Sleep disturbance can be one of the greatest worries mothers have. Gihan Shahine seeks advice on how to encourage a resistant child to comply with bedtime routines Will I ever be able to sleep all through the night?" This is one of the most frequently asked questions that new bleary-eyed moms ask upon having a baby. Sleep deprivation is, in fact, one of the biggest challenges facing parents of newborns, and it is a problem that may persist for a long time. I remember when I was pregnant almost everybody advised me to sleep as much as I could because after having a baby I would not get much sleep at all. I used to shrug off such advice since I had no idea that my baby would be sleeping less than others and I did not know just how sleep deprived I would feel. Then my son Youssef used to wake up every couple of hours, and he did not adjust to any bedtime routine for a very long time. Like many mothers, I wondered whether the day would ever come when I would be able to sleep through the entire night. Today, my three-year-old preschooler sleeps throughout the night, but putting him to bed at the right time remains challenging, especially when he takes naps at the wrong times, or during illness or when we have a social event. Occasional late-night visits also remain a problem. However, it seems that I am not the only one. Statistics provided by Babycentre.com indicate that about a "quarter of children under five in the UK have sleep problems, particularly refusing to go to bed or waking in the night, and the two often go together." Yet, no matter how difficult regulating children's sleep can be, Dr Andrew Adesman, chief of developmental and behavioural pediatrics at Schneider Children's Hospital in New York, insists that parents should not give up since adequate sleep is essential for their children's physical, emotional and mental health. Research has found links between adequate sleep and a child's behaviour, health and ability to learn. Experts insist that disturbed sleep patterns and lack of sleep affects the mood and behaviour of children. Overtired babies, for instance, are reportedly not able keenly to observe and process what they see as well as rested babies, according to experts at Babycentre.com. Overtired children are also easily bored and thus are less likely to play independently, this being an important skill that develops a child's creativity, resourcefulness and emotional maturity. Even seven- to 11-year-old kids who experience poor sleep have been reported to have more communication problems and intellectual deficits than those without sleep problems. Dr Andrew Adesman, the author of a book called Baby Facts and founder of BabyFacts.com, outlines a range of negative effects that lack of sleep can have on kids. These include "irritability, impatience, lack of concentration, impaired gross motor activities, carelessness on the playground or in sports, and a decrease in overall daily function." Sufficient sleep, on the other hand, boosts immune function, physical development, cognitive function, emotional health and daytime focus, according to Adesman. "Based on research in adults, it is believed that sleep in young children is important for immune function, growth and healing of body tissue, learning, processing of memory, and daytime attention/concentration. Inadequate sleep can compromise a young child's emotional and behavioural health and well being," Adesman says. However, sleep is equally important for mothers. It is not just that disturbed sleep patterns make it harder for mothers to cope with daily chores the next day, but studies have also shown that mothers whose sleep is disturbed may be more prone to depression and temporary memory loss. Professionals at Babycentre.com stress the importance of sorting out children's sleep difficulties, for otherwise they can "put pressure on relationships" between partners and between mother and child. Understanding why children do not sleep throughout the night is the first step towards solving sleep problems. Newborns normally wake up every two or three hours, or four hours at best, and they need help to get back to sleep. Experts at Babycentre.com insist that babies "have to grow big enough to go longer and longer without being fed: a six-month-old baby may sleep six hours at night before needing to eat. And many babies go back to sleep easily after their nighttime feedings." Babies should not be expected to be great sleepers. Although the average infant sleeps around 13 to 16 hours or so, this sleep usually occurs for just a few hours, perhaps three or four hours at a time. No matter how much advice one gets on how to manage a baby's sleep at this stage of early infancy, Adesman insists that much of this well-intentioned advice just does not work. In early infancy, "you can't externally induce a baby to sleep; she is on her own internal schedule that is dictated by hunger, a wet diaper, or sensory stimulation from noise or motion," Adesman says in his book. "The truth is you can't regulate your baby's internal clock." For Adesman, all that mothers can do is to "be patient and try to get as much sleep when their babies sleep." However, consultant pediatrician Amr Qatamish, disagrees and says that a mother can act to regulate her baby's internal clock a week or two after delivery when she is making sure her breast milk is sufficient and the baby's weight is increasing healthily. "The truth is that the earlier you regulate your child's sleep the better," Qatamish said. His advice is that mothers should space out feeds every three hours during the first week before they start regulating night feeds. "Mothers should then train their babies to remain unfed for six hours between midnight and six in the morning," he said. "It's a strenuous job, of course, and it will take a lot of patience on the part of mothers who will have to soothe their children in any way they see possible. In no more than a couple, or perhaps three, days the baby will be sleep-trained, and the mother will get to rest." For child psychologist Amira Shawqi it would be even better to encourage a regular sleep pattern from the first night of a newborn's life. "Babies cannot tell whether it's day or night, and so mothers should put a baby's crib beside a window and try to wake him early in the morning and make noise in order to teach him that it is morning and it's wake-up time," she said. At night, babies should be given a warm bath, put in comfortable pajamas and given a good feed, perhaps coupled with soothing lullabies. Then they should be put in a crib away from the mother's bed in a dark or dimly lit room. "It's key that mothers be consistent in inducing the same sleep pattern every night and stick to the same sleep hours," Shawqi said. Babies start resisting this pattern on the third day when they start crying heavily and loudly. "It's crucial that mothers do not give in to such crying, which is probably a painful experience for many. However, mothers should know that such crying, which will probably last for around 20 minutes, is not harmful to the baby -- making sure, of course, that the baby is not hungry or colicky and is clean. The crying will eventually stop in a few days when the baby realises that it cannot achieve anything this way." Mothers can soothe their babies with a little pat or a lullaby every five to seven minutes, provided that they do not carry or breastfeed them. "On the fourth night, mothers should stick to the same rule and even prolong soothing visits every 10 minutes in order to deliver the message that crying for no reason will not lead to anything," Shawqi said. "If the mother does not give up, she will notice her baby start to calm down on the fifth night, and she will start getting some rest and eventually sleep on the sixth night." As infants grow their brains start to mature and feeds become less frequent and more predictable. At this point mothers will start to gain control over their babies' naps and bedtimes. But not all mothers should expect that regulating their babies' sleep will be an easy ride. Statistics on Babycentre.com indicate that "even at two years old, one child out of every five wakes up and cries most nights. This could be the result of the baby's restless personality, which makes him wake up easily. Some children may need less sleep and thus wake up very early in the morning." Jodi Mindell, author of Sleeping Through the Night: How Infants, Toddlers and their Parents can get a Good Night's Sleep, insists that "night wakings are a normal part of our sleep cycle, but good sleepers know how to fall back asleep without help," a skill which many toddlers and preschoolers have yet to master. Toddlers or preschoolers may still count on his/her mother, or some other sleeping aid, to get back to sleep, and such children may have trouble drifting off again when they wake in the wee hours. Preschoolers commonly have fears, imagining monsters and ghosts under their beds, while nightmares peak between the ages of three and six, turning even the best sleeper into a troubled one. "Likewise, any departure from your child's normal routine -- a vacation, an illness, or even a change in bedtime -- can derail her normal sleep patterns," Mindell said. Tips to encourage regular sleep patterns: - Have a consistent bedtime routine. Children who have regular sleep and wake-up times feel more rested. - Make sure your child does not go to bed hungry. - Prepare children for sleep. Avoid high- energy, exciting activities that are mentally and physically stimulating late in the day and make daytime full of stimulating activities and fun. A bedtime routine including a warm bath, bedtime stories or lullabies, and keeping the bedroom environment calm and dimly lit can all reduce bedtime battles, turning it instead into an enjoyable experience for both kids and mothers alike. - Avoid caffeinated drinks or foods several hours before bedtime. - Put children to bed when they are ready to go. Forcing children to go to bed when they aren't tired increases the likelihood of bedtime struggles and turns bedtime into a hateful experience for kids. According to Shawqi, children normally have "immense energy that, if not given full vent in the morning, will normally make them resistant at bedtime." - Train your baby to comfort himself. Putting babies to bed while they are still awake, providing a pacifier (a soft toy or a special blanket) can help them to get back to sleep on their own if they wake up at night. Check on your baby every now and then until he/she learns how to soothe her/ himself to slumber and eventually sleep all night. - Dispel fears. Children of preschool age sometimes develop a fear of the dark and have nightmares. Leaving a dim light on, or doing a "monster search" at bedtime, can be helpful.
