By: Tracy G. Cassels
Wendy Middlemiss
John Hoffman
Darcia Narvaez
Sarah Ockwell-Smith
Kathleen Kendall-Tackett
Helen Stevens

Infant sleep problems are some of the most common concerns reported by parents of young children.  Ask any new parent and most will complain about lack of sleep. Many will also be worried that what they are experiencing isn’t “normal” and that they believe that their child has a problem that needs fixing.  So they search books, ask friends and family or even their doctor about what to do about their child’s problematic sleep patterns.  And to top it off, they feel immense anxiety and worry about it.  Part of this epidemic of parental angst about children’s sleep is that we live in a culture in which parents are repeated told that they need to worry about their child’s sleep, that there will be dire consequences if their child doesn’t get enough sleep. Another problem is that most new parents, having had little experience with children prior to having their own, have little awareness about what truly is “normal” when it comes to infant sleep.

Simply being made aware of normal sleep patterns can help alleviate the stress and anxiety parents feel, leading to happier times for the entire family.

So what is normal?

In this series of posts, we’ll tackle some of the more common sleep concerns parents have with the hope that they can see them as normal, developmental stages for their child.

 PART 1: THE CRITICAL ROLES OF FEEDING METHOD AND CHANGES IN DEVELOPMENT

PART 2:  THE IMPORTANCE OF UNDERSTANDING INDIVIDUAL PATTERNS IN SLEEP

“My child wakes up at 2am and is up for 1-2 hours!”

One of us remembers very clearly the first time her daughter ended up doing this.  At around 14 months, she woke up in the middle of the night and didn’t seem ready or able to go back to sleep for one to two hours no matter what strategies her parents tried.  This continued regularly for a couple months.  And then as quickly as it started, it stopped and hasn’t happened again in over a year.

The “why” of this is relatively unknown—although researchers are continuing to explore the physiological underlyings of sleep—but we do know that extended night wakings like these are experienced by many children until around 3 years of age (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).  Many times the wakings are brief and the child settles quickly. Other times settling takes longer. In either case, these wakings do not readily suggest your child has a sleep “problem”.  Increased night wakings, call-outs, and crying are more common around 6 months of age or so, and again as infants near 2 years of age. These wakings may simply be one (of many) manifestations of separation anxiety experienced by the child—a normal change resulting from infants learning that they exist separately from their caregivers (for a review, see Middlemiss, 2004).

Some argue that night wakings in toddlerhood are reflective of sleep problems, but these opinions are based on criteria that do not necessarily reflect the realities of infant sleep.  Several studies found that night waking is relatively common between age 12 and 24 months (Richman, 1981; Goodlin-Jones, Burnham, Gaylor, & Anders 2001; Scher, 2000; Weinraub et al., 2013). Thus, a parent’s perceptions about what constitutes a sleep problem may be triggered by either a disconnect between expectations of uninterrupted sleep and a toddler sleep pattern that arguably falls within the range of normal, or by the impact that night waking has on the parent’s quality of sleep and daily functioning (Loutzenhiser,  Ahlquist, & Hoffman 2012).  However, although changes in sleep patterns may be inconvenient and frustrating, they are normal occurrences in the context of a healthy parent-child relationship. When viewed as indicating problematic, rather than normal, sleep patterns that will come and go, parents can experience greater stress and worry (Middlemiss, 2004). As we have learned from many parents, understanding that these night wakings are normal can go a long way to making them more bearable.

 

“My child won’t go to sleep before 10 pm.”

It is not uncommon in some parts of Western societies to assume that infants and young children must be in bed by, for example, 7 pm to develop good sleep habits.  Unfortunately, that’s just not the reality for many families and it’s not because parents are negligent in getting their infants to bed, but because some children simply have a different circadian rhythm or a later schedule may work for the family.  Some children will continue this pattern into their toddler years and beyond.

Cross-cultural data on bedtimes for infants and toddlers shows that later bedtimes are actually quite frequent in predominantly Asian countries (Mindell, Sadeh, Wiegand, How, & Goh, 2010).  Whereas the mean bedtime for children in predominantly Caucasian countries was found to be 8:42 pm, it was a full hour later for predominantly Asian countries (with a mean at 9:44 pm), with the latest mean bedtime being 10:17 pm in Hong Kong.  Notably, the rising time was also significantly later in these countries.  A concurrent finding was that the vast majority of children in predominantly Asian countries sleep either in the parent’s bed or room.  Thus children who sleep with their parents may naturally have a sleep schedule closer to their parents owing to the sleeping arrangements.

What is important to remember is that a late bedtime in and of itself is not a problem.  If it poses a problem for the family as a whole, then parents may want to adjust the bedtime routine (Mindell, Telofski, Weigand, & Kurtz, 2009) or start the routine earlier in small increments in order to gradually move to an earlier bedtime (Richman, 1981).

 

“My child sleeps less than (or more than) the recommended amount no matter what I do!”

Most people have seen the “sleep guidelines” about how much sleep our children need at various stages.  Parents are told that newborns should sleep around 16-18 hours, that at two years of age, children require a total of 13 hours sleep, and so on.  When researchers explore questions of how long infants and children should sleep and what are healthy recommendations, the answers are not particularly clear and are often based on examining how much children are sleeping at different times in history (Matricciani, Olds, Blunden, Rigney, & Williams, 2012).

As parents it is important to remember that they are recommendations.  Each child is different and the recommendations may not fit every child.  Some will require much more sleep and some will require less.  If a child is truly sleep deprived, there will be noticeable signs.  Signs of sleep deprivation include rubbing eyes, looking dazed and not focusing on people or toys, becoming overly active late at night, and having a hard time waking up in the morning.  By paying attention to your child and his or her cues and behaviours, you will be able to tell if your child is getting enough sleep, regardless of the exact number of hours your child sleeps.  Sleep is important, but there are many ways to get it apart from one long, uninterrupted stretch.

*Interestingly, researchers are now telling us that waking in the middle of the night is common in adulthood and was viewed as normal in past eras—the “first sleep” lasted about 4 hours with an awake period in between followed by a “second sleep” of another four hours (for more details, see here and the book: At Day’s Close: Night in Times Past by Roger Ekirch (Norton 2005).

Click here for Part 3 which deals with normal parent behaviour and why it’s not bad!

[Image Credit: Bebo Mia]

References:

Goodlin-Jones, B. L., Burnham, M. M., Gaylor, E. E., & Anders, T. F. (2001). Night waking, sleep-wake organization, and self-soothing in the first year of life. Journal of developmental and behavioral pediatrics: JDBP, 22(4), 226.

Loutzenhiser, L., Ahlquist, A., & Hoffman, J. (2011). Infant and maternal factors associated with maternal perceptions of infant sleep problems. Journal of Reproductive and Infant Psychology, 29(5), 460-471.

Matricciani, L. A., Olds, T. S., Blunden, S., Rigney, G., & Williams, M. T. (2012).  Never enough sleep: a brief history of sleep recommendations for children.  Pediatrics, 129, 548-556.

Middlemiss, W.  (2004). Infant sleep: a review of normative and problematic sleep and interventions.  Early Child Development and Care, 174, 99-122.

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. T. (2010). Cross-cultural differences in infant and toddler sleep.  Sleep Medicine, 11, 274-280.

Mindell, J. A., Telofski, L. S., Weigand, B., & Kurtz, E. S. (2009).  A nightly bedtime routine: impact on sleep in young children and maternal mood.  Sleep, 32, 599-606.

Richman, N.  (1981a).  A community survey of characteristics of one to two-year-olds with sleep disruptions.  Journal of the American Academy of Child Psychiatry, 20, 281-291.

Richman, N. (1981b).  Sleep problems in young children.  Archives of Disease in Childhood, 56, 491-493.

Scher A. (1991). A longitudinal study of night waking in the first year. Child: care, health and development. Professional Care of Mother and Child, 17(5), 295-302.

Weinraub, M., Bender, R. H., Friedman, S. L., Susman, E. J., Knoke, B., Bradley, R., Houts, R., & Williams, J. (2012).  Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age.  Developmental Psychology, 48, 1511-1528.