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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
--Normal Sleep in Children |
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Sleep Disorders: How to Prevent and Treat
Introduction: One of the most commonly asked questions
during a well child check-up is: How can I get my child to sleep through the
night? Your answer will vary with the age of the child, but children are
never too young for you to bring up this subject and offer advice.
1. 2 months - 6 months of age: As a pediatrician you
should start talking about sleep at the two month check-up if not before.
You can advise the parent the following:
- never put the child down asleep, or rock to sleep; never put baby down
with bottle
- always try to encourage feeds around 10 PM and again at 6 AM. This
will help start a schedule for the baby. Advise parents to not feed
between 8 PM and 10 PM. Most parents do this; the child sleeps the
expected 6-8 hours, but that means is awakening from 2-4 AM.
- encourage that child be out of parents’ bedroom by 2 months of age.
2. 6 months - 2 years of age: The general advice is
similar to the younger infant:
- never put the child down asleep, rock to sleep; never put baby down
with bottle.
- never put child in bed with parent; while a short-term benefit, this
usually associated with poor sleepers.
- if not responding to usual measures, consider trying Ferber Program:
by which parents wait increasing time intervals before going to the child
at night. See next page for details.
- with Ferber Program: even if go into the room, parent does so to
reassure child is OK, not to pick up, change diapers, hold, rock back to
sleep, etc. Going in room in fact may make child cry louder and longer.
3. 2 - 5 years of age: Sleep problems in this age group
are often associated with other sorts of control issues: eating problems,
aggression, irritability, poor peer interactions. Any child with sleeping
problems in this age should have a quiet time before bedtime; possibly a
warm bath will help soothe the child.
- only effective treatment in this age group is behavior modification.
Physical punishment does not work and should not be used. Most behavior
modification is based on positive reward systems: if you stay in your room
you get a gold star on your chart; if you get 3 gold stars in a row, you
get a prize.
- however, this does not always work, so must take firmer methods:
- always tell the child that once you leave him in the room, the child
should not come out
- give a small dose of Benadryl about 1/2 hour before bedtime for 4-5
nights
- latch the door; this makes all parents feel guilty, but it works.
It takes from 5-7 nights for child to get the message that he really
will be staying in his room from that time on.
4. Over 5 years old: Sleep problems in this age group are
often associated with nightmares, night terrors, anxiety, phobias, and
school problems.
Treatment: support, reassurance, limit setting, short-term med such as
Benadryl for a few nights.
May also need to consider counseling if long-term problem.
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