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By Dr. Adam Aronson, father of 5, still working to get his kids to sleep efficiently
Adam Aronson, MDSleep – for many parents and children it is a topic that generates stress and frustration.  Families understand that sleep is important for growing bodies and brains, so parents read books and hire sleep trainers and will try almost anything to get a their kids to bed.  And as all parents quickly learn – if their children are not sleeping well, neither are they.  How do we get kids ready for bed, what time should they go to sleep, how many hours do they need, what do I do if they wake up or cry?    These are some of the most common questions that parents want to discuss when they bring their children for routine check ups, and in this month’s medical memo we hope to tackle some of these difficult topics.

Establishing a bedtime routine

One of the most critical parts of good sleep hygiene is establishing a bedtime routine.  Children are creatures of habit and having a regular bedtime is very important.  This time must be concrete and consistent.  There should be a 30 minute period before bedtime that is set aside for “winding down”.  Children should be alerted that this winding down period has arrived. Computers, TVs, video games, and all electronics should be turned off and there should be no food, drink, or active play during this time.  Parents can accompany their children to the bathroom to help with using the toilet, washing up and brushing their teeth.  Find soothing activities such as reading a book or telling stories.  Kids can choose their pajamas and snuggle in with their favorite stuffed toy or security blanket.  Establish in their young minds that the bed is for sleep and not for play.   To this end, TV’s and video games should not be allowed in children’s bedrooms at any time.  When bedtime arrives – tuck your child into bed, remind them to stay in bed and kiss them goodnight.  Children frequently try to manipulate the situation – drawing things out with request for drinks or for their parents to lay down with them.  Parents need to provide comfort and reassurance, but children need to learn to sleep independently.  If a child cries – wait a few minutes before going in to check on them.  If they are afraid – it is OK to set up a nightlight and “check for monsters”.   This monster check can even be part or the nightly bedtime routine.  Remind your son or daughter that it is time to go to sleep and that you will come back to check on them in a few minutes.  And of course they should get lots of praise and positive feedback in the morning when they cooperate with bedtime and stay in bed.

How many hours?

It is important to remember that every child is a unique individual – and some children need more sleep that others.  These needs can vary depending on age, stressors, illness, daytime pressures but there are general guidelines based on age that parents can work towards.
0-6 months:  Newborns generally sleep for 15-20 hours a day, but their internal clocks are immature and not fully developed.  Their sleep will be in stretches of up to 3-4 hours, depending on their feeding schedule.  By 3 months the amount of sleep is closer to 13-14 hours a day, and many are sleeping as long as 6 hour stretches at night.   Try to get your baby into their crib before falling asleep.  They are not too young to start establishing bedtime routines so be consistent with time, environment and soothing activity.
6 – 12 months:  By this age the babies can sleep for up to 10 or 11 hours at night.    They will also typically take 2 or 3 naps during the day.  When putting them to bed, parents can allow for a little more time allowing them to settle be softly talking or rubbing their backs.  They can be comforted if they are fussing, but do not pick them up.  Parents also need to be aware that during this age range their babies can be expected to go through a period of separation anxiety.  This a normal developmental phase, and it is critical for families to avoid turning on lights, feeding or playing with their child, and picking them up.  These activities will encourage repeated awakenings and limit the child’s learning to fall asleep on their own.  Of course if a child is sick – these rules can be modified and the child can be picked up and cared for.
Toddlers:  Parents can expect 10-12 hours of sleep for this age group.  The bedtime routine becomes even more important at this time, as these children tend to find creative ways to try to stay up later and have strong inclinations to want to stay up and not to miss out on night time activities.  One helpful strategy is to allow the child to have a sence of control by allowing them to choose which pajama to wear or what books to read.  Active dreaming begins in this group, and for young children this can be very alarming as they have trouble distinguishing dreams from reality.  When they wake up frightened by a nightmare it is appropriate to go into their room to holds and comfort your child.  Allow them to talk about the dream to help them calm down, then encourage him or her to go back to sleep without prolonged awake time.
Sleep is such an important part of childhood and it warrants the effort parents put into it.