Poor sleepers: one doctor's tips for wakeful toddlers

Parents often believe that if their child is a restless sleeper or can’t seem to settle down at night, it’s because he is by nature a poor sleeper or doesn’t need as much sleep as other children of the same age.

These beliefs are almost never true. Virtually all children without major medical or neurological disorders have the ability to sleep well. They can go to bed at an appropriate time, fall asleep within minutes and stay asleep until a reasonable hour in the morning. And while it is normal for a child (or an adult) to wake briefly a fewtimes during the night, these arousals should last only a few seconds or minutes and the child should go back to sleep easily on his own.

In fact, the mistaken belief that your child is unable to sleep normally can have a strong influence on how his sleep pattern develops from the day you bring him home from hospital. I have seen many parents who were told by the nurse in the maternity unit, ‘Your baby hardly sleeps at all. You’re in for trouble!’ Because parents like these are led to believe their child is a poor sleeper and there isn’t anything they can do about it, they allow him to develop poor sleep habits; they don’t think it is possible for him to develop good ones.

As a result, the whole family suffers terribly. Yet almost all of these children are potentially fine sleepers, and with just a little intervention they can learn to sleep well. It is true that children differ in their ability to sleep. Some children are excellent sleepers from birth. In the early weeks they may have to be wakened for feedings. As they grow older, not only do they continue to sleep well, but it becomes difficult to wake them even if one tries. They sleep soundly at night in a variety of situations: bright or dark, quiet or noisy, calm or chaotic. They can tolerate an occasional disruption of their sleep schedules, and they sleep well even during periods of emotional stress.

Other children seem inherently more susceptible to having their sleep patterns disrupted. Any change in bedtime routines – an illness, a hospitalisation or the presence of houseguests – can cause their sleep patterns to worsen. Even when these children have always been considered ‘non-sleepers’, we usually find that they, too, can sleep quite satisfactorily once we have made appropriate changes in their routines, schedules, surroundings or interactions within the family. Such children may still have occasional nights of poor sleep, but if the new routines are followed consistently, normal patterns will return quickly.

There are, of course, children who sleep very poorly for reasons we have as yet been unable to identify; however, these problems are extremely uncommon and account for only a tiny percentage of the children we see with difficulty sleeping. For these few, our usual behavioural treatments may help very little or not at all, and medication may even be required. If your child is up a great deal in thenight, it may be tempting to assume that he is one of these genuinely poor sleepers. But that is almost certainly not the case. Such instances of truly poor sleep ability are quite rare among otherwise normal young children.

In all probability your child’s sleep problem can be solved. He almost certainly has a normal inherent ability tofall asleep and remain asleep. This is true even if he has a sleep disturbance such as sleepwalking or bed-wetting. These problems, occurring during sleep or partial waking, are sometimes bigger management challenges than is sleeplessness, but with the appropriate intervention, they too can usually be decreased significantly if not resolved completely.

Read more from Dr Richard Ferber in his new book Solve Your Child’s Sleep Problems (Vermilion, £12.99).