Caption: Sleep
Text: All children show some waking at night and resistance to sleep during their first thirty months. Resistance to sleep commonly appears about six months of age, but may occur as early as three or four months. Waking at night, like sleep resistance, may be due to many causes. The frequency of waking and restless sleep increases at nine months and remains at a high up to thirty months. That this is common does not necessarily mean that it is normal. The baby himself goes through many challenging developmental stages during this period, and what is happening in his environment, particularly how his parents are handling him in the daytime and at night, may be contributing to this disturbed sleep.

It is wise to find out what the current sleeping arrangement is and to look for evidence of any problems

Establish a regular bedtime and sleep routine.

Does the child sleep in his or her own bed? Parents may start to take the baby into bed with them when s/he awakens and cries. When s/he is able to get out of his crib, they may allow him to get into bed with them. These practices seem like an easy solution to parents in the beginning, but they only complicate the difficulty that lies behind the toddler's nighttime wandering, and add to the problem of how to get him to sleep in his own bed.

The child should not be allowed to take a bottle to bed. If the child takes his bottle to bed with him, s/he will usually be unable to get to sleep without it for many months.

It may be necessary for the parent to tolerate some crying at bedtime. Many infants cry just before they fall asleep, perhaps as a release of tension. This usually lasts only a few minutes.

Encourage firmness where indicated. In the middle of the first year, most commonly between six and nine months, babies may cry and refuse to go to sleep when they are put down, stop crying when the mother reappears and cry again when she leaves. We can help mothers by preparing them for these new reactions, and by encouraging them to be firm.

Avoid overstimulation. Sleep disturbances may arise when parents excite their baby excessively.

Moving a child to a room of his own from an unfavorable sleeping environment such as his parent's bedroom usually decreases a sleep disturbance within two or three days. But waking at night often follows an environmental change such as a move, a trip or a new sleeping room.

An illness and its treatment can start a sleep disturbance. The child's pattern of waking during the illness may continue after recovery. When the importance of going back to the pre-illness routine is discussed with a mother after her child has recovered, she is usually able to follow this advice, and the pattern of sleep soon returns to normal.

Evidence points to the occurrence of dreams by about one year, and some two-year-olds can describe their dreams. Night terror may occur beginning around age two years. The child screams, cries out, and thrashes about while s/he appears to be asleep. They appear to be a form of anxiety reaction. One third of children age 2-3 years have disturbed sleep with crying out, bad dreams and night terrors. A comforting blanket at bedtime can be helpful. If night terrors are frequent, the clinician should interview carefully for stresses and conflicts in the environment and counsel accordingly.