• “Le Sommeil, le rêve et l’enfant” by Marie Thirion and Marie-Josèphe Challamel - Albin Michel publications, 2002.

Professional experience

• Marie-Josèphe Challamel, a paediatrician who retired a year ago, was a researcher at INSERM where she was responsible for the children’s sleep unit at the Lyon-Sud hospital and then the Debrousse hospital in Lyons.

Sleep disorders in young children: what do we mean?

By Dr Lyliane Nemet-Pier, clinical psychologist.

When do we speak of sleep disorders in small children?

“We will speak of sleep disorders around the age of 6 months, if the problem recurs every day and night, and especially when the parents are no longer able to endure it.
A sleep disorder thus depends on the tolerance of the parents, because it does not really put the child’s life in danger.
Under the age of 6 months, we can only speak of a disorder if the baby does not sleep at all, for no more than a quarter of an hour at a time, or if they are unable to sleep through a number of sleep cycles in sequence.”

What sleep disorders of psychological origin do we find in children and what are their causes?

“The most frequent disorders are difficulties falling asleep and waking up multiple times, after which the child is unable to go back to sleep again by themselves. It is sometimes difficult to determine the causes, because each case is specific.

It may be a child-rearing problem (a child without any limits during the day is suddenly forced to go to bed, used to sleeping cradled in someone’s arms with a dummy or bottle), the behaviour of the parents who are afraid that their baby will die and run to them at the slightest cry (problem during pregnancy, traumatic separation, feeling of guilt, depression), psychological changes in the environment (problems in the couple, redundancy, death in the family, moving house or change in childcare arrangements, etc.).

Or they could be due to a lack of emotional affection towards the child who does not see their parents enough during the day to have a peaceful night’s rest or, if they appear in the Oedipal phase, to the jealousy of the child, who cannot stand their parents being together when they go to bed.

Night terrors are much less frequent. They may be of psychological origin and arise in relatively introverted children who find it hard to express what they feel during the day and especially affects such as aggressiveness or jealousy towards a little brother who has just been born, for example.

They must not be confused with nightmares, which are a normal phenomenon that punctuate the child’s psychological development and the difficulties that they meet. In the case of night terrors, there is no need to waken, shake or console the child as they are fast asleep and untouched by words of consolation, unlike with nightmares, when they really must be consoled. If terrors or nightmares happen too frequently, you must consult a psychologist.”

How can these sleep disorders be cured?

To find out more

“Moi, la nuit, je fais jamais dodo…” par Lyliane Nemet-Pier – Fleurus publications, 2000.

Professional experience

• Lyliane Nemet-Pier is a clinical psychologist and psychoanalyst.
• She has an independent practice and gives external consultations in general paediatrics at the Robert-Debré hospital in Paris.

Practical advice on children’s sleep

Being attentive for the signs that indicate sleep cycles

Is a first step in resolving sleep problems. Often parents do not take their child’s sleep cycles sufficiently into account. In fact, in order to go to sleep easily, the child must be put to bed when they express the desire to sleep at the beginning of a sleep cycle.

Each child expresses this desire by a sign that is specific to them and that you must learn to decipher: yawning, rubbing their eyes, touching their earlobe, superciliary arches that turn red, sucking their thumb, getting excited and being unable to calm down or, on the contrary, withdrawing into themselves, etc.

Their own little corner:

Children should not be moved from one place to another. It is important to give them their own little corner, decorated with familiar objects, a poster, a mobile, cuddly toys, etc., where they have their reference points so that they feel at ease and want to stay and play there. They will thus go to sleep there gladly.

Valance:

These are generally not recommended as they may cause the baby to suffocate. If, however, there is one on the bed, it must be firmly tucked under the mattress so that the child cannot lift it up.

To keep the baby safe, it is best not to put it around their head, so that it does not conceal from the child what is happening around them and so that the child can immediately identify the sounds that they hear.

Bedtime routine:

This is not a superfluous luxury, but an indispensable passage between day and night, a transition phase to prepare for the long separation of the night.
Cuddles, stories and calm games in the bedroom are all good ways for a parent to set time aside for their child to be with them and say goodnight. A little music or an anonymous voice cannot replace the affection that a mother or father gives to their baby when they are looking after them.
Every routine should have a beginning and an end, and it is essential not to draw it out excessively, otherwise you really give them the impression that the night is dangerous because you are afraid of leaving them alone.

Rocking:

This can help very young babies to go to sleep if they haven’t yet learned to calm down by themselves, but if it becomes a habit, it can encourage the child to wake up many times. To prevent this, it is recommended to put the child back in their bed while they are still awake after rocking them in your arms, so that they learn to go to sleep by themselves and can do this when they wake up normally during the night.

Comforters and cuddly toys:

All of these objects can help the child to part from their parents and thus encourage them to go to sleep by themselves.

Dummies and bottle:

Dummies are too often given automatically; yet they encourage the child to wake up frequently, as its takes several months before they learn to put a dummy back in by themselves when they lose it. However, many babies have a real need to suckle to go to sleep. Likewise, you should not give a bottle to make your child go to sleep, as it encourages tooth decay and it is not recommended to associate food with sleep.

Light:

In principle, children under 18 months are not afraid of the dark and leaving the light on under this age only reassures the parents. Moreover, certain very active children need total darkness to sleep, otherwise they are tempted to play or are stimulated by what is going on around them.

Sleeping in their parents’ bedroom:

This is completely normal for a baby who has just been born, because the mother needs to get to know her baby and vice versa. However, after a certain period – which may vary widely – a mother will want to let her baby sleep in a separate room to return to her life as a couple. If she still finds it hard to be apart from her baby after 8-9 months and there is nothing medically wrong with her or her baby, the dad can help her to gradually do this so that she manages to “detach herself”. Parents should not feel guilty about wanting to move their child further away; it is normal behaviour in a couple’s life. In addition, it is strongly recommended not to let babies sleep in their parents’ bed, because a child should not be present in the place where they express their sexuality.

What advice should you give a young mum to encourage her baby to sleep?

By Sophie Transler, paediatric nurse

What advice would you give a young mother in the maternity hospital to help her and her baby to sleep?

“I would first of all advise her never to waken her child for any reason whatsoever and to respect their rhythm. The mother will gradually adapt her rhythm to that of her child, without trying to impose her own pattern on them. She could, for example, rest at the same time as them. This will allow the mother to reach out towards her child. In addition, she should let the child find a comfortable position for going to sleep because they will try to recreate the feelings they had in their mother’s womb.”

Does the parents’ attitude have an influence on baby’s sleep?

“Yes, parents must respect their child’s sleep. In particular, they must not run to them when they cry a little, because they may be in the dream phase.

If they settle down in the next few minutes, it means that they were in the middle of dreaming and they must be left to calm down themselves. If they really need something, they will continue to cry and the parents will know that they are calling them. Taking them in your arms or disturbing them unnecessarily risks breaking their rhythm and creating a need. Nor is it necessary to be completely silent when the baby is sleeping; on the contrary, they may be reassured by hearing their parents’ voices from the next room. But, all the same, you must not make more noise than the baby could discern in their mother’s womb.”

Should mums feed their baby every time that they cry? Is there a time when they should stop feeding them during the night?

Can breastfeeding on demand be behind sleep disorders?

“In theory, no, because the child knows exactly when and how hungry they are. The problem is above all to find out why they are crying. Mums must learn to recognise their child’s cries and eliminate all of the possible causes before coming to the conclusion that they are hungry. This is all the more important if the child has colic or reflux, because breastfeeding will calm them for a while but the unease will return in the following hour. It is not necessary to have a strict schedule for meals, but you must find a balance.

For breastfeeding, I would recommend waiting 2-3 hours between each feed and 3-4 hours for bottle-feeding, as artificial milk takes longer to digest.”

To find out more

• http://sommeil.univ-lyon1.fr
• www.sommeilsante.asso.fr

Professional experience

• Sophie Transler obtained her nursing diploma in 2001.
• She undertook paediatric training at the Paris Paediatric School and has since been working in the haematology-oncology unit in Armand-Trousseau children’s hospital in Paris.

Sleep cycles

Specific sleep characteristics in foetuses, children and adults

The foetus sleeps from the age of approximately 28 weeks of gestation. There is already a sleep cycle with periods of active sleep, which is equivalent to REM sleep, and quiet sleep, which corresponds to deep slow wave sleep.

Their sleep cycle is shorter than that of an adult, lasting 50 to 60 minutes. At the beginning, it is for the most part made up of undifferentiated sleep (neither active nor quiet), and then from 8 months of gestation up to approximately 1 month after term, of a great deal of active sleep. Accordingly, a newborn’s sleep is comprised of 50% active sleep, 40% quiet sleep and 10% indeterminate sleep, over 16-17 hours of sleep per 24 hours.

Between 1 1/2 months and 3 months, quiet sleep is transformed into light slow wave sleep (stages 1 and 2) and deep slow wave sleep (stages 3 and 4). Over the first year, the amount of REM sleep decreases while deep slow wave sleep and especially light slow wave sleep increase. After the 2nd year, the sleep cycle is extended with the elimination of naps. In adults who sleep 7 to 8 hours out of 24, sleep is made up of 2 hours of deep slow wave sleep, 2 hours of REM sleep and 4 hours of light slow wave sleep.

The role of sleep

We still do not know the exact function of sleep, but it is indispensable.

During the foetal period and the first months of life, active sleep is thought to send stimuli to develop the nerve circuits in the absence of external stimuli. It is thought to be a substitute for wakefulness.

REM sleep is therefore thought to play a fundamental role in the development of the nervous system, along with cognition (learning and memory). Deep slow wave sleep, which the body makes up for as a priority in the event of sleep deprivation, is also thought to be involved in cognition, in addition to growth and tissue repair.

Representation of the development of the sleep cycle from birth to adulthood

These sleep cycles are repeated during the night. From the age of 9 months, babies fall asleep into slow wave sleep, like adults, while they fall asleep into active and then REM sleep under the age of 9 months.

From 12 months, sleep cycles in the first half of the night are extremely rich in deep slow wave sleep, whereas light slow wave sleep and REM sleep predominate during the cycles in the second half of the night.

“First of all, you must teach your baby to remain or play alone at certain times of the day. By acquiring the capacity to be alone for a few minutes, then for increasingly long periods during the day, they will be able to remain alone in their bed without any anxiety. They must also learn and develop ways (thumb, comforter or a different position) in which to calm themselves down and go to sleep without their parents’ help. In this way, when they wake up in the middle of the night, they can go back to sleep without their help. In the case of major events taking place among close friends or family, it is recommended that you speak to your baby or child about it, so that they don’t feel responsible for their parents’ unhappiness.
If sleeping disorders continue, it is important to take the time to stop and have no hesitation in consulting a psychologist*. The child’s place will then be redefined within the family and among siblings and the parental couple.”

*Specialised sleep consultations at the hospital lasting approximately two hours.

“Over the first days, yes, and all the more so when the mother is breastfeeding, because only small amounts of milk are being produced and the milk is easily digested. It is therefore normal that the baby is hungry 1 ½ to 2 hours after a feed.

On the contrary, after babies are one week old, we may consider other reasons why they are crying before automatically putting them to the breast or giving them a bottle: they have a dirty nappy, they are too hot, they have colic or perhaps they simply need a cuddle, etc.

Up to about 3 months, it is normal for them to wake up during the night with a feeling of hunger. If they still cry during the night after 6 months, it may be because they are not eating enough during the day.”

From 9 months to 3 years: 70 min cycle
From 3 years to 10 years: 90 min to 120 min cycle

THE LITTLE SLEEP TRAIN - 1 train = 1 sleep cycle
From 0 months to 2 months: 50 min cycle
From 2 months to 6-9 months: 70 min cycle

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