Robert A. Regal, Ph.D      
Pediatric Sleep Problems        

A Typical Story

Roseanne and Joe are not, and never were, patients of mine.  They are composites of many parents that I’ve seen.  They met and married in their late thirties.  They had full lives and active careers before they took their vows.  They wanted children and after two years, Roseanne became pregnant with Bianca.   The pregnancy and delivery were without complications.  Bianca was a beautiful but fussy child.  She developed colic, which lasted into her fourth month.  Both parents were very involved.  Roseanne took an extended leave from her job as a teacher;  Joe owned his own auto parts business and made a serious effort to be home with his family,  sharing all parenting responsibilities with Roseanne. Bianca is now three years old.
Getting Bianca to sleep was always a challenge.  She required a great deal of special attention to fall asleep, and each time she woke up (typically 2-3 times per night) Bianca required the same amount of attention to fall back to sleep.  Over time, both Roseanne and Joe found it easiest to have Bianca fall asleep in their bed.  She seemed to sleep better, and it meant that neither of them had to get out of bed to quiet her.  The price they paid for this quick-fix solution, however, was that their sleep was never completely sound.  They feared of rolling on top of Bianca and also found that intimacy between them became a memory.  Bianca was fine--Roseanne and Joe were miserable, always tired, increasingly frustrated and frequently arguing. 
Bianca’s peers moved from their cribs to their beds.  Roseanne and Joe reported that they tried to get Bianca to sleep in her room, in her new “big girl” bed, but Bianca loudly resisted.  She appeared to be very frightened to be alone in her room at night.  Both parents say that they are at their wits end. “We’ve tried everything from bribery to threats, from lights on to lights off, nothing seems to work.  We need help."

How does it begin?

     Pediatric sleep problems often carry histories that include all, or part of the story of Roseanne, Joe and Bianca.  Sleep is a natural part of the biorhythmic cycle of all human beings.  Pediatric sleep problems develop because parents unwittingly become necessary (conditioned) elements of their child’s sleep cycle.  It happens innocently enough.  Parents hear their child cry and they respond.  As they rush to soothe, the child calms down, relaxes and eventually falls back to sleep.  When this pattern repeats itself night after night, the child soon develops a conditioned need for their parent to be present to enable sleep to occur.  This dependency can grow even more problematic when “light sleeping” children require parents to remain with them for protracted periods in order to remain asleep.

How to avoid developing sleep problems

     Patience is the key.  When given the chance, most children will settle down after a few minutes and fall back to sleep.  Give the child the opportunity to calm themselves down without parental intervention.  Clearly no one is suggesting that all crying at night should be ignored.  Children cry as a signal of distress.  Learning to distinguish whether that distress is momentary and inconsequential, or of significance, is part of the learning curve that all young parents need to experience.  Patience and tolerance are important qualities that allow parents the ability to distinguish which cry is which.  You need to listen and wait.  Often the cries will settle down and your baby will resume sleep.  If the cries escalate, go to where the baby is sleeping and assess the situation.  If there is a problem, address it.  Keep in mind, however, that this is a time your baby should be sleeping, so take care of whatever requires your attention, then reassure your baby and leave the room.  Often a doll or a special blanket will help your child feel secure in your absence.  Since these props do no harm, feel free to use them. Do not lose sight of the goal.  You want your child to feel safe and secure in his or her bed/crib.  Fears will dissipate when given time and the opportunity to do so.

What do we do if the situation has progressed too far?

     In our "composite story,"  Bianca’s problems were now firmly established.  She told her parents  that she was afraid of the dark.  She said that she feared that ghosts came into her room when it was dark--under her bed, in her closets…   Roseanne and Joe repeatedly told her that there were no such things as ghosts.  They tried in every way to reason with her.  Bianca, however, learned that although her parents didn’t like her waking them at night, they would eventually give in and as she climbed into their bed her fears would soon dissolve.  
Anxiety (of any type) can be treated successfully by getting the sufferer to face, challenge and push through his/her fear.  There are a variety of treatment methods that can be used to do this, but all of them require the partnership of the sufferer.  Children pose a special problem because they have little reason to join in such a partnership.  From their perspective, fear is uncomfortable and avoidance (getting into Mommy and Daddy’s comfortable bed) makes the fear go away.  Treating sleep problems that have become resistant to reasonable parental strategies often benefit from professional assistance.  Simple behavioral programs can be designed to help your child overcome nighttime fears and establish healthy sleeping habits. 

 To Contact Dr. Regal : Call 914 - 347-4797 or e-mail: