Nap Deprivation
When parents have invested the effort to create an age-appropriate sleep schedule and their child is well-rested, occasional disruptions due to illness, trips, parties, or holiday visits cause only minor disruptions of sleep. Such a kid requires only a brief recovery period before getting back on track. But when parents allow poor-quality sleep patterns to emerge and persist, then there is a gradual accumulation of significant sleep deficits. Now, even minor disturbances create long-lasting havoc.
In this age range, nap deprivation seems to be a major culprit in ruining healthy sleep patterns. It's only natural that you want to get out more and do more things with your child, who is now full of new social charms, is cheerful, and crawling or maybe even walking … why not hang out together and enjoy the good weather at the park or beach?
Your child is likely to feel the same way. Self-agency might lead him to protest naps because he would rather play than sleep. If you allow him to skip his nap, then he will become fatigued. The natural adaptive response to fatigue is to fight it with stimulating hormones, which allow him to maintain more wakefulness. However, this heightened state of alertness or arousal creates an inability to easily fall asleep or stay asleep for subsequent naps and night sleep. Not only does a vicious circle of sleep problems begin, but your child may also develop emotional ups and downs or a reduced attention span as a by-product.
As naps slip and slide, a trend of increasing fatigue clearly develops. First, the child becomes a little more crabby, irritable, or fussy, maybe only in the late afternoon or early evening. You might think it's normal for children this age to be easily frustrated or sometimes bored. Then he starts to get up at night for the first time ever, “for no reason.” Later, maybe following a cold or a daylong visit with his grandparents, he starts fighting going to sleep at night, and you wonder why night sleep is a suddenly a problem.
When you reestablish healthy, regular nap routines, the night-sleep problem corrects itself (although noncompliant behaviors still exist and separation anxiety is unchanged). I have seen this over and over again. That's why I think nap deprivation and not a particular “stage” is the culprit behind disturbed night sleep.
PRACTICAL POINT
Boredom may be masked tiredness. If your child's motor is idling and she's not going anywhere, maybe she's tired.
Normal Naps
You may think your baby needs only one nap now, but most babies in this age range still need two naps. One clue some parents have noticed is that their baby-sitter can have the child take two good naps, but they can only get her to take one, if that. The child is obviously more rested after the sitter leaves, and the parents wonder how the sitter does it. Well, children are very discriminating at this age. They know that the sitter, following parents’ instructions, has a no-nonsense approach and will put them to sleep on a fairly regular schedule. But they figure that with mom or dad, enough protesting may gain them more playtime together. After all, sometimes it works. And so long as your child retains the expectation that you will come to her and take her out of her boring, quiet room, she will fight naps.
Here are three dramatic turning points in sleep maturation for young children:
At six weeks of age, night sleep becomes organized.
At four months of age, day sleep is developing and night sleep is adultlike in terms of sleep cycles.
At nine months of age, the third nap is eliminated, naps are longer (especially for postcolic babies), and there is no need to be fed at night.
These turning points are so highly predictable and independent of parenting practices that we know they reflect maturation of the brain. Anticipating these changes and allowing them to occur naturally will set the stage for preventing all common sleep disturbances.
Comforting Habits
Routines that comfort your baby include rocking, soft lullabies, stroking, patting, and cuddling. Maintain these routines so your child learns to associate certain behaviors occurring at certain times in a familiar place with the behavior called “falling asleep.”
HELPFUL HINTS FOR COMFORTING
Soft, silky, or furry-textured blankets, dolls, or stuffed animals in crib
A small soft blanket over the forehead, like a scarf
Dim night-light
Nursing to sleep
Nurse to Sleep?
There is nothing wrong with nursing your baby to sleep when there is no sleep problem. Most nursing mothers in my practice do this all the time. But if you have difficulty letting your child learn to fall asleep unassisted, your child always falls asleep at the breast, and your child has disturbed sleep, then nursing to sleep might be part of the sleep problem. It may reflect the kind of separation problems discussed in Chapter 12.
Most mothers nurse their babies for soothing and comfort, and their babies either fall asleep at the breast or they don't. In either case, they are put in their cribs when they need to sleep. I think that this intimacy between mother and infant is beautiful, and nursing to sleep, in itself, does not cause sleep problems.
Q: Do I roll my older child over to his favorite sleeping position when he wakes up during the night? Do I help him get down when he stands up and shakes the crib railings?
A: No. I doubt that you like playing these games with your child at night. Think, too, about what you teach him when you go to him at night to roll him over or help him down. If he rolls over only once at night or gets stuck in the railings of the crib, then help him go back to sleep.
Q: Won't he hurt himself if he falls down in his crib? He can't get down by himself.
A: No, he won't hurt himself. He may fall into an awkward heap … and sleep like a puppy.
Try to be reasonably regular by watching the intervals of wakefulness in babies four months of age or younger, and by watching your baby and the clock when he's over four months. However, try not to get locked into a fixed or traditional bedtime hour; vary the bedtime a little depending on duration of naps, when the second nap ended, and indoor versus outdoor activities. Often babies between nine and twelve months need to go to bed earlier because of increased physical activity in the afternoon and the absence of a third nap. Remember, too late a bedtime causes disturbed sleep just as nap deprivation does.
When you are somewhat organized regarding sleep schedules, sleep is accepted and expected. But don't feel you have to be this way for feeding or other infant care practices! When parents are creative, free-spirited, and permissive regarding wholesome foods, feeding goes well. So respect the biological basis for regular sleep, but accept or reject the social customs for feeding as you see fit.
Preventing and Solving Sleep Problems:
Months Five to Twelve
It cannot be emphasized enough: The major sleep problems in babies from five to twelve months old develop and persist because of the inability of parents to stop reinforcing bad sleep habits. Some parents don't see themselves as interfering with an important learning process in their child, namely, learning how to soothe themselves to sleep unassisted. The failure of children to fall asleep and stay asleep by themselves is the direct result of parents’ failure to give their child the opportunity to learn these self-soothing skills. In other words, some parents can't leave their kids alone long enough for them to fall asleep by themselves. Don't underestimate children's competence and ability to learn at these early months!
Helping Babies Sleep Also Helps Mothers
One recent study of 156 mothers of infants aged six to twelve months with severe sleep problems used controlled crying (Graduated Extinction) to help solve the problems. This intervention improved sleep problems in the children and reduced symptoms of depression in the mothers. Unfortunately, the benefits for the child and the mother lasted only about two months. Another study was comprised of 738 mothers of infants six to twelve months of whom 46 percent reported their infant's sleep as a problem. They described a strong association between the maternal report of infant sleep problems and depression symptoms in
the mother. After looking at all the variables that might have contributed to maternal depression and the observation that the better the child slept, the less likely the mother was depressed, they concluded that teaching how infants sleep should decrease or help prevent maternal depression. A third study consisted of 114 mothers enrolled when their infants were eight to ten months old; the mothers were again studied when their children were three to four years old. They concluded that infant sleep problems tend to persist or recur in the preschool years and are associated with more child behavior problems and maternal depression. Analysis of their data led to the conclusion that the maternal depressive symptoms are a result, rather than the cause, of the children's sleep problems. It is uncommon for so many studies to be in agreement.
WARNING !
Sleep problems in children may cause maternal depression.
The Importance of Early
Experiences: Theory versus Facts
What does it mean to be a “good parent”? Parents feed and protect their young and provide comfort and guidance. When your baby cries, you go to him. On the surface, it certainly seems reasonable to say that the cry of your baby communicates messages: feed me, change me, pick me up, hold me, hug me, or rock me. The question is, Why is it that when a parent makes a complete response to these messages, some babies still cry? Alternatively, if crying is a form of necessary communication, why is it that many parents will deliver complete, loving, and sensitive care even when their babies do not cry? Perhaps crying as a signal system is not perfect: Some babies cry even when they don't need to cry because their needs are being cared for, and other babies don't cry but still receive the care they need. It may be an instinct: Birds fly, babies cry. In infants, it is possible that crying is no longer tightly linked to infant survival but still occurs as a behavioral remnant of some distant past. An important fact is that the meaning of crying changes with age.
The baby may cry because he is hungry and needs food to survive. The toddler may cry because he wants a second helping of dessert after dinner. The child may cry when afraid. The teenager may cry when feeling hopeless. The adult may cry from happiness at a wedding. Not all crying signifies pain. Unfortunately, when parents talk about crying, the assumption is that crying equals pain. This leads to the sometimes hidden thought: “If my baby cries, I am a bad parent.”
Thinking about how mothers relate to their babies during these early times and how they forge close relationships led to two popular concepts: infant bonding and attachment theory. Both focused almost exclusively on mothers and both claimed that future events would be strongly influenced by early experiences.
Infant bonding theories promoted the importance of early physical contact between baby and mother as a mechanism to a better adjustment later in life. The good news was that this concept caused the delivery of babies to become more comfortable even in a hotel-like environment. This was definitely an improvement for the family, compared to the cold, impersonal environment of a traditional delivery room. The bad news was that mothers who missed this experience because of complications around the delivery, and mothers who adopted older children, felt deprived and worried about their future relationship with their children. You see, infant bonding was thought to take place only during a critical period, very much like the imprinting of baby geese, who will follow any large, moving object they see at a specific time in their development. The fact is that there is no scientific evidence that a similar critical period exists for human babies, and there is no evidence that lack of “bonding” at a specific time right at birth effects subsequent behavior in either infant or mother.
Attachment theory not only considered the interaction between the mother and the child but claimed that if attachment doesn't develop well, the infant grows into an adult who has difficulty in peer relationships, romantic relationships, or parenthood. The good news was that mothers were encouraged to be affectionate, tactile, and warm without fear of spoiling their child. The bad news was that attention to children twenty-four hours a day was thought to be good.
The sad fact was that older theorists were unaware of the benefits of healthy sleep and how we are different in sleep and wake modes. Child psychologists, child psychiatrists, and pediatricians did not know the benefits of healthy sleep until recently.
The improvement in educating child health care professionals has been slow; a recent national survey of pediatric residency programs showed that only 4.8 hours of instruction on sleep and sleep disorders took place during their three years of training. This explains why pediatricians in practice so often incorrectly advise parents that their child is likely to “outgrow” the problem.
Popular distortions of attachment theory claimed that a twenty-four-hour parent—meaning one who attends to every cry day and night—would produce a more securely attached child than would a “selfish” parent who ignores a cry at night so she can get some sleep. Accumulated scientific data do not support these claims. In fact, published research on children between seven and twenty-seven months of age has shown that when parents are instructed not to attend to their children's protest crying (the technique called “extinction”), over time measurements of infant security significantly improved and all the mothers become less anxious. A similar study in sleep-disturbed infants also showed no evidence of detrimental effects on security. It's a simple but true statement that when the entire family gets more sleep, everyone feels better, even if the cries of one member of the family have to be ignored for a while to get there.
In discussing the myth of attachment theory, the famous child psychologist Michael Lewis emphasizes how the development of social skills and peer relation skills are encouraged and protected both by family members other than the mother and by people outside the family. Further, this development depends more on current, ongoing relationships than on past experiences.
Extremely violent or catastrophic events aside, for ordinary families the power of past events has been extremely exaggerated and the singular influence ascribed to the mother is unjustified. Strong proponents of the importance of early events have created in the minds of many mothers a false conclusion: “I am a bad mother if my child cries, because this may cause permanent emotional damage.”
Locus of Control
When your baby was younger, she slept when she needed to. She controlled your relationship with her, in the sense that you met her needs whether you wanted to or not. You didn't let her go hungry simply because you didn't feel like feeding her just then. You didn't let her stay wet because you didn't feel like changing her. Her needs determined your behavior.
But from now on, a shift should occur so that you are in charge. For example, when your child is older, you may decide not to give her junk food simply because she asks for it. You will not risk her physical safety by letting her climb too high on a tree simply because she wants to. And you will not let her stay up to play when she needs to sleep. What, then, are we to do when the child does not cooperate, crying because she does not want to go to sleep even though she needs to sleep?
“Let Them Cry”: A Division of Popular Opinions
There is disagreement among those who write for popular magazines about what happens when children cry after being left alone at night to sleep. In September 1984, McCall's said: “Letting a baby ‘cry it out’ will not teach him the basic trust of confidence he needs to feel secure in his new world.” While Parents magazine, in November 1983, said: “It may give him the feeling that there's nobody out there who cares. The child may become a passive, ineffective person, or he may become angry or hostile.”
On the other hand, the editor in chief of Parents wrote in the October 1985 issue, after the birth of her third child: “The trick was that after eight years of parenthood, my husband and I have discovered … [that] the first sound does not mean that the baby needs to be picked up immediately.”
Don't wait eight years to learn what experts discovered a long time ago!
“Let Them Cry”: An Agr
eement of Expert Opinions
While the popular press may give all types of conflicting advice from a variety of sources, expert opinion is solidly together. In fact, all evidence accumulated by a wide array of child health specialists concludes that “protest” crying at bedtime will not cause permanent emotional or psychological problems. In plain fact, the contrary is true. For example, Dr. D. W. Winnicott, a British pediatrician and child psychiatrist, emphasizes that the capacity to be alone is one of the most important signs of maturity in emotional development. In his view, parents can facilitate the development of the child's ability to soothe herself when left alone. Please don't confuse this with abandonment or, on the other hand, use this notion as an excuse for negligence.
Margaret S. Mahler, a prominent child psychoanalyst, has identified the beginning of the separation-individuation process whereby the infant begins to differentiate from the mother at four to five months of age. This is the age when children naturally begin to develop some independence.
Dr. Alexander Thomas and Dr. Stella Chess, two American child psychiatrists, followed over a hundred children from infancy through young adulthood. One item they examined was the regularity of irregular sleep and how parents responded. They wrote: “Removal of symptoms by a successful parent guidance procedure has had positive consequences for the child's functioning and has not resulted in the appearance of overt anxiety or new substitute symptoms. … The basic emphasis [of the] treatment technique is a change in the parents’ behavior.”
Healthy Sleep Habits, Happy Child Page 29