INFANT SLEEP PROBLEMS

During the first two years of life, sleep problems are one of the most common complaints of parents at the time of their visit to the child's physician. When a parent mentions a sleep problems they are usually concerned about the infants regulation or consolidation of their sleep pattern. Regulation refers to the child's ability to transition smoothly from wakefulness to sleep (e.g., without a lot of fussing or crying). Consolidation refers to a child's ability to sustain sleep for a developmentally appropriate length of time. Nighttime awakenings are more common than most parents report. A problematic awakening occurs when the child is not able to "self-sooth" themselves back to sleep. By one year of age 60-70% of children are able to self-sooth and return to sleep. That is, these children are able to go back to sleep without a parental response. Sleep problems in infancy tend to persist into toddlerhood and childhood. Figures range from 40 to 80%. Daytime behavioral problems are often associated with sleep difficulties during toddlerhood and childhood.

The assessment of sleep problems requires multiple levels of observation and information gathering. The following domains of functioning need to be addressed: 1) the biological status of the infant, 2) the physical and mental health of the parents, 3) the parent's knowledge about children's sleep patterns and behavior, 4) the parent's external environment (e.g., job or economic stressors), 5) the parent's relationship with each other 6) the parent's perceptions and expectations for their child, 7) the quality of the parent-infant interaction.

The assessment will guide the intevention that takes place. The three levels of intervention are remediation, reeducation, and redefinition. Remediation is a level of intervention where a specific factor can be addressed (e.g., ear infection. formula intolerance). The parents may need reeducation. Solve Your Child's Sleep Problems by Richard Ferber, M.D. specifically addresses sleep issues. Parents may also need reeducation around their expectations of their child or what is developmentally appropriate to expect from their child. Parenting magazine is an excellent resource for the young parent. It may be helpful for them to attend a parenting workshop. The third level of intervention can be labeled redefinition. Parental attributes or the relationship between the parent and child may need to be addressed specifically. Parental psychopathology or conflict between the parents may need to be addressed before any intervention around the sleep problem will be successful. Behavioral interventions often fail when more complex issues underly the sleep difficulties. Typically this level of intervention will require more in depth assessment and intervention. It may be appropriate to consult with a mental health professional who works with infants and toddlers.