Is My Child Overtired?: The Sleep Solution for Raising Happier, Healthier Children

1 HOW CAN I TELL IF MY CHILD IS WELL RESTED?

Step One: Suspect the Diagnosis

If your child is old enough to articulate her feelings, she may simply tell you that she is tired. However, most parents aren’t this fortunate. Many five-year-olds with a thousand-word vocabulary will deny with their last waking breath that they need to go to bed, and then collapse into a deep sleep on the couch.

You may be able to tell when your child is tired by her behavior, but unfortunately many parents don’t realize that their children are seriously fatigued. They may search for another explanation for a child’s behavior when in reality sleep is the solution. Here are some ways to tell if your child is well-rested.

Let’s Check the Numbers

Dr. Richard Ferber, clinical director of the Center for Pediatric Sleep Disorders at Children’s Hospital in Boston, has kindly allowed me to reprint a chart from his classic book, Solve Your Child’s Sleep Problems (Fireside Press). It clearly displays the relationship between age and sleep requirement.

FIGURE 1 Typical Sleep Requirements in Childhood

Like many other parents, you may be shocked to see how poorly your child’s sleep patterns compare to Dr. Ferber’s bar graph. You may be tempted to defend the situation by uttering the phrase I hear in my office on a daily basis: My daughter [or son] just doesn’t seem to need as much sleep as other children. You are probably wrong.

Yes, it is true that the sleep needs of individual children can vary widely, and Dr. Ferber’s table should be used only as a rough guideline. However, in my experience most parents seriously underestimate their children’s sleep needs. There are several reasons for this unfortunate miscalculation. One is the temptation to accept as normal certain fatigue-related phenomena such as falling asleep in the car or having to be awakened in the morning. Another is the failure of parents to recognize symptoms such as crankiness, temper tantrums, hyperactivity, headaches, and leg pains as manifestations of sleep deprivation. Instead these behaviors and complaints may be blamed on dietary deficiencies or some inherent personality flaw.

Carried by waves of technological change, our society has drifted from a lifestyle that was once dictated by sunrise and sunset. We have come to accept an abbreviated night’s sleep as the norm. I continue to be troubled by how many parents believe that nine o’clock is an acceptable bedtime for a five-year-old who must be awake by seven to get ready for kindergarten. They wrongly assume that because their friends’ children go to bed that late or later it must be normal.

There is a phenomenon scientists call biologic variation. In simplest terms it means that we are all a little bit different. Your child may become tearful and clingy when she gets overtired. Mine may become belligerent and hyperactive. Your neighbor’s six-year-old may appear to function perfectly well on ten hours of sleep each day, and your six-year-old may wake with fatigue-related leg pains if she gets anything less than twelve hours. It just happens.

I doubt that I will live long enough to see all of these differences and vulnerabilities explained, but I am sure that eventually scientists will be able to identify some of the minor variations in brain structure and chemistry that are to blame for these inequalities that at times seem terribly unfair. Don’t wait for science to catch up with your own observations. Learn how your child’s body and behavior respond to sleep deprivation and learn how much sleep your child needs. You can use Dr. Ferber’s chart as a place to start, but your child’s requirement may be slightly more than his table suggests is optimal. Don’t compare your child’s sleep patterns to her playmate’s or her cousin’s. You may be unaware of the problems their parents are experiencing. Each child has her own limits and peculiar ways of responding when those limits are exceeded. Yes, there are patterns, but treat your child as the special and unique individual that she is.

Here Are Some Clues That Your Child Is Sleep-Deprived:

Your Child May Not Be Getting Enough Sleep/Rest If …

• When compared to Dr. Ferber’s table, her sleep deficit is more than an hour.

• She must be awakened in the morning.

• When allowed to sleep in the morning she sleeps more than a half hour longer.

• She falls asleep as soon as she begins an automobile ride.

• She is frequently cranky and whiny.

• She has numerous temper tantrums.

• It is hard to describe her as a happy child.

• She wants to carry a special stuffed toy or blanket all of the time.

• You frequently find her sucking her thumb.

• She often wakes at night with leg or foot pains.

• She frequently has what appear to be nightmares.

• She has severe afternoon or evening headaches that may be accompanied by vomiting.

• She seems distractible or hyperactive at times, usually in late morning or late afternoon.

• Despite doing well in grade school her grades begin to fall in middle or high school.

• She frequently says she is tired.

This is only a partial list. There are numerous other symptoms and behaviors that can be attributed to fatigue. If you can honestly describe your child as happy and content 95 percent of the time, your child is probably getting enough sleep and rest. However, if your child frequently seems unhappy or angry, and/or you aren’t enjoying being a parent, it is time for the sleep solution.

2 THE SOLUTION CAN BEGIN BEFORE YOUR BABY IS BORN

As a parent-to-be you must have been warned a hundred times that your sleep patterns are in for a significant change. You have already heard from your parents and friends with children that when you finally join the club your baby will be waking frequently at night to be fed. With a smirk on his face your father has reminded you about all of those hours he was up at night walking the floor with you or about how he would have to take you for a ride in that old Honda Civic to get you to sleep.

Sleep deprivation is just part of the package that comes with new parenthood, isn’t it? Sleepless nights are just the first installment when you begin paying your dues, aren’t they? Not exactly. Of course, parenting a newborn is going to be tiring. His nutritional needs will demand that he be fed every few hours for the first few weeks or months, but many of the horror stories you have heard from exhausted parents were preventable. If you learn a bit about the sleep patterns of babies and by organizing your life and your home before the baby is born, many of the traditional problems with fatigue that you were warned to expect can be avoided. This chapter will show you how, with a little thought and planning, you can create an environment in which your child can develop good sleep habits and you can keep sleep deprivation to a minimum. Although some of these recommendations are meant to be applied before the baby is born, don’t fret if you already have a baby. It isn’t too late to get the ship back on course. Read on.

Where Will Your Baby Be Sleeping?

This may seem like a simple question, but the wrong answer can jeopardize your chances of success as you struggle with your first attempts at sleep management. The correct answer to Where will your baby be sleeping is In his own room.

You may have assumed that the baby will sleep in your bedroom for a while and then move into his own room. The problem is defining what a while is going to mean. If this is your first child, I propose that two or three nights is the best answer, because I know that I won’t get you to move him out sooner than that. A few experienced parents who have already learned a thing or two about sleep will have their newborn sleeping in his own room from the first night.

Why shouldn’t your child be sleeping in your bedroom? For one thing, babies are noisy sleepers. They snort and sneeze. They rustle around. They breathe loudly and rapidly at times and then they will pause and seem not to breathe at all, certainly an unnerving experience if you are a parent trying to sleep just a few feet away.

Sleeping like a baby does not necessarily mean sleeping quietly. They are noisy little buggers and will unsettle the sleep of anyone trying to sleep in the same room. As a new parent you will need your sleep. We know that your sleep is going to be interrupted by your child’s need to eat, but we don’t want your sleep to be interrupted by those little noises that accompany his normal sleep patterns.

The other side of the coin is that your presence in the bedroom can serve as a distraction to the baby. Your noises may interfere with the baby’s sleep. If your child has a premature wakening (often called an arousal and a normal part of the sleep cycle) and senses that you are in the same room, he may cry until you respond. If, however, your baby finds himself alone, he will resort to his own ingenuity to settle himself and go back to sleep. Don’t worry about his being lonely. If you give him only half as much attention as I suspect you are going to lavish on him when he is awake, that will be more than enough to prevent him from feeling abandoned.

You may ask, What about crib death? We’re worried about not hearing our baby if he’s in trouble. Although there has been one study that suggests that a baby sleeping in the same room as his mother may have a slightly decreased risk of crib death, this kind of survey has not been successfully repeated in the United States. The sad news is that your presence in the same room is not a guarantee of protection against the tragedy of crib death.

I have had patients die of crib death in their parents’ bedrooms, even in their own beds. Crib death is a terrible tragedy, and we are still not much closer to an answer than we were twenty years ago, probably because there is no single answer.

As this book is being written, most pediatricians are instructing parents to put their children to bed on their backs to minimize the riskof crib death. Although there are a few dissenting voices, primarilythose of older pediatricians, the back to sleep recommendationshould be followed until more data is collected.

When you become a mother, your hearing will seem to develop a special sensitivity that allows you to hear those important noises your baby will make—even though he may be in another room and you may have thought you were sleeping soundly. Barking coughs, the gurgles of a vomit about to happen, and the restlessness of a child with a fever are just a few of the sounds a mother can detect even though her child is one room away. Unfortunately, few fathers possess this special hearing acuity. It seems to be a peculiar sixth sense reserved for mothers, sort of an auditory maternal intuition. It penetrates doors and walls, ceilings and floors.

If it will make you more comfortable, purchase a monitor for daytime use. At night monitors can merely allow reentry into your bedroom of those nuisance baby noises I have warned you about. However, if your bedroom is on a different floor or level from your baby’s nursery, a monitor is a good idea. It can also be useful if you have a large house or want to be out in the garden while your child is sleeping. But, if your child’s bedroom is just a few steps away, I would discourage you from using a monitor at night.

What About Bed Sharing?

In the last few years an increasing number of parents have brought their newborns into bed with them. This trend toward co-sleeping has been fueled by a few reports that when infants and mothers sleep together their sleep cycles might change and synchronize. This observation has led some observers to theorize that bed-sharing may reduce the risk of sudden infant death syndrome (SIDS).

Babies who sleep with their mothers might feed more often, and if a baby is being breastfed these frequent awakenings and feedings might improve the chances of nursing success. In spite of these more frequent interruptions to feed some mothers have reported that they sleep better when they bed-share with their infant.

Although in some cultures bed-sharing is the norm, in North America this has not been the case. However, you may be tempted to create a family bed after your baby is born because it just sounds like the more natural way to raise your child. On the other hand, if the thought of sharing your bed with a three-year-old is troubling, you may have considered starting off by co-sleeping with your baby to take advantage of the safety and nutritional benefits you have heard about. Then when he is eight or nine months old, has passed the highest risk of SIDS, and is no longer relying on breast milk, you would plan to move him into his own crib.

Before you try either this shortened variation of co-sleeping or allow your child to share your bed until he decides to move into his own, let me offer you a few things to consider. First, bedsharing has its risks. Babies have been inadvertently smothered by their parents or their parents’ bedclothes. In fact, in 1999 the Federal Consumer Product Safety Commission warned parents against bringing children into their beds. They cited a study that found that over an eight-year period 515 children under age two (an average of sixty-four children per year) died as a result of sleeping in adult beds.

Second, the reduced risk of SIDS claimed for co-sleeping is controversial and not widely accepted. In 1997 the American Academy of Pediatrics’ Task Force on Infant Positioning and SIDS stated: There is no basis at this time for encouraging bed sharing as a strategy to reduce SIDS risk. It also warned that if a child is brought into bed, soft sleep surfaces should be avoided and the bed sharer should not smoke or use substances such as alcohol or drugs that may interfere with normal sleep patterns.

Although I believe that co-sleeping babies probably nurse more often and may experience better weight gain, there are numerous other strategies that can improve your chances for breast-feeding success that don’t involve bed-sharing with your infant. I have watched thousands of babies who sleep independently gain weight very nicely on breast milk alone.

Although there may be some debate over whether co-sleeping offers any advantages, the majority of the parents in my practice who have tried it complain that they wake the next morning feeling tired as a result of their baby’s frequent awakenings. However, the strongest argument against bed-sharing is that it can delay the development of sleep independence, which is one of the cornerstones of raising a well-rested child and the focus of the next chapter. If your child is going to form good sleep habits that include healthy bedtimes and adequate naps, he must first learn to put himself to sleep without your assistance. Co-sleeping will delay this process and can create sleep problems for you and your child. Unfortunately, waiting until your infant is eight or nine months old often makes matters worse because at that age he will be going through the normal stage of what is often called separation anxiety or distress. It won’t be easy to get him out of the bed that he has thought was his own for nearly a year.

What About Nursing in Bed?

Some mothers want to bring the baby into bed just for nursing. While occasionally this is fine, don’t make a habit of it. Having listened to thousands of mothers describe their nursing experiences, I can tell you that at least half of the time when you nurse your baby in your own bed you and/or your baby will fall asleep.

Plan on doing most of your baby’s night feedings in his bedroom. I realize that this means you must leave the warmth of your bed and walk on the cold floor to your baby’s room. However, this arrangement will make it less likely that you will inadvertently co-sleep. As you are decorating the nursery, include a comfortable chair for yourself and a soft night-light at knee level or below.

What to Do If Your Baby Doesn’t Have His Own Room

This situation can certainly present some problems, but often with some creativity there can be an acceptable solution. I can be very sympathetic to the plight of young married couples with small living quarters. My wife and I have been there and done that. Here are some suggestions that have been successful for my patients. I hope that they help you solve your bedroom deficiency.

First, take an inventory of all of the rooms, nooks, closets, and odd spaces that you have. I have known some families who have converted large closets into sleeping quarters for the baby. Remember, we are just looking for a place for the baby to sleep, we aren’t planning a playroom or gymnasium. Some houses have an extra bathroom that with a carpet and some wall hangings can be made safe and quiet for an infant. That little den filled with boxes of books and unwanted wedding gifts could be made into a sleeping area. Rent one of those self-storage units that have popped up all over the country and put your extra stuff in it. It is probably much cheaper than moving to a bigger house or apartment.

The bedroom doesn’t have to have a door, but it would be very nice if it did. If you rent, ask the landlord if you can hang a cheap door in the empty door frame. If this is really impossible (ask more than once) a thick drape or old bedspread hung over the doorway can keep the light out and the sound down. The room does not have to have a window, but it should be large enough to assure good ventilation. Install room-darkening shades or hang thick, opaque curtains.

If there isn’t a room, partition off a corner of the living room with folding screens or heavy drapes or bedsheets. I realize this may raise havoc with your decorating scheme, but for now decorating isn’t a priority. Move the TV, computer, and stereo equipment into your bedroom so that during the evening your baby can sleep with a minimum of visual and auditory interruption. So that you all can have your own space, consider temporarily converting your bedroom into the living room. Because the quantity and quality of your baby’s sleep are so important, put your heads together and try to think of how you and the baby can each have a place for uninterrupted sleep.

Who Is Coming to Help You After the Baby Is Born?

This is really a ticklish question, but the correct answer can be important to your early success in family building. The first question could be, do you want an extra person around while you are trying to figure out how this parenting thing is going to work? Could you be asking for trouble? Is this a potential too many cooks situation? If there are two of you, there may not be much need for help in the first few days. With cooperation and close communication with your pediatrician, hospital, and visiting nurses the two of you can probably do a pretty darn good job of getting your new baby off to a good start.

Grandmothers can often provide some valuable assistance and have been the traditional first choice. Your mothers will probably be expecting to be called on. Even if their schedules make it difficult to come, they might be offended if you don’t at least ask. However, if you would really like to fly solo for the first few weeks, don’t be afraid to explain the situation: Mom, we want you to come help if you can. Bob will be taking a week and a half off once the baby is born; it would be great if you could come sometime after he goes back to work.

Finally, what could be the most important question: Where will the helper sleep? Remember that it is imperative that the mother and baby get as much quality sleep as possible, and it is preferable for your baby to have a separate place to sleep. This is likely to mean that you just don’t have a place in your