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When is sleeplessness a problem?   How can you help your child deal with his nightmares?  Is snoring a problem?  How long do children wet the bed?

Dealing with sleeplessness
Some struggles should be expected as your baby becomes accustomed to your own sleep schedule.  Sleeplessness can occur for a number of reasons including teething, illness, separation anxiety, and more.  In order to discover the cause of your baby’s sleeplessness, be patient and try multiple solutions until you find one.  While it may be necessary for you to spend time comforting your child and helping him return to sleep, it is important for this to occur in his own bed whenever possible.  If you allow a tantrum to keep you and the child up, it will begin an ongoing battle.  Likewise, if you allow the child to sleep with you in your bed, it could be the end of your private bedtime.  Firmly and lovingly putting the child back to sleep in his own bed will support good sleep patterns, promote health through needed rest, and encourage independence as your child learns to sleep separate from you.

When to seek help from your pediatrician
If your child’s prolonged sleeplessness is not because of a known illness or teething, contact your doctor to discuss his symptoms.  Prolonged periods of sleeplessness, crying, or disinterest in sleeping could be serious warning signs. 

The American Academy of Pediatrics recommends you call your pediatrician immediately if you see any of these warning signs:

• Your baby seems overly irritable and cannot be soothed.
• Your baby is difficult to wake from sleep.
• Your baby generally seems uninterested in feeding efforts.

Follow your instincts and experience–ask your pediatrician whenever you have a question or concern about your baby’s sleep habits.  Working closely with your pediatrician can help ensure that you and your baby won’t have to suffer from sleepless nights.

Separation anxiety
The American Academy of Pediatrics calls separation anxiety “your baby’s increased awareness of his separateness from you.”  Separation anxiety tends to develop between 8 and 12 months of age and makes it harder for your baby to be away from you, especially when it’s time for bed.

Here are some strategies for easing your baby’s anxiety:

• Keep your baby’s door open (so he can hear you).
• Let your child suck his thumb or fingers.
• Avoid using a pacifier.  He will cry for you to give him the pacifier each time he drops it in the middle of the night and wakes.

If your baby wakes in the middle of the night, remember to be loving, consistent, and firm.  Let him know you are there, but that he needs to go back to sleep.

Nightmares and night terrors
Nightmares are a scary thing for children.  The best you can do for your child is to reassure him that everything is okay (“I am here, you are okay”), hold him and comfort him, and stay with him until he falls back to sleep.

Night terrors are more severe than nightmares and can cause your child to wake screaming.  These intensely frightening dreams can cause your child to fear the dark and sleep.  While your child may not remember the dream, patiently soothing your child and reassuring him that you’re there to protect him will help him return to sleep.

Some things you can do to prevent nightmares and night terrors:

• Avoid scary TV, stories, or games – even cartoons can be scary.
• Tell a happy and calm bedtime story.
• When changes are happening (moving, divorce, etc.), talk with and comfort your child often.

If nightmares or night terrors are continuous or progressively worse, speak with your pediatrician.  Together, you can come up with the best ways to help console your child and make him less afraid of sleeping.

Nighttime bedwetting (nocturnal enuresis)
Nighttime bedwetting is relatively common in children under 5 years of age – especially when actively toilet training, around 2-3 years.  Often the cause is simply that the child’s bladder hasn’t grown large enough to accommodate a full night’s urine output.  Also, the “alarm” that wakes the child with the urge to urinate takes a little while to develop, especially in boys.  Until these two systems are fully developed, bedwetting may occur.  It is not the child’s fault when accidents occur. 

Here are some tips to deal with nighttime bedwetting:

• Do not punish a child for wetting the bed, since he may already be embarrassed and will need your support.
• Treat the incident as a learning experience  and use diapers at night until no longer necessary.
• Avoid excessive water or drinks with caffeine near bedtime.
• Have your child use the toilet just before bed each night.
• Reward the child for “dry” nights to encourage his achievements.

Usually bedwetting will end on its own before age 5. Speak with your pediatrician if:

• your child continues to struggle with bedwetting beyond age 5 years
• incontinence is a problem during the day after age 5 years
• urination is painful or if urine is pink or bloody
• frequent bedwetting reoccurs six months or more after toilet training has been successful

These symptoms could signal an underlying problem such as an infection or a developmental delay in the urinary tract and may require immediate attention.

Obstructive sleep apnea (OSA)
While somewhat uncommon, obstructive sleep apnea can occur in children under 5 years of age.  Obstructive sleep apnea takes place when the soft palate, tongue, abnormally large tonsils or adenoids, or uvula relax back into the throat blocking off airflow through the pharynx.  Being overweight or obese seems to contribute to OSA.  When OSA occurs it can cause the child to go without air until the body wakes suddenly from lack of oxygen.  Symptoms may include snoring, frequent waking in the night, daytime sleepiness, and night sweats.  Nightmares or night terrors and bedwetting have also been associated with OSA.  Early diagnosis is important, because untreated OSA may lead to high blood pressure, heart attack, stroke, or Sudden Infant Death Syndrome.

For more information:
Caring for Your Baby and Young Child
Shelov, Steven P., MD; Hannemann, Robert E., MD.  Caring for Your Baby and Young Child: Birth to Age 5.   The American Academy of Pediatrics.  1998. 

American Academy of Pediatrics
The premier professional organization for pediatricians offers lots of information and advice for caring for your child, including valuable information on sleep and sleep problems.
www.aap.org

FamilyDoctor.org
This helpful fact sheet on Nightmares and Night Terrors in children offers additional insight on helping your child deal with his fears.
http://www.familydoctor.org/handouts/566.html

The Night Terror Resource Center
This site, created by David W. Richards who has suffered from night terrors for many years, answers many common questions about night terrors.  It also includes a message board to post your own questions.
www.nightterrors.org