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If your child has difficulty in establishing a routine that has most sleep occurring at night without frequent interruptions, it may create problems for the child and also for the parents and may indicate the presence of a primary sleep disorder.

Sleep problems in children are actually quite common, but thankfully most are not serious. Unfortunately they may be overlooked as an issue until the child's sleep problem becomes the parent's problem, interrupting their sleep or causing enough behavioral problems in the child to finally seek professional help. Many common problems with children's sleep can be easily corrected once the problem is recognized.
Parents can effectively handle most pediatric sleep disorders. Often the pediatrician can provide basic advice to help you. Recognizing key warning signs is the important first step to helping your child get the healthy sleep they need for proper development identifying the handful of symptoms that point to professional intervention. Some common signs include:

• Difficulty in getting the child to sleep in a timely fashion
  
• Frequent awakenings during the night
• Behavior and mood problems during the day
• Interruption of parents sleep
• Difficulty between parents and the child

If these signs are present and you and your pediatrician cannot resolve them, consultation with a sleep specialist may be indicated. Take the next step and:

• Get More Info on Pediatric Sleep Disorders
• Learn more about sleep disorders
• Get Help
  
  

Avoiding Common Sleep Problems in Children

Establish a Healthy Bedtime Routine

Avoiding or correcting a problem with sleep onset (your child's ability to fall asleep after going to bed) is often a matter of establishing a good sleep routine. Separation of the child from his or her parents can be a source of anxiety for both parties. Parents naturally sense these disturbing feelings and want to comfort their children. This is perfectly normal and is usually helpful to the child. However take care to avoid making an existing problem worse by promoting unhealthy nighttime behaviors.

When you plan your bedtime routine, it is important to set aside 10 to 30 minutes to do something special with your child before bed. The activity should not be stimulating (avoid jumping, running, or wrestling), nor should you tell scary stories. The child needs to know the time limits of this special time and that you will not exceed them. Giving in to requests for extra juice or for another story will teach a child that bedtime can always be postponed. Without established sleep-time routines, the evening is more likely to be (tilled?) with tension, anxiety, and arguments.

Solving sleep onset problems

One of the most common solutions for parents to try when sleep onset is difficult is to feed (nurse), hold or rock a child to sleep, whether at night or for a nap. Unfortunately this often leads the child to associate the action of falling asleep with this activity. When that other action, person, or object is missing, your child is unable to fall asleep. Parents often feel they need to "help" the child return to sleep by feeding him, rocking or holding him, or lying down with him. A child becomes dependent on the parent to help fall asleep, instead of learning to associate sleep with objects in his crib or bed, such as a favorite blanket or stuffed animal.

Remember, babies can learn to fall asleep by themselves!

Once an infant or young child begins to associate falling asleep with being rocked or held, she does not have any idea how to return to sleep on her own, so she starts to cry once she's awake. If she is picked up readily every time she cries and falls back to sleep in a parent's arms, the association of being held while falling asleep is only reinforced, and it will be especially difficult for the child to learn how to do it alone. Parents feel anxious and guilty allowing the child to cry. It is important for parents to know that a child can and will learn to fall asleep on her own once she is given the opportunity to do so and when other reinforcements are eliminated.

You must always make sure the child is safe and not hungry, sick, or wearing a soiled diaper. The technique described below will help your child learn to fall asleep more easily and naturally without feeling abandoned or alarmed.

Breaking bad habits

To correct your child's sleep problem, you must teach them to fall asleep during all sleep periods naptime, nighttime, and after awakenings at night with a new set of associations that do not require a response from you. It is best to begin the relearning process at night, but some parents choose to do it during naptime.

During the relearning process you should expect your child to cry at first. However, you must keep in mind that you are not abandoning your child. With an organized process of encouragement and reassurance, she can learn to fall asleep independently. If you choose to use a pacifier to comfort your child, keep in mind that using it as an object of association is discouraged after five to six months of age because it is sure to fall out repeatedly during the night. The use of a blanket or stuffed animal usually does not create a major problem, as these items will still be in the crib or bed when the child wakes up.

Teaching your child to fall asleep

The child should be placed awake or drowsy in the crib or bed after a quiet bedtime routine. Say goodnight and leave the room, making sure to allow a little light into the room. If he is still crying after two minutes, return to the room. Don't turn on lights or lift the child from the crib, or hug him; don't give in to new requests (for juice, another story, or for you to lie down next to him). You can comfort the child with words, and/or by placing a hand on his back to show him that he is not being abandoned. Leave promptly; don't stay in the room longer than one or two minutes.

If the child continues to call out or cry, allow progressively longer intervals to elapse before returning. Waiting while your child cries can be difficult, but it is the key to helping your child make the transition successfully. By not removing the child from his crib or bed, you are helping him learn that he can fall asleep by himself.

When this plan is followed consistently, significant improvement is usually seen after three nights. If you are sure you are following the protocol, it is possible that your child just needs more time to fully adjust to the change. Be patient - your persistence will pay off!

Sleeping with a light on

The need to sleep with a light on is usually triggered by fears in the child. There is probably no short-term problem with sleeping in the light. The best overall approach is to try and understand and deal with the child's fears. In most cases, there are few consequences of leaving the light on in a child's room. However, an internal clock that is sensitive to light-dark cycles controls sleep and wakefulness. The clock works better if the light-dark information throughout the 24-hour day is clear and consistent. So, sleeping in the light may ultimately confuse the body and lead to sleep problems. You may try to use progressively dimmer and dimmer lights in the child's room until they are comfortable sleeping in the dark. This is much less of a concern with infants and very young children than it is with older ones.

Sleeping with Mom and Dad (Co-Sleeping)

Young Children

In general, it seems to be better for all if your child learns to sleep by herself. If your child gets into bed with you frequently -- say, more than once a week -- then you may want to discuss the matter with them. Try to determine if there are psychological issues at the root of the behavior. If not, then she can learn to get herself back to sleep if you gently but firmly refuse to let her come into your room. Plan on walking or carrying her back to her own bed several times a night for a while. Try and deal with her fears if this is the source of the problem. If you have no success after a month of consistent efforts, then seek professional help.

Infants

The related question of an infant or very young child sleeping in the same bed as the mother and/or father has more complex answers. The nursing mother may wish to have the infant close by to minimize the disturbance of breast-feeding to their own sleep. Fathers who get up during the night to feed infants have expressed similar views. Working mothers and fathers may consider bedtime as the only time when they can be close to their young children. Such practical and emotional factors should be balanced against the fact that, for a child to sleep well, it is necessary to learn to settle and sleep alone in bed. In the case newborns and young infants, some authorities cite the risk of crushing or smothering as a reason for separate sleeping arrangements. Amidst such conflicting considerations, parents must select the sleeping arrangements that best fit their current needs. A bit of personal experimentation with various same room and same bed sleeping arrangements can be helpful in deciding what is best for you and your family.

Teenagers and Sleep

Teenagers often have a particular problem with their sleep schedule. They tend to stay up late and then have difficulty awakening and being alert for school. This problem is even worse if this behavior is exaggerated on the weekends, when they may not have to wake up until much later in the day. This sets their internal clock to a delayed phase schedule (night owls).

The body cycle that controls our wakefulness and sleep runs on about a 24-hour clock -- but not quite. That is why scientists term the cycle 'a circadian rhythm' which means 'about a day'. Actually the cycle is usually longer than 24 hours by 15 - 75 minutes depending on such factors as age and random variation among people. The cycle tends to be longer in young people and to shorten as we age. Thus, left without any information about time or the need to get up in the morning, most people will go to bed later and later each successive night and get up later and later each successive morning. It may be that your child has a particularly long wakefulness-sleep cycle. He may benefit from more and stronger time signals from our 24-hour day to override his internal 25+ hour day. The best signals are bright light and vigorous activity in the morning. The extreme form of this problem is called 'phase delay insomnia' and can lead to problems in school or on the job. The condition can be treated by sleep disorders specialists. It does require participation by your child to resetting this internal clock. Some schools are now beginning to examine the time of day they start, recognizing that many children, particularly teenagers, are not alert and fully functional early in the morning.

Pediatric sleep Disorders

Sleepwalking

Sleepwalking or 'somnambulism' is very common in children. These symptoms occur during stages 3 and 4 NREM sleep, when the brain waves show a high-voltage slow pattern. During this kind of brain wave pattern, there can be little reliable sensory and movement activity. Many people mistakenly believe that sleepwalkers will not get hurt and that they can avoid obstacles. People can be injured while sleepwalking. Sleepwalkers have gone through plate glass doors, fallen down stairs and been burned by walking into hot fireplaces. So, the sleep environment should be made safe by locking doors and windows that open on to dangerous areas. Sleepwalkers may be very difficult to awaken and very confused if they awaken during a bout of sleepwalking. However, there is no real danger if they wake up while sleepwalking.

Bed Wetting

Bed wetting (enuresis) is far more common than most people think. The necessary neurological control of the bladder sphincter can come as late as 12 - 15 years of age. It is best not to make an issue out of bed wetting in children under 6 or 7 who have never been dry for more than a few nights in a row. For older kids, there are several training methods that involve gentle alarms that do work quite well. For kids who have been dry for a number of months or years and begin to wet the bed again, parents should get a physician's opinion. Reappearance of bedwetting can mean genito-urinary problems, psychological problems or even neurological problems such as epileptic seizures.

Sudden Infant Death Syndrome

Crib death or Sudden Infant Death Syndrome (SIDS) is a tragic problem that is often related to an abnormal degree of immaturity in the systems that control the heart and lungs. It is common for such immaturity to cause problems only during sleep. There is a small tendency for SIDS to run in families. Doctors suggest that babies who are closely related to a SIDS case, be examined regularly. If your baby stops breathing or has irregular breathing during sleep, tell your doctor immediately. The sleeping position of new babies may is also important in SIDS. Studies in England have shown that 'Back to sleep' which refers the practice of putting newborns and infants into their cribs on their backs, significantly reduces the rate of crib death. Doctors now advise having babies sleep on their backs.

Snoring in Children

Sleep specialists put snoring into two categories:

• Primary snoring or simple snoring which is not dangerous
• Snoring that indicates Obstructive Sleep Apnea Syndrome, OSAS
  
  Obstructive sleep apnea is a condition in which collapse of the pharynx (upper airway) occurs during sleep. This is due to crowding of the pharynx due to the anatomy of the throat the child is born with, enlarged tonsils, other anatomical abnormalities or combinations of these.

Children with OSAS may experience difficulty sleeping at night and behavioral problems during the day. Undiagnosed OSAS can lead to school problems, delayed growth, and even heart failure because of decreases in blood oxygen levels. Both boys and girls can suffer from OSAS.

Common symptoms of Sleep Apnea in Children

o Sleeping in an abnormal position
o Loud snoring
o Pauses in breathing during the night for a short period-followed by snorting or gasping or completely waking up
o Sweating heavily during sleep
o Having school or other behavioral problems
o Restless sleep
o Difficulty waking up, even though it seems he or she has had enough sleep
o Having headaches during the day, particularly in the morning
o Irritable, aggressive, or "cranky" behavior
o Falling asleep or daydreaming in school or at home

Some of these symptoms are similar to those described in children with attention deficit hyperactivity disorder (ADHD. In fact, some children are misdiagnosed as having ADHD when they are actually suffering from OSAS. If you have noticed that your child has some of the above symptoms, you should talk to your pediatrician.

The most common treatment for OSA in children is tonsillectomy. The need for this is based on a combination of clinical signs as mentioned above, the findings of enlarged tonsils and a sleep test which measures the breathing and sleep pattern. This can be done in a sleep center (a polysomnogram (PSG), or now often in the home with portable equipment. In some older children, treatment may be more like that in adults with a nasal mask to deliver Continuous Positive Airway Pressure (CPAP).