Months Sixteen to Twenty-one: 23 percent have two naps, 77 percent have one nap at eighteen months; 12 percent have two naps, 88 percent have one nap at twenty-one months
If you have only a morning nap, try to delay its onset by shifting it slowly toward midday. Try a ten-to twenty-minute delay every few days.
Months Twenty-two to Thirty-six: 5 percent have two naps, and 95 percent have one nap at twenty-four months; 0 percent have two naps, 91 percent have one nap, and 9 percent have no naps at thirty-six months
If your child refuses to nap but still needs to nap, experiment with earlier or later bedtimes to help him get more rest.
If your child climbs out of his crib, practice a “silent return to sleep” (see page 320), whereby you always promptly return him to the crib without any talking. If this fails, consider buying a crib tent (see page 323).
Around age three, consider sleep rules (see page 325) to help keep your child in his crib or bed.
If your child gets up too early, use a digital clock to provide a visual cue that signals the start of the day.
If your child has fears, spend extra time soothing to sleep and return once during the night for reassurance; use a timer to control the duration of the middle-of-the-night soothing.
Preschool Children
Most children between three and six years of age, according to my survey, still go to sleep between 7:00 and 9:00 P.M. and awaken between 6:30 and 8:00 A.M. AS previously discussed, I think these bedtimes are too late for many children. Going to bed too late may cause bedtime battles, night waking, or early morning wake-ups, or it may mess up the nap schedule. One mother described her son as turning into a “crank monster” at 4:00 P.M. every day because he was going to bed too late, waking up tired, and taking a morning nap, which prevented an afternoon nap and so caused cumulative sleepiness by late afternoon. Another mother described her child's new early bedtime as “a rescue maneuver to get back the old good pattern he fell out of.”
Years Three to Six:
Naps Disappear
On their third birthday, most children (91 percent) are still napping every day. At age four, about 50 percent of children nap five days each week, and by age five, about 25 percent of children are napping about four days each week. Naps are usually gone by age six unless it is the family custom to nap on weekends. In Japan, it is customary to have naps in nursery 338 school, and in one study of 441 children three to six years of age, the naps caused the children to go to sleep later at night. Between ages three and four, the length of the nap varies between one and three hours, and between ages five and six the length is one or two hours. Normally, naps gradually decrease in duration; some parents try to eliminate the nap in order to enable their children to participate in organized activities. This may or may not be a problem, depending on the child's sleep needs and the remainder of the sleep schedule. For example, some children might seem to need a nap but the nap makes it difficult for them to fall asleep even when tired in the evening. If the parents eliminate the nap and the child goes to bed extra early and/or sleeps extra late in the morning, then there might not be any problems. This flexibility is mainly apparent in children who have been good sleepers in the past; serious sleep problems and disturbed sleep usually do not develop in these children.
PRACTICAL
POINT
A missed nap is
sleep lost forever.
Major problems, however, occur when parents push their children too soon into too many preschool, nursery school, or other scheduled activities. The children are overprogrammed, and naps get scheduled out before the child is ready.
Some parents provide partial compensation for their children's increased mental and physical stimulation by shifting bedtime to an earlier hour. Working parents may not accept this solution, because it reduces their playtime with their children. When you sign your child up for courses, classes, or activities, another solution to prevent sleep deficits is to simply enforce a policy of “declared holidays”: Once or twice a week the child stays home and naps, or he engages in less-structured, low-intensity, quieter activities.
The Sleep-Temperament Connection
I studied a group of sixty children when they were about four months old and again when they were three years old. At both ages, children with easy to manage temperaments slept longer than children with difficult to manage temperaments. Easier children were more regular, approaching, adaptable, mild, and positive in mood than the more difficult children. Which came first, the temperament traits or the sleep?
I don't think sleep habits, temperament, and fussing or crying are independent; rather, I believe they are all interrelated. However, we name and measure items such as sleep duration, temperament traits, or fussiness in the same way we might describe different features of a rose: its color, its smell, or its texture. But the rose is still a rose and a baby is still a baby; even though we give names to different features, none of them could exist without the whole.
It seems to me that after about four months of age, parenting practices such as loving attention during wakeful periods and encouraging good-quality sleep during sleep times can modulate or influence those features we call temperament. For example, easy infants who stayed easy slept a total of 12.4 hours (day and night sleep combined), but those easy infants who became more difficult slept less, 11.8 hours. So to help keep easy infants easy when they arrive at toddlerhood, protect their sleep.
What about those difficult infants? Some of them remained difficult and slept only 11.4 hours, but others became easy and slept 12.0 hours. I think part of the reason why these difficult infants mellowed into easy three-year-olds is because they were handled in a more structured and regular fashion, learning more social rules and becoming better rested.
Adaptability, which is the ease with which children adjust to new circumstances, was the only trait that showed individual stability over the three-year study. But this does not mean that a fussy baby will always have a fussy personality. Temperament traits are not like fingerprints, which are completely biologically based, unchanging over time, and unique identifiers. Temperament traits are more like hair. Our hair has a biological basis, but it changes over time; texture, length, curliness, and color can change naturally or at our will. How we care for our hair affects its health and appearance. And how we care for our children, including how we care for their sleep, influences temperament.
You shouldn't be surprised if your colicky three-month-old has a difficult temperament at four months, but this doesn't predict anything for the future, not even for five months. A fussy nature may persist when colic and parental mismanagement cause enduring postcolic sleep deprivation, and it may improve when the child develops healthier sleep habits. You cannot change the fundamental personality of your child, but you can modulate it.
Evidence that social learning, temperament, and sleep habits go together comes from my nap study. Among the children I studied were three between the ages of two and three who stopped napping during a period of marital discord or problems with caretakers. And when they stopped napping, they underwent what looked like a personality transplant! Fatigue masked their sweet temperaments. But after resolution of the conflicts, all three resumed napping and continued to nap for years. The resumption of napping restored their original or “natural” temperament.
Reestablishing naps will be discussed later. But it is noteworthy that stressful events that tend to disorganize home routines, such as the death of a parent, divorce, a move to a new home, the birth of twin siblings, or the death of a sibling did not cause any napping problems in 90 percent of the children during the study. It appears that when parents and caretakers maintain nap routines, children continue to nap, despite disruptive and stressful events.
After the publications of my original discovery on the association between sleep patterns and temperament—in infants in 1981 and in toddlers in 1984—many other studies in preschool children confirmed my findings. In adults, sleep loss has been
shown to affect mood more than cognitive or motor performance; we all get a bit testy or cranky when we are tired, but we can still learn and perform reasonably well. For children it may be a different story, because the developing brain may be more sensitive to sleep loss than the mature brain. Evidence to support this suggestion comes from animal studies, which have shown that less light was needed to affect the sleeping and behavior of young animals. In other words, the developing brain may suffer more, and in more ways, than the adult brain from the harmful effects of insufficient sleep.
Q: Is it ever too late to see benefits from better sleep quality?
A: No. It is never too late to help healthy children sleep better. In addition, some neurologically impaired children can be helped to have fewer seizures by becoming better rested. Other children have neurological diseases or medicine requirements, which directly disrupt sleep. And finally, recent research suggests that children who have been so severely traumatized by abuse or neglect beginning in infancy might not respond to ordinary sleep training like healthy children.
The Sleep-Behavior Connection
Many research studies have shown more daytime behavioral problems in preschoolers who are poor sleepers. In particular, “externalizing” problems such as aggression, defiance, non-compliance, oppositional behavior, acting out, and hyper-activity were associated with less sleep. When parents listed the types of daytime behavior problems their children were expressing, it became apparent that the less sleep they had, the longer the list! (There was no association between sleep and “internalizing” problems such as anxiety or depression.)
So sleep duration is clearly a factor associated with behavior problems. Still, we do not have absolute scientific proof on whether (1) less sleep directly causes daytime behavior problems, (2) parenting or biological forces cause both the daytime behavior and nighttime sleep problems, or (3) daytime problems cause the nighttime problems. However, recent research by Dr. John Bates on 202 four-to five-year-olds shows that sleep does have a direct effect on daytime behavior in children, in support of the first theory. My impression is that parents who are somewhat regular, consistent, and structured—in terms of both meeting the child's need to sleep and helping the child learn social rules—enable the child to have fewer behavior problems. In contrast, circumstances such as a parent who works late and keeps the child up too late in order spend time with her produce an overtired child; then behavioral problems will be more frequent.
Another study of preschool children noted that the poor sleepers who had more behavioral problems did not get up more frequently than good sleepers, but that the poor sleepers were unable to soothe themselves back to sleep unassisted. They always disturbed their parents’ sleep. I think the ability to return to sleep unassisted to avoid fragmented sleep (and to avoid upsetting parents!) is learned behavior. So, in addition to longer sleep, consolidated sleep helps avoid behavior problems.
Regular bedtimes also seem to be important, maybe even when the total amount of sleep is not quite enough. There were fewer school adjustment problems in one study where a regular bedtime was maintained by the parents. Although it is possible that better parenting practices might have caused both a more regular bedtime and a better adjustment to school, the researchers studied the families and concluded that there was a more direct link between sleep patterns and school adjustment. Again, we have the same conclusion: Better sleep quality produces fewer daytime problems. (More about regularity of sleep times later.)
New research on five-and six-year-old children in Japan and Germany has shown a connection between short sleeping hours and obesity. In the Japanese study, the later the bedtime, the greater the risk for obesity. In both studies, the shorter the duration of sleep, the more likely the children were obese. The researchers controlled for many of the variables, such as parental obesity, physical inactivity, long hours watching TV, and so forth. Maybe these overtired children felt stressed and dealt with it by eating. We know that American society is becoming more overweight; maybe our modern lifestyle is causing us to become more overtired.
Preventing and Solving Sleep Problems
Three-year-olds may no longer have tantrum behaviors, but they may call parents back many times and clearly express their feelings of love for their parents or fears of the dark.
Here are some simple ways to help your child settle down for day or night sleep. Consider them to be a sleeping routine for preschool children. Choose from this list those items that work best for your child and do them at all sleep times.
Slow down activity
Close physical contact
Gentle massage or mild stretching
Cuddle up with die child in a chair
Nestle or snuggle in her bed
Quiet voices
Imagine a fun event
Tell a story, talk about your family
Read a book
Sing or hum a song
Chat about die day
Say good night to everyone and everything in the room
Play a favorite tape, maybe grandparents singing or
saying good night, sounds of nature
Comfortable room
Photos of family and pets
Favorite stuffed animals or dolls
Night-light or flashlight
Dream catcher or guardian angel for protection
Four-year-olds might be helped to sleep better if you try the following:
Make a schedule and post it in his room: Time for bath, time for sleep routine, lights off. (Regularity helps but the times might include a range because not all days are the same.)
Try to engage or enlist cooperation by doing something together such as singing, reading out loud, or doing artwork.
During the day, you might only request a quiet time of one hour or so. Please don't think that it is all right to have a late bedtime, or late wake-up time, and a regular nap. In a recent study of 1,105 three-year-old Japanese children, it was observed that half fell asleep at 10:00 P.M. or later. For all children, the later they went to sleep, the later they woke up in the morning, and the longer they napped. However, the later bedtime was associated with less total sleep compared to those with an earlier bedtime. The later wake-up time and longer nap did not compensate for the later bedtime. Let's look at the problems that may occur with night-and daytime sleep habits and some of the strategies we can use to deal with them.
Night Sleep
Here's one mother's account of how hard it was to ignore her three-year-old at night.
“MOM, I NEED A HUG
AND KISS GOOD NIGHT”
My daughter Chelsea is almost three years old. Putting her to bed has always been an ordeal. At eighteen months of age she started to climb out of her crib anywhere from seventy-five to a hundred times a night. The problem seemed to be solved with the advent of a “big bed.” She now sleeps through the night. However, having her stay in bed and fall asleep is still an ordeal.
I have yelled and screamed. I have used gates and locks on her door to physically keep her in her room. I have used treats as an incentive for positive reinforcement of desired behavior. Unfortunately, the only consistent behavior has been my inconsistency.
If Chelsea knows that I will put a gate on her bedroom door if she leaves her room, even once, then she will gradually conform and stay in her room. But there is a catch! She eventually will start to challenge my inconsistent behavior. One night she will appear in the living room and say, “Mom, I need a hug and kiss good night.” As a parent, do you deny your child such a loving request and lock her in her room? So you give her a hug and kiss and send her off to bed again. Then the next night she wants water, and before long she's out of bed three or four times a night for hugs and kisses, water, Band-Aids, scary noises—you name it! Within a week, saying good night and falling asleep takes an hour or more. Then we have to start over.
Webster's dictionary defines the word consistent as “free from self-contradiction; in harmony with.” I long for the n
ight when I'm in harmony with Chelsea.
As this mother said, “Unfortunately, the only consistent behavior has been my inconsistency.” In other words, when a behavioral approach fails with older children, it almost always is not a failure of the method, but rather a failure of the resolve of the parents to implement it.
In an English study of children about three years of age, psychiatrists examined children who displayed difficulty in going to bed, night waking, or both. Parents were counseled to keep a sleep diary for a week and establish goals for the child that included sleeping in his own bed, remaining in his bed throughout the night, and not disturbing his parents during the night. The treatment consisted of identifying the factors that reinforced the child's sleep problem and then gradually withdrawing them or temporarily substituting less potent rewards. It was a “fade” strategy, not a “cold-turkey” approach.
Here's an example of how subjects gradually reduced reinforcement: (1) father reads story to child in bed for fifteen minutes; (2) father reads newspaper in child's bedroom until child falls asleep; (3) child is placed back in bed with minimal interaction; and (4) father gradually withdraws from bedroom before child is asleep.
Another example: (1) parents alternate, but respond to child; (2) parent gives no drinks but provides holding and comforting until crying stops; (3) parent only sits by the bedside until child is asleep; and (4) parent provides less physical contact at bedtime.
PRACTICAL POINT
At every stage of reduction of parental attention, expect the problem to get worse before improvement begins. That's because the child will put forth extra effort to cling to the old style.
In the English study, 84 percent of the children improved. Not surprisingly, the two factors that most likely predicted success were both parental: the absence of marital discord and the attendance of both parents at the consultation sessions. Also, when one problem—such as resistance in going to sleep—was reduced or resolved, other problems—such as night waking—rapidly disappeared. And although half of the mothers in this study had current psychiatric problems requiring treatment, this did not make failure more likely.
Healthy Sleep Habits, Happy Child Page 36