Sleep Problems in Toddlers and Preschoolers
Sleep problems, which generally are categorized as either difficulty falling asleep or waking at night, are common in children aged 1 to 4 years. Sleep problems can be particularly challenging for both parents and toddlers/preschoolers alike. Up to one-third of all children have some type of difficulty with sleep, which usually increases the stress level for everyone in the family. It is important to realize that sleep problems are mostly short-lived and tend not to result in any long-term consequences.
Here is some general information about sleep problems and a few suggestions for dealing with them.
Difficulty falling asleep
Difficulty falling asleep is the most frequent sleep complaint among parents of young children. In many cases, this problem is due to an inconsistent bedtime routine. Some studies have shown that children who have a difficult time falling asleep can learn to go to sleep without problems if adults begin to set clear limits around bedtime.
One common and effective solution is to establish a regular time to go to bed each night preceded by a consistent bedtime routine (such as having a drink, going to the bathroom, taking a bath, brushing teeth, then reading one story). Having a regular time to go to bed (and to wake in the morning) helps to set the body's natural clock (circadian rhythm), so that the child is tired around the same time each night. Bedtime routines help young children make the physical and emotional transition from their busy days to restful sleep.
Although it is helpful to stick to a general bedtime routine, be sure to give your child(ren) some control over the specific activities. For example, allow them to choose their pajamas, pick out a story to read, and decide which stuffed animals or other security objects to have in bed. Problems arise when parents give in to requests by their children to "stay up a little later." Not keeping to a regular schedule disrupts the body's natural clock and only worsens the problem. Of course, there are special times when you will want to do things in the evening with your children, keeping them up past their usual bedtime. Understand that when these exceptions are made, it may take a few nights to get back on schedule.
Sometimes, a child has difficulty falling asleep if he is put to bed too early or is not yet tired. This tends to be most problematic for the child who has taken a long nap during the day, especially in the late afternoon. Most children give up their morning naps by age 1, and their afternoon naps by age 3 or 4. If your child does nap, try to keep the naps on a regular schedule during the day, since changing the time can also disturb the body's internal clock.
Difficulty falling asleep can sometimes be related to fear and anxiety. Some toddlers and preschool-aged children have separation anxiety, and bedtime for them is difficult because their parents are now leaving them alone. Other children may be frightened of the dark, or they may be scared due to images seen in movies, television or video/computer games. In these cases, reassurance from parents is often the best remedy. Make the bedtime routine relaxing, by playing soft music or telling a soothing story. Tell the child that you will check on him in five minutes after the lights are out and remind him that you will be sleeping nearby. Other helpful strategies include keeping a nightlight in the room and avoiding viewing media images before bedtime.
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Awakening during the night
Once children have fallen asleep, they may have difficulty staying asleep. In fact, it is normal for them to awaken several times during the night. Problems occur when children cannot fall back to sleep on their own. The most common reason for this is that the child has never learned to fall asleep without help. Children who fall sleep while they are being held, rocked or fed often find it most difficult to fall back to sleep without these same parental interventions. In this case, the nighttime awakenings are best treated by using a regular bedtime routine, which includes putting the child to bed while still awake.
Toddlers and preschool-age children may also awaken at night from nightmares or night terrors. Nightmares are frightening dreams. They are fairly common, tend to begin during the toddler years, and often happen when a child is feeling anxious or stressed. The stressors may not always be obvious — normal developmental transitions such as toilet training or starting school can provoke nightmares. After a nightmare, the child will be wide awake and frightened. Most children need comfort and reassurance from parents to fall back to sleep. If nightmares become frequent, talk with your child in the daytime about his activities and help him address any fears or anxieties.
Night terrors (sleep terrors), often look similar to nightmares, but are actually different and much less common. With night terrors, a child suddenly sits up in bed, seems intensely fearful or agitated, and may scream or cry out. The child's eyes are open, but he or she is still asleep. He remains unaware of the presence of others and cannot be comforted or awakened. You should protect your child from hurting himself. As this episode subsides, your child should return to restful sleep and usually will not remember any of the events in the morning.
Night terrors tend to occur within one to two hours after falling asleep, and may occur in clusters of several nights at a time and then disappear. Night terrors are most common between the ages of 1 and 8 years, and can also be triggered by physical or emotional stress. In general, these episodes disappear without any treatment and have no long-term effects. Talk with your pediatrician if your child is having frequent, prolonged or severe night terrors.
Difficulty with sleep is a common problem for young children, and a source of frustration for many parents. Most cases can be addressed by the behavioral changes discussed above. However, not all children respond to these techniques. In addition, difficulties with sleep can be a sign of significant physical or emotional problems in some children. If these sleep problems persist after trying the above suggestions for a few weeks, or if you have other concerns, call the pediatrician to discuss your child's sleep habits. The pediatrician can offer additional advice and confirm that no further evaluation is necessary. Be prepared to discuss your child's sleep habits in detail, including bedtime routine, length of sleep during the night, number and length of daytime naps, and any circumstances around falling asleep and waking up. Your doctor may even recommend that you keep a "sleep diary," recording all of this information for at least a couple of weeks.
Remember that you don't have to wait until there is a problem to talk about sleep issues with the doctor. You may be able to avoid these types of problems by reviewing your child's sleep habits at routine well child visits. In most cases, knowing what to expect and then learning techniques to help establish and maintain good sleep habits may make the difference between a restless night and a restful one.