Healthy Sleep Habits, Happy Child Read online

  WARNING

  If your child does not learn to sleep well, he may become an incurable adult insomniac, chronically disabled from sleepiness and dependent on sleeping pills.

  One of the world's foremost researchers in sleep, William C. Dement, taught me at Stanford University Medical School in 1967 that we exist in three distinctly different biological domains: awake, REM sleep, and non-REM sleep. Although all three domains interact with one another, there are specific problems that can occur within each domain.

  According to Dr. Dement, traditional medical science focused on only the first domain, wakefulness. His major point was that we are fundamentally different when we are asleep than when we are awake. The body's clock knows when we should be asleep and adjusts our brain, our temperature, and our hormone levels to the sleep mode. In sleep mode, we do not respond, think, or feel as we do when awake. If you do not believe this, ask any mother of a six-week-old infant how she is when she is up at night soothing her baby!

  There has been much misunderstanding about “insecurity” and “crying to sleep” because of a failure to make the distinction between (1) the importance of sleeping well when we are in a biological sleep mode and (2) the importance of security of attachment when we are in a biological awake mode. This failure is understandable, because most child psychologists and child psychiatrists have not had the opportunity to do research or to receive training regarding the benefits of healthy sleep. They do not understand that the sleeping brain is different from the awake brain. Even today, very little teaching regarding sleep (only about five hours) takes place during the three-year pediatric residency program. Sadly, “expert” advice in popular magazines or books often reflects this lack of knowledge.

  Because there is a basic difference between the sleeping brain and the awake brain, different types of problems can develop. When the brain enters the biologic domain of sleep, problems such as night terrors might appear. Night terrors and other sleep problems simply do not occur when the brain shifts to the awake domain.

  Similarly, we are fundamentally different when we are awake.

  When our children are awake, we worry about problems such as temper tantrums, fighting, not sharing, or not eating well. Also, we sometimes wonder if we are making the appropriate emotional connection. Are our children getting enough love? Are they happy? Are they securely attached, or do they feel insecure? How we interact with our children while we feed them, bathe them, dress them, and play with them is very important. Insecurity of attachment as a concept makes no sense when the brain shifts to the sleep domain.

  BE PATIENT

  It takes time for your child to develop strength, coordination, balance, and confidence to “learn” to walk.

  It takes time for your baby to develop night sleep consolidation, regular and long naps, and self-soothing skills to “learn” to sleep well.

  We know that the process of falling asleep and staying asleep is learned behavior, and that the learning will occur naturally, just like learning how to walk, if parents do not interfere. Difficulties in learning how to walk used to occur when walkers were popular, because they interfered with the natural evolution of a normal gait. Difficulties in learning how to sleep occur when parents do not respect and protect the child's natural, periodic need to sleep. With practice, all parents will clearly see that perfect timing produces no crying!

  New parents need to practice before they achieve perfection, and they need to be patient. Because of new parents’ inexperience and the baby's shifting sleep rhythms, there will be incidents when the timing will be off and the baby will become painfully overtired. Then there may be some crying. This book will provide a guide to help coach you to catch the rising wave of sleepiness before the child crashes into an overtired state. Making children cry is not the way to help them learn to sleep.

  Helping babies and children sleep well is not just mothers’ work; fathers also play an important role in helping to establish healthy sleeping. Traditionally, mothers have suffered the burden of sleep deprivation because they were doing night duty alone. They were on call day and night much more than the fathers were, and when there were problems occurring on the night shift, guess who was expected to handle it? When babies do not sleep well, guess who gets the blame? I have tried to correct this situation by discussing how important it is—for the sake of the child, the marriage, and the family—to get the father actively involved.

  In this new edition of Healthy Sleep Habits, Happy Child, you will learn in detail how to prevent and treat sleeping problems. The discussion of prevention includes a detailed map to help you decide whether the path of breast-feeding or the family bed will be important on your journey to prevent sleep problems. The discussion of treatment has been expanded to include a comparison of different treatment strategies: extinction (ignoring), graduated extinction (controlled crying, check and console), scheduled awakenings, bedtime routines, day correction of bedtime problems, relaxation, and white noise. To make this book easier to use, Action Plans for Exhausted Parents have been included at the end of every chapter for handy reference and guidance.

  New Introduction to

  First Hardcover Edition

  Imagine a family where both parents are actively involved in parenting and agree on how to care for their child. They have a strong marriage, there are no baby blues or postpartum depression, they have only one child, breast-feeding is easy, there are no medical problems in the family, they have extra bedrooms, relatives and friends are available and want to help, they can afford housekeeping and childcare help, and they are under no financial pressure to return to work soon. Of course, most of us are not so fortunate to have such an ideal soothing support system.

  Still, the greater your resources to soothe your baby during the first few months, and the better attuned you become to your baby's changing sleep needs, the more likely that he will sleep well during the first four months. And if your baby is sleeping well, as the pages that follow will explain, it is more likely that you will prevent sleep problems from developing after four months. The emphasis is on the word prevent. If you don't have a good soothing support system in place, however, your baby might become irritable, fussy, and cry more during the first few months because, despite your best efforts, he becomes overtired.

  In the long run, when infants do not learn self-soothing, they often develop sleep problems. Or, if you have a colicky infant who appears to have less ability to soothe himself, he is likely to be come a mostly parent-soothed baby. Simply stated, the more resources you have to soothe your baby, the likelier that your baby will sleep more and cry less and, after four months, begin to learn how to independently fall asleep and stay asleep. This acquired ability to self-soothe goes a long way in preventing sleep problems from emerging.

  IMPORTANT POINT

  The over-tired infant is less likely to soothe himself to sleep and becomes more dependent on parents to be soothed to sleep.

  This book is full of tools for you to use to soothe your baby and help her sleep. Dig deep into this toolbox and get all the help you can get. Some of the tools will turn out to be more useful to some families than to others because of differences in family circumstances and the temperament of the child. You should recognize, however, that families differ in their ability to use these tools. I list these abilities on page 74 as resources for soothing. So, some tools are easier to use for some families because of different resources. Don't compare what's going on in your family with another family, because families are all different.

  There is no instruction manual that applies to all families, and parenting is the hardest work there is. This is also true because once you figure out how to handle something, your child changes and you have to start the learning process all over again. When your baby sleeps well, you sleep well. When that happens, you can figure out a parenting plan that will be good for your family, and you are more adaptable to make changes in your plan as your baby changes. Let me help you get started.


  A Simple Four-Step Plan to Prevent Sleep Problems

  Weeks one through four: Your baby becomes less portable and more sensitive to being stimulated. Attempt to put your child to sleep in a reasonably dark and quiet place within one to two hours of wakefulness. Do whatever works to maximize sleep and minimize crying. If possible, put your baby down when she is drowsy but awake. Both parents should be involved in soothing and putting the baby to sleep.

  Weeks four through eight: Focus on the one-to two-hour rule of wakefulness during the day, but plan to deal with increasing fussiness and wakefulness, especially in the evening at six weeks. Parents should anticipate peak fussiness and wakefulness in the evening; therefore, the working parent should plan to come home from work early or take a few days off when the baby is around six weeks. Get as much help in the evening as you can. Remember that putting your baby down when she's drowsy but awake might work during the day but not in the evening. That's okay. Again, do whatever works to maximize sleep and minimize crying.

  Weeks eight through twelve: Remember the one-to two-hour rule during the day. Watch for drowsy signs at night. Move the bedtime earlier, around 6:00 to 7:00 P.M.

  Weeks twelve through sixteen: First, organize your schedule to fit in a morning nap, around 9:00 A.M., for your baby. Second, organize your schedule to have your baby take a second midday nap around 1:00 P.M. A third nap in the afternoon is more variable.

  PREVENTION

  Realistically evaluate your resources for soothing your baby to help her sleep. Plan to maximize sleep and minimize crying during the first few months to prevent sleep problems from developing later.

  In addition to preventing sleep problems, there is the issue of treatment of existing sleep problems. As parents, we are all different regarding how easy or difficult it is for us to change our behavior so that our child can sleep better. Naturally, the items listed on page 74 under “Resources for Parents' Ability to Soothe” are important when trying to change our parenting practices in order to correct our child's sleep problems. Some parents have difficulty executing a treatment tip or treatment plan because other things get in the way (see Chapter 12). This new edition addresses for the first time some additional reasons why parents have difficulty fixing their child's sleep problems. These barriers to treatment could include sensitive or highly personal issues that get in the way of your ability to do what is best for your child—and make the hard work of parenting even harder.

  Barriers to Treatment

  Child psychologists and child psychiatrists deal with barriers to treatment every day in their attempts to help struggling parents deal with older children. But these same barriers often interfere with executing a treatment plan to help a much younger child sleep well. Perhaps they are only speed bumps that slow down the process of helping your child. If, however, these barriers are major roadblocks preventing you from treating your child's sleep problem, then consider getting professional counseling to overcome them before working on your child's sleep problem.

  1. Parents lack information or tools.

  Your child does not come with a parenting manual. Starting in a child's infancy or early childhood, parents may have unrealistic expectations or misunderstandings regarding age-appropriate sleep needs and sleep schedules. Or parents may not appreciate the benefits of healthy sleep or recognize the harm from sleep deprivation in their children. Parents may be misguided or unaware regarding how to set limits, or how to discipline or socialize their children. They have the right attitude but they lack the techniques or tools, so they become paralyzed. Dr. John Lavigne, chief psychologist at Children's Memorial Hospital in Chicago, strongly believes that most of the parents he sees are psychologically healthy but simply misguided or lacking skills to solve some of the common parenting problems.

  2. Working-parents’ guilt, exhaustion, or absence.

  Parents feel guilty because they are not available or because they do not want to be available to their child. So they give in to whatever their child wants. Or, selfishly, the parents feel that their child has to adapt to their schedule and stay up late at night. Alternatively, as child psychologist Dr. Diane Rosenbaum explains, a parent might truly believe that the time a child spends late at night with Mother or Father is more important than sleep. This may be more common with a parent who works outside the home, because (s)he does not see the child's overtired behavior during the day. Or perhaps it is not guilt but sheer exhaustion from the demands of work that prevents the parent from being persistent and consistent. Too often, the parent simply surrenders whenever the child cries. Sometimes it is neither guilt nor exhaustion but absence. Many modern parents do not do a lot of parenting. Because they spend so much time at work, they rely heavily on daycare or nannies. This absence can render the parents powerless to resist the demands of their child. Dr. Vicki Lavigne, a child psychologist, commonly sees fathers who are absent from the home so much that they do not recognize or appreciate the seriousness of the problem and are often in denial. These fathers tend to say, “He'll outgrow it,” or “It's not a big deal, not to worry.”

  3. Bad Marriage.

  A bad marriage can lead to a variety of issues that affect a parent's effectiveness. One possible issue resulting from a troubled relationship is that one parent becomes overly permissive in order to keep the child allied with him or her for support and love. This alliance maintains the parent's self-esteem. In extreme cases, a parent becomes deliberately overly permissive in order to provoke the spouse. A second possible issue is that of control. A parent arrogantly asserts that (s)he is right no matter what; (s)he knows best, end of story. A third issue may be a lack of communication. The parents can't communicate effectively with each other to develop a practical plan that can be consistently implemented.

  4. Parents have abandonment issues.

  Because the parents had bad relationships with their own parents, some new parents might desperately want to be liked by their child. New parents might feel that their parents were not in tune with their feelings as children, so they want to be sensitive and always address their own child's feelings. They want to be their child's best friend. They do not want their child to feel hurt, as they had felt hurt as children. Or the parents do not want to break their child's spirit or damage his self-esteem. This might lead to giving in to their child's every demand. Another possibility is that parents who had bad relations with their parents might become inept in general at parenting their own children. For example, they may not recognize that overindulgence is harmful to their child.

  5. Parents have authority issues.

  Some parents do not feel comfortable with rules and authority. It goes against their grain because perhaps they were raised without rules or authority. They are not comfortable telling anyone what to do; they would rather ask for help. They might have a “live and let live” philosophy. Or they behave irresponsibly and cannot say no to themselves, so they cannot say no to their child. In extreme cases, a parent wants to but cannot be rebellious, and so the parent gets gratification from seeing the child rebel.

  6. Family stress issues.

  Because the parents are stressed out worrying about money, jobs, family issues such as the illness of a relative, or the frequent absence of a parent, they do not have the energy to establish routines, plan events, or create schedules such as sleep times. They live from crisis to crisis, and family life is chaotic. The parents are reactive instead of proactive: They react emotionally instead of thoughtfully. The parents are not necessarily overindulgent, but they are overly inconsistent. Dr. Robert Daniels, a child psychologist, points out that “You can still be an A parent if you are 90 percent consistent; nobody is 100 percent consistent.” Some of these parents, however, have Attention Deficit Hyperactivity Disorder (ADHD; see below).

  7. Parents have undiagnosed depression, ADHD, bipolar disorder, or other mental health problem.

  These are uncommon, but depression occurs in 5 percent of American adults, ADHD in 4 percent, and bipolar disorde
r in 1 percent. Education and coaching will often fail if the parent has significant untreated mental health issues. Many times the diagnoses are not recognized, especially with ADHD, which occurs equally in mothers and fathers. But problems regarding parenting are especially prominent if the mother is affected, because she is the one who is usually expected to organize schedules and routines such as regular bedtimes and naps.

  8. Therapist failure.

  Sometimes a therapist does not listen to or understand what has failed before, so the parents do not want to try again something similar. Perhaps a therapist fails to make it clear that the parents have to work every day to permanently prevent the problem from resurfacing. I see this time and time again. For example, after working hard to successfully correct a sleep problem caused by a bedtime that was too late, and everyone was sleeping better, the parent came and asked if he could start keeping his child up later at night!

  Successful therapists such as Dr. Karen Pierce, a child psychiatrist, often start by asking a fundamental question: There are many barriers to change. Is it the child, the parent, the couple, the larger family, or outside stress issues? She emphasizes the importance of locating the barrier that prevents parents from changing in order to solve the problems. After all, the failure tolocate the barrier makes it difficult to concentrate energy on the solution to the problem.

  Dr. Robert Daniels often starts with questions such as: What is the desired behavior you want from your child? What is the desired outcome? What is the endpoint of treatment? What would you like to see happen? Both parents need to agree on what the goal is and how to achieve it before beginning a treatment plan. The failure to agree on a goal makes it difficult for parents to cooperate with each other to achieve success. Dr. Daniels observes that most parents agree on the goal but not necessarily on the path to accomplish it.