Strategies for children who won't sleep.

Health and medicine explained.
May 25 2007 7:36 AM

The Get-Out-of-Bed-Free Card

New and old strategies for children who won't sleep.

Illustration by Mark Alan Stamaty. Click image to expand.

Kids who don't or won't sleep are one of the most daunting and unwelcome challenges of parenting. If children sleep poorly, their parents are likely to do the same, and the result is irritability, grumpiness, and general misery, if memory serves me. A new study suggests the stakes might be even higher. Its authors found a clear association between the bad sleep of babies and children and the poor health of parents—physical and sometimes mental.

What can desperately tired parents do about this? Another new piece of research proposes a sensible-seeming answer I haven't heard before. And I'll tell you the sleep advice I give to parents of infants and toddlers. But first let's sort out the link between kids' poor sleep and parents' poor health.

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The new study involved 5,000 Australian children followed from infancy by a team led by Melissa Wake and Harriet Hiscock at the University of Melbourne, and an additional 5,000 children who enrolled in the study as preschoolers. The children's parents were asked whether their child's sleep was a problem. Possible answers: "no," "mild," "moderate," and  "severe." About 15 percent characterized their infants and preschoolers as having moderate or severe sleep problems.  This number seemed low to me—based on previous research, I would have expected about twice as many. But the difference probably results from the researchers' decision to look beyond mild sleep difficulties.

When Wake and Hiscock compared the children's sleep history with parents' medical histories, looking at general health, mental-health problems, and severe psychological distress, they found an association. Both fathers and mothers of infants with sleep problems reported poor general health for themselves. Alas, the researchers didn't ask whether these problems preceded the babies' bad sleep, or—as I suspect—it was the babies' sleep patterns that led to their parents' health troubles. 

The relationship is clearer for mental health. The researchers asked mothers whether they had a previous history of depression, and they found that sleepless infants put mothers with no past history of depression at risk for developing mental-health problems. (If they already had such a history, their babies' sleeplessness didn't make their prognosis any worse than it already was.) By contrast, infants who sleep poorly seem to have little effect on the distress levels of their fathers. Also, preschoolers' sleep problems were associated with milder negative effects, physical and mental, on both parents.

Why is there such a strong association between poor sleep in infants and poor physical health for both parents?  I can only speculate that the stress of chronic sleep interruption may have greater physical consequences than we have previously appreciated. Surely, this question calls out for more research. Also, I should point out that the state of physical health comes from the parents' self-reporting rather than an examination of their health records.  It's possible that their physical health isn't objectively poorer—it's just that they feel much worse.

As for the mental-health findings, they come as no surprise. Poor sleep in infants is likely to lead to poor sleep in mothers, and sleep deprivation in adults is bad for their mental health.  I would have thought that fathers would be similarly blighted, and the findings about their poor overall health suggest they aren't snoozing away while their wives tear their hair out. But maybe the sleep deprivation affects fathers differently, for some reason.

It's a relief to learn that badly sleeping preschoolers don't have the same deleterious impact. That's probably because they're just not as all-demanding as the awake-all-night infant. But if you've got one of those still-plaguing kids, here's a strategy backed by evidence, from new research by Brei Moore and Patrick Friman and their associates at the University of Nevada and the University of Nebraska. The method they test is simple: Put children to bed with a card they can exchange for one "free pass" to leave the bedroom to get a drink or a parental hug. (Not on the list is permission to stay up later.) Once the child enjoys his free pass, he has to turn in it in for the night, and his parents must ignore all subsequent bids for attention.