Tackling bedtime tantrums

Oh! Sleep it is a gentle thing
Beloved from pole to pole
To Mary Queen the praise be given!
She sent the gentle sleep from heaven
That slid into my soul.

Samuel Taylor Coleridge

Ideal sleep is when a child goes to sleep without much difficulty, sleeps deeply and soundly through the night without waking up, and is refreshed and active the next morning. Good sleep is an indicator of good physical and mental health. But in some children and adolescents, insomnia is common.

Some common sleep problems are:

*Frequent night awakening. This is particularly found in young children, aged six months to four years. Such kids are also more likely to have behavioural problems during the day, particularly tantrums.

Factors precipitating night awakening are:

*Difficult temperament
* Perinatal difficulties
* Neuro-developmental problems
* Maternal depression
* Family stress
* Parental responses such as night-time feeding and co-sleeping

*Non-adaptive sleep associations. For instance, the child falls asleep while feeding or needs to be rocked to sleep. Such children cannot fall asleep unless sleep associations are recreated by the caregiver.

* Difficulty settling into bed. This is a very common problem. It begins in pre-school kids and continues well into elementary school age (5-12 yrs). It often correlates with the time that a child moves from a crib to a bed. Developmentally, it corresponds to the time that the child is exerting his/her independence from the primary caregiver. 

* Delayed sleep phase syndrome (DSPS). This refers to a shifting of the biological sleep clock forward. The child/ adolescent falls asleep late and wakes up late in the morning.

Parents or caregivers need to:

* Structure the bedtime routine
* Teach the child to fall asleep alone on a bed
* Decrease night-time breast/ bottle feeds
* Praise “good” night-time behaviour
* Prevent unnecessary night awakening
* Teach the child how to fall asleep alone

* Reset the circadian clock. For children who have moved the bedtime and awakening time forward by two to four hours, the parent should be counselled to move the awakening time in the morning earlier by 15 minutes to half an hour every day until the desired rising time is reached. This can be achieved in a few days time by moving the bedtime earlier.

* Medication is rarely used in children who are developing normally. It can be considered in children with neuro-developmental disorders resistant to behavioural management.
Medication is considered a second line approach and should be used in conjunction with a behavioural intervention programme and under strict medical guidance.

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