I am always excited when I hear from readers and colleagues about content on the blog and ideas for other posts. I truly want this blog to be a way for those of you also passionate about children’s health, development and behavior to share resources, ideas and stories.
A big shout out and thank you to Dr. Stephen Boos, who practices in Springfield, Massachusetts, for today’s blog post. The handout was co-developed with parents as a tool to help parents establish sleep routines for school-aged children. It was also approved by a patient advisory board.
Grateful to my readers and contributors!
Submitted by Dr. Stephen Boos
Sleep, it seems like it should be an easy thing to do, but sleeping is a common problem for my patients and their families. Fights over bedtime, hours of restless time in bed, curtain call after curtain call for tired parents, the patter of cold little feet before they press up against you in the middle of the night; I hear about each of these problems again and again. Sleep problems have a two-way relationship with other behavior problems as well. When a parent complains to me of behavior problems, or asks about ADHD, I can usually expect a sleep complaint to follow. Interestingly, if the sleep problem can be improved the behavior problem will improve as well. So, what are the most common sleep problems, and what are their solutions.
Before going any further, it is important for me to say, what follows doesn’t necessarily apply to children with a significant anxiety disorder, or a history of trauma. A child who has lost or been removed from a parent, a child who had something terribly frightening happen to them or a loved one, or a child who cannot comfortably separate from a parent during the day may need more help than I will review. This is something a concerned parent should discuss with a professional.
The three most common sleep problems are: problems with the body clock, which leave a child wide awake at the selected bedtime; confusing or irregular schedules that don’t prepare a child for bedtime; and difficult sleep cues, which the child looks for but cannot find when they wake in the middle of the night. In the first case, sleeping in in the morning, too many naps, or exposure to bright light late in the day convince the child’s brain that their bedtime just isn’t right. These children are just not tired at the bedtime their parents have chosen. Children with confusing or irregular schedules may be tired, but they don’t expect or want to go to bed. These children want to play, watch TV, or play video games, when we want them to sleep. Finally, children with special sleep cues like a bottle, rocking, a singing parent, or just a warm body next to them, fall asleep just fine, but want those things again when they wake up in the night. If they don’t find them, they will call out for them, or come to your bed to get them. Fortunately, each of these common problems can be taken care of by building a good sleep schedule.
A good sleep schedule actually starts in the morning. It is easier to fall asleep at a set time, if you wake up at a same time. Every day. Weekends too. Once awake, it is good to get children into bright light and active early. This will move their body clock up, keeping their brain in synch with their bedtime. If the child still takes naps, keep them to the minimum, and not too late in the day. We want children to be tired at bedtime. Just like light in the morning moves the body clock ahead, light in the evening moves it back. Watching TV, working on the computer, and playing video games in the evening confuses the child’s brain. Get the child away from all screens two hours before bedtime, or bedtime just won’t feel like sleep time. Instead, those last few hours of daytime should be spent with reliable, comfortable, calming activity. As bedtime approaches, a reliable schedule of preparation for bed is next. A warm soothing bath, brushing teeth, getting into comfortable pajamas, and getting into bed in a darkened room are all parts of a routine that says, “sleep time is coming.” Now is the time for stories, quiet talk, lullabies, back-rubs, and snuggling. But, the parent must leave the room before the child falls asleep. The child must fall asleep alone, in a setting that will be just the same when they awaken at night.
These aren’t the only secrets to successful sleep, but a good sleep schedule is the foundation. I created the attached sleep handout to explain sleep schedules, and to help parents and children build a sleep schedule that will work for their family. Cutting out or drawing new pictures for the steps in your schedule, putting them in order, putting the hands on the clock that fit your family’s routine, and then giving stars and stickers for staying on schedule will involve the child in their own sleep behavior, and gain their cooperation. The parents that I work with came up with this idea, and have used it successfully in their families. I am happy to share it with you.
Click here for the Sleep Routine Visual Schedule to make yours today!