Infant Toddler Sleep Behaviors PREVENT Curriculum Objectives Describe

Infant & Toddler Sleep Behaviors PREVENT Curriculum

Objectives • Describe sleep patterns for infants and young children • Discuss behavioral interventions for infants and young children with common sleep issues • Identify contextual factors that may impact these interventions

Prevalence of Sleep Issues Night Waking waking and crying one or more times between 12 -5 am, at least 4 nights per week • 25% of infants 6 -12 months (up to 50% in breast fed infants) • 20% of 1 -2 year olds Difficult Bed Settling taking more than 30 minutes to settle • 50% in 4 year olds

Newborn Sleep Patterns What is the average amount of sleep? • 16 -20 hours per day, divided into 3 -4 hour naps • Shorter REM cycles • 50 minutes, vs. 90 -110 minutes in older children • May appear that they are waking, causing caregiver to pick them up

When should babies “sleep through the night”? • Most babies by 3 -4 months – Only 6 hours at one time • Introducing solid food (cereal) does not help babies sleep through the night • Sleep struggles may come and go as the child grows and develops • By 9 months, 70 -80% sleep through the night

Sleep is a Behavior! Behavior is controlled by 2 things: A = Antecedent(s) B = Behavior C = Consequence • Antecedents are events that occur before the behavior happens. • A consequence is any change in the environment that occurs after the behavior occurs.

How to get my baby to sleep? Manage the Antecedents! Start a consistent bedtime routine • Do calming activities - rocking, feeding, etc. • Do not let your baby fall asleep during the ritual • Put her in her crib while she’s still awake so she learns to fall asleep on her own

What if my baby cries? Select the Consequence – Option 1 The Ferber Method - Shaping (All caregivers must be consistent) • Let cry for 5 minutes to try to settle herself first • If crying continues, check on baby and comfort for 1 -2 minutes, with a pat on the back (don’t feed or pick up) • Continue this sequence; extending the length of time between checks

The Ferber Method • Start when parents (and baby) can tolerate some sleepless nights • If you give in during training (letting your child fall asleep in your bed, while drinking a bottle, etc. ) you may have to start over • Most children show improvement in a few days, and will be sleeping through the night in a week or two

Cry It Out Select the Consequence – Option 2 • Consistency is key • Expect an extinction burst • Consider family factors – Parental temperament – Child temperament – Concerns about neighbor complaints/calls of child neglect

What to tell parents? • When can you start sleep training? – 6 -9 months • What caregiver factors do you want to assess? – Ability to maintain consistency – Own temperament/ACEs • What are other anticipatory guidance talking points? – – Consistency across caregivers – pick the option that works best for the family Extinction burst and subsequent behaviors Nighttime feeds are not needed (unless concerned about weight) Baby’s self soothing capacity

Toddler & Preschool Sleep Patterns Toddlers Preschoolers • Sleep 12 hours per 24 hours • Sleep 11 -12 hours per night • Most give up 2 nd nap by 18 months and generally nap 1. 5 -3. 5 hours • Most give up napping by 5 yo • Peak of separation anxiety (918 mo) associated with increased night waking • Difficulties falling asleep and night waking (15 -30%) are still common

Understanding & Managing Possible antecedents: • • • Inconsistent bedtime routines/poor sleep hygiene The desire to be up with caregivers (and FOMO) Desire to be in control Lingering separation anxiety Poor/inconsistent sleep routines (tv, etc. )

Understanding & Managing Address antecedents: • Give your toddler some control with bedtime choices – Examples – choose pajamas, choose story, choose stuffed animal • Continue to use transitional objects – Nightlights may help • Bedtime pass with preschool aged children

Understanding & Managing Consequences • Sleep problems often maintained by intermittent reinforcement • Consistency is key! • Walk child back to bed • Positive rewards for staying in bed for a certain period of time (all night or shaping)

Cognitive, Cultural, and Other Considerations • For infants - adjust expectations for prematurity • Consider barriers: – Beliefs about developmental needs (e. g. , nighttime feeding, soothing capacity) – Caregiver challenges with consistency (globally) – Caregiver’s own sleep hygiene – Beliefs about sleep arrangements (e. g. , co-sleeping) – Physical environment (safety, space, neighbors)

Teach Back • Tell me one thing you learned from today’s talk • Tell me one thing you will apply to patient care