Blog Post 14-Be Flexible

Healthy Sleep Habits, Happy Child
by Marc Weissbluth, M.D.

A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.

Sleep is serious business.  If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial, from the point of view of the United States of America Department of the Army.  A major point, emphasized by the Army, is that more sleep produces more benefits for Soldiers.  Also, more sleep produces more benefits for children.  Even small amounts of extra sleep help (Blog Post 6).  At every age! 

Another point made by the army is: “A factor that determines the extent to which alertness and performance are impacted by sleep loss is individual differences in sensitivity and resistance to the effects of sleep loss. No one can maintain alertness and performance indefinitely without sleep, but some individuals are more impacted by sleep loss than others.  Individual differences are determined by both genetics and sleep history or habitual sleep.” 

The Army is clear about who is in charge: “Planning for sleep is a leader [Parent] competency.”  And “Effective leaders [Parents] consider sleep an item of logistical resupply like water, food, fuel, and ammunition.”  And “Think of sleep as an item of as an item of logistical resupply, like beans, bullets, and plan accordingly.”

“PLAN ACCORDINGLY”

            Parents would like to have a plan that guarantees healthy sleep for their child, like a tested recipe guarantees a sweet cupcake.  Unfortunately, there is not one plan that fits all families.  The principles discussed in Blog Posts 1 through 13 have to be adapted to specific individual, cultural, and family circumstances, or what the Army calls “mission constraints.”  There are three areas that will impact the sleep plan that you will design to fit your specific needs:

                        ·  Genetic individuality of your child.

                        ·  Cultural differences.

                        ·  Family differences.

GENETIC INDIVIDUALITY OF YOUR CHILD

                        ·  Trait Differences.

            Twin studies show that there are genetically based individual differences among children at any given age regarding naps, bedtimes, and sleep duration.

                        ·  Differential Susceptibility (Intra-Individual).

Between individuals, there are genetic differences regarding how they react to specific environmental events.  An environmental event might be a short sleep duration or a parenting factor.  Here are two examples:

  1.  When a serotonin transporter gene variant is present, children between 6 and 36 months of age, with short sleep durations, developed negative emotionality (discomfort, fear, frustration, sadness, and shyness), but not if the gene variant is absent.
  2. When a dopamine gene variant is present, children at 10 months, with insensitive mothers (based on scoring videotapes of mother-baby interactions) displayed more externalizing behaviors at 39 months, but not if the gene variant is absent.

                        ·  Differential Sensitivity (Inter-Individual)

Within an individual, there are task-dependent genetic differences in how an individual responds to insufficient sleep. Sleep loss in a particular individual might primarily and negatively impact cognitive processes (alertness, vigilance, and sustained attention) or executive functioning (for example, speed of cognitive processing) or subjective responses (mood and daytime sleepiness).  Resilience in one domain to sleep loss does not necessarily carry over to another.  So how your child behaves, performs, and feels when short on sleep is highly individualized.

CULTURAL DIFFERENCES

            Comparing children from predominately Caucasian, Asian, and Middle East countries, Professor Jodi Mindell showed a trend towards later bedtimes, more frequent and longer night wakings, shorter nighttime and daytime sleep durations, and more sleep problems in Middle East countries.  The average values between these regions were statistically significant.  Asian countries had late bedtimes perhaps attributed to placing a high value on academic accomplishment with studying late at night and more room sharing perhaps attributed to high population density in cities making only small apartments affordable to young couples.  Separate reports describe Spain, Italy, and South America as having late bedtimes and shorter sleep durations perhaps attributed to placing a high value on having children participate in the family evening life, including a late dinner.  In some cultures, Grandparents or nannies are highly involved in child-care including naps and they often sleep with the baby at night in a separate room.  Affordability of nannies and government paid maternity leave varies greatly among different countries.

FAMILY DIFFERENCES

            Challenges within a family might make it difficult for a child to learn to sleep well or obtain healthy sleep.  Here is a partial list of family challenges:

· Family conflict or marital strife, poverty, lack of social support.

·  Parental presence in the bedroom until the child falls asleep, smoking or drinking alcohol during pregnancy, depression or anxiety symptoms.

·  Maternal eveningness preference (“owl”), insomnia, habitual thinking that if I do not respond promptly at night my baby will feel abandoned or all sounds made by my baby at night indicate distress.

·  Paternal habitual thinking negative thoughts about himself, the world, and the future.

·  Babies born premature, with colic, or developmental delays.

·  Bed sharing in a culture that generally disapproves.

MAKE A PLAN

            Your plan to help your child get healthy sleep needs to comport with your child’s individuality, your values, your family circumstances, and perhaps your culture.  Some advice such as leaving the room after you put your baby down to sleep may be acceptable and possible for some families but neither acceptable nor possible for other families. Considering the differences described above:

Because all mothers and fathers are innately different,
please don’t judge other parents’ parenting.

Because all children are innately different,
please don’t compare your child’s sleep to other children.

IT IS NOT NECESSARY TO MAKE YOUR CHILD CRY TO HAVE A GOOD NIGHT’S SLEEP

WHAT A PARENT CAN DO

·  Make a sleep plan that you are comfortable with; be flexible and tolerant.

·  Become more aware of the difference between how you feel when well-rested versus mildly sleepy. Blog Post 13.

·  Try to maintain a regular sleep schedule.  Blog Post 12.

·  Try to not respond immediately to every quiet sound your baby makes at night.  Blog Post 11.  

·  Practice soothing to sleep and bedtime routines, every night, if possible. Blog Post 10.

·  Watch for drowsy signs. Blog Post 9.

·  Respect your child’s natural sleep rhythms.  Blog Post 8.

·  Encourage an early or earlier bedtime (even a slightly earlier bedtime may produce better sleep.  Blog Post 6) especially at 6 weeks.  Blog Post 7.

∙ Recognize that a healthy brain requires healthy sleep. Blog Posts 1, 2, 3, 4, and 5.

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