Sleep Problems in Infants and Toddlers

Sleep Behavior Problems are a Common Concern

The Journal of Zero to Three (January 2009) states that "Sleep behavior problems are among the most frequent parental concerns in pediatric practice and counseling services." As in-home therapists, we also encounter quite a few questions from parents on how to get their infants and toddlers to sleep through the night or how to establish a consistent bedtime routine. Sleep disorders have been found by various researchers to put stress on parent's emotional and physical resources, put parent-child relationships at risk, affect a child's well being, as well as strain a mother and father's relationship. Much new research is being done in this area to help parents with "fussy babies". In fact, the Erikson Institute in Chicago started a Fussy Baby Network in 2003 to help parents cope with their baby's sleeping, crying and feeding difficulties. It has been found that sleep problems in infancy can indeed carry on into the preschool and school age years if not managed early in life.

Night time awakening is an expected and natural occurrence for babies, as long as they can put themselves back to sleep on their own. It is especially important to develop good sleep habits and help your baby learn self-soothing techniques early on in infancy. Sleep problems occur when a baby does not have the ability to self-soothe and needs parental intervention throughout the night in order to fall back to sleep.

Some mom's may bottle feed or nurse their child every time he cries. Parents may give the child a pacifier, pick the child up and carry him around until he falls asleep again, wake up and play a bit, or even take him into their own bed until he falls asleep. These are natural things that any parent wants to do in order to comfort their child and allow the child to return to sleep. What many parents fail to realize is that establishing this type of routine leads to a baby's dependency and expectancy on them to help them fall back to sleep night after night. This becomes a vicious cycle, since although the baby may awake refreshed with no ill effects, the parents eventually become sleep deprived themselves which in turn leads to daytime fatigue, emotional stress and sometimes tension between parents.

The Journal of Zero to Three ( Jan. 2009) states that "sleep problems often begin or escalate around 9 months, 15-18 months, and again in the 4th year of life (Jenni et al. 2005)." The Journal also cites that sleep problems can also be related to temperament, attachment problems, tension in parent's lives or a parent's own psychological functioning (such as a Mom who needs the closeness of her baby for her own emotional security).

The Ferber Method

What can parents do to help their baby sleep through the night and establish a consistent bedtime routine? Many parents have heard of what is termed the "Ferber Method", invented by Dr. Richard Ferber. You can find tips and suggestions on using this method by doing a search for "Ferber Method" on the internet. The Journal of Zero to Three (Jan. 2009) suggests the following tips to promote positive interactions with your child at bedtime:

1. Have Mom or Dad or both parents end their child's day by giving him their complete attention and implementing a calm, relaxing routine which may include singing, bathing, rocking or reading outside of the bed.
2. Put the baby into the crib when he is still awake and give him some ways to self-soothe, such as a favorite toy, blanket or pacifier.
3. Say "goodnight" with reassurance that you will check on the baby in a few minutes and leave the door to the room slightly open, providing a nightlight or dimly lit light source in the hallway.
4. Expect your baby to cry as soon as you leave the room. A baby's crying may indicate that he is protesting being left alone, is testing the parent's limits or may want his pacifier or bottle, etc.
5. If the baby continues to cry have Mom or Dad go in and check on the baby about every 5 minutes and provide brief contact (a pat, kiss) and reassurance that everything is ok and they should go to sleep. Do not pick up the baby or feed the baby.
6.  Experts say that what is even more important than physically checking on the baby is what non-verbal messages you convey to the child. Be sure to remain positive, be reassuring with your voice and body language (You're ok, Mommy will check on you again soon, shhh, go night night), and instill the trust that you know the baby can fall asleep on his own.

A Positive Message

The main idea is to give your child the message that he can do it alone and offer him the opportunity to self-soothe and drift into sleep on his own. When your baby can fall asleep by himself, you should follow the exact same routine every night if/when he wakes up and cries. Researchers found in a recent study(Schieche et al. 2008) in the Journal of Zero to Three (Jan. 2009) that in a sample of 80 babies ages 6-18 months old whose parents completed the above method, 13% of the babies had a relapse of sleep problems, 8% did not respond at all, but 79% of the babies had continued success with being able to sleep through the night and self soothe themselves upon wakening. Many parents found that the amount of lengthy crying they experienced was much less than they had originally expected and was only noted on the first night of starting the new routine.

Complex Sleep Disorders

Keep in mind that there are some babies who are deemed to have "complex sleep disorders" and these children may need special therapy (such as sensory integration therapy) in order to learn to self-soothe and self-regulate themselves. Some children may have separation anxiety or attachment disorders (such as newly adopted children or children in foster placements) and these challenges may need to be dealt with during waking hours before being able to establish a consistent night time routine. Some babies with special health care needs or feeding problems/reflux may also need special adjustments made in order to sleep well at night.

If you have questions related to your child's sleep routine, you can ask your pediatrician for advice or if your child is enrolled in Early Intervention, ask your Developmental Specialist or Occupational Therapist for advice.

By Tamara Guo, M. Ed.

Parenting Tips in Other Areas Include

• Building Positive Habits
• Special Needs
• Adoption
• Safety
• Age Appropriate Toy Choices
   

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• What is Early Intervention?
• Understanding Services
• Contacts in Your State

Therapy Options

Thankfully, there are many ways to deal with childhood developmental delays and behaviors. These include in-home services, outpatient (you take your child to a clinic), inpatient (following injury or surgery) and school based services. Which type of therapy should you choose?

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