How to know if your baby is having trouble sleeping
If going to bed every night and the following night is difficult for both your child and yourself, it means that he has a problem with sleep. This can be just an unwanted version of the norm, or a manifestation of an emotional or physical "abnormality" - the very real psychological disorder or physiological dysfunction of the body. In some cases, the presence of the problem is obvious. In others, its manifestations are not very conspicuous and may go unnoticed.
A child almost certainly has a problem with sleep if he regularly complains that he cannot fall asleep, or wakes you repeatedly during the night. Typical problems are easiest to diagnose: frequent difficulty falling asleep at the right time, waking up at night and being unable to go back to sleep without help or parental intervention, untimely (too early or too late) awakening or going to bed, difficulty waking up at the right hour on weekdays when going to daycare or school, and unusual sleepiness during the day. Nightmares, sleepwalking and bedwetting are also obvious and unmistakable.
But some problems are easy to overlook. Parents don't always realize that a child sleeps too little at night to feel normal during the day, or learns worse just because he goes to bed late on weekends. In your (and the teacher's) view, he/she falls asleep in class or on the school bus now and then because of laziness or disinterest. In fact, he is not getting enough sleep or his sleep is incomplete. There may be a medical condition, such as narcolepsy, which makes it impossible for him to stay awake all day, no matter how much he wants to and no matter how much he sleeps. Such children are considered lazy or irritable, not realizing that their behavior is the result of lack of sleep or sleep disorders. If you are used to a child's loud snoring, you are hardly aware that it may indicate an inability to breathe normally when sleeping. Of course, it interferes with the child's sleep, causing constant fatigue and nervousness.
It is important to remember that poor sleep affects a child's mood, behavior and learning ability.
However, you should not try to attribute all daytime problems to sleep disorders either. If you do not know what a healthy sleep is, you will not be able to recognize deviations from the norm, because of which the child behaves or learns badly, or you will literally start to write off all the troubles on bad sleep, which is not the case.
One of the least obvious problems is lack of sleep. You can't tell if a particular child is getting enough sleep by the length of the day alone. The table below shows children's daytime and nighttime sleep needs. Most babies more or less fit into this data with deviations within an hour. During the first few months of life, the total amount of daily sleep decreases rapidly to 11-12 hours. Further declines are much slower. Children are surprisingly "unanimous" about total sleep duration, although they may distribute their rest hours differently. If one nine-month-old baby can sleep nine hours at night and two times an hour and a half during the day, another after a 12-hour night's sleep during the day will only have a short snooze.
A child should fall asleep quickly, sleep well through the night, wake up instantly (or at least easily) in the morning and rest during the day no more than they should at his age. If all this happens and the baby feels good in the daytime, he is likely to sleep well. A child is never woken up, and on weekends he sleeps an extra hour or two? This means that he almost certainly lacks a night's rest. Additional evidence of this is too long a daytime nap (or sleepiness), and noticeable difficulties with behavior or concentration, usually intensifying in the afternoon. Let us not forget, however, that all children are different.
You can watch your child throughout the day for signs of drowsiness or irritability, but babies may have very little sleep deprivation symptoms. Let's say your two-year-old only sleeps eight hours at night, but seems content and active during the day. So, maybe he's getting enough sleep? However, eight hours of sleep is too little at his age. If you can find out why he sleeps so little, and make the necessary changes to his routine, his nighttime sleep will probably be an hour or two longer. You may begin to notice a change for the better in his behavior, and only then will you realize the non-obvious signs of unhealthy sleep that were present before. Most likely, your child will feel even better during active time, become a little less irritable, concentrate better during play, have fewer tantrums, and argue with you less.
Almost all teenagers do not sleep enough. On weekdays they have trouble waking up, and on weekends they tend to go to bed too late (at least an hour, and often two to three hours later than on school days). When able to sleep according to need, most teenagers will sleep 9-10 hours, which, in general, is the norm for this age group.
Nocturnal awakenings are another problem when "deviation from the norm" is not obvious. A young child (about six months to three years old) can get plenty of night rest, even if he wakes up several times a night, after which he has to be put down again. Parents ask: "Tell me, is this normal? If it's normal, I'll keep getting up for the baby, but if not, something needs to be done about it!" And I explain that most healthy full-term babies start sleeping through the night (actually falling asleep on their own after night wakes, which are the norm) by three to four months of age. By six months of age, every healthy infant is definitely capable of this.
If your baby still hasn't learned to sleep through the night without your help by five or six months, or starts waking up in the middle of the night again after weeks or months of normal sleep, then something is disrupting his sleep. But he can sleep better, and the disturbance is almost certainly fixable.
General information about sleep
Before discussing specific sleep problems and solutions, you need to become familiar with at least the most basic facts. You don't need all the intricacies of a scientific understanding of sleep, a general idea of how it works, how children develop a normal sleep pattern and what can go wrong is enough. Then you will be easier to notice the wrong habits of the child, as soon as they start to form, to solve the problem that has already arisen, and to prevent the emergence of new ones.
Information about sleep is by no means dry or abstract. This information can be of interest to most people and is especially useful to parents who want to teach their child to sleep better through the night.
What we know about sleep
A lot is already known about what happens in the brain of a sleeping person, although, of course, not everything. We know which areas of the brain are activated and which ones go into a resting state, how cell activity changes and which neurotransmitters (chemical substances that transmit signals between nerve cells) are started or stopped being produced. Much is also known about the so-called biological clock, a small group of cells that governs our sleep and wakefulness cycle of about 24 hours. The biological clock regulates not only sleep, but also the diurnal fluctuations in the functioning of almost all physiological systems of the human body. This group of cells is located in an ancient region of the brain (hypothalamus) that also controls many other important automatic functions - for example, the ability to sense hunger and thirst, temperature patterns, and hormone levels.
However, we still don't fully understand why we need sleep, what makes us fall asleep, and why we need sleep at all. There may not be a single correct answer to these questions, since much depends on the level of consideration given to sleep and wakefulness. On a basic level, from a neurophysiological point of view, it can be argued that we fall asleep (and wake up) because of changes in the chemical environment of the brain and its cellular and electrical activity. On a higher level - consciousness and behavior - the need for sleep is explained by the fact that at this time the normal state of the body, and possibly the mind, is restored. Certainly, in the absence of sleep, we are unable to function normally during active times of the day: lacking sleep, we experience drowsiness, from which nothing can save us. Finally, from an evolutionary point of view, sleep is necessary because it contributes to human survival. It can be argued-as many scientists do-that sleeping at night saved Homo sapiens from encounters with nocturnal predators, gave rest to the body, maximum alertness during the day, and the ability to process memories. If we approach the problem from the other side and think about why sleep is interrupted and a person wakes up, then there is a possible answer from the positions of physiology (because of chemical and electrical changes in the brain), higher nervous activity, behavior or evolution (we need to stay awake to feed, continue our species and bring up offspring).
Until the 1950s, doctors and other researchers considered sleep to be a kind of uniform state, the opposite of wakefulness. However, we now know that sleep is of two completely different types: rapid, or paradoxical, and slow. In the slow phase of sleep, a person is motionless, with a measured heart rhythm and breathing. Perhaps, it is this state that we mean by the word "sleep". It is in this phase that the body's recovery mainly takes place. During slow sleep there is little or no dreaming, although some thought-like activity may still be present. In the Fast Sleep phase, our physiological systems are much more active, and it is during this time that dreams occur. Throughout the night, we move from slow to fast sleep and back again with sporadic (usually brief) awakenings.
After the very first months of life, slow sleep is divided into four stages. During these, there is a gradual transition from drowsiness to progressively deeper sleep, which can be recorded in the laboratory by the electroencephalogram reading, eyeball movements, and muscle tone.
As you fall asleep, you enter the first stage, a state of drowsiness. Your eyeballs move slowly under your closed eyelids, although you are not aware of this. Your awareness of what is going on around you is also weakening. You've probably experienced this at a lecture or a boring meeting. Having dozed off, you missed some of the speaker's remarks, but instantly came to your senses when your name was heard, or your head was bowed so low that you risked falling off your chair. You would not have noticed that you were asleep, if it were not for a lapse in perception. When you emerge from a drowsy state, it is not uncommon to recall special kinds of thoughts that are commonly referred to as "waking daydreams. Some describe visual or sound images that are more like the full-fledged dreams of the REM sleep phase, but more discontinuous, less structured, and less bizarre.
If one does not interfere with a drowsiness into a deeper dream, one may feel the entire body suddenly twitch, which causes one to briefly awaken. This "hypnagogic" (i.e., it occurs during falling asleep) twitching is a normal phenomenon, although it does not occur every time we fall asleep.
Drowsiness is a transitional state between wakefulness and the deeper stages of slow-wave sleep, but the onset of the next stages can only be unequivocally recorded by recording the electrical activity of brain neurons, or "brain waves". At the beginning of the second stage, the electroencephalogram shows short peaks of very fast impulses (the so-called "sleep spindles") and slower high-amplitude waves, or "K-complexes". At this stage, the person is still easily awakened and may not realize he was asleep at all, depending on how long he was in the second stage of sleep, how deep his sleep was when he awoke, and, of course, on his individual characteristics. As with awakening in the first stage, people almost never have fantasy dreams in the second stage, but they sometimes mention thought images or daydreams in their waking state.
Plunging even deeper into sleep, you move into the third and finally into the fourth stage (they are similar and can be regarded collectively as a person's deep sleep). Small, fast waves characteristic of waking and shallow sleep disappear from the encephalogram and are replaced by high, slow delta waves. Your breathing and heartbeat become very regular, you may sweat profusely, and it becomes difficult to wake you up. Now you will no longer jump up because someone calls out to you, as in the second stage. Rather, you are likely to become little receptive to sounds.
However, with sufficient stimulus, you will also wake up in the fourth stage of slow sleep. It is clear that even in the deepest sleep, our brain is capable of processing outside information. For example, it is difficult to wake you up if it is your turn to go up to feed the baby, but cries of "Fire, burning!" or cries of pain from a baby will quickly wake you up. Nevertheless, even if you wake up for some urgent reason, you will be disoriented at first. You understand that you need to act immediately, but it is difficult for you to "clear your mind" - to start thinking clearly and acting consciously. The difficulty of transitioning from the fourth stage of sleep to active wakefulness plays a huge role in a number of sleep disorders in children.
During slow-wave sleep, the muscles of the body are more relaxed than during wakefulness. The person can move (unlike fast sleep, which will be discussed later), but lies still because the brain does not send motor impulses to most of the muscles. Disorders such as somnambulism and head shaking in sleep are exceptions to this rule.
After one or two cycles of slow sleep, a person enters a completely different state of fast sleep. Breathing and heartbeat become irregular. Reflexes, kidney function, and hormone production change. Thermoregulatory systems are weakened, so there is no sweating or shivering. Men have an erection during this phase of sleep, while women have a rush of blood to the clitoris and an increase in vaginal circulation. The meaning of these processes in the genital area is not yet clear.
During the fast sleep stage, the body is active. A more intensive oxygen intake than during slow sleep indicates that the body is using more energy. The blood supply to the brain increases, brain waves become shallower and faster again, and the encephalogram resembles a combination of patterns characteristic of wakefulness and drowsiness. Now the brain "wakes up," but its activity in the REM sleep state differs significantly from that during wakefulness: it reacts mostly to signals coming from the body rather than from the environment, and the bizarre character of dreams is not subjected to critical analysis.
In this state, muscle tone is very relaxed, especially in the head and neck area, and the body relaxes as much as possible. Most nerve impulses are blocked in the spinal cord and do not pass to the peripheral muscles, which effectively paralyzes the entire body: even if the brain sends orders to move, the muscles do not receive them. Only the muscles responsible for eyeball movements, breathing and hearing remain active. The blockade is not absolute, and especially strong signals still make their way to the muscles, causing frequent small twitches of the hands, feet, and face muscles. Thus, in terms of metabolic and brain function, REM sleep is an extremely active state, but the body remains almost immobile.
Young children's ability to block motor impulses is underdeveloped, and they receive more signals to their muscles than older children and adults. This is why an infant jerks, grimaces, twirls, jerks, and even makes sounds during the REM sleep phase. Fortunately, the newborn is not capable of getting up, walking around, or bumping into anything. The braking system matures with the infant, and by 6-12 months - that is, by the age when the baby is already crawling or walking - most motor impulses are blocked and the baby stays safely in bed.
The most striking sign of REM sleep is the characteristic periods of rapid eyeball movements. During these bursts of activity, the heart rate, blood pressure, respiratory rate, and blood flow to the brain increase and become irregular. If you are awakened during such an outburst, you will almost certainly say that you have been dreaming, with the duration of the dream you describe roughly corresponding to the length of time you have been in this state. Even two-year-olds recount their dreams after waking up during these moments. Younger children are simply unable to retell the dream, and it is impossible to say with certainty what they are dreaming and whether they are dreaming at all. But all of the other signs of the REM sleep phase are observed in a person from day one, so it can be assumed that even newborns dream. Most likely, the first dreams are the simplest repetitions of daytime experiences (sounds, smells, visual images). As the higher parts of the brain and articulate speech develop, dreams become more complex.
Since the dreamer's eyeballs are moving, does that mean he is literally "seeing" the dream? We do not know this for sure, but we believe that such a statement is at least partially true. In any case, some muscle contractions do correspond to dream events. Fortunately, very few commands to move reach the muscles, and you may only move slightly from time to time, instead of getting up and "acting out" your dream at your own peril. It follows that somnambulism and night terrors are not the result of dreams or nightmares: such complex body movements are simply not possible during the fast asleep phase.
According to some scientists, REM sleep performs important physiological functions. Their research suggests that dreams allow us to process emotional experiences from the day and translate short-term memories into long-term memory. These theories have not been conclusively confirmed. The emotional significance of dreams is indisputable, but what meaning they ultimately have for the dreamer is a mystery. REM sleep certainly serves a purpose, since we all dream every night-even if we think we are not dreaming-and if we are deprived of the REM phase several nights in a row, we compensate for this lack with longer dreams the next night. On the other hand, people who have almost no REM sleep for long periods of time-for example, due to the side effects of medication-seem to have no major disruptions. (It is impossible, at least extremely difficult, to completely deprive a person of REM sleep. Experiments of this kind have been performed on animals. Absolute exclusion of the REM sleep phase resulted in exhaustion and even death).
Waking a person up during REM sleep can be both easy and difficult, depending on the significance of the stimulus and involvement in the dream. An alarm clock radio may not immediately tear you away from a truly engaging dream, and you may even incorporate the sounds of the radio into your sleep. But an important stimulus-say, the triggering of a burglar alarm-will wake you up immediately, and you will almost immediately regain lucidity, unlike a person awakened in the fourth stage of slow sleep.
So, we are in three different states during the day. In the waking state, we think rationally, are able to take care of ourselves and ensure our own survival. In slow sleep, our body rests and recovers, and our brain is at rest. During REM sleep, the brain is active but irrational and "disconnected" from the body, and large muscle movements are impossible, even if the brain sends appropriate signals.
According to one theory, the state of fast sleep was formed in humans during evolution as an intermediate state between slow sleep and wakefulness, and at this stage the brain "wakes up" before it reconnects with the body. An animal in the slow sleep phase, practically motionless and silent, apart from quiet measured breathing, does not attract the attention of predators, but if it suddenly wakes up, it will find itself physically active amid confusion and disorientation, hence vulnerable. If, however, it first enters the rapid sleep phase, the brain regains alertness, but cannot send a signal to the muscles of the body and thus provoke any movement or sound capable of attracting a predator. Being sufficiently alert, the animal is fully awake and the muscle paralysis is relieved. It is now possible to react adequately to danger. This ability is probably still important for humans. We all wake up easily after having been asleep, and at that moment we are especially susceptible to any disturbance around us: the smell of cigarette smoke, the sound of footsteps on the stairs, or the quiet sniffing from the next room. If everything is normal, we go back to sleep peacefully, and in the morning and do not remember that he woke up. But small children often cannot fall asleep quickly after these normal awakenings, because many things seem "wrong" to them. For example, the fact that they are not in their parent's arms, but alone in the crib. A typical situation!
Formation of stages of sleep in children
Sleep patterns begin to form in the child even before birth. Fast sleep is observed in the fetus from the sixth to seventh month of pregnancy, after a month or more there is also a phase of slow sleep. Fast sleep of the fetus and newborn is called "active" sleep, and slow sleep is called "restful" sleep. By the end of the eighth month, both sleep phases are well established in the fetus.
The active sleep of the newborn is easy to recognize. The infant twitches and breathes irregularly, and eyeball movements can be clearly seen through the thin eyelids. Sometimes a fleeting smile can be seen. During restful sleep, the infant breathes deeply and lies very quiet, sometimes making quick sucking movements and suddenly shaking his whole body.
A peaceful sleep of a newborn is somewhat different from a slow sleep of older children and adults. Thus, it is not differentiated: distinguishable stages occur later. On an encephalogram, slow amplitude waves go in pulses, not uniformly. In the first month of life, the brain waves of slow-wave sleep become continuous, and the shudders disappear. By one month of age, "sleep spindles" begin to appear on the encephalogram of a sleeping infant, and over the next one to two months, stages of less and deeper slow sleep can already be observed. The "K-complexes" characteristic of mature slow-wave sleep are not recorded until about six months of age, although their precursors appear somewhat earlier.
The fast sleep phase is the first to form. In premature infants, it takes 80% of the time; in preterm infants, it takes half of the time. Why REM sleep is so important at the beginning of human development is not entirely clear. However, it is known that a certain level of maturity of the brain is necessary for restful sleep, so the lower expression of this phase in newborns is understandable. During REM sleep, the higher centers of the brain receive stimuli from the deeper, more primitive structures. Nervous impulses pass through the same pathways as visual images and sounds, as well as possibly tactile, olfactory, and gustatory sensations. Subsequently, these stimuli are apparently incorporated by the brain into the meaningful fabric of the dream. We know nothing about infants' "dreams," but we assume that through this condition their brains learn to process sensory signals - "seeing" and "hearing" - even before birth. This is important information for the emerging higher parts of the brain.
We also know that a fetus that is carried to term does not perform breathing movements during slow sleep. Without the slightest skill to breathe independently, the baby would be born with muscles completely unadapted to perform this vital work. During the rapid sleep phase, the unborn child performs breathing movements, and possibly exercises other types of motor activity as well. Muscle impulses in the fetus are not blocked as completely as they are in children and adults, leaving it some opportunity to practice real body movements during REM sleep. Fortunately for the mother, some impulse blocking does occur, otherwise the baby in her belly would never behave calmly!
So, REM sleep is most important during intrauterine development and early life, losing paramount importance as the baby gets older. While soon after birth a full-term infant spends half of his or her sleep time in this phase, by the age of three the share of REM sleep decreases to one-third, and in the subsequent childhood and teenage years to the characteristic 25% of adult sleep.
Sleep cycles in children
When children (and adults) sleep, they have alternating phases of rapid and slow sleep. Once the four stages of slow-wave sleep are identified and the child has a single extended period of nocturnal sleep, a cyclical pattern of alternating phases is formed that remains virtually unchanged throughout life. It is important to become familiar with this pattern in order to understand how the child's normal sleep cycle is formed and what kind of disruptions may occur.
During the period from the first months of life to adolescence, the duration of one cycle increases from 50 to 90 minutes. In parallel, the cumulative duration of REM sleep and its share of the cycle decrease until it reaches "adult" values. During childhood and adolescence, as the total need for sleep decreases, so does the time spent in the fourth stage of slow sleep, which, however, still accounts for about a quarter of all the time that a child sleeps.
A newborn enters the rapid phase of sleep immediately after falling asleep. But by about three months of age, it begins to dive into slow sleep first, and this pattern is permanently cemented. Unlike adults, who enter deep sleep gradually, young children literally fly through dozing and the initial, shallow stages of slow sleep and find themselves in its fourth stage in just a few minutes. In babies, stage four sleep is extremely deep, and it is almost impossible to wake them up at this time. For example, if a baby falls asleep in the car in the evening, you can bring him/her into the house, change clothes and put him/her to bed, and he/she will only wiggle a little. If your little one is forever waking up when you try to move her into the crib after rocking her, just wait until the fourth stage of sleep comes before putting her down. And if you do wake the baby at this stage to bathe him, he will be half asleep, after bathing will immediately fall into a deep sleep and in the morning will not even remember that he was lifted. This incomplete awakening is very close to the state of sleepwalking and night terrors.
The child remains in the fourth stage for about one or two hours, after which he wakes up briefly. A partial awakening may last from a few seconds to several minutes. The pattern of brain waves changes dramatically, becoming a mishmash of patterns of deep sleep, shallow sleep, drowsiness, and wakefulness. The child usually fidgets, rubs his face, chews, turns over, may whimper or utter a few incoherent words. He may open his eyes briefly, looking into a void, and even sit up, but soon he will lie down again and fall asleep. Sometimes there is a complete awakening, but very brief, after which the sleep cycle continues.
During these brief awakenings a variety of manifestations are observed. The above-described ones do not cause any problems and are perfectly normal. But there are also more active ones, including sleepwalking, night terrors, and fighting with a non-existent enemy. All of these occur against the background of a partial awakening after a deep, slow sleep, and the child invariably shows signs of both sleep and wakefulness. For now, let us just remember that they are not triggered by dreams. As has been said, real dreams, including nightmares, occur only in the phase of REM sleep.
After a brief awakening for a few minutes, a state resembling slumber or REM sleep sets in. A short dream may indeed occur during this time, especially in older children and adults, but this does not usually happen with babies. The first stay in the phase of REM sleep, whenever it occurs, is usually quite fleeting - five to ten minutes - and not very intense. The movements of the eyeballs are not intense, and the breathing and heart rhythm are more or less even.
After this episode of REM sleep or a similar condition, the child enters the phase of deep, slow sleep a second time. Young children return to the fourth stage fairly quickly, although a little slower than the first time. This time, deep sleep lasts from 30 minutes to two hours (which partly depends on the age of the child). Waking after it marks the end of the period of slow sleep characteristic of the first third of the night. Thus, children spend the first three to four hours of their night's rest mostly in very deep sleep, when it is not easy to wake them. Many parents are aware of this, because the subsequent period of less deep sleep with more frequent awakenings begins just as they themselves go to bed.
The awakening, which ends the first three or four hours of deep sleep, is almost certainly followed by a 5 to 20 minute fast sleep phase. This period may be interrupted by several brief awakenings, each time ending in a quick fall asleep.
In infants, REM sleep is particularly unstable and is often disrupted by rapid movements and awakenings. However, by the age of six months, the child has acquired the ability to block motor activity and REM sleep becomes more restful.
The period of rapid sleep ends with another brief awakening. The child fidgets, tries to settle down, unconsciously checks if everything is all right around, and goes back to sleep. This brief wakefulness accomplishes several tasks. Changing the body position is necessary for the health of the skin, muscles and joints, and the instinct of self-preservation requires making sure that nothing bad has happened since going to sleep. It is important to understand that such awakenings occur in all children and adults and are completely normal. Many parents find it disturbing, especially if the child then cannot go back to sleep on his or her own due to the absence of the usual conditions of falling asleep, such as rocking or stroking.
The middle part of the night's rest after the first period of fast sleep begins with another period of slow sleep, followed by a short awakening and a longer, more pronounced fast sleep. This part of the child's night usually lasts about four hours, during which longer and more active periods of rapid sleep and relatively shallow periods of slow sleep alternate with each other. During these hours of shallow sleep, especially during transitions from one phase to another, awakenings occur most often. Normally, they are of short duration, but with insomnia, it is during this period that the problem becomes most acute. Even teenagers and adults find it easier to wake up in the middle of the night (say, to take a bath) than in the morning when the alarm clock rings. Some children who are put to bed too long for a night's sleep only sleep at the beginning and end of the night, and their intermediate period of shallow sleep turns into full wakefulness.
As morning approaches, children once again enter the deepest, fourth stage of slow sleep, and then finally wake up. So the last one or two hours are usually quiet, no matter how troublesome the night may have been. Children who transition to wakefulness directly from the fourth stage of sleep appear unhappy or cry every morning. An attack of irritability usually lasts about ten minutes, and there is nothing to worry about. If, however, the child, before waking up, once again enters the less deep second stage of slow sleep or REM sleep, he or she rises in good spirits. The stage of sleep in which awakening occurs is a natural feature of every child and cannot be changed.
For older children and adults, a very deep sleep at the end of the night is not typical. This is not because they have lost this ability, but because they rarely have the opportunity to sleep long enough. An adult who sleeps for about 11 hours, or a teenager who falls asleep on a day off, may also have the typical deep sleep of a toddler at the end of the night. The fact that the night begins with a slow sleep can be explained by the accumulated need for deep rest during the day, but why that extra period at the end? In any case, the repeated fall into deep sleep in the morning is a characteristic of our sleep cycle, which is governed by the biological clock.
Now you have a rough idea of what happens to your baby in different stages of sleep throughout the night. This overview will help you understand what state your child is in at a particular moment, taking into account when he went to bed and how he is behaving now. These observations will help you find answers to the question of what kind of sleep problems he has and how to deal with them.
Sleep and Wake Mode
As you read this section, keep in mind that this is only the most general pattern, with all sorts of individual variations.
A newborn baby sleeps about 16 hours a day, but no more than a few hours in a row. About seven periods of sleep and wakefulness are more or less evenly distributed throughout the day. Each such period, lasting from 20 minutes to five to six hours, begins with fast sleep. Then the rapid and slow sleep phases alternate several times, depending on the total duration of sleep. Even if the infant sleeps soundly for hours on end, brief awakenings usually occur. In the first weeks of life, there may not be a definite cycle at all - sleep and wakefulness periods of varying lengths alternate randomly and change from day to day.
At about three months of age, three daytime naps are formed: two main naps - in the middle of the morning and in the middle of the day - and, most often, a short nap in the early evening. At three or four months, your baby still sleeps a lot, about 13 hours a day, but in an orderly fashion. He has four or five regular and predictable periods of sleep in his day, with two-thirds of the cumulative sleep duration occurring during the night hours. By this age, the child should not confuse day and night. Most infants' sleep is already "established" and lasts most of the night, at least from a late-night feeding to an early-morning nap.
By six months of age, the routine is established in almost all babies, and the length of uninterrupted nighttime sleep continues to increase. The transition to continuous night sleep, of course, may occur differently: some babies begin to wake up less often and this process is gradual, while others just suddenly "forget" the habit of eating in the middle of the night. For some, the rejection of night feeding occurs intermittently. In any case, at some point between three and six months, your baby should start sleeping through the night until morning. A typical six-month-old baby sleeps a total of 12-13 hours a night. Normal nighttime sleep lasts an average of nine hours and a quarter (but can be as long as 11 hours if your baby sleeps little during the day) and is only occasionally interrupted by brief awakenings. In addition, there are two afternoon naps of one or two hours each, in the middle of the morning and in the afternoon. (At about this age, a baby usually doesn't need an evening nap any more.) A typical morning nap is between 9.30 and 10.30, and an afternoon nap between 2 p.m. and 3 p.m.
Most one-year-olds sleep almost 12 hours a night, of which 9 to 10 hours at night. At one year of age or over the next few months, it is more common to give up morning naps. Only one afternoon nap remains, usually in the afternoon, at 12:30 or 13:00, that is, between the first and second afternoon naps of the earlier period. The transition to one quiet hour may be complemented by accompanying changes. Because the child is now awake longer, he falls asleep faster both during the day and at night. (This change is especially striking if the baby was previously difficult to put down.) In addition, the abandonment of a second daytime nap lengthens either the remaining daytime or nighttime sleep, and the total length of a day's sleep does not change.
At age two, the child still sleeps about 9 to 10 hours at night and one to two hours in the afternoon, which is a total of 11.5 hours. Quiet hours are likely to continue at least until the age of three. However, some children stop sleeping during the day as early as age two, and others sleep as late as age five. This is the most unpredictable moment of regime change in the first five years of life. However, most children give up daytime sleep between their third and fourth birthday. Those who take long (up to 11 hours) naps at night are more likely to simply not be able to fall asleep during the day as well. If this pattern develops too early in the child's life, he or she will not be able to stay fully awake all day. By reducing the nighttime nap to 9-10 hours again, daytime sleep can be restored. Some children continue to rest during the day in circumstances particularly conducive to sleep (for example, in the car) or in kindergarten (where there is necessarily a quiet hour), but refuse to do so at home or on weekends.
From age three to adolescence, the need for sleep gradually decreases, but much less and more slowly than was commonly thought. Children beyond toddlerhood rarely retain daytime sleep, and nighttime sleep also begins to diminish little by little from 11 hours in the preschooler to 10 or so in the pre-adolescent years. Age 5 to 12 is the most active age: the child sleeps perfectly well at night and remains as awake as possible all day. The urge to take an afternoon nap almost disappears (even in traditional siesta countries), and if a child suddenly lies down, it can mean that he or she is sick. Children forced to sleep during the day most of the week, especially at school, may develop narcolepsy (however, even children with narcolepsy only rarely sleep during the day at this age). Chronic nighttime insomnia can cause daytime sleep, but this disorder is atypical for schoolchildren. The most widespread consequence of insomnia is behavioral problems during the active time of the day.
During the four-year pubertal period, the child's body changes rapidly, and the need for sleep remains almost the same. To function fully, children 14-17 years old need at least nine hours of sleep. However, not many people get that much sleep, especially on weekdays.
Remember, every child and family has a different need for sleep. However, if your child sleeps one or two hours more or less than their age, it is reasonable to assume that their routine needs to be adjusted.
The importance of biorhythms
To understand the specific disorders of children's sleep, it is necessary to get acquainted with the functioning of biological systems that control sleep and wakefulness patterns. Daily biorhythms are biological cycles that repeat approximately every 24 hours. Each person has many such rhythms. These are sleep and wakefulness patterns, activity and rest, hunger and satiation signals, as well as fluctuations in body temperature and hormone production levels. For a person to feel great throughout the day, these cycles must be in harmony. Our ability to fall asleep and sleep without disturbance is firmly linked to their synchronicity. Usually we fall asleep when our body temperature drops to its daily minimum and wake up when it begins to rise. If we have to wake up during a period of low temperature, it is very difficult to wake up. Similarly, we have a hard time falling asleep if our body temperature has not yet begun to decrease or has not decreased sufficiently.
It is important to know that, by nature, all of these cycles are slightly longer than 24 hours. The difference is only a few minutes. But because of the artificial light in the evening after sunset and the artificial darkness in the bedroom in the morning when the sun has already risen, the internal clock slows down even more - as if it were designed more for a 25-hour cycle. Each day, morning light and night darkness reset our circadian clocks to zero. However, on weekends and vacations, when we live on a more flexible schedule, many people switch to a 25-hour rhythm: going to bed later and getting up later. And when it's time to go back to school or work, it can be very difficult to adjust to the old routine.
Living on a 24-hour cycle is not at all difficult if you stick to it. Problems arise from disorder or from trying to go against the rhythms of sleep and wakefulness. Workers working in shifts and teenagers, who mostly sleep for different hours on weekdays and weekends, as well as travelers crossing time zones, face discomfort, difficulty falling asleep and general malaise - the so-called desynchronosis, or biorhythm disorder.
The same thing happens to children if their sleep cycle has been disrupted or shifted, or if they simply live in an irregular or unsuitable routine. Such children do not sleep well at night, are sleepy or cranky during the day. It is important to pay attention to this, because problems caused by inappropriate routines are treated very differently from other sleep disorders. Even if inadequate routines are not the main problem, they often complicate other sleep disorders and should be considered when selecting treatment.
For now, let's remember: a normal daily biorhythm is a prerequisite for healthy sleep and full wakefulness, and many diurnal rhythm abnormalities are fairly easy to diagnose and treat.
Teach your child to sleep properly
We all form their children certain habits regarding sleep. Differences are family, ethnic and cultural. A baby can sleep swaddled, in light night clothes or undressed, in his or her own room, in a shared nursery with siblings or in the same room or even in the same bed with the parents. Children are laid on their stomachs, on their sides or on their backs, in complete darkness, in semi-darkness or in bright light. The room may be quiet or noisy: the constant noise of a humidifier or air conditioner, the regular sounds of the radio, TV, or traffic, the sudden roar of an airplane taking off, or the voices of other children. One infant falls asleep at his mother's breast, another with a bottle or pacifier, in a rocking chair, or alone in his crib. Some babies say "good night" to loved ones in the living room, going to his room and go to sleep, and some will fall asleep only when he tells a bedtime story, pray with him, play a quiet game or discuss the day before. Some children go to bed at different times each time and without a certain ritual, while others go to bed every night in a strictly defined way.
Evening rituals also vary, but not all are equally good for children.
Why a bedtime ritual?
I believe that there are more and less successful bedtime rituals, but any ritual must meet a few imperative requirements. If your ritual suits everyone involved - it suits parents and baby, helps them fall asleep quickly and rarely wake up in the middle of the night, provides your baby with adequate rest, which shows up in acceptable behavior throughout the day - then everything is fine.
Keep in mind, however, that certain techniques and approaches will almost certainly accustom your child to a healthy sleep and get rid of problems as he gets older. For example, if you are used to every night for 20-30 minutes rocking a baby (or stroking his back, etc.), and this ritual has to repeat once or twice in the middle of the night to put him back to sleep, then you are interfering with a natural sleep your child and preventing him to get used to falling asleep independently for the night. Let you "uncomplicated" to jump up to your baby, you yourself will only be happy if you can just put him to bed at the right hour and know that he will sleep peacefully until morning. Regardless of whether you find it difficult to interrupt your own sleep, you have to understand: a child needs to sleep well, without interruptions. You should analyze all the rituals and habitual patterns of action in preparing the child for sleep and falling asleep. For example, you change a baby's diaper and hold him in your arms until he falls asleep. Maybe you rock him and then move him to the cradle, bassinet, or crib. Or maybe your baby is still awake when you move him and falls asleep out of your arms. In general, all these schemes are suitable for the first months of life, when the baby is not able to sleep through the night anyway. But around three months of age, most full-term babies are able to sleep through most of the night. If your baby still wakes up once or twice a night or has not given up night feedings by five or six months of age, you should think carefully about her nighttime habits. A baby who is always being fed or rocked before bedtime has difficulty returning to sleep on her own after her natural nocturnal awakenings. To help him sleep soundly through the night, you may have to change something about his habits. For example, it is important to put some children to bed while they are still awake, so that they learn to calm down and fall asleep unaided in the evening and after midnight awakenings.
Rituals are important for a child at any age. If a nap evokes pleasant associations, the child anticipates it instead of being scandalized and stymied. Of course, the bedtime ritual varies, and you'll give preference to whatever works for your family, but be sure to include enough time for every night socializing. Follow the ritual as closely as possible. Your child should know when to change into his pajamas, brush his teeth and lie down. Let him know what activities precede going to bed, how much time is allocated for them and how many bedtime stories he will be told.
Going to bed is usually the moment of separation from parents, which is difficult for many children, especially little ones. When the baby is simply sent to bed alone, it seems unfair or even frightening. You're also missing out on perhaps one of the most wonderful moments of the day. So set aside 10-30 minutes to spend time with your child before bedtime. The last part of the ritual should take place in the room where he sleeps, so the baby goes there with pleasure. Otherwise he will realize that he has to leave a wonderful place to go to sleep, and his own bed or bedroom will begin to associate him with the end of communication with his parents and with separation from them. If the child falls asleep alone, it's not him who has to leave, but the parent: the child stays where he just enjoyed his mom or dad's company. Do not stir up the baby, do not tell terrible stories, do not do anything that will excite him - for fun fiddling enough time during the day. Enjoy communicating together, playing quietly or reading aloud.
However, the child should know that the special time of your evening communication can't be prolonged and ends at a fixed point that you have agreed upon. It is useful to warn them when time is almost up or you have two or three pages left to finish reading. Don't give in to entreaties to read more of the story: the child will only learn the rules if you follow them firmly. If you both know exactly what's coming next, you'll avoid the arguments and frustrations that arise in a situation of uncertainty.
Paul is four years old. His dad goes to work early in the morning, and he and Paul don't see each other until dinner. Dad likes to put his son to bed himself, because otherwise they wouldn't have a chance to socialize until the weekend. Between seven and eight p.m. is a special time for both of them.
At seven they sit down together for 25 minutes to play with cars or Lego, and when the weather is warm they sometimes go for a walk. Dad tells Paul it's 7:25 p.m., and the bedtime ritual begins. Paul takes a shower and Dad helps him put on his pajamas. Often they read a good children's book, a chapter a night. They both enjoy the evening reading, and Paul enjoys getting ready for bed instead of resisting it. When there are a couple of pages left to the end of a chapter, his father warns him about it. Here the reading is done, the overhead light goes out and the nightlight comes on. Paul kisses his father and wishes him good night, hugs the stuffed monkey, and falls asleep when his father leaves the room.
As the child gets older, he too will appreciate the time he spends with you before bedtime. He needs the feeling of warmth and closeness, your undivided attention, and watching TV together can't replace this. Even if the TV program doesn't overexcite or scare the child (are there many of them on the air?) and you are sitting next to him, it's a bad idea because of the lack of direct communication. It's better to spend time discussing schoolwork, weekend plans, soccer games, dance lessons, extracurricular clubs, or music lessons. It is helpful to talk about anything that worries your child so heavy thoughts don't keep him from falling asleep. (Don't forget common sense, though. Some things are better to discuss during the day, so as not to throw wood on the fire of his worries before he goes to sleep.) The bedtime ritual of a grown child can be changed. Today you go for a walk, tomorrow you go for ice cream, the day after tomorrow you play a board game or ping pong (if you are sure that he is not too rambunctious) or help him with his homework.
It's not uncommon for an 11- to 12-year-old child to need some time alone in preparation for bedtime. He may want to read, listen to music, or take time for a hobby before turning off the light. But don't give up the habit of stopping by to chat with him before bedtime. It's still important to have a routine before bedtime, even if your child now manages it on his own. Let him see that you are still happy to spend time with him, that you are always available to discuss problems and concerns, and ultimately that you remain in charge, not allowing his bedtime routine to drag on or otherwise take an undesirable turn.
Eleven-year-old Emily has a successful bedtime ritual. After dinner, she finishes her homework, practices on the piano, and sometimes chats on the phone with a friend. Then she and her mother, who is raising her alone, spend time together. They like to make something with their hands (a birdhouse or a picture frame), and now they're working on a huge puzzle. It's easy to communicate while working. Around 9 p.m. Emily gets ready for bed, goes to bed and reads to music. Her mother stops by to discuss plans for tomorrow, and at 9:30 p.m. Emily turns off the lights and the music center and falls asleep.
Of course, not all of Paul and Emily's evenings at home are peaceful and pleasant, but there are few exceptions, nor are there any serious disturbances. If bedtime in your family traditionally turns into a war, the salvation may be the development of a more pleasant unchanging ritual. At first, it will be difficult to follow it, and your child may resist the innovation. But if you're persistent, then gradually everyone will love the process, and bickering will be over. Undoubtedly, the result is worth any effort.
"Back to sleep": how to reduce the risk of sudden infant death
A chapter on healthy sleeping habits would not be complete without a discussion of sudden infant death syndrome (SIDS), because there is a link between the death of apparently healthy infants in their sleep and their posture and environment. SIDS is the leading cause of death in infants. The term refers to the sudden death of a child under one year of age, the causes of which remain unspecified despite careful medical investigation. The presumed cause of death is respiratory failure (although why this occurs is unclear) followed by cardiac arrest. Nine out of ten cases occur in the first six months of life, with the maximum occurring between two and four months. A single cause has not yet been established, but certain habits and circumstances are known to increase the risk of "death in the cradle." These factors include late onset or lack of prenatal care, prematurity and low birth weight, and maternal smoking during pregnancy. Some ethnic groups (e.g., African Americans and Native Americans) are at increased risk for SIDS, and boys are more likely than girls to succumb to the syndrome. Some studies suggest that breastfeeding reduces the risk of sudden infant death somewhat, but if it does, the effect is small. Not all studies support this conclusion - although scientists generally agree that breastfeeding is beneficial, but for different reasons - and the effect observed may be due to other factors, such as fewer smokers among breastfeeding mothers.
But it turned out that sleeping on your baby's stomach (face down) significantly increases the risk of SIDS. So unless your pediatrician has prescribed that your baby sleep on his or her stomach, always put him or her on his or her back. Side down is also better than upside down, but back down is preferable. The American Academy of Pediatrics has been recommending that infants lie on their backs (face up) since 1992, and since 1994 it has been working with other organizations on the "Back to Sleep" campaign. Over the years, the percentage of U.S. infants sleeping on their stomachs has dropped from over 70% to 20%, and the number of sudden deaths while sleeping has dropped by over 40%, a stunning result considering how simple the measure is.
At first, some parents and pediatricians expressed fears that an infant sleeping on his back might suffocate if he vomits, but these fears have not been borne out. Temporary flattening of the back of the head is possible, especially if the baby always sleeps in the same position. To avoid this, tilt the baby's head slightly to one side or the other and turn the baby or crib so that the door or light source is not always in the same direction from it. In any case, SIDS is a disproportionately serious threat, and flattening does no harm and gradually goes away on its own.
The infant's position on its back is important only during sleep. During the waking periods, the baby should spend part of the time on its tummy and in an upright position in the arms of adults (especially now, when children lie too much in car seats and rocking chairs). This helps to develop upper body motor function and avoid further flattening of the back of the head.
At around five or six months of age, most babies are able to turn from back to tummy (tummy-to-back is learned a few weeks earlier). From this point on, it is no longer guaranteed that the baby will sleep on his or her back, but the risk of SIDS itself decreases as well.
Certain details of the environment can be dangerous for a newborn. It is risky to leave it sleeping on a surface not designed for infant sleep, especially a very soft one: a soft chair or sofa, a water mattress, a pillow, a down or cotton blanket, a sheepskin. On loose surfaces or a sheet that is not tight enough, the baby runs the risk of suffocation. Mistaken choice of bed is fraught with pinching - the child's face may be caught between the mattress and the wall or bed rim, or between the pillows. If sleeping together with an overweight parent or one who is unable to wake up normally due to drug or alcohol use, the infant may not only get stuck and suffocate, but also be crushed if the sleeping parent is piled on top of him or her. The more people in the same bed as the baby, the less room there is for the baby and the greater the danger. Unsuitable mattress and bedding, unfortunate placement of the crib against walls and furniture, which is often the case in a parent's bedroom, further increase the risk.
Smoking in the home, especially in the same room as the baby, doubles or triples the chance of sudden infant death. Overheating, another risk factor, can be avoided by dressing your baby properly before bedtime, keeping his or her room at a temperature comfortable for a lightly dressed adult, and not using inappropriate bedding. If the child is properly dressed and the temperature is comfortable, you can do without a blanket at all. A baby who is too warmly wrapped suffers from overheating, which may explain the increasing number of "crib deaths" during the cold season. (Another reason could be a seasonal exacerbation of respiratory infections.)
Finally, based on the few studies reporting decreased rates of SIDS among infants falling asleep with a pacifier, the American Academy of Pediatrics recommends that parents consider giving babies a pacifier before night and daytime naps in a 2005 guideline. Here's what those recommendations sound like:
- During the first year of life, "it is desirable to use a pacifier when putting an infant to bed...If an infant refuses the pacifier, you should not force it." (There is no recommendation to use or refrain from using a pacifier while awake.)
- The pacifier should not be "given again to an infant if he is already asleep," as studies have found no reduction in the positive effects of a pacifier falling out of the mouth of a falling asleep infant.
- "The pacifier should be washed frequently and changed regularly" and "do not lubricate it with anything sweet."
- "When breastfeeding, you should delay introducing your baby to the pacifier until the baby is one month old, when feeding is fully established."
How valuable these recommendations are can only be shown by additional research. The period of two to six months is particularly important, after which the risk of sudden infant death is relatively low and the likelihood of developing middle ear infections due to pacifier use increases. It is unclear how, if at all, a pacifier helps protect a baby from SIDS. It may simply be occupying the baby's mouth, preventing him from swallowing soft bedding. If it is about the more frequent awakenings typical of babies who are given a pacifier, then greater sleep security comes at the cost of reduced sleep quality.
Should the baby sleep in your bed?
So-called co-sleeping - when a child and parents sleep in the same bed - is probably the most fiercely debated. Some argue that it is in any case the best option for the child, while others consider it unacceptable. And both sides argue that their opponents' choice threatens the psychological and even physical health of the baby.
In more than 25 years of working with children with sleep disorders and their families, I have come to the conclusion that children can sleep just fine in a variety of settings. If a child has a healthy sleep, there is nothing to suggest that one system is superior to another. Children do not grow up insecure just because they sleep alone or in the nursery with their siblings, just as sleeping with their parents does not in itself prevent them from getting used to independence and forming their own individuality. Whatever you want to do, whatever you are comfortable and like, is right, if it goes well. I see no need or right to impose a parenting philosophy on parents. And if I do not see their chosen path as a direct threat to their child, then I work within the framework of their choice. Specific techniques may vary, but most problems are resolved irrespective of the principal approach. There are no irreversible solutions: parents are free to try one principle and, having realized that their expectations were not met, to switch to another. If the chosen approach suits everyone, then it is the right choice. If someone is dissatisfied or does not sleep well, it makes sense to reconsider the principles.
Some panelists attach great importance to the fact that some form of co-sleeping was originally intrinsic to humans as a species and persists in the most "primitive" - socially and economically traditional - cultures. Indeed, a curious fact - but one that says little about how a child's sleep should be organized in modern culture. We are not about to return to the domestic conditions of our ancient ancestors (most of whose offspring did not live to see their first birthday): moving newborns from heated houses to caves, sleeping on the ground, a boardwalk or straw instead of beds and doing without medical care, hygiene and most clothing. Obviously, not everything in the culture of ancient people can serve as a model for us.
Moreover, the traditions of many cultures that practice co-sleeping prescribe separate sleeping arrangements for women with young children and men, as well as for older boys. They have no need for privacy: for example, coitus usually takes place not in the privacy of the marital bedroom, but in full view of everyone. In the modern West, there are hardly many people willing to adopt these customs.
The conditions of our lives are drastically different from those in which the first people lived. This does not mean that we are always obliged to do the opposite. However, we do have to consider various factors, including the circumstances of our present existence. When applied to baby sleep, this means that you are free to choose the path that best suits you and your views on parenthood.
Children usually fall asleep quickly and sleep soundly wherever they are put. In the absence of problems, the vast majority of children will sleep 98-99% of the time from the evening "good night!" until they are fully awake - that is, they are awake for only a tiny fraction of their nightly rest time, a total of five to ten minutes per night. And even during these minutes they are half asleep, barely conscious of anything except the need to lie back down and go back to sleep. Thus, most of the night children are not aware of where they are or who is present or absent.
But most of the day they are conscious and active. This is when they need the constant proximity of loving and caring adults. They also need to know that while they are sleeping, their parents are there to protect them - then waking up will not be accompanied by anxiety. But once they are asleep, they don't know where their parents are, so many moms and dads approach their children at night to their urgent cries, but slip away as soon as they fall asleep again.
Most of the families I worked with practiced separate sleeping arrangements. Many of those who slept with their child did so involuntarily because of lack of money or space, or because it was the only way they could sleep. Others preferred "partially shared" sleeping: they put their baby's crib or bassinet in their room for the first few months of life. But I also had the pleasure of working with families who deliberately and consciously chose co-sleeping, and most of them were happy with the decision.
Before you make a choice, consider the following. It should be your decision alone, as a couple or as a single parent, and you should make it based on your own beliefs, not because of pressure from your child or anyone else. The other family's successful or unsuccessful experience in sleeping together or apart should not affect you. After all, you have different children and different families. Finally, and this is very important, if you stop at co-sleeping, you will have to plan when and how you will give it up. So many families start by co-sleeping with a very young child, convinced that at some point he himself will give it up, and years later, suddenly it turns out that their five-, seven- or 12-year-old child still can not "leave" their bed. Parents are unhappy, the child is confused, because he feels that he is "different", and he can't even go to sleepovers or invite his friends over. In such cases, most children yearn to leave their parents' bed even more than the parents themselves dream of getting rid of them.
When one parent insists on sleeping together and the other protests, any choice will lead to frustration and bitterness. If co-sleeping is not to the liking of both, but persists because the child "demands it," then in the long run the choice was wrong. There are times when a child sleeps with one parent and the other parent sleeps separately, and both adults feel that the child has forced them to separate, has replaced one parent as the other's partner. The decision, made under the influence of compassion or despair, is fraught with irritation toward the spouse and child. And an irritated and tired parent has a hard time caring for the baby during the day and making sound decisions at night. I've seen quite a few parents who say they'll keep co-sleeping with their baby if it's the only "way out," but won't even think about having another baby.
Specifics of co-sleeping
Advantages and disadvantages.
Co-sleeping with your baby has several potential advantages:
- Proximity to the child from the first minute of awakening. Children love it, and many parents also enjoy the feeling;
- Instantly getting rid of any anxiety associated with feeling detached from the child at night, as well as other fears and problems;
- Ability to quickly, without getting out of bed, feed the baby and deal with other issues during nighttime awakenings;
- Being able to spend more time together with the child;
- Ability to get a better night's sleep for both the child and the parents if the child does not sleep well in principle.
Sleeping together also has possible negative consequences:
- A slight increase in the risk of SIDS cannot be ruled out;
- If the child sleeps restlessly, it prevents the parents from getting enough sleep;
- As a result, parents may start to sleep in different rooms and become irritated with each other and with the child;
- The sleep cycles of adults and children do not coincide;
- Parents may be forced to go to bed very early, together with the children, which leaves too little time for their own evening activities and makes it impossible to use the services of a nanny even for rare outings in the evening;
- Certain sleep disorders (namely those stemming from the nature of the parent-child relationship) may be less amenable to correction;
- Parents have fewer opportunities for privacy.
The disadvantages of co-sleeping, which can lead to problems, are worth talking about in more detail.
Sleeping with an infant in a bed typical of Western cultures (soft mattresses, puffy pillows, loose plaids and blankets so unlike mats on the ground, thin headrests and covers) somewhat increases the risk of SIDS or that the baby suffocates (the available research does not always draw a clear line between these two causes of death). The risk increases if the parent is obese or under the influence of alcohol, drugs, or medications.
But there is also an opposing view that co-sleeping reduces the risk of sudden infant death, perhaps because children (and parents) are more likely to wake up during the night. Nevertheless, there is no scientific evidence for this, at least not in Western countries, where most studies have been conducted. However, these studies cover all cases of sudden infant death from any cause (not just SIDS). According to the findings, factors such as more people sharing the same bed, inappropriate mattresses and bedding for the infant, places where the baby can get stuck (gaps between the bed and the wall), and alcoholism and obesity in parents increase the risk. Thus, we are talking about the risk of suffocation rather than SIDS. Moreover, the rate of sudden infant death in countries where co-sleeping is the norm is both high and low, and where it is high, there are often associated socioeconomic factors, such as smoking and poor medical care during pregnancy and after birth. These have more impact than co-sleeping per se.
Either way, by choosing to co-sleep with your baby, you should minimize all risk factors. Most importantly, take the precautions discussed in the section on SIDS. Make sure your baby sleeps on his or her back, and don't allow smoking in the house, especially in the bedroom. To further reduce the risk, move the bed away from walls and furniture, get a firm, level mattress, get rid of fluffy, loose bedding and covers, limit the number of people sleeping with the baby, one or both parents, and do not take alcohol or other drugs that interfere with wakefulness.
The safest option that meets all requirements and still provides constant closeness to your baby is suggested in the 2005 American Academy of Pediatrics guidelines already mentioned: put your baby in a separate crib, bassinet, or bassinet with a firm mattress and appropriate bedding in your bedroom.
If you want to continue co-sleeping with your baby after the first few months of life, be aware that many young children sleep very restlessly. They kick, roll over, whimper, and wave their arms around during their natural nighttime awakenings. Often such a baby changes body position by 180 degrees several times during the night. He himself sleeps soundly, but his parents do not always. Another possible situation: parents huddle on the edge of the bed, and the child lies between them, leaning against one leg and head in the other. For most of the history of mankind there was no such a limitation as the width of the bed. In archaic cultures and among the poor, it is still common to sleep on the floor or on the ground. But modern Western parents can also use a futon (floor mattress) to give a restless one- or two-year-old child enough room without compromising themselves. Some proponents of co-sleeping advise using the bedroom exclusively for sleeping, covering the entire floor with a mattress, and moving the conjugal relationship to another room. It's effective, but many families find it unacceptable.
By: Dr. Anuj Gupta