Normal Sleep Patterns 0–16 years

Children need plenty of sleep to allow their body and mind to rest, grow and develop. But for many families bedtime can be frustrating and no fun. However most children have the ability to sleep well and understanding what is normal and when to seek help is important. 

   

Newborn sleep 

    Full-term Babies will sleep 16 to 20 hours per day. They have a 40-minute sleep cycle and cannot differentiate between day and night. They have 3 different sleep states and spend half their time asleep dreaming-called REM sleep (Rapid Eye Movement Sleep)-during which they will suck, grimace, smile and occasionally twitch their fingers and feet. They wake to feed every 3-5 hours.      Premature babies may sleep 20-22 hours per day with only very short periods of wakefulness. During REM sleep all newborn babies have a pattern of “brief pauses in breathing” (called Periodic Breathing) where they take a few breaths, pause, take  a few breaths, pause and so on-this often for long periods of sleep and can be quite normal      3 to 6 months      Time spent asleep starts to diminish as babies spend more time awake, moving, rolling and learning. Gradually, a baby’s sleep becomes more like that of a child and by about 6 months, all of the five sleep states are defined. They still wake for feeding and comfort every 4 to 6 hours and periodic breathing has ceased by 6 to 8 months of age.      Toddlers and Pre-Schoolers      At 2 years of age, 12 out of 24 hours is spent asleep without waking. A nap during the day averages one and a half hours ranging up to about 2.5 hours. By 3 years of age the daytime nap is reducing and then ceases. Dream (REM) sleep continues to decrease while the other stages of sleep lengthen and become more consolidated.      School Age Children      During primary school the average child sleeps 10-11 hours at night without waking with a gradual decrease into later childhood. By 12 years of age, slow wave (deep) sleep occurs mainly in the first half of the night while dream sleep (REM) decreases to adult levels of about 15-20% of the total time spent asleep.  “Night terrors”-where the child appears to wake, is very frightened and inconsolable-are not uncommon from 4- 8 years of age.      Adolescents      As puberty approaches sleep needs are increasingly unmet.  Pressures of schoolwork, social life and peer contact often cause adolescents to go to bed late and sleep in half the day. This practice should be discouraged as it can eventually lead to altered sleep phase where the individual wakes late and is unable to sleep at night.      A sensible balance between late night socializing and sleeping needs to be established. Normal young adult sleep should be in place by 16 years. Dream sleep (REM) occurs after 80 to 90 minutes and sleep continues to cycle over 6-8 hours.      Sleep Hygiene     
  • Parents should encourage good sleep practices from an early age. 
  • A consistent bedtime in a warm (the ideal temperature is around 21°C), dark, comfortable room with light blankets and a firm mattress; encourages children to feel safe and secure at night. 
  • Many children will wake after one or two cycles of sleep and wander to their parent’s bedroom and climb into bed with them. Children should not be punished or scolded for this, as they may not be fully awake at the time. The best remedy is to carry or walk them back to their own bed and settle them back to sleep with the minimum of fuss. 
  • Avoid spending lots of non-sleep time in bed – spending hours lying on a bed doing other activities before bedtime keeps our brains from associating the bed with sleep time. 
  • Bedtime should follow a predictable sequence of events, such as brushing teeth and reading a story. 
  • Avoid high stimulation activities just before bed, such as watching television, playing video games, or exercise. 
  • Having physical exercise as part of the day often helps with sleep time many hours later. 
  • Relaxation techniques such as performing deep, slow abdominal breaths or imagining positive scenes like being on a beach can help a child relax. 
  • Avoid caffeine (sodas, chocolate, tea, coffee) in the afternoons/evenings. 
  • If a child is awake in bed tossing and turning, it is better for them to get out of bed to do a low stimulation activity (e.g., reading), then return to bed later. This keeps the bed from becoming associated with sleeplessness. If still awake after 20-30 minutes, spend another 20 minutes out of bed before lying down again. 
  • Worry time should not be at bedtime. Children with this problem can try having a “worry time” scheduled earlier when they are encouraged to think about and discuss their worries with a parent. 
  • Children should be put to bed drowsy, but still awake. Letting them fall asleep in other places forms habits that are difficult to break. 
  • ‘Lovies’ at bedtime are often helpful for children who need a transition to feel safe and secure when their parent is not present. Try to include a doll, toy or blanket when you cuddle or comfort your child, which may help them adopt the object. 
  • When checking on a child at night, checks should be “brief and boring.” The purpose is to reassure the child you are present and that they are OK. 
  • If your child is never drowsy at the planned bedtime, you can try a temporary delay of bedtime by 30 minute increments until the child appears sleepy, so that they experience falling asleep more quickly once they get into bed. The bedtime should then be gradually advanced earlier until the desired bed time is reached. 
    Why should you help children sleep better?    
  • Learning and Memory – Children who get enough sleep seem to learn more rapidly than those who are tired. 
  • Safety –it can be more problematic for your baby to go up and down stairs, ride his tricycle, etc when he has not slept enough. 
  • Illness – Your body’s immune system has more trouble fighting off illnesses when it hasn’t gotten enough rest.
  • Obesity – A Harvard study concluded that too little sleep in babies and toddlers might be linked to obesity. Our bodies release hormones leptin and ghrelin to signal to our body we are full and hungry, respectively. When we don't sleep enough, leptin levels go down and when you get a spike of ghrelin, you will get hungry and most likely, eat when you should be sleeping.
  • Depression – Studies are now finding that it was once thought that sleep problems were a symptom of depression, but they are now considering that sleep problems may precede depression. Depression is the most common form of mental health problem and it now considered as common in children as it is adults. as many as 1 in 33 children may have depression. 
  • Mood –While some children won’t get too cranky, some get downright monstrous. Behavior problems have been linked to sleep deprivation. 
    Symptoms that may indicate Abnormal Sleep     
  • Snoring. 
  • Sweating. 
  • Restlessness. 
  • Morning headaches. 
  • Daytime sleepiness. 
  • Bedwetting after 5 or 6 years of age or after a 6-week period of dryness. 
  • Poor school performance 
      If severe may need attention     
  • Sleep walking and talking. 
  • Head rocking/banging. 
  • Like all physical and emotional disorders, sleep disorders need to be properly investigated, diagnosed and treated.  Discuss the problem with your health caregiver and they can refer you and your child on to a Sleep Physician for assessment. 
    Remember      Every age group has a different pattern of sleep, if you are concerned speak to your doctor and seek a referral to a specialist.    

 

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