ALSO BY MARC WEISSBLUTH Crybabies Sweet Baby: How to Soothe Your Newborn Your Fussy Baby This book is dedicated to Linda Weissbluth Contents FOREWORD HOW TO USE THIS BOOK INTRODUCTION NEW INTRODUCTION TO FIRST HARDCOVER EDITION Part I How Children Sleep Chapter Why Healthy Sleep Is So Important Chapter Healthy Sleep and Sleep Strategies Healthy Sleep Sleep Duration: Night and Day Naps Sleep Consolidation Sleep Schedule, Timing of Sleep Sleep Regularity Sleep Positions, SIDS The Benefits of Healthy Sleep: Sleep Patterns, Intelligence, Learning, and School Performance Sleep Strategies Drowsy Signs Soothing to Sleep Resources for Soothing Bedtime Routines Breast-feeding versus Bottle-feeding and Family Bed versus Crib Breast-feeding the Fussy Baby by Nancy Nelson, RN, IBCLC) Solid Foods and Feeding Habits Solutions to Help Your Child Sleep Better: “No Cry,” “Maybe Cry,” or “Let Cry” Prevention versus Treatment of Sleep Problems Action Plan for Exhausted Parents Chapter Sleep Problems and Solutions Disturbed Sleep Sleep Log Morning Wake-up Time Is Too Early Morning Nap Is Absent, Too Short, Too Long, or at the Wrong Time Afternoon Nap Is Absent, Too Short, Too Long, or at the Wrong Time Third Nap Is Absent, Too Short, Too Long, or at the Wrong Time Needs Two but Can Get Only One Needs a Nap but Refuses to Nap Bedtime Is Too Late: Sometimes or Always a Battle Night Waking, Difficulty Staying Asleep More Than One Child Creates Bedtime Problems Unable to Fall Asleep Afraid of the Dark or Being Alone Will Not Stay in His Crib or Bed Will Not Sleep Anywhere Else Only One Bedroom Transition from Family Bed to Crib Action Plan for Exhausted Parents Chapter Sleep, Extreme Fussiness/Colic, and Temperament How to Use This Chapter Introduction Sleep and Extreme Fussiness/Colic Temperament at Four Months Connecting Sleep, Extreme Fussiness/Colic, and Temperament Postcolic: Preventing Sleep Problems After Four Months of Age Summary and Action Plan for Exhausted Parents Part II How Parents Can Help Their Children Establish Healthy Sleep Habits: You Can Prevent Sleep Disturbances from Infancy to Adolescence Chapter Months One to Four Newborn: The First Week Weeks Two to Four: More Fussiness Weeks Five to Six: Fussiness/Crying Peaks Weeks Seven to Eight: Earlier Bedtimes and Longer Night Sleep Periods Develop Months Three to Four: Extreme Fussiness/ Colic Ends Morning Nap Develops at 9:00 to 10:00 A.M Preventing and Solving Sleep Problems Action Plan for Exhausted Parents Chapter Months Five to Twelve Months Five to Eight: Early Afternoon Nap Develops at 12:00 to 2:00 P.M Variable Late Afternoon Nap at 3:00 to 5:00 P.M Month Nine: Late Afternoon Nap Disappears No More Bottle-feeding at Night Months Ten to Twelve: Morning Nap Starts to Disappear but Mostly Two Naps Preventing and Solving Sleep Problems: Months Five to Twelve Action Plan for Exhausted Parents Chapter Months Thirteen to Thirty-six Months Thirteen to Fifteen: One or Two Naps Months Sixteen to Twenty-one: Morning Nap Disappears Months Twenty-two to Thirty-six: Only a Single Afternoon Nap Preventing and Solving Sleep Problems Action Plan for Exhausted Parents Chapter Preschool Children Years Three to Six: Naps Disappear Preventing and Solving Sleep Problems Action Plan for Exhausted Parents Chapter Schoolchildren and Adolescence Years Seven to Twelve: Bedtime Becomes Later Adolescence: Not Enough Time to Sleep, Especially in the Morning Preventing and Solving Sleep Problems Part III Other Sleep Disturbances and Concerns Chapter 10 Special Sleep Problems Sleepwalking Sleep Talking Night Terrors Klackenberg, G (1982) Somnambulism in childhood —Prevalence, course, and behavioral correlations Acta Paediatrica Scandinavia, 71, 495-499 Sleep Talking Reimao, R., and Lefevre, A B (1980) Prevalence of sleep-talking in childhood Brain Development, 2, 353-357 Night Terrors DiMario, F J., Jr., and Emery, E S 3d (1987) The natural history of night terrors Clinical Pediatrics, 26, 505-511 Kales, J D., Kales, A., Soldatos, C R., Chamberlain, K., and Martin, E D (1979) Sleep walking and night terrors related to febrile illness American Journal of Psychiatry, 136, 1214-1215 Weissbluth, M (1984) Is drug treatment of night terrors warranted? American Journal of Diseases of Children, 138, 1086 Nightmares Cason, H (1935) The nightmare dream Psychological Monographs, 46 (5, Whole No 209) Cellucci, A J., and Lawrence, R S (1978) Individual differences in self-reported sleep—Variable correlations among nightmare sufferers Journal of Clinical Psychology, 34, 721-725 Mindell, J A., and Barrett, K M (2002) Nightmares and anxiety in elementary-aged children: Is there a relationship? Child: Care, Health and Development, 28, 317-322 Smedje, H., Broman, J E., and Hetta, J (2001) Shortterm prospective study of sleep disturbances in 5-to 8year-old children Acta Paediatrica, 90, 1456-1463 Head Banging and Body Rocking Abe, K., Oda, N., and Amatomi, M (1984) Natural history and predictive significance of head-banging, head-rolling and breath-holding spells Developmental Medicine and Child Neurology, 26, 644-648 Leung, A K., and Robson, W L (1990) Head banging Journal of the Singapore Paediatric Society, 32, 12-17 Bruxism Reding, G R., Rubright, W C., and Zimmerman, S O (1966) Incidence of bruxism Journal of Dental Research, 45, 1198-1204 Reding, G R., Zepelin, H., and Monroe, L J (1968) Personality study of nocturnal teeth grinders Perceptual and Motor Skills, 26, 523-531 Reding, G R., Zepelin, H., Robinson, J E., Smith, V H., and Zimmerman, S O (1968) Sleep pattern of bruxism: A revision Psychophysiology, 4, 396 Weideman, C L., Busch, D L., Yan-Go, F L., Clark, G T., and Gornbein, J A (1996) The incidence of parasomnias in child bruxers versus nonbruxers American Academy of Pediatric Dentistry, 18 , 456460 Narcolepsy Challamel, M J., Mazzola, M E., Nevsimalova, S., Cannard, C, Louis, J., and Revol, M (1994) Narcolepsy in children Sleep, 17 (Suppl 8), S17-S20 Wise, M S., and Lynch, J (2001) Narcolepsy in children Seminars in Pediatric Neurology, , 198206 Yoss, R E., and Daly, D D (1960) Narcolepsy in children Pediatrics, 77, 1025-1033 Poor-Quality Breathing (Allergies and Snoring) Ali, N J., Pitson, D J., and Stradling, J R (1993) Snoring, sleep disturbances, and behavior in 4-to 5year olds (1993) Archives of Disease in Childhood, 68, 360-366 Ali, N J., Pitson, D J., and Stradling, J R (1994) Natural history of snoring and related behavior problems between the ages of and years Archives of Disease in Childhood, 71, 74-76 Anderson, O W (1950) The management of “infantile insomnia.” Journal of Pediatrics, 38, 394-401 Ballenger, W L (1914) Diseases of the Nose, Throat and Ear Philadelphia: Lea and Febiger Brouillette, R., Hansen, D., David, R., Klemka, L., Szatkowski, A., Ferbach, S., and Hung, C (1984) A diagnostic approach to suspected obstructive sleep apnea in children Journal of Pediatrics, 105, 10-14 Brown, S L., and Stool, S E (1982) Behavioral manifestations of sleep apnea in children Sleep, 5, 200-201 Butte, W., Robertson, C, and Phelan, R (1985) Snoring in children: Is it pathological? Medical Journal of Australia, 143, 335-336 Chervin, R D., Archbold, K H., Dillon, J E., Panahi, P., Pituch, K J., Dahl, R E., and Guilleminault, C (2002) Inattention, hyperctivity, and symptoms of sleep-disordered breathing Pediatrics, 109, 449-456 Chervin, R D., Dillon, J E., Bassetti, C, Ganoczy, D A, and Pituch, K J (1997) Symptoms of sleep disorders, inattention, and hyperactivity in children Sleep, 20, 1185-1192 Flemming, B M (1925) A study of sleep of young children Journal of the American Association of University Women, 19, 25-28 Goldstein, N A., Fatima, M., Campbell, T E, and Rosenfeld, R M (2002) Child behavior and quality of life before and after tonsillectomy and adenoidectomy Archives of Otolaryngology—Head and Neck Surgery, 128, 770-775 Gozal, D (1998) Sleep-disordered breathing and school performance Pediatrics, 102, 616-620 Guilleminault, C, Winkle, R., Korobkin, R., and Simmons, B (1982) Children and nocturnal snoring: Evaluation of the effects of sleep related respiratory resistive load and daytime functioning European Journal of Pediatrics, 139, 154-171 Guilleminault, C, Pelaya, R., Leger, D., Cler, A, and Bocian, R C V (1996) Recognition of sleepdisordered breathing in children Pediatrics, 98, 871882 Guilleminault, C, and Dement, W C (1977) 235 cases of excessive daytime sleepiness Journal of Neurological Sciences, 31, 13-27 Guilleminault, C, Eldridge, F L., Simmons, F B., and Dement, W C (1976) Sleep apnea in eight children Pediatrics, 58, 23-31 Kahn, A., Mozin, J., and Casimir, G (1985) Insomnia and cow's milk allergy in infants Pediatrics, 76, 880884 Klein, G L., Ziering, R W, Girsh, L S., and Miller, M F (1985) The allergic irritability syndrome: Four case reports and a position statement from the Neuroallergy Committee of the American College of Allergy Annals of Allergy, 55, 22-24 Kravath, R E., Pollack, C D., and Borowiecki, B (1977) Hypo-ventilation during sleep in children who have lymphoid airway obstruction treated by nasopharyngeal tube and T and A Pediatrics, 59, 865-871 Lind, M G., and Lundell, B (1982) Tonsillar hyperplasia in children: A cause of obstructive sleep apneas, CO2 retention, and retarded growth Archives of Otolaryngology, 108, 650-654 Mangat, D., Orr, W C, and Smith, R O (1977) Sleep apnea, hypersomnolence, and upper airway obstruction secondary to adenotonsillar enlargement Archives of Otokryngology, 103, 383-386 Mauer, K W., Staats, B A., and Olsen, K D (1983) Upper airway obstruction and disordered nocturnal breathing in children Mayo Clinic Proceedings, 58, 349-353 Owens, J., Opipari, L., Nobile, C, and Spirito, A (1998) Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders Pediatrics, 102, 1178-1184 Weissbluth, M., Davis, A T., and Poncher, J (1984) Night waking in 4-to 8-month-old infants Journal of Pediatrics, 104, 477-480 Weissbluth, M., Davis, A T., Poncher, J., and Reiff, J (1983) Signs of airway obstruction during sleep and behavioral, developmental, and academic problems Journal of Developmental and Behavioral Pediatrics, 4, 119-121 Locating the Problem Brouillette, R., and Thach, B T (1979) A neuromuscular mechanism maintaining extrathoracic airway patency Journal of Applied Physiology: Respiration, Environment, Exercise and Physiology, 46, 772-779 Brouillette, R., Fernbach, S K., and Hunt, C E (1982) Obstructive sleep apnea in infants and children Journal of Pediatrics, 100, 31-40 Chokroverty, S (1980) Phasic tongue movements in human rapid-eye-movement sleep Neurology, 30 , 665-668 Felman, A H., Loughlin, G M., Leftridge, C A., and Cassisi, N J (1979) Upper airway obstruction during sleep in children American Journal of Respiration, 133, 213-216 Haponik, E E, Smith, P L., Bohlman, M E., Allen, R P., Goldman, S M., and Bleecker, E R (1983) Computerized tomography in obstructive sleep apnea: Correlation of airway size with physiology during sleep and wakefulness American Review of Respiratory Diseases, 127, 221-226 Remmers, J E., deGroot, W J., Sauerland, E K., and Anch, A M (1978) Pathogenesis of upper airway occlusive during sleep Journal of Applied Physiology: Respiration, Environment, Exercise and Physiology, 44, 931-938 Wilkinson, A R., McCormick, M S., Freeland, A P., and Pickering, D (1981) Electrocardiographic signs of pulmonary hypertension in children who snore British Medical Journal, 282, 1579-1581 Finding the Answers McGeary, G D (1981) Help a snorer Journal of the American Medical Association, 245, 1729 Simmons, E B., Guilleminault, C., Dement, W C., and Tilkian, A G (1977) Surgical management of airway obstruction during sleep Laryngoscope, 87, 326-338 Enjoying the Cure Guilleminault, C., Winkle, R., Korobkin, R., and Simmons, B (1982) Children and nocturnal snoring: Evaluation of the effects of sleep-related respiratory resistive load and daytime functioning European Journal of Pediatrics, 139, 165-171 Hyperactive Behavior Busby, K., Firestone, P., and Pivik, R T (1981) Sleep patterns in hyperkinetic and normal children Sleep, 4, 366-384 Conners, C K (1974) Rating scale for use in drug studies with children Psychopharmacology Bulletin, 10, (Special Issue), 24 Greenhill, L., Puig-Antich, T., Goetz, R., Hanlon, C, and Davies, M (1983) Sleep architecture and REM sleep measures in pre-pubertal children with attention deficit disorder with hyper-activity Sleep, 6, 91-101 Porrino, L J., Rapoport, J L., Behar, D., Sceery W, Ismond, D R., and Bunney, W E (1983) A naturalistic assessment of the motor activity of hyperactive boys Archives of General Psychiatry, 40, 681-687 Simonds, J E, and Parraga, H (1984) Sleep behaviors and disorders in children and adolescents evaluated at psychiatric clinics Journal of Developmental and Behavioral Pediatrics, 5, 6-10 Weissbluth, M (1984) Sleep duration, temperament, and Conners’ ratings of 3-year-old children Journal of Developmental and Behavioral Pediatrics, 5, 120123 Weissbluth, M., and Liu, K (1983) Sleep patterns, attention span, and infant temperament Journal of Developmental and Behavioral Pediatrics, 4, 34-36 Seasonal Affective Disorder Carskadon, M A., and Acebo, C (1993) Parental reports of seasonal mood and behavior changes in children Journal of the American Academy of Child and Adolescent Psychiatry, 32, 264-269 Glod, C A, Teicher, M H., Polcari, A, McGreenery, C E., and Ito, Y (1997) Circadian rest-activity disturbances in children with seasonal affective disorder Journal of the American Academy of Child and Adolescent Psychiatry, 36, 188-195 Swedo, S E., Allen, A J., Glod, C A, Clark, C H., Teicher, M H., Richter, D., Hoffman, C, Hamburger, S D., Dow, S., Brown, C, and Rosenthal, N E (1997) A controlled trial of light therapy for the treatment of pediatric seasonal affective disorder Journal of the American Academy of Child and Adolescent Psychiatry, 36, 816-821 Bed-wetting Bader, G., Neveus, T, Kruse, S., and Sillen, U (2002) Sleep of primary eneuretic children and controls Sleep, 25, 579-583 Chapter 11 Special Events and Concerns Twins, Triplets, and More Linkowki, P (1994) Genetic influences on EEG sleep and the human circadian clock: A twin study Pharmacopsychiatry, 27, 7-10 Injuries Belechri, M., Petridou, E., and Trichopoulos, D (2002) Bunk versus conventional beds: A comparative assessment of fall injury risk Journal of Epidemiology and Community Health, 56, 413-417 Carey, W B (1972) Clinical application of infant temperament measurement Journal of Pediatrics, 81, 823-828 Richman, N A (1981) A community survey of 1-to 2year-olds with sleep disruptions Journal of the American Academy of Child Psychiatry, 20, 281-291 Weissbluth, M (1981) Sleep duration and infant temperament Journal of Pediatrics, 5, 817-819 Weissbluth, M (1984) Sleep duration, temperament, and Conners’ ratings of 3-year-old children Journal of Developmental and Behavioral Pediatrics, 5, 120123 Overweight, Exercise, and Diet Butte, N F Jensen, C L., Moon, J K., Glaze, D G., and Frost, J D (1992) Sleep organization and energy expenditure of breastfed and formula-fed infants Pediatric Research, 32, 514-519 Carey, W B (1985) Temperament and increased weight gain in infants Journal of Developmental and Behavioral Pediatrics, 6, 128-131 deVries, M W (1984) Temperament and infant mortality among the Masai of East Africa American Journal of Psychiatry, 141, 1189-1194 Neumann, M., and Jacobs, K W (1992) The relationship between dietary components and aspects of sleep Perceptive Motor Skills, 75, 873-874 Sekine, Y, Yamagami, T, Handa, K., Saito, T, Nanre, S., Kawaminami, K., Tokui, N., Yoshida, K., and Kagamimori, S (2002) A dose-response relationship between short sleeping hours and childhood obesity: Results of the Toyama Birth Cohort Study Child: Care, Health and Development, 28, 163-170 von Kries, R., Toschke, A M., Wurnser, H., Sauerwald, T, and Koletsko, B (2002) Reduced risk for overweight and obesity in 5-and 6-year-old children by duration of sleep—a cross sectional study International Journal of Obesity and Related Metabolic Disorders, 26, 710-716 Youngstedt, S D., O'Connor, P J., and Dishman, R K (1997) The effects of acute exercise on sleep: A quantitative synthesis Sleep, 20, 203-214 Child Abuse Arvola, T., Tahvanainedn, A., and Isolauri, E (2000) Concerns and expectations of parents with atopic infants Pediatric Allergy and Immunology, 11 , 183188 Kemp, A S (1999) Atopic eczema: its social and financial costs Journal of Pediatrics, 35, 229-231 Reuveni, H., Chapnick, G., Tal, A, and Tarasiuk, A (1999) Sleep fragmentation in children with atopic dermatitis Archives of Pediatrics and Adolescent Medicine, 153, 249-253 Chapter 12 Competent Parents, Competent Child, Karen Pierce, M.D Basch, M F (1988) Understanding Psychotherapy: The Science Behind the Art New York: Basic Books Brazelton, T B., and Cramer, B G (1990) The Earliest Relationship Reading, Massachusetts: Addison-Wesley Company Caplan, L (1978) Oneness and Separateness Oak Park, Illinois: La Leche Siegel, D J (1999) The Developing Mind: Toward a Neurobiology of Interpersonal Experience New York: The Guilford Press Stern, D N (1990) Diary of a Baby New York: Basic Books Chapter 13 The Pros and Cons of Other Approaches to Sleep Problems Sears, W (1995) Nighttime Parenting: How to Get Your Baby and Child to Sleep New York: New American Library About the Author A pediatrician with thirty-two years of experience, MARC WEISSBLUTH, M.D., is also a leading researcher on sleep and children He founded the original Sleep Disorders Center at Chicago's Children's Memorial Hospital and is a Professor of Clinical Pediatrics at Northwestern University School of Medicine Dr Weissbluth discovered that sleep is linked to temperament and that sleeping problems are related to infant colic His landmark seven-year study on the development and disappearance of naps highlighted the importance of daytime sleep In addition to his own research, he has written about sleep problems in manuals of pediatrics, lectured extensively to parent groups, and appeared on Oprah Dr Weissbluth has four sons, three grandsons, and, thankfully, one granddaughter—and they are all good sleepers Linda, his wife of more than forty years, has provided both inspiration and original ideas for this book Copyright © 1987, 1999, 2003 by Marc Weissbluth Foreword copyright © 2003 by Cindy Crawford New Introduction copyright © 2005 by Marc Weissbluth All rights reserved Pulished in the United States by Ballantine Books, an imprint of The Random House Publishing Group, a division of Random House, Inc., New York Originally published in trade paperback in the United States by Ballantine Books, an imprint of The Random House Publishing Group, a division of Random House, Inc., in 1987, and revised in 1999 and 2003 BALLANTINE and colophon are registered trademarks of Random House, Inc eISBN: 978-0-345-51840-8 www.ballantinebooks.com v3.0 ... Part I How Children Sleep Chapter Why Healthy Sleep Is So Important Chapter Healthy Sleep and Sleep Strategies Healthy Sleep Sleep Duration: Night and Day Naps Sleep Consolidation Sleep Schedule,... own child toward healthy sleep habits SLEEP DEPRIVATION HARMS CHILDREN Sleep deprivation can be prevented and treated What I mean by healthy sleep? Do you know how to get a good night's sleep. .. some kids have much shorter fuses than others? Healthy Sleep Habits, Happy Child will explain how fatigue caused by poor-quality sleep makes some children pop off more often or explode with more