Sleep-A Learned Behaviour

Following birth, sleeping patterns evolve rapidly and become consolidated in early childhood. Parental behaviours at bedtime — especially their response to their child’s nighttime awakenings — play a big part in consolidating their child’s sleep patterns. This according to findings published in the Archives of Pediatric and Adolescent Medicine.

The study investigated the sleep patterns of 1741 children in Quebec, at ages five, 17, and 29 months, and collected data from the mothers via interviews and questionnaires. Three major conclusions emerged from the results:

Sleep behaviour evolves rapidly and consolidates by 17 months of age.
How parents behave at bedtime and during nighttime awakenings can determine how their child’s sleep pattern evolves and how fast it consolidates.
Children not sleeping six consecutive hours by 17 months of age have greater difficulty consolidating a healthy sleep pattern as they grow older.
These findings make intuitive sense to Dr. Ian MacLusky, head of respiratory medicine at Children’s Hospital of Eastern Ontario (CHEO) in Ottawa. The key to solving many common sleep problems in young children is to teach them to fall asleep, says Dr. MacLusky, who was formerly the Sleep Lab director at the Hospital for Sick Children. “Sleep is a learned behaviour, like talking. And since the plasticity of the brain is greatest at infancy, infants can be more easily taught to fall asleep by themselves than older children can.”

Insufficient sleep is an issue-
The Quebec study addresses a prevalent, but often overlooked issue of insufficient sleep in children. A poll conducted in 2004 by the National Sleep Foundation in the U.S. looked at the sleeping habits of children aged from infancy to 10 years old. Results showed that most children do not get the daily required amount of sleep, most parents are not satisfied with their children’s sleep pattern, and most doctors do not ask about a child’s sleep habits. Childhood sleep disorders are one of the most common complaints brought to family doctors, with nearly half of new mothers complaining of infant sleep problems. However, less than 15% of children with sleep problems had it on their medical charts.

Doctors are not the only ones overlooking the sleep issue: one study found parents significantly underestimated the length and quality of their child’s nighttime sleep.

Dr. MacLusky explains that although nighttime awakenings may be disruptive, they are normal. “We all wake up three or four times a night. Most of us just roll over and go back to sleep again. But children who haven’t learned to fall asleep on their own call on their parents.”

If a baby or young child does not sleep well at night it can disturb not only the child but the whole family, causing lack of sleep and stress for the parents and older siblings as well. Fragmented sleep in older children has been correlated with problems in learning, emotional development, and growth.

Techniques to help a baby sleep-
Recommended hours of sleep per day for children have remained constant over the past few decades, beginning with about 15 hours of sleep for infants, gradually reducing to 13 hours by two years of age, 12 hours by three years of age, and coming down slowly to 10 hours by 10 years of age.

Results of the Quebec study found support for the following general recommendations to parents for quickly establishing a good sleeping pattern in their healthy child:

Put the child to bed while sleepy but not yet asleep.
Try to avoid nighttime feedings.
Do not bring the child into the parent’s bed.
While these recommendations may sound simplistic, several studies have shown their usefulness. Other studies have emphasized routine and an organized environment: children put to sleep at the same time and place every night fell asleep more easily and had more regular sleep. One study specifically focused on educating parents on such positive behaviours to use with regard to their child’s sleep and found the results to be very successful in improving the sleep of their child.

Sleep problems as a result of a health disorder-
Most sleep problems in children are like the ones looked at in the Quebec study. They involve difficulty falling asleep, are behavioural in nature, and can usually be solved by changing the parents’ responses. Some sleep problems, though, are resistant to behavioural modification and can indicate a health problem that requires further investigation.

Tourette E, Petit D, Paquet J, Boivin M, Japel C, Tremblay RE, Montplaisir JY. Factors associated with fragmented sleep at night across early childhood. Archives of Pediatric and Adolescent Medicine. 2005;159;242-249