Kids and Sleep

WebMD Live Events Transcript

If your kids aren't sleeping, chances are you aren't getting your ZZZ's either. Children's sleep disorders can affect the whole family. Whether the problem is adjusting to daylight-saving time or has been going on for months, help is on the way. Children's sleep expert Jodi Mindell, PhD, joined us on April 5, 2005 to answer your questions.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Mindell. Thank you for joining us today. If your child's sleep is disturbed, then your sleep is disturbed. How big is this problem?

MINDELL:
Most studies have shown that 25% of all infants and toddlers have some kind of sleep problem.

However, last year's Sleep Foundation's poll of sleep in children ages zero to 10 found 74% of parents want to change something about their child's sleep. Basically that means sleep issues are a universal problem for parents and children.

MEMBER QUESTION:
How long should you let your child cry before entering the room?

MINDELL:
If you're trying to help your child fall asleep on his own, he may be upset for awhile. Please go in and check on your child as frequently or infrequently as you wish. How long you wait will depend on your tolerance and your child's temperament.

Some children get more upset when you check on them. However, please do make sure that you go in because leaving a child to cry for a long time usually makes the process longer.

Typically you find that the second night is worse than the first night, but then you'll be over the hump and your child will start falling asleep much quicker and easier.

"Typically we recommend doing sleep training between 3 and 6 months at the earliest. However, if you start developing good sleep habits when your baby is a newborn, you hopefully will never have to let your baby cry."

MEMBER QUESTION:
When is it too early to let your baby cry it out?

MINDELL:
Typically we recommend doing sleep training between 3 and 6 months at the earliest. However, if you start developing good sleep habits when your baby is a newborn, you hopefully will never have to let your baby cry.

Developing good sleep habits includes:

  • a set bedtime
  • a consistent bedtime routine
  • putting your baby to bed drowsy but awake

If you do that, your baby will start sleeping for long stretches without tears.

MEMBER QUESTION:
When my daughter is sick with a cold, she tends to wake up numerous times. Is it OK to leave her alone in the room or should I be in there to comfort her?

MINDELL:
First, talk to your doctor about what will help your baby sleep while having a cold, such as using a humidifier in her room.

When your baby is sick, it is best to go and comfort her. However, don't go rushing in, as you may find that she'll often soothe herself back to sleep without your help. You may end up waking her more by going in every time.

MEMBER QUESTION:
Does teething interfere with sleeping?

MINDELL:
We do know that when babies are in pain it's going to disrupt their sleep. But if you always blame teething for sleep issues, you'll probably have a year of sleepless nights, as babies have a lot of teeth that need to come in.

Again, talk to your doctor about what you can do to help relieve your baby's pain.

MEMBER QUESTION:
I have a 13-month-old who started sleeping through the night at about 2 months, but since 7 months has been waking up. What can I do? Sometimes the only way she falls asleep is holding my hand. She also still has a pacifier.

MINDELL:
We do know that even the best sleepers often start waking up again between 6 and 10 months. I suspect it's more an issue of the hand holding than the pacifier.

Try taking a week and being very consistent about not holding her hand when she falls asleep at bedtime and you'll likely solve the problem quickly. You know she can sleep through the night, so it's just going to take a bit of encouragement.

Very often parents find themselves needing to encourage their child to switch from co-sleeping to sleeping alone.

MEMBER QUESTION:
My son is a year old and he does not nap well or sleep well at night. Any suggestions would be greatly appreciated.

MINDELL:
Take it in slow steps by moving both you and him into his room and staying with him while he stays asleep.

Once he's falling asleep in his own bed, you can start easing yourself out at bedtime by moving three to four feet farther away every few nights. Because this is such an issue, I added a chapter on co-sleeping and making the switch in my newly revised book Sleeping Through the Night.

MEMBER QUESTION:
My 12-month-old son just started a new daycare and has not been accustomed to sleeping with other babies and with other people in the room. How long might it take for him to adjust to new surroundings?

MINDELL:
You'll be surprised to find that most children at daycare centers nap incredibly well. Even with all the distractions and all the other babies, they all seem to fall asleep.

Sometimes I wonder if it's peer pressure. However, expect your baby to take at least a few weeks to get used to going to daycare and his naps may take that long also to fall into place.

MEMBER QUESTION:
My 12-month-old daughter is a very inconsistent sleeper. She is still breast feeding and the more I try to wean the more often she gets up during the night.

MINDELL:
Almost all babies no longer need nighttime feedings after six months. Check with your doctor to be sure there are no growth issues. Otherwise she should be fine without feeding during the night.

Typically the issue is that a baby is nursing to sleep at bedtime and then when she naturally awakens will need to nurse back to sleep throughout the night. So focus first on stopping nursing to sleep at bedtime.

Take a week and rock her to sleep instead. If someone else can do it, like dad or grandma, it will be even easier on your baby. Once she no longer needs to nurse to sleep at bedtime, it will be much easier to stop the middle-of-the-night feedings.

"Almost all babies no longer need nighttime feedings after six months."

MEMBER QUESTION:
What do you do when the baby wants to nurse?

MINDELL:
You just have to win the battle and hang in there. She will eventually fall asleep, but it will be reassuring to you to be holding her and letting her know you're there. She'll probably put up a battle, but realize for the bigger picture it's to her benefit to help her get a good night's sleep.

MEMBER QUESTION:
My son is 21 months old and has never been a sleeper. Rarely -- maybe once or twice since he was born -- has he slept through the night. For the most part, he goes down pretty easy. Then every night between 1 and 3 a.m. he wakes up screaming as if he is in pain.

About six months ago, my son's pediatrician did blood work for JRA (juvenile rheumatoid arthritis) and said that the results were normal. Last night when he woke up crying and kicking his legs, I gave him Tylenol and it seemed to work. I certainly do not want to get in the habit of giving him Tylenol every night. Any suggestions?

MINDELL:
Wow! Sounds like both you and he are really struggling. And I agree that it sounds like he's in pain rather than it being a behavioral issue. Since he's still waking up screaming in your bed, there's probably something going on that's disrupting his sleep.

It's probably worth going back and talking to your pediatrician again and also possibly having him evaluated by different specialists. This may include a GI doctor to see if he has stomach pains or a sleep specialist to see if his leg movements are disrupting his sleep.

There is such a thing as restless legs syndrome, which causes pain in the legs, usually at bedtime, but can also occur during the night. It's unusual to see it in such a young child, but that doesn't mean it can't happen.

To find a sleep specialist in your area, go to the web site of the American Academy of Sleep Medicine at www.aafmnet.org. Good luck, and I hope you solve the problem.

MEMBER QUESTION:
My 9-month-old is used to falling asleep on her last bottle. In the past, I would be able to put her in her crib and she would sleep through the night. Now once I place her in the crib she wakes up and is hysterical.

MINDELL:
Time to stop the bedtime bottle, as she has figured out that the moment she falls asleep it goes away, which wakes her back up. Decrease her bottle at bedtime by an ounce per night to make a slow change, rather than taking it away abruptly.

MEMBER QUESTION:
Is there a recommended age for transitioning from two naps a day to one?

MINDELL:
Most babies switch from two naps to one by 18 months, although there are some who continue until 20 or 22 months.

Some signs your baby is ready to make the switch:

  • She takes a long time to fall asleep at one of the naps
  • She doesn't nap at all, either in the morning or the afternoon
  • When she misses a nap she doesn't fall apart later in the day

All these are signs she's probably ready to make the switch. It can take a few weeks of some bumpy days when you switch her from two naps to one, as it usually doesn't happen overnight.

MEMBER QUESTION:
My 4-and-1/2-month-old baby wakes at around midnight and demands a bottle. Then he sleeps until sometime between 5 and 6 a.m., when he's hungry again. Is he demanding the midnight bottle out of habit or because he really needs it?

MINDELL:
One thing you may want to try is getting him up and feeding him before you head to bed, around 10 or 11 p.m. This way, if he wakes up at midnight you'll know that he really isn't hungry.

Adding a focal feeding will probably make it so that he can either sleep through or just get up for his 5 a.m. bottle.

"To help her make the transition, you may want the Sleep Fairy to visit and leave a present if she sleeps in her bed all night."

MEMBER QUESTION:
I can't get my 4-and-1/2-year-old daughter to stay in her bed at night. She gets up every night, early morning and gets in bed with me. This has gone on since we moved into a new house almost a year ago.

MINDELL:
At this point it's probably pure habit that she's waking up every night and coming to your bed. To make a change, be sure to bring her back to her bed every single time she heads your way.

To help her make the transition, you may want the Sleep Fairy to visit and leave a present if she sleeps in her bed all night. Sleep Fairies often leave a sticker or a penny or a note to let your little girl know that she's done a good job.

Start with having the Sleep Fairy reward her if she sleeps in her own bed all night, even if you have to return her during the night. Once that is going well, you can then have the Sleep Fairy come only if she stays in her bed all night without coming to you.

So start with a step where you know she can be successful, and you'll likely find that things will change quickly.

MEMBER QUESTION:
A friend of mine has a sick 19-month-old child who has had a cough for a couple of months; he can't get through the night without waking up once or twice. He then cries until his mom comforts him back to sleep. When is it OK to let him cry and when is it OK to comfort him?

MINDELL:
At this point with such a persistent cough, his parents should really check out what's going on. Some things like asthma can lead to nighttime coughing. While they're figuring this out, please have them comfort him during the night. It sounds like he's having a hard time.

MEMBER QUESTION:
My 5-year-old refuses to go to sleep. She insists on keeping the light on all night. When we try to leave her room at night she either becomes hysterical or keeps finding excuses to get out of bed. She usually falls asleep around 11:00.

MINDELL:
Start by moving her bedtime routine close to the time that she typically falls asleep, so start at 10:30 expecting her to fall asleep at 11:00. Don't worry. Later on you can start moving her bedtime earlier by 15 minutes every day or two.

Second, try to calm things down by staying with her at bedtime until she falls asleep. In a few days, you can start moving yourself out of the bedroom at bedtime, moving several feet away every few nights.

The key to the whole thing is being consistent and being clear about bedtime rules, and at the same time, being as boring as possible so you don't get into long discussions about what she is and is not allowed to do. Slow and steady changes and being completely consistent is going to help you make a change.

MEMBER QUESTION:
My son is almost 7 years old and cannot fall asleep at night. He is up until 11, 12, 1 or 2 a.m. and then cannot get up for school. He does not know why he can't sleep but it is really bothering all of us. He was crying the other night for us to give him a sleeping pill. I don't know what to do. Our pediatrician says there is nothing he can do.

MINDELL:
Given how long it's been going on, it's well worth consulting with a pediatric specialist. Either your doctor can give you a referral or try contacting a children's hospital in your area. I understand there aren't that many pediatric sleep specialists out there, but hopefully there is one close by you.

"The same National Sleep Foundation poll that found that televisions and caffeine caused sleep problems, also found that including reading at bedtime, whether you are reading to your child or your child is reading to you, was related to more sleep and fewer sleep problems."

MODERATOR:
Can a child's sleep be affected by the quantity of caffeinated beverages they drink?

MINDELL:
Absolutely. The National Sleep Foundation poll found that almost a third of all school age children had a caffeinated beverage every day and these children got significantly less sleep at night.

There's no question children should not be drinking caffeinated sodas, both because of the empty calories and also because of the caffeine.

Another major cause of less sleep and sleep problems is televisions in the bedroom. There have been many studies showing the impact of television on kids' sleep. It's not a good habit, so get rid of them.

MODERATOR:
For those children who watch television before bed, but not in their rooms, how does what they watch affect their sleep?

MINDELL:
Surprisingly, the studies have all found that the type of television shows that children are watching didn't really matter, it was just literally watching TV.

So whether or not a child watches television around bedtime makes a huge difference in how well they sleep. And it was much worse if the television was literally in the bedroom.

MODERATOR:
Bedtime stories with mom and/or dad are much better in many ways.

MINDELL:
Absolutely! The same National Sleep Foundation poll that found that televisions and caffeine caused sleep problems, also found that including reading at bedtime, whether you are reading to your child or your child is reading to you, was related to more sleep and fewer sleep problems.

So not only is reading at bedtime good for literacy, it's also a great way to transition from a busy day to a peaceful night's sleep.

MEMBER QUESTION:
My 17-month-old son still wakes up once or twice a night, about 2 a.m. and 5 a.m., with screams. Sometimes it is clear night terror, other times he wakes up completely, and only a bottle helps. He goes to bed without problems, and when awake -- no bottle, no pacifier. Why can't he fall asleep when he wakes up at night?

MINDELL:
That's a good question. You're right, there are some kids who have perfect bedtime habits but still wake during the night. It's well worth getting rid of his nighttime bottle as nutritionally it's unlikely he needs it.

Another thing to try is to move his bedtime much earlier as children who go to bed earlier surprisingly sleep earlier. An earlier bedtime will also help decrease the likelihood of him having a sleep terror, as sleep deprivation is the number one contributor to sleep terrors. So moving to an earlier bedtime will most likely help both types of nighttime awakenings.

MEMBER QUESTION:
My child is a 12-year-old boy. After falling asleep he will jump and twitch. Is this a symptom of something or am I just overly concerned?

MINDELL:
Many people twitch in their sleep and it's meaningless. If the movements, though, look the same every time it could be periodic limb movements in sleep, which is a rhythmic kicking of the legs. Often people sleep well with this type of sleep problem, but it can cause arousals during the night, which will make him feel tired the next day.

A rarer likelihood is that it's a seizure, but nighttime seizures usually only occur once per night and rarely every night.

"I think it's vitally important that parents make sleep a priority for their children and for themselves."

MEMBER QUESTION:
My 2-year-old daughter snores and often has irregular breathing while sleeping. When she was 6 months old I asked the doctor about her irregular breathing and he said it is normal among infants. My husband is currently being evaluated for
sleep apnea. Should I be concerned about my daughter?

MINDELL:
There is a chance that she has sleep apnea. Your doctor is right that irregular breathing in young infants is rarely a concern, but now that she is 2 the likelihood of apnea increases.

If she's snoring, having difficulty breathing or has breathing pauses when she's asleep, definitely talk to your doctor again. In children, sleep apnea is usually caused by enlarged tonsils and adenoids and the problem is solved once they are removed.

MODERATOR:
Dr. Mindell, any final words for us?

MINDELL:
I think it's vitally important that parents make sleep a priority for their children and for themselves. As your grandmother told you, adults really need between 7 and 9 hours of sleep every night, and getting that amount will help you be the parent that you want.

Also getting your child the help that he or she needs will help her function at her best during the day to keep her happy, growing, and learning.

For lots more information about children's sleep and parents' sleep, check out my newly revised book Sleeping Through the Night: How Infants, Toddlers and Their Parents Can Get a Good Night's Sleep. The book came out two weeks ago and I'm very excited about all the changes and additional information I was able to provide. Pleasant dreams.



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