she does wake up, especially if these awakenings occur every night. The next time she wakes up crying, comfort her and make sure that there's not something bothering her physically (such as a wet or dirty diaper, a cold room, or an empty stomach). Try putting a nightlight in her room and making sure a favorite toy or blanket is within reach. If she awakens again, go to her but don't pick her up; leave her in her crib as you pat her and tell her that everyone else is sleeping. If she continues to wake you up, comfort her from the doorway of her room; let her see you, and tell her that everything is fine but that it's time for sleeping. Finally, if it continues, just call to her from your room and reassure her that everything's all right. Eventually, she will learn that while you love her and care about her, it's time for sleeping.

Two-and-a-Half to Five Years

The sleep needs of preschoolers vary enormously. Typically, however, preschoolers sleep about 11 hours straight through at night. Although they usually require a short afternoon nap at the beginning of this period, by the time they are five, most have given up napping. Still, setting up a "quiet time" or "rest time" at midday is a good idea, even if your preschooler doesn't use it to sleep. The opportunity to simply take a little time out from the hustle and bustle of his daily routines and activities is certainly appropriate. It is likely to be good for your preschooler -- and it may be an absolute necessity.

On the next page, learn how to create a bedtime routine for your child.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Create a Bedtime Routine

Creating a bedtime routine is not as hard as you might think. Babies and children love routines because it helps them know what is coming next. (If the world were as new to you as it is to young children, you'd be glad of routines, too.) When you and your child follow a schedule that includes a set routine each night, your child gains a secure feeling in knowing what to expect.

In the early weeks of your child's life, you pretty much have to follow her schedule. Still, it may not be too early to begin a habit that may help you both in the long run. It's natural, of course, to hold or rock your baby to make her sleepy. This closeness is beneficial for both of you. If you continue to hold her until she is asleep, however, you may find she is unable to fall asleep on her own if she awakens at night. And that, obviously, can cause sleep problems for you both down the road. The solution: Hold her or rock her until she's sleepy but not yet asleep, then put her in her crib. This way, she will learn to associate her crib, rather than your arms, with sleep.

By the time your baby's about three months of age, try to establish a routine for meals, play, and sleep time. Once you set the routine in motion, it is important to stick with it, otherwise it will have little of the desired effect.

The purpose of the bedtime routine is to get your mind and body ready for sleep. The routine of taking a bath, listening to soft music, reading, brushing your teeth, or whatever you choose to do, gradually tells your mind it's time for sleep. It's a relaxing way to wind down from a busy day. That's exactly what you seek to accomplish for your child in establishing a bedtime routine. The routine you set up also puts sleep patterns into place that your child may follow for many years.

When setting up the bedtime routine, keep two things in mind:

  • Leave plenty of time to walk through the routine without hurrying. End your time together calmly and quietly. Rushing through the routine or pushing your child to hurry defeats the purpose of the routine. In addition, never send your child to bed as a punishment; it only fosters negative associations with bed and bedtime.
  • End the bedtime routine in your child's bedroom. This communicates that the whole routine, from start to finish, is about going to sleep. Over time, the routine itself may help make your child sleepy.

It may not be necessary to go through the entire sleep routine at nap time. In fact, you should abbreviate the routine to one or two items such as reading one story or listening to one song. While some children can nap anywhere, others may feel more secure in their own bed. It might help to give her something familiar to sleep with such as the stuffed animal or blanket she uses at night. Whenever possible, encourage your child to nap at about the same time each day. This helps establish and reinforce a regular wake-sleep rhythm.

On the next page, learn how make bedtime pleasant, instead of an ordeal, and how to help your child fall asleep.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Helping a Child Get to Sleep

Helping your child get to sleep can be an exercise in parental patience. No parent has been spared their child's bedtime plea to stay up "just five more minutes." The excuses children come up with for wanting or needing to stay up later are endless: I'm thirsty...I need to go potty...I want to hear another story...I'm not tired...and on.

When the attempts to stay up past bedtime are infrequent or related to special occasions, they don't indicate a real problem. Allowing your child a rare night up past his regular bedtime is generally harmless. However, when a child repeatedly puts up a fight at bedtime, you need to put your foot down. After all, you are responsible for his health and well-being at this stage, and getting plenty of sleep is essential for a growing child.

First, you need to determine a good bedtime for your child. Not every child needs exactly the same amount of sleep. So observe over time the amount of sleep that allows your child to function well. Then, make getting him to bed on time a priority. Resist the distractions that can delay you in this mission: Open the mail later, don't answer the phone, and leave the dishes. Schedule evening activities so that you have adequate time to make bedtime pleasant, relaxing, and nurturing for your child. His need for gentle coaxing through his bedtime routine is an excellent reason for you to slow down, really listen, and engage with him emotionally. It can help enhance your relationship with him, help him sleep better, and be satisfying to you. You may even find that you look forward to this special time with your child each night.

If a relative, babysitter, or other caretaker watches your child, keep your child's bedtime routine the same. Be sure to inform the caretaker of the pre-sleep routine and the approximate time it should begin and end. When children must shuttle between parents who are separated or divorced, make deliberate efforts to agree upon a bedtime routine and bedtime that are consistent at both homes.

Let 'Em Ride

It's every parent's nightmare: You try every trick in your parental bag, but your child still won't take a nap, even though she's obviously cranky and tired. You beg; you plead; you begin talking to yourself in search of a solution. Oh, wouldn't it be nice to just get in the car and drive off for some peace and quiet. And then it hits you. That's it!

You gently bundle your child into the car, strap her into her car seat, then drive around the block a few times...maybe a few dozen times. Within five minutes, your little one is sound asleep. There's something about the steady vibration of a moving car that seems to put a child out in minutes. This trick has never been formally studied. Nevertheless, it has been field-tested by the ultimate authorities -- parents with cranky children. It usually works with children up to about age six and may provide you with a last-ditch way to get your child to take a nap.

Help Toddlers Transition

Saying goodbye is not easy for toddlers. When they can't see you, they think you are gone and are never coming back, even though you may be in the next room. This is called separation anxiety, and it can often strike at bedtime or during the night.

To help ease your child's anxiety, try giving him a transitional object. This transitional object, usually a blanket or stuffed animal, can help him feel more secure as he makes the transition from being with you to being without you. Some studies have shown that even an item of clothing that a child has frequently seen his mother wearing and that has his mother's scent can be an effective transitional object to aid sleep. Indeed, your child may become so attached to the transitional object that he takes it wherever he goes. (Remember Linus, the Peanuts character who never goes anywhere without his blanket?) To your child, the object is much more than just another toy. It is uniquely important because it provides comfort and security. When you wash it, don't be surprised if he sits at the dryer waiting for the final cycle to finish.

Although the value of the transitional object goes beyond aiding sleep, that is one of its most important functions. Your child must learn to fall asleep without your physical presence. Also, when your child awakens in the night, he must learn to return to sleep without calling for you each time. The transitional object can help a great deal.

On the next page, learn about various methods to treat childhood sleep disorders and help your child get a good night's sleep.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Treating Childhood Sleep Disorders

Treating childhood sleep disorders is a common parental duty. What child hasn't heard monsters under the bed? While some sleep disorders can be easily resolved, others may require more time and effort to treat. Here are a few of the most common sleep problems among children.

Sleepwalking in Children

Sleepwalking in children is extremely common because their sleep is so deep. When something happens to arouse them in the night, the part of their brain responsible for waking them cannot easily overcome the part responsible for sleep. The result is a state in which the child is partly awake and partly asleep.

Children sleepwalk with their eyes open and can see objects around them. But, they may misinterpret what they see. A window might look like a door, and the child might attempt to climb out. While children are usually able to go up and down stairs while sleepwalking, they may do so clumsily, and a fall could result. Therefore, if your child sleepwalks, it's important to protect her by locking windows, blocking stairways (with a safety gate, for example), and removing hazardous objects from her immediate vicinity.

Children who walk in their sleep generally do not need medical attention. Most children outgrow the problem by early adolescence. Parents need only know how to handle sleepwalking episodes when they do occur. Contrary to popular belief, waking a sleepwalking child is not dangerous. But, a child who awakens suddenly in strange surroundings may become frightened and confused. It is usually not necessary to wake a child who is sleepwalking. Most times, you will be able to gently take your child by the hand and lead her back to bed. Be persistent but not forceful or confrontational. The child will probably have no memory of the episode in the morning.

Night Terrors

As with sleepwalking, night terrors occur when a child is in deep sleep. The child screams loudly, disturbing any nearby sleepers. At times, the child may even dash out of bed screaming. The techniques for handling night terrors are the same as for coping with sleepwalking: Protect the child from danger, carry on as few exchanges as possible, and guide the child back to bed. Don't ask the child to tell you why he is screaming or carrying on: He doesn't know, often cannot answer at all, and will just get more agitated if you try to arouse him from this state.

Parents may worry that something is wrong with a child who experiences night terrors. Unless the terrors occur frequently, this is generally not the case. Night terrors are more common in children younger than five, and in most cases, eventually cease without treatment. If your child experiences a night terror, simply go to him, rub his back, offer gentle words of assurance, and guide him back to bed. He will not remember the episode in the morning. You can return to sleep knowing night terrors are fairly common and, unless they occur frequently, do not require medical attention.

Nightmares

Nightmares are scary dreams that can wake your child and leave her upset and in need of comfort. After a nightmare, she may be afraid of going back to sleep or being left alone. She is not yet able to tell the difference between a dream and reality and may fear that what she saw in her dream will actually happen. Knowing this, the best thing you can do for a child awakened by a nightmare is to comfort her -- hold her, stroke her hair, reassure her, perhaps even turn on a light to reinforce the difference between her nightmare and reality. Try to be patient: It may take a while for her to fall back to sleep, and she may need the reassurance of your presence until she does.

Nightmares are often confused with night terrors, but they are not the same. Night terrors usually occur during the first couple of hours of sleep. The child never fully awakens during a night terror, so she is likely to fall back asleep easily once it's over and won't remember it the next day. In contrast, nightmares typically occur after a child has been asleep for several hours. The nightmare wakes the child, so she is likely to need comforting and may have trouble falling back to sleep.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

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ABOUT THE AUTHOR:

Virgil D. Wooten, M.D., is the medical director of the TriHealth Sleep Centers at Good Samaritan and Bethesda North hospitals in Cincinnati. He is also a diplomat of the American Board of Sleep Medicine, a fellow of the American Academy of Sleep Medicine, and a consultant, writer, and speaker on sleep-related subjects. Dr. Wooten has more than 25 years of research, clinical and teaching experience.