Healthy Sleep Habits, Happy Child Read online

  ALSO BY MARC WEISSBLUTH

  Crybabies

  Sweet Baby: How to Soothe Your Newborn

  Your Fussy Baby

  This book is dedicated to

  Linda Weissbluth.

  Contents

  FOREWORD

  HOW TO USE THIS BOOK

  INTRODUCTION

  NEW INTRODUCTION TO FIRST HARDCOVER EDITION

  Part I. How Children Sleep

  Chapter 1. Why Healthy Sleep Is So Important

  Chapter 2. Healthy Sleep and Sleep Strategies

  Healthy Sleep

  Sleep Duration: Night and Day

  Naps

  Sleep Consolidation

  Sleep Schedule, Timing of Sleep

  Sleep Regularity

  Sleep Positions, SIDS

  The Benefits of Healthy Sleep: Sleep Patterns, Intelligence, Learning, and School Performance

  Sleep Strategies

  Drowsy Signs

  Soothing to Sleep

  Resources for Soothing

  Bedtime Routines

  Breast-feeding versus Bottle-feeding and Family Bed versus Crib

  Breast-feeding the Fussy Baby by Nancy Nelson, RN, IBCLC)

  Solid Foods and Feeding Habits

  Solutions to Help Your Child Sleep Better: “No Cry,” “Maybe Cry,” or “Let Cry”

  Prevention versus Treatment of Sleep Problems

  Action Plan for Exhausted Parents

  Chapter 3. Sleep Problems and Solutions

  Disturbed Sleep

  Sleep Log

  Morning Wake-up Time Is Too Early

  Morning Nap Is Absent, Too Short, Too Long, or at the Wrong Time

  Afternoon Nap Is Absent, Too Short, Too Long, or at the Wrong Time

  Third Nap Is Absent, Too Short, Too Long, or at the Wrong Time

  Needs Two but Can Get Only One

  Needs a Nap but Refuses to Nap

  Bedtime Is Too Late: Sometimes or Always a Battle

  Night Waking, Difficulty Staying Asleep

  More Than One Child Creates Bedtime Problems

  Unable to Fall Asleep

  Afraid of the Dark or Being Alone

  Will Not Stay in His Crib or Bed

  Will Not Sleep Anywhere Else

  Only One Bedroom

  Transition from Family Bed to Crib

  Action Plan for Exhausted Parents

  Chapter 4. Sleep, Extreme Fussiness/Colic, and Temperament

  How to Use This Chapter

  Introduction

  Sleep and Extreme Fussiness/Colic

  Temperament at Four Months

  Connecting Sleep, Extreme Fussiness/Colic, and Temperament

  Postcolic: Preventing Sleep Problems After Four Months of Age

  Summary and Action Plan for Exhausted Parents

  Part II. How Parents Can Help Their Children Establish Healthy Sleep Habits: You Can Prevent Sleep Disturbances from Infancy to Adolescence

  Chapter 5. Months One to Four

  Newborn: The First Week

  Weeks Two to Four: More Fussiness

  Weeks Five to Six: Fussiness/Crying Peaks

  Weeks Seven to Eight: Earlier Bedtimes and Longer Night Sleep Periods Develop

  Months Three to Four: Extreme Fussiness/ Colic Ends. Morning Nap Develops at 9:00 to 10:00 A.M.

  Preventing and Solving Sleep Problems

  Action Plan for Exhausted Parents

  Chapter 6. Months Five to Twelve

  Months Five to Eight: Early Afternoon Nap Develops at 12:00 to 2:00 P.M. Variable Late Afternoon Nap at 3:00 to 5:00 P.M.

  Month Nine: Late Afternoon Nap Disappears. No More Bottle-feeding at Night

  Months Ten to Twelve: Morning Nap Starts to Disappear but Mostly Two Naps

  Preventing and Solving Sleep Problems: Months Five to Twelve

  Action Plan for Exhausted Parents

  Chapter 7. Months Thirteen to Thirty-six

  Months Thirteen to Fifteen: One or Two Naps

  Months Sixteen to Twenty-one: Morning Nap Disappears

  Months Twenty-two to Thirty-six: Only a Single Afternoon Nap

  Preventing and Solving Sleep Problems

  Action Plan for Exhausted Parents

  Chapter 8. Preschool Children

  Years Three to Six: Naps Disappear

  Preventing and Solving Sleep Problems

  Action Plan for Exhausted Parents

  Chapter 9. Schoolchildren and Adolescence

  Years Seven to Twelve: Bedtime Becomes Later

  Adolescence: Not Enough Time to Sleep, Especially in the Morning

  Preventing and Solving Sleep Problems

  Part III. Other Sleep Disturbances and Concerns

  Chapter 10. Special Sleep Problems

  Sleepwalking

  Sleep Talking

  Night Terrors

  Nightmares

  Head Banging and Body Rocking

  Bruxism

  Narcolepsy

  Poor-Quality Breathing (Allergies and Snoring)

  Hyperactive Behavior

  Seasonal Affective Disorder

  Bed-wetting

  Chapter 11. Special Events and Concerns

  Changes with Daylight Savings Time

  New Sibling

  Twins, Triplets, and More

  Moving

  Vacations and Crossing Time Zones

  Frequent Illnesses

  Mother's Return to Work

  Home Office

  Dual-Career Families

  Adoption

  Injuries

  Overweight, Exercise, and Diet

  Child Abuse

  Atopic Dermatitis and Eczema

  Chapter 12. Competent Parents, Competent Child, by Karen Pierce, M.D.

  Self-esteem

  Good-Enough Parenting

  Development of Internal Controls

  Saying No Helps Your Child

  My Child Has Sleep Problems. What Do We Do Now?

  When Other Issues Get in the Way

  Summary

  Chapter 13. The Pros and Cons of Other Approaches to Sleep Problems

  Proper Association with Falling Asleep (Richard Ferber's Theory)

  Unrestricted Breast-feeding and the Family Bed (William Sears's Theory)

  Summary

  REFERENCES

  Foreword

  A friend recommended this book to me when my first child, Presley, was seven months old. I was still nursing, but getting ready to stop, and definitely ready to stop the 4:00 A.M. feeding. Also, we had let Presley get into the bad habit of only wanting to nap on someone. This was great when I needed an excuse for a nap, but not so convenient on busy days.

  I devoured the book in a matter of hours and put the principles into practice immediately—with instant results. I especially liked how Dr. Weissbluth taught me to watch out for my child's sleepy signs and then encouraged me to get him to bed before he's overtired. I was also very comforted by Dr. Weissbluth's explanation of sleep as one of your child's basic needs. You offer healthy food to your child when she's hungry. You must also offer healthy sleep when your child is tired—even if she doesn't know it or thinks she doesn't want it (just like my kids won't usually choose the vegetable!).

  As a correspondent for Good Morning America, I was able to contact and interview Dr. Weissbluth as part of my series Baby's First Year. I feel tremendously lucky to have Dr. Weissbluth as a resource in my life (yes, there are some perks!). Dr. Weissbluth has become a trusted advisor not only on the topic of sleep, but also on potty training and discipline.

  Dr. Weissbluth, thank you for being a mentor and friend. I wish I could say my kids never wake up at night or always go to sleep without a powe
r struggle. We have our ups and downs—I guess that's parenthood. But what I do have is a structure for sleep, which we're always trying to get back to after traveling or a cold. It really helps to have that and to know it works—especially when you are bleary-eyed at 2:00 A.M. I love Dr. Weissbluth's philosophy that the most important thing to have is a well-rested family. And fortunately, thanks to Healthy Sleep Habits, Happy Child, most days (and nights) we do!

  —Cindy Crawford

  How to Use This Book

  If you are still pregnant, it is important for both parents, not just the mother-to-be, to read the Introduction and Chapters 1, 2, 4, and 5. Try to read all of this before your baby is born because no matter how tired you may feel now, you will be even more tired once your baby has arrived. Trying to read anything then is difficult, to say the least. In these chapters you will gain an understanding as to why healthy sleep is valuable, how to satisfy your baby's need to sleep, how to cope with fussiness or crying in the evening, and how to prevent sleep problems.

  If you have already delivered your baby, it is likely that you are exhausted, feeling a little lost, or both. Shortly after the birth, you may have “baby brain” and be unable to concentrate, focus, or develop a plan of action because you are so sleep-deprived. And if you are breast-feeding, it is possible that you feel physically drained. It is absolutely necessary for husbands, who never have “baby brain,” to read portions of this book and to act as a coach for their wives. First, even if your baby was not very fussy or crying much in the evenings, please read Chapter 4, because all babies have some fussiness. Then go to the sleep problems discussed in Chapter 3; first read about the problem and then consult the Action Plan for Exhausted Parents. Finally, read the Action Plan for Exhausted Parents in the chapters before and after the chapter for your child's age, because chronological age is only a rough guide both for sleep problems and their solutions. If your child has snoring or mouth breathing during sleep or has very dry and itchy skin, read the appropriate sections in Chapter 10 or 11.

  Introduction

  Why won't my child sleep better? Where does he get all his energy? He really never seems tired; he just goes and goes and goes until he crashes. I'm burned out and I know he must be exhausted. Of course, he never slept well, even when he was a baby. He was up at all hours during the night, every night. Naps’? Forget them. Sure, he took catnaps, but only in my arms or in the car. I just thought it was normal because no baby wants to sleep with so many interesting things going on around him. Anyway, I didn't want to hear all that crying when he didn't want to sleep. But now he's two, and I'm getting tired of those constant bedtime battles. There are times when I wish he would simply just settle down and be less wild.

  Sound familiar?

  All kids occasionally are firecrackers when things are not going their way. But why do some kids have much shorter fuses than others?

  Healthy Sleep Habits, Happy Child will explain how fatigue caused by poor-quality sleep makes some children pop off more often or explode with more force than others. It will also explain how chronic fatigue can reduce your child's ability to succeed in school. This book will show how you can nurture, enhance, and maintain calm and alert behavior in your child by instilling good sleep habits.

  I will lead you on a tour through the shadows of your child's night and shine my flashlight on the most frustrating nocturnal problems that can disrupt sleep. The first leg of our journey covers terrain that may not be familiar even to experienced parents. Part I, “How Children Sleep,” describes healthy sleep, disturbed sleep, sleep problems, and common myths about sleeping. It also covers some sad territory that has not been explored previously: the harmful effects of disturbed sleep when everyone in the family suffers from fatigue. The second part of our journey, “How Parents Can Help Their Children Establish Healthy Sleep Habits,” is an age-specific guide to understanding sleep patterns and solving common sleep problems in your child. Finally, in Part III, we explore “Other Sleep Disturbances and Concerns.” When we finish our tour, you will be able to direct your own child toward healthy sleep habits.

  SLEEP DEPRIVATION HARMS CHILDREN

  Sleep deprivation can be prevented and treated.

  What do I mean by healthy sleep?

  Do you know how to get a good night's sleep and feel rested? I think I do. But sometimes I go to bed too early, sometimes too late—and I'm supposed to know a lot about sleeping! The truth is that no one really knows exactly how to program good sleep so that we always feel rested. In fact, we're really in the dark ages when it comes to understanding how sleep works. Interestingly enough, adult volunteers in early sleep studies were kept in deep, dark caves. This was done to eliminate day-and nighttime cues so that researchers could study how sleep affects our body and our feelings. Of course, sleep researchers now use specifically designed laboratories and trick clocks that run faster or slower than “real” time to figure out how our biological rhythms, or “internal clocks,” work when external time cues are removed. Studies also have been performed on shift workers and Air Force pilots who often cross time zones and suffer from jet-lag syndrome to observe how time differences affect sleep patterns.

  But children's sleep habits have not been studied in such detail. Obviously, it's a bigger problem if a bomber crew carrying nuclear weapons is inattentive because of a lack of sleep or jet-lag syndrome than if a child has fatigue-driven temper tantrums. But if it's your child, you might not agree!

  I have studied both healthy and disturbed sleep in thousands of children as founder of the original Sleep Disorders Center at Children's Memorial Hospital in Chicago. I have helped hundreds of families understand how their children's sleep habits are directly connected to how they behave and how they will do in school. Based on this research, my general pediatric practice spanning more than thirty years, and life with my own four sons and four grandchildren, I have discovered that there is hope for bleary-eyed parents. In fact, both you and your child can benefit from this knowledge. I personally benefited from my sleep research: I used to think naps were a waste of time. I wanted to spend time with my boys, and I had all those chores to do. The result? I was combative and irritable from accumulated sleeplessness. Now I think my whole family benefits when I take the naps I need.

  Prevention and treatment of unhealthy sleep habits in infants and young children are important because if they are uncorrected, they will persist. There is no automatic correction. Children do not simply outgrow these problems. The good news is that the harmful effects of unhealthy sleep are reversible when parents provide treatment. The younger the child, the more successful you will be in reversing the ill effects of unhealthy sleep.

  Preventing the development of unhealthy sleep patterns is something all parents can do. But it requires that they start early, paying attention to their baby's evolving natural sleep rhythms and to synchronize their soothing-to-sleep behavior with the time when the sleep process first begins. Perfect timing produces no crying. This book is designed to educate parents as to how they can accomplish perfect timing and prevent sleep problems in their child. But to achieve perfect timing requires practice, so it is possible, especially if this is your first child, that there may be a little crying when your baby becomes overtired.

  Treatment of sleep problems is more difficult than prevention for the simple reason that both the child and the parents are stressed from being overtired. Overtired children are fatigued, and the body's natural response is to fight the fatigue by producing a stimulating chemical. This response was important for survival, as primitive man had to flee, fight, or continue hunting even when overtired. This “second wind” of stimulating energy causes a hyperalert or hypervigilant state, which prevents easy entry into sleep or sleeping for long periods. That's why overtired children appear “wired,” unable to fall asleep easily or stay asleep. But why the crying?

  First, severe fatigue itself can be painful. Second, changing established habits is very disturbing. After the first few months of
life children can protest changes in routine by crying; they would rather play with their parents than sleep.

  No parent wants her child to cry. The truth is that encouraging healthy sleep habits will prevent a lot of crying in the long run. It is possible that the treatment of unhealthy sleep habits may initially increase crying around sleep times, but subsequently it will eliminate crying altogether. Some treatments will involve no crying.

  How is a parent able to trust what they read in books, magazines, or on the Internet? When you compare advice on sleeping and crying from different writers, ask yourself on what are they basing their advice. Besides practicing general pediatrics since 1973, conducting and publishing original research, and lecturing on crying and sleeping problems in children since 1981,1 have helped my wife raise our four sons.

  These experiences have led me to the conclusion that sleeping patterns, temperament, and infant fussing or crying are all connected. And in young babies, these features are mostly biologically determined. Other studies have confirmed these observations, so I am reasonably confident that children are born with a package of interrelated initial predispositions or tendencies.

  In the same way that we know how much calcium your baby needs for his bones to grow stronger, we know how important healthy sleep is for the growing brain. Calcium deficiency in childhood harms bone development, but the problems of osteoporosis may not show up until much later in adult life. So if your child eats a calcium deficient diet, the problem is “hidden” because there are no immediately apparent ill effects. Likewise, sleep deficiency in childhood may harm neurological development; the problems remain “hidden,” not showing up until later. I think it is possible that unhealthy sleep habits contribute to school-related problems such as attention deficit hyperactivity disorder (ADHD) and learning disabilities. I also suspect chronically tired children become chronically tired adults who suffer in ways we can't measure: less resiliency, less ability to cope with life's stress, less curiosity, less empathy, less playfulness. The message here is simple: Sleep is a powerful modifier of mood, behavior, performance, and personality.