Sleep 

Many parents consult us for child sleep problems. It may come as a surprise to some people that sleep in children is a big stressor for parents. Yet, acquiring good sleep habits is not always as simple as you may think. 

Sleep is essential for your baby's health and development. While asleep, the brain is hard at work. Memories are forming, the brain is processing the day's events, the immune system is strengthening and growth hormones are being released. Sleep cycles evolve as the baby develops. Each stage of the sleep cycle is important and has it's own purpose. 

Right from birth, you can put in place certain elements that will encourage good sleep habits. For example, place your baby in their bed at night, in a dark room. For naps, place them in their bed aswell and dim the lights. Don't stop yourself from making noise during naptime. Your child will learn the difference between daytime naps, and nighttime sleep much faster if you continue to make noise during the day, while eliminating noise at night. Once you notice that your baby is tired but awake, put them in their bed so that they fall asleep under the same conditions every time. If they start to cry, stay near them to caress and calm them. Try as best as possible not to associate breast or formula feeding with sleep to avoid creating this difficult to break habit. 

Yawning, rubbing of the eyes, impatience, irritability and crying are all signs that your little one is ready to sleep. Don't wait too long before putting them to bed; ideally within 20 minutes. An overtired baby has a harder time settling down to sleep. 

A baby's cries don't carry the same significance as an adult's cries. Your baby's only method of communication is to cry to express their needs and frustrations. They simply do not have the verbal ability yet to express themselves in any other way. When your child cries in their bed, you can go to them to reassure and calm them at regular intervals so that they don't feel completely abandonned. Keep in mind that learning to sleep is the same as learning to speak or to walk. It takes time and effort. Pick a sleep training method. Your child will protest; this is normal. Does your child cry so hard that they vomit? Change their clothes and the bedding without giving them too much attention to avoid encouraging them to start all over again. Then, go back to the sleep training method of your choice and persevere. Whatever sleep training approach you decide to use, it must align with your values and not be influenced by social pressure. 

There are two types of co-sleeping: 1) the child sleeps in their parents room, in their own bed, 2) the child sleeps in the parents bed. The Canadian Pediatric Society recommeds that a baby sleep in the same room as their parent, but in their own bed up until six months of age. Once you decide it's time for baby to sleep in their own room, the change will need to take place for both naptime and bedtime. It will take a few days for your baby to adapt to their new environment. They will protest and cry. In comforting them and engaging in sleep training, your baby will end up adjusting just fine. 

The 5-10-15 technique is a sleep training method used to help your baby learn to fall asleep on their own. There will be tears along the way, so be prepared. 

After going through your baby's bedtime routine, put your child in their crib with their pacifer or teddy and stay with them in the room for 5 minutes. Go to their crib briefly, without picking them up, speak to them softly and confidently and tell them to go to sleep while petting their back. After 5 minutes, leave the room. Go back to see them 10 minutes later, repeating the same soft spoken words as before, (ex. go to sleep my love). Repeat this every 15 minutes until they fall asleep. If your baby wakes up in the middle of the night, start the process all over again from the beginning until they fall asleep on their own again. With each subsequent night, increase the time it takes for you to go back into their room by 5 additional minutes. Repeat for 1 week. You will not traumatize your child if you let them cry a little. They will learn quickly that they can fall asleep on their own and that you will still be there for them. 

This method is efficient, but it may not be suitable for everyone. You will need to be able to tolerate your baby's cries and be as determined as they are. 

Here are three other sleep training options you may want to try instead. You can reduce the wait time from 5-10-15 to 1-3-5 or 2-4-6, if you have a hard time hearing your baby cry for long periods. 

Another option would be to stay in your baby's bedroom, without interacting with them. Place a chair near their crib and night after night move the chair a little farther away from their crib until you eventually are sitting outside their bedroom. You essentially become a silent reassurant presence for your baby. Once your chair is finally out of the bedroom, tell them that you will be waiting outside while they are in their bed. They will likely be able to sleep on their own at this point. You can also tell your baby that you are leaving their bedroom and will come back later to check on them. Keep your word; babies respond well to consistency. 

A third option is for children 2 years and older. This is the door open technique. If the child stays in their bed, the door remains open. If not, the door is closed. 

The transition from crib to toddler's bed happens around age 2. At this age, your child is starting to exhibit assertiveness. They can therefore become oppositional and defiant once they realize that they can get out of their bed on their own. They need to understand from the very beginning that once the bedtime routine is complete it's time for bed and they must stay in their bed. 

It helps to always repeat the same message, ex., you will stay in your bed. Bring them back to their bed without any other explanation or display of affection. If they get up several times, stand at the door to their room and the first toe that leaves the bed, say: you will stay in your bed. Maintain a determined and confident tone and look in your eyes until your child tires themselves out. You can impose a consequence if they ignore your request and get out of bed nonstop. You can also place a baby gate at the door to prevent them from leaving their room. Don't worry, your child will eventually fall asleep. 

By the early age of 1 month, your baby has already developed the neurological capacity to sleep 6 hours straight. At 3 months they can sleep nine hours without interruption, and by 6 months they can sleep up to 12 hours. 

From 0-6 months: Respond without too much delay to your baby's needs. 

From 6-12 months: Generally speaking, your baby won't need anymore night feedings. If they are healthy and their diaper isn't spilling over, you can wait for them to fall back asleep on their own. If they have trouble falling back asleep, you can go see them and reassure them with a soft and firm tone without picking them up out of their crib. You don't want to reinforce the behaviour of being picked up. Stagger your visits to their room until they fall back to sleep. 

From 12-18 months: At this age, nighttime wake ups are usually related to an event, such as the arrival of a newborn sibling, a move, a divorce, a death etc. These nighttime wake ups require more delicacy and patience on your part. If your child is ok, don't rush into their room. Give them a chance to fall back asleep on their own. 

2 years and up: At this age, children are typically sleeping in a toddler's bed. They try to demonstrate and develop their independence and their assertiveness by getting out of bed. Each time this happens, use a soft but firm tone and bring them back to their bed. 

By the age of 6 months, if your child is only able to fall asleep with movement from the stroller or the car, it's time to teach them to fall asleep in their crib. Get ready for some tears of frustration. It may take up to 2 weeks for your baby to learn this new way of napping. During this time, it's helpful to stay home as much as possible to get this new routine engrained in your baby's mind. You can choose from one of the sleep training methods we discussed earlier to get them to fall asleep on their own in their crib. 

By 6 or 7 months, the end of day nap disappears on its own. Your baby will no longer feel the need to recuperate their energy at this time. Progressively, your baby's naptime will come earlier in the day and your baby will demonstrate signs of fatigue later in the evening. 

By about 12 months, the morning nap is no longer very useful. You can schedule the afternoon nap earlier in the day. The length of the nap depends on your baby and the home environment. 

By 3-5 years of age, some children don't really feel the need to nap anymore. 

In case you were wondering, changing a child's naptime will not affect the hour at which they wake up in the morning. 

By the age of 4 to 6 months, nighttime feedings are no longer necessary as your baby has developed the neurological maturity that makes them capable of sleeping several hours without food. Around this age, babies also start consuming solid foods which will leave them satiated at night. According to experts, the increase in daytime feedings meets their caloric and energy needs. Consult with your doctor before cutting out nighttime feedings to determine where along the developmental curve your baby sits. You doctor will give you the green light based on your baby's overall health.

To decrease nighttime feedings, space them out. Start by eliminated one nighttime feeding and gradually decrease the time you breastfeed or the amount of milk in the bottle. Try to avoid allowing your baby to fall asleep while feeding. Find a transitional object like a pacifier or a teddy to comfort them. 

"My baby falls asleep in my arms but the moment I put them down in their crib, they wake up." This is a very common sentence voiced by parents. For your child to learn to fall asleep on their own, the bedtime routine needs to be structured and consistent to help your baby learn that it's time for bed. Ideally, the routine should take place in the calm of your baby's bedroom so that they associate their room and the routine with bedtime. Pay attention to signs of fatigue and put them in their crib while drowsy but still awake. 

"My child never falls asleep on their own at night, while at daycare he easily falls asleep on his own during naptime." This is good news! Your child has demonstrated the ability to fall asleep on their own. It is just a matter of time before they start to do the same at nighttime. If your baby eats enough to meet their nutritional and caloric needs, and they are in good health, they will be able to learn to fall asleep on their own with time. 

In order for your child to know how to fall back asleep on their own when they wake in the middle of the night, they need to have learned to fall asleep on their own at bedtime. When a baby wakes up in the middle of the night, they need to find themselves in the same place as when they feel asleep. That means that if your baby falls asleep in your arms but wakes up in the crib, they will be confused and search for your arms. Studies have shown a significant link between these situations. 

As your child gets older they will experience different challenges that can affect their ability to sleep through the night, for example, illness, a change of room or bed, the arrival of a newborn sibling, a divorce etc. 

You can try placing many pacifiers in their crib to facilitate them finding one in the middle of the night. However, if they are unable to find any of them, they will start to cry. You will have no choice but to get up to help them find the pacifier. A helpful hint, keep a few pacifiers by your bed to avoid having to stumble in the dark to try to find a pacifier that has fallen from the crib. Don't fret, this is temporary. Soon enough, your baby will be able to find and grab the pacifier in their crib on their own. 

The transition usually occurs around the age of 2 once a child has learned to get out of the crib on their own, or if a newborn sibling is on the way. Try to maintain the same bedtime routine: bath, snack, brushing teeth, story, pee pee, hugs and time for sleep. The transition to a toddler bed usually happens easily as the child is often proud of his new big kid bed. 

Some children need less sleep than others. If they are normally following along their growth curve and have no medical condition, then you have nothing to worry about. Each child is unique and follows their own sleep rhythm! There are many charts available online that indicate the average number of hours a child should sleep per day, but these are general guidelines that may not necessarily correspond to your child's sleep needs. Getting to know your child's signs of fatigue will help them respect their biological clock, and will help you structure their nap and bedtime schedule. 

Illness often has a negative impact on sleep. If your child has a cold, an ear infection, fever, congestion etc, they will likely wake up several times at night. If as a parent, you tend to your child to comfort them, sleep with them or bring them to your bed to sleep, you will affect their sleep habits. Once healed, your child will continue to want to get your attention at night to fall asleep and stay asleep. You will need to return to your sleep training method of choice to encourage them to fall back asleep on their own. 

You want to teach your baby to fall asleep on their own using sleep training, but you don't want to disturb your other child who sleeps in the same room. Explain to your older child what you are planning to do and what will be the potential consequences on their own sleep. If the baby's cries wake up the older sibling, you may want to let them sleep in your room until sleep training is complete. Let your older child know that this is an exceptional circumstance and that once the baby has learned to fall asleep and stay asleep, the older child will return to sleeping in their own bed. 

Find out why your child keeps coming into your room in the middle of the night. If it is only because of a bad habit, bring them back to their room and softly but firmly tell them: It's nighttime, which means it's time to sleep in your own bed. Always repeat the same message, night after night. Your child needs to understand that they have nothing to gain from getting up in the middle of the night. Don't succumb to the temptation to let them sleep next to you in bed. If you do, you're opening the door to letting them try again another night. 

You can try hanging a bell from the doorknob of their bedroom door so that you hear it ring when they leave their bedroom. If your child is old enough to understand, explain the dangers associated with their nighttime strolls. 

Between ages 3 and 6, children with a very expansive imagination can develop night terrors which they experience right after falling asleep. To overcome this fear, give your child the power to confront their fears by using their fertile imagination. For example, suggest to your child they have a magical, colorful water vapor that can push away monsters. Or, that they have a styrofoam sword to fight night villains. This usually leads to good results. If, however, the situation persists, remain in their room for short periods to reassure them, and then progressively decrease the amount of time spent in their room. If the fears persist or worsen, you may want to consider consulting a professional. 

A nightmare is a bad dream. Your child will wake up on their own, scared, and will tell you about their dream. They may not want to fall back asleep right away out of fear of reliving their nightmare. You can help them control their fears by tapping into their imagination. If, during the day, your child speaks again about their nightmare, try to normalize the situation and reassure them. If they don't talk about their nightmare, don't be the one to bring it up. 

During a night terror, your child is asleep but they may move, speak, scream and can even have their eyes open with a blank stare. If you speak to them, they will not be able to respond or will respond in an incoherent fashion. The next day your child will have no recollection of their night terror. The episode may be brief, but can also last up to 30 minutes. Stay in their room to be a reassuring presence and make sure their surrounding space is safe as they are not in control of their movements. 

A child's sleep is biologically fragmented, as is the parents. To help yourself during this time of disturbed sleep, try to take 15-20 minute power naps to re-energize, or longer ones of around 90 minutes if necessary. If your nap falls in between these timeframes, you may feel disoriented upon waking up as your sleep cycle is interrupted. 

REFERENCES :

LANGEVIN, BRIGITTE. Comment aider mon enfant à mieux dormir ?, éditions De Mortagne.

MARTELLO, ÉVELYNE. Enfin je dors et mes parents aussi, Édition du CHU Sainte-Justine

PENNESTRI Marie-Hélène, psychologue Ph. D. et chercheure, Marie Dumont, psychologue Ph. D. et chercheure, Julie Carier, psychologue Ph. D. et chercheure, De la berceuse à la berçante, conférence mai 2018

ARTICLES 

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Le sommeil : l’enfant qui se réveille la nuit, équipe Naître et Grandir, juillet 2017

Sommeil : efficace le controversé 5-10-15 ?, Kathleen Couillard, juin 2016

La Presse + : Le sommeil : et les parents, eux ?, mars 2016

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