Sleep disorders in children; baby doesn't sleep well

As a pediatric neurologist, every day in my work I deal with various manifestations of sleep disorders. I often see worried mothers who are very depressed because the baby is not sleeping well.

Indeed, a child's good sleep indicates his health. And if a child sleeps restlessly, often wakes up, and cries, this alarms the parents, and they seek help from a doctor. Parents of small children are especially often worried, because not being doctors, they cannot be sure of the health of the little person whom you cannot ask: “What happened? Does anything hurt? What dream did you have?". At first, parents may also doubt their child’s neurological health: “Is poor sleep evidence of more serious problems?” A pediatric neurologist can assess the baby’s health status and dispel the parents’ fears and help with effective advice.

Let's look at the main reasons for poor sleep in children:

• Physiological characteristics of a child's sleep
• Emotional overload
• Somatic problems
• Neurological problems

Physiological characteristics of a child's sleep

At the physiological level, a child's sleep differs from an adult's sleep. Children sleep differently than us, their sleep is more superficial, more sensitive, and this is the norm.

As you know, sleep consists of alternating phases - slow and fast. In children, most of the sleep is REM sleep (and in adults, REM sleep is only 25%). During this phase, the mother can observe how the child’s eyeballs move quickly under closed eyelids, at which time the child dreams. Muscle tone is lost (except for the muscles of the eyes and nasopharynx), the child cannot move, as nature intended. If the possibility of movement remained, people would make all the movements that they dream about.

Creating conditions for sleep

In order for a small child to sleep better, no matter how strange it may sound, you should not isolate him from extraneous noise. If the baby hears in his sleep the quiet background of a working washing machine, the calm muffled voices of his parents, he will get used to these sounds and will not be afraid of them in his sleep, and accordingly, he will sleep better, and the parents will be able to continue doing their usual things without fear of waking up the baby .

Before going to bed, it is necessary to ventilate the room in which the child sleeps well. Fresh air will help your baby sleep better. Sleeping in the open air is very beneficial, as it increases the body's resistance to colds. Older children benefit from walks before bed.

For a good night's sleep, how comfortable the pillow and blanket are is also important. The baby should not be too hot or cold while sleeping, so the blanket should be appropriate for the season and the general temperature in the room. If a child's feet are cold, he will fall asleep faster in socks. For older children, you need to pay attention to the selection of the pillow, in particular its height. It is also important how the child sleeps on the pillow: the edge of the pillow should rest on the neck, and the shoulders and upper back should lie on the mattress - this is the most physiologically correct position.

Sleep duration

Everyone knows that the smaller the child, the more he should sleep. However, the duration of sleep is individual for everyone; it often depends on temperament and psychophysiological state.

The table shows daily sleep norms depending on age:

As a child ages, the duration of periods of wakefulness increases; this is associated with an increase in brain performance. Some children, due to their individual characteristics, require less sleep than their peers; if a child sleeps a little less, but feels and behaves well, parents should not worry.

You can understand that your baby has grown up and needs a different sleep schedule by the following signs: the child falls asleep very slowly, wakes up early after a nap, remains active during all periods of wakefulness

Causes of restless sleep in children under one year old

Physiological

1. Damage to the central nervous system.
   If in the last trimester of pregnancy or during childbirth the mother has health problems, causing hypoxia, asphyxia or infection of the fetus, over time the baby may experience sleep disturbances. Timely treatment will help alleviate this condition.
2. Lactose intolerance.
   Babies may experience unpleasant bloating and colic due to insufficient breakdown of milk sugar and disruption of intestinal microflora. Periodic pain bothers and interferes with sleep. If you eliminate intestinal colic in a child, your sleep will improve.
3. Congenital anatomical features.
   These include the narrowness of the nasal passages - this is a common problem in newborns who sleep poorly. Young parents should not panic ahead of time: as the child’s body grows, the structure of the nasopharynx will change, making it easier for the baby to breathe. Only in rare and abnormal cases is surgery required, but the ENT will definitely warn you about this.
4. Lack of vitamin D3.
   If an absolutely healthy person with an excellent appetite begins to sleep poorly and wakes up frequently (especially in winter), he lacks vitamin D3. The climatic features of central and northern Russia practically contribute to such a deficiency - children really lack the sun. Notice: your palms and feet are wet, and the back of your head is sweating? A reason to see a doctor is that you will most likely need to take vitamin-containing medications.
5. Maturation of reflexes.
   After 6 months, the baby begins to actively sit down and stand up. Sometimes he is too fast, so he does it unconsciously in his sleep, waking up from the movements. This is a common problem for curious fidgets who are “ahead of the rest” in development. Therefore, it will be useful for parents of active children to limit active games before bedtime and organize a bedtime ritual for their child.

Psychological

1. Features of temperament.
   How many times does the little one wake up during the night and how does he behave afterwards? Calm, phlegmatic children sleep a lot. Energetic, active and easy-going sleep little, but soundly, having time to rest during short periods of sleep, and while awake to play in the crib. Then go back to sleep safely. The worst thing is for easily excitable and impressionable children: they sleep little and poorly, and often cry at night. Observe the baby: what worries and frightens him during the day? Is he tired enough? Perhaps you should change your children's routine?
2. Age-related characteristics of the psyche.
   The baby often wakes up if its basic needs for food, warmth and drink are not met. This also includes insufficient motion sickness, too rough a diaper and a wet diaper. Children older than 6–8 months may be afraid of loneliness: during this period, babies often fall asleep hugging their mother’s hand, and when they do not find it in their sleep, they immediately wake up. Closer to the year, toddlers very keenly feel the psychological atmosphere around them and can react to this with a poor night's sleep due to emotional experiences. A child needs an individual approach; a mother should learn to feel her baby in order to create comfortable conditions specifically for him.
3. Eating disorder.
   At six months and beyond, the baby can already do without food or drink for 5–6 hours of sleep at night. This time is an excellent reason to abandon night feedings, which the baby is accustomed to and strongly associates with sleep. Gradually reduce your food portions and then “lose” the bottle. By 10–12 months, the baby will be able to sleep almost the entire night without waking up (not counting being put on the potty).
4. Excessive anxiety of parents.
   You cannot wake up a child to eat or drink “according to a schedule” - let an individual wakefulness and sleep regime be established specifically for your baby. Absolute silence is also not necessary: ​​household sounds are natural and should be. Paradoxically, it is with quiet “background” noise that children sleep the most soundly.

Remember that parental fears and anxieties are normal. In some cases, restless sleep in a child under one year old does not require any measures from the parents; you just need to wait for the baby to “outgrow” the anxious period. At the same time, it’s worth moderating your excitement so as not to disturb the baby once again. Do not hesitate to ask questions to doctors, do not ignore their recommendations and be extremely attentive to the health of the little man.

Sweet dream with mom

A few decades ago in Russia, many believed that a child should sleep separately from his mother. Immediately after giving birth, the baby was taught to sleep in his own crib, which often exhausted both the baby, who did not want to sleep away from his mother, and the mother, who was also sleep-deprived.

Modern psychologists and neurologists agree that sleeping together with a mother is not a child’s whim, but a normal physiological need. The baby is born a completely helpless creature (unlike many animals), and for a long time his life is completely dependent on his mother. Being close to mom means survival, so children feel uncomfortable if mom is not around. Mother's smell, mother's warmth, tender hugs, accessibility of the breast - all this creates the most favorable conditions for the full psychological development of the child and, of course, affects the quality of sleep. After all, psychological stability is the key to good sleep, both for children and adults.

If the baby wakes up, frightened by something in a dream, the mother will quickly calm him down, he will not have time to scream, and, consequently, the quality of sleep will be preserved.

Don’t be afraid to spoil your child; up to 1.5 years old, he can calmly stay in his parents’ bed, this will only benefit him. Such children grow up calmer, more balanced, and more self-confident. After all, they receive the necessary amount of maternal love at the age when it is most necessary, when the foundations of his physical and psychological health are laid. Later, at the age of 1.5 to 3 years, he is already “big” and will gladly move to his own bed.

Why might a child sleep poorly?

According to neurologists, there are 4 main groups of causes leading to sleep disorders.

These include:

• psycho-emotional overload;
• somatic pathologies;
• neurological diseases;
• individual physiological characteristics of the child.

Insomnia in a child aged 3 to 5 years is caused by infections, intoxication of the body, iron deficiency anemia and neurological disorders.

Somnambulism is most pronounced between the ages of 2 and 4 years, although signs of the disorder appear already in the first year of life. The baby may sit up in bed or walk without realizing his actions. Night terrors most often appear between the ages of 3 and 8 years. With disorders of this type, a child, an hour and a half after falling asleep, suddenly sits up in bed and begins to scream. With night terrors in children, there is an increase in muscle tone, tachycardia, increased breathing and dilated pupils. Nightmares are defined as frightening dreams that result in awakening in the REM sleep phase. Apnea is a cessation of breathing that lasts from 5 to 40 seconds. The consequence is frequent awakenings and insufficient deep sleep. Some children develop cramps in the calf muscles during sleep, accompanied by intense pain. This pathology is characterized by a sharp onset of an attack and its sudden end. An episode can last up to 30 minutes.

Individual characteristics of the child

In rare cases, a child may be healthy and sleep restlessly due to his individual characteristics. In my practice, there have been cases when a mother went to the doctor with a complaint about the child’s poor sleep, but an examination, additional examinations, and consultations with medical luminaries confirmed the child’s health. Such cases are rare, but they do happen, and here, unfortunately, you just have to wait for the child to “outgrow” this condition. But most often, if the child is neurologically healthy, the cause of poor sleep should be sought in somatic problems or excessive emotionality of the child. Which is what we will talk about next.

Emotional overload

Emotional overload is the most common cause of poor sleep not only in children, but also in adults.

If your child is overstimulated or overtired, falling asleep can be a long and painful process. Therefore, parents should monitor their child’s activities before bedtime; it is not advisable to watch TV, play computer games, or encourage active, noisy games with peers or parents. Overfatigue can also be caused by the child being overly busy during the day, which happens quite often among today's preschoolers and schoolchildren.

If your child has trouble falling asleep, first of all, analyze what the child does before bed to see if there are any factors that can overstimulate his nervous system. For example, maybe dad works all day and comes only when the child is put to bed. Waiting for dad to return from work, communicating with him before bed can excite the baby and disrupt the mood for sleep.

The emotional state of the mother is very important for a child’s good sleep. If a mother is nervous for any reason, this will definitely affect the baby’s condition. Analyze your behavior, do you get irritated over trifles, do you splash out your negative emotions when communicating with your child? An uncomfortable psychological situation in the family, strained relationships between mom and dad or other relatives with whom you live in the same apartment can also upset the emotional balance of an impressionable baby.

Causes of restless sleep in children

The most common causes of poor sleep in children are:

1. Features of the physiology of a child’s sleep. 2. Emotional overload. 3. Somatic problems. 4. Neurological problems.

Sleep disturbance can be caused by a change in diet (for example, “weaning”), changes in daily routine and lifestyle, conflict situations in the family, etc. Sleep disturbance in very young children can be due to colic in the tummy or teething , if the child is hungry or hot (or cold). In this case, sleep disturbances are often temporary. They usually disappear as the child adapts to new living conditions. However, sleep disorders can also be associated with somatic diseases (for example, diseases of the internal organs, nervous system) and mental disorders. Therefore, it is necessary to promptly identify the cause of sleep disturbances in a child and carry out appropriate therapeutic therapy. Doctors identify several phenomena of pathological sleep in children. Let's look at just a few.

Laying procedure

In order for your baby to fall asleep, it is advisable to adhere to a certain bedtime procedure. If every evening before bed your child performs the same actions, for example, putting his toys away, watching “Good Night Kids,” brushing his teeth, this nightly ritual will help him get ready for sleep. After putting him into bed, mom can read him a story, kiss him and wish him a “good sleep.” If your child is afraid of being in the dark, it is better to leave the night light on.

When putting small children to bed (up to one year old), I also advise you to adhere to a small ritual, this could be singing a lullaby or reading a fairy tale, don’t worry if the baby doesn’t understand you yet, at this age the main thing when putting them to bed is monotony of speech. One of my patients (a university student) read notes to her one-year-old baby before bed - and the baby fell asleep faster, and the mother prepared for exams.

I do not recommend rocking your baby to sleep for a long time; sleep during rocking is not deep, and besides, the child gets used to it very much and the mother becomes hostage to motion sickness. If your baby sleeps well at the breast, you can feed him while lying in bed and this may be a better ritual for him. Don't try to immediately put him in a crib; let him fall asleep more deeply.

Sleep disturbance in children 2-3 years old

SLEEP DISORDERS IN CHILDREN 2-3 YEARS OLD

About age itself

The fact that a child has difficulty falling asleep in the evening is, as a rule, not a sign of pathology. This is a feature of a certain period of his mental development, which is aggravated by misunderstanding and incorrect behavior of parents.

Many mothers often have a question: “What to do if the child has trouble falling asleep at night?” Doctors assure that if before this time there were no problems with sleep, then there is no need to sound the alarm. The main explanation for this problem is the age characteristics of the baby, or, as psychologists say differently ,
the crisis of 2-3 years
.

During this period, children become independent and clearly realize that they can manipulate the situation and their parents. The main thing is to prevent the problem from growing and put the child in his place in time, pointing out who is in charge in the family.

And it is not uncommon when many parents, faced with the fact that their child has trouble falling asleep at night, scold the baby, while humiliating their child in every possible way. There is no need to do this, thereby you instill self-doubt in the child and provoke him to even greater hysterics.

The main reasons why sleep may be disrupted:

1. Active evening games.
2. Watching cartoons.
3. Late afternoon nap.
4. Child psychology and physiology. Many guys experience an additional surge of emotions after overwork. And instead of relaxing and falling asleep, they, on the contrary, want to have fun, run, jump.
5. The child has a lot of energy that he does not spend during the day, so he has problems falling asleep.
6. Daytime naps last too long. If your baby falls asleep and can’t wake up, you definitely need to wake him up.
7. Evening quarrel, showdown. After scandals, it is very difficult for children to recover.

If a child has difficulty falling asleep both day and night, makes constant scandals, and does not respond to parents, it is better to contact a pediatric neurologist.

How to help a baby who has difficulty going to bed:

1. Form nice bedtime ritual

   , and strictly adhere to it. A familiar sequence of actions, repeated every evening, will calm the baby and create a feeling of security. A ritual, for example, might include bathing with a favorite toy, wrapping yourself in a soft towel, gentle back rubs, quiet conversation with mom, or reading a fairy tale. By performing these actions every day at the same time, you can ensure that they become pleasant and expected for the child;

2. Install for baby smooth transition

   from daytime activities to evening worries. Keep him busy with quiet games, don't let him scream loudly and run around the house. In this case, it will be easier for the baby to calm down. You cannot demand that a child “immediately put down his toys and go wash himself,” he cannot do this. It is useful to include transitions from one activity to another, normalized by time (“start putting toys in 10 minutes”) in your evening ritual. Young children have poor understanding of time intervals, and setting a timer will help with this. Children are interested in the use of such mechanisms if they are used in a playful way;

3. Sometimes a child has trouble falling asleep because he uncomfortable

   . Parents should provide a normal indoor microclimate, soft light, comfortable night clothes and bedding for the baby;

4. It can be of great help to use aromatherapy

   . You can add a few drops of lavender oil to the bathing water (excluding, of course, allergies), as well as other “baths with soothing herbs.”

5. Warm milk with a spoon of honey, drunk shortly before bedtime, also helps to fall asleep.
6. If a child has difficulty falling asleep in the evening, parents should under no circumstances scold him or show their annoyance. This can frighten the baby and make the problem worse.
7. You also can’t argue with a stubborn little one about bedtime or follow his lead, allowing adults to be manipulated with requests, conditions and complaints.

The ability to calm down and move from wakefulness to sleep, on which the child’s health will depend in the future, does not appear on its own. The skill of falling asleep develops over time, and the task of parents is to help the baby with this.

Somatic problems

Somatic problems are diseases not associated with disorders of the nervous system. To exclude somatic disorders, you need to consult a pediatrician.

If your baby has a tummy ache, don't expect him to sleep well. The reason for this may be gastrointestinal colic or spasms. But, as a rule, gastrointestinal disorders cause temporary sleep disturbance - only during the period of exacerbation.

The most common cause of persistent sleep disorder in the first year of life is rickets - a disorder of phosphorus-calcium metabolism due to vitamin D deficiency. In the initial stages of rickets, there is always an increase in neuro-reflex excitability; this symptom can be clearly detected from 3-4 months, in some cases even earlier - from 1.5 months. The child develops anxiety, fearfulness, irritability, and sleep is noticeably disturbed. Children often startle, especially when falling asleep. Sweating increases, especially during sleep and during feeding. The face and scalp sweat the most. Prescribing an appropriate dose of vitamin D by a doctor leads to an improvement in the condition.

Neurological problems

Sleep disorders that are caused by disruption of the child's central nervous system can be of epileptic or non-epileptic origin. Only a neurologist can determine the nature of the disorder, so if you have any suspicions, you should consult a doctor.

What should alert a mother and serve as a reason to contact a neurologist:

• Nocturnal enuresis (in children over 4 years old)
• Sleepwalking, sleep talking
• Nightmares

Separately, I would like to dwell on nightmares of epileptic origin. In this case, the mother notices that the child’s night terrors are repeated as if according to the same scenario. During such a nightmare, the child may have a frozen gaze, limbs may tremble, and at the same time there may not be a bright emotional coloring of the night terror. In the morning, such children are always lethargic, depressed, and feel bad.

In conclusion, I would like to repeat that in most cases, sleep disorders do not require serious medical intervention, and disappear without a trace after the mother herself stops being nervous and adjusts the child’s sleep-wake schedule. But if the baby continues to sleep restlessly, it is better to entrust the solution to this problem to the doctor.

Types of sleep disorders in children

Unfortunately, sleep disorders in children are not uncommon.

The most common types of violations include:

• insomnia;
• parasomnia;
• snoring and apnea.

Insomnia (insomnia) in children is characterized by problems falling asleep, too frequent awakenings at night, as well as restless and insufficiently deep sleep. Parasomnias include night terrors and nightmares, sleep talking, sleepwalking (sleepwalking or somnambulism) and enuresis.