How to help child sleep

How to Help Kids Who Have Trouble Sleeping

Countless parents have experienced the frustration of trying to get kids to go to sleep and stay asleep. The coronavirus hasn’t helped matters. A lot of kids, even those who had no significant sleep issues before the pandemic, are having trouble now. And those who had struggled in the past may have regressed.

Confusing changes in routine and increased anxiety — older kids may be worrying, while younger children may be sensing their parents’ anxiety — are causing behavioral issues across the board. Sleep is no exception.

Fortunately, there are well-tested strategies for helping kids learn to fall asleep in their own beds and stay asleep. A form of behavioral therapy called CBT-I (cognitive behavioral therapy for insomnia) has been shown to be more effective than medication for treating kids with insomnia, explains Wendy Nash, MD, a child and adolescent psychiatrist. And for children with less severe problems, parents can use CBT strategies to change sleep habits.

So what’s a parent to do? First, you want to identify the issue. Then you can seek out solutions. The same guidelines can also be applied to naps, which are more invaluable than ever, given how many parents are working from home.

Talk to your child

Just chatting with a child about the issues surrounding sleep is a good jumping-off point. Anna Loiterstein, PsyD, a clinical psychologist, says parents should first try to understand what’s going on with their child. Let’s say they’re anxious. Before the coronavirus, it might have been school, conflicts with friends or separating from their parents. Now, is it the crisis itself? A fear that they or their parents will get sick? Knowing these things will help you assist your kids.

Validate fears, encourage bravery

Dr. Loiterstein says the idea is to empathize and validate the child’s fear. Start by saying, “I understand you’re feeling scared and that’s a really hard feeling,” and then encourage bravery. So, a parent could tell their child they understand it can feel really frightening to sleep in one’s own room, and then explain they’re going to practice going to sleep in steps to overcome this worry.  Let them know you are very confident that they can do it.

Sleep training

Once you know what’s going on with your sleep-challenged child, you can use behavioral techniques to help them move towards sleeping independently.

We aren’t talking about the “cry-it-out” form of sleep training used with infants, but rather one for older children that involves gradually moving farther away from the child.

“Again,” says Dr. Loiterstein, “we want the child to learn that they have the self-soothing skills to manage whatever it is that’s distressing them. Otherwise, they become too reliant on the parent for their presence or reassurance.”

She cautions parents to remember this will take time and patience. “You’re not going to go from one night sleeping in your child’s room to them sleeping independently the next,” she says.

There are systematic steps to work up to that. As an example, if you are lying in bed with your child, the first thing to do is to move to a chair next to them, just holding hands. The next thing could be to move the chair farther away, followed by sitting outside the door to get more distance away from the bed. Individual steps you might take would depend on the specific case.

Ultimately, your goal is to get to the place where you can come in and say good night and leave the room. It’s fine to have a sleep routine where the parent comes in, say, to read a story to a younger child or hug an older one, but the child shouldn’t be reliant on you to be there for them to fall asleep.

Create a routine

A posted sleep schedule with a consistent, predictable routine will help everyone, parents and kids alike, stay on track, from brushing teeth to lights out, as well as wakeup time. As the child accomplishes each step, they can be reinforced by that chart, which allows them to see their progress, earning them rewards for doing brave steps like staying in their room after their parents leave.

The parents can also be using charts to track progress and notice any patterns. “If it seems to a parent, ‘Oh, my child’s having a harder time on a Sunday than they are on a Friday,’ that tells us something,” Dr. Loiterstein says. “So tracking this type of information can really help to target certain interventions.”

Minimize dependence, reward bravery

Some kids get into the habit of falling asleep fine on their own but wake up in the middle of the night and go to their parents’ bedroom.

“They like to have these interactions with their parents,” Dr. Loiterstein says. “It’s their comfort zone.” She says the best thing when that happens is to bring them back to their own bed as soon as possible.

“We don’t want to reinforce this interaction and make it more likely that the kid is going to want to come in every night,” she says. “We want to minimize the reward they’re getting from their parents’ bedroom.” A reward system for their bravery can be used here, as well.

Instill good sleep hygiene

In addition to behavioral techniques, there are ways to create an environment that’s conducive to sleep. The idea is to train our bodies to go to bed and wake up at the same time each day. Some methods to get into that rhythm:

•  A calming, warm bath. “It can be helpful to have a hot bath one to two hours before bedtime,” Dr. Loiterstein says, “because it raises your body temperature, causing you to feel sleepy.”
• Meditation and relaxation techniques. Dr. Nash recommends meditation apps specifically for sleep, created for different ages. With calming music and a guiding voice, apps help kids relax, from a “body scan,” during which you relax your body starting with your toes, to breathing and visualization. All are meant to reduce anxiety and guide kids toward relaxing enough to fall asleep.
• Noise-canceling headphones. Some kids may tolerate the soft devices.
• Eye masks and room-darkening curtains. These can help create a dark, “cave-like” environment.
• A cool room. Adding a fan also provides soothing white noise.
• A weighted blanket. There is anecdotal evidence a weighted blanket can help kids. Just be sure it’s not too heavy or hot.
• No exercise right before bed. Exercising raises body temperature, speeds up heart rate and stimulates the nervous system, none of which are good for sleep.
• Make the bed for sleep only. Use the bed only for sleeping, not as a place for homework, eating or watching TV. “We really want to train our bodies to know that bed is associated with sleep and bedtime,” Dr. Loiterstein says.

When it’s time to evaluate

Dr. Nash says if these measures fail and there’s real, chronic insomnia, it’s time to talk to your pediatrician. “Make sure any underlying issue is being addressed,” she says. These could include asthma or sleep apnea; medication side effects might also be the reason.

If a child needs a sleep study, she adds, there are ones that can be done at home.

If none of the above is at play, it’s time for parents to check for any underlying psychiatric conditions with an evaluation, which can now be done via telehealth.

Disorders such as anxiety, depression, bipolar, ADHD, autism and OCD can all interfere with sleep, as can phobias and media stressors, says Dr. Nash. For instance, children and teens with autism may be kept up by sensory issues while separation anxiety might lead to clinginess.

Cognitive behavioral therapy for insomnia

If a child has persistent trouble sleeping, cognitive behavioral therapy for insomnia, or CBT-I, can be effective. CBT-I teaches children how to manage their own anxiety, now and in the future, and supports parents in helping their children get better. Dr. Nash says that CBT-I has been shown to be more effective than medication in treating insomnia.

Medicating for insomnia

Medications are the last resort. “We don’t have any FDA-approved medication for sleep in children,” Dr. Nash says. “I’d say the most commonly used is melatonin, for sleep initiation, but kids could wake up after four hours. Some parents try the timed-release XR but then you risk them being groggy in the morning.” The idea is to start with a low dose.

Dr. Nash notes that there have been anecdotally variable results with the blood-pressure medication clonidine; while she’s used it with some patients, it may not get them a full night’s rest.

Two more medications that are used off-label for sleep are the antidepressants Trazodone and Remeron. Dr. Nash notes that Trazodone’s side effects can include grogginess, so again, she recommends starting at a low dose. “I’d probably only use in teenagers with really severe cases,” she says.  As for Remeron, when used at low doses, it works like an antihistamine. It also increases appetite, so it tends to be good for kids who are on stimulants and anxious and have insomnia. For these reasons, she will usually try Remeron before Trazodone.

Parents may have heard of Gabapentin, an anti-epileptic drug also used to treat nerve pain in adults. But it can be sedating and cause nausea.

What about the antihistamine diphenhydramine, best known as Benadryl, some parents’ go-to when they want their child to sleep? Dr. Nash doesn’t recommend regular use because of side effects including tolerance and weight gain.

Eight ways to help your child get a good night’s sleep

Nothing looks more peaceful than a sleeping child. But even when they’re curled up and tucked into bed, their brains are working hard on developmental activities like memory consolidation (the process of putting experiences in order, learning what’s important and unlearning what’s not).

“[Sleep] is crucial for everyone but especially for kids, who are developing both mentally and physically,” says Dr. Sumit Bhargava, director of Stanford Children’s Health Sleep Center. “We are learning more and more about the impact of sleep on regulatory hormones. For example, in kids, the most intense period of growth hormone release is shortly after the beginning of deep sleep.”

So, sleep is important, especially for kids. Sadly, just knowing your kids need a good night’s sleep doesn’t mean they’ll get it. Adam Seligman, a physician’s assistant in the Stanford Children’s Health Sleep Center, offers these helpful suggestions:

1. Make a plan
Write up a bedtime ritual. If you have an infant, it might be as simple as singing a song and turning on the white-noise machine. If you have a toddler or an older child, ask for their input in forming the plan. Let them decide how many books you will read together and when the cuddles will happen (this helps them identify their own settling needs and gives them a sense of control). Next, list the steps in sequence — “Put on pajamas, brush teeth, read books, cuddle, lights out” — so everyone knows exactly what will happen. For kids that can’t read, use a chart with pictures. Review the plan together before you begin. When a plan is communicated and rehearsed, children are more likely to internalize it and less likely to ask for things that are not on the script.

2. Time together
Some kids become unsettled at bedtime because they’re longing for more attention from their caregiver. When parents work full time during the day, evenings are when kids get their parents’ attention. On the other hand, when a caregiver is home all the time, kids become dependent on the caregiver’s presence for comfort. Either way, spending a few minutes asking kids questions about their day (focusing on the positive) or telling them things you’ve noticed about them can be a nice ritual. For babies, spend 5 or 10 minutes cuddling and making eye contact, singing or saying soothing words.

3. Respect the routine
Sticking to a set bedtime helps children feel secure because it offers predictability. Kids of all ages (and grown-ups, too) should ideally go to sleep and wake up at the same times every day, give or take 30 to 60 minutes. Yes, that includes weekends, too. This may mean discouraging teens from sleeping in on Saturday mornings since it can disturb their circadian rhythm and make waking up on school days that much harder. For younger kids, earlier bedtimes (before 9:00 p.m.) mean they get more sleep and are better rested in the morning. Younger kids need between 10 to 12 hours of sleep a night, so if your kids have an early rise time for daycare or school, make sure their bedtime is early enough to ensure they get a full night’s rest.

4. Power down
Electronic screens are a bad idea before bed because their light stimulates the brain. This can make kids feel wired just when they should be resting, and it can also inhibit the production of melatonin and serotonin, the sleepy-time hormones. Ideally, kids should turn off screens at least one to two hours before bed. Limiting screen time can help in other ways, too. Kids who are off their screens will be more active, burning through their natural physical energy, which makes it easier to settle down at bedtime. What happens during the day affects the night.

What about sleep technologies? For younger kids, some parents use a special, colorful lighted sleep/wake clock to help their kids know when it’s nighttime and when it’s wake-up time. Personal wearable devices that track sleep (like a FitBit) can sometimes work as an effective screening tool for sleep issues. But they’re not diagnostic. If your child’s wearable device indicates they’re not getting quality sleep, it’s definitely worth seeing a sleep specialist to figure out why.

5. Keep it positive
Help younger kids who can’t tell time learn when it’s OK to rise by using a special clock that changes color at the appropriate sleep and wake times. Reward kids for waiting until the appointed hour. You can use a sticker chart and reward seven consecutive nights with a special treat or with fun one-on-one time, such as 10 minutes of playing a board game in the morning. But keep it positive. Don’t punish your kids for getting up. It might be frustrating as a parent to keep walking them back to bed, but you don’t want to create negative associations with being in bed.

6. Practice makes perfect
It’s also important to practice good “sleep hygiene.” Use the bed and bedroom for resting. Make sure toys and distractions are cleaned up before bed, or store them in another area of the house, if possible. Creating a strong sleep association with the bed and bedroom makes it easier to fall asleep there. The more your mind practices relaxing and falling asleep in a certain place, the easier it becomes.

7. Restless nights
If your child is having a hard time at night, it’s important to figure out if it’s from night terrors, sleepwalking or nightmares.

Nightmares are bad dreams that occur during REM sleep, and they are common in people of all ages. The distinguishing feature of a nightmare is that the dreamer will remember it. If your child had a nightmare or didn’t sleep well the night before, you can ask them about it in the morning. If they can talk about a bad dream, you can help them come up with some alternative endings or some other images to focus on instead. Explain that nightmares are a product of their imagination, and reassure them that they’re safe.

Sleepwalking and night terrors occur in slow wave sleep. They happen during the first third of the sleep cycle, and the dreamer won’t remember them. If your child is having night terrors or sleepwalking episodes, it’s important to have them evaluated by a sleep specialist.

8. This too shall pass
If you’re still facing a little insomniac after all your best efforts, don’t despair. Try to pull back and consider what might be going on. Sometimes children regress as they face a new developmental milestone. Sometimes they’re struggling to process a significant event. Trust your intuition.

Up until the age of four, parents really do have to teach children to sleep. This means taking them back to bed when they get up at the wrong time and helping to soothe their anxiety after bad dreams. If you need to use bribes at this age, don’t despair. It’s just a phase, and you’ll all make it through soon enough.

And if you’re unsure, talk with your pediatrician or contact a sleep specialist to help you create a plan that you can stick to. You don’t need to have a major issue to see a sleep specialist. Sometimes having an expert weigh in to help determine why the child is waking can help everyone relax and sleep better.

How to help your child fall asleep

If we get very tired, we literally fall off our feet and instantly fall asleep as soon as our head touches the pillow. Yes, it's us adults. But things are different for children: the more tired they are, the more difficult it is for them to fall asleep. And all because the processes of self-regulation and inhibition are poorly developed in babies, it can be very difficult for them to relax and fall asleep.

Parents know that if the baby is only a little "out of the way", it becomes simply impossible to put him to bed. nine0004

And so the tortured mothers and fathers put the child to bed for hours, scrolling in their heads thousands of reasons why he does not sleep.

Today we want to help parents deal with their children's sleep and tell them how to create an atmosphere for healthy children's sleep.

Mode

Healthy sleep is the result of a proper daily routine. Try to do everything at the same time every day, do not deviate from the schedule. Only then will the baby begin to perceive sleep as a special ritual, he will be ready for it in advance, which means you can do without whims. nine0004

Consistent actions that are repeated from day to day help to tune in to sleep. The child must get used to being bathed, fed and put to bed at the same time every evening.

Sleep norms for children and adults. Chart from One Habit a Week for the Whole Family

Sleepy Atmosphere

Babies feel the mood of their parents, so when you go to bed, create a calm atmosphere. Do not make sudden movements and speak more quietly than usual, be attentive to the movements and condition of the baby. So the child will tune in to sleep and feel safe. nine0004

Scientists have shown that the emotional state of parents affects babies in the same way as all kinds of lulling techniques. Before putting the baby in the crib, talk to him, focus on his feelings. And then you won't have any problems falling asleep.

Illustration from the book Sleepy Rabbit

Ritual

Children are slaves of habits, which is why they need a nightly ritual (as well as a ritual before bedtime). The correct ritual should include four stages. For example, bathing - a bottle - a light massage - reading a fairy tale. nine0004

Each family may have its own ritual, but it is important that the same actions are repeated every day at the same time.

If you swap stages, exclude stages, vary the time, then the ritual will simply stop working.

Sleeping area

Even the smallest child should have their own sleeping place. Is it a crib or a cradle - it's up to you. The main thing is that the baby always sleeps in the same place. Before going to bed, put the child on the back, so it will be more convenient for him to roll over in his sleep. nine0004

It is good if there are no bright and annoying objects in the room where the baby sleeps. In such a room, it is easier for a child to fall asleep. It is better not to use devices for falling asleep, like mobiles. They just get in the way.

There should be no toys in the crib of the little ones, they prevent the baby from concentrating on falling asleep. An older child can take his beloved bear with him if he helps him fall asleep.

Source

Sleepy books

The so-called "sleepy" books help the child smoothly sink into slumber and fall asleep, as they are based on special psychological techniques. This is a simple and effective method that is popular all over the world today. Three such books have been published in MIF:

“Rabbit who wants to sleep”

“Baby elephant who wants to sleep”

“Tractor baby who wants to sleep”

These are fairy tales from a professional psychologist, built on techniques that help the baby fall asleep. Especially for parents, they marked places where you need to address the child by name, read the text slower, faster or quieter.

What else helps to go to the kingdom of Morpheus?

Background noise. nine0021 It can be any monotonous sounds or soft music. A lot depends on the preferences of the baby. Experiment! Perhaps your child falls asleep exclusively to the blues or (why not?) to Vysotsky's songs.