Sleep Disorders of Early Childhood: A Review
Benhamou, Isabelle, The Israel Journal of Psychiatry and Related Sciences
Abstract: Night awakening and refusal to go to sleep are common problems during the first three years of life, comprising 6-30% of children in the general population. The organization and regulation of child sleep is thought to be closely related to his mode of attachment to his mother. Sleep aids (pacifier, teddy bear, etc.) during the night seem to reduce the occurrence of sleep disorders whereas prolonged breastfeeding and co-sleep with the parents interfere with the normal development of sleep. During the preschool years, the main issue affecting sleep is the ability of parents to set firm limits while respecting the sense of autonomy of the child. Sleep disorders are considered to be more common among physically and mentally handicapped children. Children with a difficult temperament sleep less than those with an easy one. A clear association is found between sleep patterns and psychopathology of the mother probably due to emotional unavailability and inappropriate behavior. Evaluation of the disorder should follow medical examination. It should take place in the presence of the child in order to view the real interaction as well as given information about the reported interaction between the child and his mother. Therapeutic interventions in cases of early childhood sleep disorders can be behavioral or psychodynamic and are advised to be focused and brief, unless there is psychopathology in the parents.
Sleep is one of the most fragile functions in childhood. Due to its immediate impact on the family ambiance, sleep disorders are a frequent cause for consultation in pediatric and pedopsychiatric clinics, and more particularly night waking and bedtime struggle. Whereas Gesell and Ilg (1) consider sleep difficulties as nearly universal and transient problems in the first three years of life, others view persistent sleep problems as a hallmark of psychological disturbances in early childhood (2, 3). Because of the dependence of the child's adaptation upon the care-giving environment it will be detailed how the quality of care and sensitivity of the care-giver - acting as "external" regulators of children's biological rhythms, states, affects and behaviors - either facilitate or hinder the young child's capacity to organize his sleep.
Definition - Prevalence
The prevalence of sleep disorders varies widely, according to the adopted definition. When the definition focuses entirely on the child's symptomatology (4) it varies between 6- 10% among a child population aged one to two years. When it takes into account the dimension of the parent's distress (3) the prevalence is higher, up to 30% of a population of 96 children aged one month to four years. About the same results are found by the telephone surveys of parent's reports of Johnson (5) and Scott and Richards (6). The work of Minde et al. (7) has added new insights about the accuracy of these parental reports. In his study, a video was placed at homes of 30 children with a severe sleep disorder, aged 12 to 36 months and 28 controls. They compared various sleep parameters as they were reported by the parents and seen on videotape and revealed that parents of poor sleepers recorded on average 2.7 wakings per night, while the video camera recorded 3.6 wakings. At the same time mothers of good sleepers reported them waking up only 0.5 times per night while film records revealed a surprising average of 3.2 wakings. In other words, there was no difference in the incidence of interrupted sleep experienced by these children, but a real difference in the way the "good sleepers" managed to go back to sleep without waking their parents. Hence, instead of distinguishing between "good" and "bad" sleepers, we may have to differentiate between those who can regulate and soothe themselves properly and those who can't and are signaling to their parents. The prospective study of Wolke et al. (8) in 1994 corroborates the previous results of Zuckerman et al. in 1987 (9) and demonstrates that, in contradiction to general wisdom, sleep troubles don't have a natural tendency to disappear. …