Child sleeps poorly: from 3 to 6 years

Caroline Tedke, University of South Carolina Medical College, Charleston, South Carolina

Sleep disorders are common in children. It is necessary to distinguish between cases where polysomnography reveals disorders (eg, parasomnias, apnea and narcolepsy) and cases where the problems are behavioral in origin and the polysomnography is normal. Parasomnias (night terrors, somnambulism and enuresis) are caused by immaturity of the central nervous system and often resolve with age. Obstructive sleep apnea syndrome (OSA) in children is often not diagnosed on time, although it can be successfully treated surgically. Behavioral sleep disorders can be treated with proper parental coaching. Doctors can provide significant assistance to such families by recommending effective techniques to parents. (American Journal of Family Medicine 2001;63:277-84)

Sleep problems in children are often a concern for parents. A child who doesn't want to go to bed or wakes up frequently at night often causes very big problems in the family. Sleep disorders in children, confirmed by sleep laboratory data, are in principle similar to disorders in adults. However, problems, which are defined as a sleep pattern that is unsatisfactory to the parent, child or doctor, are more common in children. Defining sleep behavior disorder is quite difficult due to significant differences in sleep patterns at different ages. So, for example, it is not abnormal if a two-month-old baby often wakes up at night, but the same would be a pathology for a two-year-old child. To understand the complexity of the problem, one can also consider the large differences in tolerance to sleep problems, which vary significantly between families.

Normal sleep in children.

Sleep in very young children differs significantly from sleep in adults. Infants under 6 months of age spend 50% of their sleep in the inactive REM stage, compared to 20% in adults. Sleep in babies begins through the initial active REM stage, while in adults the first REM phase appears no earlier than 90 minutes from the moment of falling asleep. The active REM phase often recurs in infants, creating shortened sleep cycles. Before 6 months, restful REM (also defined as restful or uncertain sleep) cannot be subdivided into EEG stages known as mature sleep patterns. After 6 months, an infant's sleep architecture begins to resemble that of an adult. After an initial "settling" period, which usually lasts 10 to 20 minutes, there is a transition from NREM Stage 1 to Stage 3 or 4. The child may return to Stage 1 and repeat the cycle. After one or two cycles of NREM sleep, REM sleep occurs after 60-90 minutes. The first third of the night is mostly deep sleep (NREM Stages 3 and 4). In the second half of the night, stage 2 NREM and REM sleep predominate. In newborns, the total sleep time is evenly distributed between the day and night periods. Nighttime sleep gradually consolidates into one continuous episode by the first year of life. The amount of daytime sleep gradually decreases over the first three years of life. By the age of four, most children no longer need short naps during the day. The need for nighttime sleep also decreases, so that during adolescence it is comparable to the need for adults.

The most common mistakes that lead to sleep disturbances

The daily routine is not defined, chaotic, different, there is no clear routine, parents do not know when to put the child to bed. Parents call this regime: “free”, “we don’t have a regime”, “every day is different for us”, “we were told that a free regime and free feeding are useful”, “You ask such questions, doctor! How do I know when we wake up and what time we go to bed? We have a regime as it turns out.” What can I say?

Complaints about sleep disturbances

With this option, the most common complaints during an appointment with a neurologist are:

• for restless sleep;
• superficial and short daytime sleep of 20 minutes - 1 hour;
• sleeps only in his mother's arms;
• frequent awakenings at night every 30 minutes - 1 hour;
• rolling up crying during the day;
• poor or higher than normal weight gain (from overfeeding, due to frequent breastfeeding as the only sedative);
• during the day the child is restless and capricious;
• sometimes less inquisitive; sometimes masters motor and speech skills later.

The life of the child and parents is less harmonious, less calm and happy; a lot of effort is required to maintain calm in the family.

The daily routine does not correspond to age standards: short periods of wakefulness, as a result, short and shallow sleep.

The daily routine develops according to this scenario

The child wakes up at 6 o'clock for feeding; then the parents' attempt to put him to sleep and let everyone sleep longer. Sleep together for another 1-2 hours. Then comes a period of wakefulness for 1-2 hours. This period of time is short and insufficient to physically tire the child. Not tired enough, the baby cannot sleep for a long time.

Parents mistakenly believe that if a child begins to be capricious during the day, then he wants to sleep or eat every time.

If the child is capricious or tired, then you should change the type of activity: go for a walk outside; start doing exercise therapy; change a toy; wash; move to another room; change clothes; play or sing a children's song and much more.

But parents, following misconceptions, lull, rock, and put a tired child to sleep through breastfeeding. Only short sleep is possible, because the child cannot sleep longer. After a short sleep, the baby has not recovered sufficiently and does not have enough strength to stay awake for a long time. And again there are whims, and in the evening there is obvious anxiety.

The advice in such cases of sleep disturbance is this: you should gradually, 5-15 minutes each time, lengthen the periods of wakefulness over the course of a week. Create the correct physiological daily routine. And daytime and nighttime sleep returns to normal after this.

So, here is an approximate daily routine for children of different ages:

Daily routine for children from birth to 3 months

Sleep per day 16–20 hours (sleep 8 + 2.5 + 3 + 2.5 = 16); The waking period per day is 8-4 hours.

• Get up at 6 o'clock.
• 1 period of wakefulness 2-2.5 hours - from 6 to 8 hours.
• 1 nap (short) - 2.5 hours (8 to 10-30 hours).
• 2 wakefulness period 2.5 hours - from 10-30 to 13 hours.
• 2 naps (long) - 2.5 - 3 hours (13 to 16 hours).
• 3 wakefulness period 2 hours - from 16 to 18 hours.
• 3 sleep (short) - 2.5 hours (18 to 20-30 hours).
• 4 wakefulness period 1.5 hours - from 20-30 to 22 hours.
• Night sleep (with possible periods of awakening up to 3-4 times; ideally 0-1 times per night wakes up and eats) - 8 hours (22 to 6 hours).

Daily routine for 6 month old babies

Sleep per day 14.5 hours (sleep 8 +2 + 2.5 + 2= 14); The waking period per day is 9.5 hours.

• Get up at 6 o'clock.
• 1 period of wakefulness 3-3.5 hours - from 6 to 9.5 hours.
• 1 nap (short) - 2 hours (9-30 to 11-30 hours).
• 2 wakefulness period 3-3.5 hours - from 11-30 to 14-30 hours.
• 2 naps (long) - 2.5 - 3 hours (14-30 to 17 hours).
• 3 wakefulness period 3-3.5 hours - from 17 to 20-30 hours.
• 3 sleep (short) - 2 hours (18 to 20 hours).
• 4 waking period 2 hours - from 20 to 22 hours.
• Night sleep (with possible periods of waking up to 2-4 times; ideally 0-1 times per night wakes up and eats) - 8 hours (22 to 6 hours).

Daily routine for 12 month old children

Sleep per day 13.5 hours (sleep 8 + 2 + 3.5 = 13.5); The waking period per day is 10.5 hours.

• Get up at 6 o'clock.
• 1 waking period 3.5 - 4 hours - from 6 to 10 o'clock.
• 1 nap (short) - 2 hours (10 to 12 hours).
• 2nd period of wakefulness is 3.5-4 hours - from 12 to 15-30 hours.
• 2 naps (long) - 3.5 hours (15-30 to 19 hours).
• 3 wakefulness period 3 hours - from 19 to 22 hours.
• Night sleep (with possible periods of awakening up to 2-4 times; ideally wakes up 0-1 times per night, no need to feed at night) - 8 hours (22 to 6 hours).

Children's daily routine at 2 years old

Sleep 13 hours per day (sleep 10 + 3 = 13); The waking period per day is 11 hours.

• Get up at 7 o'clock.
• 1 waking period 5 hours - from 7 to 12 hours.
• 1 nap - 3 hours (12 to 15 hours).
• 2 wakefulness period 6 hours - from 15 to 21 hours.
• Night sleep (with possible periods of awakening up to 2-3 times; ideally wakes up 0-1 times per night, do not feed at night) - 10 hours (21 to 7 hours).

Children's daily routine at 4 years old

Sleep per day 11.5 hours (sleep 9 + 2.5 = 11.5); The waking period per day is 12.5 hours.

• Get up at 7 o'clock.
• 1 waking period 6 hours - from 7 a.m. to 1 p.m.
• 1 nap – 2.5 hours (13 to 15.5 hours).
• 2 wakefulness period 7.5 hours - from 15.5 to 22 hours.
• Night sleep (with possible periods of waking up to 1-2 times; ideally 0-1 times per night wakes up, but not every night) - 9 hours (21 to 7 hours).

Children's daily routine at 6 years old

Sleep per day 9.5 hours (night sleep 9.5 hours, without daytime sleep); The waking period per day is 14.5 hours.

• Get up at 7 o'clock.
• 1 waking period is 14.5 hours - from 7 to 21 hours 30 minutes.
• Night sleep (with possible periods of awakening up to 1-2 times, but not every night; ideally 0-1 times a week wakes up at night, but not every week) - 9.5 hours (21 hours 30 minutes to 7 hours).

Daily routine for children aged 12

Sleep per day 8.5 hours (night sleep 8.5 hours, no daytime sleep); The waking period per day is 15.5 hours.

• Get up at 7 o'clock.
• 1 waking period is 15.5 hours - from 7 to 22 hours 30 minutes.
• Night sleep (with possible periods of awakening up to 1-2 times; ideally 0-1 times a week wakes up at night) - 9.5 hours (22 hours 30 minutes to 7 hours).

Some parents are afraid to wake up their child.

Scope of the task.

Parents of young children are eager to learn more about what they can expect from their child's nighttime sleep routine. The studies carried out yielded different results because they were conducted on different populations and used different terminology and data processing methods. Typically, the incidence of night awakenings was estimated to be 100% in newborns and dropped to 20-30% in six-month-old infants. Once an uninterrupted night's sleep has been achieved, some children may begin to wake again during the night - this is often the result of social factors rather than maturational problems. Night awakenings are more common in early childhood. Research has shown that approximately one in three children under 4 years of age continue to wake up during the night, requiring parental intervention to get them back to sleep.

The benefits of night sleep for a child

Along with nutrition, sleep plays an important role in the development of a child.

During sleep, a number of processes occur in the body

1. The child’s brain matures and information is consolidated. Several studies have shown that children who sleep well and longer at night learn and remember information better.
2. Babies who sleep longer at night are less fussy during the day, are easier to negotiate with, and are better able to adapt to changing events while they are awake. Such children cope more easily with separation from their mother and are more willing to stay at home with a nanny or grandmother without her.
3. Lack of sleep negatively affects growth hormone. Because this hormone is produced during rest, a child who does not sleep well grows more slowly. Also, lack of sleep affects a child’s weight if the hormone leptin, which is responsible for the feeling of fullness, malfunctions. The baby will eat even after being full.
4. When children lack sleep, coordination is impaired, which leads to numerous injuries - the child more often falls and stumbles out of the blue.

Parasomnias

Parasomnias are sleep disorders that are characterized by an abnormal polysomnogram. They are episodic in nature and reflect immaturity of the central nervous system (CNS). Therefore, parasomnias are more common in children than in adults and usually disappear with age. Parasomnias tend to run in families. These disorders are paroxysmal, predictable in their occurrence in a particular sleep cycle, are not responsive to external influences, and are characterized by retrograde amnesia. Diagnosis is often made solely on the basis of a thorough history. Additional diagnostic tests are rarely required.

Pavor nocturnes or night terrors

Pavor nocturnus or night terrors occur approximately 90 minutes after falling asleep, in stage 3 or 4 NREM sleep. The child suddenly sits up and begins to scream uncontrollably. It may take up to 30 minutes for him to calm down and fall back to sleep. This is accompanied by tachycardia, rapid breathing and other signs of autonomic activation. Night terrors usually occur in children between the ages of 3 and 8 years. They must be distinguished from nightmares (Table 1). Night terrors are more likely to occur during periods of stress or overwork. Despite their frightening nature, parents need to make sure they are self-limiting. We must try to find out if there is any stressful situation in the child's life and make sure that the child has opportunities for rest and recovery. For children whose night terrors do not resolve on their own and the episodes are extremely disruptive, diazepam (Valium) can be prescribed.

Table 1. Comparison of night terrors and nightmares

Tips and tricks for improving your baby's sleep

Form a sleepy ritual for your baby: for example, bathing in the bath with your favorite toys and “Bayu-bayushki” foam from the “Moe Solnyshko” brand. It contains lavender extract, which calms the child and sets him up for a restful sleep.

Often children respond well to special “sleepy” exercises and aromatherapy. For gentle care and a final touch, use Bayu-bayushki cream, it will help the mother complete the evening ritual and prepare the baby for sleep. Apply the cream to your baby’s clean skin; it will perfectly soften and moisturize your baby’s skin, making it soft and silky.

Sleepwalking and dream-talking

During sleepwalking (somnambulism) and sleep-talking (somniloquy), the child sits up in bed with his eyes open, but with the so-called “blind gaze.” Activities can range from resting aimlessly in bed to actually walking around the house. Speech is unclear and rarely intelligible. These disorders occur in school-age children, more often in boys than in girls, and are often also accompanied by enuresis. Children who sleepwalk can be injured and parents need to take steps to avoid dangerous situations such as falling from balconies or stairs. Sleeping rooms for such children should be on the ground floor, with windows and doors securely closed. During an episode of sleepwalking, parents should interfere minimally and refrain from shaking him or yelling at him. This type of sleep behavior usually resolves with age and usually does not require special intervention other than the precautions noted above. Another method is the so-called “scheduled awakenings”. Parents keep a diary, record the time when sleepwalking occurs over several nights, and then begin to wake the child 15 minutes before the expected time. In this case, it is necessary to make sure that the child is in a state of full wakefulness for at least 5 minutes. Using this method eliminates sleepwalking in 80% of children.

Nocturnal enuresis

Nocturnal enuresis or bedwetting is one of the most prevalent and persistent problems in children. Enuresis is classified as primary if the child has never previously been “dry” in bed and secondary if it occurs after the child has been able to hold back urination for at least a year. Primary enuresis is much more common and is unlikely to be a consequence of pathology. The etiology of primary enuresis is most likely multifactorial. Often primary enuresis is associated with a family history. The ability to contain urine is closely related to the maturity of the nervous system and a child who is developmentally delayed at the age of 1-3 years is much more likely to be enuretic at six years of age. Enuretic children were found to have lower functional bladder capacity (the volume of urine the bladder is able to hold) than non-enuretic children, although true capacity did not differ. And finally, enuresis is considered by most researchers to be a parasomnia, since it is observed only in the stages of NREM sleep. However, despite the subjective opinion of parents, enuretic children are no more difficult to wake up than others. In most cases, if a thorough history, general and neurological examination shows no symptoms of other disorders, no additional diagnostic tests, including urinalysis, are required. As a rule, even before the first visit to the doctor, parents are already taking some measures, in particular, limiting evening fluid intake, waking up the child to go to the toilet before the parents themselves go to bed. Although doctors sometimes resort to drug treatments, such as imipramine (Tofranil) and, as a follow-up, desmopressin (DDAVP), numerous studies have shown the superiority of wetness signals in terms of effectiveness, lack of side effects and low recurrence rates. These devices are available through pharmacies or can be ordered online. There is also "continence training" (bladder training), which involves a number of techniques that are, however, beyond the scope of this article (see Sheldon).

The child does not sleep well at night

You will find this article so useful that you will want to print it!
Questions are often asked about how much sleep a baby should sleep at 1 month. Let's put the question differently: How much sleep should parents sleep? Many parents, especially mothers, of children under 1 - 3 years old can say: “Getting enough sleep is my dream!” If parents have intermittent, superficial, anxious sleep with frequent violent awakenings, then this is a sure path to chronic stress, fatigue, dissatisfaction, conflicts, and decreased performance.

Therefore, conditions should be created so that parents can sleep a full 8 hours at night. If a child sleeps in bed with his mother or parents, then adults cannot relax completely and for a long time. Only the alternative of getting up to the baby's bedside every few minutes or hours makes it possible to sleep together with the child. This is the only way mothers can literally “fall asleep.”

It is necessary to create the correct physiological regime of sleep and wakefulness, according to the age of the child, as well as taking into account the regime of family members. To create a good night's sleep, you need to create a rational daily routine.

Daily routine for children 1-3 months

• Rise at 6-8 o'clock (at 7 o'clock)
• After waking up, the child eats, then active wakefulness begins.
• A common mistake parents make is to put her to bed immediately after feeding or after a short period of wakefulness (after 1-1 hours). After all, parents don’t want to get up so early, that is, before 8-10 o’clock in the morning.

This leads to the fact that, without getting tired in this short period, the baby does not sleep for long, about 30 minutes - 1 hour. And then the whole daily routine goes wrong. There are short periods of wakefulness (1-2 hours), then short, shallow sleep for a few minutes - 1 hour. Moreover, sleep is often possible only in arms or under the condition of constant rocking in a crib.

• We create intervals between sleep of 2-2.5 hours. During this period, the child experiences active or quiet wakefulness.

What can you do with your child during the day when the child is not sleeping?

• Walks in the open air.
• During walks, you should not only sleep, but also explore and get to know the world around you. By showing and telling about everything that we see in front of us, we teach the baby to be inquisitive, this is the basis of learning.
• We play outdoor games and use outdoor structures: ladders, sandbox, slides, swings, carousels. Running, jumping, climbing, cycling, scootering are dynamic games that develop motor dexterity. If a child becomes physically tired after spending enough time in the fresh air, then deep sleep is guaranteed. Create conditions under which the child “runs circles around the playground”, and at this time the mother sits and relaxes for a while, communicating with other mothers. Keep your child safe!
• By the evening, active emotional and physical activity should be somewhat limited, avoiding overexcitation.
• In the evening, quiet board or floor games, drawing, modeling from plasticine, designing, reading fairy tales with a good ending, quiet music or calm children's songs, a short children's cartoon, short telephone conversations with relatives (grandparents), massage with elements of exercise therapy are suitable.
• Parents should sleep 8 hours.

Obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSA) is thought to affect 1-3% of children. Symptoms include snoring and labored or mouth breathing during sleep. Parents of infants with severe OSA may experience difficulty feeding their child. OSA in children is often caused by adenotonsillar hypertrophy. Other causes include craniofacial pathology, obesity, and neuromuscular diseases. A high percentage of allergic diseases has been reported in children with snoring and OSA. In adults, airway obstruction is transient and often very severe. In children, if the cause is adenotonsillar hypertrophy, the obstruction is permanent, but less pronounced. Children are less likely to experience hypersomnolence (daytime sleepiness) than adults, but they also often experience enuresis, excessive sweating, and developmental delays. OSA. There is clear evidence of OSA in a certain percentage of children experiencing learning difficulties and behavioral problems, including attention deficit hyperactivity disorder. The diagnosis of OSA is made in a pediatric sleep disorder laboratory using overnight oximetry and polysomnography. Most of these children experience significant improvement after tonsillectomy. The latter is not indicated if the cause of OSA in the child is another pathology (craniofacial anomaly, neuromuscular diseases, obesity). In these cases, and also if tonsillectomy surgery does not bring a satisfactory result, treatment with CPAP, a device that creates positive air pressure in the upper respiratory tract, can be prescribed. This technique is usually used in adults, but has also been shown to be effective and safe in children.

Narcolepsy

Narcolepsy is not common in childhood, although it can occur in adolescents. The main symptom, as in adults, is increased daytime sleepiness. Obviously, this can create difficulties in the learning process. Cataplexy or hypnagogic hallucinations are much less common in children than in adults. At first, the child begins to experience difficulty waking up in the morning. Upon awakening, there may be some confusion, and the child may even be aggressive in words and actions. Diagnosis can be quite difficult; initial polysomnography may be normal. If the diagnosis remains in doubt, repeated polysomnography is indicated. These children may benefit from regular short naps during the day. Sometimes drug stimulation may be required. Because it is a lifelong condition with increased mortality, children with narcolepsy should be monitored by a sleep specialist.

Secondary sleep disorders

Secondary disorders are much more common than primary ones and are characterized by normal polysomnography data. Disturbed sleep patterns are often temporary, but can cause serious problems in the family if they continue for a long time. The most common secondary sleep disorder is night awakenings and reluctance to fall asleep at the appointed time, which is most often observed in children just starting to walk and in general in the preschool period. Although 95% of newborns cry after waking up at night and require parental attention to fall back to sleep, by the age of one year, 60 to 70% of children can actually fall back to sleep on their own. The concept of sleep associations is important. A child who goes to bed awake and learns to fall asleep using comfortable measures is usually able to self-soothe if he suddenly wakes up in the middle of the night. Conversely, a child who falls asleep with the help of a parent, such as rocking or simply physical presence, may have difficulty falling asleep independently after waking up in the night. In such cases, parents can be advised to change behavior, stop rocking the child, etc., wait longer than usual when the child cries after waking up, until the child gradually learns to calm down and fall asleep on his own.

Initial causes of sleep disturbances and nightmares in children

Authors : Zakharov A. I.

Most often, nightmares (hereinafter referred to as CS) occur in children whose nighttime sleep has certain deviations. Without them, nightmares are also possible if the child is impressionable, the circumstances, the environment are traumatic, or there is any painful disorder. We were able to find out the general prevalence of sleep disorders in children through a survey of 1,466 parents at two pediatric clinic sites. The figures below are based on the opinions of parents who report visible sleep disturbances, when in fact there are many more of them.

Every third child from 1 to 15 years old falls asleep poorly, usually for a long time, without differences by gender. In preschool age, difficulties in falling asleep are significantly more common than in school age, which is associated with more pronounced signs of neuropathy and organic disorders of the central nervous system in preschoolers. Girls and boys fall asleep the worst when they are five years old. In girls, this coincides with an increase in the CS, that is, nighttime restlessness in girls is more reflected in falling asleep than in boys, or, which is the same thing, girls are more sensitive at this age to what they dream at night. Every third child also sleeps restlessly (talks, wakes up, tosses and turns), be it a girl (somewhat more often) or a boy.

Let us note (according to computer analysis) reliable relationships between disturbed sleep and the characteristics of pregnancy and childbirth, and the psychological state of the mother. Using them, you can reliably predict what sleep disturbances await children.

Let's start with superficial sleep, when even at the slightest noise the child immediately loses sleep, and at best he plays, at worst he screams and cries. It turned out that shallow sleep is associated with worries (emotional stress) of the mother during pregnancy. The unrest itself stems, in this case, from the mother’s lack of confidence in the strength of the marriage and the presence of fear of childbirth. Keeping yourself in constant tension and fear, as we see, is not in vain. The fetus is tense, restless and cannot sleep properly while still in the womb. Increased maternal fatigue during pregnancy, no matter what the reasons, leads to the same results.

Let us remember: with the most common neurosis - neurasthenia - sleep is most often disturbed. You can’t get enough sleep, sleep doesn’t bring you joy, it’s filled with all sorts of worries and anxieties. You feel even more tired during the day, your sleep gets worse - a vicious circle arises with inevitable irritability and mood disorders. What can we say about the overstrain of neuropsychic forces during pregnancy, when the load is already taking its toll, and endurance may not naturally be the highest. Accordingly, the fetal sleep biorhythm is upset, and often for a long time.

Any pediatrician will confirm another pattern we have established: restless, shallow sleep is most typical for children born prematurely. Their sleep is immature, intermittent, and day and night change places. And here everything can be settled if everything is calm at home and the mother is loving, and not always dissatisfied with the child who appeared “early of time,” and she herself is too nervous. The child's restless sleep also brings constant torment to young parents. Everything doesn’t suit him, he can’t find a place for himself, he rushes about in his sleep, throws off the blanket, babbles something, tries to fall out of bed. And... the more the child behaves in this way, the more worried and tense the parents become, invisibly conveying their excitement and only aggravating the child’s sleep problems.

You need to worry, but not excessively, and don’t dramatize your children’s nightly problems. This will not make them sleep better. But it’s worth stroking the sufferer, whispering friendly words, and calming down yourself. Parents were usually surprised when they saw how I, as a pediatrician, calmed the most hopelessly crying children. He took the children in his arms and walked around, rocking them slightly, talking gently and soothingly - for the mother, naturally. And she studied, since she was young and programmed by the rules written in another country.

How can one not remember the grandmother from the village: without any books or instructions, she rocked the cradle with one hand, cooked porridge with the other, and even sang a song. And in similar cases (in the 60s) I did not see nervous sleep disturbances in those who no longer crawled, but walked. In the village, new life is a sacred thing. The family was not supposed to worry about a newborn, and they were not supposed to invite loitering people, so that they wouldn’t “jinx it.” Folk wisdom and instincts spoke about this. On the physical side, of course, there were flaws - and they worked until the last minute, and gave birth in the field, but to “poison” a child, to prevent him from being born or to give him to strangers - this happened extremely rarely. Pregnancy as a message from God was perceived as something natural, natural, bestowed by fate.

Now there is continuous stress before birth, among which in the first place is a lack of confidence in the strength of the marriage, conflicts with the husband, other worries, poor health and irritability, the threat of miscarriage and emotional shock during childbirth from painful contractions. We ourselves can eliminate all these causes of restless sleep in children if we are more mature at the time of motherhood and more mentally protected.

Crying in a dream in children of the first years of life does not allow parents to sleep peacefully, feeling clearly “out of place.” It affects not only emotional stress during pregnancy (anxiety, poor health and increased fatigue), but also various deviations during pregnancy and childbirth (toxicosis of the first half of pregnancy, premature birth, excessively rapid or prolonged, premature release of water, entanglement of the newborn’s neck with the umbilical cord) . Swaddling is the same routine procedure as feeding. However, some children clearly calm down, being tightly swaddled, others, on the contrary, struggle to free themselves, and only when fairly tired from the abundance of movements do they calm down and fall asleep. The temperament is already visible here.

Children with a choleric temperament find it more difficult to tolerate any constraint and are just waiting to be freed; phlegmatic people prefer to be wrapped up according to all the rules. And sanguine people, that’s why they are sanguine, so as not to make special demands: not very tight and not very loose - it will be just right. But even outside of temperament, sometimes we see how a child falls asleep only tightly swaddled. Such addictions are associated with the presence of a threat of miscarriage during pregnancy and extremely painful contractions during childbirth. The same factors are involved in the origin of restless sleep in children, since sleep is in a certain way analogous to intrauterine existence, when the child is left alone, in the dark and in a confined space. In addition, negative emotional reactions were recorded in the fetus from the ninth week of life - at the standard age of artificial termination of pregnancy or abortion.

When there is a threat of miscarriage, the appearance of emotional shock cannot be ruled out, which, together with the mother’s similar stress, leads to the release of a large amount of anxiety hormones into the blood. This dose is in some cases enough to disrupt sleep in the coming months and years. A completed miscarriage means the inevitable death of the fetus, but the threat of miscarriage also leads to disruption of the placental circulation and intrauterine hypoxia (insufficient oxygen supply to the fetal brain). The same applies to excessively intense, painful contractions of the muscles of the uterus during the opening of its cervix. The threat of death, physical destruction reflexively turns on the instinct of self-preservation in the fetus in the form of a defensive reaction of motor anxiety and fear.

After birth, an excessively open space, the absence of a cradle, crib, as well as clothing, gives rise to an unaccountable feeling of anxiety, usually in the form of crying, less often - screaming and difficulty falling asleep. Now it is clear why tight swaddling calms children who have suffered the threat of miscarriage and painful contractions of the mother during childbirth. They are again, as it were, in the womb, but in safe conditions of existence. The main thing is that if there was any threat of premature birth, swaddling is necessary, reproducing the conditions of safe intrauterine life.

With organic damage to the brain from asphyxia, birth trauma, the sensitivity of the skin painfully increases, there are tremors of individual parts of the face or convulsions, tension, hypertonicity of the limbs and torso. Then tight swaddling, on the contrary, will increase the child’s anxiety and crying; The best option would be loose swaddling or more frequent positioning of the baby fully open.

In general, 10% of boys and 15% of girls are susceptible, according to their parents, to frequent night terrors. Much more accurate, but not absolute due to repression and amnesia of night fear, we obtain data from direct, morning questioning of children about what they saw at night, including nightmares. Over the course of ten days, 79 children from 3 to 7 years old in kindergartens were interviewed in a similar way. It turned out that during this time, 37% of children (at least every third) had a nightmare, 18% (almost every fifth) saw it repeatedly, sometimes in serials, almost every night. Thus, parents state only the “tip of the iceberg.”

In case of nervous disorders, as shown by an additional survey of children in the speech therapy group of the kindergarten, the CS is even greater. Regardless of the state of the nervous system, the number of CS in preschool age, according to a survey of children, significantly increases from 3 to 7 years, marking an increasing awareness of the problems of life and death, the beginning and end of one’s life. We have repeatedly been convinced of the existence of a relationship between the fear of nightmares and their actual presence in children. Moreover, such fear unmistakably indicated the existence of a CS, even if the child could not remember what exactly it was. As already noted, the question was formulated as follows: “Are you afraid of bad dreams or not?”

Despite the possibility of reflecting the past traumatic experience of dreams in the answer, in most cases the answer reflected the current, that is, the last experience of perception of terrible dreams. A total of 2,135 children and adolescents aged 3 to 16 years were surveyed. The survey data is shown in the table.

Table. Age distribution of fears of nightmares (FS)

From the table we see that the maximum values ​​of fears of CS in boys are observed at 6 years old, in girls - at 5, 6 years old and in preschoolers - at 7 years old (the survey was conducted in the late 70s). This is far from accidental, since it is in older preschool age that the fear of death is most actively represented. It is precisely this fear that is present in children’s nightmares, once again emphasizing the underlying instinct of self-preservation, which is more pronounced in girls.

A unique comparison can be made among preschoolers and schoolchildren aged 7 years. It seems that the age is the same, but the tendency towards a decrease in fears of CS is noticeable among first-graders. The explanation is similar to the decrease in the average score of all fears at school age, due to the new, socially significant position of the student. This is a kind of left-hemisphere shift in the child’s consciousness, when the right-hemisphere, spontaneous, intuitive type of response (which includes fears) must give way to the rational perception of left-hemisphere school information. We see that the number of fears of CS is significantly greater in preschool age for both boys and girls. In turn, fears of CS (like all fears in general) are significantly more often observed in girls, reflecting a naturally more pronounced instinct of self-preservation. It was previously noted that the most active in relation to all fears is the senior preschool age. The fear of CS is no exception, which is closely related (according to computer factor analysis) with fears of attack, illness (infection), death (oneself and parents), animals (wolf, bear, dogs, spiders, snakes), elements (storm , hurricane, flood, earthquake), as well as fears of depth, fire, fire and war. Based on all these fears, one can almost unmistakably assume the presence of nightmares and, accordingly, fear of them.

It is interesting to compare the fear of CS in children from the so-called normal population and children suffering from neurotic personality disorders. People with neuroses have more fears of CS than most of their peers who are healthy. This is not surprising, given the increased anxiety, emotional vulnerability, instability of mood, and lack of self-confidence, self-confidence, and capabilities that are characteristic of neuroses. What also attracts attention is the defenselessness of children, their inability to withstand danger; even a small child can offend them, as one mother said.

Children with fear neurosis are most afraid of CS, when they are so overwhelmed by fear itself that they cannot fight back any dangers that await them day and night. In children with all neuroses, fears of the CS are most often presented at the age of 6-10, when fears appear during the day, like mushrooms after rain, under the influence of experiences caused by the fear of death, problems of learning and adaptation at school. Normally, fear of CS is usually limited to older preschool age. In other words, the fear of CS in neuroses has a more prolonged, extended nature and indicates a more pronounced inability of children to solve their personal problems on their own, without the help of adults.

Since children with neuroses are much more sensitive to CS, it makes sense for them to further consider all the problems associated with CS. “What is Caesar’s is for Caesar, what is Caesar’s is for Caesar.” The same applies to girls and boys. The former have a relationship with CS during pregnancy, the latter do not, and nothing can be done about it. If there is a girl in the mother’s womb, and the mother has toxicosis in the first half of pregnancy (uncontrollable vomiting), then after the birth of the girl, they will significantly more often see CS and be afraid of them. And toxicosis of the second half of pregnancy (nephropathy), albeit at the level of a trend, will have a similar effect. Boys have similar relationships “at zero.”

Thus, the mother’s problems during pregnancy and her poor health have a more traumatic emotional impact on girls, as can be seen in their subsequent dreams. Since the fetus “sees” dreams in the womb, starting from 8 weeks of life (according to neurophysiologists), we can compare this period of pregnancy with the maximum severity of toxicosis in the first half. Then our conclusions, even statistically based ones, will not seem meaningless.

When asked why all this is expressed only in girls, we point out their more pronounced instinct of self-preservation compared to boys (remember that girls experience fears 2 times more often than boys). Therefore, toxicosis, creating the threat of weakening and termination of pregnancy, causes, first of all, hormonally mediated anxiety in girls, as a kind of instinctive protective reaction.

The relationship between fears immediately before sleep and fears during sleep, that is, CS, was examined separately. The previously made conclusion about the reproduction of children's daily experiences in the CS was confirmed. Moreover, by the anxiety experienced by children before bedtime, one can confidently judge the appearance of CS in them, even if they are completely amnesic (forgotten) in the morning.

Encyclopedia of practical psychology "Psychologos"

published 25/11/2013 14:15 updated 09/12/2013 – Pedagogy and psychology

Colic and night awakenings.

Colic in children is often a real scourge for young parents. While colic is not a sleep disorder in itself, infants with colic have shortened total sleep duration. Sleep problems can sometimes continue after colic has passed with age - because the measures that parents used to stop crying attacks (rocking in arms, in a stroller) can interfere with the development of a normal sleep pattern. An infant over 4 months of age who continues to wake during the night is considered a “trained night cryer.” These babies calm down quickly after being held. One way is to recommend that parents gradually increase the time intervals of “ignoring”; another way to stop a child’s crying is “cold turkey.” Either method leads to difficulties for several nights, but ultimately helps in “training” the child to fall asleep independently (Ferber). Another method that is also effective and more readily accepted by some parents is “scheduled wake-ups.” In this case, parents wake up the child at a certain time, shortly before the child is expected to wake up on his own. Once the frequency of spontaneous awakenings decreases, the length of the interval between “scheduled awakenings” may increase until the spontaneous awakenings stop.

Which bed is better for a child to sleep on?

Choosing a bed for a child

Standard children's beds suit the child well. The choice is up to the parents. It is important to approach the choice wisely; convenience for the child and parents is the guideline for choice.

Choosing a children's mattress: its density should be medium. An overly soft mattress leads to squeezing and bending of the body when lying down. The spine should lie straight along the line, without unnecessary bending, maintaining only physiological curves. An overly hard mattress is also uncomfortable and uncomfortable for a child.

What pillow should a child sleep on?

Choosing a baby pillow

The height of the pillow should be such that there is no tilting of the head to the side when lying on the side; There was no backward bending when lying on the back.

So, a pillow with a height of 2-3 cm is suitable for a child from birth to 3 months.

You can make such a pillow yourself: take a synthetic padding polyester, fold it into 4 layers and sew it into a pillowcase 20 by 40 cm. It is preferable to purchase a special low pillow for newborns.

We often recommend an orthopedic pillow for newborns, with a recess for the back of the head, in order to form a physiological cervical lordosis.

Orthopedic pillow from birth to 6 months

The head fits comfortably into such a pillow, like a testicle in a socket, reducing the likelihood of secondary deformation of the skull. Often we see when examining a child after 1-3 months that the back of the head is “skewed” due to the forced position of the head on its side (torticollis).

While positional treatment using an orthopedic pillow smooths out tension in the posterior cervical muscles, forming a slight, correct forward bend of the neck.

For a child 6-18 months old, we place a 4-6 cm pillow: this is already 8 layers of padding polyester.

There are doctors who say that children under 2 years of age do not need to sleep on a pillow. It is also more comfortable to sleep in the stomach position without a pillow. Try it! An individual approach is a selection method.

From 1.5 years old, we use pillows of standard sizes 40 by 60 cm, with a thickness equal to the width of the child’s shoulder, if you lightly press on the pillow.

Which pillow to sleep on

We select bedding for children in cute children's patterns, from soft natural (cotton, viscose) fabrics. For washing we use hypoallergenic special washing powders for children's clothes, using additional rinsing, followed by double-sided ironing.

Frequency of washing (changing) linen, depending on soiling: daily several times a day, but at least once a week.

Such measures may be less significant with age, in the absence of a negative reaction.

Disorders of sleep initiation and maintenance

Disorders of initiating and maintaining sleep (DIMS) are most often found in preschool children due to the characteristics of psychological development and the difficulties inherent in this age. Sometimes parents have difficulty setting firm limits or agreeing with the child’s demands - “one more glass”, “one more fairy tale”. In such cases, parents are advised to perceive such attempts to delay bedtime calmly but firmly, ignoring the child’s protests. You can avoid further confrontation by telling your child that the door to his room will be open while he is in bed, but will be closed (not locked) if he tries to get out of it. One recommended technique is called a "bed passport" - a card with the child's name written on it that can be exchanged without penalty for one short trip out of the bedroom per evening and then returned to the parent for the rest of the evening. For children who have difficulty falling asleep, it may be helpful to develop a predictable routine - 3 or 4 components, lasting 20 to 30 minutes, for example, a story, a song, a drink, a back massage; Constant use of this procedure is very effective. The procedure can be shifted in time earlier, until the desired time.

How long does a child sleep

• From birth to 3 months - 16 - 20 hours a day;
• 6 months - 14.5 hours;
• 12 months - 13.5 hours;
• 2 years - 13 hours;
• 4 years - 11.5 hours;
• 6 years - 9.5 hours;
• 12 years - 8.5 hours.

How long should a child sleep during the day?

Considering that 8 hours are spent on daytime sleep, the duration of daytime sleep is:

From birth to 3 months - 8 - 14 hours;

How long does a child sleep in:

• 1 month - on average 11 hours during the day and 8 hours at night;
• 6 months - 6.5 hours;
• 12 months - 5.5 hours;
• 2 years - 5 hours;
• 4 years - 3.5 hours;
• 6 years - 1.5 hours;
• From 12 years of age - no nap required.

How long does it take to fall asleep

It takes time to fall asleep - from a few seconds to 20-30 minutes. These are the bedtime norms for adults and children.

If the time to fall asleep extends beyond 30 minutes, then this condition is called difficulty falling asleep.

How to prepare your child for bed

Please note that the duration of night sleep will be 8 hours: optimally from 10 pm to 6 am or from 11 pm to 7 am. Therefore, every evening we plan time and distribute activities, systematically leading to sleep. Calm rather than exciting games in the evening are encouraged. When dad or mom comes home from work, which means an emotional outburst, no later than 1 hour before going to bed. Warm (at a temperature of 37.5 - 38 ° C), soothing hygienic bath before bed for 5-15 minutes, as an important daily ritual before bed.

Can a baby sleep with mom?

For children from birth to 3 years old, the most reasonable thing is to sleep in a crib, located in the parents' bedroom at arm's length from the mother.

Some babies after 1 year can easily sleep in a children's room, separate from their parents' bedroom. For most children, sleeping in a separate bedroom is comfortable from 2 to 3 years old.

Ideally going to bed looks like this:

The parents put the baby in the crib, read a fairy tale, or sing a lullaby, or calmly talk about good things, and leave the room. And looking into the room after 5-10 minutes, they observe the baby sleeping peacefully.

Most doctors do not recommend co-sleeping in a parent's bed.

Under these conditions, the mother does not rest completely, but tension and anxiety remain. There are also tragic cases where an exhausted mother, in deep uncontrollable sleep, covered the child with her body, which led to the suffocation of the baby. There is even a popular term for this phenomenon, “fell asleep.” And in my medical practice there was such a tragic incident. It is important to instill in a child from early childhood the skill of falling asleep and sleeping alone in his own bed.

Sleeping in a crib

Parents often ask the doctor: “How to teach a child to fall asleep at 1–3 months?” We answer: “We teach you a daily routine from an early age.”

How to create a daily routine for children from infancy

Correctly distribute the intervals between sleep and wakefulness, using information about age-related sleep needs.

Create a daily routine through external actions: when the child wakes up, you need to change the conditions.

And it becomes clear to the child that a period of wakefulness has begun.

Our actions during waking hours:

• we lift the child out of bed, wash, change clothes;
• feed;
• turn on the lights, increase the sound level (we talk louder and more emotionally, turn on the music);
• we play, engage in active activities, go for a walk, swim;
• We leave the child alone for a while so that he can lie down and play on his own.

How does a child understand that he should fall asleep?

We wait for the moment according to the regime when the baby is tired enough. Moreover, if he was not active enough motorly, and his waking time is over, then he is overtired emotionally, but not physically tired. This makes it difficult to go to sleep.

Task: for healthy sleep, it is necessary to create sufficient motor activity while awake - massage, walk, bathing, active crawling, exercise, exercise therapy, feeding.

If, while awake, the baby is held in his arms most of the time, rocked a little, and passed one by one to other family members, then only the adults will become physically tired.

Our actions during bedtime:

• wash or bathe, change clothes;
• sometimes (not always) we feed;
• put to bed;
• we stop playing;
• dim the lights, lower the sound level (quieter, less emotional, talk calmly, drawn out and affectionately, turn off the music, TV and other extraneous sounds);
• you can rock for a short time in your arms, in a crib, in a stroller;
• you can create conditions for sleeping in the fresh air (outside in a stroller, on a loggia in a crib);
• don't forget to ventilate the room.

It is important to ensure that the air in your child's bedroom is moist and cool.

• Frequent ventilation. If it’s cold outside, then ventilate the empty room. If there is no draft, then you can sleep with the windows slightly open.
• Heating regulators optimize the room temperature. Simple techniques are known - covering excessively hot batteries using wet diapers.
• Daily wet cleaning is ideal.
• Optimal humidity will be created by special air humidifiers. You can measure air parameters using a hygrometer and thermometer.

The recommended optimal air temperature for sleeping in a children's room is 16 - 20 °C.

The optimal relative humidity in the bedroom is 50 - 70%.

If our actions before bed are of the same, stereotypical nature, then the child creates a bedtime ritual. He quickly gets used to this sequence of events and falls asleep quickly and deeply.

If the child has not been awake enough time, or is not physically tired, or is emotionally overtired, then in order to fall asleep, he cries for a long time and loudly before going to bed. He may worry every time he falls asleep. This is already part of his bedtime ritual. He cannot sleep without crying, providing a release, an outlet for unspent energy.

This bedtime option is difficult for the baby and parents. You can avoid sleep disturbances only by following these instructions, understanding the physiology of sleep and the need for a rational regimen.

Sleep problems in older children.

In adolescence or a little earlier, sleep problems become more pressing again. As parental supervision wanes and educational and social demands increase, sleep may begin to become more and more inconsistent. Sometimes there is a delay in the onset of falling asleep, a decrease in sleep time and increased daytime sleepiness. In some cases, such children may develop delayed sleep phase syndrome. This means that they cannot sleep at night and cannot stay awake during the day. This condition may represent a form of school avoidance. Treatment consists of strict control of the time of falling asleep, which gradually shifts towards the evening. A summary of sleep problems and suggested measures is presented in Table 2.

Table 2. Sleep disorders at different ages.

Frequent awakenings at night - is this normal?

As can be seen from the description of sleep patterns at night, frequent awakenings may be the norm in the first year of life. Therefore, here it is worth talking about the number and reasons for awakenings and looking at the child’s age to understand whether it is necessary to wait it out or whether it is worth working on sleep. If the baby wakes up too often for his age, sleep becomes fragmented, its quality deteriorates, and the deep sleep phase is shortened.

Why is it important? Shallow sleep is responsible for brain development. Deep - for physical recovery, restoration of tissues, muscles and nervous system.

If a child sleeps short sleeps and does not sleep at night, this affects his health and development:

• mood worsens;
• activity decreases while awake;
• tremor of the limbs appears;
• muscles weaken;
• growth slows down;
• problems with nutrition appear.

Co-sleeping

Co-sleeping is a term that refers to parents and children sleeping in the same bed. Many experts frown upon the practice due to concerns about possible sexual harassment or infringement of personal autonomy. However, statistical studies do not reliably confirm these concerns. Co-sleeping is especially popular in a number of cultures and is believed to promote a sense of security and love in a child. Regardless of the above, it can be argued that the frequency of co-sleeping is much higher, since parents may simply not talk about it or even hide it for fear that the doctor will frown upon it. According to various sources, 33-55% of preschoolers and 10-23% of schoolchildren sleep in the same bed with one of their parents. One cannot ignore the possibility of dramatic consequences not related to sleep disturbances themselves. Recently, a special commission in the United States published a report that over 8 years described 515 deaths of children sharing beds with adults. Approximately every fourth death was caused by mechanical compression of a child by an adult. Three quarters of the cases were caused by mechanical problems with the bed or mattress, which led to strangulation and suffocation of the child.