pediatrics
Sleeping Behaviors in Infants and Children
Introduction
Sleep behaviors are culturally determined, and problems tend to be defined as behaviors that vary from accepted customs or norms. In cultures where children sleep separately from their parents in the same house, sleep problems are among the most common that parents and children face. The supine sleep position is recommended for every sleep period for all infants to reduce the risk of Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) (SIDS). Prone or side sleep positions place infants at high risk of SIDS, particularly for those who are placed on their side and found on their stomach. See also Co-sleepingis when parent and infant sleep in close proximity (on the same surface or different surfaces) so as to be able to see, hear, and/or touch each other. Co-sleeping arrangements can include Bed-sharing (the infant sleeps on the same surface as the parent) Room-sharing (the infant sleeps in the same room as the parent in close proximity) Parent–infant bed-sharing is common but controversial. There are often cultural and personal reasons why parents choose to bed-share, including convenience for feeding, bonding, believing their own vigilance is the only way to keep their infant safe, and believing that bed-sharing allows them to maintain vigilance even while sleeping. However, bed-sharing has been associated with an increased risk of SIDS as well as infant injury or death resulting from suffocation, strangulation, and entrapment. Room-sharing without bed-sharing allows for close proximity to the infant and for the facilitation of feeding, comforting, and monitoring; is safer than bed-sharing or solitary sleeping (the infant sleeps in a separate room); and is associated with a decreased risk of SIDS. For these reasons, room-sharing without bed-sharing is the recommended sleeping arrangement for parents and infants in the first few months of life. Infants usually adapt to a day-night sleep schedule between 4 months and 6 months of age. Sleep problems beyond this range take many forms, including difficulty falling asleep at night, frequent nighttime awakening, atypical daytime napping, and dependence on feeding or on being held before being able to go to sleep. These problems are related to parental expectations, the child’s temperament and biologic rhythms, and child–parent interactions. Factors that influence sleep patterns vary by age. For infants, inborn biologic patterns are central. At 9 months and again around 18 months, sleep disturbances become common because Separation Anxiety and Stranger Anxiety develops. Children can move independently and control their environment. They may take long late-afternoon naps. They may become overstimulated while playing before bedtime. Nightmares tend to become more common. Partial arousals from sleep are common among all age groups. Infants who are always held and rocked or driven in a car to help them fall asleep will not learn to fall asleep on their own in their typical sleep environment and may develop problems with frequent night awakenings. These problems can be avoided by always placing infants in their crib or bassinet when drowsy but still awake and allowing them to fall asleep on their own. In toddlers and older children, emotional factors and established habits become more important. Stressful events (eg, moving, illness) may cause acute sleep problems in older children. 