Child development

Sleep disorders in preschool children

It is of utmost importance that we, as parents, are aware, of the circumstances affecting changes in our child's rhythm of getting to sleep, sleeping and waking up, and that we influence these as best we can

How can we make our child to go to sleep easily and without hesitation, to sleep peacefully and wake up in the morning well rested, is a question many parents ask. There are several answers to that, primarily depending on your child’s age and overall psycho-physical status, as well as parents’ characteristics and family atmosphere.

In harmony with the natural rhythm

The need to sleep appears within the rhythmical exchange of day and night. In newborns it may be a bit shifted, which requires patience in order to establish the routine according to the natural rhythm. This rhythm will be important later in maintaining the right routine of your child’s day which includes going to sleep at similar times.

Sleep is a part of your child’s life necessary for his/her health. Disturbance of its natural course may result from the influence of child’s health condition, changes in the environment, especially in the routine habits of the family, or under the influence of stress. It is of utmost importance that we, as parents, are aware of the circumstances affecting changes in our child’s rhythm of getting to sleep, sleeping and waking up, and that we influence these as much as we can. Sleeping difficulties affect all aspects of your child’s development and his/her stable adjustment and growth. Typically, the process of maturation and your child’s neurological development lead to longer periods of sleep. As many as three out of ten children show some form of sleep disorder in their second year of life, while in their third, that number is half smaller.

Transitory sleep disorders

Children are psychologically sensitive to changes in their environment and often respond with transitory difficulties in getting to sleep, sleep unrest or a wish to sleep with their parents in order to feel safe. Some ask for the presence of their parents to get to sleep during trips or when they sleep in some unknown environment. These difficulties disappear after short time. If some situations when elevated stress levels last longer, children may show longer, but still transitory difficulties, until they adjust to changes and establish their unique balance again. Thus, starting to go to the kindergarten or being hospitalised may affect the child’s experience of disturbed stability of relationship, which includes shattered trust, with ensuing transitory sleep disorder, among other things.

Long-term sleep disorders

Long-term sleep disorders are those taking longer than a couple of months, which influences the child’s mood, but also the rhythm of family relationships. As the child can influence the functioning of the family with his/her sleep difficulties, the family atmosphere can influence the rhythm of his/her sleep.

We talk about insomnia when a child cannot fall asleep during more than three quarters of an hour at least three times a week for at least a month.

The cause of long-term difficulties with getting to sleep can be the child’s anxiety and increased excitement which disable the gradual transition from wake to sleep, and more than rarely such children remain awake even when they are very exhausted. There are various reasons for this. Most usually it is because the child has been exposed to high levels of stressful circumstances s/he alone is unable to cope with. Underlying causes may include separation anxiety, unconscious fear of losing parents, as well as insecure or unclear relationships in the family or long-term overwhelming traumatic experience. Consequences vary, e.g. drowsiness and fatigue during the day, attention deficits, injury proneness, frequent accidents and general irritability.

Some studies showed that sleep disorders are more frequent in obese children. Since hormones which help in metabolism regulation are released in various phases of sleep, overweight may be a consequence of insomnia. In such situations it is justified to suspect the child may be melancholic.

Expressing suppressed feelings in sleep

In clinical practice with children we often encounter situations which are not recognised as endangering the child’s safety, because the child suppresses feelings or re-adjusts, i.e. over adjusts to the environment. It is not rare that parents feel that their child is withdrawn and needs to keep his/her experiences inside, is not sharing inner thoughts and feelings with them, which requires psychological support and help for both the child and parents. In other words, parents do not always know their child’s worries, preoccupations and experiences. Suppressed feelings may be expressed as a nightmare, night terror, night time fear, bedwetting, sleep talking and sleep walking, all of these warning that the child is under pressure. Very rarely, oversleeping tendency may also appear, especially in situations when children feel they cannot cope with difficulties and when they would rather avoid them.

However, we should not forget that some of these phenomena, like fear of imaginary creatures in the fifth year of age, are expected in certain phases of development. However such developmental phenomena share the characteristic of spontaneously disappearing without negative consequences.

Fostering good sleeping habits

As parents we can foster good sleeping habits which alleviate sleep difficulties.

A moderate level of activity during the day is desirable, as well as avoiding over excitement in evening hours and fostering emotional satisfaction and relaxing atmosphere. We have an important task of becoming aware of our own mood and see if we unwittingly transfer our feelings onto our child. If so, it is useful to find the best way of helping ourselves, share it with our partner and grow stronger as a family.

It is good to choose light meals, soothing lighting, pleasant music which can relax us before sleep. Getting to sleep at the right time is important. It is useful to become aware whether we have enough time for joint activities during the day so our child delays going to sleep in order to get more time for himself/herself. Findings show that twenty minutes a day devoted to your child is sufficient to satisfy his/her need for attention.

Everyday routine of going to sleep prepares your child to calm down, and the parent should clearly show that s/he is there, present, but that it is time for rest, and that the child cannot continue some activity. It helps if you avoid your child’s getting out of bed, and respond, calm him/her down, comfort him/her if necessary, and leave the night light on, the door ajar, give your child the favourite stuffed toy. That way the parent sends the child a clear message that s/he can relax, that everything is all right, that the parent is there for the child and the separation is only temporary.

Sanja Jusufbegović, prof. psiholog