Healthy Sleep Habits, Happy Child Read online

  Likewise, when the older child pulls herself to a standing position in her crib, parents do not need to help her get down. A child might fall down in an awkward heap, but she will not hurt herself. Next time she will think twice about standing up and shaking the crib railings, or she'll be more careful when letting go.

  Parents who rush in to roll the baby over or to help a child down run the risk of reinforcing this behavior, encouraging it to be repeated night after night. Children are very crafty and learn quickly how to get parents to give them extra attention. Don't deprive your child of the opportunity to learn how to roll over or sit down unassisted at night.

  The Benefits of Healthy Sleep:

  Sleep Patterns, Intelligence, Learning,

  and School Performance

  Do sleep patterns really affect learning in children? Yes! Different studies of children at different ages all agree on this point. Focusing on perfectly normal, healthy children, let's consider the data by age groups: infants, preschoolers, and school-age children.

  Infants

  A study at the University of Connecticut showed that there was a strong association between the amount of time infants were in REM sleep and the amount of time they spent when awake in the behavioral state called “quiet alert.” In the quiet alert state, babies have open, bright eyes, they appear alert, their eyes are scanning, their faces are relaxed, and they do not smile or frown. Their bodies are relatively quiet and inactive. One mother described her four-month-old, who was frequently in this quiet alert state, as “a looker and a thinker.” She's right! These infants don't miss a thing. A study of sleep development at Stanford University showed that environmental factors, not simply brain maturation, are responsible for the proportion of time infants spend in REM sleep. Unfortunately, the exact environmental factors were not identified, but presumably parental handling could influence all of these items: sleep patterns, the proportion of REM sleep, and the amount of time the child is in the quiet alert state.

  Infants who are notoriously not quiet alert are those with colic or a difficult temperament. Their fussy behavior may be due to imbalances of internal chemicals such as progesterone or even cortisol. High cortisol concentrations in infants have been shown to be associated with decreased duration of non-REM sleep. So, even in infants, as in adults, there seem to be connections between internal chemicals, sleep patterns, and behavior when awake. Also, these fussy children tend to have irregular schedules and short attention spans. Among two-to three-month-old infants, one study showed that the more irregular and impersistent the child was, the slower the rates of learning. Looking ahead to Figure 9 (see page 395), you can see how colicky or difficult-temperament children, who sleep for brief durations and have irregular schedules and short attention spans, might not learn quickly to fall asleep unassisted. Thus they easily could become sleep-deprived, fatigued, and hyperactive older children. (This concept of increased alertness, wakefulness, and irritability due to chemical imbalances will be discussed in Chapter 3.)

  I think naps are especially important for infants. In my own studies, I've found that how long the infant sleeps during the day is strongly associated with persistence or attention span. Infants who take long naps have longer attention spans. They spend more time in the quiet alert state and seem to learn faster. Infants who do not nap well are either drowsy or fitfully fussy, and in either case they do not learn well.

  PRACTICAL POINT

  Naps promote optimal alertness for children. Children who nap well spend relatively more time in the quiet alert state when awake.

  It is a myth that long naps interfere with acquiring socialization skills or infant stimulation. While it's true that “rack-monsters” are less available for all the classes or activities that abound today—swim-gym, Mom-Tots, Pop-Tots, or infant-stimulating groups—is that so bad? Do infants suffer because they don't participate in so many activities? Are they less likely to get into the right preschool, which feeds to the right nursery school, which feeds to the right private school? No.

  Please do not confuse the quantity of time spent in these organized activities with the high-quality social awareness that well-rested children exhibit. The truth is that these infant-stimulation groups are often not important for infants but instead serve legitimate parental needs by allowing mothers and fathers to meet other parents and escape from their isolation at home.

  Preschool Children

  Three-year-old children who nap well are more adaptable. (Adaptability means the ease with which children adjust to new circumstances.) Adaptability is the single most important trait for school success. The briefer the naps, the less adaptable the child. In fact, the major temperament feature of three-year-olds who do not nap at all is nonadaptability. It is exactly these non-napping, nonadaptable children who also have more night wakings!

  My research has shown that when infants who are easy at five months of age develop into crabbier, more difficult three-year-olds, it is because they have developed a pattern of brief sleeps. In contrast, difficult infants who mellow into easier three-year-olds have developed a pattern of long sleeps. I think that parents’ helping or hindering regular sleep patterns caused these shifts to occur.

  School-Age Children

  In 1925, the father of the Stanford-Binet Intelligence Test, Dr. Lewis M. Terman, published his landmark book, Genetic Studies of Genius. He compared approximately 600 children with IQ scores over 140 to a group of almost 2,700 children with IQ scores below 140. For every age examined, the gifted children slept longer!

  Two years later, about 5,500 Japanese schoolchildren were studied, and those with better grades slept longer!

  Even seventy-nine years later, Dr. Terman's study stands apart in design, execution, and thoroughness. A 1983 scientific sleep laboratory study from Canada has provided objective evidence confirming Terman's result, that children of superior IQ had greater total sleep time. Both studies agreed that brighter children slept about thirty to forty minutes longer each night than average children of similar ages.

  Another study from the University of Louisville School of Medicine examined a group of identical twins that were selected because one twin slept less than the other. At about ten years of age, the twin with the longer sleep pattern had higher total reading, vocabulary, and comprehension scores than the twin with the shorter sleep pattern.

  PRACTICAL POINT

  Please don't think that it has no lasting effect when you routinely keep your child up too late—for your own pleasure after work or because you want to avoid bedtime confrontations—or when you cut corners on naps in order to run errands or visit friends. Once in a while, for a special occasion or reason, it's okay. But day-in, day-out sleep deprivation at night or for naps, as a matter of habit, could be very damaging to your child. Cumulative, chronic sleep losses, even of brief duration, may be harmful for learning.

  Children diagnosed with attention deficit hyperactivity disorder or learning disabilities have been shown to have sleep-related difficulties, though we don't know which came first. Nevertheless, one careful intervention study showed that improvements in sleep dramatically improved peer relations and classroom performance.

  Research on creative adults supports the concept that originality of ideas and the quality of experiences suffer when you cut back on sleep. What you lose in waking time is made up in terms of a richer life. Have you ever nodded off at an evening event that you really wanted to attend but were too tired to fully enjoy?

  There are many other studies that show an association between sleeping and school performance, but these involve children with allergies or large adenoids. (These problems are discussed in Chapter 10.)

  SLEEP STRATEGIES

  Drowsy Signs

  As your baby shows signs of becoming drowsy, you should begin a soothing-to-sleep routine. These signs usually start within one or two hours of wakefulness. About 20 percent of babies have colic and they may not show these drowsy signs, so you have to watch the clock more careful
ly. If your child often shows signs of fatigue, note how long she has been awake and next time begin the soothing process about twenty minutes earlier.

  It is not necessary for your child to be drowsy and awake when you put him down or you lie down with him in your bed. Sometimes your baby goes from drowsy to sleepy very quickly, and there is no good reason why some books suggest that you should then wake up your baby before you put him down or lie down with him.

  DROWSY SIGNS, SLEEPY CUES, SLEEP SIGNALS

  Moving into the sleep zone

  Becoming Drowsy

  Decreased activity

  Slower motions

  Less vocal

  Sucking is weaker or slower

  Quieter

  Calmer

  Appears disinterested in surroundings

  Eyes are less focused

  Eyelids drooping

  Yawning

  FATIGUE SIGNS

  Entering overtired zone

  Becoming Overtired

  Fussing

  Rubbing eyes

  Irritable

  Cranky

  Soothing to Sleep

  What exactly is soothing? Soothing is restoring a peaceful state. To soothe your newborn is to render her calm or quiet, to bring her to a composed condition. You are attempting to establish a peaceful state of tranquillity by reducing the force or intensity of fussiness. Your goal is to soften, tone down, or render less harsh fussiness or crying. Soothing is pacifying or calming. You want to bring comfort to your baby and a cessation of agitation. Snuggling her close to your body, she feels your warmth and senses your affection and protection. Cuddling is the close embrace you do with someone you love. Sometimes you just want to nestle with her as you take a cozy position and press her close to you or lie down close to her. At best, when a child is tired, we hope to lull her into a relaxed sleepy state.

  Bodily contact, sucking, and gentle rhythmic motions over long periods of time seem to work best. Sometimes loud mechanical sounds like the garbage disposal or hair dryer seem to help. Be careful, however, not to bombard your baby with stimuli. Initially, try to appeal to one sense at a time: tactile (massaging, rubbing, kissing, rocking, patting, changing from hip to shoulder), auditory (singing, humming, playing music, running the vacuum cleaner), sight (bright lights, mobiles, television), dim light or darkness when drowsy or rhythmic motion (swings, cradles, car rides, going for a walk). Sometimes, doing too many of these things simultaneously or with too much force has a stimulating rather than a relaxing effect. However, if your baby remains fussy, try combinations of these different modalities.

  Try to synchronize your actions with your baby's rhythms. If he is tense, taut, with deep exhausted heaving sobs and little physical movement, try rubbing his back ever so gently or moving your cheek over his in a slow rhythm that coincides with his breathing pattern. If he is boxing with his fists, jerking his legs, and arching his back, maybe a ride on your shoulders will grab his attention and arrest the spell. You will find that after a while you become attuned to nuances within your baby's rhythms and respond accordingly.

  Father Care: Our Secret Weapon for Soothing

  Before your baby is born, fathers should make the decision to become involved in caring for the baby from the very beginning. Some fathers hold back initially, afraid they might “do the wrong thing” when holding, burping, bathing, changing, or feeding the baby. After mothers get their strength back, they should deliberately leave the house on a weekend for a few hours to visit a friend, hang out with the older kids, get their hair done, or go shopping at a time when they expect the baby to go through a cycle of feeding, changing, bathing, and putting to sleep. Guess who has to do the work then? Often a father will feel more comfortable doing these things when the “expert” is not looking over his shoulder. So the first point is for fathers to start early in practicing baby care.

  Second, fathers should plan ahead for the six-week peak of fussing/crying that occurs in all babies. They should come home early or take a few days off from work if they are able. Make adjustments if your baby is born before or after the expected date of delivery, because the six-week peak is counted from this due date. At six weeks of age, babies fuss/cry more and sleep less. Less sleep for the baby means less sleep for the mother. All mothers need help in caring for their six-week-old and themselves. Fathers should give mothers a well-deserved break at this time by taking the baby out for long walks or car rides in the evening or night. The baby might not sleep well during these outings, but at least the mother gets a break.

  The third point is that fathers can practice and learn how to help their baby fall asleep. For example, after nursing her baby, the mother could pass her son to the father, who then rocks his baby gently for a while and puts him down to sleep or lies down with him in their bed and they both snooze. (This may only occur on weekends when the father is around.) The participation of fathers in putting their babies to sleep will help them gain confidence in becoming a parent. If the mother is giving expressed breast milk in a bottle, fathers and babies may have an easier time accomplishing the feeding if the mother actually leaves the house. This is because the baby can smell the mother's presence and might resist taking the bottle if he knows his mother is home. So, maybe on weekends, when it's time for the baby's nap, mom leaves the house and has fun while dad gives the bottle and puts his baby down to sleep.

  Fourth, fathers can learn how to soothe baby fussiness and crying and spend lots of time doing the soothing. For example, fathers can learn infant massage. Classes are offered everywhere; call your local maternity hospital or go on-line. Fathers can learn lullabies (your baby will not care how well you sing). A baby bath might be especially soothing, and fathers can spend time letting the warm water calm the baby. A father can learn to do everything a mother does to soothe the baby except breast-feed. For babies six months of age or older, fathers can attempt to help lengthen naps by responding immediately as a mininap nears its end (baby just begins to whimper or cry) by attempting to soothe the baby back to sleep for a nap extension. If mothers do this, it might be more stimulating than soothing.

  Lastly, a father can request to help feed or soothe the baby in the middle of the night when the mother needs extra sleep. This is a little bit tricky because many mothers have the attitude that nobody can do the soothing as well as they can, and also that dads need their rest so they can go out to work well rested in the morning. With this attitude, the mother rejects or resists the idea that baby care in the middle of the night should be a shared experience. For some families, this might be the right course of action. But if the mother is distressed, exhausted, sleep-deprived, or going through baby blues, then extra help at night from the father is absolutely needed to give the mother a little more sleep. After all, no matter how stressful his job might be, the father at work always gets some breaks. A mother with a baby might not get any breaks during the day. In one study of children one to three years of age, sleep problems were solved when fathers took over the management of the bedtime routine and night awakenings. Dr. Klaus Minde observed that the fathers were “more forthright and authoritative” and the mothers felt tired in the evening and perceived their toddlers as particularly difficult at that time. In this study, the fathers used the “graduated extinction” or “controlled crying” method.

  Fathers need to understand that when children are overtired and not sleeping well, it is sometimes useful to go to a temporarily ultra-early bedtime to repay the sleep debt. The child awakens better rested, then learns to nap better, and later is able to have a later bedtime. If fathers refuse to help prevent and solve sleep problems, then they have to accept responsibility for their overtired child's behavior—and not blame the mother!

  Sucking Is Soothing

  Anything you can do to encourage your baby to suck will help soothe her. Offering the breast, bottle, pacifier, finger, or wrist usually helps calm your baby. If you are breast-feeding, one way to help distinguish between sucking for soothing and suck
ing for hunger is that the sucking for soothing is often rapid, repeated sucks with very little swallowing. In addition, the fussy baby does not suck in a rhythmic steady fashion; instead, she starts and stops, twists and turns. If she is hungry, the pattern is usually a rhythmic suck-swallow, suck-swallow, and so forth. If you are bottle-feeding, do not assume that when your baby eagerly takes several ounces that this means she is hungry. Many babies with extreme fussiness/colic suck more than they need and spit up a lot.

  Because sucking is such a powerful way to calm a baby and babies often fall asleep with sucking, I think it is unnatural and unhealthy for parents to deliberately do things that interfere with sucking. One popular book that promotes “no-cry sleep solutions” tells parents to remove the breast while he is sucking, before he falls asleep, and if the baby continues to want to suck after the removal, it tells parents to hold the baby's mouth closed to prevent the sucking. Another popular book describes sucking as one of the major ways that babies can calm themselves, but then goes on to recommend that you wake your baby up during sucking if he falls asleep at the breast. Furthermore, the author instructs you to begin this practice at one month of age! Both books make the assumption that if the baby falls asleep while sucking, you will be creating a sleeping problem. There is no good evidence to support this assumption. Mothers in my practice do not deliberately interfere with sucking at the time of soothing to sleep, and their babies sleep well. Both books also incorrectly assume that feeding and sleeping are tightly linked. So they both encourage you to force-feed your baby in order to help him sleep longer. Phrases like “cluster feed” or “top off the tank” to help him sleep or “He's awake when he's hungry and asleep when he's full” reveal a profound ignorance about how the developing brain, not the stomach, controls sleep/ wake rhythms. I believe it is much more natural to follow your baby's needs. If your baby is hungry, feed him. If your baby is fussy, soothe him. If your baby is tired, put him to sleep. If you're not sure what he needs, encourage sucking at the breast or bottle until he seems satisfied because he is full or calm or asleep.