Countless homes in America face this every evening with their children.  How often have heard the frustrated cry of parents everywhere?  “My children just hate going to bed”  “It’s a battle every night and we are exhausted!”Have a conversation with your child as to why they don’t like bedtime.   Look for signs that might give you a clue.  Did something happen during the day that might have upset them?  Are they worried about something?  Are they afraid of the “monster under the bed”? Sometimes it’s just about creating a positive routine. Here are some suggestions that might help and certainly worth try.

1. Give children a 5 minute warning before you want them to start getting ready for bed.
2. Create a routine around bedtime so they know what to expect.  Children like and respond well to familiar routines.  What is your process of getting them ready for bed?
3. Make sure they have a snack before they get into bed. This avoids the need to come back out of their rooms after they are settled into bed.
4. Washing their face and brushing their teeth should occur right before they hop into bed.
5. Reading to them before they go to bed provides an activity that you can do together.  This is a great cuddle time.  A funny or silly story will be welcoming and will put them in a happy mood as they drift off to sleep.

The more relaxed you are,  the more relaxed your child will be.  If you begin to see bedtime as a routine that you look forward to, because it is fun and enjoyable, chances are your child will begin to feel that way too. No one said parenting was going to be easy but hopefully these tips will help ease the bedtime routine.

I’m asked almost everyday by some concerned parent whether their child is sleeping enough or too much. That’s not a simple answer and varies from child to child and even from day to day.

For instance, if a child has just learned to walk she will often get more sleep because she’s getting a lot more physical activity than she did just before she began walking. When a child first learns to walk, she toddles from place to place trying out her new skills with a new burst of energy. (Note: don’t put your video camera away after she’s taken those monumental first steps! There are some never-to-be-repeated times right around the corner.)

Once she’s mastered walking, her sleep needs may decrease again. Of course when a child is ill or even fighting off an infection, he might need more sleep. And if a child (or adult) is looking forward to an exciting day ahead, the excitement and anticipationmay naturally result in less sleep the night before.

But back to the question, how much sleep does my baby need? I have general guidelines for the range of normal amount of sleep needed for each age. Keep in mind, this is a general guideline:

Average Number of Hours of Sleep Needed

Related concepts:

Bad Dreams

Introduction to nightmares:

Mommy, I had a bad dream…

What are nightmares?

Nightmares are unpleasant dreams that awaken a dreamer from sleep.
We’ve learned much about nightmares from traumatic events, which are known to cause a predictable pattern of nightmares: first dreams that relive the event, then dreams that relive the primary emotion of the event using different scenarios (different pictures), then dreams that incorporate aspects of the event into other parts of life.
Nightmares are an important means of addressing the normal difficult events and emotions of childhood, to weave them into the fabric of our minds in a constructive way.
Night terrors are very different from nightmares.

Who gets nightmares?

Birth is a wonderful and terrible experience. There is much to be happy about and much to learn about in the weeks that follow. Babies’ dreams must incorporate and address those things that bring them pleasure and those that make them cry. In all likelihood, the peak age of crying, the first 6 weeks, is also the peak age of nightmares.
These nightmares are not unsuccessful dreams. Far from it! They help babies learn and grow; nightmares may even be an important reason that crying diminishes after 6 weeks.
Stressful events, such as injections, circumcision (which should never be done without anesthesia), being left alone or dropped, or even feeling hungry, need to be learned about and integrated. Anything worth crying about is worth dreaming about.
Nightmares are most evident between the ages of 3 to 5 years — the peak age when children talk about their fears.

What are the symptoms of nightmares?

Children wake up and remember a scary or sad dream, usually in the second half of the night. They may be sad or afraid when they wake up, and are often crying. Children who are old enough will often wake their parents and tell them they had a bad dream.
Unlike with a night terror, they will recognize their parents and be comforted by their presence. In addition, unlike a night terror, they will often have trouble falling back asleep because of fear.

Are nightmares contagious?

Nightmares are a normal part of development. They are not contagious, although children will often respond to the fear and sadness of those around them.

How long do nightmares last?

Individual nightmares are brief.
Nightmares can occur throughout life, but tend to decrease with each passing year.

How are nightmares diagnosed?

Nightmares are diagnosed based on the history.
They are to be distinguished from night terrors. In pre-verbal children, they should be distinguished from ear infections, reflux, hernias, or other causes of pain.

How are nightmares treated?

An individual nightmare is treated with your reassuring presence. Holding your child and talking soothingly about the dream can diminish the fear and sadness.
If your child is old enough to tell or draw the story of the dream, it can be helpful to find a way for the story to reach a happy ending. Addressing the underlying emotions can help your child make sense of them.

How can nightmares be prevented?

Much excellent children’s literature directly addresses difficult dreams. Other books address children’s common fears and concerns. This literature, and other art, can help children do some of the integrating work of nightmares without the nightmares themselves.

Related A-to-Z Information:

Colic, Ear Infection, Gastroesophageal Reflux, Hernia (Inguinal hernia), Night Terrors, Separation Anxiety, Tantrums

Related concepts:

Confusional arousal; Partial arousal state; Sleep terrors

Introduction to night terrors:

Your little angel wakes up screaming in the middle of the night, calling for his mommy – but his mommy is right there, unrecognized. You try to comfort him, but he shrieks even louder, eyes bulging. He might be having a night terror.

What are night terrors?

Within fifteen minutes of your child’s falling asleep, he will probably enter his deepest sleep of the night. This period of slow wave sleep, or deep non-REM sleep, will typically last from forty-five to seventy-five minutes. At this time, most children will transition to a lighter sleep stage or will wake briefly before returning to sleep. Some children, however, become stuck and are unable to completely emerge from slow wave sleep. Caught between stages, these children experience a period of partial arousal.
Partial arousal states are classified in three categories: 1) sleep walking, 2) confusional arousal, and 3) true sleep terrors. These closely related phenomena are all part of the same spectrum of behavior.
When most people (including the popular press and popular parenting literature) speak of night terrors, they are generally referring to what are called confusional arousals by most pediatric sleep experts.
During these frightening episodes, the child is not dreaming and typically will have no memory of the event afterwards (unlike a nightmare). If any memory persists, it will be a vague feeling of being chased or of being trapped. The event itself seems to be a storm of neural emissions in which the child experiences an intense fight or flight sensation. Once it is finally over, the child usually settles back to quiet sleep without difficulty.
These are very different from nightmares.
True sleep terrors are a more intense form of partial arousal. They are considerably less common than confusional arousals and are seldom described in popular parenting literature. True sleep terrors are primarily a phenomenon of adolescence.

Who gets night terrors?

The tendency toward sleepwalking, confusional arousals, and true sleep terrors often runs in families. They tend to be more common in boys, and are much less common after age 7.
The events are often triggered by sleep deprivation or by the sleep schedule’s shifting irregularly over the preceding few days. A coincidentally timed external stimulus, such as moving a blanket or making a loud noise, can also trigger a partial arousal (which again shows that the event is a sudden neural storm rather than a result of a complicated dream).

What are the symptoms of night terrors?

Typically, a confusional arousal begins with the child moaning and moving about. It progresses quickly to the child crying out and thrashing wildly. The eyes may be open or closed, and perspiration is common. The child will look confused, upset, or even “possessed” (a description volunteered by many parents). Even if the child does call out his parents’ names, he will not recognize them. He will appear to look right through them, unable to see them. Parental attempts to comfort the child by holding or cuddling often prolong the situation.

Are night terrors contagious?

No.

How long do night terrors last?

Most often, a confusional arousal will last for about ten minutes, although it may be as short as one minute, and it is not unusual for the episode to last for a seemingly eternal forty minutes.

How are night terrors diagnosed?

The diagnosis is based on the history. When a question remains, a physical exam or tests may be run to rule out other possibilities.

How are night terrors treated?

When an event does occur, do not try to wake the child — not because it is dangerous, but because it will tend to prolong the event. It is generally best not to hold or restrain the child, since his subjective experience is one of being held or restrained; he would likely arch his back and struggle all the more.
Instead, try to relax and to verbally comfort the child if possible. Speak slowly, soothingly, and repetitively. Turning on the lights may also be calming. Protect your child from injury by moving furniture and standing between him or her and windows. In most cases, the event will be over in a matter of minutes.
Night terrors can also be treated with medications, hypnotherapy, or with other types of relaxation training if they become a significant problem.
A Novel Approach – The Greene Technique
When my youngest child was going though night terrors, I observed that he was also “working on” achieving nighttime dryness. In fact, night terrors are most common at the same ages that children are becoming aware of the bladder feeling full during sleep. It dawned on me that perhaps some of these kids just need to go to the bathroom, but are not yet able to wake up fully when their bladders are full. I’ve now treated many kids by having the parents take them to toilet while they’re still asleep. For many of these children, even though they do not recognize their parents, they will often recognize the toilet and urinate. For these children, the episodes stop abruptly and they return to sleep. The calm is dramatic.

How can night terrors be prevented?

Prevention usually involves trying to avoid letting the child get over-tired, and trying to keep the wake/sleep schedule as regular as possible. Taking the child to the bathroom before the parents go to bed can also prevent some night terrors.

Related A-to-Z Information:

Enuresis (Bedwetting), Epilepsy, Nightmares, Sleep Apnea

Dr. Greene’s Answer:

How exhausting! Missed sleep is tough for all of us, but yours has been long and consistent and without a failsafe solution if you just get too tired. Most young kids will return to sleep well if rocked, or cuddled, or fallen asleep with (of course, whether or not you want to do this is another issue).

Sometimes adjustments in bedtime or napping can make a difference. In some children, periods of waking can occur when a child is toilet training. In these children, taking them to the bathroom in the middle of the night can solve the problem. If a child wakes up in need of comfort, a special blanket or stuffed animal may help.

But when kids don’t sleep well in the most conducive setting, I like to have them seen at a sleep center. Thankfully, sleep is beginning to get the attention it deserves, and sleep centers are springing up in many places.

Occasionally, sleep specialists recommend medicines after other options have been explored. I am in favor of this (although I am not a fan of the Benadryl class, at least as either a medium- or long-term solution). I prefer medicines in the hypnotic class that are eliminated from the body relatively quickly. Sleep is so valuable for health (his and yours) that, in some situations, the benefits clearly outweigh the costs. Your doctor can refer him to a sleep center if necessary.

Dr. Greene’s Answer:

I stood in a darkened room with two eager parents-to-be during their prenatal ultrasound. I watched their screen-lit faces at the moment they glimpsed their new baby for the very first time. The mother grasped the father’s hand tightly as they both gazed at the flickering screen. When their tiny daughter moved her thumb to her mouth, tears of joy streamed down both parents’ faces.

They knew instinctively that it is normal and healthy for babies to suck their tiny thumbs – even before they are born.

But behavior that is adorable in one so young can be a concern in an older child.

How old is too old?

According to the American Dental Association, thumb sucking does not cause permanent problems with the teeth or jaw line unless it is continued beyond 4 to 5 years of age. As it turns out, somewhere between 85% and 99% of children have finished thumb sucking spontaneously before this period.

Which children keep sucking their thumbs?

Many parents are concerned that thumb sucking at a late age is a sign of emotional immaturity or lack of self-confidence. When investigators have looked at late thumb suckers for common traits, they found only one thing in common that distinguished them from other children — a prolonged history of a strong battle with thumb sucking at an earlier age. It is striking that many well-meaning parents have actually encouraged thumb sucking by trying to forcibly take the thumb out of their children’s mouths.

When do children suck their thumbs?

As you have observed with your daughter, the most common time for sucking is when children are tired, bored, or in need of comfort. Often these children fall asleep more easily, are able to put themselves back to sleep at night more easily, and sleep through the night much earlier than their peers who do not suck their thumbs.

How do you get children to stop?

Children have control of their own thumbs when you are not looking. Pressure applied against thumb sucking can turn a natural developmental phase into an ingrained habit.

Instead, you want to create an environment where she chooses to stop on her own. You can weaken the thumb-sucking habit by distracting her when you notice her thumb in her mouth. Engage her in a way that she uses both hands.

Painting something that tastes yucky on the thumbs can make sucking them less satisfying. Commercial products are available for this purpose. Other parents have had success with pickle juice or a drop of vinegar. You might have to switch flavors periodically because people can develop a taste for almost anything (I remember my first cup of coffee – yechhh!).

If she decides she wants to stop, yet the habit continues, then helping her notice when she is doing it can help her. Otherwise, pointing it out will only seem like nagging.

Comments from other people, though, can be helpful. Her pediatrician and dentist can be important allies, helping her to feel that she wants to stop because she is growing up!

Having children she respects (and who don’t suck their thumbs) over for sleepovers can also help. If they comment on her thumb sucking, it can be a powerful motivation. If she doesn’t suck during the sleepover, it further weakens the habit.

Without nagging or battles, almost all children will stop before age 4 or 5. For the very few that don’t, their dentists can help with sleepy-time appliances and other techniques.

One way or another, soon her cuddly habit of thumb sucking will be a flickering memory of those precious days when she was so young.

Dr. Greene`s Answer:

Any child who snores may not be getting adequate sleep. Obstructive sleep apnea is a common medical condition that is now being identified in more and more children. The peak age for this is 2 to 5 years old, but it can occur at any age. Not all kids who snore have sleep apnea. Classically, those with sleep apnea snore quite loudly for a bit, then are silent, then snort briefly, move about, and resume snoring. Children with sleep apnea may adopt unusual sleeping positions, like bending their necks back so their chin is lifted upwards, in order to keep their airway open. If snoring is accompanied by nighttime breathing difficulty and pauses in breathing, then it may well be sleep apnea. This should be brought to the attention of your pediatrician. You might want to make a cassette tape of your child’s sleep noises to bring with you.

Children with sleep apnea do not get sound sleep. They may also get suboptimal oxygen to the brain at night. Obstructive sleep apnea can have a serious negative impact on a child’s intellect and behavior. The common daytime symptoms of sleep apnea are difficulty paying attention during the day, decreased academic performance, oppositional behavior, restlessness, morning headache, and dry mouth. Not all kids with sleep apnea snore. Even when they do, sleep apnea is often overlooked. Instead, the child is diagnosed with a behavioral disorder — most commonly ADD (Journal of Clinical Child Psychology, Sep 1997).

Children who suck their thumbs are able to begin at an early age to meet their own need for sucking. These children fall asleep more easily, are able to put themselves back to sleep at night more easily, and sleep through the night much earlier than infants who do not suck their thumbs.

A study by Dr. T. Berry Brazelton indicates that as many as 94% have finished with sucking their thumbs by their first birthdays.

According to the American Dental Association, thumb sucking does not cause permanent problems with the teeth or jaw line, unless it is continued beyond four to five years of age.

Many studies have looked at the number of children who continue to suck their thumbs at this time. As it turns out, somewhere between 85% to 99% of children have finished thumb sucking spontaneously before this period (the numbers vary depending on the study).

When investigators looked at this group of late thumb-suckers for common traits, they found that they had one thing in common that distinguished them from other children — a prolonged history of a strong battle with thumb sucking at an earlier age. It is striking that many well-meaning parents have actually encouraged this behavior by trying to forcibly take the thumb out of their children’s mouths.

A ten-month-old girl, who had been sleeping through the night, has now been waking up each night for one week. She pulls herself to standing in the crib, and rubs her right ear. She calms quickly when picked up by her parents.

Not bad, Dr. Watson! This child may have an ear infection, but probably not. Most 10-month-olds will begin regularly waking at night (in fact, it is one of the most difficult sleep periods in life). They typically pull to a standing position (they are sooo excited about standing at this age), and really miss their parents (separation anxiety). They will often rub their ears as a self-comforting, sleepy-time habit. Their short-term anxiety is relieved quickly by being held. This doesn’t sound like a girl who is either in pain or who has an infection.

Back To Detecting an Ear Infection

Contrary to popular opinion, bed-wetting is a very common problem. It affects somewhere between five and six million children.

Bed-wetting, or nocturnal enuresis, can be divided into two types: primary nocturnal enuresis and secondary nocturnal enuresis. These two types are very different in their causes and treatments.

In primary nocturnal enuresis, children have never achieved complete nighttime control – always wetting at least two times a month.

Secondary nocturnal enuretics are completely dry at night for a period of at least six months and then begin wetting again.

In secondary enuresis, the key is finding out exactly what has changed. There might be a new psychological stress such as a divorce, a move, or a death in the family. It might be something physical: the onset of a urinary tract infection or diabetes, for example. It might be a situational change – perhaps altered eating, drinking, or sleeping habits.

The great majority of bed-wetting children are primary enuretics. For primary enuretics, the cause is decidedly NOT stress or behavioral concerns.

In a survey of 9,000 parents of kids ages 6 – 17, 22% stated that they thought the reason their child wet the bed was laziness (survey conducted by ICR Survey Group from July 10 1996, through August 6, 1996). I am happy to tell you that this could not be further from the truth!

Research has shown that primary nocturnal enuresis is often inherited. If both parents were bed-wetters, 77% of their children will be. If only one parent was, 44% of their offspring will. If neither parent wet the bed, only about 15% of their children will wet the bed.

With primary nocturnal enuresis one almost always finds another relative who was a bed wetter. This corresponds to what is called an autosomal dominant inheritance pattern.

In recent years, researchers have identified an association with bedwetting and two genes named ENUR1 and ENUR2. In studying certain families with primary nocturnal enuresis, researchers discovered that members who wet the bed were more likely to have the ENUR1 or ENUR2 gene than those who did not. More recently, the possibility of a third primary nocturnal enuresis-related gene (ENUR3) on chromosome 22 has also been uncovered. Presumably these genes affect either whether children will need to urinate at night or how easily they can wake up when their bladders are full.