In this lecture, I’m going to review some
common behavioral problems in children.
Specifically, we’ll talk about
sleep and sleep difficulties,
infant colic and then
breath holding spells.
So let’s start with sleep problems.
Normal sleep involves a circadian rhythm
and cycles with rapid
eye movement or REM,
which are established at
around three months of age.
Most infants should be sleeping through
the night by around three months of age.
And when they’re not doing that,
that’s usually the result of some sort of
interaction with the child and the parent
that’s facilitating a
non-continuous night of sleep.
So part of it may be allowing co-sleeping.
Generally, allowing co-sleeping
may delay a full night of sleep.
Not that this is necessarily
bad for the child,
but if it’s hard on the parent, there
can be ways we can address this issue.
So let’s talk about sleep hygiene.
The first is patients should
go to bed at a specific time
and there should be a certain
routine around the bedtime.
Rocking the baby to sleep
may actually make the baby need
rocking in order to go to sleep.
So what we typically recommend
is that we do not rock the baby until they
sleep and then put them down in the crib,
but rather put them
down in the crib awake
with an expectation that now is the time to
go to sleep and give them a kiss goodnight.
Oftentimes, it’s nice to
have a routine around that.
So for example, you might
read your child a book
because reading is so
important for infants.
And then you sit together and you cuddle.
And then you place them in the
bed, kiss them goodnight,
turn off the light
and leave the room.
If we have a routine like this, the child
knows they have to put themselves to sleep
and if they wake up in the night, they
don’t have to cry to be rocked
in order to go back to sleep.
So another one is that we
should have crib hygiene.
Crib hygiene isn’t about
soap or cleaning the crib.
Crib hygiene is about keeping
the sleeping conditions well.
So the baby should be on their
back, not on their front
and there shouldn’t be too many
pillows and blankets around them.
This is important in preventing
sudden infant death syndrome.
Co-sleeping with infants is also associated
with sudden infant death syndrome.
So let’s review some common
problems with sleep in children.
These are normal and just
requires supportive care.
But let’s review the difference
between nightmares and sleep terrors.
So nightmares can
happen at any age.
Boys and girls get them in equal rates
and they usually occur during REM
sleep, which is when we’re dreaming.
This means that they’re
mostly on the last third
of the night of sleep
because REM is much more common
in the last third of your sleep.
A child may awaken from a nightmare and
be afraid and require consolation.
The child would usually remember the
dream or the episode the next morning.
This is different
than a sleep terror.
And parents sometimes
bring their children in
thinking that sleep terrors are
something bad when in fact
they’re fairly common and aren’t really a
problem outside of waking up the parent.
So these happen between the age of
typically three to eight years of age.
They’re a little more common in
boys than they are in girls.
And they typically happen in non-REM sleep.
This means not when they’re dreaming.
They may occur in the first third of the
night as opposed to the last third,
which is more common
The child may appear awake.
They may sit up and open their eyes.
They are not awake.
They’re still asleep.
And they can’t really be consoled.
The child will have no
memory of this episode.
So the child will wake and sit up from
bed, open their eyes, cry or scream, “No!”
And then go back to sleep.
This is common.
It’s not hurting the child
and they should be fine.