Teach children how to fall asleep and stay asleep

November 27, 2005|By DANIEL BUCCINO AND HANNAH FENTON-ROBERTSON

The air is filled with talk of sleep.

Every new parent has the conversation and, since all non-parents sleep, everyone else has an opinion about the best way to get the kids to bed. Whether we're debating the best techniques for putting babies to sleep or bemoaning the explosion of prescription sleep aids by adolescents, sleep is on our minds as we descend into the somnolent winter doldrums.

What few realize is that children have to be taught how to fall asleep and stay asleep.

Each parent and family must invent for itself ways for everyone to get some sleep. Whether nursing or bottle feeding, whether sleeping in the same bed with the baby or sleeping separate, parents struggle with often competing advice from doctors and professionals and from friends and family.

Parents draw on their personal experiences about sleep and project their own anxieties about closeness and separation onto their infants and children. The best kept secret in parenting is the struggle many families face in trying to structure a lifestyle that will promote and sustain sleep in their children and allow the grown-ups some, too. If children can't learn to fall asleep, the entire family begins to have difficulties.

Regardless of family sleep philosophy or expert recommendations, every parent discovers that each child in a family will require unique bedtime solutions as a function of differences in temperament and activity level.

A recent study by one of the authors found that there is no universally correct sleep solution. Parents must decide what sleep arrangements work best for their families. Those decisions are influenced by personal preference, convenience, exhaustion and anxiety about bedtime separations for the child.

But the study revealed that the more help parents provided the child in getting to sleep (nursing, bottles, cuddling, pacifiers, co-sleeping), the more difficulty children tended to have later in being able to get themselves to sleep.

In addition to recent "back-to-sleep" campaigns in which parents are encouraged to put their babies to sleep on their backs and encouraged to use pacifiers to decrease risks of Sudden Infant Death Syndrome, expert opinion seems to be swinging away from co-sleeping as an expedient solution.

Co-sleeping is thought to be implicated in an increased risk of SIDS and other nighttime accidents, but the real risk may be in not fully allowing children to learn how to get to sleep and stay asleep without the immediate intervention of someone or something else.

Will we always send our children to camp or sleepovers or school trips, and, eventually, college with an armada of transitional objects (symbolically important stuffed animals, pillows, blankets, iPods) to substitute for co-sleeping? Helping children develop long-term habits of optimal sleep hygiene begins at a young age and requires a major commitment by families.

It may be because so many children have not learned how to get to sleep that we read recent reports of adolescents and young adults swallowing handfuls of prescription medications to help them sleep, to help them wake up and to help them pay attention throughout their generally sleep-deprived days.

Certainly many children are being more carefully diagnosed with mood, attention, behavioral and even sleep disorders requiring medical intervention. But perhaps much of this diagnosis could be reduced by simply persevering with parents as they help their children learn how to sleep. This is a lesson more important than any academic one since sleep is a prerequisite for learning. It is a lesson that cannot be subcontracted to a doctor, a teacher, a nanny or a pill.

Given the exhaustion parents face, it's no wonder many look to the expedient solution, whether co-sleeping or sleeping pills, to help sleep come for everyone. But sleep today may not be helping anyone learn to sleep tomorrow, and it takes a concerted effort by parents and society to promote long-term sleep hygiene and independence.

Daniel Buccino, a founder and director of the Baltimore Psychotherapy Institute, is a supervisor in the Community Psychiatry Program at the Johns Hopkins Bayview Medical Center where Hannah Fenton-Robertson is a therapist. His e-mail is DBuccino@jhmi.edu.

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