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| The secrets of sleep in preschoolers | |
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04/01/99
Mostly as a way to get a conversation going, preschool teacher Cate Fleming of the Lexington Playcare Center recently asked the children in her group, ''How many of you spend the whole night sleeping by yourself in your own bed?'' Out of 11, six did not. Fleming was flabbergasted. ''I knew one was having sleep problems,'' she says, ''and I figured maybe there were one or two more I didn't know about. But six! That blew me away.'' These weren't just children at the young age of the preschool spectrum, either. In Fleming's mixed-age group of 3- to 5-year-olds, there were as many 5's with sleep issues as there were 3's. That worried her. As a parent who sometimes struggles with her 18-month-old's sleep patterns, Fleming likes to think things will get better as he gets older, not worse. Unfortunately, the nights of the preschool years can be hard even for children who slept perfectly as babies and toddlers. This is partly due to a more mature level of cognition. ''At 3 and 4, they're more aware they are separate from a parent,'' says psychologist Joyce Walsleben, director of the New York University Sleep Disorder Center. This causes a worry: ''`If I'm on my own [when I'm in bed], where is everybody? Who will take care of me? Who will protect me?''' Sleep disturbance is also typically due to a change in a child's life: moving from crib to bed, giving up naps, a new baby. But it doesn't play out the way parents imagine. Pediatric sleep researcher Marc Weissbluth offers an example: Mom goes back to work. The first night, she doesn't get home until 6 p.m. Dinner is late, so bedtime gets pushed up. The next night, things are still crazy, and the next night, too. When she finally wants her almost 4-year-old to go to bed at the old time, there's a struggle. Mom assumes he's upset because she is working; her guilt prompts her to do things she never did before, like giving in to requests for one more book and staying with him until he falls asleep. Now when she wants to disengage, the battle is even more fierce. The problem, says Weissbluth, is not an emotional reaction to Mom working but to being up late for many nights and then having routines changed again and then again. A pediatrician in Chicago, Weissbluth is author of ''Healthy Sleep Habits, Happy Child'' (Ballantine). Pitfalls for parents Inconsistency in limit-setting, whether it's from parent to parent, night to night, or bedtime to the middle of the night, is what most often gets us into trouble, says pediatric neurologist Richard Ferber, the nation's leading pediatric sleep researcher. ''Some parents are firm at bedtime and don't give in to `curtain calls,' those various requests for water or juice. But in the middle of the night, anything goes: `Fine, come into our bed.' Or maybe it's the other way around,'' he says: ''Strict at 2 a.m., loosey-goosey at bedtime.'' Either way, a child is getting a mixed message - ''Your job is to sleep in your own bed, uh, well, sometimes it's OK for you to sleep in our bed'' - and also is expected to figure out which rules apply when. In other words, ''Parents abdicate control,'' says Ferber. He is clinical director of the Center for Pediatric Sleep Disorders at Children's Hospital and author of ''Solve Your Child's Sleep Problems'' (Simon Schuster). Two major changes There are two changes that most commonly trigger sleep disturbances. The first is the move from crib to bed, typically at about age 3. The combination of freedom, poor impulse control, and a new awareness that fun things may be happening in the house without him makes it hard for a child to stay put. If we are inconsistent in our response, one night getting angry, the next letting him climb in our lap for some TV, we add to the problem, says Ferber. The other change involves naps. Preschool teacher Fleming gets countless requests each year from parents wanting teachers to keep a child awake during naptime. That's because parents understandably but incorrectly think that if a child doesn't nap or naps less, he'll be so exhausted that he'll fall asleep easily and sleep like a rock. In fact, the opposite is true. Weissbluth, who researches naps, says, ''When preschoolers don't get the daytime sleep they need, the body produces stimulating hormones to fight the fatigue.'' A child becomes more wired than tired, prompting parents to think he isn't ready for bed. But the later he stays up, the more sleep-deprived he is. Again contrary to common sense, when he finally falls asleep, it is not a sound sleep and he has more, not fewer, nighttime awakenings, says psychologist Jodi Mindell, pediatric director of the Center for Sleep Medicine in Philadelphia. She is author of ''Sleeping Through the Night'' (HarperPerennial). Whether the first sign of sleep disruption is at 7 p.m. or 2 a.m., parents tend to move into crisis mode. ''They come up with a new solution, try it for two nights, say it doesn't work and try something else,'' says Mindell. ''That's a mistake. Go back to what worked before,'' she says: ''Old rules, old routines.'' Ferber says 3-year-olds still need naps. Even at 4, if a child still naps on the weekend, she still needs her nap on the weekday. ''A guide for how much sleep a youngster needs is when he wakes up spontaneously,'' he says. ''If you never have to wake him in the morning, he's getting the sleep he needs.'' Don't be misled by weekends when he wakes early to watch TV, however. ''They rouse themselves to see cartoons, then go on autopilot in front of the TV,'' says Ferber. ''They aren't really awake, but they aren't asleep either.'' Similarly, a 4-year-old will force himself to stay awake to watch TV at night, fooling us into thinking he isn't tired, when he's overtired. Questions to ask At the first sign sleep is out of hand, ask some questions: Is there a peaceful bedtime routine? Mindell recommends a picture chart with all the bedtime rituals, not just things like brushing teeth but also all her stalling tactics, like kissing the dog goodnight. ''When she says, `Oh, but I have to ...' you can look at the chart and say, `See? You already had two glasses of water.''' If you set up new routines, talk about them first, says Ferber: ''Here's what we're going to do at bedtime ...'' Do you leave your child before she falls asleep? Staying with her until she's asleep can fuel mid-night wakings because she relies on you for the transition from wakefulness to sleep. Are there bedtime rules? The most important one often never gets stated, says Ferber: ''`Once you're in bed, your job is to stay there.''' Because a preschooler may feel lonely as well as left out, have a corollary to that: ''And I will come back to kiss you again in 10 minutes.'' Adds Mindell: ''Don't forget.'' Are there rules for mid-night wakings? If you don't mind having her in your bed, this is not an issue. If you do, you need a family rule: ''Everyone sleeps in their own bed.'' When she comes into yours, return her to her bed quickly, quietly, and consistently. ''If she needs to go to the bathroom, don't talk, don't turn on bright lights. Keep it boring,'' says Mindell. ''No snuggling, no snack, no side trips to the kitchen.'' If your child falls asleep on her own at bedtime but still wakes you at 2 saying she needs you, the reason could be a developmental fear of being on her own. She may be satisfied to bring blanket and pillow to the floor by your bed, just to be near you. ''She may not even need to wake you,'' Walsleben says. Because nightmares typically surface in the preschool years, Ferber offers this clue for recognizing a real fright: A child who wakes up scared usually screams and races to your room. If he comes in calmly, taps you on the shoulder, and says, ''I had a bad dream,'' it may be less than genuine. The first child needs soothing, the second needs limit-setting. Talk to him during the day about how you can help him at night: ''When it's very bad, I can come and tuck you back in, but for some scares, is it enough to see that we're in our bed in the next room and to go back to your bed? Or maybe just to have me call to you from our room, so you know you're safe?'' Preschoolers in Fleming's class have a variety of coping techniques for bad sleep nights. Some wouldn't be endorsed by researchers - ''I go get a cookie'' - but others would be applauded: ''My mom has a timer at her bed. I can stay for five minutes.'' AFTERTHOUGHT - Children who spend fewer hours eating meals with their parents are more likely to exhibit aggressive behavior, according to a University of Michigan study. One theory is that mealtime is when parents and children can share thoughts and feelings. The study is summarized in the Brown University Child and Adolescent Behavior Letter. Barbara F. Meltz's Child Caring appears every Thursday in At Home. Her first book, ''Put Yourself in Their Shoes: Understanding How Your Children See the World'' (Dell), is now available in bookstores. She welcomes letters and comments and can be reached via e-mail at meltz@globe. com. This story ran on page F01 of the Boston Globe
on 04/01/99. |
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