To those of you who have a young child who does not sleep well it might surprise you to know that on average 0–2-year-olds spend 13 months of their life asleep. Sleep is necessary for our wellbeing and development and disordered sleep can be a contributary factor to mental health issues. However, you choose to parent some things about sleep may help you. It is a requirement that your child sleeps with you until 6 months of age to reduce the incidence of Sudden infant death syndrome then it is up to you. However, you organise your child to sleep it may surprise you that there are some simple things that you can put in place to aim for that blissful night’s sleep.

Why we need sleep.

Lack of sleep can lead to the following issues in childhood:-

  • Trouble paying attention.
  • Forgetfulness
  • Poor impulse control
  • Poor school performance
  • Obesity

Sleep has a biological rhythm. Sleeping and waking is regulated through circadian and homeostatic processes. It may surprise you to know that your baby is not born with an inbuilt circadian clock but has to experientially learn it by experiencing light and dark, regular meal times and  temperature changes. The suprachiasmatic nucleus in the brain helps to control the circadian clock and it starts by making sense of repeated signals of daylight, temperature and feed ,establishing a 24 hour pattern by about 4 months of age. But it is only very well developed by 12 months of age.

 We know that young babies need feeding in the night. Infants and children  have polyphasic sleep as opposed to the monophasic sleep of adults. So being realistic with your expectations is key.

Parenting Roles in establishing a sleep pattern.

  • Try to establish and maintain a consistent sleep and wake pattern after 4 months of age.
  • Have a consistent waketime on weekdays and at weekends make sure it is not more than an hour different.
  • Have regular mealtimes and activities.
  • Try to avoid direct exposure to evening light in the bedroom. Even relatively dim light can suppress melatonin which helps us stay asleep. You could use a nightlight that does not shine directly into your sleeping child’s eyes.
  • Make sure that there is morning light This helps to increase alertness and suppresses melatonin which all helps the circadian clock.
  •  Have an age-appropriate nap schedule Late napping may delay the onset of night time sleeping.

Sleep disturbance in new-borns

Pacifiers can be important when a new born is very unsettled. However, as time goes on a pacifier can become a sleep association so much so that when a child rouses, they will expect it to be there but when they are young, they are unable to find it themselves and will call you for assistance.

Milk feeding at night. Most babies do not require milk in the night from 6 months onwards. If they persist, they will wake up for those feeds.

 Sleep related rhythmic movements such as head banging, rocking, body rolling, commonly in first year of life but not confined to the first year of life are worth investigating with osteopathic fingers. Retained birth moulding or dysfunction in the cranium or body or within the involuntary mechanism somewhere can lead to the baby or child exhibiting these behaviours.

The quality of your baby’s very first breath at birth can be extremely important in terms of sleep. An insufficient first breath may mean that although there is enough oxygen and gaseous exchange to satisfy the child’s immediate needs and the medics the child somehow experiences a decrease enough that it rouses them from sleep when they are  in a horizontal position. This child invariably  comes to my consultant room looking a bit wired ,with large eyes almost protruding from their sockets and they on the whole seem almost hyperactive. The latter could just be from lack of sleep but also seems anecdotally to be something to do with a just under parr breathing system. These children often sleep miraculously if I as an osteopath treat the diaphragm, the ribs and intercostals muscles. Incidentally they are also the children that seem to suffer more with upper respiratory chest infections. These children may or may not need some sort of sleep training after osteopathic treatment has normalised the effects of a poor first breath.

Sleep disturbance in toddlers

Sleep disturbances can come in the form of acute illnesses but also from the more chronic problems such as otitis media. Otitis media (also known as glue ear) can cause a build-up of fluid in the middle ear and in conjunction with eustachian tube dysfunction can lead to chronic pressure that the child especially feels at night. Here the osteopathic treatment must be to aid the drainage of the middle ear and then see if the child can sleep peacefully again. Obviously if your baby or child awakes in acute pain you would need to consult a doctor.

Downs syndrome children will often have disturbed sleep and will suddenly sit up and then fold in half forwards to go back to sleep. I have found in osteopathic practice that by treating all the airways and the breathing apparatus diaphragm etc that this ceases and normal sleep is restored.

Sleep disturbance in children

 Obstructive Sleep Apnoea is where there are repeated episodes of prolonged upper airways obstruction during sleep which results impartial cessation of airflow. In children Adeno- tonsillar hypertrophy is a common cause and is nearly always accompanied by can also be caused by facial anomalies, allergies, and obesity. Hypothyroidism may be related to decreased airway patency or reduced central ventilatory drive. Reduced ventilatory drive may also be caused by Arnold chiari formation, myelomeningocele brain injury.

 Osteopathically it is important to assess the child to see if they can breathe nasally without hanging their mouth open. A child who has always had their mouth open and has not had lip seal and nasal breathing as standard will develop a narrow palate so that then the tongue does not fit in the roof of the mouth and lip seal becomes very difficult. Restoring normal function to this area is very important as tonsils that constantly have non processed nasal air blown over them,i.e. mouth air , can stay enlarged creating snoring and sleep apnoea.

 The position of the mandible is also important. A persistent retrognathic mandible will put pressure on the trachea causing pressure on the trachea which may disturb sleep.

Neurodevelopmental disorders

Sleep problems in children with neurodevelopmental disabilities abound. The prevalence of sleep issues is higher than in other children and are more likely to relapse. In my osteopathic clinic lack of sleep is often the one thing that brings families with autism in. Typically there is a real problem with settling to sleep sometimes they do not sleep until 4am and then will wake early. I find that treatment while not always long lasting makes a significant difference to the time the child settles. It is a great improvement if the child starts sleeping at 10 pm rather than in the small hours. Osteopathically I find that I need to address any build-up of tension and I find that they are very responsive to calming  work with the involuntary mechanism.( Cranial -sacral osteopathy)