Sleep Difficulties in Young Children
Ahh, sleep. There is possibly no topic I talk about more behind the closed doors of an exam room than sleep. In the first years, parents tell me how hard it is to make their children want to go to sleep and stay asleep. Once children get older, they tell me themselves how hard it is to fall asleep and how tired they feel during the day. As a horrible sleeper myself, I can relate to this so well.
One of the messages I like to share with families is that there are lots of ways to raise a child. What works for me and my kids might not work for you. I think we would all be better friends to each other if we didn’t judge others when they parent in a way that doesn’t look just like we parent. This is something I have personally had to work on over the years. When I find a method that works in my home, I kind of want to preach it out to people as if this is the gospel. I sometimes believe if my way doesn’t work for you, you must not be doing it right. I forget that even within my own family we have had to modify things because each of our children is different.
There are some universals with sleep. For instance, everybody needs it. The American Academy of Sleep Medicine and the American Academy of Pediatrics (AAP) agree on the following ranges for normal sleep for children: infants 12-16 hours, toddlers 11-14 hours, preschoolers 10-13 hours, grade schoolers 9-12 hours, and teenagers 8-10 hours. Newborns can sleep up to 17 hours a day, but never more than a few hours at a time.
How to get children to sleep is more controversial. The AAP also recommends back to sleep, sleeping in the same room but not the same place as parents, sleeping on a flat surface, and not having extra items in bed with the child. As a pediatrician who practices evidence-based medicine, I support all of these recommendations. However.
I learned how to sew while I was pregnant with my son and the first thing I made was a crib set for him. I ordered beautiful safari themed fabric which was gender-neutral because I chose to be surprised by gender at the time of delivery. I made a quilt, a crib sheet, and BUMPERS for his bed. Then I learned bumpers were dangerous. For him, I used them anyway because I spent so much time making them. This was dumb and I got over myself by the time my daughter was born 2 years later. She slept in a safer, less prideful environment.
I tried with each baby to have them sleep in a bassinette in my room but, as mentioned earlier, I am a horrible sleeper. Every sweet little noise they made, every time they turned their bodies the slightest amount, I woke up. After only a couple of nights of this, I realized I would never get any sleep if my children shared my room. So, I moved them to their rooms, set the baby monitor so I could hear them when the true crying started, and life was much better for all of us. In both of these examples, I did not follow the safe sleep guidelines. My decision to use the bumpers was a bad one and I eventually came to my senses. In the second example, the safer thing for our particular family was not to sleep in one room where I would have been sleep-deprived.
What I believe, and how I practice medicine, is that recommendations are guidelines composed from data, usually, to help us keep our children safe. They are not laws. They make us safer overall, keep us healthier from a public health standpoint. But they are not personalized to the individual circumstances each of us face. If you co-sleep with your infant, the rate of SIDS and suffocation goes up. This is well documented. What I have not seen documented is how many car accidents or child abuse incidents occur from sleep-deprived parents whose babies scream all night if they are on a flat surface, on their backs, with nothing else in the bed. I would never use this blog to recommend co-sleeping. I don’t recommend it. I didn’t do it. But for some of you who can’t get sleep any other way: I hear you and I understand.
Before I had children, I thought any form of “crying it out” was cruel. When I had a 4-month-old who insisted on being held for 2 hours before going to bed and would often cry during those 2 hours regardless of whether I was holding him or not, I felt differently. We tried the graduated fading technique, where we checked on him after 2 minutes, then after 5 minutes, then every 10 minutes until he was asleep. This might work for your baby but it was a nightmare for us. Every time I went in and then left, we both felt like I was abandoning him all over again and the cries would intensify. When this failed, we went to all or nothing. I watched a movie in the other room while he cried for 57 minutes. The next night it was about 17 minutes. And then it was easy.
For other parents, crying it out is abhorrent. They would rather sleep next to their child for years than allow their child to cry alone. I have met really well adjusted, kind children who slept with their parents by their side for years. I know it can be done. Usually, when parents are asking for help it is because they want their own sleep space back. I don’t know a way to teach kids to fall asleep by themselves without actually allowing them to fall asleep by themselves. Sometimes I suggest a stuffed animal or, for older kids, a photo on the wall of parents. Sticker charts work for some kids, for others the promise of an extra story in the morning if they stay in their beds. Sometimes parents try a method where each night they sit farther and farther from the bed until eventually, they are not in the room at all. If this works for you, I am all for it. Do what works. For my children, this would have meant that I sat there and watched, from 5 feet away, as they cried for a very long time. This was not the message I wanted to send to my kids. To me, that message was, “I am here and I could help you, but I won’t.” Instead, I wanted to send the message, “At bedtime, I am also trying to go to sleep so you need to learn to put yourself to sleep.” This might not be how you interpret the messaging. That’s ok.
There are lots of things kids have to learn how to do that cause crying. Learning to self soothe is, perhaps, the hardest for us because it happens when we are exhausted and it can easily be stopped by giving them more of ourselves. We are trained in the American culture to give our kids as much of ourselves as we possibly can. The goal seems to be to make our children as happy in the moment as possible. We forget that momentary happiness is not the same as a lifetime of happiness. The Bible has many stories of God promising things and making people wait and work on something before the promise is delivered. Think about Abraham and Sarah wanting to conceive or the Israelite’s journey to the promised land. God was with them, even as He forced them to wait.
Just like these Biblical characters, your kids are never alone. If we leave our baby’s room feeling guilty about their loneliness, we are forgetting God. He sits watch over our children all of the time, even when they are asleep. I know a 4-month-old is too young to understand this, but probably not too young to feel this. I would explain to her, before you leave the room, that you are stepping out while God stays, as He always stays, and she will be safe as she works on learning to put herself to sleep. Then, when you leave that crying child, you also remember that you are not alone in parenting her.