3. Sleep Problems in Children - Sleep Tips for New
Aren't babies born knowing when to sleep?
When babies are born they have no sense of night
and day. They learn this from the behaviour of human
beings around them. The tradition in some continental
countries is that people go to sleep much later in the
evening and have a siesta in the afternoon. Babies brought
up in that sort of environment will learn that kind
of sleep pattern.
It is therefore quite normal at the beginning of life
to have a chaotic sleep pattern. Babies seem to feed
and sleep on a continuous basis throughout about 24
hours, although within a matter of a week or two some
of that sleep will clump together, although not always
My baby won't fall asleep
Babies do not know how to fall asleep at will. Sleep
is simply something which happens to them and over which
they have very little control. The ability to fall asleep
at will develops gradually over the first few weeks
of life. This is a process and takes time.
What happens during sleep? Why do we wake up more
easily at some times than others?
During sleep there are different phases. There is
an initial phase of deep sleep followed by a phase of
light sleep. This light sleep may be accompanied by
waking which is usually momentary and is often preceded
and followed by episodes of dreaming. This pattern of
light sleep followed by the sleep followed by light
sleep again continues in adults and animals and young
children throughout the night. Each of the sleep cycles
takes approximately an hour and a half. This is one
of the reasons why babies most commonly sleep and wake
after about and an hour and a half or, they may possibly
go through the first light phase and end up sleeping
for about 3 hours, or two sleep cycles.
Why don't adults wake up like babies do then?
When most adults wake at night they commonly turn
over or may open their eyes momentarily and then go
straight back sleep again. This process is facilitated
by the fact that they usually fall asleep in the same
situation in which they are likely to wake during the
course of the night. Also most animals have an inbuilt
sense of time and seemed to know approximately how long
they may have been asleep and approximately what time
it is. It is not easy to wake animals when they are
in the phase of deep sleep but it is much easier to
wake them in one of the light phases. This means that
if any time you are trying to manipulate your baby's
sleep pattern, you would do better to try to wake them
in one of the light sleep phases so that they do not
wake miserable and cross.
Do babies dream?
Premature babies seem to have much more dream sleep
than babies born at term and the amount of dream sleep
declines in all babies over the first year of life.
During phases of dream sleep, the eyelids flicker backwards
and forwards continuously while the rest of the body
hardly moves. This dreaming phase occurs during light
sleep and if you are planning to tactically wake your
baby, you would do better to wait until you see their
eyelids flickering in the way described.
Does it matter where a baby sleeps?
For the first six months of life, babies will fall
asleep pretty much anywhere, any time. However by about
six months of age they gradually begin to become more
aware of their surroundings and begin to develop some
sort of settling routine. By settling routine this might
mean anything from eating, having a bath and possibly
a bottle and then falling asleep. This settling routine
has an important function in that it is part of a process
of beginning to quiet down in preparation for a long
phase of sleep. This involves a separation from the
mother and father and from the world itself. By this
stage the baby can voluntarily fall asleep alone and
the circumstances in which it does so become much more
This means that if a child is still sleeping in with
you, you need to think about where your child is going
to sleep in the long-term. If you plan to move your
baby out of your room and into a room of their own,
you would do best do this before six months of age.
If your baby has been sleeping in a Moses basket or
cot beside your bed, it would be best to move this into
the new room ready for their sleep during the day. It's
much easier for a child to adjust to this kind of process
in the daytime and if they do find it difficult or cry
frequently for reassurance it's much easier for you
to go and deal with them when you're feeling slightly
more awake. If your child is in a Moses basket you could
try putting a Moses basket inside a new cot in a new
room to begin with so that you are minimising the difference
in their surroundings. Once they become used to the
new surroundings, the Moses basket can be removed. If
they are in a cot, you could put them in the cot to
play during the day while you sit with them, so that
they get used to being in the cot in a different room.
It doesn't matter if you don't have a separate room
to put them in but if you do, you will probably find
that they will sleep better. Adults make a lot of noise
at night-time, which can be quite disturbing to babies.
How do I settle my baby to sleep?
There is a very important piece of advice about
settling routines which is that, in an ideal world,
you should not do anything which you are not prepared
to get up and do again at two o'clock in the morning.
This is because children need to learn ultimately to
fall asleep in the dark and on their own. These are
the conditions that they will be in when they wake throughout
the night and it is much more likely that they will
be able to fall asleep again, if these are the circumstances
that they associate with going to sleep in the first
place. If they associate falling asleep with being rocked
or walked up and down by you, the chances are that they
will need that again at two o'clock. Not all babies
do and my advice here is guided by the number of parents
I see in my clinic who have told me this. I don't see
the parents who rock their babies to sleep and whose
babies do not wake at two o'clock in the morning and
therefore it isn't a problem for them. But you never
know what kind of child you are going to have and it
is slightly better to err on the side of caution.
A word about bottles: most babies are most likely to
fall asleep while sucking a bottle until they stop sucking
bottles basically, although some begin not to towards
the end. You should not try deliberately at this point
to withdraw the bottle from your child. What you could
possibly do is try and give the bottle a little time
before bedtime so that there is a slight gap between
bedtime and the end of the bottle. Or you could wake
them momentarily as you put them down into the cot -
not enough to get them agitated and screaming but -
enough to have them associate the idea of being in the
cot and falling asleep from being awake rather than
falling asleep somewhere else. I see many parents whose
children fall asleep in front of the television in the
evening when the adults are around and the light is
on full blast with lots of noise and everything else
going on. They then transfer their children to their
cot when they themselves go to bed. These children then
wake up in the early hours of the morning and scream
the place down because they're terrified of being alone
in the dark because that was not the situation they
went to sleep in in the first place.
The best way to settle your child is to put them in
their cot at a time you have noticed is a common time
for them to fall asleep (this could be 9pm or later
and won't necessarily be at 7pm). You should then tell
them that it is time to sleep now in a calm and soothing
voice and then leave the room. You could then be doing
things outside the room that don't make loud sudden
noises but just let your baby know that you are still
around. You will commonly notice that they will cry
but this is normally just a fussing kind of cry and
not real distress. Try not to go back for 10 minutes
and give them a chance to fall asleep.
My child always seems to wake for bottles in the
night? The only thing that gets my child back to sleep
at night is a breastfeed or a bottle.
If your child waits repeatedly throughout the night
for a bottle, this is extremely common in young babies
and it is not something you should worry about. By about
10 months of age babies do not normally need to be fed
during the night, although there will be some breast-fed
babies who will still feed at this time and it is more
difficult to get babies off the breast at this point
than it is to get them off the bottle. However that
is not a reason to switch over to bottle feeding at
this stage necessarily.
How do I get my child off the bottle/breast at night?
If they are still waking and appearing to indicate
that they need to feed and you are bottle feeding it
is slightly easier to manage this. You can reduce the
amount of milk being given at this time or alternatively
you can try gradually watering it down over the course
of a few weeks, an ounce at a time. You can be confident
that if your baby is at least 10 months of age, unless
they are ill, or the weather is particularly hot, they
do not need a drink or food during the night. If you
give lots of milk at night you may find the baby eats
less during the day and this will affect weaning. If
they are not coping with weaning very well it isn't
a good idea to keep on giving the milk during the night
because it will inhibit their hunger during the day
which you need to stimulate in order to get them eating
food. The other thing is that there begins to be a crossover
and instead of the milk being something comforting that
sustains them throughout the night, it becomes something
uncomfortable for them, rather in the way that eating
a large heavy meal just before bedtime is for adults.
If you are breastfeeding, you could try removing your
nipple just as they appear to be falling asleep, rather
than waiting until they are, and thereafter, you could
try removing it just a little earlier still. It is worth
allowing a few days at each stage of this change to
allow them time to get used to it and waiting until
they settle easily before you move onto the next stage.
If one stage doesn't work, you can just go back to the
previous one that you know worked and then try to move
on again from there in a few days' time.
My child screams when I try to leave the room
If your child's screams when you try to leave the
room and refuses to settle without you there are three
main methods of dealing with this behaviour.
Cold turkey - (described by Richard Ferber in
his book 'Solve your child's sleep problems').
This method simply involves ignoring your child's screams
and not returning at all. In behavioural terms it is
known as extinction and it works very rapidly. By very
rapidly I mean that it will work within two to three
days. However it involves an awful lot of distress and
screaming while children are learning that you will
not respond as it is night-time now and time for them
to go to sleep. The vast majority of parents that I
see in the sleep clinic do not use this method because
they find it too traumatic. If they did use it they
wouldn't be coming to see me because it does work very
quickly. However is not easy method to use and I would
not suggest that anyone uses it with a child under 14
months of age because I think that they are simply too
young to cope with it. Normally parents recognise this.
Go back and check method (but there are various
names for it).
This is exactly as it sounds. The idea is that you leave
your baby after you have put them down settle to sleep
and if they cry, you wait five minutes before you go
back to them. Then you leave the room when they are
settled again. If they start to cry again there are
two variations on the theme this point: there is one
method which says that after another five minutes you
go back and that you keep doing that. There is an alternative
method which says that you leave it 10 minutes the next
time and then you go back and that if your child's screams
again you leave it 15 minutes the following time and
so on, always adding on five minutes rather than keeping
it a constant. The first of these variations adds the
5 minutes on the next night. There are many people who
swear by this method but I personally think it's a bit
confusing. It seems to me that just as your baby gets
used to doing without you and begins to settle, back
you come again. However, there are many who swear by
The last method is that you remain in the room with
your child and you stay with them until they fall asleep.
This method is often very useful for parents where there
have been concerns about separation or loss. When I
take a history of the pregnancy and birth and experiences
before pregnancy from parents, I find a striking number
of parents who have had losses, or threats of loss,
either just before the pregnancy, sometime during the
pregnancy or around the time of birth. These experiences
often sensitise parents to loss and make them far more
anxious and unable to be calm around the separation
time with their child. Sleep is of course a separation
and this may be the first time that you see this sort
of underlying feeling becoming more evident.
This method depends on you sitting beside the bed/cot
while your child falls asleep and being very calm and
very boring. This will reinforce the idea that daytime
is for playing and doing things and having conversations
and night-time is a rather boring, uninteresting time
when people lie still and do very little and have their
Try not to end up lying down with your child to get
them to go to sleep but if you have somehow got into
that situation, as many parents do, you have to gradually
extricate yourself from this. This might mean instead
of lying down beside your child sitting beside them,
or sitting on a chair beside the bed, sitting on a chair
beside the door to your child's room, although inside
it, etc. These are also stages that you can go through
to teach a small child gradually to learn to fall asleep
Commonly when parents come to see me, they have reached
the point of lying down on a bed with their child and
often falling asleep because they are exhausted! This
means that the first stage needs to be sitting up beside
your child and as long as you are calm, the message
to your child is that you feel they are perfectly safe
if you sit there beside them. When they have reached
the point that they can fall asleep within five minutes
and that's been going on for at least three or four
days, you can then move onto the next level of the hierarchy.
By this I mean, instead of sitting on the bed, you could
sit on a chair right beside the bed/cot and in that
case the child will know that you are still there. You
will be a reassuring but rather boring presence.
Again, when your child can fall asleep within five minutes,
allow three or four more days for that to consolidate
and then move your chair slightly away from the bed.
In an ideal world you should have the lights down low
and be reading a book or a newspaper or being very very
uninteresting at this point. When that becomes easy,
depending on how big your child's room is, you could
move your chair right over by the door. The last step
is that you leave the chair in the room and you get
up periodically and you wander off bustling about in
the corridor outside, putting things away for example,
eg. washing or anything you can think of that makes
a slight noise to let your child know that you are still
there but which means that you are not in the room any
more. By this stage your child should be sleeping slightly
How should I deal with my child's distress?
Children are extremely sensitive to the feelings
of their parents, especially before they are verbal.
They will know from the way you hold them, from the
way you touch them, from the way you look at them, from
your tone of voice and many other signals that you are
feeling anxious about what you are doing, even if you're
not aware of this yourself.
If you have doubts about this I would urge you to try
and think about walking into a room where there is a
funny atmosphere. How do you know? What tells you? What
are you going on? Often people can't tell you but they
will know that there is a funny atmosphere in the room
when they walk in but they have absolutely no idea how
they reached that conclusion. I would suggest that you
and they are tuning into something that involves a mixture
of non?verbal behaviour and probably unconscious communication.
Children are much better at this than adults and if
you are in the slightest bit anxious when you put them
down to sleep your baby will scream or cry for reassurance.
If you then pick them up in an attempt to reassure them,
they will assume that they were right to be concerned
and that you agree because you picked them up. This
is where it gets complicated because you have to balance
being a nice parent who cares about your child and who
is meeting their needs with the message you are giving
them by your actions. If you take a child out of cot
when they cry, one message is that you care and that
you're looking after them, whilst another message is
that you agree with them and they were not safe there
which is why you're taking them out. It depends slightly
on the emotional situation in which this happens as
to how various messages will be interpreted. However
what you must realise, is that not all of the signals
from your child relate to how your child is feeling
but how they think you might be feeling as well.
Won't loud noise disturb my baby?
A word about noise, parents often feel that you
have to be absolutely silent or tiptoe around a baby
but this is not necessary. Babies seem to be able to
sleep remarkably well when there are vacuum cleaners
on and other loud repetitive noises or radios and all
manner of things. In fact if you tiptoe around them
you teach them to be much more sensitive to any noise
that they hear and then it does become like self-fulfilling
prophecy that they almost wake up at the drop of a pin.
If you continually make noises your baby will hear
these and will be reassured that you are still around
and have not left the planet but they will tune them
out when they need to fall asleep. In other words these
noises are usually quite reassuring. What is more likely
to wake them is unfamiliar loud, startling noises and
these should be avoided if possible. If you have a baby
who appears to have become extremely sensitive to noise,
you can put a radio on near them when they are asleep
and turn it up so that it becomes slightly louder. They
then have to tune it out quite actively to go to sleep.
Then you can begin to turn volume down slightly so that
they can sleep through pretty much anything.
Will light disturb my baby?
Generally speaking, unless your baby is soaking
wet or has had diarrhoea or genuinely seems uncomfortable,
it is not necessary to change their nappy in the night.
This is likely to wake your baby up completely and is
also likely to confuse the difference between night
and day. It also means that you will need to have a
light on. It doesn't matter if this is a low, soft light
but if you put a main light on, this will reset your
sensitivity to time and it is likely to make it very
difficult for you and your baby to fall asleep again.
How much sleep do babies need?
The amount of time for which children sleep varies
enormously. At birth the range is anything between 7
and 21 hours out of 24. This means that one baby could
be sleeping as much as three times as another baby.
However this becomes much more consistent over the course
of the first year of life and the average amount of
sleep of a baby of a year of age would be about 12 hours.
However this still means that some babies will be sleeping
more and others will be sleeping less. If your baby
is waking repeatedly at night for no particular good
reason, it is possible that they are going to bed too
early, waking up too late or having too much sleep during
By the time they reach a year of age, most babies will
settle to the point where they only need one nap during
the day, although they might still be having two. If
they appear to be waking a great deal at night it may
be worth trying to consolidate these two naps into one.
This can be achieved by starting the earlier one slightly
later and also by waking them before the end of the
second or by putting them down slightly earlier for
the second nap.
No child should be put down after about 2.30pm, particularly
if you expect them to go to sleep again at 7pm because
it is very unlikely that they will be ready to go to
sleep at 7pm especially if they did not wake up until
4pm. This of course doesn't apply to very young babies
who can sleep at all sorts of funny times.
Lastly remember that is very unlikely that you are
the only person pacing the floorboards at 4am. Unfortunately
again most parents come to see me come because they
tell me that all their friends' babies are sleeping
wonderfully since they were about four months of age.
There are certain constitutional factors that affect
sleep which have nothing to do with anything else.
Premature babies are much more wide awake during the
night whereas babies who were quite big at birth are
more likely to sleep through the night slightly sooner.
There is little to you can do to influence any of that.
The most important thing that you can do is to be as
calm as you can at bedtime.
If you are extremely worried about cot death or anything
else then you need to try and think about this during
the daytime and to try to put in whatever precautionary
measures you can. These days this includes putting your
baby down to sleep on their back, not on their stomach
and it's worth having a baby monitor so that you can
be aware of your child breathing.
Can my baby sleep with me?
In some cultures, including ours, it is not unusual
for children to sleep with their parents all the time.
The standard advice is that there is no problem with
this providing parents have not taken drugs or large
amounts of alcohol. There is a book called 'Three in
a bed,' although the author's name escapes me, which
talks a lot about managing your life when you have a
child in bed with you.
Although most of us take our children into our beds
periodically, either because we're too exhausted, or
they're not well, whatever, in an ideal world, unless
you are committed to this particular way of managing
things, generally speaking it's not the greatest habit
to get into. If you find yourself persistently doing
this, it is worth asking yourself whether you are somehow
avoiding a sex life with your partner, or whether there
are some unresolved marital difficulties that are too
difficult to talk about, that having your baby in bed
helps you avoid.
Also remember that up to a fifth of all babies are
still waking in the night at one year of age. When everyone
you know seems to have a child who is sleeping, remind
yourself that this is just relates to your particular
circle of friends. In all the community Child Psychology
Clinics around and in GP surgeries and paediatric departments,
the commonest reason why parents come to talk to somebody
is because their child is not sleeping at night. This
means that you are by no means the only one and it also
means that there are lots of sources of help available
and you shouldn't be ashamed or embarrassed to go and
talk to somebody about it.
If you have any further queries please