How to make babies sleep longer, better
Study shows a prebedtime hygiene routine with massage helps
Sleep affects every aspect of an infant's early physical, emotional, cognitive, and social development. In older children, there is a higher risk for mood and behavioral disorders with poorer academic performance. Sleep problems in children may also adversely affect the rest of the family and caregivers in that their sleep and rest patterns are also disrupted.
"From babies to [adults], there are a lot of concerns regarding sleep," said Dr. Michael Alexius Sarte, unit head of The Medical City Center for Snoring Sleep Disorder. Speaking at a lecture organized by Johnson & Johnson Philippines in April, Sarte said since diseases in adulthood have their beginnings in childhood, "sleep deprivation and abnormalities in childhood may have an impact on vascular diseases among other conditions."
Together with Dr. Jodi Mindell of the Sleep Center at the Children's Hospital of Philadelphia, Sarte discussed why sleep is important to infants, and offered tips on how to help them sleep better. Dr. Luis Rivera, pediatric pulmonologist at the Makati Medical Center, discussed recent scientific evidence showing how a regular bedtime routine can improve the sleeping habits and patterns of babies.
The symposium also served to introduce Johnson's Before-Bed Routine using Johnson's Baby Bedtime Wash and Bedtime Lotion.
Slow-wave sleepers
Children are slow-wave sleepers. Compared with adults, their sleep cycles are shorter, lasting 50 to 60 minutes, making them more vulnerable to waking up at night. A lengthy light-sleep stage may last 20 minutes or longer, but having the deeper type of sleep is more important for growth and development.
The stimulation of growth hormones becomes an integral part of childhood development, especially since children who lack sleep "do not grow as well as those who [get enough] sleep," said Sarte. Growth hormones serve to strengthen tendons and ligaments and help improve metabolism and protein synthesis. The immune system has also been shown to be more vulnerable with a constant lack of sleep, even among adults. Kids who don't get enough sleep, Sarte added, "are more prone to infections, and do not heal as quickly as those who have good sleep."
Learning and memory are important functions also affected by adequacy of sleep. Some babies are reported to have better cognition with ample sleep. Since good memory is essential to proper learning, a child must have the required amount of sleep to learn simple tasks and even to articulate his first few words.
A healthy cardiovascular system and proper function of hormones (as in insulin production) also owe a lot to good sleeping habits that are instilled early in a child. Lack of sleep may stimulate inflammatory agents such as cytokines to descend on the blood vessels, raising the risk for injury that may give rise to cardiovascular and cerebrovascular illnesses. Likewise, some degree of insulin resistance may build up with lack of sleep, increasing blood-sugar levels and raising one's risk for diabetes.
Overall body metabolism is also closely linked with adequacy of sleep. Two satiety hormones actively involved in regulating hunger signals are affected by sleep adequacy. Grelin, produced in the stomach, is activated during bouts of fasting and stimulates hunger signals, telling the brain to eat more. Leptin, on the other hand, is produced from adipocytes and serves to inhibit appetite, signaling to the brain that the individual has had enough to eat. With sleep deprivation, however, more grelin is released and leptin is decreased, thus making one feel as if he were hungry, which could induce overeating, and then weight gain. Said Sarte: "If you have good sleep, your metabolism is better and you tend not to be on the heavier side, and this is actually proven by science."
Other consequences
However, sleep problems are common among children. About 25 percent of children would have one or more of the 84 known sleep disorders of varying severity and duration at some point during childhood.
Sleep is also a problem for the one who is taking care of the child. Evidently, having a child who can't sleep well means that the parents, even the entire family, will not be able to sleep, which could cause mood disturbance and daytime fatigue, among others. A mother who has just given birth, who is sleep-deprived, and who is at risk for postpartum depression, may experience an aggravation of her symptoms, which may result in "decreased level of parenting." Lack of sleep by the caregiver may even be a risk factor for child abuse.
Sarte said that there is a need to identify sleep problems early because they can exacerbate underlying medical, psychiatric, developmental, and psychosocial problems in childhood. Children in particular run a higher risk of suffering from sleep disorders and yet are less likely to be diagnosed and treated, hence are more prone to suffer serious consequences.
Some of the more common sleep problems in infants are:
-
Day/night reversal. There is no distinction between day and night-time sleep
for infants. It's only until they are eight to 12 months old that will they
begin to fall into sleep cycles that are close to those of adults.
-
Irregular sleep patterns. This is especially common in children at 22 to 23
months old.
-
Night-time arousal.
Treatable and preventable
Adjustment in common practices and primary prevention through education for parents and caregiver are at the core of management of sleep problems, with an adherence to sleep "hygiene" proving effective for both parents and guardians. Since children at such a young age are not expected to have the same quality of sleep as adults, it is important to train them to follow regular sleep schedules early on.
Diagnosis is aimed at excluding precipitating factors or complications, while intervention would effectively be in the form of behavioral management and reassurance in the child. Sleep disorders in general are managed conservatively, and rarely require pharmacologic intervention.
Better, longer sleep
Effective nonpharmacologic management was the subject of a clinical study conducted by Mindell, which aims to make use of before-bed routines and personal-care products to help improve infants' sleep, reducing tension and anxiety in the mother as well.
The study enrolled 58 healthy male and female infants (seven to 18 months), together their mothers, whose sleeping habits were observed over a three-week period, the first week serving as baseline/control before the prebedtime routine was given. In the second and third weeks, the prebedtime routine was initiated, with the primary study measures collected via three questionnaires: Brief Infant Sleep Questionnaire (BISQ), Infant Daily Sleep Questionnaire (St. Mary's), and Profile of Mood States (POMS, for the mother).
The routine involved putting the child to bed within 30 minutes after a bath. The infant was bathed for a minimum of five minutes with the help of the bath product, after which the baby was massaged gently for at least two minutes using lotion. After the routine, no active play was allowed, encouraging only quiet activities before bedtime such as reading stories and singing lullabies.
At the end of the study, the right product combination and prebedtime routine showed positive results in four outcome measures. There was a sharp reduction in time-to-fall-asleep (sleep-onset latency) over the previous week's baseline (37 percent), coupled with a 37-percent dip on average times that the baby woke during the night.
The total amount of time at night spent awake (night waking) was also reduced by almost 50 percent, such that the child spent more time asleep. Lastly, there was a 23-percent longer during a typical night.
A follow-up survey on the mothers and other caregivers giving the bedtime routine showed 80 percent believed that their babies' sleep improved, 85 percent continued giving the routine, while 100 percent enjoyed performing it.
Added maternal benefits
Beneficial effects on the mother were entered as secondary measures, with favorable results. Approximately 55-percent less tension and anxiety was noted among the mothers after employing the routine, with 59-percent reduction in maternal fatigue. Since the infants were sleeping better, the mothers experienced significantly less stress.
Rivera was upbeat about these results: "I know it is one study, but it shows very encouraging results and seems very effective not only in benefiting the baby but also in benefiting the mother."
M
|
