How Can Parents Tackle Sleep Struggles with Their Children?

In this episode of MomDoc Talk, host Kristen Cook, a pediatrician with over a decade of experience and a parent herself, delves into the critical role of sleep in parenting. Kristen discusses the common struggles parents face with their children's sleep patterns and the impact of sleep deprivation on family life. She provides valuable insights and practical strategies to help parents navigate these challenges, emphasizing the importance of good sleep hygiene and realistic expectations. Kristen also highlights the varying sleep needs of children at different ages and reassures parents that sleep struggles are a normal part of parenting.

• Importance of sleep for children and parents
• Common sleep challenges faced by parents
• Recommendations for sleep duration based on children's age
• Unique sleep needs and variations among children
• Misconceptions about sleep training and its effectiveness
• Strategies for promoting good sleep hygiene
• Creating a conducive sleep environment for infants
• Addressing sleep refusal and bedtime avoidance in toddlers
• Impact of electronic devices on sleep quality
• Importance of parental self-care and flexibility in managing sleep struggles

The information in this podcast is for educational and informational purposes only. It is not a substitution for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider for medical issues. All the opinions are of Dr. Kristen Cook and do not reflect the opinions of her employer nor the hospitals she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.

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Transcript

0:01

Welcome to my talk with Doctor Kristen Cook, where real life parenting meets medical expertise. I'm your host, a pediatrician with over a decade of experience. And just like you, a parent navigating the ups and downs of raising good human beings with stories from my own experience as a mom, lessons in child development, and insights based on scientific evidence. I'm here to share practical strategies that work. Let's dive into this journey together and make parenting feel a little more peaceful and a lot more rewarding. Daylight saving time is fast approaching, and if you are anything like me, you are dreading the loss of an hour of sleep. I have to be honest, even when I was working 80 hours a week as a pediatric resident, I did not fully appreciate the importance of sleep. Nothing makes you realize how precious sleep is more than becoming a parent. For the mamas out there, you most likely became sleep deprived far before your child was born. Between the fetal kicks, heartburn, and other pregnancy related discomforts, sleep suddenly becomes a commodity. As a pediatrician, one of the most common concerns that I experience in my medical practice relates to sleep. Most parents of infants want to know when their child will sleep through the night on a regular basis. It's a great question. By definition, sleeping through the night involves sleeping for 6 to 8 hours continuously without waking up. Here's the truth no one will ever be able to predict when your child will sleep through the night. Ever. Sure, people can tell you the normal or expected hours of sleep based on a child's age, but in reality, some kids are great sleepers and other kids are not. In 2016, the American Academy of Sleep Medicine, or RSM, released guidelines as to how many hours a child should sleep at night to promote optimal health. These numbers were based on a multitude of medical studies that were reviewed by a panel of experts, according to the RSM. Children who regularly achieved the recommended hours of sleep had better health outcomes. This includes improved emotional regulation, behavior, learning, physical health and mental health, among other metrics. On the other hand, children who routinely slept less than the recommended values were at a higher risk of attention and learning problems, as well as an increased risk of high blood pressure, obesity, depression, and diabetes. Now, before you panic that your teenager is destined to develop obesity and diabetes because they are on their cell phone until midnight each night, take a deep breath. Most of the medical studies reviewed did not determine causation, meaning that poor sleep has been associated with negative health outcomes, but is not necessarily the main cause of those outcomes. Just like a parent's relationship with a teenager, it's complicated. According to the RSM, sleep recommendations were broken down into the following 24 hour periods. It's important to note that these timeframes included naps for children five years old and younger. Infants aged 4 to 12 months should sleep 12 to 16 hours. Toddlers aged 12 to 24 months should sleep 11 to 14 hours. Children 3 to 5 years old should sleep 10 to 13 hours. Children 9 to 12 years old should sleep 9 to 12 hours. Children 13 to 18 years old should sleep 8 to 10 hours. That is a lot of shoulds. Parents, we need to put these recommendations into context. Kids don't care how much they should sleep. Some babies even develop infantile colic and spend some of the time they should be sleeping by screaming their head off instead. Different ages have their own unique set of potential sleep struggles, which I'll discuss in detail soon. Rather than focusing on the clock, it helps to pay attention to indications of restorative sleep as well as indications of poor sleep. If your child wakes up for the day feeling energized and refreshed, they probably had a good amount of restorative sleep. On the other hand, if your child routinely struggles to wake up in the morning or seems excessively tired or cranky, they are likely struggling with poor sleep. Even young children can develop a sleep disorder. If your child snores loudly, intermittently stops breathing in the middle of the night, grinds their teeth, falls asleep on a regular basis while they're at school, or complains of a headache as soon as they wake up, it may be time to seek medical attention Again. Some kids are great sleepers and others load the idea of sleep with every fiber in their being. If your child is in the latter category, it does not mean that you throw your hands up in the air, except that your kids will be sleep aversion monsters and ignore the importance of good sleep. If you follow a few important principles, you will be on track to support your child's health and development. Let's start with infants. Young infants need to eat every few hours, which means that at least one parent must wake up several times each night to provide said nutrition. And that's assuming that the infant falls asleep easily after eating, which not all infants do. Multiple middle of the night awakenings are usually the biggest sleep struggle for parents of infants and young toddlers. If somewhere along your parenting journey, you learn that you could somehow teach your child to sleep through the night with sleep training. I am so sorry for the misunderstanding. Let me explain. Sleep training is the process of helping people, and usually infants fall asleep on their own and sleep through the night. There are numerous methods of sleep training out there the cried out method, the Ferber method, the Weiss Bluth method, the chair method, the pick up put down method, and the list goes on. Here's why I dislike the term sleep training. The wording itself leads parents to believe that they can somehow teach their child to fall asleep easily, sleep through the night, and in turn get more sleep themselves. You can encourage good sleep, but you cannot teach it. This is so important that I'm going to say it again in a slightly different way. You cannot train someone to sleep through the night. I know far too many parents who have researched sleep training online chose a particular sleep training method for their child, only to have it fail miserably. I happen to be one of those parents because back in the day, I didn't know any better. When my son Mason was five months old, I decided to give sleep training a try. One night I took a deep breath and decided to let him cry it out. Chad and I were tired of being tired and we were desperate for a good night's sleep. I fed Mason, then laid him down in his crib. He started to cry and he cried, and he cried some more. And then he began to scream. After 45 minutes of screaming, I could not take it anymore. I picked him up and felt like the worst mom in the world. While I am not an advocate of sleep training, I do believe that you can help a child to develop behaviors that lead to improved sleep quality. This is also called sleep hygiene. Sleep hygiene involves environmental factors as well as habitual behaviors. Let's start with environmental factors. For newborns and young infants, it is helpful to mimic the intrauterine environment. Make sure that the sleep environment is dark. Consider using a white noise machine, as the fetus is used to the washing noise of mom's abdominal aorta. Swaddle your infant with their arms inside the swaddle until they start showing signs of rolling over. Keep the room temperature consistent. The ideal thermostat setting is 65 to 70°F. Start a consistent bedtime routine as early as possible. The actual events of the bedtime routine are far less important than the consistency of implementing that routine. The predictability of this routine will help your child associate those events with sleep. I would be remiss if I did not discuss the safe sleep environment. A safe sleep environment is important for an infant and young toddler safety. A safe sleep environment can absolutely decrease the risk of SIDs or sudden infant death syndrome. In fact, the risk of SIDs has declined by over 40% since the American Academy of Pediatrics recommended placing an infant on their back to sleep. Always put your infant on their back to sleep. Make sure that they are sleeping in a crib, bassinet, or a pack and play that has a firm mattress. There should be no loose blankets, pillows, stuffed animals, luvvies or crib pads. Even the breathable kind within the sleep space, wedgies or other infant positioning devices are not safe. Finally, do not let anyone smoke or vape in the home. Smoking, whether it be nicotine containing products or marijuana containing products, have been associated with an increased risk of SIDs. If your infant wakes multiple times per night, meet their basic needs. Feed them if they seem hungry, but do not do anything that encourages your child to view this time together as playtime. Don't talk to, sing to, or play with your infant in the middle of the night. Hold them for comfort, but do not rock them excessively. I know that this sounds harsh, but there is plenty of time for play and snuggles during daytime hours. Both of my kids woke up to eat in the middle of the night, until they were about two years old. By the time I had my daughter, Savannah. I had learned a few things. Starting around six months of age, I would actually turn my head away from her as I was feeding her. The white noise machine was on and I didn't say a word to her in the middle of the night. While I will never know for sure. I like to think that my actions helped her to realize that nighttime was for sleeping. A lot of parents ask me about introducing a blanket to their child's sleep environment. According to the American Academy of Pediatrics, there is no specific age where it is considered 100% safe. I counsel the families in my medical practice to wait until a child is at least one year of age to introduce a loose blanket during sleep. Larger, thick blankets should be avoided in until the child is older. Also, avoid blankets with long strings or ribbons as these can be a choking hazard. And never, ever let an infant or a young child use a weighted blanket. What about stuffed animals? Just as with blankets, there is no specific age of adding a stuffed animal to the sleep environment. Again, I recommend introduction after 12 months of age. The stuffed animals should be small, lightweight, and free of small parts and choking hazards. Pillows are a different story. The American Academy of Pediatrics recommends avoiding the use of the pillow until about the age of two, and only after a child has transitioned from a crib to a toddler bed. The initial pillow should be small, firm, and thin. Unfortunately, sleep struggles do not end in infancy. Sleep refusal is a common problem once a child enters the toddler years. As incredulous as it may seem for parents. For most toddlers, preschoolers, and even younger school age children, sleep is boring. This means that bedtime battles are the norm, not the exception. Kids would rather be running around playing video games, watching TV, scrolling on a electronic device, or doing almost anything else rather than going to bed. If your child requests multiple bedtime stories, then suddenly needs to get out of bed for a drink of water and a snack, and then asks for a few minutes to pet the dogs before they'd settle down for the night. They may be trying to avoid bedtime. Yet another factor that is involved in bedtime avoidance is fear. Separation anxiety is a very real thing for toddlers, who look to their attachment figures to meet their physical and emotional needs, which means that they may not fall asleep unless a parent is lying next to them. Sometimes toddlers refuse to sleep unless they lay in their parent's bed. Let's face it. It can be scary to be in a dark room all by yourself at night. The risk of SIDs is negligible after about 12 months of age. So let's talk about co-sleeping. When Savannah was a toddler, she would not sleep unless Chad or I slept next to her. For about a year, Chad would lay in Savannah's bed until she fell asleep. Sometimes he fell asleep right next to her. If your little one is constantly climbing into your bed or insisting that you sleep in theirs, hang in there. This is just a phase. Do what you do to get through it as long as you are being safe. I promise. Once your child turns 16 years old, they will certainly not demand to sleep in the bed with you. Another aspect to consider when it comes to bedtime refusal is if the sleep environment is unfavorable. Is the room temperature too hot or too cold? Is the room too bright or too loud? Our pajamas made of itchy material. All of these can contribute to sleep struggles. The school aged years are often the sweet spot of sleeping. Kids may resist bedtime, but as long as a consistent bedtime routine is in place, they will likely go to bed with minimal resistance. Regardless of your child's age. Try to maintain a consistent sleep environment. That means whether it is winter or summer, the temperature in your child's bedroom should be about the same year round. And make sure to account for your child's personal preferences. Some older kids will sleep better with the use of a white noise machine or sleep music, and others prefer silence. Some kids will sleep better if the room is pitch black. Others prefer a nightlight. These preferences may change over time, so be flexible. Do not allow televisions or gaming systems in your child's room, not even for teenagers. Determine a time that all electronic devices must be turned off at night and stick to that time. I encouraged the families in my medical practice to create an electronic drop box for their kids portable electronic devices. The electronic Dropbox is exactly what it sounds like a place to store portable electronics when they are not in use. While I encourage families to have a discussion about the exact time those devices need to be stored in the box for the night. Ultimately, the parents get to make the final decision. Likewise, it's important to have discussions about the consequences that will be implemented if those devices are not in the box by the specified time. Again, parents have a final say in the consequence. I've said it before, but I cannot stress the importance of actually implementing that consequence when it comes to parenting, the fortune is in the follow through. If you tell your child that they will receive a consequence for misbehavior, you better implement that consequence. If you do, and there's still considerable struggle, consider turning off the Wi-Fi in the home at a specific time at night. Implementing an electronic free environment in the evening may be your best defense against poor sleep. And if all else fails, consider hiring a pediatric sleep coach. These are coaches who specialize in helping parents adjust their child's sleep schedule and sleep habits. Pediatric sleep coaches offer a personalized approach based on family preferences, and they also work within the context of a child's unique temperament. While all of these strategies may improve your child's duration of sleep, I need you to understand something. Most parents are sleep deprived at some point during their parenting journey, and unfortunately, no one likely warned you of this when you decided to become a parent. But here we are. The quantity and the quality of the sleep we have as parents is usually in direct correlation to the quality and quantity of sleep that our children receive. Rather than begrudge your struggles, meet your child where they are and adjust your expectations accordingly. Understand that some kids will fight, sleep, and recognize that this is normal. Kids do not view sleep in the same manner that adults view. Sleep at the end of the day. Sleep. Like so much of parenting, can be unpredictable, ever changing, and often frustrating. But it's also essential. While you can't force your child to be a great sleeper, you can create an environment that encourages healthy sleep habits. So give yourself some grace. Stay consistent. And remember, this phase won't last forever. Thanks for listening to Mom Talk, where we explore the world of parenting with a little bit of science and a whole lot of heart. If this episode resonated with you, please consider sharing it with a friend. Don't forget to subscribe and review this episode as it helps me reach more parents like you. I'd love to connect on social media. You can find me at Moms Talk underscore CMD.