Sleep Problems
For most children, sleep problems are intermittent or temporary and often do not need treatment.
Nightmares: Nightmares are frightening dreams that occur during rapid eye movement (REM) sleep (see Section 6, Chapter 81). A child having a nightmare can awaken fully and can vividly recall the details of the dream. Nightmares are not a cause for alarm, unless they occur very often. They can occur more often during times of stress, or even when the child has seen a video containing aggressive content. If nightmares occur often, parents can keep a diary to see if they can identify the cause.
Night Terrors and Sleepwalking: Night terrors, episodes of incomplete awakening with extreme anxiety shortly after falling asleep, are most common between the ages of 3 and 8. The child screams and appears frightened, with a rapid heart rate and rapid breathing. The child does not seem to be aware of the parents' presence and does not talk. He may thrash around violently and does not respond to comforting. After a few minutes, he goes fully back to sleep. Unlike with nightmares, the child is not able to recall these episodes. Night terrors are dramatic because the child screams and is inconsolable during the episode. About one third of children with night terrors also experience sleepwalking (rising from bed and walking around while apparently asleep, also called somnambulism (see Section 6, Chapter 81)). About 15% of children between the ages of 5 and 12 have at least one episode of sleepwalking.
Night terrors and sleepwalking (see Section 6, Chapter 81) almost always stop on their own, although occasional episodes may occur for years; usually, no treatment is needed. If a disorder persists into adolescence or adulthood and is severe, treatment may be necessary. In children who need treatment, night terrors may sometimes respond to a sedative or certain antidepressants; however, these drugs are potent and can have side effects. Installing a lock on the outside of the bedroom door keeps a child from wandering but may frighten the child.
Resistance to Going to Bed: Children, particularly between the ages of 1 and 2, often resist going to bed. Young children often cry when left alone in their cribs, or they climb out and seek their parents. This behavior is related to separation anxiety (see Section 23, Chapter 267) and, in older children, to the child's attempts to control more aspects of his environment.
Resistance to going to bed is not helped if parents stay in the room at length to provide comfort or let the child get up. To control the problem, a parent may have to sit quietly in the hallway in sight of the child and make sure the child stays in bed. The child then learns that getting out of bed is not allowed. The child also learns that the parents cannot be enticed into the room for more stories or play. Eventually, the child settles down and goes to sleep. Providing the child with an attachment object (like a teddy bear) is often helpful.
Awakening During the Night: Children often awaken during the night, but they usually fall back to sleep on their own. Repeated night awakening often follows a move, an illness, or another stressful event. Sleeping problems may be worsened when the child takes long naps late in the afternoon or is overstimulated by playing before bedtime.
Allowing the child to sleep with the parents because of the night awakening is likely only to prolong the problem. Also counterproductive are playing with or feeding the child during the night, spanking, and scolding. Returning the child to bed with simple reassurance is usually more effective. A bedtime routine that includes reading a brief story, offering a favorite doll or blanket, and using a small night-light (in children who are older than 3) is often helpful. Parents and other caregivers should also try to keep to a routine each night, so that the child learns what is expected. If the child is physically healthy, allowing him to cry for 20 to 30 minutes often teaches him that he needs to settle himself down, which will diminish the night awakening.
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