During the routine wellness checkup, parents often ask for my advices on sleeping issues that their children have. I realized that disruptive sleeping habits actually are quite common among infants and toddlers.

 

1.   Establish a good bedtime routine

      

      Some people call the first three months of a baby’s life the fourth trimester for good reasons. During these early months, the baby is learning to adapt to the environment outside of the mom’s womb. They don’t have the ability to follow certain schedules to be fed or to fall asleep, etc. And they don’t know the difference between day and night. Therefore the best way to take care of a baby is feeding on demand and helping him to fall asleep when he is drowsy.

    At about 3 months of age, however, the parents can start training the baby to establish a good bedtime routine. This is the age when about 90% of babies will be able to sleep about 6-8 hours straight. At about 4-6 months of age, babies no longer need to be fed at night.

      There are a few things parents can do to help your baby to develop a good bedtime routine.

 

• Observe your baby for early signs of tiredness such as rubbing her eyes, little crankiness, or getting quiet down. Yawning is an obvious sign for bed.

• When your baby is ready for bed, you either sing a lullaby; give her a bath and/or a message, or do any other quiet soothing activities you might choose. The key is that you need to do it every night at the same time, same place and the same sequence. You may call it sleep ritual or sleep cues. You baby eventually will associate this ritual with time for sleep and prepare herself psychologically and physically for sleep.

• When your baby is drowsy, put him to his crib when he is still awake. So he may put himself to sleep. This will help him to develop the ability to sleep on his own not with the help of an adult.

• Help your baby to establish the healthy circadian rhythm. During the daytime, take your baby out for some outdoor activities. Even when it rains or it is cloudy, you may turn on the indoor lights to make the room bright. At night, your baby should be sleeping in a quiet and dark room. This will help to regulate the healthy suppression and release of Melatonin at the pineal gland. Melatonin is the hormone that sets the circadian rhythm. 

• Babies and toddlers need 12-14 hours of sleep every day. That means they need to get ready for bed at 6-7 pm. Many people believe that if children go to bed late they tend to sleep in and sleep longer. It is a myth. If children are overly tired by staying up late, it will be harder for them to fall asleep and stay asleep. Therefore, they get much less sleep than they really need. 

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2.    The Common sleep issues and ways to solve them.

 

a.  My baby is 9 months of age. She was sleeping right on schedule until recently. Every time I try to get her to sleep she starts to cry and fuss.

It is very common for babies this age suddenly protect at bedtime. They have just reached an important developmental milestone, object permanence. They realize now that an object disappears from the sight may still exist. When they are put to bed (separation from the parents), they know their parents are still around. And they want them, so they cry for them.

Besides being consistent on the established sleep routines, the parents may adopt the method of “crying it out”. Let the child cry out a few minutes before the parent goes into her room. When the parent goes in, she may gently pat on her baby, may give a quick kiss and walks out. Avoid turning on the light, picking the baby up, rocking or feeding. The bottom-line is to keep the interaction minimal. Be prepared that your baby will cry or scream when you walk out. Repeat the process. Each time, let your baby cries little longer before you walk in.

The research has shown that there is no long term negative effect by letting a baby crying it out. A baby, who is well loved, nurtured and responded to during the day, will not be traumatized by fussing a little at night.  

 

b.    My baby is 12 month old. He still wants his milk a couple of times a night. What should I do?

 

Babies who are older than 6 months don’t need to be fed at night. He still wants his bottle at night either for the extra attention he used to get, a habit he developed months ago or occasionally he might be too active to eat enough during the day.

At 12 months of age, he just learned to walk. The world is exciting and new. During the day, if parents are not keeping the strict meal and snack schedule in an undisrupted and undistracted environment, he may not get enough food in.

 

If he has enough food intakes during the day, then parents should gradually cut down and cut out the night feedings in a few days of time. Crying it out is still a practical and effective way for helping your child get over this sleep issue.

 

For children who are older than one year, a lovey, a stuffed animal, a blanket, etc might be placed in his crib. When he wakes up he could use it to sooth himself back to sleep.

For children who wake up at night crying not for the milk bottle but for parents, the strategies are similar. We all wake up a few times throughout the night. Learning how to put one self back to sleep is an important sleep skill for young children to master.

 

c.   My baby falls asleep in my arms. Every time I put her down to her crib, she wakes up and cries immediately.

After a baby is 3 months of age, the parents should try to observe their baby’s early signs of drowsiness, and then perform the bedtime ritual. The important last step is to put their baby to the crib when he is drowsy but still awake. This will give him a chance for him to put himself to sleep. When he wakes up at night as we all do he will most likely go back to sleep on his own. On the other hand, the parents who rock, sing and swing their baby to sleep in their arms do not give their baby the chance to fall asleep on his own. Therefore when he wakes up, he cries for his parents to help him back to sleep.

 

d.    My toddler sweats a lot during sleep. Should I be concerned?

Children are more likely to sweat at night than adults do for a few reasons. Night sweating occurs during deep sleep. Children in general have longer hours of deep sleep than adults do. Their ability to regulate the temperature is not mature. And children have more sweat glands relative to their small body size.

 

Certain medical problems such as heart disease, obstructive sleep apnea also could cause excessive sweating. But these medical conditions will have other symptoms such as difficulty feeding, poor weight gain, loud snoring, etc. If your child appears to be healthy, no other symptoms, the night sweating is probably not a concern.

Of course, setting the right temperature at your child’s bedroom is an obvious thing to consider so as the proper beddings. 

For Chinese translation, please see（本文中文版请参见）

怎样让孩子和父母都睡个好觉？

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Sleep like a baby

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