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Shhh… They’re Sleeping!

I think one of the most common questions I get at ALL well child visits is about sleep. How much does my child need? How do I get him to sleep better? How do I make changes?

boy sleeping in carseatSleep needs vary by ages, but many children are not getting anywhere what they need. Common culprits include bedtimes that are too late and giving up naps too early. Most children should be going to bed between 6-8 p.m. and waking between 6-8 a.m. This is an average… so your family may be slightly different, but overall these are good guidelines. In addition, most kids up to 9 months have 2-3 naps per day. The morning nap tends to disappear naturally around 15-18 months… but unfortunately it often gets taken away much earlier, likely due to older siblings and activities, daycare, or a very stimulated child (a.k.a. “nap-fighter”). Children tend to give up naps altogether around 3-5 years of age, although I do still recommend a quiet time every day to help recharge their little brains and bodies.

This is a chart that shows typical sleep needs in a 24-hour period. Keep in mind these are averages and your child’s needs may vary slightly.

typical sleep requirement in children chart

Let’s review a few key points that will work with children of most any age.

1. Sleep begets sleep.

The more well-rested your child is, the better he/she will sleep overall. Overtired children tend to put up more of a fight for naps/bedtime and their quality of sleep is less.

2. Earlier bedtimes often produce later waking times.

It seems counter-intuitive, but it’s true. Often times the answer to early waking is to put children to bed earlier by 30 minutes (or more!).

3. Stimulated children/bedrooms do not foster quality sleep.

This seems obvious, but television, video games, and bedrooms that are lit up do not help ready the body/brain for sleep. Screen time should be cut off at least 1 hour prior to bedtime. That hour should involve quiet activities such as reading, puzzles, coloring, etc. as well as the bedtime routine of bath, pajamas, snuggling, and whatever else you and your children enjoy.

baby sleeping in cribFor the younger ones…

Every parent wants her child to get a good night’s sleep. Ideally, we’d love for them to sleep through the night and for us to be well rested also. Some children do this on their own. Some don’t.

1. Sleep training does not simply mean “crying it out.”

There are many different methods to help teach your child to sleep better – some including hardly any crying at all. The most important things are that parents are ready and on the same page and that the child is healthy.

As a parent and pediatrician, I personally prefer the “cry it out” method. I think it’s faster (typically takes 3-4 days, or at the longest, 1 week), but it is also the hardest method (i.e. most emotionally difficult for a parent). Some parents do not want to do this and I completely understand why. There is also the “gradual extinction” method where parents check on their child every 5, 10, or 15 minutes and gradually lengthen the time between checks. This may be perfect for some families who are okay with some crying but have children who would respond better to a slower, more gradual process. For families who would prefer even less crying, there are several other options which can be found in my favorite book about sleep, Healthy Sleep Habits, Happy Child by Marc Weissbluth.

We are entrusted to teach our children to communicate, eat healthy, and play nicely…. Why should teaching them to sleep well be any different?

2. Co-sleeping can be a hard habit to break.

The American Academy of Pediatrics recommends that babies have their own space to sleep from day one. Sleeping in the same room is recommended. Sleeping in the same bed is not. Research has shown that the incidence of SIDS is increased for children who share a bed, but decreased for sharing a room.

I understand that there will be families who disagree with this advice—and in the end, you have to do what is best for your family. YOU are the parent.

Am I saying I never had my babies in my bed with me? No. I’ve been there, too… in that old familiar place of complete exhaustion… but is it the safest place for my son to sleep? No, it’s not.

Recently I had some parents in my office with their 1 ½-year-old who were wondering how to go about getting him into his crib at night after bed-sharing for his entire life. He screams when they attempt to put him there now.

My best advice for transitioning from co-sleeping to crib sleeping is what I like to call the “Super Nanny Method.”

You can go as fast or as slow at this as you want, and you can choose to be more or less affectionate depending on how you feel your child will respond.

3. Children over 6-9 months do not physically need to eat during the night.

They may want to, for the emotional and social connection they get with their parents, but at this age it’s only creating a poor sleep habit for later down the road. Remember, sleep begets sleep.

4. Please make sleep a priority.

If you can, try to make naps and nighttime sleep be in a similar place. I realize this is difficult with older children, but a bed produces higher quality sleep than a stroller. Good quality sleep is as important to a child’s growth and development as a healthy diet.

Lastly, know that breaking a few of the “rules” sometimes is okay. Your children are only little for so long. Enjoy them.


Meet Guest Blogger Dr. Tricia Cooperrider

Dr. Tricia CooperriderHello! My name is Tricia Cooperrider, and I’m a local pediatrician in Waukee with UnityPoint Clinic.

I grew up in southern Minnesota on a farm. I went to college in Minneapolis at the University of Minnesota. After graduation, I worked for one year doing Applied Behavioral Analysis therapy with children with autism. I then moved to Des Moines for medical school and pediatric residency at Blank Children’s Hospital. Following completion of my residency in 2011, I was able to find my dream job with the UnityPoint Clinic Pediatric location in Waukee. It’s been wonderful to grow my practice and develop relationships with my patients over these last few years. I look forward to watching these children grow up into amazing people.

I am not only a full-time pediatrician, but also a full-time mom and wife. I am constantly working to find the balance between work and home. I’m married to my husband of five years, Jeff, and we live in Waukee. I have a very energetic 3-year-old, Liam, and I gave birth to our second son, Noah, this past August.

I love my job taking care of children but struggle to be everything to everyone – home, work, family – it’s overwhelming! Despite the craziness, I’m in love with my life and my work. I hope to be able to offer you a little perspective from the world of pediatrics while keeping it real… because, let’s face it—textbook advice does not always line up with reality!

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14 Responses to Shhh… They’re Sleeping!

  1. kelsey January 30, 2014 at 10:25 pm #

    Great post! Again, SO glad to call you my child’s pediatrician!

  2. stacy hancock January 31, 2014 at 4:14 pm #

    I’d be interested in a response as to how this makes sense given what’s now known on infant brain development.

    http://www.psychologytoday.com/blog/moral-landscapes/201112/dangers-crying-it-out

    http://www.psychologytoday.com/blog/moral-landscapes/201303/normal-infant-sleep-night-nursings-importance

    Lots of fantastic links below the second one.

    • Tricia February 1, 2014 at 3:49 am #

      Thanks for your comment. I’m working on a response but need a chance to look at the articles you cited. My hope is to have something back to you in the next day or two.. please stay tuned. I will either post my comments on here, or direct you to my blog (www.coopscoop.net) for my response.

    • Tricia February 2, 2014 at 2:09 am #

      I’ve been working on a response to your questions/comments regarding sleep training causing problems with brain development. Please check it out on my blog http://www.coopscoop.net on Monday morning.

  3. Laurie B January 31, 2014 at 8:29 pm #

    A white paper recently published by a working group of mother-baby sleep experts concluded that “Many Behaviors Labeled as ‘Infant Sleep Problems’ Are Actually Normal Patterns of Infant and Child Sleep”:

    http://www.prweb.com/releases/2013/8/prweb11056827.htm

    Not every doctor agrees with this author’s perspective on co-sleeping. If parents make the bed a safe sleeping surface for baby, it can be safe and beneficial.

    Dr. Jay Gordon on safe co-sleeping:

    http://drjaygordon.com/attachment/safe-cosleeping.html

    Dr. James McKenna’s safe co-sleeping guidelines:

    http://cosleeping.nd.edu/safe-co-sleeping-guidelines/

    website for Dr. James McKenna’s Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame:

    http://cosleeping.nd.edu/

    McKenna on “Cosleeping and Biological Imperatives: Why Human Babies Do Not and Should Not Sleep Alone”

    http://neuroanthropology.net/2008/12/21/cosleeping-and-biological-imperatives-why-human-babies-do-not-and-should-not-sleep-alone/

    P.S. – Isn’t “Healthy Sleep Habits, Happy Child” (this guest blogger’s “favorite” book) the one that says that if your baby cries so hard she vomits, it’s ok to leave her lying in her own vomit in a crib rather than “reward” her by picking her up and comforting her?

    • Tricia February 1, 2014 at 6:16 am #

      You’re right… not every doctor or person agrees with me. I don’t expect them too. I’m offering advice based on my experience and education. Like I said in my post, I don’t expect every family to agree with me.

      Let’s be clear on who you are referencing. Dr. James McKenna has his PhD. He did not go to medical school and is not a physician.His studies are based on behavioral science and should be accepted as such. I am speaking from a medical perspective as well.

      Let’s also be clear that Dr. Jay Gordon is a medical doctor…a pediatrician, in fact. I very openly disagree with his opinions…but he is entitled to give the advice he feels is correct, just as I am entitled to mine. I”m sure his patients respect him and his opinion, just as mine do as well.

      As for the book, although I have read it multiple times, I do not clearly remember the specific portion you are referencing. To that point, I do not think you should leave a baby lying in her own vomit. I also would like to point out that Dr. Weissbluth’s book offers SEVERAL viewpoints to reach as many parents as possible. The parents that look to a book like his are desiring a change in their lives regarding their child’s sleep. If you as a parent do not feel there is something you’d like to change, then I wouldn’t recommend his book, nor would I expect you to read it or care what it offers as advice.

      In the end, we all need to be respectful of what different families choose to do while parenting their children. If one family feels they want to sleep train their child, who are we to judge? Likewise, if you do not think my advice is appropriate for your family, then you are just as entitled to parent as you choose. We need to be supportive of each other as moms and realize that what may work for one family may not work for another.

  4. Tricia February 1, 2014 at 10:08 am #

    The excerpt is, verbatim:

    Q: Once I let my child cry for a long time and she vomited. Won’t I be trading one problem for another?

    A: Consider other sleep strategies that involve less crying. However, if the vomiting always occurs, I think you will always want to go in and clean her promptly and then leave her again. If the vomiting is irregular and occasional, you should try waiting until after you think she’s deeply asleep before checking, and then quickly clean her if needed.

  5. Melanie Clark February 5, 2014 at 3:55 pm #

    This post was very eye-opening to me. Thank you! As a mom of two older children and one toddler, I was surprised to see how much sleep a 9, 10, & 11 year-old really benefit from. Last night, I put my 9 year old to bed earlier than normal and she slept 11 hours! (Thank you late start). 🙂 I think we’ve been shorting our older ones on precious zzz’s. Thanks again for your advice!

    • Tricia February 5, 2014 at 7:21 pm #

      I am so glad it was helpful for you! Isn’t it amazing what happens when we put them to bed just a little bit earlier?

      Here’s to more restful nights for you and your kids!

  6. Mary February 13, 2014 at 10:28 pm #

    My daughter (and firstborn) has always been a good sleeper. Around one month old she had days/nights correct. She also liked to “stay up late” for awhile also, but I think around 3 months she had a better set bedtime. My husband and I are both night owls and I think she sensed that. 🙂 She was always active late at night while in the womb.

    Today she is 16 months, and sleeps roughly 11 hours at night and two naps (est 1.5 to 2hrs long). When she happens to wake up in the night we have always gotten her, nursed, diaper change, and put her back down. She knows the routine. And she is really good at putting herself back to sleep (less than 10 mins). So I never think of it being a “bad thing.” She doesn’t wake up in the night for company it’s usually when she is sick or her naps were off that day. So when it is not her fault she’s not sleeping through the night, we ALL sleep better if we just do the routine: nurse, diaper, put back down. She has NEVER needed rocked to sleep.

    Her Dad has a harder time with letting her cry it out, while I have had many years of working with children and know the benefits of letting them learn. I think that is why she is so good at falling back asleep so easily. But I know if she sees anyone in the night she wants nursed because that’s the routine and she can’t fall back asleep any other way. We’ve tried. But it’s hard when my hubby isn’t around in the night (long story why) to try to have him do a new routine to help her not “need Mom’s milk” in the night.

    Do you have any suggestions of what can be done? Or is this just “how our family goes about things?” It seems normal but if there’s a way to help her go back to sleeping through the night better, that would be good for her.

    • Tricia February 26, 2014 at 7:48 pm #

      Sorry it’s taken me so long to reply to your question! My family has been hit with influenza, croup, ear infections, and most recently a hospitalization for RSV bronchiolitis..so I apologize!

      I think you are doing the right thing by having hubby take care of the night stuff… so she isn’t tempted by mama’s milk. I do understand that this is hard when he’s not aroudn though. My best advice may not be the easiest…but I think that if you want her to be able to just go back to sleep, without needing to nurse, then thats what you need to do.

      I am by no means advocating that you shouldn’t nurse your daughter. (For all the people out there who want to call me out 🙂

      But, if thats what is going to work best for your family right now, then you need to do just that. Cut it out. When she realizes that mommy is no longer going to nurse her, it should stop being such an issue. Also, you’ll have to limit the other contact (i.e. stimuation) you have with her in the middle of the night when she wakes. You can go to check on her, but limit touch, eye contact, and talking to nothing if possible. Make sure that she is ok…and that she just wants some socialization, and then leave. It may be a few rough nights, but it should improve the problem.

      If this doesn’t help, definitely talk to your pediatrician for more ideas…

      Hope you have some restful nights soon!

      • Mary February 26, 2014 at 8:24 pm #

        No problem, I understand! Even since I last posted my daughter got sick as well!
        Last week she was slowly getting better so I let her tell me what she wanted to do (the benefits of having just one), since she had a poor appetite and diarrhea. She seems to wake up more in the night (besides sickness) when she knows Daddy is around. 🙂 Such a Daddy’s girl! Last night we tried to keep things simple, but she couldn’t stop chattering away while my husband changed her diaper. She is very vocal! 🙂 She went right back to sleep though. I think I’ll hold off on getting her to not wake up in the night once we get adjusted. We are moving on March 10th to our new house (where my hubby is when he’s not with us/remodeling). We’ll slowly be adjusting to a new crib, new bedroom, new house, new routine, etc. I’ll need to allow her to get use to it for sure! But thanks for the thoughts. She’s doing better, I think. 🙂

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