- The Washington Times - Saturday, August 7, 2004

Two-year-old Isabel used to wake up three or four times a night needing a little cuddle or something to eat, says her mother, Jane Sharp of Takoma Park.

Ella, 15 months old, used to nap only 20 minutes at a time and could only go to sleep in her mom’s arms, says her mother, Jessica Gilmore of Northwest.

Hudson, 9 months old, used to wake up every time his pacifier slipped out of his mouth, which kept his parents up all night long, says his mother, Erin Reitkopp of Bethesda.

These sleep stories can sound nightmarish but all-too familiar to many families. Getting young children to sleep and stay asleep for long naps and through the night can be challenging and exhausting, sleep researchers say. But they urge parents to establish good sleep habits early on because sleep is essential for overall health.

“Sleep habits is one of the most important things you can teach your child,” says Jodi Mindell, author of “Sleeping Through the Night — How Infants, Toddlers and Their Parents Can Get a Good Night’s Sleep.”

“Lack of sleep affects children’s ability to regulate their emotions, it affects memory and problem-solving ability. It affects your behavior. A tired child has more tantrums,” Ms. Mindell says.

Daniel Lewin, director of Behavioral Sleep Medicine at Children’s National Medical Center in Washington, agrees.

“Adequate sleep is essential for optimal physical and mental health,” says Mr. Lewin, who holds a doctorate in psychology.

Lack of sleep has such far-reaching effects on a child’s mental and physical health that sleep deprivation sometimes is misdiagnosed as other diseases or complications, he says. In fact, up to 20 percent of children who are diagnosed with attention-deficit hyperactivity disorder really just are sleep-deprived, he says.

While many Americans know the importance of good sleep, a recent poll from the D.C.-based National Sleep Foundation shows that American children on average don’t get enough shut-eye.

Infants ages 3 to 11 months should get 14 to 15 hours of sleep for each 24-hour period. In reality, children this age get an average of 12.7 hours, the poll states. Children ages 12 to 35 months should get 12 to 14 hours of sleep for each 24-hour period. In reality, they get 11.7 hours, according to the poll.

Aside from the guidelines above, a good way to know if your children are getting enough quality sleep is to watch their mood when they wake up.

If the child is always waking up cranky and tired and goes to sleep within seconds of getting into the stroller, that is a sign the child is not getting enough sleep, says Kim West, an Annapolis-based sleep coach, who is also known as the “Sleep Lady.” Ms. West holds a master’s degree in clinical social work.

Sleep solutions

When Mrs. Sharp was 8 months pregnant with her second child, Eleanor (now 11 months old), she decided to get help. Isabel was 18 months and still not sleeping through the night.

“I realized that I couldn’t keep getting up at all hours of the night to take care of Isabel once Eleanor arrived,” she says.

Mrs. Sharp says she knew she didn’t have the heart to let her daughter cry it out. Dr. Richard Ferber and Dr. Marc Weissbluth advocate different versions of the cry-it-out method. She says she needed more hands-on help and contacted Ms. West, whom she found out about through DC Urban Moms, a local online group.

Mrs. Sharp says Ms. West told her to keep a sleep log and try to establish consistent bedtime routines, such as taking a bath and reading a story.

Ms. West advocates that parents don’t nurse their babies to sleep, but rather encourage them to learn to self-soothe in the crib. Children who can self-soothe will be able to lull themselves back to sleep without their parents help if and when they wake up in the middle of the night, she says.

But how does the child learn to self-soothe without what Ms. West calls sleep crutches, such as pacifiers?

“I have the parents sit next to the crib the first three nights,” she says. The parent can stroke the child’s back and sing, but not pick up the child. “Then I have them moving further away every three days until they are sitting in the hallway.”

Mrs. Sharp, who says she’s “a wimp of the cry-it-out scale,” says she had to change her attitudes about crying. It wasn’t the end of the world if her child cried for just a few minutes.

“Kim helped me realize what projections I was putting on crying,” Mrs. Sharp says.

After about two weeks, the parent is sitting outside the room allowing the baby to go to sleep by him- or herself. If the child wakes up in the middle of the night, the parents repeat the routine from earlier in the evening.

After an initial 90-minute in-person evaluation, which includes a sleep history, Ms. West was in daily contact with the Sharp family to encourage them, answer questions and tweak the sleep plan, if needed. The cost was $500 for the evaluation and follow-up calls, Mrs. Sharp says.

“I hope to empower parents to combine the information I give them with their knowledge of the child’s temperament,” says Ms. West, whose book “Good Night Sleep Tight: The Sleep Lady’s Gentle Guide to Helping Your Child Go to Sleep, Stay Asleep and Wake Up Happy” is expected in early 2005.

Ms. West’s method ended up working very well for the Sharp family, whose young members currently are sleeping through the night and taking one- to two-hour naps.

“I’m merging into humanity again, but I am still in recovery after 2 years” of sleep deprivation, Mrs. Sharp says with a laugh.

Consistency is key

A sleep coach, however, is not the answer for everyone.

Ms. Reitkopp, who describes herself as a basket case by the time her son Hudson was 4 months old and never sleeping more than two or three hours in a row, decided to read everything she could on the topic.

“I made an amalgamation of all the main books,” Ms. Reitkopp says. She set a bedtime, usually at 6:30 p.m., and established a bedtime routine that includes a bath, songs, books and pulling down the room-darkening shades.

“By 6:50 it’s night-night,” she says.

Using this method, Hudson never cried more than about five to seven minutes, she says.

Ms. Mindell says this type of consistency in the bedtime routine is key.

“You want to have three or four activities that are quiet and soothing, and you want to do them in the same order every night,” she says.

Ms. Mindell, as opposed to Ms. West, only advocates the routine for evening bedtime. She says if the child wakes up in the middle of the night, the parents should do whatever they feel comfortable doing to get the child back down, including feeding or co-sleeping.

“I think it’s a waste of effort in the middle of the night,” she says. “Parents are often too exhausted to tackle the battle then.”

When the baby is 6 months old or so is a good time for parents to establish a nighttime sleep routine, sleep researchers and coaches say.

“After 6 months of age, children generally don’t need to eat after 7:30 at night,” Mr. Lewin says.

He also recommends a comprehensive health evaluation of the child, particularly if the sleep problems are severe, to make sure the child has no gastrointestinal or neurological conditions. About half of his patients have these type of medical issues that have to be addressed before sleep training can start, he says.

After the health evaluation, it’s important to pick a good time for the sleep training. Don’t pick the week when the family is going on vacation, since consistency is so important, sleep researchers say.

With older children who start arguing or manipulating their parents into staying with them at bedtime, asking for just another glass of water or just one more story, it’s important to be very firm, Mr. Lewin says.

“When the kids know that their parents have erected a wall and there is no door in it, they will stop fighting,” he says.

Anja Robakowski of Northwest says that when Noah Van Stralen, her now 3-month-old, was born, her older son, 3-year-old Benedict Van Stralen, started refusing to go to sleep.

“He would say anything to get attention — a glass of water, a monster under the bed,” Ms. Robakowski says.

Ms. Robakowski and her husband, Kenneth Van Stralen, decided to stay firm with Benedict while also rewarding good behavior.

“We started giving him stickers for good behavior, and after three stickers he would get a small gift, like a book,” Ms. Robakowski says.

It worked like a charm, she says.

While books, researchers and coaches on sleep can make it sound easy, it’s important to remember that for many families, it takes time to establish good sleep, Ms. Mindell says.

“Always give everything at least two weeks before giving up,” she says. “It’s going to get worse before it gets better. It’s like cleaning the closets. You start out with that big pile on the floor.”

Protecting sleep

Once a family has established good sleep habits, they can become very protective of night sleep and naps.

Mrs. Sharp says she will only run errands and plan activities between 11 and 1 p.m. and 4 and 5 p.m. when she is sure that her girls will be up from their naps and rested.

It may not be practical, but it’s worth it because Isabel and Eleanor sleep through the night, she says.

“You really need to change your lifestyle to fit their schedule,” Ms. Gilmore says. She also went to Ms. West for advice. “It’s socially awkward at times, but it’s worth it because Ella is happier. The dark circles under her eyes are gone.”

Sometimes this kind of rigidity receives criticism from extended family members and friends who say that a child who hasn’t taken a nap will sleep better at night. But armed with research, parents say they can meet these comments with scientific facts.

A well-rested baby, for example, is more likely to go to sleep quickly than an overtired one, sleep researchers say.

“We don’t know physiologically why it is — but an overtired child gets more agitated and has a harder time falling asleep,” Ms. Mindell says.

The sleep training employed by different sleep coaches and researchers are not cures, they are strategies, Ms. Mindell says. There will be stumbling blocks, such as ear infections, and developmental milestones along the way. But once a family has established routines they will have an easier time finding their way back to good sleep, sleep researchers say.

The bedtime for children up to 5 years of age should be between 7:30 and 8:30 p.m., Ms. Mindell says. This can sometimes be challenging, however, since many parents work late and still want to spend a few hours with their children.

Ms. Reitkopp knows this feeling well.

“I leave work around 5 o’clock, and any traffic jam on the Beltway breaks my heart because I know that means less time with Hudson before he has to go to bed,” she says.

Because Hudson’s bedtime is non-negotiable, he is in his crib at 6:30 p.m. no matter what, Ms. Reitkopp says.

“I miss him terribly, but I know that getting a good night’s sleep is best for him,” she says. “This is not about me.”

Ms. Mindell applauds this kind of dedication to a child’s sleep schedule.

“It’s detrimental to your child to take away a basic need,” she says. “You wouldn’t deny them dinner because you want to play in the back yard. Why would you deny them sleep?”

MORE INFO:

BOOKS —

• “SLEEPING THROUGH THE NIGHT — HOW INFANTS, TODDLERS, AND THEIR PARENTS CAN GET A GOOD NIGHT’S SLEEP,” BY JODI A. MINDELL, HARPERCOLLINS PUBLISHERS, 1997. THIS BOOK PROMOTES SELF-SOOTHING AND HELPS PARENTS ESTABLISH BEDTIME ROUTINES THAT ENCOURAGE THEIR BABIES OR TODDLERS TO FALL ASLEEP ON THEIR OWN. IT ALLOWS FOR SOME CRYING.

• “NO-CRY SLEEP SOLUTION: GENTLE WAYS TO HELP YOUR BABY SLEEP THROUGH THE NIGHT,” BY ELIZABETH PANTLEY, MCGRAW-HILL, 2002. THIS BOOK OFFERS A 10-STEP PLAN, INCLUDING CREATING A SLEEP LOG, TO ENCOURAGE THE BABY TO SLEEP THROUGH THE NIGHT. IT REJECTS THE CRY-IT-OUT METHOD.

• “HEALTHY SLEEP HABITS, HAPPY CHILD,” BY MARC WEISSBLUTH, BALLENTINE PUBLISHING GROUP, 1999. THIS BOOK INCLUDES INFORMATION ON THE IMPORTANCE OF SLEEP AND APPROPRIATE BEDTIMES. IT PROMOTES SELF-SOOTHING AND ALLOWING THE BABY TO CRY IT OUT WITHOUT PARENTAL INVOLVEMENT.

• “SOLVE YOUR CHILD’S SLEEP PROBLEMS,” BY DR. RICHARD FERBER, SIMON & SCHUSTER, 1986. THIS BOOK IS CONSIDERED A CLASSIC AMONG SLEEP BOOKS. IT ADVOCATES A VERSION OF THE CRY-IT-OUT METHOD. THE BOOK HAS SOLD MORE THAN 800,000 COPIES.

ASSOCIATIONS —

• NATIONAL SLEEP FOUNDATION, 1522 K ST. NW, SUITE 500, WASHINGTON, DC 20005. PHONE: 202/347-3471. WEB SITE: WWW.SLEEPFOUNDATION.ORG. THIS DISTRICT-BASED NONPROFIT GROUP WORKS TO IMPROVE THE PUBLIC’S UNDERSTANDING OF SLEEP. ITS WEB SITE FEATURES INFORMATION ON CHILDREN AND SLEEP, INCLUDING A 2004 POLL ON CHILDREN’S SLEEP HABITS IN THE UNITED STATES.

• AMERICAN ACADEMY OF PEDIATRICS, 141 NORTHWEST POINT BLVD., ELK GROVE VILLAGE, IL 60007-1098. PHONE: 847/434-4000. WEB SITE: WWW.AAP.ORG. THIS GROUP, WHICH HAS 60,000 MEMBERS IN THE UNITED STATES, CANADA AND LATIN AMERICA, WORKS TO IMPROVE THE PHYSICAL AND MENTAL WELL-BEING OF ALL CHILDREN AND ADOLESCENTS. ITS WEB SITE PROVIDES INFORMATION ABOUT CHILDREN’S SLEEP PATTERNS, PROBLEMS AND SCHEDULES.

ONLINE —

• BABYCENTER (WWW.BABYCENTER.COM), WHICH IS BASED IN SAN FRANCISCO AND IS A MEMBER OF THE JOHNSON & JOHNSON FAMILY OF COMPANIES, PROVIDES INFORMATION ABOUT HOW TO ESTABLISH GOOD SLEEP HABITS. IT ALSO PROVIDES A SLEEP INDEX THAT SHOWS HOW MANY HOURS OF SLEEP INFANTS AND CHILDREN NEED DEPENDING ON THEIR AGE.

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