Apr 6, 2009

Is nap necessary for all children?

Aryya woke up at 5:15 in morning yesterday. It is 2 to 2.5 hrs earlier than usual. She didn't have fever or any other problem and was active and alert. She wakes this early once in a couple of months.

We were expecting that she would take a nap after lunch but she didn't look sleepy at all the whole afternoon. She slept very early, around 7:30 in the evening.

Aryaa's not taking naps in the afternoon has been one of our biggest worries regarding her so far. From a few months after her birth, it was very hard to make her sleep in the afternoon. After she turned two, it became even harder. Teachers in her kindergarten too used to write to us that she was the only child not taking naps regularly (Kids below 4 have to take naps after lunch in kindergartens), other children used to fall asleep immediately after lunch. The only time it was little bit easier, according to them, was the two months during summer when children enjoyed in the swimming pool. They had requested us to make her take naps on holidays too so that she will have a good 'rhythm'. But we were unable however we tried.

So we went to a doctor. He said that we didn't need to worry as she was having sound and continuous sleep in the nighttime and slept enough hours needed for her age. So we stopped trying to make her sleep in the afternoon but they continued in the kindergarten. looking at the 'notes' that we got from her teachers (carers) everyday, Aryaa seemed to take afternoon nap only once or twice a week.

The teacher responsible for her GUMI(group) in the new kindergarten, after talking with us, has told us that she won't 'force' Aryaa to sleep if she doesn't look sleepy and will let her play with older kids (who aren't required to nap).

While searching about children sleep, I found this very comprehensive article in a site called WebMD. I hope it can be a reference for you too if you are having sleep related problem with your kids.

How Much Sleep Do Children Need?
By Michael J. Breus, PhD
WebMD Feature
Reviewed by Brunilda Nazario, MD

1-4 Weeks Old : 15 ½ - 16 ½ hours per day

Newborns typically sleep about 15 to 18 hours a day, but only in short periods of two to four hours. Premature babies may sleep longer and colicky ones shorter.

Since newborns do not yet have an internal biological clock or circadian rhythm, their sleep patterns are not related to the daylight and nighttime cycles. In fact, they tend not to have much of a pattern at all -- their needs are unpredictable at this age. And there is not much you can do about it. You have to go with the flow, do what works to soothe and comfort your baby, and be on "baby time."

During transitions from wake to sleep and vice versa, you may see a sudden jerk or body twitch, as well as her eyes rolling upward as she falls asleep. As the brain develops, you may also see restless movements and agitation accompanied by crying for no apparent reason. This is all quite normal and no cause for alarm.

1-4 Months Old: 14 ½ - 15 ½ hours per day

5-8 Weeks Old

By 6 weeks old social smiling begins, your baby is beginning to settle down a bit, and you may notice more regular sleep patterns emerging. The longest periods of sleep run four to six hours and now tend to occur more regularly in the evening. Day-night confusion ends.

Two hours is about the longest time your baby can stay awake and remain happy and alert. So he needs to take a nap within that time frame. Waiting until your child is overtired or keeping him up past two hours often results in resistance to going to sleep, as well as fussiness and behavioral changes. Interestingly, if naps are deprived on a regular basis, his body produces stimulating hormones to fight fatigue that may actually cause night awakenings. So it is important to become sensitive to your baby's sleep needs.

Learn to recognize early when your baby is becoming tired. Look for signs like rubbing eyes, pulling ears, getting circles under the eyes. Begin the wind-down routine right away; soothe him in a consistent manner that works for you, and then put him to sleep in his crib. He is now developing sensitivity to his surroundings, recognizing cues like light, noise, and vibration. So when sleeping, he should be motionless and in a quiet, darkened area. All this helps your baby become a more regular sleeper.

3-4 Months Old

Your baby is now getting about two-thirds of sleep at night with three daytime naps, and so is beginning to establish a more firm day-night cycle. She may still sleep irregularly, and at this stage it is OK to forego rigid scheduling, because it is her biology and not her sleep habits that is the predominant factor.

That said, it is important to develop and maintain consistent routines so she does not develop unhealthy sleep habits, which will soon play a major role in her ability to sleep soundly. She needs to begin to learn how to soothe herself and put herself to sleep unassisted. Also, now that she is more interested in the world around her, it becomes more important to place her in a quiet, darkened room, where she will be able sleep well.

Now that your baby has become more social (smiling, giggling, laughing) she may well prefer to be with you and play rather than go to sleep. So you may find some resistance to nap- and bedtime. Do not deny her the critical sleep she needs. Overtired babies quickly become miserable; many may cry with such duration and intensity that they even appear to be sick.

I like the surfing analogy Mark Weissbluth, MD, uses in his book Healthy Sleep Habits, Happy Child: "You want to catch the wave of drowsiness as it is rising to enable your baby to have a long smooth ride to deep slumber. If your timing is off and your wave crashes into an overtired state, then the ride is bumpy and brief....Crying is the consequence of being overtired."

4-12 Months Old : 14 - 15 hours per day

4-8 Months Old

While up to 15 hours is ideal, most infants up to 11 months old get only about 12½ hours sleep. Establishing healthy sleep habits is a primary goal during this period, as your baby is now much more social, and his sleep patterns are more adult-like. The key is being sensitive to his sleep needs and adapting your lifestyle and scheduling your activities to be in sync with them. As Weissbluth notes, "You are harming your child when you allow unhealthy sleep patterns to evolve or persist -- sleep deprivation is as unhealthy as feeding a nutritionally deficient diet."

You should use the clock together with your child's natural daily sleep/wake rhythms, his internal clock or circadian rhythm. By learning when your child is naturally sleepy and awake, you can properly and consistently apply healthy sleep routines.

Crying when being put to bed and after awakening at night will only be reinforced and "learned" if you respond to it. So, as a general principal, unless your baby is sick or hungry, do not go to him. Starting routines early and being consistent are keys for success. It typically takes only a few days for a baby to learn to fall asleep unassisted, but it is up to you to maintain the schedule and routines so habits are not lost. The sound sleep that follows is a gift to him and you as well.

Babies at this stage may wake up early (5 - 6 a.m.) and go right back to sleep or wake up a bit later (7 a.m.) and start the day. Whichever the case, there is nothing you can do to change this (like keeping him up later). It is just part of his biology.

Babies typically have three naps and drop to two at around 6 months old, at which time (or earlier) they are physically capable of sleeping through the night. Establishing regular naps generally happens at the latter part of this time frame, as his biological rhythms mature. The midmorning nap usually starts at 9 a.m. and lasts about an hour. The early afternoon nap starts from 12 - 2 p.m. and lasts an hour or two. And the late afternoon nap may start from 3 - 5 p.m. and is variable in duration.

Don't let the early afternoon nap start beyond 3 p.m., or it may mess up the rest of his sleep schedule. If he misses a nap, keep him up until the next sleep period, though it may begin a bit earlier. Remember that an overtired baby will have difficulty falling asleep and staying asleep.

9-12 Months Old

Your baby now typically sleeps from 10-12 hours at night, takes two naps, and no longer needs to be fed at night.

With the absence of the third nap you may find that she needs an earlier bedtime. It may vary, however, depending on her nap schedule. Interestingly, changes as small as 20 minutes may have a large impact on behavior. Contrary to what you may think, earlier bedtimes allow your child to sleep later and more soundly. Keeping her up too late will increase, not decrease, night awakenings and other sleep-related problems.

With the emergence of her ability to engage more socially and express herself, your little angel may become less cooperative. She is probably much more interested in playing with you and exploring the world than going to a boring, quiet room to take a nap. Naps are essential, though. So do not let naptimes slip and slide. If you do, your child will become fatigued.

Fighting this fatigue results in a heightened state of wakefulness that makes it harder to fall asleep and stay asleep. Nighttime sleep problems often develop. If loss of naps is persistent, the fatigue accumulates and creates a vicious cycle that may lead to emotional and behavioral difficulties. Luckily, when you re-establish your sleep schedule, the problems typically disappear.

Allowing your child to soothe herself and put herself to sleep unassisted are critical to establishing good sleep habits, sleeping soundly, and preventing future sleep problems. As Mark Weissbluth, MD, says in his book Healthy Sleep Habits, Happy Child, "The failure of our children to fall asleep and stay asleep by themselves is the direct result of parents' failure to give their child the opportunity to learn ... self-soothing skills.... Some parents can't leave their kids alone long enough for them to fall asleep by themselves.... The major sleep problems in babies 4-12 months old develop and persist because of the inability of parents to stop reinforcing bad sleep habits."

1-3 Years Old : 12 - 14 hours per day

As your child moves past the first year toward 18-21 months old he will lose his morning nap and nap only once a day for an hour and a half to two hours. While toddlers need up to 14 hours a day of sleep, they typically get only about 10½.

The transition to one nap may be a bumpy one, though, where one nap is not enough and two are too many. If this is the case, you may try moving his bedtime earlier, so that he is more rested and better able to skip the morning nap. Another approach involves alternating one-nap and two-nap days, depending on his sleep the previous night.

Most children from about 21-36 months old still need one nap a day, which may range from one to three and a half hours long. They typically go to bed between 7 - 9 p.m. and wake up between 6 - 8 a.m. It is important to be regular (but not necessarily rigid) with bedtimes and naptimes and consistent with your routines or rituals.

If your child is sleeping well and is rested, occasional changes in his daily routine are generally well tolerated. However, if he is not sleeping well, changes may cause quite a few problems. Children at this age move to a bed from a crib and often develop sleep issues that include fears (monsters, the dark, separation), refusing to take naps, resisting going to sleep, night waking, getting out of bed, and getting up too early.

Though this may sound overwhelming, starting early and consistently maintaining healthy sleep habits prevents many problems and makes dealing with those that do occur much, much easier.

3-6 Years Old : 10 ¾ - 12 hours per day

Children at this age typically go to bed around 7 - 9 p.m. and wake up at about 6 - 8 a.m., just as they did when they were younger. At 3, most children are still napping, while at 5 most are not. Naps gradually become shorter as well. New sleep problems do not usually develop after 3 years of age.

You are impressed and exasperated at how well your child has developed bedtime stalling tactics, and at how easily you may be manipulated -- "I need to go to the bathroom (again). I need a glass of water; I am so thirsty. Wait, I love you (for the fourth time)."

As always, you must be sensitive to your child's sleep needs and aware of how well rested she is. Nursery school, preschool, playgroups and the like may wind up eliminating naptime. This may or may not be problematic. If, by altering her nighttime sleep schedule, by going to bed earlier and/or sleeping later, she is well rested, then you're OK. But don't eliminate naps if she is not ready. Both you and she will pay the price if you do; major problems can occur.

Sleep, among other factors, influences your child's temperament. Poor sleep (too little and/or poor quality) is associated with behavior problems like aggression, defiance, non-compliance, oppositional behavior, acting out, and hyperactivity. The inability to put herself back to sleep unassisted and irregular bedtimes are also associated with behavior problems. It is clear, then, that the proper amount and quality of sleep are very important for your child's development.

7-12 Years Old : 10 - 11 hours per day

At these ages, with social, school, and family activities, bedtimes gradually become later and later, with most 12-years-olds going to bed at about 9 p.m. There is still a wide range of bedtimes, from 7:30 - 10 p.m., as well as total sleep times, from 9 - 12 hours, although the average is only 9 ½ hours.

Sleep needs do not decrease and remain vitally important to your child's health, development, and well-being. Without the proper amount of sleep, your child will become increasingly sleepy during the day. Those children with a history of sleep problems see them persist. They do not "outgrow them."

In his book Healthy Sleep Habits, Happy Child, Marc Weissbluth, MD, sums up what you may find in children who routinely do not get the sleep they need, with a bit of a Catch 22: "School achievement difficulties were found more often among poor sleepers compared to good sleepers.... Young children who have difficulty sleeping become older children with more academic problems. But children who are academically successful risk not getting the sleep they need!"

12-18 Years Old : 8 ¼ - 9 ½ hours per day

Sleep needs remain just as vital to health and well-being for teenagers as when they were younger. It turns out that many teenagers over 15 actually need more sleep than in previous years. Now, however, social pressures conspire against getting the proper amount and quality of sleep.

Teens are not getting the sleep they once did, and many have difficulty falling asleep and frequently wake up at night. This is not normal, and all this is taking a toll. Sleep deprivation is associated with mood changes and behavioral problems, including conduct disorders and inattention.

One study of U.S. high school students found that 13% were chronically sleep-deprived. Other international studies confirm the global nature of this problem. Not getting enough sleep and not sleeping well is not OK.


Tejasvi said...

very useful.. loved it ....thankyou!

Anonymous said...

Nice and very useful Basanta ji! Regarding the article, I think one have to be critical- has to think from socio-cultural viewpoint. We have our own very good child rearing practices in our culture. Thanks for sharing!!

Basanta Gautam said...

Thank you Tejasvi and Sushamajee for visiting this blog!

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