Sleep Problems

Question 1

What is “difficulty settling to sleep”?

Answer 1

Child not going to sleep unless parent is present

Question 2

Causes of difficult settling

Answer 2

Separation anxiety (most common)

Too much sleep in late afternoon

Displaced cycle

Overstimulation in evening

Kept awake at night

Erratic parental practices

Using bedroom as punishment

Dislike of darkness/silence

Chronic physical conditions causing pain or distress

Question 3

Management of difficult settling

Answer 3

Creating a bedtime routine that cues child for sleep

Telling child to lie in bed quietly until falling asleep

Graded pattern of lengthening periods between tucking to bed and returning to visit, but leaving room just as child is sleeping (even if child protesting)

Question 4

What are “nightmares”?

Answer 4

Bad dreams recalled by child in the morning

Question 5

What are “night terrors”?

Answer 5

~1.5hrs from settling

Child sitting up in bed, eyes open, seemingly awake but obviously disoriented, confused or distressed

Unresponsive to questions or reassurance

Child settles back to sleep after a few minutes with no recollection

Question 6

Management of nightmares

Answer 6

Rarely requires professional support

Reassurance adequate unless PTSD suspected

Question 7

Management of night terrors

Answer 7

Reassurance directed to parents

Self-limiting and ceases over time

Most importantly make environment safe for sleep-walking child to prevent injury