Deal with Insomnia of Children a behavioural sleeping disorder



Deal with InsomniaIt is essential that the child learns soon as possible to sleep in his own bed, gradually developing autonomy.


Many couples are having to deal with what may seem “intractable”: frequent awakenings and difficulty falling asleep of your child in the first three years of life. “It is insomnia in effect – explains Paola Proserpio , neurologist at the Hospital Sleep Medicine Center of Niguarda Milan -, but the child has different characteristics than that of an adult: the first does not want to sleep and struggles to stay awake, the second would like to sleep but can not. ” In the first 3 years of life, 20-30% of children have sleep disorders: a percentage that drops to 15% after 3 years. The most ‘at risk’ seems to be the first-born or only children, who were breastfed and those who sleep in Latvia. “Rarely causes are organic – continues Proserpio – for the most part (over 80%) insomnia depends on psycho-physiological factors, mainly related to the organization of the day, the multitude of stimuli that are located around and habits given by the parents (98%). There are also organic matters, the most frequent are: reflux, ear disorders, asthma, atopic dermatitis.”

The importance of the evening routine

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Normally, the small mom and dad sees only in the evening hours, once finished the work day, and then would like to extend as much as possible the time spent with them, trying not to fall asleep. Besides children, since very young, they are subjected to many stimuli: sound and light games, television, PCs, tablets, video games. “It is good to create a routine for the evening hours – explains Paola Proserpio – in a peaceful and tranquil environment in which the stimuli are gradually decreased. You can read a book, sing a lullaby: the important thing is that the child recognizes the existence of even a habit in going to bed at a regular time and maybe with one or more objects (soft toys, pacifier) reserved at bedtime. ” It is essential that the child learns soon as possible – from 6 months – sleeping in your own bed, gradually developing the autonomy and the ability to fall asleep alone even in case of night waking.

What to do, what to avoid

But if this does not happen? “We begin to say what you should not do – clarifies Proserpio -: to lull the baby in her arms, in Latvia, in the stroller, car or anywhere that is not her bed; accustom to a contact with the mother during the falling asleep (eg. the hand); give the bottle or breastfeed while taking sleep; do get tired because sleep more. Let us see what you can do beyond this evening ritual, the parent must stay with the child until it is quiet, maybe always say the same phrase (eg. “Make sweet dreams”) and then leave the room, explaining to the child where It goes and why. If your baby cries you can wait a few seconds before returning to calm him, always leaving him in his bed. The qualities required of parents in this process are: security, peace of mind, willingness to teach, repetitive movements. ” It is important, as mentioned, the baby asleep in his room, with his game and his things if you need to correct insomnia a good starting point may be to create or re-create it in the small space, emphasizing the ‘ importance of this step in relation to its autonomy and to its welfare.
The method “Take a nap”
On how to “re-educate to sleep,” There are many theories, but one in particular has made (and makes) much discussion specialists and parents. It is the one proposed in the book “Take a nap” (published in Italy in 1999) of the Spanish Eduard Estivill doctor, specializing in paediatrics and clinical neurophysiology, director of Clinica del Sueño Barcelona. A manual explaining it said on the cover, “the simple method that teaches you to solve forever insomnia your child” also said gradual extinction method. This is basically to put the baby to bed, leaving him alone in the room, and eventually cry for controlled periods of time before returning, gradually increasing the wait. One method partially revised by the same Estivill, who in an interview with Pais in September 2012 made it clear that “the rules explained in Make bedtime worth for children from three years of so-called child who suffered insomnia for incorrect behavior. These rules can not be applied with small children due to the immaturity of their biological clock.”

A space for me

“Let cry your child goes against the parental instinct – comments Proserpio – so it is difficult to implement this method. But we consider valid the first part of the book, which covers the already good habits cited for falling asleep and the importance of sleep in their own space. The child must be accustomed to sleep as a child in his bed, and possibly in his room, because otherwise there is a habit that is difficult to correct when he gets older. It must be said that there are also theories favorable to sleep together in Latvia ( co-sleeping ), a practice that would favor especially the mother-child relationship. But according to others that could hamper the achievement of the autonomy of the child in managing his or her sleep, and of course reduce the intimacy between the parents. ” A critical moment, even if the child is accustomed to sleep without problems, can show up around 9 months of age, when little is ever more aware of the reality that surrounds him and increased nocturnal awakenings, partly because of dreams and nightmares, starting to take shape at that time. It is important that the parent continues to convey confidence, without become anxious, because children constantly live a reflection of what they “read” in their parents (and kids in this are extraordinary): if they perceive fatigue, insecurity, fear, They will in turn be brought to live the same emotions and thus to sleep even worse. “There are two types of children, autoconsolatori and markers – adds Proserpio – the former being able to go back to sleep by themselves (at one year of age are 60-70% of the total), others” reporting “very clearly their discomfort and need frequent reassurance. Again, the difference is mostly dependent on the dates habits from their parents.”

Manifestations of emotional distress

According to Christian De Ranieri , a clinical psychologist at Children’s Hospital Bambino Gesù in Rome, the disturbance in sleep is often caused by states of anxiety, for example due to the increasing awareness of themselves or of the relationship between the parents. “To sleep disorder – explains De Ranieri – we generally mean a difficulty to enjoy a sufficiently long night’s rest, of course depending on the age of the child. This kind of interference can relate to the difficulty in falling asleep, frequent awakenings, the difficult recovery of sleep, sometimes with the presence, but not always, manifestations of emotional distress: crying, agitation, inconsolabilità. ” Restless sleep may just be a sign of excitement in the achievements of the past day. During the first year of life babies sleep a lot, but soon manage to stay awake for longer periods. Even the states of anxiety of the second year of life, which result in many children nightmares and fears, are signs of mental maturation process and the creative imagination and are often linked to early separations. Around the third year children often call parents after being put to bed or complain for fear of the dark is a normal stage in child development and can be linked to an awareness of the progressive autonomy from parents. “Critical issues that can be overcome by following certain precautions. Parents – explains Dr. De Ranieri – may accompany the evolution of baby sleep by containing the emotionally strongest sides to be flexible, yet also maintain firm positions. As with other behaviors, in fact, provide a border and giving a regularity to respect the sleep habits helps the child feel content and gives continuity to his experiences: both during the day as at night. If a difficulty in falling asleep sphere were to assume uncontrollable sizes may be useful to consult a developmental psychologist.

Melatonin or tryptophan in selected cases

What are the possible treatments for sleep disorders in children? It is the recent scandal of Nopron , one antihistamine syrup (actually its active ingredient, niaprazine, has sedative properties-hypnotic) often recommended for children sleepless until January 2012, when it was withdrawn from the market after the suspension of authorizations to Genopharm Laboratoires (France) and the workshop production of Alkopharm Blois. “The use of pharmacological therapy in pediatric insomnia is extremely controversial – clarifies Proserpio -. In any case, the first approach is to change the habits and rituals of going to sleep. Only in very selected cases, you can resort to the use of substances such as melatonin or tryptophan (a precursor of the neurotransmitter melatonin), has always been associated with behavioral therapies. We also consider that a child who does not sleep enough, maybe because it falls asleep later at night and then you have to wake up early to go to kindergarten, can suffer a deprivation of sleep, daytime sleepiness and reduced cognitive performance. ” A recent study, published in the Journal of Epidemiology and Community Health , pointed out that the lack of a clear evening routine has a negative impact on brain development and the children’s performance.

It grows: children

“Usually the happiest time for children tend sleepless is elementary, but in junior high and high school the boy back to life a sleep deprivation – said Proserpio – to coincide with the new commitments, new interests, the desire to staying up late at night. In many cases, the teenagers return to the afternoon nap early childhood. This can be problematic because it shifts the rhythm of sleep / wake and in severe cases, the subject is no longer able to sleep the night before: it is called disorder postponement phase , or circadian . Even in these cases we suggest melatonin treatment and a review of rules of behavior, which is often very tiring: the goal is to rearrange biological clock. In practice, it can be proposed to patients to anticipate the time to go to bed a quarter of an hour adorn 3-4 days, until you return to a normal schedule.”