Preventing Sleep Problems
and Developing Healthy Sleep Habits
in Young Children
Maya Garbuz, MSSW, CISW
Certified Child Sleep Consultant
madisonsleepconsultant.com
maya@madisonsleepconsultant.com
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Outline
Sleep physiology
 Causes and effects of sleep disruptions
 Prevention of sleep disruptions
 Intervention techniques
 Cultural Competence
 Community resources
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Sleep Cycles
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Circadian Rhythms
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More information:

Secrets of Sleep Science: From Dreams to Disorders; Craig Heller. Stanford
University Lectures
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Melatonin
Hormone that regulates sleep
 Melatonin production depends on light
 Melatonin manufacturing is not regulated by
FDA:
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 Side effects don’t have to be listed
 Dosage may not be accurate
Not enough studies to test safety of melatonin
use on children
 More information:
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 National Sleep Foundation: sleepfoundation.org
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Light’s Impact on Sleep
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Research:
◦ Exposing eyes to lots of light during the day increases
melatonin production at night
◦ Exposing eyes to light in the evening decreases
melatonin production at night
Blue Light is the biggest melatonin suppressant
More information:
◦ Lowbluelights.com
◦ Richard Hansler, Ph.D. Pregnant? New Baby? Need Sleep!
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Statistics
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1 in 4 adults struggle with sleep in some way
20-30% of young children experience some kind
of sleep disorder at some point in their
childhood
Up to 80% in children with special needs and
chronic illnesses
80% of children with Autism (20% being severe
sleep issues)
About 50% of all children with sleep issues
having this being an “every night” occurrence
More information:
 American Academy of Sleep Medicine: aasmnet.org
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The Bizarre Phenomena of Sleep
Suppose you have a new baby and your obstetrician is telling you of the
neonatal exam: he says you have a beautiful, healthy baby, but there are a few
things you should be aware of as new parents: frequently, your baby will go
unconscious and be unresponsive to normal stimulation; the frequency of
these attacks will gradually decrease to one a day by the time she goes to
school, but they will last throughout life. Periodically, when unconscious, she
will be paralyzed, except for spastic muscle twitches; her eyes will dart back
and forth and her heart and breathing rate will get irregular. As she gets older,
she will have hallucinations during these episodes; she will hear voices and see
things that are not there. Some of these things will be very strange, and may
be even terrifying, causing her to sit up and utter screams of fright; but not a
problem, because this condition is also characterized by total amnesia: she
won’t remember any of these terrifying experiences.
Loss of consciousness, paralysis, spastic muscle contractions, cardiac and
respiratory arrhythmia, hallucinations, terror, amnesia, my word! You are upset,
anxious, but the doctor tells you: nothing to worry about it; this is completely
normal. It is sleep! (From Secrets of Sleep Science: From Dreams to
Disorders, Craig Heller; Stanford University Lectures )
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Causes of Sleep Disruptions
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Obstructive Sleep Apnea
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Night Symptoms:
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Snoring
Gasping and pausing for breath
Restlessness
Sweating
Bedwetting (leaking diaper)
Day Symptoms
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Sleepiness
Difficulty awakening in the morning
Irritability
Long naps
Falling asleep in the car
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Environmental Issues
7 Ingredients of healthy sleep environment:
◦ Dark
◦ Quiet
◦ Comfortable
◦ Low-stimuli
◦ Cool
◦ Consistent
◦ Safe
◦ More information:
 National Sleep Foundation: sleepfoundation.org/bedroom/
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Other Causes of Sleep Disruptions
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Other Medical Issues
Behavioral/Temperament Issues
Trauma
Sensory Processing Disorder
Hunger
Separation Anxiety
Overstimulation
Nutrition Issues
Unbalanced Internal clock
Many changes happening
Travel Effects
Developmental Milestones
Lack of Consistent Schedule & Bedtime Ritual
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Effects of Sleep Disruptions
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Physical:
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Lack of energy, fatigue
Compromised immune system
Weight gain
Slow and impaired reaction
Emotional:
◦ Bad mood
◦ Impaired social interactions
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Effects of Sleep Disruptions
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Behavioral:
◦ Hitting
◦ Moving all the time or not at all
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Cognitive:
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Difficulty learning new concepts
Short attention span
Impaired abstract thinking
Lack of desire to play, especially with new and challenging toys
Delays in all areas of development
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Symptoms of Sleep Deprivation in
Children
Moodiness and irritability, aggression
 Temper tantrums
 Grogginess when they wake up in the
morning
 Child falling asleep in the car
 Having to wake child up almost
every morning
 Child has trouble thinking during the day
 On some nights, child “crashes” much
earlier than their usual bedtime
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PREVENTIONS OF SLEEP
DISRUPTIONS
Stop singing Rock A Bye Baby to put me to sleep… A
song about a baby in a cradle that comes crashing
down does not exactly make me want to close my eyes
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What Do We Need to Prevent
Sleep Disruptions:
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Consistency!!!
Bedtime routine
Sleep environment
Good-for-sleep foods
Level of activity during the day
Light exposure during the day
Boost melatonin production at night
Watching sleep cues
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Sleep Cues:
“I am ready for bed”
If being fed – sucking slower or weaker
 Yawning
 Turning away from faces
 Decreased activity
 Glazed look
 Babbling less
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Sleep Cues:
“I am close to losing it”
Being disinterested in surroundings
 Laying head down for a second
 Rubbing eyes
 Slower movement
 Nuzzling into your neck
 Seeking contact
 Red circles around eyes
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Sleep Cues:
“No way I am sleeping now!”
Fussing
 Crying
 Can’t nurse
 Arching
 Flailing
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Average Sleep Hours
Age
Nighttime
sleep
Daytime sleep
Total Hours
1 month
8.5 hours
7.5 hours/many
naps
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3 months
6-10
5-9 / many naps
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6 months
10-12
3-4.5 / 2-3 naps
14.5
9 months
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3 / 2-3 naps
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12 months
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2.5 / 2 naps
13.5
18 months
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2.5 / 1-2 naps
13.5
2 years
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2 / 1 nap
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3 years
10.5
1.5 / 1 nap
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4 years
11.5
Optional nap
11.5
5 years
11
Optional nap
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INTERVENTION TECHNIQUES
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# 1: Change Parents’ Expectations
What is “sleeping through the night?”
(American Academy of Pediatrics vs. public
awareness)
 When is my child should be sleeping through
the night?
 Differences between child and adult sleep
 More information:
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Parentingscience.com (Gwen Dewar, Ph.D.)
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Differences Between Child and
Adult Sleep
Adult
Child
90-110 min. cycles
45-60 min cycles;
Adult-length cycles by age 3
4 phases
2 phases
Regular circadian rhythm
Circadian Rhythm is not fully
established until about 4-6 months
Regular Melatonin production
Melatonin is produced in low and
consistent (same during day and
night) quantities the first 4-6 months
of life
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#2: Teach Child to Self-Soothe
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Cry-It-Out is not the only option:
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Extinction (Weissbluth)
Gradual Extinction or Controlled Crying (Ferber)
Extinction with parental presence (West)
No-cry (Pantley)
Research shows that consistency, not the
method delivers results
 More info:
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Timothy Morgenthaler, etc. Practice Parameters for Behavioral
Treatment of Bedtime Problems and Night Wakings in Infants
and Young Children. An American Academy of Sleep Medicine
Report
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# 3: Introduce Consistent Routines
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Sense of Control:
◦ Knowing when something happens creates a
sense of control and safety
◦ Reduce bed time struggles (blame the clock)
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Physical Cues
◦ “My body feels sleepy”
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# 4: Improve Bed Time Routine
What is a good bed time routine?
 Older children can be a part of
developing their own routine
 Sleep Aids
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Picture schedules
Timers
Pass system
Loveys (Build-A-Bear)
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Children’s Books About Sleep
Goodnight, Moon by Margaret W. Brown
 Goodnight, iPad by Ann Droyd
 The Quiet Book by Deborah Underwood*
 Dr. Seuss’ Sleep Book
 The Going To Bed Book by Sandra Boynton
 Just Go To Bed by Mercer Mayer
 Time for Bed by Mem Fox
 The Boy Who Wouldn’t Go to Bed by Helen Cooper
 I Love to Sleep In My Own Bed by Shelley Admont
 I Don’t Want to Go to Sleep by Chris Francis*
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# 5 Improve Nutrition
Sleep-inducing foods
 Problem foods
 Iron deficiency
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More information:
National Sleep Foundation:
Sleepfoundation.org/bedroom/taste.php
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# 6: Don’t Neglect Naps
Research: important for development in various
areas (cognitive, physical, emotional) & longer
attention span
 Support night sleep
 Age
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Naps and Learning
There is evidence that we are more likely
to retain what we’ve learned if we go to
sleep shortly after our studies (G. Dewar)
 Naps are as effective as night sleep for
learning
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How to Promote Naps at Daycare
Quiet and dark room
 Lullabies or white noise?
 Pre-nap slow-down activity
 Comfortable (shoes off, warm)
 Low-stimuli setting (toys cleaned up)
 Loveys
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Cultural Competence
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Cultural differences affect where, when, and
how children sleep
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No difference in the total amount of sleep
within 24-hour period between white and
ethnic minority children
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Differences in timing and distribution of sleep
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Cultural competence – Cont.
When talking about sleep have to take culture
into consideration
 African-American infants have higher incidence
of SIDS and are more likely to be placed in
prone for sleep – prevention!
 More info:
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◦ Oskar G Jenni, Bonnie B. O’Connor. Children’s Sleep: An
Interplay Between Culture and Biology. Pediatrics.Vol. 115
◦ Julie Boergers, Daphne Koinis-Mitchell. Sleep and Culture in
Children with Medical Conditions. Journal of Pediatric
Psychology.Vol. 35(9)
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SIDS Awareness
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Factors that may contribute to SIDS:
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Prematurity
Smoking during and after pregnancy
Bed-sharing*
Sleeping alone in the room
Having “fluff” in the crib
Prone to sleep
Trying to sleep-train too early
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Co-sleeping vs. Bed-sharing
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Community Resources
◦ Medical
 Sleep Clinics
 Chiropractors
◦ Behavioral:
 Sleep Consultants
 Psychologists
 Occupational Therapists
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On-line Resources
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American Academy of Pediatrics
◦ Aap.org
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National Sleep Foundation
◦ Sleepfoundation.org
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American Sleep Association
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Sleepassociation.org
Gwen Dewar, Parenting Science
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Parentingscience.com
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Books on Sleep and
Sleep Training Methods
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Good Night, Sleep Tight by Kim West (all ages)
The No-Cry Sleep Solution by Elizabeth Pantley
(best for infants)
Solve Your Child’s Sleep Problems by Richard
Ferber (great info on sleep)
Sleeping With Your Baby: A Parent’s Guide to Cosleeping by James McKenna (information on safe
bed sharing and co-sleeping)
Sleep Better! A Guide to Improving Sleep for
Children with Special Needs by Mark Durand
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Questions?
No, seriously… Tell me
more. You are so
interesting…
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