9 MONTH OLD AND NAPTIME RESISTANCE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
9 MONTH OLD AND NAPTIME RESISTANCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our healthy 9-month-old son has started to resist going down for his naps. We have tried every method in the book (quiet time, reading, rocking, dark room) but he still cries/wails before each nap.

On good days, he takes two one-hour naps; on bad days (more often lately), one or two 45-minute naps. He goes to sleep easily at night without nursing and sleeps through for about 10 hours.

A. Most 9-months-olds require about 12 hours of sleep during each 24-hour period – including nighttime sleep and naps. Sleep needs vary among babies. The range for 9-month-olds is from 11 to 13 hours per day, according to pediatric sleep specialist Richard Ferber, M.D. So on “good days” your son is within the average.

Many children resist naps, even when they need them. Up until 6 months, most babies take three naps a day – one in the morning, one midday or early afternoon and one later in the afternoon.

At around 6 months, one nap is dropped. At around 12 months, babies often drop one of the two remaining naps. A little ahead of schedule, your baby may be getting ready to switch from two naps to one.

When a baby is on the verge of dropping a nap, a period of back-and-forth may follow for a few weeks. This transition is typical of what we call a touchpoint, when an area of development such as sleep becomes briefly disorganized to reorganize into a more mature pattern.

One day, your baby may take one nap and skip the other, or he may have trouble falling asleep before both. He’ll also be cranky and tired when he has had fewer or shorter naps. Falling asleep at night may be harder, also.

When one nap replaces two, naptime also shifts – between the old morning and afternoon naps. The remaining nap’s length may be longer, or the baby may sleep a little longer at night. At 12 months, the sleep total is only about 30-45 minutes less than at 9 months, so the single remaining nap may be longer than before.

Can a parent help this transition? Try to be sure that the baby is getting enough sleep over each 24-hour period. Inadequate sleep can interfere with falling asleep and sleeping restfully.

Help your baby consolidate his two naps into one by putting him down for his morning nap a little later. Put him to bed later, too, which might lead him to sleep longer – thus easing the shift to consolidate morning and afternoon naps.

The transition will happen anyway in a few months, if not sooner. You may be just as glad for him to keep napping twice a day for a while longer, even if he struggles to get himself to sleep and the naps are shorter.

If he gets tired and cranky, encourage quiet time for cuddling and reading together so that he can get a little rest and comfort even if he can’t sleep then.

(For more information, see “Solve Your Child’s Sleep Problems,” by Richard Ferber, M.D. published by Simon & Schuster.)


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A 5-YEAR OLD WITH TROUBLED SLEEP

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 5-YEAR OLD WITH TROUBLED SLEEP
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My almost 5-year-old son is very tired during the day, even though he gets 10 hours of sleep most nights. He is in school now, so he can’t take daily naps. I’ve noticed that he kicks a lot during the night. Should I look into another cause, like periodic limb movement disorder?

A. By age 5, most children no longer need naps, so not napping is unlikely to explain the fatigue. Ten hours of sleep is enough for most children his age although the necessary amount varies from child to child.

So sleep quality may indeed be the problem. A number of disorders can disturb a good night’s sleep, including narcolepsy and obstructive sleep apnea, which is commonly caused by allergies, asthma and obesity.

Period limb movement disorder is another cause to consider when a child (or adult) kicks or moves his legs while asleep and is tired during the day. (Certain kinds of seizures can also cause unusual movement during sleep.)

Child sleep experts Judy Owens, M.D., and Jodi Mindell, Ph.D., note that PLMD is often missed because the symptoms are not reported. Also, many doctors don’t know about of this condition. PLMD is relatively common in adults, especially as they age. But not until recently has the condition, been recognized in children.

Your pediatrician could refer you a pediatric sleep specialist who can conduct a sleep study, make a diagnosis and recommend treatment.

Such a study is carried out in a sleep lab (usually in a hospital), where the child spends the night – and where a parent should be encouraged to stay too.

The lab monitors and records the child’s heart rate, blood pressure, breathing rate, movements and brain waves through the night.

A child with PLMD may also have Restless Legs Syndrome. A child with PLMD isn’t aware he’s kicking. RLS, however, involves an uncomfortable sensation in the legs, often described as a tingling, or the need to move.

Children with RLS will resist going to bed at night because lying down brings on the distressing sensations at their worst.

Both RLS and PLMD seem more common in children with Attention Deficit
Hyperactivity Disorder. Some scientists think that similar brain chemicals may be involved in the conditions.

Sleep disorders often lead to irritability and other behavioral problems at school, with related trouble in concentrating and remembering. But these problems often clear up when sleep quality improves.

PLMD’s cause is unclear, but the condition appears to run in families. It may be associated with iron and folate deficiencies. Sometimes, if the deficiencies are treated, the condition abates. (PLMD is also more common in children with leukemia, but most children with the disorder do not have leukemia.)

Usually, however , PLMD persists. Medication may effectively treat it. Avoid caffeine, present in many soft drinks, and be sure that the child devotes an adequate amount of time to sleep. Some doctors think that moderate exercise a few hours before bedtime may help.


(For more information, see “Take Charge of Your Child’s Sleep,” by Judith A. Owens, M.D., and Jodi A. Mindell, Ph.D, published by Marlowe & Co.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.