No subject generates more discussion — or causes more anguish — among new parents than the roller-coaster sleep patterns of their children. Lewis First, chief of pediatrics at Vermont Children's Hospital and editor-in-chief of Pediatrics, shares some bedtime tips.
KIDS VT: When's the right time to start an infant on a regular sleep schedule?
LEWIS FIRST: For the first month or so, most newborns sleep 16 to 20 hours per day. Babies have to feed every three to four hours, so for the first two months, it's very difficult to even think about a routine. By three to four months, a baby will cut down to about 12 to 13 hours of sleep, of which eight to nine hours are at night. So it's not a bad time to start thinking about developing a sleep routine.
KVT: How do parents do that?
LF: One way to start is to take care of necessities as quickly and quietly as possible. Your baby may wake up hungry, wet, cold or not feeling well. Doing things quickly and quietly will allow your baby to get back to sleep without a lot of fanfare. Ideally, place baby in the crib before he or she actually falls asleep. Then he or she will figure out how to fall asleep again without calling for a parent.
KVT: What about toddlers?
LF: Most toddlers sleep about 10 to 12 hours per day. Having a consistent bedtime routine allows kids to relax and get ready for sleep. It starts with slowing down the activities, what I call "clean up, suit up, stack up, brush up and read up," then saying goodnight. The best thing is to be consistent and get quieter and quieter — a story, a bath, listening to soft music. Saying goodnight while your child is still slightly awake will allow him or her to realize there's no more activity in the day.
KVT: What are your thoughts on bed sharing?
LF: There have been articles that say a baby who sleeps in the same bed with a parent is more likely to sleep through the night and become more secure and confident, and has the convenience of having a parent there to breast-feed.
KVT: Are there risks involved?
LF: Yes. The Consumer Products Safety Commission and numerous studies have found that when you bring a baby to bed with you and you fall asleep, there's a substantive increase in the likelihood of a baby suffocating, being wedged between the mattress and wall, getting caught in the bed frame, being rolled onto by a parent, or having his or her head get lost in a pillow. This has occurred in Vermont. There are now additional data to suggest that a parent who bed shares increases the risk of that baby experiencing sudden infant death syndrome (SIDS). That's especially true for parents who smoke. I do not recommend bed sharing. If a parent wants to co-sleep, I recommend bringing a crib, bassinet or a sidecar cradle into the bedroom.
KVT: What if parents still choose to bed share?
LF: Parents who still want to bed share should not be under the influence of drugs or alcohol. They should use a single-piece mattress, tight-fitting sheets, and no loose pillows or soft blankets. Certainly, never bring babies onto a waterbed, where their face can sink down and not be raised. That's a formula for disaster.
KVT: How important are daytime naps?
LF: Naps are good because they focus a child's energy away from constant, active play and channel it toward growth. They also give parents and caregivers a break. By the time kids reach 2 or 3, some don't need naps, while others need naps through age 5. If kids aren't showing irritability or grumpiness without a nap, it's time to say goodbye to the nap, much to the parents' chagrin.
KVT: What's the difference between nightmares and night terrors?
LF: Nightmares are really scary dreams. They occur in about 25 percent of kids, usually beginning in toddlerhood and running throughout their lives. They're quite common and occur in the dream phase of sleep, which is usually the second half of the night. Nightmares will result in children waking up and screaming and seeking comfort ... they are frightened about something they dreamed about, and they can tell you about it. Night terrors occur in about 3 percent of kids. They usually happen an hour or two after a child goes to sleep. A night terror results in a child bolting upright in bed, screaming, crying, or thrashing around with his or her eyes open. A child may even sleepwalk. And, the following morning, he or she has no recall of the event.
KVT: Anything to worry about with either one?
LF: The good news is, neither nightmares nor night terrors correlate with anything troubling from a developmental or neurological standpoint, except that a child can get hurt sleepwalking. Make sure that if kids get out of their rooms during a night terror, that you've gated any staircases. Night terrors tend to run in families and usually occur between the ages of 4 and 12. Most kids outgrow night terrors. Interestingly, both nightmares and night terrors are associated with kids who potentially have been exposed to something stressful, or are just overtired — another reason for developing a good sleep routine.