Sleep phases in children 2 years old. Biological rhythms and internal clock. Sleep is conditionally divided into phases

Every adult spends about one third of his life sleeping. Newborns sleep much more. Let's figure out together what and how happens during this very important process for everyone.

Theory about sleep

Despite the fact that many people think of sleep as a vacation, it is actually a very complex and active life process. Next, we will analyze several aspects of physiology. healthy sleep to understand its structure and the problems that may arise in this area.

Sleep phases.

During a night's rest, a person experiences two states of sleep. For the sleeper himself, these transitions pass imperceptibly. But if you apply an electroencephalogram, you can clearly see the difference between these two phases.

First- this is REM sleep, or, as it is also called REM sleep (from the English “rapid eye movement”, “rapid eye movements”). Characteristic of this state is that there is a movement closed eyes at the sleeper. Looking closely, you can see how under the closed thin eyelids of a sleeping baby move eyeballs. This type of sleep is also called active sleep. It is at this stage that the increase blood pressure, can go astray and heartbeat. Muscle tone decreases, legs, arms, facial muscles can finely tremble. If you lift a man from the stage REM sleep, then he will abruptly go into a state of wakefulness. Dreams also come to a person during this period, however, we do not always remember them in the morning. A large proportion of REM sleep occurs in the early morning. Newborns may well wake up briefly during this stage, and this is completely normal. The child may turn over, look around, pull up the blanket or shift his head to the other side, but then he will fall asleep again just as quickly and carelessly. A change in the environment around him can interrupt the baby's falling asleep after a short awakening. Here, in order for the baby to fall asleep again, it will be necessary to re-create that primary environment. By the way, this is often one of the most common sleep problems. This can be avoided if you initially teach your baby not to pay attention to the situation and fall asleep after a short awakening in the REM stage, despite its changes.

second phase of sleep also called slow sleep. During such a dream, the actual rest occurs. During slow sleep, breathing and heart contractions remain unchanged and rhythmic. The sleeping person lies motionless, his muscles are completely relaxed. Four stages can be distinguished slow sleep, from drowsiness (first stage) to deep sleep (fourth stage). The lion's share of slow sleep occurs at the very beginning, namely in the first hours after falling asleep. Quite often, hypnagogic fright occurs when falling into non-REM sleep. This is a condition in which all parts of the body tremble, and these tremors can be so sharp that they can lead to a short-term awakening of a person. But still, if the sleeper has reached the phase of slow sleep, it is not at all easy to wake him up, especially in his deep phase.

Some babies, closer to the end of the slow wave sleep stage, may wake up for a while. These awakenings are somewhat different than in the stage of REM sleep. The baby can sit up in bed, open his eyes, look around with an unseeing eye, make chewing movements, even scream something or mumble incoherent words, and then fall asleep again. This phenomenon is quite normal, there is nothing wrong with this behavior of the baby.

Sleep structure.

The phases of fast and slow sleep replace each other throughout the night, making up cycles. For newborns, the REM-NREM cycle takes about 50 minutes. Teenagers and adults are given about an hour and a half for this cycle. Upon reaching babies 3 - 6 years old one month old, their sleep structure will be as close as possible to that of an adult. In the beginning, there will be an immersion in slow sleep, and after 10 minutes they will already be in the deep stage of this sleep. The duration of such a dream will be from 40 minutes to an hour, followed by a short awakening, which will take only a few minutes, and then a REM sleep, which will last from 5 to 20 minutes. Further, within a few hours, the baby will fall into REM sleep, then into the second phase of a slow one. Younger children may additionally be in the third or fourth stage of non-REM sleep in the morning. Dreams usually appear early morning. It is possible to recognize the structural specifics of sleep even during the period when the child is in the womb. Already in the sixth - seventh month of development, REM sleep becomes characteristic of the fetus. slow stage manifests itself somewhat later, on the seventh - eighth month, but it is still not fully developed at this time. Usually, all four phases of slow sleep can be identified only in a six-month-old child.

Baby sleep video:

Schedule

How does the daily routine of a child change at different ages?

After your baby is born, he will need to get used to being outside of his mother's belly. A full-term baby will sleep 16-17 hours a day for up to three months of his life, a premature baby and even more - about twenty. There is usually a clear distribution of sleep and wakefulness. Often after three hours of sleep comes an hour of walking. This is related to the feeding cycle. As soon as the baby satisfies his need for food, he falls asleep. Waking up again hungry.

Sometimes a newborn can be awake for a while after feeding, but he cannot do without sleep for a long time. Closer to one and a half - two months in daytime there is also time for the activity of the baby. This period is the most successful for the games of the child with his mother. Such stimulation of activity will only play into the hands of parents, because the newborn will be more clearly aware of the difference between sleep and awakening. This will help solidify your daily routine. Changes in regimen will come by the age of three months. This will be noticeable by how it will put the baby to sleep in the morning and at noon. And this precedes the emergence of a new daily routine, according to which the child sleeps two to three times a day. This regimen will last up to 12-15 months.

When the baby is three to six months old, his rhythm of life becomes more adapted to the general way of the family. The duration of his sleep is 14 hours a day, of which 9 - 10 hours are at night and about 5 per day. The time of onset of sleep is almost identical and repeats from day to day: night sleep can start from 7 to 9 pm, and the morning rise will be between 6 and 8 am. At this age, almost all children can sleep without awakening for about seven hours.

At six to nine months, the baby's daily routine becomes more complex. The child sleeps about 13 - 15 hours. Basically, the morning awakening occurs around 6.30 - 7.00, then there may be two daytime sleeps lasting about an hour and a half and a night sleep from 19.30 - 20.00. Most of the children, and this is about 80%, sleep through the night. Gradually, the connection between feeding and sleep begins to blur. If you correctly stimulate the activity of the baby, then he will not fall asleep immediately after eating. It is during this period that you need to try to develop a new version of putting the child to sleep in order to prevent all kinds of problems related to this in the future.

With the onset of 9 - 12 months, the child spends 14 hours a day sleeping. 12 hours falls at night and twice a day for an hour. Sometimes children may refuse their first daytime nap. At the same time, they either sleep longer in the afternoon, or go to bed early in the evening. Different temperaments of children also make their own adjustments to the daily routine. Hyperactive babies, and at this age their activity is always quite high, require a longer rest. If the child diligently learns to walk, then he may try to develop these skills even in the crib. Sometimes even a child may wake up and burst into tears simply because he will not know how to lie down to continue the dream. In such cases, mothers should try to develop this skill during the daytime.

Upon reaching the baby of this age, it will be necessary to make the moment of going to bed longer. Now it should be at least 20 minutes, because it is necessary to give the child the opportunity to calm down. During this period, your baby may refuse to go to bed. His physical strength is already able to survive a long wakefulness. In a very short time, the child will use this power with might and main, especially at those moments when he is nervous, when he does not want to interrupt the game he is interested in, or when he does not want the people he likes to leave.

Temperament and mode.

Each individual, as we know, has his own character traits and his own temperament. And all these features play a huge role in our life, adjusting everything in their own way. In particular, this affects the mode of life, how long a person can stay awake, how much and when to sleep. Child psychologists, analyzing temperaments, distinguish three main types of children: difficult, flexible and slow guys.

Compliant child has a clear daily routine. Both wakefulness and sleep occur unchanged, daily, at the same time. Such a baby falls asleep on its own, without anyone's help. As soon as you put him in the crib, he immediately begins to gradually fall asleep. Such children sleep for a long time and soundly enough, they do not tend to cry even with short-term awakenings during sleep. For difficult children characteristic features are prone to bad mood and isolation, erratic daily routine, hyperactivity, intensity of reactions. It would seem that such children have no inclination to at least a minimal ordering of the periods of sleep and wakefulness. To establish this mode, one cannot do without the help of others. He needs more time to fall asleep. If you connect external stimuli, then the transition from wakefulness to sleep will be somewhat easier. For example, you can swaddle a child, shake him in your arms.

Just remember that when the baby gets used to this kind of laying, then it will be much more difficult to wean him. Such children usually sleep less by two hours at night and an hour during the day, compared to complaisant ones. Also, these children are characterized by the prevalence of REM sleep, which, in turn, is dependent on external stimuli. That is why such children are prone to frequent awakening and anxiety.

Children with a slow temperament are no different increased activity. They often withdraw into themselves, especially when they find themselves in an unfamiliar situation. It is quite difficult for them to adapt to a new environment and they need to get used to it. extra help parents. It should also be noted that the temperament of children does not depend on the upbringing of parents, it goes to the baby from birth. Keep this in mind, especially if you are going to self-flagellate about the child's inappropriate behavior.

A place to sleep.

Part of the room, or a room in the apartment where the baby will sleep, should become his fortress, his little planet, a place where he would be calm and good. In no case should parents allow the child to associate negative things with this place. You should not punish him for disobedience, for example, by sending him to a place of sleep, so as not to form negative parallels.

The crib is the most important and most central element of the "sleeping kingdom". The main characteristic of this piece of furniture should be safety. Choose a crib made from environmentally friendly materials, preferably from natural wood. It is also worth paying attention to the rods.

Between them there should be neither too small nor too large a distance, ideally, they should be at a distance from each other within 2.5 - 6 cm. This will be enough to prevent the baby from falling out or suffocating. Painted cribs must also comply with safety requirements. The paint used should not contain salts. heavy metals especially lead.

Such a crib device is considered ideal, where the bottom is adjustable, falling to a lower height, which is convenient when the child grows up. The height must be such that top part the crib was up to the shoulders of the baby standing on the mattress. The mattress itself should fit snugly against the crib frame, without gaps and cracks, so that the baby does not damage his arm or leg.

There are several types of mattresses: spring, foam and stuffed. Mattresses made using springs or stuffed with durable orthopedic material (coconut flakes, for example) will last you much longer, but they will also cost a pretty penny. Foam mattresses are much lower in cost, but they need to be turned over from time to time to prevent deep dents. This must be done at least once a month. The main requirements for a mattress are the correct rigidity and a flat surface. This is an extremely important point, since the mattress is directly involved in the formation of the child's spine, in addition, it should not block the air supply.

You should also remember that for a child under one and a half years old, it is unacceptable to use pillows, folded diapers, etc. If you allow your baby to play with toys or objects in the crib, be careful. Tie a soft protector to the sides of the crib. Remove any items from the crib that your child might use as a stepping stone, especially if your child has already learned to stand. This also applies to large soft toys. Also, make sure that small toys, objects, laces and ribbons do not get to the child - all this can cause suffocation. If your baby takes a pacifier, in no case do not hang it around his neck. There are special clips for these purposes, which are safe and will not harm the health of the child.

Baby sleeping position.

Quite often, parents doubt the correctness of the sleeping position chosen by the baby. Most scientists lean toward the supine position as the most appropriate for newborns, as there is an opinion that cases of sudden infant death are associated with sleeping on the stomach. If you look at the situation from the other side, then, lying on your back, the child may burp, especially if he is predisposed to this. Being in a state of sleep, he can simply choke on the products of regurgitation. Therefore, the most optimal, as it seems to us, is the pose on the side. There are special rollers that can help fix the baby in this position.

No need to accustom the child to sleep in absolute silence. There is absolutely no need to tiptoe, turn off the TV, or shush anyone who is talking next to the crib. Also, do not artificially shade the room during daytime sleep. Children from birth have the ability to ignore external stimuli, especially when they want to sleep. And you, by striving for the ideal, can form bad habits sleep in an infant, he will quickly get used to sleeping only if certain parameters are observed. By doing this, you will significantly complicate the life of all other family members.

Uninterrupted night sleep.

The long-awaited for every parent is the time when he sleeps through the night, without sudden awakenings. For a child, the whole night is a dream for 5 to 6 hours in a row. This is where maturity plays an important role. nervous system, because it is in her power to combine several sleep cycles during these 5-6 hours. Some significant changes does not occur during sleep, it’s just that the baby develops a good habit of coping with night awakenings on his own. And so, the phases of quiet and active sleep alternate, as before.

Until the moment when the baby reaches the weight threshold of 5.5 - 6 kg, he will not be physically able to withstand long intervals between feedings (more than 3 - 4 hours). Most pediatricians are inclined to the fact that the child himself should refuse to feed at night.

In this situation, there are two options. If your child, for all ideal performance height and weight for his age, waking up in the middle of the night, actively sucking his breast, then perhaps his body has not yet lost such a need. And if he just reflexively sucks his chest and immediately falls asleep, barely waking up and not eating the proper amount of food, then here, most likely, just a habit, one of the ways to facilitate the transition to sleep. In this case, you can try to rebuild his associations and reflexes associated with the period of sleep in a different direction.

daytime sleep

Sleeping in the daytime will help you gain strength for a cheerful rest of the day in good mood. Parents should remember that for the children's daily routine, both the time and duration of daytime sleep are of great importance. If the child goes to bed too late, or sleeps longer than expected, this will definitely affect the night's sleep and it will be more difficult for you to put him to bed in the evening.

Sleep ritual

If a child has a persistent reluctance to go to bed, parents should consider a special ritual that will help him come to terms with the fact that he needs to part with mom and dad for a while. During the growing up of the baby, this very ritual will become an indicator of independence in specially given conditions. Parents have the right to decide how many books they read to the baby before bed, but the child himself will choose which books they will be. The same is true with audio recordings, the baby himself has the right to decide what to listen to today. With the help of such a ritual, we provide the opportunity for children to control the situation themselves. When the sequence of ritual actions is clearly developed, the child will be ready for this and will even be in anticipation of each element of the ritual.

It is possible to determine which ritual to apply according to the level of development of the child. As he grows up, the action itself will change. For newborns, everything should be extremely simple, but better, everything should develop naturally, as if by itself. If, upon reaching the child for six months, the ritual has not been developed, then the parents must create it. It may include soothing activities such as rocking or swaddling, music, singing or reading can play an important role in this. At the end of a short transitional period, the child, not yet completely asleep, should be placed where he will spend the rest of the sleep. Objects that can be put to the baby in the crib can help to finally fall asleep. It can be a toy, or maybe even an item of clothing for mom or dad with their characteristic smell. Just don't forget about safety!

Co-sleeping with a child

Until this time, we talked about the fact that the child should sleep separately from the parents. But there is a completely opposite opinion on this matter. For many families, it is absolutely normal for the baby to stay in the bed of dad and mom while sleeping, this is considered very useful and, of course, the most convenient.

The place where the child will sleep is chosen in the first year of his life. It is not difficult for a newborn to adapt to both independent sleep and sleep with parents. Once the habit of falling asleep is fully formed, it will be extremely difficult for you to change something and redo it in a new way. Therefore, when making a decision, take into account the opinion of all family members. In any case, your choice should not infringe anyone.

Benefits of co-sleeping.

The main arguments in defense co-sleeping can be called those that the baby has constant access to parents at any time of the day. Such a pastime gives a more sense of security to the child, and he feels happier. For parents, this is another confirmation of their love and care for the baby.

It also makes it possible to quickly calm or feed the baby before he starts crying. Next to dad and mom, the baby constantly feels their warmth, he is not afraid of going to bed, he is not annoyed by this moment, because he knows that he will not have to part with his relatives. There are studies that have shown that babies who sleep with their parents wake up less often and are less prone to nightmares. There is also an opinion that when a child and his parents have a joint rest, the phases of sleep are synchronized.

Arguments against co-sleeping.

On the other hand, there is an opinion that co-sleeping prevents the child from acquiring such a necessary skill as sleeping alone. Such children, according to opponents of joint sleep, grow up more dependent, restless, prone to infantilism. There are also certain fears that such children, having become accustomed to the fact that their parents are available around the clock, become spoiled. Adults themselves also need at least some time to be alone in order to replenish their energy reserves. Many, in addition to this, are concerned about how co-sleeping affects spontaneity. In addition, according to pediatricians, parents can infect the baby with various infectious diseases. Do not forget about the danger of accidentally crushing the baby in a dream.

To resolve the situation regarding joint sleep, young parents can choose compromise solutions. They can identify a range of circumstances in which it is okay to take your baby to bed, such as early mornings or weekends, or when the baby has a nightmare or is sick. Whatever your decision, it is important to determine the motivation for this choice.

Often, mom and dad, only out of desperation, allow the child to sleep with them if he constantly wakes up at night. Co-sleeping saves them from having to get up from their warm bed and go to the next room to calm them down crying baby. Often, children sleep more peacefully with their parents, but do the parents themselves feel comfortable at the same time? Quite often they experience irritation and anger in such situations. So isn't it easier to solve the problem with the awakening of the baby, and not add to this a new one - the problem of personal discontent?

The main task of parents is to create a favorable atmosphere in the family for healthy formation, growth, development of the child. The health of the baby is laid not from the first days of life, but long before conception. In order to adulthood the little man entered physically and mentally healthy, competent parents take care of a full-fledged balanced diet, a favorable atmosphere in the family, compliance with the mode of wakefulness and sleep of the newborn.

Why do you need sleep

Sleep is necessary for the body to rest, relax, restore. In a dream, a person relaxes, daytime stress is removed. Nature is conceived in such a way that during sleep, immunity is activated, regeneration of all systems and organs is underway. Such work takes time, an adult is given an average of 8 hours a day for this.

A full restful sleep is necessary for a person, especially such a small one, just born. His small body is not yet sufficiently formed, it does not know how to independently recover and defend itself. Therefore, parents create comfortable conditions so that the sleep of the newborn proceeds calmly, for a long time. Pediatricians are advised to monitor the duration and quality of daytime and nighttime sleep, keep a diary so that it is possible to trace the dynamics of changes.

How much sleep do you need

Small children under the age of one year sleep long enough. Monthly baby (until he was three months old) sleeps from 16 to 20 hours a day. At night, the baby wakes up two or three times to eat.

Up to 3 months, babies sleep about 20 hours, that is, almost all the time, waking up only to “eat”. But 16-17 hours of sleep is also a variant of the norm

Gradually, time moves in the direction of decreasing sleep hours and increasing waking hours. By six months, the child sleeps only 14-15 hours, and the rest of the time is devoted to eating, studying the environment, and communicating with parents.

In a year, this time decreases even more, to 13-14 hours. Night rest lengthens, during the day there are more and more interesting things, the baby begins to walk and talk, so he has no time to sleep.

From a year old to 3 years old, the baby grows rapidly, changes, the rest time decreases to 12 hours, and to school - up to 9-10 hours. After 12 years, the child gradually moves to 8 hours of sleep, as in adults.

How babies sleep

Young parents often do not know how to properly put their baby to sleep. Experienced Moms they argue and prove that the baby after eating should sleep only on his side. This is true, because the position on the side helps good digestion, and if regurgitation occurs, everything will drain onto the pillow.

Pediatricians say if the baby sleeps on the tummy, do not be alarmed, this is normal. When the baby lies on his stomach, his gas is moving away, and at the onset of colic this is the best position. Even the smallest ones can turn their head on their side to breathe in air. But this is provided that the mattress (and not the downy feather bed) is quite hard, the child has the opportunity to lean on and push off.

The best sleeping positions are on your side and on your tummy. If the baby likes to sleep on his stomach, take care of safety precautions: a moderately hard mattress, no pillow and mom's vigilance

Sleep disturbance

The first year, while the baby is small, the mother is frightened by every deviation in his behavior, nutrition, movement, breathing, in his entire little life. It happens that in a dream the baby shudders, tosses and turns, sleeps with open eyes, sighs, groans. All this scares mommy and seems like a terrible problem.

In fact, if the baby is healthy and full, he sleeps calmly, serenely spread out, spreading his arms and legs in all directions. Some babies constantly sleep in the fetal position, so they are calmer.

Sleep disturbances occur different reasons, but often the problem is solved without the intervention of a doctor. So, if during the day the baby receives a lot of information, his nervous system and brain are overexcited. If the tummy hurts or teeth are cut, the child behaves nervously, restlessly. Do not be surprised, but conflicts in the family between adults also affect the quality of sleep. Adequate parents remember this and do not allow scandals in the presence of crumbs.

If the causes of sleep disturbance are mental or somatic, try to identify them, get treatment to eliminate the problems if possible.

Among the main causes of sleep disturbance in an infant (provided that he is physically healthy), there are colic, nervous excitement, the desire to feel mom near

Sleep phases

Doctors say tiny babies don't sleep like adults, but their sleep also goes through phases. During the night they alternate five or six times, one cycle lasts up to 100 minutes.

Active or superficial sleep occurs immediately after falling asleep. The phase lasts about 40 minutes, when the children move, blink, startle.
The deep phase lasts one hour. The calm, relaxed posture of the child speaks of deep dive into waves of morpheus.

Interesting: babies do not know how to doze off, but immediately fall asleep.

Mommy why

In the first year of a baby's life, regarding growth, development, and health, mothers have many questions that require immediate answers. Let's take a look at some of them.

Why do babies sleep with their eyes open

Let this question not bother you if the newborn is mentally healthy.

Pediatricians say that sleeping a baby with open eyes is not a violation.

It's just that at this moment he is in an active sleepy phase, when he can roll his eyes, roll them up, tremble with eyelashes.

But at the same time he sleeps and sees nothing open eyes.

When you get older, at a year or a year and a half, it will become less and less likely to sleep with your eyes open, then this phenomenon will stop altogether.

Why does the baby not sleep during the day

Sometimes mothers complain that the baby sleeps little at all, in the daytime it walks all the time. If the baby does not scream and is capricious in moderation, then he may have his own daily routine, because each person is individual. Practice only calm games an hour before bedtime, perhaps the baby is overexcited.

Remember, if the child is "on his feet" all day, he will be excessively tired, so night dreams may also be disturbed. Try to breastfeed and calmly shake the baby, whisper in your ear, maybe he just doesn’t have enough of your warmth.

Why sleep during the day and not at night

It is even worse for other families if the baby sleeps all day, and joyfully wants to walk at night, and it is impossible to put him to sleep. Exhausted parents dream of laying their heads on the pillow, but the child joyfully walks with open eyes.

If psychosomatic reasons are excluded, then we can say that the baby has confused day with night. In a small organism, the biological clock has not yet been established, therefore, the care of restoring the correct regimen is on the shoulders of the parents. Walking and sleeping in the fresh air, massages, active gymnastics will help here. Make an effort and put the baby on the regimen.

Why do you sleep so much

Sound sleep and breastfeeding are important components of healthy development. But it happens that the baby sleeps a lot and eats little. At first glance, he seems healthy, should mom be worried? It is necessary if the baby does not wake up for a long time, misses the next feeding, because without food the baby weakens and gets sick. It is desirable that the baby sleep no more than five hours in a row.

Mom needs to make every effort so that the daily allowance is eaten. To do this, wake up the baby as many times as required for good nutrition. In a few days, he will wake up on time on his own.

Why sleep restlessly

If the baby sleeps restlessly, changes positions, grunts and pushes, he may want to poop. If he reproduces some sounds, screams, even moans and cries, then problems with the tummy begin. Observe the child's behavior carefully, write down everything that worries you, contact your doctor. The doctor will exclude colic, constipation, ill health, indoor climate, and other causes. A competent pediatrician will tell you how to help calm the baby. After all, a restless baby alarms and frightens the mother.

Usually this is how the baby behaves during active phase when emotions can be used to judge his condition. The body does not fall asleep completely, but analyzes how it feels, thus protecting itself. The baby whimpers, makes other sounds, shows how he feels, and the attentive mother, together with the doctor, draws conclusions. Sometimes the baby just wants to go to his mother, in which case it is easy to calm him down.

Mom and baby have a tight emotional connection. If the mother is nervous, worried, then the child will feel that it will not fail to affect his sleep.

Is it possible to put the baby in bed with parents

Of course, you can put the baby in the parent's bed for a while, but think about it, is it worth it? In addition to the fact that co-sleeping with a newborn is not hygienic, deprives the little man of his own personal space, you, among other things, can accidentally crush him.

Smile in a dream

Seeing a smile in a dream on the face of a baby is a great pleasure for parents. But why sometimes sleeping kids smile, is this normal or a deviation? Scientists claim that monthly crumbs dreams happen. Although there is an opinion that this is just an infantile grimace. It is more pleasant to assume that the baby is dreaming of something good, and he feels great.

sleeping baby

Everyone knows that you can endlessly admire how water flows and fire burns. But only loving parents endlessly admire the serene sleep of their children. No matter how the baby sleeps, on his stomach or on his back, no matter what he does in a dream, parents are ready to admire the little happiness all night long, even if they have to wake up many times for this.

Sleep is one of the most important indicators of health and wellness baby. Some mothers are so worried that their baby is not sleeping well that they go to the pediatrician with this problem. But very often the doctor, having counted the number of hours that the baby sleeps, comes to the conclusion that it is fully consistent with his age norm. But for the mother, this is little consolation, because if a newborn wakes up every half hour, she simply does not have enough time and energy to do household chores. Therefore, the question of how to make a baby’s sleep normal is very relevant for many.

The sleep of a newborn baby is sensitive and disturbing

It is worth noting that human sleep has a certain structure: it consists of two phases - deep sleep and superficial sleep, which replace each other alternately. In newborns, the deep sleep phase lasts from 25 to 40 minutes, after which the superficial sleep phase begins, during which anything can wake up the baby (rustle, light, touch, and so on). The phase of the so-called fast (superficial) sleep is very easy to notice: the baby's cilia tremble, the pupils move, he begins to toss and turn. Experts note that it is difficult to wake a child when he is in a deep sleep phase. Over the years, the duration of the deep sleep phase gradually increases, so older children sleep quite soundly.

Parents should ensure that their baby gets a good night's sleep. To do this, they must create the right conditions in the room where he is, and also teach the baby to fall asleep on his own in the event that he accidentally woke up in the REM phase.

Some newborns in the first month of life sleep from 17 to 20 hours, waking up only when the time comes. For most children, experts consider the following number of hours of sleep per night to be normal:

from 0 to three months - from 16 to 17 hours;
from 3 to 6 months - from 14 to 15 hours a day;
from 7 to 12 months - about 14 hours;
from a year - about 12 hours.

To ensure that the child’s sleep is not interrupted, it is necessary to create good conditions:

Feeding, especially breastfeeding, promotes sound sleep. If the newborn is breastfed, then after the bottle he needs to be given a nipple.
Good, calm music will either help to calm the baby, set him in a calm mood.
The air in the room where the baby is constantly should be clean, fresh and cool. The optimum air temperature is considered to be from 18 to 20 degrees. Before going to bed, the room must be ventilated. It is often necessary to do wet cleaning. Sleeping a child outside is also beneficial, as he.
To make the baby fall asleep, you can shake it. True, the baby very quickly gets used to rocking and gradually the mother has to rock him more and more so that he falls asleep. Also, some newborns get used to sleeping in a stroller, waking up when it stops.

If your child does not sleep well, then perhaps you are not planning his daily routine correctly, how to do it right on our child care portal.
Perhaps your baby's sleep is disturbed by colic in the abdomen. Why they arise and how to deal with them safely for the health of the baby, read in.
And in you will find all the causes of a rash in a newborn. Allergic causes or associated with poor hygiene.

The room in which the baby will sleep should be darkened, so you need to hang curtains or blinds on the windows. You can leave the lights on in the hallway or purchase a night light for the room.
All children fall asleep much faster in their mother's arms.
You can put the baby's cradle next to the mother's bed, then she can soothe him with her voice.
At night it is better to wear a baby diaper, in otherwise his sleep will hardly be sound.
If the baby is not yet three months old, then he may experience colic in the abdomen. Therefore, before going to bed, the child needs to do massage and gymnastics. A warm diaper placed on the stomach, special drops, or Dill water. After feeding, it is necessary that the child stay upright for some time (in the arms of an adult).
Try to create a special "ritual" falling asleep. That is, you need to put the baby to bed every day at the same time, performing the same actions before that;
Before you need to put the baby to sleep, do not overload his psyche. Do not turn on the music and TV loudly, make noise.

There are many reasons why a baby does not sleep well. Experts identify the main ones:

illness - if the baby has a fever, his sleep will be restless;
skin irritation (diaper rash or sweating);
gas and intestinal colic. The cause of this condition can be the swallowing of air during feeding, as well as during a cry;
hunger;
some children sleep better during the day than at night (due to their age, they have not yet developed a clear biorhythm);
if the baby is overexcited (if the house is very noisy, there are many guests);
pathology of the nervous system;
if teeth are erupted;
the baby is too hot or cold.

Good sleep for a baby who has recently been born is very important. Therefore, parents make sure that their child gets enough sleep. If the baby sleeps too little, and the above tips do not help, then it may be worth consulting with a pediatrician. In doubtful cases, an examination carried out on time will help to identify a serious pathology and conduct a course of necessary treatment on time.

If we are talking about a child of the first month of life, then parents and a pediatrician should be alerted by too short periods of sleep (the total duration does not exceed 18-20 hours per day). A doctor's consultation is also needed in the case when the child grows, but the structure of his sleep does not change - a decrease in the total duration of sleep with age is one of the signs of the normal functioning of the child's body and evidence of his growing up.

The first days after birth, the baby spends almost around the clock in a dream. The kid is not yet accustomed to a different way of life. In his mother's stomach, he only slept and ate, because it was dark around. When a child is born, the organs of vision and hearing still do not work well, it is difficult for him to perceive the world in full. Very little time will pass, the child will grow up and gain strength, then his interest in the world around him will increase hundreds of times. The kid will be happy to look at faces, the street and various items. The older your child gets, the less he will want to sleep. In the meantime, parents must create favorable conditions for the existence of the child in the mode that is prescribed to him by nature itself.

Sleep norms for newborns

The neonatal period is considered the moment from birth to the 28th day of the baby's life. This is the most difficult period for both mother and child. There is an acquaintance of parents and a newly made family member. During this period, it is important to find an approach to the baby and carefully study his behavior. Usually in the first days, parents have a lot of questions about caring for a newborn, especially if this is the first child in the family. One of the exciting questions is how much sleep a newborn should have.

It is considered normal if the child in the first four weeks after birth sleeps from 18 to 20 hours. Small deviations of 1-2 hours are acceptable, since it would be wrong to equate all the kids under one.

Every newborn is different. The duration of sleep depends on its physiological data. One needs more time to rest and recuperate, the other less.

If the baby does not have any diseases, then he sleeps exactly as much as his body needs.

Why does the baby sleep so much?

The first days the child wakes up only to eat. If nothing bothers him, then after a short time of being awake, he again falls into a dream.

Everyone knows that in a dream there is a rest of all body systems, and in children there is still growth and weight gain. For infancy, perhaps this is the main thing. All that is required of the baby is to eat well, sleep well and grow in accordance with established normative indicators.

The mode of sleep and wakefulness is regulated by certain structures of the brain and hormones. Sleep hormone levels fluctuate throughout the day. Naturally, this rhythm of day and night does not appear with birth. It must be developed within a certain time. And this time falls on the neonatal period.

Scientists have proven that the regimen of daytime and nighttime sleep, developed in the first weeks of a baby's life, plays a big role in shaping his mental development in the future. So, children who did not get enough sleep in infancy, in the future become impulsive, uncontrollable, with an attention deficit (the current diagnosis is “attention deficit hyperactivity disorder”).

Newborn daytime sleep

The kid still does not know that time is divided into days and nights. Parents should teach him that the day is for playing and exploring the world, and the night is for sleeping and relaxing. A newborn sleeps a lot during the day, waking up to eat and talk a little with his parents.

It is important to teach your baby not to forget to wake up for feeding. This should be done every 3-4 hours. Even if he is fast asleep, he needs to be awakened. The baby must understand that you need to sleep long at night, and not during the day. At this age, babies often confuse day and night, which brings inconvenience to parents and prevents him from developing the correct regimen himself.

How much does a newborn baby sleep at night?

A baby who has just been born wakes up quite often at night. There is an awakening due to hunger. Babies usually wake up every 2-3 hours.

The frequency of awakenings depends on several factors:

Babies who receive formula rather than breast milk sleep longer. The assimilation of mother's milk is faster than the adapted mixture, so the child wakes up faster for a new portion.
If the room is hot and dry, the baby will be thirsty and will wake up to quench her milk.
Wet diapers. Parents who don't use disposable diapers have to get up more often at night to change wet diapers. Sleep in a wet bed for a long time will not work.
It has been observed that children who sleep separately from their mother wake up much more often than those who sleep side by side. This is due to the loss of contact with the mother, and the fear of being alone.

If the baby sleeps little

The first days of his extrauterine life, the baby sleeps a lot. If a newborn has problems sleeping, then this is a signal that he is not all right. Here you need to find out the reasons that led to sleep disturbance. These can be diseases or violations in care, organization of the daily routine. What actions to take if the baby sleeps little:

Report this to the pediatrician to rule out diseases.
With the help of a doctor, determine if he is getting enough food. When malnourished, sleep also suffers.
Maintain optimal temperature and air in the child's room.
Change diapers as they get dirty, giving preference to quality products.
Protect from noise and bright light both day and night.
Take daily walks on fresh air.

The danger of prolonged sleep

Some children, after being discharged from the hospital, spend days and nights in a dream, rarely waking up for feeding and practically not reacting to external stimuli. Parents are usually happy that their child is so calm and does not bring worries. However, such a "sleep mode" may indicate a pathology. This phenomenon occurs in the case of difficult childbirth, with congenital pathology in the fetus, jaundice, and also with the inability of the baby to grab the nipple and suckle the breast. A pediatrician will help to identify the cause, to whom you will need to contact if you suspect too longer duration sleep.

The baby sleeps soundly during the day at night, rarely waking up for feedings, which contributes to exhaustion and dehydration, and this further causes drowsiness.

Parents should start sounding the alarm if, in addition to long sleep noticed the following signs:

The baby is very difficult to wake up, he reacts badly to sounds and braking.
His skin and mucous membranes are dry to the touch.
After compression, a wrinkle remains on the skin for a long time.
The baby rarely and quietly cries.
No weight gain is noted.
Rarely writes.
Body temperature is elevated.

Upon detection of at least one of listed symptoms, the child needs emergency medical care.

Every adult spends about one third of his life sleeping. Newborns sleep much more. Let's figure out together what and how happens during this very important process for everyone.

Theory about sleep

Despite the fact that many people think of sleep as a vacation, it is actually a very complex and active life process. Next, we will analyze several aspects of the physiology of healthy sleep in order to understand its structure and the problems that may arise in this area.

Sleep phases.

First- this is REM sleep, or, as it is also called REM sleep (from the English “rapid eye movement”, “rapid eye movements”). Characteristic of this condition is that there is a movement of the closed eyes of the sleeping person. Looking closely, you can see how the eyeballs move under the closed thin eyelids of a sleeping baby. This type of sleep is also called active sleep. It is at this stage that an increase in blood pressure occurs, and the respiratory and heart rhythms can go astray. Muscle tone decreases, legs, arms, facial muscles can finely tremble. If you wake a person from REM sleep, he will abruptly go into a state of wakefulness. Dreams also come to a person during this period, however, we do not always remember them in the morning. A large proportion of REM sleep occurs in the early morning. Newborns may well wake up briefly during this stage, and this is completely normal. The child may turn over, look around, pull up the blanket or shift his head to the other side, but then he will fall asleep again just as quickly and carelessly. A change in the environment around him can interrupt the baby's falling asleep after a short awakening. Here, in order for the baby to fall asleep again, it will be necessary to re-create that primary environment. By the way, this is often one of the most common sleep problems. This can be avoided if you initially teach your baby not to pay attention to the situation and fall asleep after a short awakening in the REM stage, despite its changes.

second phase of sleep also called slow sleep. During such a dream, the actual rest occurs. During slow sleep, breathing and heart contractions remain unchanged and rhythmic. The sleeping person lies motionless, his muscles are completely relaxed. Four stages of non-REM sleep can be distinguished, from drowsiness (stage one) to deep sleep (stage four). The lion's share of slow sleep occurs at the very beginning, namely in the first hours after falling asleep. Quite often, hypnagogic fright occurs when falling into non-REM sleep. This is a condition in which all parts of the body tremble, and these tremors can be so sharp that they can lead to a short-term awakening of a person. But still, if the sleeper has reached the phase of slow sleep, it is not at all easy to wake him up, especially in his deep phase.

Sleep structure.

The phases of fast and slow sleep replace each other throughout the night, making up cycles. For newborns, the REM-NREM cycle takes about 50 minutes. Teenagers and adults are given about an hour and a half for this cycle. When babies reach 3-6 months of age, their sleep structure will be as close as possible to that of an adult. In the beginning, there will be an immersion in slow sleep, and after 10 minutes they will already be in the deep stage of this sleep. The duration of such a dream will be from 40 minutes to an hour, followed by a short awakening, which will take only a few minutes, and then a REM sleep, which will last from 5 to 20 minutes. Further, within a few hours, the baby will fall into REM sleep, then into the second phase of a slow one. Younger children may additionally be in the third or fourth stage of non-REM sleep in the morning. Usually dreams appear in the early morning. It is possible to recognize the structural specifics of sleep even during the period when the child is in the womb. Already in the sixth - seventh month of development, REM sleep becomes characteristic of the fetus. The slow stage appears somewhat later, on the seventh or eighth month, but it is still not fully developed at this time. Usually, all four phases of slow sleep can be identified only in a six-month-old child.

Baby sleep video:

Schedule

How does the daily routine of a child change at different ages?

Sometimes a newborn can be awake for a while after feeding, but he cannot do without sleep for a long time. Closer to one and a half - two months in the daytime, there is also time for the activity of the baby. This period is the most successful for the games of the child with his mother. Such stimulation of activity will only play into the hands of parents, because the newborn will be more clearly aware of the difference between sleep and awakening. This will help solidify your daily routine. Changes in regimen will come by the age of three months. This will be noticeable by how it will put the baby to sleep in the morning and at noon. And this precedes the emergence of a new daily routine, according to which the child sleeps two to three times a day. This regimen will last up to 12-15 months.

When the baby is three to six months old, his rhythm of life becomes more adapted to the general way of the family. The duration of his sleep is 14 hours a day, of which 9 - 10 hours are at night and about 5 per day. The time of onset of sleep is almost identical and repeats from day to day: night sleep can begin from 7 to 9 pm, and the morning rise will be between 6 and 8 am. At this age, almost all children can sleep without awakening for about seven hours.

Temperament and mode.

Compliant child has a clear daily routine. Both wakefulness and sleep occur unchanged, daily, at the same time. Such a baby falls asleep on its own, without anyone's help. As soon as you put him in the crib, he immediately begins to gradually fall asleep. Such children sleep for a long time and soundly enough, they do not tend to cry even with short-term awakenings during sleep. For difficult children, the characteristic features are a tendency to a bad mood and isolation, a disorderly daily routine, hyperactivity, and intensity of reactions. It would seem that such children have no inclination to at least a minimal ordering of the periods of sleep and wakefulness. To establish this mode, one cannot do without the help of others. He needs more time to fall asleep. If you connect external stimuli, then the transition from wakefulness to sleep will be somewhat easier. For example, you can swaddle a child, shake him in your arms.

Children with a slow temperament are not characterized by increased activity. They often withdraw into themselves, especially when they find themselves in an unfamiliar situation. It is quite difficult for them to adapt to a new environment and they need additional help from their parents to get used to it. It should also be noted that the temperament of children does not depend on the upbringing of parents, it goes to the baby from birth. Keep this in mind, especially if you are going to self-flagellate about the child's inappropriate behavior.

A place to sleep.

Such a crib device is considered ideal, where the bottom is adjustable, falling to a lower height, which is convenient when the child grows up. The height should be such that the top of the crib is up to the shoulders of the baby standing on the mattress. The mattress itself should fit snugly against the crib frame, without gaps and cracks, so that the baby does not damage his arm or leg.

Baby sleeping position.

No need to accustom the child to sleep in absolute silence. There is absolutely no need to tiptoe, turn off the TV, or shush anyone who is talking next to the crib. Also, do not artificially shade the room during daytime sleep. Children from birth have the ability to ignore external stimuli, especially when they want to sleep. And you, by striving for the ideal, can form the wrong sleep habits in a baby, he will quickly get used to sleeping only if certain parameters are observed. By doing this, you will significantly complicate the life of all other family members.

Uninterrupted night sleep.

The long-awaited for every parent is the time when he sleeps through the night, without sudden awakenings. For a child, the whole night is a dream for 5 to 6 hours in a row. Here, the maturity of the nervous system plays a very important role, because it is in its power to connect several sleep cycles during these 5-6 hours. There are no significant changes during sleep, it’s just that the baby develops a good habit of coping with night awakenings on his own. And so, the phases of quiet and active sleep alternate, as before.

In this situation, there are two options. If your child, with all the ideal indicators of height and weight for his age, waking up in the middle of the night, actively sucks his breast, then perhaps his body has not yet eliminated such a need. And if he just reflexively sucks his chest and immediately falls asleep, barely waking up and not eating the proper amount of food, then here, most likely, just a habit, one of the ways to facilitate the transition to sleep. In this case, you can try to rebuild his associations and reflexes associated with the period of sleep in a different direction.

daytime sleep

Sleeping during the daytime will help you gain strength for a cheerful rest of the day in a great mood. Parents should remember that for the children's daily routine, both the time and duration of daytime sleep are of great importance. If the child goes to bed too late, or sleeps longer than expected, this will definitely affect the night's sleep and it will be more difficult for you to put him to bed in the evening.

Sleep ritual

Co-sleeping with a child

Benefits of co-sleeping.

The main arguments in defense of co-sleeping are those that the baby has constant access to parents at any time of the day. Such a pastime gives a more sense of security to the child, and he feels happier. For parents, this is another confirmation of their love and care for the baby.

Arguments against co-sleeping.

Often, mom and dad, only out of desperation, allow the child to sleep with them if he constantly wakes up at night. Co-sleeping saves them from having to get up from their warm bed and go into the next room to soothe a crying baby. Often, children sleep more peacefully with their parents, but do the parents themselves feel comfortable at the same time? Quite often they experience irritation and anger in such situations. So isn't it easier to solve the problem with the awakening of the baby, and not add to this a new one - the problem of personal discontent?

In order to take right decisions, it is very important to have the most complete information about the subject of interest. The upbringing of children, and even more so the correction of sleep habits, is an area that especially requires certain knowledge. This is important so that parents can be confident in their choice of this or that technique, do not give up at the first difficulties, and also find motivation to continue in difficult moments (sleep happens at night, and at 3 in the morning all willpower is needed to do something right, not fast!).

Of course, to become an expert you need to spend a lot of time, effort and dedicate yourself somewhere, but we offer you a concise version of the basics about baby sleep. In this series, we will briefly outline what sleep is like, how it changes, and what is important for its full development in children from birth to school years.

Sleep phases

In general, sleep in adults and children is divided into REM sleep (the main feature is the rapid movement of the eyeballs), during this phase we see dreams, and Slow-wave sleep (non-REM, the absence of rapid eye movements). It must be remembered that the sleeping brain is not a “resting” brain at all, the level of activity is different, but the work is uninterrupted. In adults and children during sleep, both phases replace each other: first slow, then fast, and again in a circle. The mature brain usually distributes the phases in the following order: slow (40-80 minutes) - fast (12-25 minutes). The closer to the morning, the more often the phase of REM sleep occurs. Between full cycles (REM-REM) almost always there is a partial awakening. At this time, an adult can roll over, straighten pillows or a blanket, and effortlessly fall into new cycle sleep. In the morning we don't even remember it. Children between cycles can roll over, cry (from a minute to 10 minutes), and if they do not know how to fall asleep on their own, they wake up completely.

The change of cycles per night can occur up to 12-15 times. That's where the skill self-falling asleep becomes key!

REM sleep is relatively light sleep. The brain at this time is very active and seems to be drifting on the surface of consciousness. Apparently, in order not to “overload the system”, a slight paralysis of the whole body sets in at this time - only the eyeballs, heart and respiratory muscle. During REM sleep, new information is stored and distributed in memory. That is why it is important that children have full-fledged REM sleep cycles, with their help they learn better, remember new things faster. Newborns (up to 3-4 months from the date of the expected date of birth) sleep chaotically, unlike adults, REM sleep can prevail in them (well, there is a lot to learn!), cyclicity can begin with it and it takes a larger percentage of total sleep time.

non-REM (slow-wave sleep) is sleep that itself has 4 stages. The purpose of this phase is tissue regeneration, growth, and the formation of new neurological connections. The first two stages are relatively shallow sleep, you can wake up from it even with a little ambient noise. The next two stages are characterized by immersion in deep sleep. During this period, it is very difficult to wake a person, and if it succeeds, then he will be disoriented. Also in this segment there are bouts of sleepwalking, talking in a dream.

Daytime sleep in children

Depending on age, the number of segments of daytime sleep in children varies: by 4 months there are 3-4 segments, by 6 months there are 2-3, and by 18 months most children sleep once a day. Between the ages of 2 and 4, regular daytime sleep completely disappears. I note that sleep at different times of the day is not the same. The first morning dream becomes, as it were, a continuation of the night dream and is rich in dreams. At this time, the sorting and consolidation of the new, known yesterday, continues. Lunchtime sleep is a deeper, mostly non-REM sleep. Sleeping in the afternoon helps the child grow in the literal sense. Evening sleep is a bridge that helps to “survive” until bedtime without much overwork.

Hormonal regulation: how to help the baby sleep?

You most likely suspect that sleep, like many processes in our body, is regulated by special chemical compounds- hormones. No, never give hormones to a child just to make him sleep! Wise human body he does whatever he needs.

Biologically, we are all programmed to sleep when it gets dark. The signal about the onset of darkness comes from the eyes to the brain and the hormone melatonin is released. It is he who “lulls” us and helps us sleep until dawn. Violation of the production of this hormone in adults contributes to the retention of excess weight (sleep in the dark!). This hormone begins to be produced in children from 3-4 months (or a little later in premature babies), and it is precisely with it that the global restructuring of sleep in babies of this age is associated. How can we use it?

Firstly.
Try to avoid nightlights in the bedroom, or make them as dim as possible;
Secondly.
Limit the amount of light in the baby's room for the time when you want him to sleep - early morning, daytime sleep etc.;
Third.
Half an hour before bedtime, try dimming the lights. This will give a feeling of "sunset" to the child's brain, melatonin will begin to be released and it will be easier for him to fall asleep.

Cortisol is another hero (or rather, anti-hero) in our story about sleep. It is a stress hormone and is released when we are tired. Its task is to cheer us up, give a surge of strength and energy, open a second wind when the main charge of vivacity has already been exhausted. Not bad, right? In our case, it is dangerous. If you let a tired baby walk until the release of cortisol, then it will be very difficult to put the baby down. A surge of new energy will not allow him to relax and tune in to sleep, but at the same time, this energy is borrowed from deep storerooms in case of an emergency. The waste of such energy tires the child several times more. In addition, cortisol is not so quickly excreted from the body. Therefore, even if the baby fell asleep (and believe me, you will spend sooooo much effort on this), he will not oversleep for long. Don't overwork your child! Watch the time and for signs of fatigue, as soon as you notice - quickly fit!

Biological rhythms and internal clock

Human natural biological rhythms are a complex system.

To simplify, here are a few key points:

IN vivo(without social restrictions like work schedules or class schedules) the biological clock runs in a 24.8 hour circle. This means that if the process of internal time is not controlled, our schedule will constantly shift, and at some point we can hardly fall asleep even at 2 am, and we will wake up by 1 pm. Practical advice: make sure that the time of going to bed at night and the time of waking up, meals are about the same from day to day. This will help you maintain a healthy (and comfortable!) routine throughout the day.
The biological clock is controlled not only through social norms(to catch the train at 7.15), but also through the sunlight. Our body understands that the day began with the advent of sunlight and prepares to sleep at nightfall. practical advice: Help your child wake up on an early winter day by turning on a bright light in his room. Set it up for sleep by dimming the lights shortly before bedtime.
Body temperature also responds to internal time. When the body considers that night has come, it lowers the body temperature, and with the approach of morning, it raises it. Practical advice: If you put your baby to bed during this drop in temperature, he will fall asleep very quickly (the drop lasts about 90 minutes). Keep the room cool as well so that the air temperature does not overheat the child during sleep.
There is a “perfect time” when it is easiest to put your baby to sleep during the day. According to age, experiment in segments from 8-9 in the morning and from 12-13 in the afternoon. For younger children, try more early time in the segment, for the elders - move to its end. These segments are also accompanied by a decrease in temperature and sufficient, but not excessive, accumulation of fatigue.

Daily regime

Due to the fact that the body as a whole and the biological clock in particular respond well to training, the daily routine becomes key point. Compliance with regular intervals and periodicity of actions (everything is within reason, we by no means urge you to live Groundhog Day!) will help set up the body for timely sleep. Depending on the temperament of the child and mother, the daily routine can be quite tough (for persistent, inflexible, difficult to adapt children) or can allow a large percentage of variability (this is suitable for flexible, adaptive, contact children).

Remember that during the holidays, vacation trips or visiting relatives, the regime begins to play an even greater role. It will not only help your baby fall asleep easier and gain strength for new adventures, but also feel more secure and confident in a new environment.

In order to make the right decisions, it is very important to have the most complete information about the subject of interest. The upbringing of children, and even more so the correction of sleep habits, is an area that especially requires certain knowledge. This is important so that parents can be confident in their choice of this or that technique, do not give up at the first difficulties, and also find motivation to continue in difficult moments (sleep happens at night, and at 3 in the morning all willpower is needed to do something right, not fast!).

Of course, becoming an expert takes a lot of time, effort, and somewhere to devote yourself to it, but we offer you a concise version of the basics about baby sleep. In this series, we will briefly outline what sleep is like, how it changes, and what is important for its full development in children from birth to school years.

Sleep phases

In general, sleep in adults and children is divided into REM sleep (the main feature is the rapid movement of the eyeballs), during this phase we see dreams, and Slow-wave sleep (non-REM, the absence of rapid eye movements). It must be remembered that the sleeping brain is not a “resting” brain at all, the level of activity is different, but the work is uninterrupted. In adults and children during sleep, both phases replace each other: first slow, then fast, and again in a circle. The mature brain usually distributes the phases in the following order: slow (40-80 minutes) - fast (12-25 minutes). The closer to the morning, the more often the phase of REM sleep occurs. Between full cycles (REM-REM) almost always there is a partial awakening. At this time, an adult can roll over, adjust pillows or a blanket, and effortlessly fall into a new sleep cycle. In the morning we don't even remember it. Children between cycles can roll over, cry (from a minute to 10 minutes), and if they do not know how to fall asleep on their own, they wake up completely.

The change of cycles per night can occur up to 12-15 times. This is where the skill of falling asleep on your own becomes key!

REM sleep is relatively light sleep. The brain at this time is very active and seems to be drifting on the surface of consciousness. Apparently, in order to “not overload the system”, a slight paralysis of the whole body sets in at this time - only the eyeballs, cardiac and respiratory muscles move. During REM sleep, new information is stored and distributed in memory. That is why it is important that children have full-fledged REM sleep cycles, with their help they learn better, remember new things faster. Newborns (up to 3-4 months from the date of the expected date of birth) sleep chaotically, unlike adults, REM sleep can prevail in them (well, there is a lot to learn!), cyclicity can begin with it and it takes a larger percentage of total sleep time.

Daytime sleep in children

Depending on age, the number of segments of daytime sleep in children varies: by 4 months there are 3-4 segments, by 6 months there are 2-3, and by 18 months most children sleep once a day. Between the ages of 2 and 4, regular daytime sleep completely disappears. I note that sleep at different times of the day is not the same. The first morning dream becomes, as it were, a continuation of the night dream and is rich in dreams. At this time, the sorting and consolidation of the new, known yesterday, continues. Lunchtime sleep is a deeper, mostly non-REM sleep. Sleeping in the afternoon helps the child grow in the literal sense. Evening sleep- this is a bridge that helps to "survive" until the night of laying without much overwork.

Hormonal regulation: how to help the baby sleep?

You most likely suspect that sleep, like many processes in our body, is regulated by special chemical compounds - hormones. No, never give hormones to a child just to make him sleep! A wise human body itself produces everything that it needs.

Firstly.
Try to avoid nightlights in the bedroom, or make them as dim as possible;
Secondly.
Limit the amount of light in the baby's room for the time when you want him to sleep - early morning, afternoon nap, etc .;
Third.
Half an hour before bedtime, try dimming the lights. This will give a feeling of "sunset" to the child's brain, melatonin will begin to be released and it will be easier for him to fall asleep.

Biological rhythms and internal clock

Human natural biological rhythms are a complex system.

To simplify, here are a few key points:

Under natural conditions (without social restrictions like work schedules or class schedules), the body clock runs in a 24.8 hour circle. This means that if the process of internal time is not controlled, our schedule will constantly shift, and at some point we can hardly fall asleep even at 2 am, and we will wake up by 1 pm. Practical advice: make sure that the time of going to bed at night and the time of waking up, meals are about the same from day to day. This will help you maintain a healthy (and comfortable!) routine throughout the day.
The biological clock is controlled not only through social norms (catching the train at 7.15), but also through sunlight. Our body understands that the day began with the appearance of sunlight and prepares to sleep with the onset of darkness. Practical tip: Help your child wake up on an early winter day by turning on bright light in his room. Set it up for sleep by dimming the lights shortly before bedtime.
Body temperature also reacts to internal time. When the body considers that night has come, it lowers the body temperature, and with the approach of morning, it raises it. Practical advice: If you put your baby to bed during this drop in temperature, he will fall asleep very quickly (the drop lasts about 90 minutes). Keep the room cool as well so that the air temperature does not overheat the child during sleep.
There is a “perfect time” when it is easiest to put your baby to sleep during the day. According to age, experiment in segments from 8-9 in the morning and from 12-13 in the afternoon. For younger children, try an earlier time in the segment; for older children, move towards its end. These segments are also accompanied by a decrease in temperature and sufficient, but not excessive, accumulation of fatigue.

Daily regime

Due to the fact that the body as a whole and the biological clock in particular lend itself well to training, the daily routine becomes a key point. Compliance with regular intervals and periodicity of actions (everything is within reason, we by no means urge you to live Groundhog Day!) will help set up the body for timely sleep. Depending on the temperament of the child and mother, the daily routine can be quite tough (for persistent, inflexible, difficult to adapt children) or can allow a large percentage of variability (this is suitable for flexible, adaptive, contact children).

Baby sleep often worries young parents. Is he sleeping too long?

Do you need complete silence?

How to understand that the child fell asleep?

The answers to these and related questions can be found by understanding the phases of sleep in children. Our article will help you learn more about them.

A complete dreaming cycle consists of four stages of slow sleep and one REM.

The main feature of napping in infants is that their deep sleep is rather short and increases only with growing up.

During sleep, the phases constantly replace each other, first it is slow, then fast, then the cycle repeats.

In adults, the slow phase lasts about an hour, and the fast phase lasts about 15 minutes. REM sleep occurs more frequently as morning approaches.

Between full cycles, although we do not notice it, there is almost always a brief awakening. During this period, we usually go to the toilet, roll over, straighten the blanket with a pillow, and without much languor fall into a new sleep cycle.

In children, everything happens a little differently between sleep cycles, they can turn around, cry (up to 10 minutes in a row), and if they don’t know how to fall asleep on their own, they can finally wake up and not go into a new dream cycle. The skill is one of the most important, as the cycles per night can be repeated up to 15 times. Imagine what will happen if, after each cycle, the baby will require attention to be rocked.

During the day, children, depending on age, can go to bed several times. Up to 4 months they fall asleep 3-4 times, at half a year already 2 or 3, and after a year and a half, almost all children sleep only once a day in the afternoon.

At different times is not the same, it can be divided into:

morning, which is a continuation of the night, is characterized by vivid dreams and the consolidation of knowledge about the world gained over the past day;
dinner, as a rule, deeper (mostly slow) sleep, during this period the body grows very actively;
evening, it is needed so that the newborn does not overwork and so that he has enough strength until a night's sleep.

As we have already learned, there are two main states of rest: fast and slow. In infants, due to the still unsettled system of functioning of the body, the change of these two types of naps is very specific.

REM sleep

The fast or paradoxical phase is the most important in the life of a newborn. It is also called REM (rapid eye movements). The name speaks for itself, at this stage, cilia often flinch in children, and eye movement is visible under closed eyelids. These signs often mislead young parents, as they may think that the baby has not fallen asleep.

In the meantime, very important processes take place in this phase:

intensive brain development due to vivid dreams;
relieve stress and tension;
consolidation of new information and its reflection;

baby sleeping

The child enters the paradoxical phase immediately from the state of wakefulness. The brain at this time is very active and seems to be on the verge of the world of dreams and reality. Over time, the proportion of this phase becomes smaller.

In the paradoxical phase, newborns already dream and also react to them by smiling, grimacing, frowning, and twitching their arms and legs.

What they see in their dreams is not known for certain, but there is a theory that at first, children see light spots, the image of the mother's breast, and also experience sensations that they have already met in the real world.

Learning a new world and developing, the baby will begin to see more and more information in dreams: the faces of his parents, his room, familiar objects, and also distinguish a wide range of sensations.

slow sleep

Deep or, as it is also called, orthodox sleep (non-REM, which means "without active eye movement"), is formed when the cerebral cortex is almost mature. It is thanks to this phase that the child plunges into a long and restful sleep. There are four stages in total:

Napping - the baby still reacts to external sounds.
Falling asleep - a transition to a state of rest, with extraneous noise, you can still wake up.
Deep sleep - muscle relaxation, ceases to respond to weak external stimuli.
Very deep sleep complete relaxation and disconnection from external life, as they say - "you can't wake up from a cannon." If the child is artificially awakened, then he may not immediately understand where he found himself.

Usually, the slow-wave sleep stage is short, no more than half an hour, but over time it increases, as the baby grows, begins to show more activity and, accordingly, spends more energy and gets tired.

This phase of sleep is very important for proper development baby, it allows him to completely relax, recuperate and restart the body.

Best watch for orthodox sleep- the interval between seven and nine o'clock in the evening. If the child did not manage to sleep during this period, then at night or in the morning it will no longer be possible to compensate for this omission. Therefore, it is worth trying to put the child in this time interval.

Sleep table

In the first year of life, the child's body grows every day, so the time needed for sleep is different, and it is constantly changing. For your convenience, we have compiled a table by which you can easily verify the correctness of the newborn's sleep cycles.

After a year, the child's sleep is already beginning to resemble the sleep of an adult, he will get enough sleep at night in about 9 hours. A one-hour afternoon break will suffice during the day.

It is important to understand that all figures in the table are approximate and small deviations are quite normal.

Sleep Cycle Testing

When it already seems that you have lulled the baby, one has only to put him in the crib, as he wakes up.

Common situation? Testing, or determining the sleep cycle, will help not to encounter it, for this:

take the child's hand with thumb and forefinger;
lift to a small height (4-5 cm);
let go.

If the hand falls and the baby does not start to move, then he is already in the phase of deep sleep, which means that he can be laid in the cradle with peace of mind, and he will not wake up.

On the contrary, if the child moves, then this means that he is still in REM or light sleep and can easily wake up. Therefore, it is worth continuing to rock the baby.

Such a simple test will save you and your baby from unnecessary worries.

Formation of the regime

Since the body lends itself well to training, the formation of a daily routine is very important.

To do this, you must try to observe the constant intervals of the main activities: feeding, sleeping, bathing and socializing.

Depending on the nature of your child, the daily routine can be either tough (for capricious children) or allow small liberties (suitable for obedient children). This moment should be clearly understood for a young mother.

It is important not to break the regime, even if you go on a trip or visit. In the first place is the regime, and in the second place are all other life events. This will help the child always feel at ease, feel protected, because his usual rhythm will not be disturbed.

Conclusion

Sleep, especially in the first months of life, plays the most important role in the formation of the baby's body.

During sleep, the brain and body rest from an overabundance of new information about the world around them, and also “digest” it.

A child in a nap adds height and weight, since growth hormone is activated in the first hours of sleep. Therefore, it is important for parents to create favorable conditions for a healthy sleep of the baby.

We hope that knowledge of the cycles and phases of sleep will make it easier to understand the processes that occur with a newborn in the world of dreams, and will help to look at the baby's sleep from a scientific point of view.

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SLEEP DISORDERS IN CHILDREN

WHEN YOUR CHILD DOES NOT SLEEP

pediatric neurologist Zaitsev S.V. Meeting at the entrance:
- Hello neighbor! How is your grandson? Does everyone sleep well too?
- Yes ... everything is the same ... but, actually, I'm his dad ...

AND ALL THEY DO NOT SLEEP!

Especially children are good in a state of sound sleep ...

According to most scientific research recent years using the methods of instrumental diagnostics (polysomnographic examination), it is believed that only a little more than a third of children in the first 3-4 months of life have intermittent night sleep with frequent awakenings. Approximately 20% or less of these children have such features of night sleep until 6 months, and only one in ten children have these disorders detected at 12 months or later. It is clear that the criteria for sleep disorders are different and depend on many factors. But if you register sleep disorders only on the basis of complaints from parents, these numbers will immediately increase several times! This is the subjective perception by surrounding adults of the child's sleep changes.

Mom's voice cries out in the "desert" - Help! My baby is not sleeping! And the doctor, after an appropriate consultation and examination, makes a verdict: the child is healthy. There is no cause for concern. So who is right?

First, a few words about the quite normal physiological phenomena often observed during sleep in children.

But this is quite normal!

Often, parents are disturbed by the shuddering of a child in a dream. When falling asleep and during active superficial sleep, such single, sometimes massive, muscle contractions, leading to trembling of the arms or the whole body, are a natural phenomenon and do not indicate any nervous pathology. In young children, especially those who are hyperexcitable, the inhibitory system is still very immature, and in their sleep such tremors can manifest themselves with particular intensity. With age, the frequency and strength of such shudders gradually decreases and they disappear. It is important to note that only a doctor has the right in this case to confirm the normality of the symptoms found.

Often, parents are forced to go to the doctor by nightly awakenings of the child, followed by crying, when the mother has to get up and lull the baby to sleep. We have already said that in the first months of life, such a sleep pattern is considered the norm, and parents should not worry about this at this age. However, under certain circumstances, such primarily natural awakenings can transform into behavioral sleep disorders and require the intervention of a specialist.

And finally, most common cause parental excitement at night are "whims" or crying baby in a dream. Scientists have long proven that such periodic whimpers of a child who does not wake up at the same time are as natural a process as the above night awakenings and shudders. There can be several reasons for such sleepy crying. Perhaps the child during the entire wakefulness receives such great amount new, emotionally significant information (games, communication, joy, fears, etc.), that she has to intensively “digest” during the phase of active sleep with dreams and “push out” in the form of nightly cries and awakenings. Also, probably, with the help of such whims and whimpers, the baby manages to control the presence of the mother, determine the degree of her possible removal and the likelihood of new communication and affection. Absence feedback(if the mother does not "fly" to the rescue) can make the child wake up and cry "as it should." Or, much more often, the child learns to calm down and fall asleep autonomously, which further saves the family from behavioral sleep disorders. Should you run headlong to help at the slightest sound of a child at night, or, gritting your teeth, fighting off grandma and dad, wait indefinitely until the child, tired of nighttime tantrums, immediately falls into a deep sleep? There are a lot of opposite advice and recommendations. It's up to the parents to decide.

He just can't sleep!

There are many ways to classify sleep disorders. The most logical and understandable classification for all was proposed by American pediatric neurologists and pediatricians. Primary disorders are distinguished: disorders exclusively of sleep and awakening that do not have concomitant problems (they are also called protodyssomnias), which form without obvious external causes. And secondary disorders, obviously related to external factors (combined with disruption of other organs and systems, in particular, sleep pathology with emotional disorders, allergies, diseases gastrointestinal tract etc.). Most often, at the same time, violations of the central nervous system, the main regulator and coordinator of sleep processes, are detected. Sleep disturbances are short-term and long-term.

Unfortunately, in our country it has historically developed, and there is still some, to put it mildly, "confusion" in the formulation of neurological diagnoses in the first year of life. The same “disorder” is typical for diagnosing sleep disorders in infants, when secondary sleep disorders associated with the pathology of the central nervous system are often “detected” (for example, sleep problems allegedly associated with intracranial hypertension and perinatal encephalopathy).

In fact, the most common (up to 20-30%) in infancy are primary sleep disorders - the child has difficulty falling asleep, and does not know how to sleep at night without waking up. This is the so-called violation of the standards of behavior in a dream or behavioral insomnia. Behind this tricky term lies an ordinary inability to fall asleep on its own and / or a typical inability to maintain uninterrupted sleep. Most children from 2-3 months of age at night, awakening slightly due to uncomfortable posture(for example, a pen is numb), they can easily, autonomously, change an uncomfortable position, and fall asleep again, without requiring the help of their parents. But in some children (very sensitive and exciting), the habit of falling asleep only with the help of their mother is born very easily, almost reflexively, one or two appropriate stimuli are enough. The child simply cannot fall asleep without the help of adults, he is already accustomed, without further ado, to fall asleep with songs, “dances” and motion sickness - mother and other surrounding adults have tried! Such falling asleep, more often in the evenings, for more than 30-40 minutes, is usually combined with a “sweet” habit of often waking up at night and crying to the bitter end, waiting for calming and lulling with the help of mom. Thus, with perhaps the same number of awakenings during a night's sleep, the main difference between children with behavioral insomnia and healthy children is the inability to quickly and easily fall asleep again after waking up. As a rule, an internal desire to wake up arises in an infant at the end of the first or second phase of slow sleep. With excessive fatigue and/or overexcitation (an overdose of daytime emotional information), erratic awakenings occur, sometimes with night terrors. Mostly they are noted in the first half of the night, more often 1-3 hours after falling asleep, often as a reaction to insignificant external stimuli (just enter the bedroom, straighten the blanket, carefully cover the window ... and that's it - the child woke up). Somewhat less often, primary sleep disturbances can manifest themselves in the second half of the night or closer to the morning.

The reasons for such violations lie in common mistakes organization of the behavior of the child and parents during periods of sleep. A fact proven by science: parents who objectively assess the interests of their baby and correctly respond to his signals, the child does not have sleep disorders (or minimal, quickly transient deviations). And, conversely, parents who do not know how to properly assess the situation and respond correctly to the baby's signals, or who do not notice his alarming warnings, most often have serious childhood sleep disorders. For example, what an unexpected "discovery" for parents is the simplest conclusion of a pediatrician about the lack of mother's milk or rickets! Then it is enough to properly feed the baby, or to accurately select the dosage of vitamin "D" - and the problem of sleep is instantly solved.

And here colic or why is he screaming like that

To inexperienced parents, colic seems like a hopeless, relentless nightmare of a nightly blindfolded car ride through a minefield, never knowing where it's going to explode next. By the way, the mechanisms for the development of colic in infants in all details are still unknown to science. Most frequent option are unexpected stormy awakenings and crying of the baby in response to sharp pains and sensations of discomfort due to sharp contractions of the smooth muscles of the intestines and bloating of the abdomen. The child screams loudly, tightens and twists his legs, the stomach becomes stone, relief usually comes after the discharge of gas. The causes of such spasms are diverse and multifaceted: inadequate food tolerance, allergic reactions, dysbacteriosis, autonomic regulation disorders, etc. It goes without saying that the quantity and quality of sleep in babies with colic is almost always reduced.
Time passes, usually the first 2-4 months, and colic magically disappears. As a rule, the pediatrician is able to make life easier for the baby and his unhappy parents. However, sometimes, in excitable and hypersensitive children, an entire army of pediatricians cannot cope with colic. Then comes the neurologist, who has many ways to help parents survive until the end of the period of colic, and at the same time remain sane. Unfortunately, in the future, there is no clear connection between the disappearance of colic and the normalization of sleep. The baby, who during colic calmed down and fell asleep, rocking in his mother's arms, very quickly gets used to this lifestyle. In this case, even after the disappearance of colic in 3-4 months, the usual sleep disturbance remains; the child easily becomes a professional "trainer" of the parents.

It is well known (although it has not been proven by science) that one of the many causes of sleep disorders in infants may be the psychological state of the mother during pregnancy and after childbirth: a high level of anxiety, unfounded fears, frequent stress etc. For some anxious parents, a smart baby learns right from birth to fall asleep and rest in his arms - it's so convenient. At the first request of the child (whining in a dream), the mother rushes to the rescue, cradles in her arms, offers a snack and takes him to her bed. This is how an erroneous, but strong, connection between falling asleep and sleep with the surrounding circumstances is born, under which the baby feels peace and security. Who would refuse such heavenly life? It goes without saying that the baby will continue to persistently defend his rights to such a convenient and correct, from his point of view, mode of life. At first, such an order of life suits the parents as well - the child is satisfied with life, seems to be sleeping, and does not burst into tears. But what will happen next? The answer may not always please parents ...

And the final touch: the question arises, what if there is a serious reason (illness) that makes the child wake up and cry? How not to miss the signals of the real problem. Experienced parents on their own, or with the help of a pediatrician, can easily conduct an initial analysis of the situation. Pathological crying-sobbing in this case is characterized by great tension and drama, suffering and irritability, monotony and monotony, while painful cries are often combined with pronounced motor excitement, muscle tension, and skin color changes. It is important to know that, unlike crying, behavioral disorders sleep, when the baby easily falls asleep in his mother's arms, pathological crying is very difficult to appease. Even using a huge arsenal of all kinds of means and tricks, the child cannot be lulled, or he can only be calmed down a short time, whining and whimpering continues, and then the crying breaks out with renewed vigor. In such cases, do not rely on intuition and own experience but it is better to consult a doctor.

DISORDERS OF DAILY (CIRCAD) RHYTHMS

The highest degree of contentment happens
from parents who blissfully contemplate their own,
sound asleep baby...

Sleep disturbance

A separate frequent reason for going to the doctor are complaints about sleep disturbance. For children 3-7 years old, as well as younger and older children, a different picture is characteristic. Time to sleep, baby in bed, story read. And it starts: “Mom! Another fairy tale”, “I want to drink!”, “I want to write” and many other ways to push back the moment of falling asleep as much as possible. At the same time, the kid, a great psychologist, is firmly convinced that certain efforts will certainly lead to the fulfillment of his desires. One or several evenings of such manipulations are enough, and distorted relationships of conditions are formed! going to bed and the quality of falling asleep. "Sow a habit, reap a character..." Falling asleep only in bed with mom or in her arms, with mandatory motion sickness or feeding, with a finger in her mouth, etc. - all this refers to bad habits and erroneous associations that lead to the formation of a stable disorder of falling asleep and maintaining sleep. In such situations, a child who, for some reason, woke up at night, will no longer fall asleep on his own, and will stubbornly cry and call on his mother to provide him with the usual conditions for falling asleep. And although, perhaps, the quality of the child’s sleep usually does not decrease, but for others (more often for mom and dad), such nights turn into hopeless constant nightmares, sometimes for several years!

In contrast to such "cunning" ordinary child, who goes to bed awake and knows how to fall asleep on his own, using convenient methods, is able to calm down and fall asleep again without the help of his mother, if he suddenly wakes up in the middle of the night. It is good if parents have enough willpower and patience to adequately understand the efforts of the child to "slow down" the process of falling asleep. Parents should reject children's manipulations coolly and decisively, in no case openly yielding to the wishes of the child. It is desirable to act diplomatically (“both the sheep are safe and the wolves are full”). In such a situation, a gradual change in stereotypes of falling asleep and behavior at night helps a lot: perhaps you should stop rocking the baby, offer to drink, etc., carefully try, gradually increasing the time of the “help approach” if the child woke up and cries; while sincerely hoping and hoping that the child will slowly learn to calm down and fall asleep on his own. It is very effective to jointly create a certain bedtime ceremony (3-4 stages with a total duration of up to 15-20 minutes), develop useful habits and associations: tell a fairy tale or read a story, drink kefir, stroke your back, sing a song, etc. The process of falling asleep should be maximally adapted for relaxation and soothing of the child. Now, for the convenience of parents, many smart remote monitoring devices (“video and baby monitors”) have been invented that allow you to control the situation in the bedroom without appearing in front of the child without special need.

Sleep-wake cycle disorder

Each person has an internal biological clock that is synchronized with the external circadian day-night rhythms, and accurately determines the cycles of sleep-wake time, as well as total time sleep. If the time of these hours does not coincide with the child's daily routine, or some external factors and the way of life of the child-family do not correspond to internal rhythms - this gradually leads to malfunctions in the work of internal cycles. This is how a fairly common disorder of circadian (daily) rhythms is formed. At the same time, the child (especially often in adolescents!) Cannot easily fall asleep at a certain time and wake up in a timely manner. A person suffers in bed sometimes for several hours and does not fall asleep in any way, even if it is time to sleep a long time ago - of course, in the morning he cannot wake up in any way, and parents have to apply "intensive" awakening measures.
Naturally, such a child will experience constant daytime sleepiness and fatigue, which will necessarily lead to a decrease in academic performance. After lunch or in the late afternoon, a short daytime nap is possible, which inevitably worsens the process of going to sleep even more. It turns out vicious circle from which it is sometimes difficult to get out. Underestimation of the danger of such sleep disorders leads to chronic disorder circadian rhythms, and then you can’t do without the help of a specialist. Interestingly, such sleep disturbances are common among high school students and students, adults who work at night, and parents of infants who do not sleep well!
Successful therapy of this pathology is possible only under the guidance of a neurologist-somnologist, and it requires willpower and perseverance of family members. Unfortunately, they have not yet invented such a pill that could easily and quickly adjust upset biorhythms. The most effective methods of chronotherapy: for example, intensive exercise stress and walks in the fresh air during the day, combined with the indispensable control of the exact time of morning awakening and evening falling asleep.
In children of the first 3-4 years of life (most often in infants), disturbances in the sleep-wake cycle may be associated with individual rhythms of family members that do not correspond to the day-night cycle. For example, mom goes to bed after midnight and gets up closer to dinner. At the same time, the child does not form the correct rhythms of sleep-wakefulness. Another common cause of such disorders is the inattention of parents who cannot correctly "catch" the time of going to bed and try to "push" the child to sleep when he is not at all ready for this. For example, the child's internal clock gives the command to fall asleep around 9 o'clock, and the mother tries to put him to bed at 20 oo, or, much worse, at 23 oo. Of course, in the first case, the child will fall asleep in about an hour, and in the second, perhaps even after a few hours, with hysteria and conflicts. At first, such problems are quite easy to solve, it is enough to listen to your intuition, paying more attention to this problem, and the daily routine can be synchronized with the child's internal biorhythms. In severe, chronic cases, specialist help is needed.