The child has trouble sleeping. Sleep disorders in children. Medicinal and homeopathic treatment of insomnia

“Sleeps like a baby” is a phrase that reflects our ideas about children’s sleep as something ideal, a role model. However, not all parents of young children will agree with this statement. Unfortunately, sleep disturbance is a fairly common occurrence due to serious reasons. A somnologist will help you deal with this problem.

Sleep is a complex physiological state that is characterized by relative rest, immobility and a pronounced decrease in reactions to external stimuli. The main function of sleep is restorative. It plays an important role in metabolic processes in the body. Thus, during slow sleep, growth hormone is released and the synthesis of cellular proteins increases. During sleep, immunity is restored by activating protective immune cells T-lymphocytes and producing immunoglobulins necessary to fight infections. During REM sleep, information is processed and short-term memory transitions to long-term memory.

Sleep is a heterogeneous process and is a genetically determined state of the body, which is characterized by a sequential change of phases - slow sleep (sleep without dreams) and fast sleep (paradoxical sleep or sleep with dreams). The main function of the slow-wave sleep phase is restorative. The breathing rate and heart rate decrease, muscles relax and eye movements slow down. As slow-wave sleep deepens, the total number of movements of the sleeper decreases, it is difficult to wake him up at this time, and dreams are not remembered upon awakening. The main function of the REM sleep phase is to process information and create a behavior program for the future. During REM sleep, on the contrary, physiological functions are activated, breathing, heart rate and movements become more frequent. Brain cells are extremely active during this phase, but information from the sensory organs does not reach them and is not sent to the muscles. This is the paradoxical nature of this condition. The movements of the eyeballs become fast - the sleeper is dreaming; if you wake him up after 10 minutes, he will talk about the dream.

The need for sleep in children is more important for the body than the need for food. The amount of sleep is the main component of the concept of “quality of life.” Sleep in babies is significantly different from sleep in adults. Up to six months it begins with the stage of active, REM sleep. Total sleep time is approximately the same during the day and night. As they grow older, night sleep gradually “consolidates”, the number of night awakenings decreases, daytime sleep becomes shorter, and by the age of 4 the need for daytime sleep disappears in most children. The daily sleep duration of young children is on average from 12 to 14 hours. By 18 months, most of them spontaneously establish their own sleep schedule, which includes a single afternoon nap of 1.5 to 3 hours.

The main feature of sleep disorders in children is the richness of motor and autonomic phenomena, which can be divided into the following groups:

Stereotypical movements associated with sleep: rocking, beating, folding, the “shuttle” phenomenon, finger sucking in sleep, masturbation in sleep, other stereotypical movements.

Paroxysmal phenomena during sleep: convulsions, night terrors, nocturnal enuresis, bruxism, nocturnal asthma, paroxysmal nocturnal nosebleeds, nocturnal vomiting, other paroxysms during sleep.

Static sleep phenomena: strange positions, sleeping with eyes open, sleeping with mouth open.

Complex forms of mental activity in sleep: sleepwalking, sleep-talking, nightmares.

Disorders of “switching” in the sleep-wake cycle in children: disturbances in falling asleep, disturbances in awakening, disturbances in wakefulness, inversion of sleep and wakefulness.

Today there are more than 100 sleep disorders. In children, the most common conditions are insomnia (difficulty falling asleep), parasomnia (night terrors, nightmares, sleepwalking, sleep talking, enuresis) and sleep apnea (stopping breathing).

Insomnia is insufficient or inadequate sleep, including difficulty falling asleep, restless sleep, frequent awakenings at night, difficulty waking up, early awakening. The most common causes of insomnia in children: psychophysiological factors (stress, change in routine); disruption of circadian rhythms (jet lag); somatic, neurological and mental disorders (for example, anxiety); periodic movements of the limbs during sleep (iron deficiency anemia, orthopedic diseases); drug dependence (frequent use of nasal drops - adrenergic agonists with a pronounced stimulating effect, for example, naphthyzine); inappropriate sleep habits (poor sleep hygiene); sleep apnea syndrome (hypertrophy of the tonsils, diseases of the neuromuscular system and anatomical features of the upper respiratory tract).

In children aged 3 to 5 years, the most common causes of difficulty falling asleep and maintaining sleep may be: iron deficiency anemia, infection and intoxication, helminthic infestation, anxiety disorders.

Sleepwalking (somnambulism) is the most common sleep disorder that parents encounter. It can happen to a child at any age, but is more often observed in children in the first year of life with maximum manifestation between the ages of 2 and 4 years. When sleepwalking, the child sits up in bed with his eyes open, the so-called blind gaze. Speech is usually slurred. The child is not aware of his actions. In severe cases, episodes of walking around the house may occur. It is very difficult to wake up a sleepwalker - it is better to carefully guide him back to bed. Attempts to wake a child with somnambulism, as with other parasomnias, are unsuccessful and can lead to manifestations of aggressiveness. Sometimes aggression can occur spontaneously. Those around you should be warned about this, as well as about the undesirability of interrupting an attack by forcibly awakening. About 25% of sleepwalkers cause various injuries to themselves during night wanderings. It happens that somnambulists fall out of windows, mistaking them for doors. In such cases, consultation with a doctor and treatment are necessary.

Dream talking more often occurs in children during periods of stress and anxiety, while children are completely mentally healthy. In rare cases, when sleep-talking is combined with sleepwalking, differential diagnosis with epilepsy is carried out.

Night terrors usually occur in the first half of the night and are accompanied by a high-pitched scream or crying, vegetative and behavioral manifestations of severe fear. Typical age of onset is between 3 and 8 years. 60-90 minutes after falling asleep, the child suddenly sits up and starts screaming. The condition is accompanied by increased heart rate and breathing, dilated pupils, and increased muscle tone. In the morning the episode of fear is forgotten. Treatment is usually not necessary, but may be indicated if episodes become frequent. In these cases, they usually resort to a short course of sleeping pills, only after consulting a somnologist.

Nightmares are frightening dreams from which awakening occurs in the REM sleep phase (dream phase). Such dreams occur in 10-15% of children aged 3-6 years. Up to 75% can remember at least one such episode in childhood. In rare cases, nightmares can continue into adulthood, sometimes throughout life. Severe infectious diseases and watching films with frightening content can contribute to the occurrence of nightmares. is a common problem in children. It is divided into primary and secondary. Primary enuresis is understood as a hereditary variant of night urination. It is much more common and continues from infancy, with a frequency of 1-2 episodes per week to several daily. Secondary enuresis is characterized by the reappearance of urinary incontinence after the child’s mechanisms that prevent enuresis have matured, and there have been no episodes of which for a long time (3-6 months or more). In this case, it is necessary to look for reasons that can be very different - from urological to psychiatric. Enuresis is observed in 30% of children at the age of 4 years, in 10% at 6 years and in 3% at 12 years. Of particular concern are children with persistent enuresis over 5 years of age. A connection has been found between obstructive respiratory disorders (sleep apnea - stopping breathing) and enuresis. In such children, nighttime urination may occur several times during the night due to hypoxia.

Snoring and sleep apnea. 3-12% of children of preschool and primary school age have complicated snoring. Snoring occurs with the same frequency in boys as in girls. The most common and clinically significant complication of snoring is obstructive sleep apnea-hypopnea syndrome. It is almost always accompanied by snoring and has the following characteristics: absence or reduction of air flow with airway obstruction with a decrease in oxygen content in the blood. Such pauses in breathing can last from 5 to 40 seconds, be quite frequent and lead to inadequate and ineffective sleep. The onset of sleep is accompanied by an increase in upper airway resistance, and partial or complete airway obstruction periodically occurs. The child usually wakes up for a short time due to hypoxia or hypercapnia (hypoxia - oxygen starvation, oxygen deficiency, decreased oxygen content in tissues, hypercapnia - increased partial pressure and carbon dioxide content in the arterial blood and in the body), as well as due to increased effort when trying to breathe. These phenomena cause repeated awakenings, lead to sleep fragmentation and daytime sleepiness. During obstructive episodes, a marked decrease in blood oxygen saturation may occur, which can cause life-threatening arthrythmias. Daytime manifestations of obstructive sleep apnea-hypnoea syndrome in children often include behavioral disorders: inattention, distractibility, irritability, hyperactivity.

Bruxism is periodically occurring paroxysmal contractions of the masticatory muscles, accompanied by clenching of the jaws and grinding of teeth. In addition to teeth grinding, the child may complain of muscle and joint pain in the lower jaw. During examination, no abnormalities may be noted, but in severe cases of the disease, dentin abrasion, caries, and inflammation of periodontal tissues are often observed. The diagnosis can be confirmed using a special polysomnographic study. In addition, polysomnography is important to exclude epilepsy as a causative factor of bruxism.

Periodic leg movements during sleep and restless legs syndrome are periodic limb movements during sleep, characterized by frequent movements, usually in the legs, but sometimes in the arms. Repeated during sleep at intervals of 10-90 seconds. May cause awakenings, leading to sleep fragmentation and daytime sleepiness. Children sleep very restlessly, they can take pretentious poses and even fall out of bed in their sleep. Restless legs syndrome is characterized by unpleasant sensations in the legs (sometimes in the arms) that appear before sleep (and sometimes at other times) and cause a strong desire to move the limbs. Children experience itching, scraping or aching sensations that temporarily disappear when the lower limbs move, but return after a few seconds at rest. Symptoms last from a few minutes to several hours and can significantly delay the onset of sleep and sometimes even cause sleep deprivation.

Rhythmic head or body shaking at night is a sleep disorder caused by rhythmic movements. The main symptoms occur in the first 2 years of life. Stereotyped movements of the head and neck are typical, occurring immediately before falling asleep and persisting during light sleep. Various types of stereotypical movements are noted - head banging, rotation, swinging to the sides, rolling the body. In adolescence, these disorders are sometimes observed in autism, schizoid disorder, and borderline mental disorders.

Jerks when falling asleep are sudden short-term contractions of the muscles of the arms and legs, sometimes the head, that occur when falling asleep. In this case, feelings of illusion and falling are often experienced. In some cases, startles lead to frequent awakenings, which may interfere with falling asleep.

Night cramps of the calf muscles (cramps) are accompanied by intense pain in the calf muscles. The attack continues for 30 minutes, then suddenly passes, accompanied by a strong cry. Often, such paroxysms can be secondary and occur in a wide range of diseases, such as rheumatism, endocrine, neuromuscular disorders and metabolic disorders. During an attack, calf massage, movement, and warming are recommended; Sometimes taking medications containing magnesium and iron supplements is helpful.

When assessing sleep status, it is recommended to start with open questions about the child’s general well-being. It is always worth considering daytime symptoms associated with sleep disturbances. Then you can additionally ask a few clarifying questions to parents regarding individual symptoms: 1) difficulty falling asleep; 2) frequent awakenings during the night (impaired sleep maintenance); 3) premature morning awakening; 4) sweating during sleep; 5) the child’s emotional state and daytime sleepiness; 6) snoring during sleep. It is also worth clarifying whether the child sleeps with his mouth open or closed.

Prevention of sleep disorders should be addressed already in early childhood, developing in children the habit of going to bed at a certain time. Before going to bed, it is necessary to avoid exciting conversations, emotionally stimulating music and television programs, and tiring mental activities. Air baths, dousing and rubbing, evening walks, general massage, and playing sports contribute to falling asleep. If there is a sleepwalker in the house, you should make a fence in front of the stairs leading down, provide the bedroom windows with strong bars, and do not leave electrical wires, glass tables or fragile decorations lying in the possible path. Due to the fact that with somnambulism there is an “internal logic” of actions, you can interrupt the episode by “entering the game”, for example, telling a child “preparing his homework” that he has already done everything, then he obediently goes to bed. For preschool children with severe bruxism, special mouth guards have been developed to protect teeth. Prevention of dental anomalies also eliminates the risk of sleep disorders associated with teeth grinding. Bruxism, which develops in infancy, usually does not require treatment and stops on its own by the age of 6-7 years.

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A restless baby affects the performance of all family members. At night, the body recovers, and sleep problems negatively affect the immune system.

If sleep disturbances occur repeatedly in children, this indicates pathology. We need to see a doctor. It is important to determine whether a sleep disorder is a whim or a disease.

Types and causes of sleep disorders in children

Falling asleep at night and uninterrupted sleep are not determined genetically, but are established during life: in the womb there is no change of day and night.

Therefore, babies of the 1st year of life always wake up at night and sleep during the day.

The causes of sleep disorders are varied:

• diseases of internal organs;
• hereditary predisposition;
• emotional stress, stress (going to kindergarten, mother going to work);
• incorrect behavior pattern in relation to sleep and wakefulness;
• physical discomfort (teething, colic, wet bed, crumbs on the sheet, unsuitable room temperature);
• hunger;
• late dinner, weaning.

Sleep disturbances in children under one year of age can be caused by rickets, inguinal and umbilical hernia, diseases of the spine, stomach and intestines, and rheumatism.

20% of babies have difficulty falling asleep in the evening, wake up and cry at night.

Different types of disorders have different manifestations.

Main manifestations of sleep disorders in children

An incorrect pattern of sleep and wakefulness is expressed in the fact that the baby repeatedly falls asleep during the day and wakes up at night.

In addition, the following deviations are common:

Fears. Sleep disturbances in children of this nature usually occur between the ages of 2-6 years, more often in whiny boys. The child sits up half asleep, screams and cries in bed; calmed down by the efforts of the parents.

During an attack, it is impossible to wake up the child; by the morning he cannot remember his behavior and retell his dreams.

These are manifestations of strong excitation of the nervous system. By the age of 10-12 years the disorder goes away.

Waking up in the middle of the night. Occurs in babies from 4 months to a year. There is nothing serious here and the reason lies in the incorrect behavior of parents who rush to lull their child to sleep. The baby develops a conditioned reflex in which the parents’ attention acts as reinforcement. The body is “set” to awaken to receive food and parental care.

The cause can also be diseases of the heart, blood vessels, and respiratory organs.

Sleepwalking. While sleeping, a child (usually a boy 5-10 years old) behaves actively, walks and performs purposeful actions. His eyes are open, his movements are clumsy, but he does not stumble or bump into furniture; in the morning he doesn’t remember anything.

The disorder can occur in connection with epilepsy, enuresis, diseases of the central nervous system and the genitourinary system.

Talking in your sleep. Children, while in a state of sleep, utter words or sentences, albeit unclear; after waking up they don’t remember anything.

Nightmares are typical for any age, but more often such a sleep disorder can be noticed in a child 3-7 years old, as well as 10-12 years old. Man wakes up in the middle of the night and remembers what he dreamed - this is different from fears. If your nightmares last more than once a week, it's time to see a doctor.

Bruxism. A child (usually 12-13 years old) clenches his teeth, his breathing and heartbeat change. The reason for this behavior is not clear, but worms have nothing to do with it.

This may indicate an incorrect bite. Due to the abrasion of the enamel, the child needs to be shown to an orthodontist. Bruxism is a consequence of nerve dysfunction, when tension in the facial muscles does not go away even at night. This requires the help of a neurologist.

Trembling appear in babies under one year of age, born with hypoxia or developmental defects, and adolescents. Trembling indicates epilepsy ill health of the nervous system and mental sphere.

Urinary incontinence (enuresis) Children aged 6-12 years, with mental retardation or genetically predisposed are susceptible.

The reason is the immaturity of the nervous system (awakening reflexes are not developed), as well as urological diseases and stress.

In this case, a neurologist will help.

Stopping breathing occurs in everyone. The person breathes through his mouth, snores, his breathing is intermittent; Sleep disturbance in infants can be expressed in difficulty eating; older children have difficulty learning due to daytime sleepiness. The disease is associated with enlarged adenoids and tonsils, sometimes with diseases of the nerves and muscles, congenital pathologies, and excess weight.

A consultation with an ENT specialist is required here.

Sleep initiation disorder. Difficulty falling asleep in the evening among preschoolers is common due to difficulties in adapting to a team, increased excitability of the nervous system, and psychological discomfort.

Delayed sleep phase syndrome. Teenagers lead an active life at night, and in the morning it is difficult for them to wake up; they are lethargic all day. The problem has psychological roots associated with entering adulthood and increased school loads.

Sleep disorders in children treatment

You should go to the pediatrician if you have a sleep disorder:

• accompanied by a serious change in mood;
• combined with enuresis and shortness of breath;
• lasts more than 3 weeks;
• occurs in children under 1 year of age.

Correction of fears, night awakenings, walking and talking in a dream is that the child must be woken up 10-15 minutes before the onset of the symptom (horrible dreams are seen 1-2 hours after falling asleep).

Then the awakened baby will fall asleep again and will no longer disturb his parents at “school time.”

During bruxism, mouthguards are worn to protect the jaw; if its cause is neurological, take sedatives. For enuresis, “wetness alarms” are used - alarms that go off as soon as the baby urinates. It is important to wake up your child so that he does not do this unconsciously, and always go to the toilet before bed.

For those suffering from sleep initiation disorder, falling asleep at a certain time will help. The baby will intuitively begin to prepare for sleep in advance. Delayed sleep phase syndrome is corrected by shifting nighttime rest to an earlier time.

Pediatricians often prescribe "Bayu-Bai" drops for active, excitable children over 5 years old, the bromine mixture "Citral", as well as the drugs "Notta", "Domirkind", and "Epam" drops for depressed teenagers.

Before going to the doctor you must:

• Keep a sleep diary. Over the course of a week, write down the time the child wakes up, the duration of the anxiety, the time he goes back to sleep, etc.
• Go to bed and wake up, eat at the same time. Walk in the air for at least 2 hours a day, do exercises and wet rubdowns in the morning.
• Limit emotional stress (even pleasant ones). Watching a large number of cartoons overloads the nervous system. You need to watch TV 2 hours before bedtime. You can’t play outdoor games with your child in the evening or force him to eat something. It is better to physically load the child in the first half of the day, and read a fairy tale at night. Do not give sweets before bedtime.
• Regularly ventilate the baby’s room and monitor physical parameters. Optimum temperature 22°C, humidity 70%. This can be achieved by placing a damp cloth on the battery.
• Take care of your bed linen. It should be clean, made of natural fabrics, the mattress should be semi-rigid.
• Provide a comfortable psychological climate. There must be a trusting relationship between family members. Parents need to find out whether their child feels comfortable at school and whether he has good relationships with teachers.

To correct sleep, you may need to prevent your child from sleeping during the day. A soft toy – a symbol of protection – will ensure a peaceful fall asleep.

When a child who falls asleep only in his arms wakes up in bed, he is capricious. You can stop this with the following procedure. Mom sits near the bed and minds her own business. The child, in a rage, throws all the toys around and moves the pillow. Mom comes up, puts everything back in place, then leaves.

Under no circumstances should you deny your child sleep when he asks, under the pretext of being busy with various things.

It is impossible not to react to the crying of a child: in adulthood this will develop into neurosis and complexes.

Sleep is favored by twilight, reading at night, planning for tomorrow, the monotonous noise of a washing machine, a TV from the next room.

Children's sleep is the key to a child's health and a fulfilling married life. Parents who do not limit irritating factors are to blame for sleep disturbances. If there are no visible causes of the disorder, you should see a doctor.

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Causes of sleep disturbances in children

Insomnia is a sleep disorder that results in a prolonged process of falling asleep and can have various causes. Satisfactory sleep quality involves falling asleep within 5-10 minutes after a person lies down. It is not uncommon for children to toss and turn in bed for an hour before they go to bed. What are the causes of childhood insomnia?

• Babies do not sleep for a long time due to dysbiosis and diaper rash, hunger and during teething.
• Also, the youngest can often be disturbed by the unstable psycho-emotional atmosphere in the house, especially if the parents argue emotionally, or the mother often talks loudly on the phone next to the child.

• Older children suffer from their own nervous and mental imbalance, especially for hyperactive and emotionally labile children.
• Problems of the child in relationships with peers, with the teacher - in kindergarten, with the teacher - at school. Disagreements with parents.
• Common reasons are periods of change in a child’s life, when he needs to adapt to new conditions. For example, when moving, when entering a kindergarten, group or school, during hospitalization.
• Serious stressful situations - death of a relative, divorce of parents, being in a military conflict zone, violence or presence in violent acts.


• Frequent and long sitting in front of a TV screen, at a game console or computer.
• Strong mental and physical stress.
• Children's fears, especially if the child is of kindergarten age. Fairy tales and cartoons, new acquaintances, aggression from peers often result in nightmares.
• Uncomfortable sleeping place and uncomfortable air temperature in the room.
• Violation of the child's daily routine and inactive wakefulness, when the child simply does not get physically tired and really does not want to sleep at night.

Treatment of childhood insomnia

Treatment of sleep disorders in a child is a complex and lengthy matter. Adults often immediately resort to medicinal methods - drugs containing bromine or phenobarbital, magnesium B6 or phenibut are no less popular than herbal complexes for insomnia in the form of tablets or drops. If the causes of insomnia are depression or a more serious nervous or mental illness, then heavy artillery is used. Treating children with medications is undesirable, especially when it comes to children of kindergarten or primary school age.

Treatment of a child should be based on the normalization of the psycho-emotional background, tightening or simplifying the daily routine, a thorough analysis of the child’s mental and physical stress, and clarification of your child’s possible problems in relationships with others.

Treatment of insomnia in children using homeopathic remedies

If the causes of your child’s sleep problems are related to the child’s internal tension and emotional lability, his hyperactivity and characteristics of the nervous system, help him cope with insomnia. What can you do to ease your child's sleep problems?

Drug treatment for insomnia

If traditional methods do not help, and the child suffers from insomnia for a long time, neurologists prescribe medication treatment in accordance with age. More often, medications containing phenibut, magnesium and vitamin B6 are prescribed. “Glycine” and “Glycised” are also popular; children under three years of age can take them.

Treat insomnia with care!

Whatever the root causes of childhood insomnia, try to keep your baby’s daily routine harmonious. 3 hours before going to bed, do not play noisily, turn off the TV. Before bed, read a book to your child and sing a lullaby, or you can turn on calm instrumental music. This is a safe and effective treatment for insomnia that is entirely up to you. Many kids fall asleep well to the sounds of nature - the sound of rain or the rustling of leaves mixed with the quiet trills of birds. Don't turn on the TV loudly in the next room. Let your child fall asleep with a night light on if complete darkness makes him anxious. Do not discuss family problems and work issues in front of the baby, try not to bring negative emotions home, especially do not take it out on the child. You will provide him with a good mood and healthy sleep.

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Insomnia baby

The nature and structure of sleep changes throughout life. Children especially often suffer from insomnia, which is commonly known as insomnia. And this is not surprising: the central nervous system of infants is immature, the “rhythm-wakefulness” cycle is not fully formed. Insomnia is defined by the International Classification of Sleep Disorders as a state of disturbance in the continuity of nighttime sleep. On the list of reasons why people turn to a doctor for help, insomnia follows immediately after colds, gastritis and headaches. The statistics are not encouraging: more than 25% of children aged one to 5 years sleep very poorly.

No need to be sad

Among the reasons insomnia in children Undoubtedly, emotional and stress factors are in the lead. An impressionable child will begin to worry at night if he has experienced mental trauma. For example, the death of a pet. Such an event can leave a much deeper mark on a child’s soul than parents think. The baby's sleep is upset if family harmony is disturbed: parents separate, get divorced, get sick or quarrel.

Moving to a new home or changing schools can trigger insomnia in children. Insomnia is especially costly for children. Suffice it to recall the well-known fact: somatotropic hormone, or growth hormone, is produced mainly during sleep, so physical development often slows down in babies who sleep poorly. The gradual increase in sleep deficiency also affects the child’s thinking abilities.

In some cases, the ability to think logically is lost, and children begin to behave like an airplane on autopilot. Simple tasks are completed easily using a stereotypical set of answers. And everything that goes beyond the usual is accompanied by errors. To the main causes of insomnia, which do not depend on age, are added specific forms of insomnia, which are characteristic of certain age groups.

Possible causes of insomnia in infants

Insomniac children Infancy is often a reaction to teething: salivation increases, saliva accumulates in the throat, causing the child to worry and wake up. In addition, babies experience pain as growing teeth erupt, expanding the gums. Breasts are also very sensitive to irritants in the air. The most common respiratory irritant is cigarette smoke. That is why it is not recommended to smoke in the room where the child sleeps, and also to leave baby powder, paints, perfumes, or use hairspray open.

Food allergies are often the reason why babies wake up at night. The baby is worried about a period of pain and a feeling of tension in the tummy overflowing with gas. The most common culprit of such symptoms is cow's milk. Other possible allergens include eggs, wheat, corn, citrus fruits, onions, fish, nuts, cabbage, and chocolate.

Sometimes insomnia is caused by the gastroesophageal reflex (GPR) - regurgitation of gastric juice. For children, this is the same painful sensation as heartburn for adults. It is much easier to tolerate when the child is in an upright position. Other symptoms of gastrointestinal tract include frequent bouts of crying, regurgitation after eating, and frequent respiratory infections.

There is another cause of insomnia - helminthic infestations, in particular pinworms. Female pinworms move down the intestines to the anus, where they lay eggs. This causes severe itching, which causes the child to wake up.

One of the most difficult diseases to recognize in infancy is ear infections. Often the only symptom indicating the disease is sleep disturbance. The fact is that when lying down, the fluid that forms due to infection puts pressure on the eardrum. When the baby moves to a vertical position, the fluid recedes, pressure and pain decrease.

Learning to walk

• Between the ages of 9 months and 2 years, many babies have not yet fully adapted to the new skills of standing and walking, which both fascinate and frighten them. Therefore, sometimes children, trying to get up in their crib at night, do not know how to lie down again. During the daytime, parents should help their child develop this skill.
• An overabundance of information and physical activity during the day can also disrupt your baby's sleep.
• The child becomes so accustomed to the nightly ritual before bed that its absence or change can significantly disrupt sleep. This type of sleep disorder is designated in the International Classification of Sleep Disorders as a disorder of sleep associations.

Be near!

• Most emotional reasons for a 2-3 year old child's night waking are related to separation anxiety. At this age, the baby strives to control the environment and immediately notices someone’s absence. Children fear that during sleep the world they value so much will change.
• Another common problem among children under 3 years old is frequent awakenings at night. This happens to babies who are used to falling asleep only when rocked or fed and cannot fall asleep on their own. You can develop this skill by changing the set of associations your child has with sleep.

Fear, horror

At the age of 3-6 years, children are often prevented from falling asleep by an overdeveloped imagination, which can create frightening images. Preschoolers are afraid of noisy, evil, uncontrollable monsters generated by their own imagination. Fears reach their peak just during the period of falling asleep, when the child is left alone with the fruits of his imagination. Often frightening images are projected onto real objects and objects, forming so-called hypnagogic hallucinations.

Children's imagination can give threatening features to such peaceful and harmless interior items as a wardrobe or an armchair. The reflection of a street lamp on the wall turns into a menacing monster, a sweater forgotten on a chair turns into an insidious burglar. No wonder a child can’t fall asleep in such a nervous environment! The peak of nightmares occurs in preschool age. Don’t worry, this only indicates that the child is actively gaining life experience.

If nightmares are rare, there is no need to worry: within a couple of years, your baby will be dreaming about a math lesson, not an angry bull. If you have frequent, recurring nightmares, you need to consult a specialist.

Light and sound

• Often, all that is needed for a baby to sleep better is the formation of a well-established sleep-wake cycle. Try to create a contrast between these two states. It's good when the day is filled with loud sounds, laughter, and games. The closer to evening, the quieter you speak, dim the lighting. This will soon be your bedtime signal.
• Light mode is also important for normal sleep. During the daytime, it is recommended to be in bright light, which has a beneficial effect on subsequent sleep. The fact is that the thyroid hormone melatonin is produced in the dark. In the morning, when the brain is saturated with melatonin, sunlight allows you to quickly get rid of this hormone, which has a positive effect on your emotional state. This effect is the basis of phototherapy - the use of a special lamp to treat sleep disorders.
• About a third of all cases of insomnia are associated with an inconvenient sleeping place: a mattress that is too soft or too hard, a high pillow, or a narrow crib.
• Another potential problem is sounds in the bedroom. One of the ways to solve this is to create so-called white noise, the generators of which can be a fan or a recording with the sounds of surf, wind, rain.
• Before going to bed, you should avoid showdowns, scandals, and even pleasant surprises. A state of emotional stress slows down the process of falling asleep and worsens the quality of sleep.

Treatment of insomnia in children

To medication treatment of insomnia in children, of course, should be treated with extreme caution. Sleeping pills, so beloved by adults, should, of course, not be given to children. It is also impossible to resort to the help of sedative herbal medicines without a prescription from an experienced specialist. Among the methods of treating insomnia, psychotherapy is the leader, which involves working not only with the child, but also with the parents. Various self-regulation techniques are very widespread in the treatment of sleep disorders:

• muscle relaxation methods;
• calming exercises (stretching, self-massage);
• breathing exercises;
• exercises for imagination (the baby’s fingers, head, and nose can become characters in games, and wishing good night to various parts of the body makes the process of falling asleep easier);
• Acupressure gives a good effect.

Aromatherapy is also useful, which is used in the form of massage with essential oils, inhalations, evaporations and aromatic baths, sleeping herbal pillows (male fern, pine needles, hop cones, mint, geranium, oregano, rose petals, lavender, and rosemary).

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Causes of the disorder

The sleep of infants and older children is somewhat different, since they have differences in the functioning of the central nervous system. Babies do not have a well-established biorhythm; due to the imperfection of their development, they can confuse day with night. There is nothing surprising in the fact that the baby sleeps soundly during the day and is awake in the middle of the night. But if he cannot sleep properly, constantly tosses and turns, often wakes up and is capricious, it makes sense to consult a doctor.

In infants, the following problems can cause disruption of rest:

• dysbacteriosis;
• hunger;
• gastric reflex (belching);
• teething;
• diaper rash;
• ear infections;
• the presence of allergens or dust in the air;
• too high air temperature and dryness;
• unfavorable emotional background (constant swearing, loud and harsh sounds in the house, etc.).

As children get older, they begin to discover new abilities in themselves: they learn to walk, get acquainted with the world around them, and learn something new every day. These events cause a large emotional outburst, due to which the nervous system cannot adjust to a night's rest in time.

At school there are additional reasons for inadequate night rest. The child begins to interact closely with other people, he becomes a full-fledged part of society. Worries about relationships with friends and teachers, school, and other aspects can lead to disrupted sleep at night.

The disorder can also be a consequence of fidget hyperactivity, disruption of the daily routine, lack of physical activity, poor nutrition, severe stress, change of place of residence, or excessive mental stress. All these factors affect the functioning of the central nervous system.

Why you need to take action

Some parents think that insomnia in children is a trivial matter and do not take any measures to treat it. Under no circumstances should the problem be ignored, as it can lead to serious irreversible consequences.

During sleep, the child's body produces somatropin, a growth hormone. If the baby does not sleep, then his growth and development begin to slow down, which is especially scary when this happens in infants.

Also, inadequate rest leads to the following disorders:

• lethargy during the day;
• irritability, tearfulness;
• lack of appetite;
• problems with memory and thinking;
• decline in immunity;
• headaches and migraines;
• slow development;
• obesity;
• diabetes.

Specialist help

Only a specialist can help a child with insomnia. You should contact a neurologist, pediatrician or somnologist. These doctors will help you find the true cause of the disorder and select the most optimal ways to eliminate it.

Medications for children are prescribed extremely rarely; they are completely contraindicated for children under 3 years of age.

Treatment boils down to the use of the following drugs:

If the problem lies in the destabilization of the psycho-emotional background, you will need the help of a psychotherapist. Sessions can only be attended by children, but most often they are held together with parents.

You can also fight insomnia with acupressure, breathing exercises or light therapy. The specialist chooses the technique for each child individually.

Homeopathic remedies

Drug therapy almost always has a negative effect on the body, especially when it comes to children. You can avoid taking drugs that contain chemicals using homeopathy. Natural, 100% natural and safe for use products have no contraindications. They do not contain components that can disrupt the functioning of organs or systems. Let's look at what will help kids get rid of insomnia.

• gaba ashan - a healing herbal component that normalizes sleep, speeds up falling asleep, improves blood circulation, fights melancholy and other disorders of the nervous system;
• beaver stream is an effective remedy that is used to treat nervous and cardiovascular diseases, it calms the nervous system, relieves spasms and helps get rid of migraines, increases tone and improves mood;
• the lofant plant is an effective natural antiseptic, immunostimulant, stabilizes blood pressure and strengthens the nervous system;
• a collection of 32 medicinal herbs - eliminates anxiety and neuroses, stabilizes heart rate and blood pressure, relaxes the entire body, promotes easy and quick sleep, and gives sound, restful sleep.

The product is also suitable for young patients who suffer from sleep disorders due to excessive mental activity.

1. "Sonylux". An innovative development of Russian scientists, a completely natural drug that can be used from 2 years of age. In 2015, clinical studies of “Sonylux” were conducted, during which it was proven that it gives the following effect:

A full course of taking the product will help your child get rid of sleep problems. It is very convenient to dose the medicine; the package contains a measuring spoon. You will notice the first positive results after just a few days of using Sonilyux, and upon completion of treatment, problems with night rest and increased excitability of the nervous system will completely disappear.

How parents can help

Successful relief from childhood insomnia primarily depends on the parents. It is important to properly organize the rhythm and lifestyle of the child so that he can fully rest at night. It is also worth observing sleep hygiene and providing your baby with maximum physical and psychological comfort.

The following measures will help restore normal sleep:

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Insomnia in children occurs for various reasons:

1. Psychological. This may include stress,
   excitement, fear, fear, active games at night. Children are often afraid of the dark, sounds, noise, and rustles.
2. Physiological or physical childhood insomnia. This includes hunger and pain. Any cold can interfere with your baby's sound and healthy sleep. Young children often suffer from insomnia due to teething.
3. Environment. A wet diaper or panties, heat or cold, light - all this can disturb a baby's sleep.
4. Health problems. Diseases of the heart, respiratory system, and nervous system can also disrupt the baby’s much-needed sleep.

Prevention and treatment

Parents need to try to get rid of all possible causes of childhood insomnia, namely: walk more with the child in the fresh air, exclude active games before bedtime. You need to establish a daily routine and strictly follow it. This will help your child fall asleep faster and sleep more soundly.

We also need to set restrictions on cartoons. A child should not spend a lot of time in front of a computer or TV. Programs and cartoons should be instructive and kind. No horror stories to avoid insomnia or restless sleep.

Hardening and physical activity will also help solve this problem. This way, the child’s immunity will increase, and problems with insomnia will fade into the background.

These are the main causes of insomnia and methods of its treatment; attentive parents, after observing the child, can themselves understand what the reason is and will be able to help their baby.

If the case is more serious, then you should not delay it and should contact a specialist. Doctors will help determine the cause and prescribe the necessary medications.

Most often, nightmares (hereinafter referred to as CS) occur in children whose nighttime sleep has certain deviations. Without them, nightmares are also possible if the child is impressionable, the circumstances, the environment are traumatic, or there is any painful disorder. We were able to find out the general prevalence of sleep disorders in children through a survey of 1,466 parents at two pediatric clinic sites. The figures below are based on the opinions of parents who report visible sleep disturbances, when in fact there are many more of them.

Every third child from 1 to 15 years old falls asleep poorly, usually for a long time, without differences by gender. In preschool age, difficulties in falling asleep are significantly more common than in school age, which is associated with more pronounced signs of neuropathy and organic disorders of the central nervous system in preschoolers.
Girls and boys fall asleep the worst when they are five years old. In girls, this coincides with an increase in the CS, that is, nighttime restlessness in girls is more reflected in falling asleep than in boys, or, which is the same thing, girls are more sensitive at this age to what they dream at night. Every third child also sleeps restlessly (talks, wakes up, tosses and turns), be it a girl (somewhat more often) or a boy.

Let us note (according to computer analysis) reliable relationships between disturbed sleep and the characteristics of pregnancy and childbirth, and the psychological state of the mother. Using them, you can reliably predict what sleep disturbances await children.

Let's start with superficial sleep, when even at the slightest noise the child immediately loses sleep, and at best he plays, at worst he screams and cries. It turned out that shallow sleep is associated with worries (emotional stress) of the mother during pregnancy. The unrest itself stems, in this case, from the mother’s lack of confidence in the strength of the marriage and the presence of fear of childbirth.
Keeping yourself in constant tension and fear, as we see, is not in vain. The fetus is tense, restless and cannot sleep properly while still in the womb. Increased maternal fatigue during pregnancy, no matter what the reasons, leads to the same results.

Let us remember: with the most common neurosis - neurasthenia - sleep is most often disturbed. You can’t get enough sleep, sleep doesn’t bring you joy, it’s filled with all sorts of worries and anxieties.
Fatigue during the day is even greater, sleep becomes worse - a vicious circle arises with inevitable irritability and mood disorders. What can we say about the overstrain of neuropsychic forces during pregnancy, when the load is already taking its toll, and endurance may not naturally be the highest. Accordingly, the fetal sleep biorhythm is upset, and often for a long time.

Any pediatrician will confirm another pattern we have established: restless, shallow sleep is most typical for children born prematurely. Their sleep is immature, intermittent, and day and night change places. And here everything can work out if everything is calm at home and the mother is loving, and not always dissatisfied with the child who appeared “early in time”, and she herself is too nervous.
The child's restless sleep also brings constant torment to young parents. Everything doesn’t suit him, he can’t find a place for himself, he rushes about in his sleep, throws off the blanket, babbles something, tries to fall out of bed. And... the more the child behaves in this way, the more worried and tense the parents become, invisibly conveying their excitement and only aggravating the child’s sleep problems.

You need to worry, but not excessively, and don’t dramatize your children’s nightly problems. This will not make them sleep better. But it’s worth stroking the sufferer, whispering friendly words, and calming down yourself. Parents were usually surprised when they saw how I, as a pediatrician, calmed the most hopelessly crying children. He took the children in his arms and walked around, rocking them slightly, talking gently and soothingly - for the mother, naturally. And she studied, since she was young and programmed by the rules written in another country.

How can one not remember the grandmother from the village: without any books or instructions, she rocked the cradle with one hand, cooked porridge with the other, and even sang a song. And in similar cases (in the 60s) I did not see nervous sleep disturbances in those who no longer crawled, but walked. In the village, new life is a sacred thing. The family was not supposed to worry about a newborn, and they were not supposed to invite loitering people either, so as not to “jinx them.”
Folk wisdom and instincts spoke about this.
On the physical side, of course, there were flaws - and they worked until the last minute, and gave birth in the field, but to “poison” a child, to prevent him from being born or to give him to strangers - this happened extremely rarely. Pregnancy as a message from God was perceived as something natural, natural, bestowed by fate.

Now there is continuous stress before birth, among which in the first place is a lack of confidence in the strength of the marriage, conflicts with the husband, other worries, poor health and irritability, the threat of miscarriage and emotional shock during childbirth from painful contractions. We ourselves can eliminate all these causes of restless sleep in children if we are more mature at the time of motherhood and more mentally protected.

Crying in a dream in children of the first years of life does not allow parents to sleep peacefully, feeling clearly “out of place.” It affects not only emotional stress during pregnancy (anxiety, poor health and increased fatigue), but also various deviations during pregnancy and childbirth (toxicosis of the first half of pregnancy, premature birth, excessively rapid or prolonged, premature release of water, entanglement of the newborn’s neck with the umbilical cord) .
Swaddling is the same routine procedure as feeding. However, some children clearly calm down, being tightly swaddled, others, on the contrary, struggle to free themselves, and only when fairly tired from the abundance of movements do they calm down and fall asleep. The temperament is already visible here.

Children with a choleric temperament find it more difficult to tolerate any constraint and are just waiting to be freed; phlegmatic people prefer to be wrapped up according to all the rules. And sanguine people, that’s why they are sanguine, so as not to make special demands: not very tight and not very loose - it will be just right.
But even outside of temperament, sometimes we see how a child falls asleep only tightly swaddled. Such addictions are associated with the presence of a threat of miscarriage during pregnancy and extremely painful contractions during childbirth. The same factors are involved in the origin of restless sleep in children, since sleep is in a certain way analogous to intrauterine existence, when the child is left alone, in the dark and in a confined space. In addition, negative emotional reactions were recorded in the fetus from the ninth week of life - at the standard age of artificial termination of pregnancy or abortion.

When there is a threat of miscarriage, the appearance of emotional shock cannot be ruled out, which, together with the mother’s similar stress, leads to the release of a large amount of anxiety hormones into the blood. This dose is in some cases enough to disrupt sleep in the coming months and years. A completed miscarriage means the inevitable death of the fetus, but the threat of miscarriage also leads to disruption of the placental circulation and intrauterine hypoxia (insufficient oxygen supply to the fetal brain).
The same applies to excessively intense, painful contractions of the muscles of the uterus during the opening of its cervix. The threat of death, physical destruction reflexively turns on the instinct of self-preservation in the fetus in the form of a defensive reaction of motor anxiety and fear.

After birth, an excessively open space, the absence of a cradle, crib, as well as clothing, gives rise to an unaccountable feeling of anxiety, usually in the form of crying, less often - screaming and difficulty falling asleep. Now it is clear why tight swaddling calms children who have suffered the threat of miscarriage and painful contractions of the mother during childbirth. They are again, as it were, in the womb, but in safe conditions of existence.
The main thing is that if there was any threat of premature birth, swaddling is necessary, reproducing the conditions of safe intrauterine life.

With organic damage to the brain from asphyxia, birth trauma, the sensitivity of the skin painfully increases, there are tremors of individual parts of the face or convulsions, tension, hypertonicity of the limbs and torso. Then tight swaddling, on the contrary, will increase the child’s anxiety and crying; The best option would be loose swaddling or more frequent positioning of the baby fully open.

In general, 10% of boys and 15% of girls are susceptible, according to their parents, to frequent night terrors.
Much more accurate, but not absolute due to repression and amnesia of night fear, we obtain data from direct, morning questioning of children about what they saw at night, including nightmares. Over the course of ten days, 79 children from 3 to 7 years old in kindergartens were interviewed in a similar way. It turned out that during this time, 37% of children (at least every third) had a nightmare, 18% (almost every fifth) saw it repeatedly, sometimes in serials, almost every night. Thus, parents state only the “tip of the iceberg.”

In case of nervous disorders, as shown by an additional survey of children in the speech therapy group of the kindergarten, the CS is even greater.
Regardless of the state of the nervous system, the number of CS in preschool age, according to a survey of children, significantly increases from 3 to 7 years, marking an increasing awareness of the problems of life and death, the beginning and end of one’s life.
We have repeatedly been convinced of the existence of a relationship between the fear of nightmares and their actual presence in children. Moreover, such fear unmistakably indicated the existence of a CS, even if the child could not remember what exactly it was. As already noted, the question was formulated as follows: “Are you afraid of bad dreams or not?”

Despite the possibility of reflecting the past traumatic experience of dreams in the answer, in most cases the answer reflected the current, that is, the last experience of perception of terrible dreams.
A total of 2,135 children and adolescents aged 3 to 16 years were surveyed. The survey data is shown in the table.

Table. Age distribution of fears of nightmares (FS)

From the table we see that the maximum values ​​of fears of CS in boys are observed at 6 years old, in girls - at 5, 6 years old and in preschoolers - at 7 years old (the survey was conducted in the late 70s).
This is far from accidental, since it is in older preschool age that the fear of death is most actively represented. It is precisely this fear that is present in children’s nightmares, once again emphasizing the underlying instinct of self-preservation, which is more pronounced in girls.

A unique comparison can be made among preschoolers and schoolchildren aged 7 years. It seems that the age is the same, but the tendency towards a decrease in fears of CS is noticeable among first-graders. The explanation is similar to the decrease in the average score of all fears at school age, due to the new, socially significant position of the student. This is a kind of left-hemisphere shift in the child’s consciousness, when the right-hemisphere, spontaneous, intuitive type of response (which includes fears) must give way to the rational perception of left-hemisphere school information.
We see that the number of fears of CS is significantly greater in preschool age for both boys and girls. In turn, fears of CS (like all fears in general) are significantly more often observed in girls, reflecting a naturally more pronounced instinct of self-preservation.
It was previously noted that the most active in relation to all fears is the senior preschool age. The fear of CS is no exception, which is closely related (according to computer factor analysis) with fears of attack, illness (infection), death (oneself and parents), animals (wolf, bear, dogs, spiders, snakes), elements (storm , hurricane, flood, earthquake), as well as fears of depth, fire, fire and war. Based on all these fears, one can almost unmistakably assume the presence of nightmares and, accordingly, fear of them.

It is interesting to compare the fear of CS in children from the so-called normal population and children suffering from neurotic personality disorders. People with neuroses have more fears of CS than most of their peers who are healthy. This is not surprising, given the increased anxiety, emotional vulnerability, instability of mood, and lack of self-confidence, self-confidence, and capabilities that are characteristic of neuroses. What also attracts attention is the defenselessness of children, their inability to withstand danger; even a small child can offend them, as one mother said.

Children with fear neurosis are most afraid of CS, when they are so overwhelmed by fear itself that they cannot fight back any dangers that await them day and night.
In children with all neuroses, fears of the CS are most often presented at the age of 6-10, when fears appear during the day, like mushrooms after rain, under the influence of experiences caused by the fear of death, learning problems, etc.
Normally, fear of CS is usually limited to older preschool age. In other words, the fear of CS in neuroses has a more prolonged, extended nature and indicates a more pronounced inability of children to solve their personal problems on their own, without the help of adults.

Since children with neuroses are much more sensitive to CS, it makes sense for them to further consider all the problems associated with CS.
"What is Caesar's is for Caesar, what is Caesar's is for Caesar." The same applies to girls and boys. The former have a relationship with CS during pregnancy, the latter do not, and nothing can be done about it. If there is a girl in the mother’s womb, and the mother has toxicosis in the first half of pregnancy (uncontrollable vomiting), then after the birth of the girl, they will significantly more often see CS and be afraid of them. And toxicosis of the second half of pregnancy (nephropathy), albeit at the level of a trend, will have a similar effect. Boys have similar relationships that are “zero.”

Thus, the mother’s problems during pregnancy and her poor health have a more traumatic emotional impact on girls, as can be seen in their subsequent dreams. Since the fetus “sees” dreams in the womb, starting from 8 weeks of life (according to neurophysiologists), this period of pregnancy can be compared with the maximum severity of toxicosis in the first half. Then our conclusions, even statistically based ones, will not seem meaningless.

When asked why all this is expressed only in girls, we point out their more pronounced instinct of self-preservation compared to boys (remember that girls experience fears 2 times more often than boys). Therefore, toxicosis, creating the threat of weakening and termination of pregnancy, causes, first of all, hormonally mediated anxiety in girls, as a kind of instinctive protective reaction.

The relationship between fears immediately before sleep and fears during sleep, that is, CS, was examined separately. The previously made conclusion about the reproduction of children's daily experiences in the CS was confirmed. Moreover, by the anxiety experienced by children before bedtime, one can confidently judge the appearance of CS in them, even if they are completely amnesic (forgotten) in the morning.

Caroline Tedke, University of South Carolina Medical College, Charleston, South Carolina

Sleep disorders are common in children. It is necessary to distinguish between cases where polysomnography reveals disorders (eg, parasomnias, apnea and narcolepsy) and cases where the problems are behavioral in origin and the polysomnography is normal. Parasomnias (night terrors, somnambulism and enuresis) are caused by immaturity of the central nervous system and often resolve with age. Obstructive sleep apnea syndrome (OSA) in children is often not diagnosed on time, although it can be successfully treated surgically. Behavioral sleep disorders can be treated with proper parental coaching. Doctors can provide significant assistance to such families by recommending effective techniques to parents. ( American Journal of Family Medicine 2001;63:277-84 )

Sleep problems in children are often a concern for parents. A child who doesn't want to go to bed or wakes up frequently during the night often causes very big problems in the family. Sleep disorders in children, confirmed by sleep laboratory data, are in principle similar to disorders in adults. However, problems, which are defined as a sleep pattern that is unsatisfactory to the parent, child or doctor, are more common in children. Defining sleep behavior disorder is quite difficult due to significant differences in sleep patterns at different ages. So, for example, it is not abnormal if a two-month-old baby often wakes up at night, but the same would be a pathology for a two-year-old child. To understand the complexity of the problem, one can also consider the large differences in tolerance to sleep problems, which vary significantly between families.

Normal sleep in children.

Sleep in very young children differs significantly from sleep in adults. Infants under 6 months of age spend 50% of their sleep in the inactive REM stage, compared to 20% in adults. Sleep in babies begins through the initial active REM stage, while in adults the first REM phase appears no earlier than 90 minutes from the moment of falling asleep. The active REM phase often recurs in infants, creating shortened sleep cycles. Before 6 months, restful REM (also defined as restful or uncertain sleep) cannot be subdivided into EEG stages known as mature sleep patterns. After 6 months, an infant's sleep architecture begins to resemble that of an adult. After an initial "settling" period, which usually lasts 10 to 20 minutes, there is a transition from NREM Stage 1 to Stage 3 or 4. The child may return to Stage 1 and repeat the cycle. After one or two cycles of NREM sleep, REM sleep occurs after 60-90 minutes. The first third of the night is mostly deep sleep (NREM Stages 3 and 4). In the second half of the night, stage 2 NREM and REM sleep predominate. In newborns, the total sleep time is evenly distributed between the day and night periods. Nighttime sleep gradually consolidates into one continuous episode by the first year of life. The amount of daytime sleep gradually decreases over the first three years of life. By age four, most children no longer need short naps during the day. The need for nighttime sleep also decreases, so that during adolescence it is comparable to the need for adults.

Scope of the task.

Parents of young children are eager to learn more about what they can expect from their child's nighttime sleep routine. The studies carried out yielded different results because they were conducted on different populations and used different terminology and data processing methods. Typically, the incidence of night awakenings was estimated to be 100% in newborns and dropped to 20-30% in six-month-old infants. Once an uninterrupted night's sleep has been achieved, some children may begin to wake again during the night - this is often the result of social factors rather than maturational problems. Night awakenings are more common in early childhood. Research has shown that approximately one in three children under 4 years of age continue to wake up during the night, requiring parental intervention to get them back to sleep.

Parasomnias

Parasomnias are sleep disorders that are characterized by an abnormal polysomnogram. They are episodic in nature and reflect immaturity of the central nervous system (CNS). Therefore, parasomnias are more common in children than in adults and usually disappear with age. Parasomnias tend to run in families. These disorders are paroxysmal, predictable in their occurrence in a particular sleep cycle, are not responsive to external influences, and are characterized by retrograde amnesia. Diagnosis is often made solely on the basis of a thorough history. Additional diagnostic tests are rarely required.

Pavor nocturnes or night terrors

Pavor nocturnus or night terrors occur approximately 90 minutes after falling asleep, in stage 3 or 4 NREM sleep. The child suddenly sits up and begins to scream uncontrollably. It may take up to 30 minutes for him to calm down and fall back to sleep. This is accompanied by tachycardia, rapid breathing and other signs of autonomic activation. Night terrors usually occur in children between the ages of 3 and 8 years. They must be distinguished from nightmares (Table 1). Night terrors are more likely to occur during periods of stress or overwork. Despite their frightening nature, parents need to make sure they are self-limiting. We must try to find out if there is any stressful situation in the child's life and make sure that the child has opportunities for rest and recovery. Children whose night terrors do not resolve on their own and whose episodes are extremely disruptive may be given diazepam (Valium).

Table 1. Comparison of night terrors and nightmares

Sleepwalking and dream-talking

During sleepwalking (somnambulism) and sleep-talking (somniloquy), the child sits up in bed with his eyes open, but with the so-called “blind gaze.” Activities can range from resting aimlessly in bed to actually walking around the house. Speech is unclear and rarely intelligible. These disorders occur in school-age children, more often in boys than in girls, and are often also accompanied by enuresis. Children who sleepwalk can be injured and parents need to take steps to avoid dangerous situations such as falling from balconies or stairs. Sleeping rooms for such children should be on the ground floor, with windows and doors securely closed. During an episode of sleepwalking, parents should interfere minimally and refrain from shaking him or yelling at him. This type of sleep behavior usually resolves with age and usually does not require special intervention other than the precautions noted above. Another method is the so-called “scheduled awakenings”. Parents keep a diary, record the time when sleepwalking occurs over several nights, and then begin to wake the child 15 minutes before the expected time. In this case, it is necessary to make sure that the child is in a state of full wakefulness for at least 5 minutes. Using this method eliminates sleepwalking in 80% of children.

Nocturnal enuresis

Nocturnal enuresis or bedwetting is one of the most prevalent and persistent problems in children. Enuresis is classified as primary if the child has never previously been “dry” in bed and secondary if it occurs after the child has been able to hold back urination for at least a year. Primary enuresis is much more common and is unlikely to be a consequence of pathology.
The etiology of primary enuresis is most likely multifactorial. Often primary enuresis is associated with a family history. The ability to contain urine is closely related to the maturity of the nervous system and a child who is developmentally delayed at the age of 1-3 years is much more likely to be enuretic at six years of age. Enuretic children were found to have lower functional bladder capacity (the volume of urine the bladder is able to hold) than non-enuretic children, although true capacity did not differ. And finally, enuresis is considered by most researchers to be a parasomnia, since it is observed only in the stages of NREM sleep. However, despite the subjective opinion of parents, enuretic children are no more difficult to wake up than others.
In most cases, if a thorough history, general and neurological examination shows no symptoms of other disorders, no additional diagnostic tests, including urinalysis, are required. As a rule, even before the first visit to the doctor, parents are already taking some measures, in particular, limiting evening fluid intake, waking up the child to go to the toilet before the parents themselves go to bed. Although doctors sometimes resort to drug treatments, such as imipramine (Tofranil) and, as a follow-up, desmopressin (DDAVP), numerous studies have shown the superiority of wetness signals in terms of effectiveness, lack of side effects and low recurrence rates. These devices are available through pharmacies or can be ordered online. There is also "continence training" (bladder training), which involves a number of techniques that are, however, beyond the scope of this article (see Sheldon).

Obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSA) is thought to affect 1-3% of children. Symptoms include snoring and labored or mouth breathing during sleep. Parents of infants with severe OSA may experience difficulty feeding their child. OSA in children is often caused by adenotonsillar hypertrophy. Other causes include craniofacial pathology, obesity, and neuromuscular diseases. A high percentage of allergic diseases has been reported in children with snoring and OSA.
In adults, airway obstruction is transient and often very severe. In children, if the cause is adenotonsillar hypertrophy, the obstruction is permanent, but less pronounced. Children are less likely to experience hypersomnolence (daytime sleepiness) than adults, but they also often experience enuresis, excessive sweating, and developmental delays. OSA. There is clear evidence of OSA in a certain percentage of children experiencing learning difficulties and behavioral problems, including attention deficit hyperactivity disorder. The diagnosis of OSA is made in a pediatric sleep disorder laboratory using overnight oximetry and polysomnography. Most of these children experience significant improvement after tonsillectomy. The latter is not indicated if the cause of OSA in the child is another pathology (craniofacial anomaly, neuromuscular diseases, obesity). In these cases, and also if tonsillectomy surgery does not bring a satisfactory result, treatment with CPAP, a device that creates positive air pressure in the upper respiratory tract, can be prescribed. This technique is usually used in adults, but has also been shown to be effective and safe in children.

Narcolepsy

Narcolepsy is not common in childhood, although it can occur in adolescents. The main symptom, as in adults, is increased daytime sleepiness. Obviously, this can create difficulties in the learning process. Cataplexy or hypnagogic hallucinations are much less common in children than in adults. At first, the child begins to experience difficulty waking up in the morning. Upon awakening, there may be some confusion, and the child may even be aggressive in words and actions. Diagnosis can be quite difficult; initial polysomnography may be normal. If the diagnosis remains in doubt, repeated polysomnography is indicated. These children may benefit from regular short naps during the day. Sometimes drug stimulation may be required. Because it is a lifelong condition with increased mortality, children with narcolepsy should be monitored by a sleep specialist.

Secondary sleep disorders

Secondary disorders are much more common than primary ones and are characterized by normal polysomnography data. Disturbed sleep patterns are often temporary, but can cause serious problems in the family if they continue for a long time. The most common secondary sleep disorder is night awakenings and reluctance to fall asleep at the appointed time, which is most often observed in children just starting to walk and in general in the preschool period. Although 95% of newborns cry after waking up at night and require parental attention to fall back to sleep, by the age of one year, 60 to 70% of children can actually fall back to sleep on their own. The concept of sleep associations is important. A child who goes to bed awake and learns to fall asleep using comfortable measures is usually able to self-soothe if he suddenly wakes up in the middle of the night. Conversely, a child who falls asleep with the help of a parent, such as rocking or simply physical presence, may have difficulty falling asleep independently after waking up in the night. In such cases, parents can be advised to change behavior, stop rocking the child, etc., wait longer than usual when the child cries after waking up, until the child gradually learns to calm down and fall asleep on his own.

Colic and night awakenings.

Colic in children is often a real scourge for young parents. While colic is not a sleep disorder in itself, infants with colic have shortened total sleep duration. Sleep problems can sometimes continue after colic has passed with age - because the measures that parents used to stop crying attacks (rocking in arms, in a stroller) can interfere with the development of a normal sleep pattern. An infant over 4 months of age who continues to wake during the night is considered a “trained night cryer.” These babies calm down quickly after being held. One way is to recommend that parents gradually increase the time intervals of “ignoring”; another way to stop a child’s crying is “cold turkey.” Either method leads to difficulties for several nights, but ultimately helps in “training” the child to fall asleep independently (Ferber). Another method that is also effective and more readily accepted by some parents is “scheduled wake-ups.” In this case, parents wake up the child at a certain time, shortly before the child is expected to wake up on his own. Once the frequency of spontaneous awakenings decreases, the length of the interval between “scheduled awakenings” may increase until the spontaneous awakenings stop.

Disorders of sleep initiation and maintenance

Disorders of initiating and maintaining sleep (DIMS) are most often found in preschool children due to the characteristics of psychological development and the difficulties inherent in this age. Sometimes parents have difficulty setting firm limits or agreeing with the child’s demands - “one more glass”, “one more fairy tale”. In such cases, parents are advised to perceive such attempts to delay bedtime calmly but firmly, ignoring the child’s protests. You can avoid further confrontation by telling your child that the door to his room will be open while he is in bed, but will be closed (not locked) if he tries to get out of it. One recommended technique is called a "bed passport" - a card with the child's name written on it that can be exchanged without penalty for one short exit from the bedroom per evening and then returned to the parent for the rest of the evening. For children who have difficulty falling asleep, it may be helpful to develop a predictable routine - 3 or 4 components, lasting 20 to 30 minutes, for example, a story, a song, a drink, a back massage; Constant use of this procedure is very effective. The procedure can be shifted in time earlier, until the desired time.

Sleep problems in older children.

In adolescence or a little earlier, sleep problems become more pressing again. As parental supervision wanes and educational and social demands increase, sleep may begin to become more and more inconsistent. Sometimes there is a delay in the onset of falling asleep, a decrease in sleep time and increased daytime sleepiness. In some cases, such children may develop delayed sleep phase syndrome. This means that they cannot sleep at night and cannot stay awake during the day. This condition may represent a form of school avoidance. Treatment consists of strict control of the time of falling asleep, which gradually shifts towards the evening. A summary of sleep problems and suggested measures is presented in Table 2.

Table 2. Sleep disorders at different ages.

Co-sleeping

Co-sleeping is a term that refers to parents and children sleeping in the same bed. Many experts frown upon the practice due to concerns about possible sexual harassment or infringement of personal autonomy. However, statistical studies do not reliably confirm these concerns. Co-sleeping is especially popular in a number of cultures and is believed to promote a sense of security and love in a child. Regardless of the above, it can be argued that the frequency of co-sleeping is much higher, since parents may simply not talk about it or even hide it for fear that the doctor will frown on it. According to various sources, 33-55% of preschoolers and 10-23% of schoolchildren sleep in the same bed with one of their parents. One cannot ignore the possibility of dramatic consequences not related to sleep disturbances themselves. Recently, a special commission in the United States published a report that over 8 years described 515 deaths of children sharing beds with adults. Approximately every fourth death was caused by mechanical compression of a child by an adult. Three quarters of the cases were caused by mechanical problems with the bed or mattress, which led to strangulation and suffocation of the child.

How to improve and normalize your sleep pattern.

Due to the prevalence of sleep disorders in children, the pediatrician or family doctor should pay attention to this aspect during each of his visits or examinations by asking parents (Table 3). The doctor should tell parents about the importance of healthy sleep in a child, no less important than normal nutrition or dental growth. If you have any sleep problems, you need to take a thorough history and look for other medical problems, such as chronic diseases, respiratory problems, seizures, recurrent ear infections, and medications. It is very effective for parents to keep a diary of their child’s sleep throughout the week. Parents need to be taught how to develop bedtime rituals and how to behave at night in the event of a particular problem.

Table 3. Questions for parents to assess their child’s sleep

Each visit should include questions:

If in response to a question the parent indicates problems
What time do you put your child to bed?
What usually happens in your house before dinner and falling asleep?
What do you usually do 60 and 30 minutes before falling asleep?
What happens when the lights turn off?
When a child cries, how do you respond? How fast?
Does the baby get a bottle or be handled when falling asleep in the evening?
Is the baby given a bottle or handled when waking up at night?
How many times does a child wake up at night?
How do you or the other parent react?
How quickly does a child fall asleep again?
What time does the child wake up in the morning?
Does the child play quietly on his own before falling asleep or does he wait for someone to approach him?
Does the baby sleep in a cradle or in a bed?
Are the conditions in the child's room conducive to falling asleep?
Does your child ever sleep in bed with you?
Does your baby sleep with a toy, stuffed animal or favorite blanket?
Does your child fall asleep during the day? How often? How long?

The child's body needs more sleep than food. Good sleep indicates the health of the child.

15% of children have some disturbances in night rest. Let's look at why some children have sleep problems. In what cases should you consult a doctor because of your child’s poor sleep? Let's listen to the advice of neurologists and baby food nutritionists.

Many children experience sleep disorders to varying degrees.

Why do children need to sleep?

Sleep is a physiological state in which recovery processes occur in the body. At night, children produce growth hormone. It’s not for nothing that they say that children grow in their sleep. During sleep, the immune system is restored through the production of immunoglobulins and the activation of protective T-lymphocyte cells. While children sleep, the short-term information they accumulated during the day passes into long-term memory. In other words, at night the knowledge gained during the day is consolidated.

The duration of sleep in children aged 2–3 years is 12 hours, of which 1.5–3 hours are during the daytime rest. As they grow older, daytime rest decreases and by the age of 4, the need for it disappears in many children.

Types of difficulty falling asleep and awakening at night

The disorder is considered to be difficulty falling asleep or waking up frequently at night. There are more than 100 types of sleep disorders, which fall into 3 main types:

1. Insomnia – difficulty falling asleep and waking up at night.
2. Parasomnias – sleepwalking, night terrors, enuresis, sleep talking, bruxism, twitching.
3. Sleep apnea is short-term cessation of breathing.

Parasomnias are caused by immaturity of the nervous system and disappear by adolescence. Long-term sleep disturbance for more than 3 months requires observation by neurologists. If the problem persists, somnologists conduct a study using polysomnography.

Individual characteristics of children

Each child is different, so he may need less sleep than other children his age.

As children get older, they need less time to rest at night and more time to stay awake. The peculiarities of the physiology of children from 2 years of age are that their sleep and wakefulness patterns are already established, and babies can sleep all night. Due to individual characteristics, some children sleep less than their peers, but still feel fine. Such characteristics of children are not associated with any diseases. The fact that, in your opinion, your child is sleeping little for his age is a problem, may be the reason to consult a doctor.

Causes of difficulty falling asleep or waking up at night

Sleep disturbance in children 2 years old is often associated with improper diet and diet or caused by diseases.

The most common reasons:

• neurological causes;
• emotional overload during the day and before bedtime;
• poor nutrition;
• physiological characteristics;
• somatic diseases.

In children 2 years old, the most common reason for poor sleep or interruption of night rest is emotional overload, which can manifest itself in the form of night fears.

What to do if you have disturbed sleep?

Most often, the cause of night fears is emotional overload before bedtime and improper sleep schedule. Sometimes the cause of fear is fear. Emotional overload can be caused by the late return of the father, who before bedtime arranges noisy emotional communication with the child. Excited children have difficulty falling asleep and often wake up and call for their mother. Such conditions occur several times a week. Night terrors go away by adolescence.

Noisy games in the evening should be canceled

If the baby wakes up at night from his own scream, take the baby in your arms, calm him down in a quiet voice and ask all household members who have come running to the scream to leave the children's room. If your child has frequent night terrors, you should consult a neurologist. Prolonged night terrors may be of epileptic origin.

When treating sleep disturbance in children 2 years old, it is very important to adhere to the following measures:

• maintain a daily routine;
• do not allow games on the computer or phone before a night's rest;
• It is recommended to put a 2-year-old baby to bed at 21:00 at the same time;
• ensure daytime sleep of 1.5–2 hours;
• Avoid watching TV before going to bed;
• an hour before falling asleep, do not allow noisy active games;
• It is useful to take a walk with your baby before bedtime or dinner;
• Before going to bed, ventilate the room well;
• The baby should not be too hot or cold during the night's rest.

Daytime rest is important for children 2 years old. A baby who does not sleep during the day will not sleep well at night. It is useful to perform a ritual of preparation for falling asleep - collect toys, read a fairy tale. At a younger age, if you have trouble falling asleep or waking up at night, you can give soothing herbal infusions of valerian and lemon balm. It is useful to conduct a course of treatment before going to bed with warm baths with an infusion of a herbal collection consisting of equal parts of thyme, valerian, motherwort, and lemon balm. For infusion, brew 2 tbsp. l. dry mixture with 1 glass of water and leave for a quarter of an hour in a water bath. The water temperature should not be higher than 37.0 °C.

Poor nutrition

The child’s diet should be balanced and fortified

Sleep problems in healthy children can occur due to poor nutrition. The daily diet should be sufficiently high in calories. The food eaten at dinner should be enough to prevent the baby from waking up at night from hunger. A large dinner before bed will cause stomach cramps. Chips and fast food can cause vomiting in children at any time of the day. The nutrition of children 2 years old should be balanced.

The diet of children from 1 to 3 years old should contain the following products daily:

• Animal protein is a building material necessary for growth and providing iron to the blood. With a lack of beef meat dishes, children develop iron deficiency anemia and the immune system weakens. Due to a lack of protein, children lag behind in development and their memory deteriorates.
• Fish is a source of vitamin D, without which a deficiency of calcium, phosphorus and magnesium occurs in a growing body. An imbalance of these minerals negatively affects the growth of bones and teeth of a growing organism. With a lack of minerals, children sleep poorly, sweat in their sleep, and develop dental caries. Deficiency of minerals and vitamins affects the intellectual development of children.
• Dairy products are a source of calcium and protein, which are needed for the formation of bones and teeth in a growing body.
• Fruits and vegetables provide the body with vitamins and minerals.

Children from 1 year to 3 years old need food after cooking. Vegetarianism for children from 1 to 3 years old is unacceptable. From a medical point of view, fasting is interpreted as an inhumane attitude towards children. The raw food diet method is also unacceptable for feeding children. Children as young as 2 years old cannot digest that much raw food. The gastrointestinal tract of children from 1 year to 3 years is not able to provide enzymes to digest raw fiber. The result of a raw food diet will be gastritis and colitis. Eating problems make it difficult to fall asleep and cause awakenings at night.

Snoring in children

The reason for frequent awakenings may be snoring, which occurs in some children after 1 year with enlarged adenoids and tonsils. With severe enlargement of the tonsils, the flow of air to the lungs is limited. The child wakes up from oxygen deficiency. In severe cases, the adenoids can be so enlarged that during sleep they completely block the air flow and cause a short-term cessation of breathing - apnea. Children often wake up and feel drowsy during the day. With such a serious sleep disorder, children need examination by ENT specialists and somnologists who examine sleep using polysomnography. In case of enlarged adenoids and tonsils, surgery eliminates snoring and restores nighttime rest.

As a result, we emphasize that the main sleep problems are emotional overload and disruption of the routine. Improper or insufficient nutrition also contributes to sleep disturbances in children aged 1 to 3 years. To get rid of the problems of night rest, you need, first of all, to establish the correct regime and regulate a balanced diet.