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Establishing Good Sleep Habits Early

Establishing Good Sleep Habits Early. Rachel J. Valleley, Ph.D. Munroe-Meyer Institute University of Nebraska Medical Center. Overview. Occurrence of sleep problems Impact of sleep problems Common sleep disturbances in infancy and young children

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Establishing Good Sleep Habits Early

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  1. Establishing Good Sleep Habits Early Rachel J. Valleley, Ph.D. Munroe-Meyer Institute University of Nebraska Medical Center

  2. Overview • Occurrence of sleep problems • Impact of sleep problems • Common sleep disturbances in infancy and young children • Strategies to encourage healthy sleep habits

  3. Pediatric Sleep Disturbance • 20-30% of children • 15% of adolescents • Highly disturbing to parents (stress & depression) • Few children outgrow sleep problems • Study found 84% of babies with sleep problems still experience problems 3 years later • Related to daytime behavior problems

  4. Impact of Sleep Problems • Mood and affect (irritable, sad/depressed, crying/temper tantrums) • Behavior problems (noncompliance, aggressiveness, hyperactivity, poor impulse control) • Neuro-cognitive deficits (attention, concentration, memory) • Performance deficits (learning, task persistence) • Family disruption

  5. The Sleepy Child…. • May not report feeling tired • May not act tired or lethargic • May look hyperactive & impulsive • May be irritable & easily provoked • May show low frustration tolerance

  6. How much sleep should your child be getting?

  7. Bed-sharing or Co-sleeping • Cultural issues • Marital issues • Family values • Behavioral issues • Regular • Part-time • Reactive

  8. Common Sleep Problems: Infancy • Sleep-onset association disorder • Nocturnal eating/drinking syndrome

  9. Sleep Onset Association Disorder • All children wake at night • Good sleepers quietly go back to sleep • Poor sleepers cry, call-out, enter parents room • Lack independent sleep onset skills • Child cries until parent responds to reestablish familiar conditions to “put” child to sleep • Rocking, feeding, patting, sleep with parent

  10. Nighttime Feedings • By 4 months of age, there is no nutritional basis for nighttime feedings • Waking to feed is a learned behavior • Nocturnal feeding patterns prevent the development of a more mature sleep pattern

  11. Strategies for Stopping Nighttime Feedings for Infants • Break association between feeding and sleep • Lengthen daytime feeding intervals • Delay time between nighttime awakening and feeding (re-swaddle, diaper, walk around) • Reduce fluid intake gradually during nighttime awakenings • If child falls asleep during feeding, awaken briefly before placing back in crib • Non-contingent waking for feeding

  12. Strategies for Teaching Independent Sleep in Infants • Have child fall asleep in crib alone for naps or at bedtime first • Use a structured bedtime routine and stick to it • A couple of bedtime options • Place child in bed & return in morning, unless ill or in danger • Crib checks every 10 minutes when crying (Ferber method)

  13. Common Sleep Problems in Young Children • Obstructive Sleep Apnea • Nightmare Disorder • Sleep Terror Disorder • Sleepwalking Disorder • Bedtime Resistance

  14. Sleep Problems • Most common: Bedtime resistance • Sleep-onset delays up to 1 hour • Night awakening • Morning wake-up problems

  15. Sleep Problems • Most common: Bedtime resistance • Sleeping independently is a skill • Laying in bed is “time-out”

  16. Pitfalls to Healthy Sleep Habits in Toddlers • No regular bedtime and routine • Child determines how & when to go to bed • Parent in room as child falls asleep • Attending to “curtain” calls • Allow child to sleep in living area & then transfer to bed • When child awakens in night, stay in room until back asleep or allow child into bed

  17. Resolving these bedtime struggles • Provide consistent bedtime routine • Get child to bed at determined time • Establish bedroom conducive to sleep (calm, quiet, dark) • Prohibit stimulating bedtime activities (TV, videos, radio, rough play)

  18. Sample Bedtime Routine • Take bath • Put on PJ’s • Light snack • Brush teeth • Read book • Get in bed at 8 PM

  19. Bedroom Environment • Non-stimulating • Relatively dark • Quiet (can use white noise machine) • Comfortable temperature • *Familiar setting (child used to sleeping in own bedroom)

  20. Teach & reinforce sleep/bedtime skills • Independent sleep onset • Remain in bed quietly while awake • Reinforcement for remaining in bed • Reinforce sleep compatible behaviors (“Excuse Me Drill”)

  21. The Excuse-Me Drill:(Reinforce Sleep Compatible Behaviors) • Make sure child is sleepy • Late bedtime • Keep wake-up and naptimes same • “Excuse me, I need to…” • Give attention when child is laying in bed, quiet, relaxed • Slowly move bedtime earlier once child develops independent sleep onset skills

  22. Reinforce Sleep Compatible Behaviors • Amazon.com or behavenkids.com Burke, R. V., Kuhn, B. R., & Peterson, J. L. (2004). Brief Report: A "Storybook" Ending to Children's Bedtime Problems--The Use of a Rewarding Social Story to Reduce Bedtime Resistance and Frequent Night Waking. J. Pediatr. Psychol., 29(5), 389-396.

  23. How to handle “curtain calls”, nighttime wakings • Build in common curtain calls in routine (bathroom, drink, kiss) • If wake up in middle of night, quietly escort back to bed • May need some type of signal to alert you when child gets out of bed

  24. How to handle nightmares • Listen while child talks about it • Remind child it is a dream • Point out strange aspects of dream • Avoid scary movies • Avoid lengthy discussions, monster proofing, and psychoanalyzing dreams

  25. Naps: Steps to good sleep • Demonstrate sleep compatible behavior • Prompt sleep compatible behavior • Praise sleep compatible behavior FREQUENTLY at first • Use stickers for sleep compatible behavior • Offer incentive to follow nap if quiet during naptime • Use a time out if absolutely necessary

  26. Summary • Independent sleep is one of the 1st skills a child should master • Break feeding/parent association with sleep onset • Use a routine • Set up room to be conducive to sleep • Reinforce sleep compatible behavior • Minimize reaction to sleep incompatible behavior

  27. Resources • www.babycenter.com • www.sleepfoundation.org • www.aasmnet.org • http://www.sleepeducation.com

  28. Sleep Books for Parents: Mindell JA. Sleeping through the night: How infants, toddlers, and their parents can get a good night's sleep. New York: HarperPerennial/HarperCollins; 1997. Ferber R. Solve your child's sleep problems. New York: Simon & Schuster; 1985. Weissbluth M. Healthy Sleep Habits, Happy Child (Revised Edition). New York, NY: Fawcett Columbine; 1999. Durand, V. M. (1998). Sleep better! A guide to improving the sleep for children with special needs. New York: Paul H. Brookes. Behavioral Pediatric Sleep Clinic

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