Children are all different.
Sleep problems are quite common in this age range. Common problems include: separation anxiety, night-time fears and nightmares. Problems that you may have experienced when they were infants can also return. Sleep habits change as the child develops and in order for children to get enough sleep, their daily routines need to match their developmental stage.
How much sleep does my child need?
All children are different which means that some children will sleep more and some will sleep less.
From 12 months to 3 years: children need between 12-13 hours per day over a 24 hour period with one long overnight sleep and 1 to 3 sleep/s during the day depending on their individual needs. Some children will not require a day sleep. If your child is happy and displays no tired signs or cues your child may not require a day sleep. A short `nap’ or quiet time may be sufficient.
Tired signs or cues
When your child becomes tired or overtired, behaviour can become irritable, overactive and/or demanding. Respond to your child’s’ tired signs or cues by introducing a quiet time to wind down (reducing activities and decreasing stimulation) in preparation for sleep.
Sleep cycles
The sleep-wake cycle, is the time spent going through both deep (quiet) and light (active) stages of sleep. Between each sleep –wake cycle, children rouse/wake briefly then resettle to sleep. A sleep cycle from four (4) months to being a toddler is around 30 to 50 minutes, increasing to 60-90 minutes for a preschooler.
Sleep Associations
Sleep associations create the conditions under which children can fall asleep. Sleep associations can either be helpful or unhelpful. Some children are dependent on their parents to help them fall asleep. These children may have difficulty self settling and resettling unless the same conditions for settling are met. For example, if your child needs a complicated routine to fall asleep such as a breast feed, bottle and/or dummy, after one sleep cycle your child may wake and need this process repeated to settle.
Preparation for sleep
Bed time routines
Your child is strongly influenced by their environment, daily activities and routines. A predictable bedtime routine (sequence of activities) including a wind-down period (for example, meal, bath, cleaning teeth, story time, brief cuddle and kiss, and into bed) is important to help your child recognise and establish good sleep patterns.
When assisting your child develop a sleep pattern it is better to use levels of distress as your guide to comfort your child rather then a time schedule. In preparation for sleep, a bedtime routine (depending on day or night) encourages a wind-down period and ensures that your child’s physical needs are met such as.
- Bath time
- Clean nappy
- Clean teeth
- Dim lighting
- Talk quietly, gentle song, cuddle, story time tuck/wrap depending on age
- Kiss and say goodnight
- Ensure your child is adequately clothed especially for the night e.g. warm pyjamas, enough blankets or a sleeping bag.
- Having a favourite small soft toy or similar in the cot/bed may provide comfort
- If in a cot ensure that the sides are up and securely in place
Settling Options
Comfort Settling
Comfort settling provides your child with reassurance and support while also providing an opportunity for your child to discover their own way of going to sleep.
Following a bedtime routine as above:
1. Talk quietly, reassure child i.e. 'good night it is time for sleep’ to encourage a state of calm
2. Position your child on their back in the cot/bed awake [calm/drowsy]
3. Comfort your child providing verbal reassurance in a calm firm voice ‘time for sleep’ rhythmic patting, or stroking
4. As your child calms, move away from the cot/ bed or leave the room
5. Listen to your child’s level of distress (intensity of cry)
6. If your child is not calming return to the room using a calm voice provide reassurance (steps 3), then lay him/her down and tuck in the bedclothes move away from the cot/ bed or leave the room
7. You may have to repeat steps 1-6 several times before your child responds
8. During the day if your child does not respond pick your child up, cuddle until calm then either
- Reattempt comfort settling (steps 1-4)
- Stay with your child until asleep
- Get your child up, continue with daily routine and try again at the next sleep time
9. During the night if your child does not respond continue (steps 1-6) providing comfort / reassurance however if your child remains distressed you may need to consider other options. Such as:
- Picking your child up and cuddle until calm
- Offering a drink of water (cup)
- Staying with your child until they are asleep
The length of time it takes to calm your child will decrease as your child learns to settle.
Self settling
Following a bedtime routine as above:
Prepare your child for sleep as per steps 1 to 3 above.
10. Leave the room promptly allowing the child the opportunity to self settle
11. If your child is not calming, return to the room using a calm voice provide reassurance (step 3), then lay him/her down and tuck in the bedclothes, then leave the room
12. Continue reassuring your child intermittently by comforting in the cot/bed for brief periods until calm and leaving the room for slightly longer periods
13. You may have to repeat the steps several times before the your child responds
14. The length of time out of the room is dependent on your child’s level of distress and your capacity to wait and listen for crying to reduce
15. During the day if your child does not respond pick your child up and cuddle until calm then either:
- Reattempt (steps 1,2, 3,10, 11 and 12)
- Staying with your child until asleep
- Getting your child up, continue with daily routine and try again
16. During the night if your child does not respond continue (steps 1-6) providing comfort / reassurance however if your child remains distressed you may need to consider other options. Such as:
- Picking your child up and cuddle until calm
- Offering a drink of water (cup)
- Staying with your child until they are asleep
The length of time it takes to calm your child will lessen as your child learns to self settle.
Gradual withdrawal
This option helps children who may find self-settling too difficult for various reasons such as co-sleeping or high levels of separation anxiety. Following a bedtime routine as above:
Prepare your child for sleep as per steps 1 to 3 above.
17. Remain in close proximity allowing your child to fall asleep with a parent in view. (e.g. chair beside the bed or sitting on the bed)
18. Over time the distance between you and your child is gradually increased as your child gains confidence and the ability to fall asleep without you present.
Parental presence
You may prefer this option if your child is over 6 months of age and has not been separated from you at sleep time. Following a bedtime routine as above:
Prepare your child for sleep as per steps 1 to 3 above.
19. Once calm lie down or sit beside the cot within sight of your child and pretend to be asleep
20. If your child remains awake, give a little cough or quietly ‘ssshhh time to sleep’ signalling you are still in the room
21. If your child becomes distressed respond with the minimal action required to calm your child and repeat steps 19-20
22. Stay in the room until your child is asleep during the day and sleep in the same room as your child throughout the night
23. This continues for at least 1 week or until your child has 3 consecutive nights of relatively uninterrupted sleep. You can now begin to leave the room before your child is asleep.
Transition from cot to bed
Moving into a bed is an exciting step towards being an independent grown-up. Make sure your child knows how proud you are of them sleeping in a bed.
- A new ‘big bed’ routine may help with this transition
- Have quiet time before bed. Pack away toys and prepare the bedroom as a place of quiet rest, rather than somewhere exciting
- Encourage your child to climb into bed by them self
- Provide verbal reassurance ‘time for sleep’
- Tell your child what you expect from her/him and what is going to happen next. In a calm firm voice give positive instruction , ‘It’s time to go to sleep – see you in the morning,’ this makes bedtime seem less scary
- Pull up bedcovers and arrange soft toys as your child wants
- Keep a familiar blanket from the cot this might also make your child feel more secure.
General Safety issues
Pillows are not recommended for children under two. They can increase the risk of suffocation, and should only be introduced with caution.
- Ensure the cot sides are completely raised whenever the child is left unattended in the cot.
- Don’t leave toys in the cot that can be used to climb over the cot sides
- It is important to choose options that are safe and suit you and your child. If your child does not calm [during the day] after an attempt to settle and becomes too distressed, get your child up and continue your daily routine. If your child remains unsettled ask for help from family, friends, the Child and Family Health Nurse or local doctor.
For all young children
There are three main ways to reduce the risk of SIDS:
- Put your child on their back to sleep, from birth;
- Make sure your child’s head remains uncovered during sleep.
- Keep your child smoke free
No comments:
Post a Comment