This months letter of the month:
My toddler is almost
3 and has been sleeping through the night for nearly a year
when suddenly she started waking up and crying hysterically...
screaming and rolling around. When I ask her what is wrong
she say's "nothing". What can we do?
With small children the one thing you can be sure of is that
nothing stays the same. Sleep routines are easily disrupted
and it can be tricky figuring out what exactly is going on!
Night waking after months of sleeping
through could have any number of causes. The eruption of
molars, nightmares, or night terrors, fear of the dark,
or of falling asleep. Anxiety brought on by stress in the
family, a change in schedule due to travel or other causes;
breathing lapses, known as obstructive sleep apnea, usually
caused by enlarged adenoids or tonsils, illness, particularly
ear infections, and rarely threadworms, which cause itching
of the skin around the anus particularly at night. There
are a few things to try which may solve the problem, but
it will be a case of trial and error.
1. An important skill for your toddler
to learn is to fall asleep on her own. So providing a restful
and reassuring bedtime routine is vital. But once she is
drowsy, she should be put into her bed to fall asleep. This
aids the process of falling asleep again when waking in
the night.
2. During the night, keep contact gentle
and brief. Give positive words and a little rub, but no
hugging or getting out of bed. Whisper and keep interaction
quiet and sleepy. Ssh everyone's sleeping. Punishment at
this time is not helpful.
3. Waking should not be rewarded by
any kind of cuddling. It is ok to let her cry herself back
to sleep. You can return periodically to give a pat and
a word of reassurance, but increase intervals between each
visit, starting with every 5 or 10 minutes and adding 10
minutes on every time. Do not linger, just reassure the
child and then leave.
4. If your toddler does not have a 'cuddle'
(a soft object that she is attached to) it may be worth
introducing one. Having something to cuddle really helps
a toddler go back to sleep. You can employ a variety of
strategies to ensure that baby forms a bond with the cuddle
object.
5. Unless its unavoidable, changing
of nappies should be avoided because it will wake the child.
6. This may be a signal to reduce the
length of afternoon nap.
Dealing with nightmares is a little
different from the normal sleep training..
Several factors contribute to nightmares:
Stress, (family discord), change (a new nanny), a move,
a new day-care situation, a new bed or room; bedtime excesses
e.g. excitement, activity or food; But the most common causes
of nightmares in young children is an improved memory and
a growing imagination unchecked by reason. And as your toddler's
imagination becomes more complex, so does her nightmares.
Help reduce the risk of nightmares:
1. Keep time before bedtime tranquil
2. Ask her to tell you about her dream..
(don't say what is the matter?) ... she may feel better
if she's shared it with you. Help her express herself in
her toddler's vocabulary.
3. Tell her she's safe. Tell her her
dream was make-believe like a story book. Explain that everyone
has bad dreams sometimes, even grown-ups. Stay calm yourself
and don't overreact.
4. Show her she's safe. Turn on the
light and show her that her room looks just as it normally
does. Plug in a night light if necessary. If she's afraid
as to what may be lurking behind cupboard doors, do a "monster
check". If she has trouble going back to sleep, give
her a sip of water, and tell her you will sit with her for
a little while.
5. In the morning, reinforce the
feelings that she's safe. It is possible that she wont remember
the nightmare, but will awaken with a vague sense of anxiety...
Be especially sensitive to undercurrents of anxiety during
the day. Praise her too for having the courage to fall back
to sleep.
Regards
Nurse Penny
