Initial causes of sleep disturbances and nightmares in children

Periods of sleep at night in a child under four years of age: normal mode

0-3 months

Babies from 0 to 3 months sleep for 30-50 minutes at night, going through the stages of shallow and deep sleep. At this age, shallow sleep prevails over deep sleep. Your baby will wake up after finishing one sleep cycle and often need help getting back to sleep.

3-6 months

By 3 months, the beginnings of a sleep-wake pattern appear. Children sleep up to 3-4 hours straight at night. This reduces the number of awakenings.

6-12 months

By 6 months, your baby is sleeping through his longest stretches of sleep without waking up during the night. Going to bed for the night is between 18:00 and 20:00. It takes your baby less than 30 minutes to fall asleep. Provided that there are no problems with sleep and the child is not overtired. At night, a child can sleep up to 6 hours. Sometimes more.

Almost two thirds of children wake up only once at night for feeding. But there are also babies who still wake up about 3-4 times.

1-2 years

After one year, children can sleep peacefully all night and do not need additional feedings if their diet is adjusted and there is no food-sleep association.

2-4 years

At this age, night sleep is already stable.

In the first hours after going to bed, children sleep in the deep sleep phase. Therefore, it is difficult to wake them up. In the second half of the night, babies sleep more superficially and shallowly. At this time, it is easier to wake up the child; night awakenings occur more often during this period.

But if the baby has problems sleeping, then even in the first half of the night he may wake up often.

The sleep cycle lengthens as the child gets older. By 3 years it reaches 60 minutes. By age 5, children have the same sleep cycle as adults—90 minutes.

Talking about diapers

Diapers mean comfort and healthy baby skin, freedom from multiple changes of diapers and cloth diapers throughout the day and night.

Let us remember that in the era before the invention of diapers, it was necessary to stock up on 24-48 warm and light diapers for a newborn, and now 6-15 may be sufficient.

We select disposable diapers according to the principle: comfortable, sized, reliably moisture-proof, safe.

A child wearing a disposable diaper wakes up less often at night, but there are also pitfalls - it is more difficult to correctly instill neatness skills by 1.5 - 2 years.

The article also uses freely available advice from the famous pediatrician E.O. Komarovsky.

Frequent awakenings at night - is this normal?

As can be seen from the description of sleep patterns at night, frequent awakenings may be the norm in the first year of life. Therefore, here it is worth talking about the number and reasons for awakenings and looking at the child’s age to understand whether it is necessary to wait it out or whether it is worth working on sleep. If the baby wakes up too often for his age, sleep becomes fragmented, its quality deteriorates, and the deep sleep phase is shortened.

Why is it important? Shallow sleep is responsible for brain development. Deep - for physical recovery, restoration of tissues, muscles and nervous system.

If a child sleeps short sleeps and does not sleep at night, this affects his health and development:

• mood worsens;
• activity decreases while awake;
• tremor of the limbs appears;
• muscles weaken;
• growth slows down;
• problems with nutrition appear.

The benefits of night sleep for a child

Along with nutrition, sleep plays an important role in the development of a child.

During sleep, a number of processes occur in the body

1. The child’s brain matures and information is consolidated. Several studies have shown that children who sleep well and longer at night learn and remember information better.
2. Babies who sleep longer at night are less fussy during the day, are easier to negotiate with, and are better able to adapt to changing events while they are awake. Such children cope more easily with separation from their mother and are more willing to stay at home with a nanny or grandmother without her.
3. Lack of sleep negatively affects growth hormone. Because this hormone is produced during rest, a child who does not sleep well grows more slowly. Also, lack of sleep affects a child’s weight if the hormone leptin, which is responsible for the feeling of fullness, malfunctions. The baby will eat even after being full.
4. When children lack sleep, coordination is impaired, which leads to numerous injuries - the child more often falls and stumbles out of the blue.

Obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSA) is thought to affect 1-3% of children. Symptoms include snoring and labored or mouth breathing during sleep. Parents of infants with severe OSA may experience difficulty feeding their child. OSA in children is often caused by adenotonsillar hypertrophy. Other causes include craniofacial pathology, obesity, and neuromuscular diseases. A high percentage of allergic diseases has been reported in children with snoring and OSA. In adults, airway obstruction is transient and often very severe. In children, if the cause is adenotonsillar hypertrophy, the obstruction is permanent, but less pronounced. Children are less likely to experience hypersomnolence (daytime sleepiness) than adults, but they also often experience enuresis, excessive sweating, and developmental delays. OSA. There is clear evidence of OSA in a certain percentage of children experiencing learning difficulties and behavioral problems, including attention deficit hyperactivity disorder. The diagnosis of OSA is made in a pediatric sleep disorder laboratory using overnight oximetry and polysomnography. Most of these children experience significant improvement after tonsillectomy. The latter is not indicated if the cause of OSA in the child is another pathology (craniofacial anomaly, neuromuscular diseases, obesity). In these cases, and also if tonsillectomy surgery does not bring a satisfactory result, treatment with CPAP, a device that creates positive air pressure in the upper respiratory tract, can be prescribed. This technique is usually used in adults, but has also been shown to be effective and safe in children.

Why does my child sleep poorly at night?

Children's sleep at night is influenced by 3 main factors: physical, physiological-emotional and sleep habits.

Why doesn't a newborn sleep?

• Until 2-3 months, many newborns can sleep in any conditions. But there are more sensitive children who react sharply to the atmosphere around them. In this case, the child's sleep can be affected by temperature, humidity, extraneous sounds around and lighting during sleep and sleep.
• Overtiredness is the most common reason why a newborn does not sleep well. Up to 3 months, the baby is able to stay awake for no more than 45-75 minutes. The younger the baby, the less time he spends actively. Now even an extra 5 minutes can lead to excessive fatigue, which will make it difficult to fall asleep and make sleep more sensitive.
• Severe overexcitation. Babies are born with an immature nervous system and need time to adapt to the new world. Therefore, a newborn is easily overstimulated by excessive noise, long periods of wakefulness, and new people around. Your baby finds it difficult to process all the new information and needs quiet time to calm down and relax.
• Confusion of day and night. During pregnancy, the baby's sleep rhythms are closely related to the mother's movements. When she is awake and moving, her movements lull the baby to sleep. And when she goes to rest, the baby often wakes up and is ready to play. Babies also rely on their mother's hormones, especially melatonin, to help them sleep. After birth, the baby has to adapt and rely on its own internal clock, which “tells” it when to sleep and when to stay awake. But the newborn's circadian rhythms have not yet been formed. Therefore, the baby can sleep more during the day than at night.
• Health problems: colic, allergies, dermatitis, colds.

Why does the baby not sleep (3-6 months)

1. Sleep regression at 4 months. This is the most significant regression. The child develops circadian rhythms and begins to sleep according to an adult scenario. During regression, the baby often wakes up at night and cannot fall back to sleep. Sleep regression can begin at 3.5 months or, conversely, a little later than 4 months. It lasts from two to four weeks.
2. Nutrition. Does hunger cause frequent waking up at night? By 4 months, the baby may have formed the habit of eating and sleeping, if before that the mother gave the breast or a bottle every time to make him fall asleep, and fed him until he fell asleep. And if you form a habit in your child of eating often at night, it really awakens him to wake up to eat. However, this does not mean that the baby is hungry at night. He doesn't know how to fall asleep any other way.
3. Inappropriate routine that causes fatigue to accumulate. For example, with too short naps during the day, not enough naps during the day, staying awake too long and leaving late at night. With chronic excess, the level of the stress hormone cortisol inevitably rises in a child, which has a cumulative effect. Due to the action of cortisol and its partner adrenaline, the sleep cycle is shortened, and the child begins to sleep mostly superficially. Gradually, if the mother does not work under overwork, the child enters the phase of superficial sleep and wakes up without going into deep sleep. Over time, the baby sleeps only superficially. And sleep of 20 minutes, no more, which is also gradually reduced. As a result, the child stops sleeping at night, often wakes up and sleeps only on the chest, while rocking or with a pacifier in his mouth.
4. Teething. The child's first teeth appear. In the acute period in the first 2-3 days, when the pain is especially severe. At the same time, there will be other symptoms - the baby will put everything in his mouth, you will see increased salivation.
5. External factors. After 3 months, sleeping conditions greatly affect the baby's sleep, especially if the baby is sensitive.

6-12 months

• Problems with the regime. By 6 months, a predictable routine should already appear with 3 naps during the day, getting up at 7:00-7:30 in the morning and going to bed until 20:00. But if the baby sleeps poorly during the day and goes out late at night, then due to accumulated fatigue he will sleep poorly at night and wake up often.
• Nedogul. This factor is less likely to affect night awakenings. But it happens that a mother, afraid of overtiring her child, puts her to bed too early. An untired baby takes a long time to fall asleep and “walks” at night. Sleeplessness also happens if the child sleeps too much during the day.
• Inability to fall asleep on your own. At 6-12 months, most children, if they are not overtired and do not have sleep associations, are able to fall asleep on their own. They no longer need their mother’s help, as they did in the first months of life. But often a child has a habit of falling asleep while being fed, rocked, with a pacifier in his mouth, with his mother next to him. At night, waking up between sleep cycles, the child will ask for help to fall asleep too.
• Period of growth spurt, mastering a new skill. This is not the main reason for frequent night awakenings. No developmental leap can seriously affect a child's sleep. Only for a few days. If you see that after mastering a new skill the child has stopped sleeping, it is worth checking other factors.
• Sleep conditions are now especially important for quality rest. The child actively explores the world around him and is easily distracted. Therefore, if the room is too bright, he will be distracted by the objects around him. Temperatures that are too high or too low will make it difficult to fall asleep, as will air that is too dry, which can make breathing difficult.
• Physical discomfort. The child may wake up due to an overfilled diaper, uncomfortable sleep clothes, or if he sleeps under the blanket, keeps throwing it off and wakes up from the cold in the morning.

1-2 years

1. Switching to one nap too early. At 10-12 months, children have a period when they refuse a second nap. Mom doesn’t insist and switches to one nap. But physically, the child’s body is not yet ready for long periods of wakefulness. By the evening, fatigue accumulates, the child takes a long time to fall asleep and wakes up at night.
2. Daytime sleep ends too late. The child's brain regards sleep after 17:00 as nighttime. And if you decide to put your baby to bed for his second nap late, for example at 5:00-6:00 pm for an hour or two, he will wake up crying and then go to bed very late at night. If your baby consistently takes naps after 4 pm, it will be difficult for him to sleep 12 hours straight at night.
3. Something or someone wakes the child up at night. After a year, if the child can fall asleep on his own, he can sleep in a separate room. He may be sensitive to outside noise and would rather sleep alone in the room. You should only transfer your child to another room after consulting a pediatrician.
4. Teething, ear infections, digestive problems, and a stuffy nose cause frequent awakenings.
5. Too early transfer to a crib without sides. Until 2.5-3 years old, a child is not yet able to control his emotions in order to stay in bed without physical boundaries. If you transfer to an “adult” crib too early, you may encounter nightly “festivities”, the child’s trips to the parents’ room.

2-4 years

• Fatigue and nervous overexcitation. At this age, children begin to attend developmental classes and kindergarten. As a rule, problems arise with daytime sleep - the baby refuses to sleep or falls asleep too late during the day. New impressions and knowledge overstimulate the child’s nervous system and, with a lack of rest during the day, lead to light sleep at night.
• Fears, separation anxiety, stress. These factors appear if your baby is going through a difficult time in life: the addition of a second child, potty training, a new nanny, or the start of kindergarten can cause separation anxiety during the day and restless sleep at night. Nightmares may also appear during this period.
• Inability to fall asleep on your own. This is your case if, after completing breastfeeding, the child does not sleep better, or if he wakes up at night to drink compote and cannot fall asleep without you.
• Checking the boundaries of what is permitted. The child actively expresses his “I” and tests the boundaries of what is permitted. Often when it comes to sleep. Another fairy tale, another trip to the potty, another little kefir. The bedtime takes longer, and at night there are awakenings to check if mom is nearby.
• Active speech acquisition. Like the previous skills that the baby has mastered, mastering speaking also affects sleep. Your baby's brain is active and literally wakes him up to practice a new skill.

Why does the child not sleep at all at night and cry?

0-3 months

• The baby is going through the so-called “ purple cry ” . The apogee of crying occurs at 6-8 weeks of a child’s life. The crying may be sudden and unpredictable, as if the baby is crying in pain. The tears last for hours, especially in the evening and at night. As a result, the baby does not sleep at night.
• Colic, allergies, dermatitis.
• Excessive fatigue.

4 months-2 years

• New skills. The child is actively trying to practice a new skill. During light sleep, the baby thinks about a new skill and begins to try it: crawling, standing up, etc. As a result, he wakes up. It `s naturally. If your baby cannot fall asleep on his own, you will need to put him down again.
• The child is cold or hot, he slept in an uncomfortable position. The baby experiences physical discomfort (cold/hot, rested his arm/leg while sleeping. He can eliminate it himself if he can move, or the mother can eliminate it if the baby does not yet have motor skills.
• Frequent awakenings at night in the middle of sleep and crying are a sign of accumulated fatigue in the baby. The child may also shake his head and tremble.
• Requesting help if the child cannot fall asleep on his own. Most often, the baby forms an association between feeding/rocking/pacifier/mother nearby—sleep. His brain thinks that it is impossible to fall asleep any other way, and it is impossible. As a result, the tired child cries for help.
• Nightmares. Typically, nightmares may be closer to 2 years of age. Until this age, the child does not know that he needs to be afraid. All fears are formed in children under 2 years of age in response to their mother’s reaction.

Pavor nocturnes or night terrors

Pavor nocturnus or night terrors occur approximately 90 minutes after falling asleep, in stage 3 or 4 NREM sleep. The child suddenly sits up and begins to scream uncontrollably. It may take up to 30 minutes for him to calm down and fall back to sleep. This is accompanied by tachycardia, rapid breathing and other signs of autonomic activation. Night terrors usually occur in children between the ages of 3 and 8 years. They must be distinguished from nightmares (Table 1). Night terrors are more likely to occur during periods of stress or overwork. Despite their frightening nature, parents need to make sure they are self-limiting. We must try to find out if there is any stressful situation in the child's life and make sure that the child has opportunities for rest and recovery. For children whose night terrors do not resolve on their own and the episodes are extremely disruptive, diazepam (Valium) can be prescribed.

Table 1. Comparison of night terrors and nightmares

What to do if your child has trouble sleeping at night?

What to do if a child does not sleep at any age:

• Make sure your child is healthy. The pediatrician observing your baby will help you with this.
• Create suitable sleeping conditions: - The temperature should be no more than 18-21 degrees in winter and no more than 23-25 ​​degrees in summer. Avoid overheating your baby. Dress your baby according to the room temperature.
  — Maintain optimal humidity of at least 50%.

  - Darken the room during all sleeps with curtains that do not let in sunlight. It is important that there is no gap between the curtains and the window, and that no electronic devices should be lit in the room. If your baby sleeps in a stroller, also use a special curtain over it or cover the stroller with a diaper.

• Spend the time 30-60 minutes before bedtime in quiet games. Finger games, puzzles, cutting, modeling, and drawing are suitable here. Depending on the age of the child.
• Move active activities to the first half of the day - trips to the doctor, massage, developmental activities.
• Introduce a bedtime ritual that will help your baby get ready for sleep.
• Be consistent in your actions. It will take time for your baby and you to get used to a new routine or sleep habits. Remember this and continue.

0-3 months

Organize a place to sleep that your baby will later associate with rest. It could be:

• Adult bed for co-sleeping.
• A crib that is attached to the parent's bed with one wall down.
• Separate cot in the parents' room. In each case, the place to sleep must comply with safety regulations. You should not put your baby in the crib while he is awake to play. It is also necessary to place the child on his back, and not on his side or stomach. The American Pediatrics Association recommends this position as the safest for infant sleep.

Learn to recognize the signs of fatigue. This will help you prevent your baby from becoming overtired. Common signs of fatigue in newborns:

• yawn;
• clenching fists;
• thumb sucking;
• distant look.

Start putting your baby to bed as soon as you see these signs.

Keep track of your waking hours. Typically, in the first months, babies can stay awake no more than the time of their previous sleep.

Use different styling methods and alternate them. For example, for one nap you rock it to sleep, for the second you feed it, and for the third you put the baby in the stroller to sleep. Perform a short ritual before bed.

Teach your baby to distinguish between day and night. While awake, open the curtains, take the baby out into the light, and do not muffle the noise. In the evening, turn off the overhead lights and reduce your activity. This will help adjust your baby's internal clock so that he sleeps longer at night.

Use white noise and swaddle your baby so that he does not wake himself up with his arms and legs during sleep and does not wake up from extraneous sounds.

3-6 months

Reduce fatigue. From 3 months, shift bedtime to earlier, so that by 4 months the baby begins to fall asleep between 18:00-20:00. Also try to gradually get up in the morning no later than 7:30. Switching to a physiological regime at 4 months will help avoid frequent night awakenings in the future.

Don't skip naps, but don't let your baby sleep too much during the day. Use the recommended sleep guidelines for each age as a guide.

When waking up at night, try to use a minimum of lighting, do not talk to the child unless necessary. This way he will understand that he still needs to sleep, and will fall asleep faster after feeding.

As your baby gets older, reduce the number of night feedings to avoid developing the habit of waking up to feed. By 6 months, babies are ready to eat every 4-5 hours and are able to sleep for longer periods of time.

Around 4-6 months we will notice that the baby is trying to fall asleep on his own. Help your baby: put him in his crib while he is not yet completely asleep. At night, at the first rustling sound, wait a minute or two and only then go to calm the child. However, if your baby already has a habit of waking up and asking outside help to fall asleep, this may not work.

If the baby sleeps only on the chest, you rock him day and night, awakenings are too frequent, then it is worth teaching the child the skill of falling asleep independently. The skill is taught from 4 months.

Don't know how to teach your baby to fall asleep independently? Join the online course on SZ and your child will sleep through the night in less than a month. Find out more on the website.

6-12 months

From this age, a fairly predictable routine with 3 naps a day should already appear. Maintain a consistent daily routine so your baby's body knows when to sleep.

Finish your last nap of the day before 5 p.m. and do not take it for more than 45 minutes in a three-nap routine. If the baby sleeps twice, both sleeps should be at least 1 hour each.

If your baby often wakes up in the morning to feed and then does not fall asleep, try changing the feeding schedule. For example, if your baby falls asleep after feeding at 19:00 and wakes up to eat at 2 in the morning, try waking him up at 23:00. Then put your baby to sleep until feeding at 6am.

If there are too many feedings and the child wakes up not because of hunger, but out of habit, and cannot fall asleep on his own, it is worth teaching the baby the skill of falling asleep independently using one of the methods.

Does the baby wake up and try to crawl, stand up in the crib and roll over? Actively practice a new skill while awake so that your baby quickly masters the new capabilities of his body.

Offer your child a toy to sleep on. It will become a positive association. Choose a medium-sized toy, without small parts.

1-2 years

Avoid overtiring your child. Baby still needs early bedtime and two naps until 15-18 months. You shouldn’t wait for your baby to show you when he wants to sleep. At this age, napping during the day should already be done by the hour. For example, if you wake up at 7:00, they will start at 9:30/10:00 and 13:30/14:00. Avoid staying awake for too long before heading out into the night.

Avoid watching cartoons and playing on your phone in the afternoon.

Do not transfer your baby to a crib without sides. If he starts waking up at night and tries to get out:

• lower the bottom of the crib as low as possible;
• increase the sides of the crib;
• change the mattress to a thinner one;
• Use a sleeping bag to sleep in, which will limit your baby's movements.

2-4 years

Maintain a daily bedtime routine.

Take a nap during the day and end it before 4:00 p.m. Stick to an early bedtime. Night sleep should begin no later than 20:30.

If your baby is afraid of the dark, try using a lamp with a dim, warm light. But not a projector with stars.

At night when he wakes up, calmly get up and put him back down with minimal interaction.

Explain to your baby the rules of nighttime sleep:

• everyone sleeps in their own beds
• we don't play at night
• We read one book while going to bed, go to the potty before going to bed

Co-sleeping

Co-sleeping is a term that refers to parents and children sleeping in the same bed. Many experts frown upon the practice due to concerns about possible sexual harassment or infringement of personal autonomy. However, statistical studies do not reliably confirm these concerns. Co-sleeping is especially popular in a number of cultures and is believed to promote a sense of security and love in a child. Regardless of the above, it can be argued that the frequency of co-sleeping is much higher, since parents may simply not talk about it or even hide it for fear that the doctor will frown upon it. According to various sources, 33-55% of preschoolers and 10-23% of schoolchildren sleep in the same bed with one of their parents. One cannot ignore the possibility of dramatic consequences not related to sleep disturbances themselves. Recently, a special commission in the United States published a report that over 8 years described 515 deaths of children sharing beds with adults. Approximately every fourth death was caused by mechanical compression of a child by an adult. Three quarters of the cases were caused by mechanical problems with the bed or mattress, which led to strangulation and suffocation of the child.

How to teach a child to fall asleep after waking up at night?

1. Wait a few minutes before approaching your child and soothing him. Let him try to fall asleep on his own.

2. When waking up at night, be as quiet as possible; if possible, do not use light.

3. If the baby does not fall asleep on his own, stroke his tummy, shush him, but do not take him out of the crib.

4. If the child is used to falling asleep during rocking, reduce their amplitude so that he gradually gets used to falling asleep in a static position.

5. Does the baby fall asleep only during feeding? Feed him and put him in his crib, soothing him with stroking.

Mistakes that parents make when organizing their child's night sleep

• They wait until the baby wants to sleep and put him to bed too late.
• They let the baby play until the last moment and then abruptly begin to move on to putting him to bed.
• They don't always perform a ritual before bed.
• The last hour before bedtime is spent with the baby in active games.
• Allow your child to watch cartoons before bed.
• They do not create suitable conditions for sleep and hope that the child will sleep in light and noise.

When do you need specialist help if your child has trouble sleeping at night?

Symptoms for which you should definitely seek help

The baby does not sleep at all at night and sleeps during the day.

The baby refuses to eat during the day and hangs on his chest all night.

Going to bed at night lasts an hour and a half and is accompanied by tears, protests and hysterics.

The child wakes up too often for his age, cries when he wakes up and wakes up cranky in the morning.

You observe symptoms in your baby such as: hyperactivity, tremors of the limbs, slow growth and development, constant drowsiness, apnea, snoring, nightmares.

The child stopped sleeping after 4 months and the old ways of putting him to sleep do not help.

You notice that the baby does not get out of his hands during the day and has lost interest in games.

A child over 4 months sleeps no more than 20-30 minutes during the day in one nap; you cannot prolong dreams.

Disorders of sleep initiation and maintenance

Disorders of initiating and maintaining sleep (DIMS) are most often found in preschool children due to the characteristics of psychological development and the difficulties inherent in this age. Sometimes parents have difficulty setting firm limits or agreeing with the child’s demands - “one more glass”, “one more fairy tale”. In such cases, parents are advised to perceive such attempts to delay bedtime calmly but firmly, ignoring the child’s protests. You can avoid further confrontation by telling your child that the door to his room will be open while he is in bed, but will be closed (not locked) if he tries to get out of it. One recommended technique is called a "bed passport" - a card with the child's name written on it that can be exchanged without penalty for one short trip out of the bedroom per evening and then returned to the parent for the rest of the evening. For children who have difficulty falling asleep, it may be helpful to develop a predictable routine - 3 or 4 components, lasting 20 to 30 minutes, for example, a story, a song, a drink, a back massage; Constant use of this procedure is very effective. The procedure can be shifted in time earlier, until the desired time.