There are several factors that can contribute to baby insomnia, including medical conditions, environmental factors, and developmental changes
Your baby might be having trouble sleeping because they are finding it hard to breathe at a sufficient rate. Observe this carefully
Newborn babies usually sleep a total of about 8 to 9 hours in the daytime and a total of about 8 hours at night. But they must wake every few hours to eat.
In infants and young children, bedtime problems and night waking are common and the main presentations of insomnia. Poor sleep may critically impact the daytime functioning and mood of the child and their caregivers. A comprehensive sleep history, a sleep diary/log, and the BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) sleep screen are useful for diagnosing sleep problems in young children. Behavioral therapies for this type of insomnia include extinction, bedtime fading with positive routines, and scheduled awakening. Previous studies of behavioral interventions for young children showed significant improvements in sleep-onset latency, night waking frequency, and night waking duration. Parent education about their child’s sleep, bedtime routines, and sleep hygiene is essential for treatment.
Keywords: Sleep, Insomnia, Pediatric, Behavioral intervention
Nocturnal wakefulness is normal during early infancy and usually decreases substantially over the first few months of life. Thus, the majority of children sleep through the night by 6 months of age [1]. Differentiating sleep problems from normal physiologic changes in development can be challenging for clinicians. Sleep problems are commonly referred to as “bedtime problems and night waking” in infants and young children and insomnia in older children and adolescents [2].
Insomnia affects both sleep duration and quality. Total mean sleep duration is 14.2 hours (standard deviation [SD], 1.9 hours) at 6 months of age versus a mean 8.1 hours (SD, 0.8 hours) at 16 years of age [3]. The American Academy of Sleep Medicine recommends the amount of sleep per 24 hours for pediatric populations to promote optimal health [4] (Table 1). Chronic insufficient sleep quantity and inadequate sleep quality can impact a child’s daytime functioning, causing daytime behavior problems, cognitive impairment, and mood disturbances [5]. Sleep problems in young children disrupt their parents’ sleep, affecting their mood and daytime functioning as well [6,7].
Sleep amounts recommended by the American Academy of Sleep Medicine for pediatric populations
Age
Recommended total sleep time (hr)
4–12 Months
12–16
1–2 Years
11–14
3–5 Years
10–13
6–12 Years
9–12
13–18 Years
8–10
Chronic health problems (e.g., asthma, epilepsy, or atopic dermatitis) and developmental disorders will also adversely affect sleep [8]. This review describes behavioral insomnia of infants and young children and details its common interventions.
Considering its characteristic features, the International Classification of Sleep Disorders (ICSD) 2nd edition classified pediatric insomnia independently as “behavioral insomnia of childhood (BIC)” [9]. In the ICSD 3rd edition, pediatric insomnia was integrated into “chronic insomnia.” [9,10] Considering the distinctive characteristics of pediatric insomnia, the text mentions three subtypes of pediatric insomnia: (1) sleep-onset association type, a “child’s dependency on specific stimulation, objects, or setting for initiating sleep or returning sleep following an awakening; in the absence of these conditions, sleep-onset is significantly delayed;” (2) limit-setting type, “bedtime stalling or bedtime refusal that is met with and reinforced by inadequate limit-setting by a caregiver;” and (3) mixed type, “sleep-onset association difficulties and bedtime resistance.” [10]
Sleep associations are certain behaviors or environments that customarily appear at the time of sleep-onset that the child learns to need to fall asleep [5]. In the presence of a negative or inappropriate sleep-onset association, parental interventions (e.g., rocking, nursing, swinging) are required for the child to initiate sleep or return to sleep after a night awakening [5,9-11]. Therefore, frequent night awakenings are the presenting symptom of the sleep-onset association type [9,11].
The BIC limit-setting type, which usually begins after 2 years of age, occurs when the child refuses to go to bed [5,10]. Bedtime refusal and delaying tactics include attempts to delay bedtime (e.g., watching additional television) and the bedtime routine (e.g., requesting another story) or “curtain calls” after lights out (e.g., needing another story, hug, drink) [5,11]. It occurs when there are few or no limits instituted by parents around sleep behaviors (e.g., allowing the child to fall asleep while watching television or to play games until lights out) [11]. Parents may also institute limits in an inconsistent way (e.g., allowing the child to stay up late on weekends) [5,11].
Using a latent class analysis, Bruni et al. [12] recently suggested three pediatric insomnia subtypes and advocated different therapeutic approaches for each as follows: (1) presence of restless legs syndrome in dopaminergic dysfunction; (2) frequent depression and/or mood disorders in serotonergic dysfunction; and (3) common allergies and/or food intolerance in histaminergic dysfunction.