AN AGE-BY-AGE GUIDE TO SLEEP

BEDTIME: THE PERFECT MOMENT FOR KIDS TO NEED A SNACK, FOURTEEN STORIES, A TRIP TO THE BATHROOM, A NEW NIGHTLIGHT, LESS SCRATCHY PAJAMAS AND AN ANSWER TO THE MEANING OF LIFE.

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Ask any parent and they’ll be quick to tell you that sleep—or lack thereof—is often on their minds. It’s one of the most common complaints paediatricians hear. In fact, research shows that up to 50% of children experience sleep struggles at some point (which means their parents do, too!).

That isn’t to say you’ll never sleep soundly again. Having an understanding of sleep as it pertains to your child at each stage of development will help everyone get more zzz’s.

So what are sleep struggles? They can range from a baby waking for a feeding to your toddler stalling at bedtime (come on, just *one* more story!), trouble falling asleep or waking in the night due to nightmares, sleep terrors and sleepwalking.

It’s a no-brainer that sleep is important. Without it, we’re all a bit on edge. But it’s especially important for kids to get the right amount of shuteye, as lack of sleep directly affects their psychological and physical development and can lead to a host of issues affecting their daily function, focus, productivity, mood and behaviour.

Most of the time the signs are obvious, but here are some easy indicators of a poor night’s sleep: • Irritability and moodiness • Poor concentration, attention, memory and having a tough time making a decision • Unplanned naps or needing naps past the age of four to five years • Needing to be woken in the morning and constant prompts to get ready • Daytime sleepiness • Overactivity • Difficulty managing daytime behaviours, which could include tantrums and acting aggressive • Poor performance at school But it goes beyond your child and their behaviour and temperament, because having Captain Crankypants on the loose can also cause a lot of emotional unrest at home. The lack of sleep can cause huge parental distress (and disturb your own sweet slumber), which can lead to less effective parenting and strained relationships. And it doesn’t take much—even losing 30 to 60 minutes of sleep can take a toll on your child’s behaviour.

SLEEP STRUCTURE

Children get most of their deep sleep in the first third of the night. Light sleep is the most common in the last half to last third of the night which is why young children sometimes wake more as the night goes on. Periods

of REM dreaming sleep increase as the night progresses. This is why we often wake up in the morning and can remember dreaming.

It is normal for children to partially wake about two to six times a night.

RECOMMENDED SLEEP BY AGE

CHILD’S AGE NIGHT DAY TOTAL*

0 to 3 months Unpredictable Varies widely 14 to 17 hours 3 to 12 months 11 to 12 hours 2 to 4 hours 14 to 15 hours

1 to 2 years 11 to 12 hours 1 ½ to 3 hours 11 to 14 hours 3 to 5 years 10 to 13 hours 0 to 2 hours 10 to 13 hours 6 to 12 years 9 to 11 hours No nap 9 to 11 hours *Children may sleep longer at night after they drop their naps.

NEWBORN (0 TO 2 MONTHS)

As you may have noticed, newborns tend to sleep a lot. Often, newborns will fall asleep after just one to two hours of being awake, though every baby is different. Some newborns will sleep more and wake for a short period. Others may be more wakeful and fussy, only snoozing for short snippets. Your baby will let you know which they prefers, so follow their lead.

Your feeding style can sometimes dictate sleeping patterns. When babies are breastfed, they may sleep for two- to three-hour stretches. Bottle-fed babies average around two to five hours.

Common Newborn Sleep Patterns

In the first few weeks, you may notice irregular sleeping patterns. Your baby is still getting adjusted to day and night. Because of their small stomachs, babies wake up to eat every few hours. Every baby is different but generally at the three-month mark, your baby will display a more regular sleep-wake cycle, maybe even sleeping through the night.

What is Day/Night Reversal?

It’s not uncommon for some newborns to sleep more during the day than during the night. This backwards sleeping habit is called day/night reversal and it’s usually temporary. Here’s how to help them align to your schedule and teach them that nighttime is for sleeping: • Keep the lights dim and noise to a minimum during nighttime feedings, and use a soft voice. • Increase your baby’s wakeful time during the day by allowing background noise; wake your baby for feedings.

• Expose your baby to light during the day (especially early morning natural light) and normal levels of noise. It’s not one-size-fits-all when it comes to helping your baby’s schedule realign. Some developmental issues can also impact sleep like: • Sleep and wakeful periods are strongly linked to hunger and feelings of fullness. • Babies with colic, gastroesophageal reflux or milk/formula intolerances may face more sleep challenges.

Newborn Sleep Recommendations

Here are a few tips to keep in mind when it comes to safe sleep for your new addition. • Maintain a safe sleep environment. • Develop good sleep habits. That means when you notice that your baby is drowsy, place her in the crib and see if she can fall asleep on her own. Don’t worry if she isn’t able to every time; keep trying. • Soothe your baby when she needs you. Many paediatricians give the green light for allowing the baby to practise falling asleep on their own around four to six months of age. Before three months of age, babies should not be left to cry when put down to sleep for more than a few minutes. If your baby needs help to fall asleep you can rock, hold or feed them. Some newborns are soothed by being held; others like white noise or motion. • Place your baby on her back to sleep for all sleep periods.

INFANTS (3 TO 12 MONTHS)

Nighttime sleep starts to consolidate at two months of age with nine to 12 hours of sleep occurring at night. The number of naps your baby needs will usually decrease from four to two, generally by the age of one.

Common Infant Sleep Patterns

Infants tend to be dependent on parental help to fall asleep. You may find they go down easiest when you rock or feed them.

By the age of three to six months, most babies are capable of sleeping through the night. However, many will continue to wake due to continued nighttime feeds and things like needing a pacifier or a diaper change.

Short naps or missed naps during the day are common in infancy and are often the result of not being able to fall asleep independently.

Developmental Issues That Can Affect Infant Sleep

There are a few things that can cause or worsen sleep problems at this age including: • Greater cognitive awareness due to baby becoming more alert

To ensure a safe sleep, refer to these guidelines from Health Canada.

• Young children should sleep on a firm flat surface in a crib or bassinet for all sleep periods (e.g. car seats and infant swings should not replace the crib for sleep). • Always place your baby on his back to sleep when placing him in his crib until 12 months of age. The “back to sleep” position is associated with a reduced risk of SIDS. • Avoid all soft and non-breathable materials in a child’s crib. • Do not let anyone smoke near your baby, including near where your baby sleeps or spends time.

Exposure to smoke is one of the greatest risk factors for SIDS. • Co-sleeping is not recommended due to evidence linking it with accidental smothering and suffocation by parents or bedding.

Co-sleepers that are attached to a bed are not recommended due to safety concerns. • Room-sharing (e.g. having your baby sleep in a crib next to your bed) until six months of age is associated with a reduced risk of SIDS. • Avoid overheating your child.

Being overheated is a risk factor for

SIDS and can lead to discomfort during sleep. • Ensure your baby’s crib meets current Health Canada regulations. • Keep the crib away from windows, curtains, blind cords, lamps, electrical plugs and extension cords; keep out of reach of small objects. • There appears to be an association between pacifier use at bedtime and a reduced risk of SIDS.

• Reaching new motor milestones like rolling and standing • Separation anxiety

Infant Sleep Recommendations

To ensure your baby gets a safe and comfortable sleep, try the following: • Maintain a safe sleep environment. • Establish a bedtime and nap routine by three months and be consistent with it. Doing this will act as a cue for your baby that sleep time is approaching.

Your routine might include a bath, massage, putting on pajamas, feeding, brushing teeth and singing a song. You can employ a condensed routine for naptime, too. • Until 12 months of age, place your baby on her back to sleep.

Once a child can move to another position on her own, it’s not necessary to reposition her throughout the night and during naps (unless there is a medical reason to do so). • Encourage selfsoothing. Falling asleep independently is a skill and it’s important for your little one to learn it.

TODDLERS (1 TO 3 YEARS)

Welcome to the toddler phase. A lot of key development happens at this stage. Most toddlers will drop their morning nap between 12 and 24 months of age. The remaining nap should be scheduled after lunch. One daily nap will generally extend into the preschool years.

Common Toddler Sleep Problems

Many toddlers continue to be dependent on their parents to fall asleep. Here are a few other things you may notice with your toddler: • Bedtime resistance and stalling are common. Watch for repeated requests for various things to delay bedtime, also known as“curtain calls.” • Parental presence at bedtime and following night wakings, including co-sleeping, is a common culprit for sleep problems in toddlers. • Many toddlers experience night wakings, often related to not falling asleep independently and/or parental contact following night wakings.

Developmental Issues That Can Impact Toddler Sleep

The following can hinder your toddler’s rest: • Ability to climb out of the crib or get out of bed. • Growing imagination can result in fears and/or nightmares. • Increased independence can lead to bedtime resistance and stalling. • Separation anxiety, which peaks between 10 and 18 months, can lead to bedtime problems and night wakings.

Toddler Sleep Recommendations

Use these tips to help your toddler snooze like a champ: • Ensure your toddler falls asleep independently. • Set limits on bedtime behaviours. Limits should be clearly communicated, consistent and enforced. Include reasonable requests in a toddler’s bedtime routine (last drink of water, hug, trip to the potty). • Make sure that too much sleep during the day or napping too late in the day are not contributing to bedtime problems. • Encourage the use of a security object, like a small breathable

“blankie.” Providing several blankies can ensure they will be able to find one during the night. • Maintain a regular sleep schedule and bedtime routine. This will help provide structure and predictability to your toddler’s day. • Ensure the bedroom environment is consistent and conducive to sleep. The optimal sleep environment includes little to no light or noise and a temperature on the “cool side of comfortable.” • If your toddler is having nighttime anxiety or nightmares, reassure them they are safe and that you are nearby.

• Wait to transition from crib to bed. If there are no safety concerns, delay the transition to a bed until age three (or even a little beyond). • Limit pacifier use and thumb-sucking to periods of sleep.

PRESCHOOLERS (3 TO 5 YEARS)

Your preschooler’s development is probably blowing your mind at this point. Most are ready to stop napping between ages three and four (though some nap until age five). Because of this, bedtime may need to be a bit earlier.

Common Sleep Problems for Preschoolers

Resisting bedtime and not falling asleep independently usually continue to occur in up to 50% of preschoolers. This is often due to poor sleep habits and limit-testing behaviours. • When they wake at night, this is often related to not falling asleep independently. • Nighttime fears and nightmares are common and often reflect normal cognitive development and the growing imagination. • Sleep terrors and sleepwalking are common behaviours that often start during preschool years.

Development Issues that Can Impact Preschooler Sleep

Your little one has an active imagination and is becoming more and more independent, which can sometimes make bedtime challenging. • Transition from crib to bed. • Language development can lead to more limit-testing behaviours. • Greater comprehension allows the use of a reward system (reward chart, coins for a piggy bank) for appropriate sleep behaviours. • Growing imagination can increase nighttime fears and/or nightmares.

Sleep Recommendations for Preschoolers

All is not lost when bedtime feels like a negotiation strategy gone wrong. Try these tips: • Ensure your child has a regular bedtime and morning wake time.

If continued napping makes a bedtime of 8:30 p.m. difficult to achieve, limit the nap to one hour, or, if necessary, eliminate the nap and move bedtime earlier. • Maintain a bedtime routine. Lights should be low. Snacks and screen time (if applicable) should be done prior to starting a bedtime routine. • Ensure your preschooler’s bedroom environment is comfortable, dark, quiet and cool. Use of a low-level nightlight is fine. • Use guard rails.

SCHOOL-AGED CHILDREN (6 TO 12 YEARS)

Sleep is likely coming a bit easier to everyone in your house, but there are still some challenges that come with sleep for bigger kids.

Common Sleep Problems for School-Aged Kids

Children in this age set may have trouble falling asleep due to general anxiety, nighttime fears, consumption of caffeine or being overstimulated before bed. Many school-aged kids go to bed too late and don’t get enough sleep.

Sleepwalking is most prevalent between the ages of four and eight. It can include sitting up in bed, mumbling, walking around the house and urinating in places other than the bathroom. Talk to your doctor if you’re concerned, but treatment isn’t usually required.

Developmental Issues That Can Impact Your School-Aged Kid’s Sleep

Bedtime is probably getting a bit easier, but with that bright, active mind comes a new set of triggers, like anxiety and the allure of screen time. • Increasing awareness and understanding of real-life dangers may lead to an increase in nighttime fears, nightmares or anxiety. • Increasing interest in TV, tablets and other electronics can lead to a delayed bedtime and less overall sleep. • Greater independence including less parental supervision over enforcing appropriate bedtimes.

Sleep Recommendations for School-Aged Kids

There may be more of a tug-of-war regarding negotiations and a push to stay up due to ever-expanding independence but try to do the following: • Maintain a relaxing bedtime routine. Avoid use of screens during a bedtime routine and encourage reading before lights out. • Keep your child’s bedroom cool, quiet and dark. Keep TV, computers and gaming systems out of the bedroom. • Avoid caffeinated products (including soda beverages and iced tea).

When Sleep Issues Warrant a Trip to the Doctor

Chat with your paediatrician if your child displays any of the following: • Has difficulty falling or staying asleep • Snores, especially if the snoring is loud • Has noisy breathing or pauses in breathing during sleep • Grinds teeth during sleep • Has frequent nighttime fears or nightmares • Shows signs of being overtired during the day • Complains of leg discomfort at bedtime (this is generally growing pains) • Frequently moves legs while trying to fall asleep or during the night • Has unusual night wakings including sleep terrors or sleepwalking