Thursday, February 16th, 2012
I’m used to seeing parents having spirited debates about sleep methods. But now sleep experts are having their own debate about sleep guidelines.
A recent paper suggests that the sleep recommendations for kids are, in essence, not supported by research. The implication is that kids may not really need as much sleep as we are told. An expert’s reaction to this paper was that, in general, the guidelines are backed up by enough research to make them useful.
So what do you, the parent, make of all this? Here are two things to consider.
First, keep in mind that the sleep recommendations – such as those provided by the National Sleep Foundation – have a lot of fuzziness built into them. How fuzzy? Check these out and notice the numbers that I have italicized and bolded:
Infants (3-11 months): typically sleep 9-12 hours during the night
Toddlers (1-3 years): typically need 12-14 hours of sleep daily
Preschoolers (3-5 years): typically sleep 11-13 hours each night
Second, consider why these guidelines are so broad. Yes, you already know the answer. Simply put, not all kids are the same – some kids need more sleep, others need less. And that’s where we should focus our attention in this debate. These figures do come from both research and clinical practice. As broad guidelines, they are reasonable. What I suggest is that the expert debate move on to address the real need for parents: to stop talking about how much sleep kids need on average and start developing better, empirically-supported, guideposts that help parents understand how to figure out how much sleep their own child needs. If a toddler sleeps 13 hours a night, is that enough? (It’s within the guidelines). If a toddler sleeps 11 hours a night, is that problematic? (It’s outside the guidelines). The problem is that these guidelines don’t give you the answer to these questions. It’s possible the toddler getting 13 hours of sleep needs more – and the toddler getting 11 hours of sleep does not.
So where does that leave you, the parent, right now? I suggest you become familiar with a few indicators that can tell you how well your child’s sleep routine is working beyond the obvious goal of having them sleep through the night (click here to read about this in more detail). You can start looking for these during the toddler years and beyond (once sleep patterns become established):
- Does your child get to sleep around the same time most nights? (They should)
- Does your child get to sleep within 15-30 minutes once they are settled in and it’s clearly time to sleep? (They should)
- Does your child wake up pretty easily in the morning – and after a nap – without lots of prompting? (They should)
- Does it feel like it takes a long time for your child to seem alert after waking up? (It shouldn’t)
- Does your child seem tired a lot during the day (e.g., yawning, eye rubbing, etc) – excluding nap time? (They shouldn’t)
- Does your child fall asleep frequently when you drive – excluding nap time or if you are driving near bedtime? (They shouldn’t)
- Does your child sometimes fall asleep (crash) much earlier than the usual bedtime? (They shouldn’t)
If you go through this list and find that your child is showing signs that their sleep routine needs adjusting, then it does. Continual sleep deprivation can have severe effects on kids, including interference with learning and compromised health. So getting a handle on this as soon as possible is important. In addition to doing your own research and trying out different methods, it’s often helpful to consult with your pediatrician. And if that doesn’t work, see if you can visit a pediatric sleep clinic – you can learn lots of little tricks that can help you set up a routine (click here to see my post from last month that discusses tips I learned) that can be calibrated to get your kid the amount of sleep that’s right for them.
Restful Sleep image via Shutterstock.com
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Tuesday, January 17th, 2012
I’ve heard from a lot of (tired!) parents about my recent blog post on the sleep challenges you’ll face in the toddler years - many have asked for more specific advice. So I’m offering some tips I received as a parent who took my toddler to a sleep clinic (as I was befuddled by the whole thing and waved the white flag!).
You need to convince your toddler that sleep is not a punishment. This to me is the biggest hurdle. Telling a toddler that it’s time to go to sleep can get translated in their head as “It’s time to stop doing something fun.” While you won’t be able to solve this entirely, you will need to find appealing – but not overly stimulating – things to do before bedtime that will transition them to sleep. Your child loves having books read to them and love it when you tell them stories. The trick is to establish these activities (or a combination of them) as the first stage of the bedtime ritual – and it helps even more if you pick a favorite spot in the house where this happens. Make it fun and something to look forward to and plan on around 15-20 minutes of this. AND STICK WITH IT EVERY NIGHT – NO EXCEPTIONS! You are trying to create a routine. TV and any other electronic device is not advised during this transitional time.
You could make going to bed a bit of a game. Maybe it sounds silly to you, but you could try to put a little fun into that difficult time (for some) of actually making the move to your child’s room. Use your imagination. Put a voice to a stuffed animal who coaches them into their room. The idea is to do something that kids like and will look forward to. Kids love rituals if they are fun – and you want to create a “get in bed” ritual.
You may need to get them a big kid bed. We thought it was too early, but the clinic suggested that it was time and gave guidelines about making sure it was safe. The bigger point here is that change may be a good thing for some toddlers – and a big kid bed might make them feel a little pumped up about their development (which you can then use to your advantage by pointing out that big kids go to sleep at a proper time at night – all’s fair in sleep wars!)
You need to help your toddler handle their new emotions about sleep. Expect to do a lot of soothing. Toddlers start to experience changes in their sleep cycles which make them wake up after a few hours of sleep. They may be afraid of being apart from you. They may remember bad dreams. They may be a little scared about the big kid bed you just introduced! Find a transitional object (I used to use one of my T-shirts) for your kid to cuddle with along with a stuffed animal. And then consider that …
“Graduated extinction” can be a very helpful method for toddlers with sleep issues. We all have our favorite methods. But since the assumption is that nothing is working now (remember, I was at a sleep clinic), we started from scratch following the principles of graduated extinction. Here’s how we did it. Week 1: We sat up on the bed for about 10-15 minutes and then left the room (this was with full disclosure to our daughter). If she woke up crying, we would sit on the bed for 5-7 minutes. Week 2: We sat up on the bed for 5 minutes and then sat in a chair for 5 minutes (if she woke up crying we sat on the bed for 2 minutes and in the chair for 2 minutes). Week 3. Same as week 2, except we sat in the chair for 2 minutes and then left the room (if she woke up crying we repeated the process – the point being we eventually left the room). Week 4: Realized that she preferred if we sat on the bed for 10-15 minutes (the Week 1 routine) and then left the room before she was fully asleep (the sleep clinic clinician loved this on our follow-up visit because our daughter partnered with us to let us know what she liked). We stayed with this for quite a long time and she hardly ever woke up overnight.
Reward sleep behaviors! Find a simple (and cheap!) reward system. Stickers worked really well. Every morning if we met a goal (like getting back to sleep if she woke up or sleeping through the night) our daughter would pick out a sticker to place on a fun calendar in her room. If it’s a bad night for no reason (e.g., she wasn’t sick) – no sticker.
Monitor the naps really closely. Part of the deal was to calibrate the daily nap – 1 hour every day around 2 in the afternoon. We did whatever it took to make this happen. Walked her in a stroller. Drove her in the car. Didn’t care. The point was the nap was from 2-3 every day, no matter who she was with. The sleep clinic endorsed this and wan’t concerned with how we got her to sleep (the faster the better!) as long as we woke her up after an hour. Following this routine, she was tired around 9 at night and slept until 8 the next morning nearly every night.
Be vigilant about changes in the routine. Life happens. Kids get sick. Schedules change. Holidays arrive. Visitors arrive. Whenever you get thrown off, try to get right back into the routine and be really strict about sticking with it.
So that’s it – some tips from a real life visit to a sleep clinic. Will these tips work for you? Some may and some may not. Every kid is different. Some toddlers may seem “hard-wired” to not sleep much. But the principles discussed here are really important, as is the very serious endorsement of talking to your pediatrician about visiting a pediatric sleep clinic if these tips (or others you come across) don’t work. They will come up with a plan for you, your child, and your situation. And you all will sleep much better as a result. One other tip: there may be a wait of several months or more for an appointment at a sleep clinic. So if you are thinking of doing this it’s good to get the ball rolling ASAP.
Image of little girl not ready to go to bed via Shutterstock.com
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