Sleep in Infants and Young Children: Part One: Normal Sleep

Katherine Finn Davis RN, MSN, CPNP; Kathy P. Parker PhD, RN, FAAN; Gary L. Montgomery MD

Disclosures

J Pediatr Health Care. 2004;18(2) 

In This Article

Case Study

Abandonment of daytime naps is a developmental phenomenon that occurs when children can obtain sufficient sleep during the nighttime sleep period. Cultural variations are common, but this "giving up" of naps can be expected to occur around the age of 5 years in the United States. Parents often have questions regarding when their child is ready to give up naps. Consider Sarah's sleep pattern:

Sarah was 4 1/2 years old and had typically been a very good sleeper until recently. Her mother had phased out Sarah's morning nap when she was 21/2 years old without any problems, and Sarah had continued since that time to take an afternoon nap, which lasted approximately 2 hours. Lately, at naptime, Sarah did not seem particularly tired but would lie down and eventually go to sleep. Sarah's mother reports that Sarah appears to be wide awake at her regular 7 o'clock bedtime and that it is now very difficult to put her to bed. Sarah's mother also reported that when Sarah was allowed to stay up later, she went to bed without protest and awoke in the morning well rested. Sarah's mother confided that she often took afternoon naps and considered them a "break" in her hectic day.

It is likely that Sarah is ready to give up her afternoon nap or at least shorten it to about 30 to 45 minutes. Her mother may believe that since she needs a "break," so does Sarah. Advice to Sarah's mother should include explaining how unnecessary daytime napping can disrupt nighttime sleep and that many children Sarah's age can obtain all of their needed sleep in the nighttime period. Her mother should be given direction on how to shorten the afternoon nap or gradually phase it out altogether. Sarah's mother should also be aware that when the nap is removed, Sarah should be more amenable to her 8 o'clock bedtime and that her bedtime may need to be advanced somewhat to account for sleep lost during the day.

As the child matures, the sleep cycle and REM sleep continue to approach adult distribution. Overall cycle length remains stable at approximately 60 minutes at age 3 years and gradually extends to the adult level of 90 minutes by age 5 years. Children in this age range have six to eight sleep cycles per nighttime sleep period (Sheldon, 2002). The first REM sleep period usually begins 60 minutes after sleep onset. As the child gets older, the initial REM period will shorten while later REM periods lengthen. The first third of the night is dominated by NREM stage 3 and 4 sleep, whereas REM sleep occurs predominately in the latter half of the night (Sheldon, 2002) (see Figure 2). Children in this age range spend 20% to 25% of their total daily sleep in REM sleep and 75% to 80% in NREM sleep, which approximates adult proportions (Roffwarg et al., 1966).

Typical nighttime course of sleep stage progression and waking in a young child. (Adapted from Adair, R. H., & Bauchner, H. [1993]. Sleep problems in childhood. Current Problems in Pediatrics, 23, 147-170. Used with permission.)

In both infants and young children, episodes of semiwakefulness during the nighttime sleep period are common and are often referred to as night wakings. These short intervals of wakefulness occur about five to seven times per night (Mindell, Owens, & Carskadon, 1999), are typically seen at the end of a sleep cycle (Dahl, 1998), and last 1 to 5 minutes (Anders et al., 1995). Children will often reach semiwakefulness, open their eyes, and survey their surroundings. Familiar surroundings typically result in the return to sleep. However, if the surroundings are unfamiliar or different than those that were present at sleep onset (ie, lights on, parent present), children may progress to full waking (Adair & Bauchner, 1993). Therefore, children should be put in bed when drowsy, not fully asleep, and allowed to fall asleep in the surroundings that will be present when they awaken at night, such as their crib or bed. This practice teaches children how to fall asleep without parental assistance and encourages self-soothing after a night waking.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....