Young & Restless Kids' sleeping habits make bedtime nightmarish

THE BALTIMORE SUN

From the time parents bring their newborn home until they send a teen-ager off into the world, bedtime tests their patience and their willpower.

For children, unlike their parents, sleep isn't a respite. It's deprivation, an interruption to all the excitement of the day. They don't want to go to bed.

Though sleep seems to be something that should come easily and naturally, most children have to be taught to sleep the way the rest of us do -- in their beds and at night.

"Ninety percent of the kids I see are normal, average kids," says Dr. Marcel Duray, director of the Sleep-Wake Disorder Center at Miami Children's Hospital. "But they have been taught to sleep in a certain way -- by rocking or with a bottle, or on the sofa, or in the parents' bed. They don't know how to fall asleep any other way or by themselves."

So from infancy on, some children have trouble dropping off. Many wake up in the middle of the night, calling for parents. Others suffer from sleep disorders -- sleepwalking, nightmares and night terrors. Though most of these problems disappear by the time children reach adolescence, sleep habits may continue to be a point of contention between teen-agers and their parents if the child either sleeps too much or too little.

All kids suffer some type of sleep disturbance at some point in their lives. But for 1 in 5, the problem is persistent, according to the Virginia-based Better Sleep Council, an educational organization funded by the bedding industry.

Children's sleep needs have not changed substantially from past generations, but the hours they and their parents keep have. The advent of electricity, television and round-the-clock lifestyles have contributed to a national sleep debt.

"What has changed is our society," says Nancy Butler, a spokeswoman for the Better Sleep Council. "Over the last century we have been steadily cutting back on our sleep time, so now we are sleeping 20 percent less than what our grandparents were. If you're a mother and a breadwinner, you're already shaving time off from your sleep. So when your kids have problems sleeping, you don't have the tolerance to deal with them."

Night wakings are the most common problem among children 3 and younger, from babies who can't find their pacifier in the crib to the toddler who is frightened of the dark. A child will wake up in the middle of the night -- as we all do -- and not be able to soothe himself back to sleep. This could happen several times a night, wreaking havoc with a parent's rest.

What's a weary parent, torn between compassion and the craving for sleep, to do? That depends, in large part, on the age of the child. The crib years

For older babies who sleep in cribs, many pediatricians recommend a method introduced by Dr. Richard Ferber, director of the Center for Pediatric Sleep Disorders of Children's Hospital in Boston. After a parent checks that the child is fine -- not in pain or uncomfortable from a soiled diaper -- Dr. Ferber tells parents to let the baby cry for five minutes before returning to the room. Parents should then reassure the child they are nearby, but they should not pick him up.

If the child continues to cry, the parent can return to the room in 10 minutes and then in 15-minute intervals thereafter until the baby falls asleep. In subsequent nights, parents should increase the amount of time they wait before going to check. In theory, the baby will learn to cry less each evening and sleep through the night in a few days.

Some parents swear by this method. Kathy O'Such used it to get her oldest, Erin, now 9, to fall asleep when she was about a year old. "It took three days, so it wasn't too bad," Ms. O'Such recalls. "But I remember the cries were gut-wrenching for me. I knew they weren't cries of pain, but it was hard to take anyway."

Other mothers, however, aren't sure the Ferber method is for them. They are haunted by the age-old question: Are we spoiling children or are we simply meeting their needs? They believe that by answering a baby's cry quickly, whether during the day or in the middle of the night, she will grow up more secure and eventually wean herself from Mommy's help in a more natural way.

Elizabeth Rhodes says she followed her doctor's orders with Heather, the oldest of her three children. "I was told to let her cry it out, so my oldest was the one left to cry the longest. Now she's the one with the worst sleeping pattern. With my youngest two, I comforted them or my husband held them and rocked them, and they sleep through the night without a problem."

Dr. Ferber warns that too often his technique is recommended when it shouldn't be. The method, he says, should not be used on children younger than 4 to 6 months, nor on every child.

"The technique is not meant to be a universal cure," Dr. Ferbesays. "The first thing you have to determine is why they are not sleeping well. You should only use it with kids who have normal sleep patterns. It's not for kids who have nightmares or sleep terrors."

Toddlers need limits

As the baby becomes a toddler, then a preschooler, nighwakings are likely to disappear, but other sleep problems may emerge. Bedtime resistance begins to show up in most children 2 or older. This problem can be aggravated by parents who do not enforce a set bedtime every night or who unknowingly stimulate the child at a time when he should be winding down. This happens more often when both parents work, experts say. Eager to spend time with Johnny or Suzy, Mom and Dad roughhouse after dinner or allow the children to stay up later than they should.

"Flexible bedtime is the rule in America," says Dr. Charles Schaefer, director of a sleep counseling center for parents at Fairleigh Dickinson University in New Jersey. "And it's impossible to enforce a flexible rule. We've become more permissive over time and in something like this it's important to be firm. There should be a regular wake-up and bedtime hour."

Dr. Duray of Miami Children's Hospital says he often must insist that parents set limits. "I see a lot of sleepy kids here, and I have had several where one parent gets home late at night and wakes the child up to play. When the parent wants to change that, it can be hard. It's learned behavior," he says.

What can parents do? First, check how much sleep a youngster gets in a 24-hour period. If she is taking a long nap in the afternoons, she may not need to go to bed at 8 p.m. A bedtime of 10 may be more appropriate. Or, insist on a shorter nap for toddlers.

"Move the bedtime to when the child is actually feeling sleepy," Dr. Ferber says. "What use is it to put a child to bed at 7 p.m. when it really should be 9 p.m.?"

Once you figure out the right time, be firm about it. Then, if you haven't already, create a winding-down period that begins about an hour before bedtime. This will provide your child with the predictability of a daily bedtime ritual. Some parents try music, while others read books.

Once the child is in bed, make it clear that this is your final goodbye. If he ventures out of the room, escort him back -- without reprimands or extra hugs. But also understand that darkness is scary, so leave a nightlight on if the child wants it. Keep the door to the room open so the child doesn't feel isolated.

Debbie Roberto has set up a bedtime ritual with her 2 1/2 -year-old daughter, Christina. "I lie down with her, scratch her back, do whatever she wants," Ms. Roberto says. "They grow up so fast that I really enjoy that time I spend with her. I look forward to it. And if I'm not home, her father does what I would do."

Christina now sleeps through the night alone in a queen-size bed. But when she was 6 months old and waking through the night, Ms. Roberto decided to bring her into her bed, where she continued to sleep every night for about a year and a half. "I didn't want to hear her cry, so I followed my instincts," Ms. Roberto explains. "Bringing her to bed felt very natural."

Yet sharing the parental bed is often frowned upon. Olga Ramon, a Florida teacher, lets her 2-year-old, Eric, sleep with her and her husband.

"I get a lot of raised eyebrows," says Ms. Ramon. "I hear a lot, 'You're spoiling him. He shouldn't be sleeping with you.' But we don't mind. He doesn't kick. He cuddles with us."

Some experts say all the hoopla about "the family bed" is much ado about nothing. "Either way is fine," Dr. Ferber says. "It's really up to the parents. If the family has decided on this and not forced into it by not being able to get the child out, then it's not a problem."

Dealing with nightmares

While sleep disturbances decrease with age, some may persist into pre-adolescence. About 10 percent to 15 percent of children between the ages of 5 and 12 walk in their sleep at least once. Six percent do so once a week or more.

If you spot a sleepwalker, try not to startle the child. If possible, lead him gently back to bed without waking him. Also make sure that the environment is as safe as possible by locking windows and doors, installing protective gates at stairs and hiding dangerous objects.

Nightmares are also a common occurrence in children, particularly before age 7. Usually they reflect the emotional concerns of childhood -- toilet training, aggressive play, separation and even sexual impulses. The best response is reassurance -- a hug and kind words -- in the middle of the night.

If nightmares are persistent, however, they may point to more serious emotional problems. Parents should consult their pediatrician.

Nightmares are different from night terrors, when children awaken abruptly, usually with a scream of panic. This usually happens to kids between 3 and 8 years old. Though night terrors may frighten a parent, the child frequently doesn't remember the episode and is only partially awake. The cause of night terrors is not fully understood. "Unfortunately," Dr. Ferber says, "there's not too much parents can do about them."

SLEEP REQUIREMENTS

Experts offer these guidelines on how much sleep a child needs:

* Children under 1: 13 1/2 to 16 1/2 hours, including naps

* Toddlers (1 to 3): 12 to 13 3/4 hours, usually with one daytime nap

* Preschoolers (4 to 6): 10 3/4 to 11 1/2 hours (with no daytime nap)

* Grade schoolers (6 to 12): 9 1/4 to 10 3/4 hours a night

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