Healthy Sleep Habits, Happy Child: Prevent and Treat Sleep Problems

Written by Rebecca Unger, MD

Dr. Marc Weissbluth’s first question to the audience at the Northwestern Children’s Practice’s evening discussion was, “How many of you have ever been or are currently sleep deprived?" Not surprisingly, everyone's hands went up.  After a discussion of how many uncomfortable physical and emotional symptoms result from being overtired, Dr. Weissbluth reported that the more tired you are, the harder it is to fix a difficult situation.   The common state of “subjective blindness”, or the failure to appreciate our own sleep deprivation, interferes with noticing overtired signs in our children. Dr. Weissbluth’s discussion with our audience, which ranged in age from two months to eighty-two years old, included age-old advice about sleep for the entire family, as well as new research. The information about new research updates our knowledge even since the fourth edition of Dr. Weissbluth’s book, “Healthy Sleep Habits, Happy Child” was published in December 2015.

Dr. Weissbluth says sleep deprivation is “painful and sad”. The good news is that parents can prevent this and the not as good news is that parents can also contribute to this. Some babies naturally seem to cry more than others. Understanding this infant characteristic may help guide parents on their soothing strategies. For example, if a baby cries more, they will have a harder time with self-soothing. Other babies might get more (unnecessary) attention at night, which disrupts their sleep.  For all fussy babies, it is helpful to start working towards self-soothing skills at six weeks of age (from the due date). On the other side of the spectrum, for babies who are less fussy and who cry less can start learning self-soothing skills right from the start, at birth.

Dr. Weissbluth explained there are three components of facilitating self-soothing; putting your baby down when they are drowsy but awake, getting other people involved in baby care (“many hands on”), and offering many naps throughout the day. At six weeks of age (46 weeks from conception) the brain matures in a very predictable fashion.  As a result, this is when a social smile develops and babies need an earlier bedtime. There is a lot going on in the brain of a six-week-old baby!

The next sleep milestone occurs at 3-4 months of age, with the development of regular daytime sleep patterns. Parents should plan most activities around nap times. Again, parents can either prevent sleep problems or contribute to them, depending on how they are looking at a baby’s cues and “signaling” behaviors. Parents should look for early signs of drowsiness (less socially engaging, decreased movement, and slowing down of movement). Waiting for later signs of being tired (droopy eyelids, rubbing eyes, crying) will make it harder for a baby to self-soothe because the baby is already overtired at that point. It is helpful to learn about your baby's’ cues through observation. Overtired babies “fuss and cry and go to a high level of alertness” and therefore be difficult to soothe. Dr Weissbluth pointed out that this is related to a primitive state of man who had to maintain wakefulness to hunt and flee rapidly from predators.

There are several parenting styles that influence infant crying, signaling and waking at night. Parents with a “limit setting” style vs. an “infant demand” style hold their children less, their babies might cry more at two and five weeks of age, but wake up less at night by ten months. Dr. Weissbluth described several soothing techniques (hugging, kissing, rocking, feeding) and emphasized that, “not one size fits all”.  Important variables in this equation include different parenting styles and infant temperament.

Dr. Weissbluth addressed questions about these concepts.

Q and A excerpts include:

Q:  What is self-soothing?

A:  “Drowsy but awake, many hands, many naps”.

Q:  What about exceptions in the schedule?

A:  If parents are careful and have exceptions 1-2 x/months there should not be a problem. If the exceptions are more frequent, it could be a problem.

Q:  What if we missed signs of drowsiness and our baby has a  “second wind”?

A: You should shorten the interval of wakefulness for the next sleep time.

Q:  What is the best way to learn about our baby’s cues and “signaling”?

A:  Ask yourself, “How does your baby look at end of day?” If your baby is overtired, trust your instincts to put your baby to bed earlier. Sleep routines create associations that can be very powerful.

Dr. Weissbluth concluded that different children and different parenting styles have children who sleep differently at different ages. There is not one solution to help children sleep better, but there is one word that helps children sleep better…. and that word is…..(can you guess???)….timing. You begin your efforts to soothe when the early signs of drowsiness begin to appear. The “California” in Dr Weissbluth said that helping your child sleep better is like surfing. “Catching the wave” of drowsiness will help with timing of long naps and easy sleep nights