Children are no strangers to sleep disorders. It's estimated that 25-30% of visits to the pediatrician are related to a sleep-related problem, and parents can do a lot to help their children get the deep, restorative sleep they need to grow, live healthy, and to maintain. wide awake during the day. Here's how to understand and cure childhood insomnia.
Insomnia in children: What you need to know
L' insomnia in children
Before birth, children have brain neurons capable of acting as a "biological clock" and the control of sleep and wakefulness is determined by this biological clock, which allows the child to sleep at certain times and wake up at others. However, the functioning of this biological clock is also influenced by light-dark environmental conditions, so that in dark conditions our brain secretes a hormone called melatonin, which facilitates sleep, while this hormone is inhibited by external light. . From about the third month of life, the brain learns to synchronize these two pieces of information, so that the sleep-wake cycle can begin to coincide with the day-night cycle.
How many hours do children need to sleep ?
A newborn needs 12 to 16 hours of sleep, in 6 to 8 sleep episodes of 2 hours each, with interspersed periods of wakefulness. Thus, the newborn does not respect the cycle of the night, waking up one or more times throughout it.
From the first month to 3-6 months, the duration of nocturnal awakenings decreases and he begins to sleep continuously practically throughout the night. However, in almost a third of preschool children, these nocturnal awakenings persist, a consequence of insufficient consolidation of the nocturnal sleep period.
Between 2 and 4 years, they sleep at night for about 10 hours, plus the usual two naps. From the age of three, the "need" to sleep during the day decreases, until it practically disappears before the age of six.
5 to 10 years, the sleep reaches a sufficient degree of maturity to allow a comparison with the adult. Although there are significant individual variations, the number of hours of sleep is generally higher than that of adults and the proportion of REM sleep is similar to that of adults.
After 7 years, it is not usual for the child to need a nap. If this happens, it's likely he's getting less sleep than he needs at night.
From adolescence, the number of hours of sleep will decrease to an average of 7 to 8 hours, which could be insufficient because there is an increase in daytime sleepiness, which led us to believe that total sleep requirements are not decreasing . but they increase during adolescence.
When should a problem be suspected? sleep in a child ?
Sleep needs vary widely. There is no consistent sleep pattern, and what one child needs doesn't have to apply to another. However, if he regularly has trouble getting you to sleep or staying asleep through the night, or if he's tired and sleepy during the day, you should suspect a sleep problem or the habits that lead to it.
Why does he sleep badly?
Bad habits
As with adults, children may have difficulty initiating or maintaining sleep, although they rarely complain about this problem and are often happy to stay awake.
The initiation of sleep requires a complex coordination of biological circumstances and learned behaviors: on the one hand, the organism must be physiologically prepared for sleep. In contrast, behaviors practiced in the moments before sleep end up becoming sleep-facilitating rituals that, when absent, prevent them from sleeping.
Reconciliation rituals are also necessary in children, and often the problem of childhood insomnia is not due to waking up at night, but to the inability to fall asleep again, because the stimuli associated with falling asleep are not present in the middle of the night when waking up (dad or mum, light, story, etc.).
The stress
Due to irregular schedules, excessive activation, family issues, childhood fears, or separation anxiety
Children need a routine to grow, because it gives them security. When this safety is threatened, children react by showing their anxiety by crying, changing their behavior and resisting falling asleep at night. They behave the same way when, after an exciting day, they are told that they must go to bed, because falling asleep is a change in the activity they enjoy so much. Sometimes the problem can be excessively irregular family hours.
Another common cause of difficulty falling asleep is long afternoon naps.Therefore, when faced with a problem of childhood insomnia, one of the first measures to consider is the reduction or even elimination of daytime sleep.
A child may have difficulty separating from the rest of the world at night, or they may detect subtle changes in the home environment and what may be causing problems at bedtime. Even in the safety of a happy home, children may be afraid of dark or imaginary creatures in dark corners of the bedroom.
Either way, the parents' response should always be supportive. You need to talk to the child about his fears.
For children over three years old, positive reinforcement techniques can be used as a reward if their behavior is appropriate.
Child's insomnia : some medical causes of childhood insomnia
Some medical issues that should be ruled out for a child with insomnia:
- Allergies : affected children will sleep in a fragmented and interrupted way.
- Pain : otitis and colic are very common in children. Any symptom that causes pain, discomfort, or nighttime fever will interrupt nighttime sleep. If the disease is chronic, over time it will usually have conditioned poor sleep habits in the child, which may persist despite the disappearance of the pain, probably due to shifts in the rhythm of sleep and the acquisition of bad habits.
- Enuresis : The enuresis is probably the most stressful sleep disorder for the child, as it not only causes sleep loss, but also embarrassment. It is considered that if bedwetting exists at the age of five, there is still no control over the bladder sphincter. Enuresis affects 15% of boys and 10% of girls, although most of them improve as they get older, it is advisable to go to the doctor to find a solution and speed up the process.
- Chronic diseases : In principle, any chronic disease is likely to cause persistent sleep disorders. Disorders such as headaches, asthma, diabetes, gastroesophageal reflux disease or epileptic seizures can disturb people who suffer from them. The insomnia problem can be a direct consequence of the problem, the treatment or the anxiety generated by the disease. For all this, it is appropriate that, as a first step, the child undergoes the most complete medical examination possible by his pediatrician.
- pharmaceuticals : Any medication can affect sleep. Relatively harmless medications prescribed to treat acute or chronic illnesses can disrupt sleep (eg, antibiotics, bronchodilators, etc.).
- Once the problem is localized (due to a temporary association between the start of treatment and the sleep disorder), treatment should be discontinued whenever possible. If not, it must be attempted; change the time of taking, change the dose, use another similar medicine, keep the same medicine but use a different preparation, vary the route of administration.
Other medical causes to consider are dental, gastrointestinal, allergy and sleep apnea issues. It is also convenient to exclude the presence of parasites.
The sleep of children with hyperactivity infant.
They are usually restless children, find it difficult to stay and complete the tasks they are doing, are distracted and frequently annoy other children at school, cry easily and have mood swings. They often show restlessness and hyperactivity. They are easily frustrated by efforts and can exhibit destructive behaviors. During sleep, the most characteristic symptom is the presence of frequent awakenings and restless sleep.
Sleep-related problems are common among these children, with 16,5% having difficulty falling asleep and 39% waking up at night. Early diagnosis and treatment is important, because hyperactivity disorder and sleep deprivation feed off each other, so a hyperactive child often has sleep problems, and in turn, sleep deprivation leads to hyperactivation. and daytime attention deficit.
Parasomnias, separation anxiety, and insomnia caused by bad habits, stress, illness, certain medications, or over-excitement are causes enough to alter sleep, which can occur at any time in any family. .
What to do? Childhood Insomnia Treatment Plan: the Ferber method
In the late 1970s, American pediatrician Richard Ferber published a behavioral method for managing childhood insomnia, which became popular around the world. The basis of this method is the extinction of crying for a short time. But this method is not for everyone. Therefore, other variants based on physical attachment have been developed. There is no universal and unique method to treat all types of childhood insomnia and these must be adapted at all times to the situation of the parents.
In very general terms, the recommendations we can make are:
If we suspect that the cause may be medical, we must go to the specialist with the child to solve the problem.
If we suspect the cause may be poorly learned sleep patterns or behavioral issues, we can try to implement actions corrections mentioned below.
The basis of treatment is to teach the child to transition from wakefulness to sleep on his own. All habits should be done in less than a week, and if you follow the instructions faithfully, the chances of success are high.
The child must learn to fall asleep alone.
In some cases, aggravation will occur during the first two or three days, so it is advisable to start during the weekend, so that if the parents do not sleep the first nights, they can do so the next day.
- Place the child in the bed or crib with only favorite objects that can stay with him all night so that he gets used to falling asleep next to these objects and associates them with sleep. This way, if you wake up in the middle of the night, you can go back to sleep without needing anyone.
- The room should be dark, quiet and at a comfortable temperature. Failing this, protect these eyes from light with a sleep mask.
- Parents can reassure and comfort the child until he is quietly lying in bed. Once calm in bed or cradle, the mother/father must leave the room.
- If the child starts crying, it is not necessary to go immediately to see him. After a few minutes (at least 2 minutes), the mother or father can return to the room to comfort the child, who should not get out of bed until he is calm (although he is awake) . Then the parent must leave the room.
- If the child cries again, the parent will wait a little longer (eg 2-5 minutes) before entering and repeating the previous step.
- The process must be repeated (keeping the waiting time no more than 2-5 minutes during the first night) until the child is asleep.
Keep in mind that during this first night, the process of responding to crying may take several hours until the child falls asleep. Now the plan will only be successful if we are persistent and consistent with the "treatment" and don't give in to the temptation to get the child out of bed.
On successive nights, the expected durations gradually lengthen to reassure the child if he cries. Wait times are generally proportional to the age of the children.
- Parents' interventions must be positive. The child must know that he is close and that he understands him.
- Parents should never express anger or frustration. Nor should they allow these emotions to be over night.
- Improvement is generally observed from the third night. Nocturnal awakenings are generally shorter and crying is increasingly weak. The child learns to fall asleep alone without the help of his parents.
10 universal solutions to eliminate childhood insomnia
1- Maintain a sleep routine with regular hours of at least 8 hours.
2- Avoid large dinners shortly before sleeping . If the child is hungry between dinner and time, he can have a light snack, such as milk with cookies.
3- Avoid caffeinated products or with too much liquid at bedtime.
4- Use the bed only for sleeping . Avoid other activities like watching television or reading and studying.
5-Keep the bedroom air-conditioned and comfortable. In the dark, without noise, well ventilated and at a comfortable temperature.
6-Remove unnecessary lights from the room, such as as clocks or decorations.
7-Minimize the interruptions of possible sleep , such as external noise.
8-Encourage children to express their concerns, emotions and experiences to prevent them from going to sleep with them and disrupting their sleep.
9-Make sure the child does a relaxing activity before going to bed, like reading a story. Avoid watching television or playing video games in the late afternoon and before going to bed.
10-Keep electronic devices out of the child's room. Among them, computers, mobiles or video games.
11- Write an activity diary for the next day , when the child is old enough to do so, to lessen their worry about forgetting something. It is recommended to do this at least three hours before going to sleep to forget the obligations of the next day.
12-In case of persistent insomnia, it is advisable to make a good diagnosis to exclude sleep disturbances.
