Health: How to turn nightmares into sleeping beauties

If your bundle of joy is an unpredictable alarm clock, wrecking any hope of rest, relax: there are ways to teach children to sleep

It's 11am, and 18-month-old Chloe is sleeping soundly in her father's arms. Father and daughter are the envy of passing parents, battling with noisy, demanding toddlers. But this scene of tranquillity is deceptive. Chloe kept her parents up most of the night, as usual. Every evening for the last year, she has woken up half a dozen times, and it's almost impossible to get her back to sleep.

After more than a year of this disturbance, Chloe's parents are besides themselves from lack of sleep. So much so, that the couple have been referred to a sleep centre for therapy, after their baby was diagnosed as suffering from night waking and settling problems.

According to research presented to a Royal College of Psychiatrists conference at the weekend, as many as a quarter of all children aged under five now have severe sleep problems, which means that they are difficult to get to sleep and that they wake up at least three times a night.

Night waking and settling problems are not only the seeds of potential long-term behavioural problems in the child; they are also a source of anxiety, stress and depression in the rest of the family.

There's also growing evidence that many fraught and despairing parents are getting prescription drugs for children as young as nine months, to help them to go to sleep so that the whole family can get some rest.

We all need sleep; an adult requires an average of seven and half to eight hours, every night. In contrast, a newborn baby will sleep most of the time, waking once every three hours, while a six-month child should be able to sleep most of the night, apart from waking in the early morning for a drink. By nine months, the baby should have established a routine, and at 12 months ought to be sleeping without waking for 10 to 12 hours a night.

But, as Dr Paul Ramchandani and his team say in their research at Oxford, one in four children does not have a sleep routine, and the problem in most cases is that they have never been taught. Sleep is a learnt behaviour, and many parents fail to teach it properly. That failure can lead to years of problems, because once a child has found that he or she can get attention by crying, whatever the time of day or night, the rot has set in.

"Sleep problems are very common in under-fives, but 12 per cent of 12- year-olds also have settling and waking problems, and among those with learning disabilities, it can be as high as 50 to 60 per cent,'' says Dr Lyn Quine, a reader in health psychology at Kent University.

The rates are also higher among children who suffer from nocturnal asthma, eczema and chronic illnesses, as well as a range of rare disorders involving defects of the central nervous system. These symptoms can affect the rest of the family, triggering sleep deprivation, anxiety and depression.

It can also effect physical health and performance. "Sleep is essential for our physical and emotional well-being. It can, for example, seriously undermine the functioning of the immune system, making us vulnerable to infection,'' says Professor William Regelson of Virginia University, co-author of The Melatonin Miracle.

Researchers in San Diego have gone some way to proving the point, by depriving a group of men of sleep between 3am and 7am on one night, the most common period for night waking. They found that the levels of the body's natural defences against viral infections had fallen significantly when they were measured the following morning.

In the past, many families have muddled through with the sleep problems of their children, but the growing number of working parents has increased the need to find solutions. "A lot of parents do put up with it, partly because they are not aware that there is anything they can do about it. Some try to sort it out, and are then left with feelings of failure. We see a lot of parents coming to the clinics who have tried medication, or who have left their child to cry and not gone back to check on them, but have found that neither has been a solution,'' says Dr Ramchandani, a specialist registrar in child psychiatry in Oxford.

He says that antihistamines are the most common drugs given to small children for sleep problems. There is evidence that the sedative diazepam is also being prescribed, although sleeping drugs designed for adults should never be given to children. "Antihistamines are used mainly for treating allergies, but the old-style antihistamines cause sleepiness as a side-effect, and this is used to sedate children with sleep problems," says Dr Ramchandani.

He strongly advises that medication should be considered only for short- term emergency treatment. The treatment of choice is behavioural therapy, where both the child and the parents are re-educated about sleeping. It involves a variety of tactics, including fixed night-time conventions, the gradual withdrawal of the parent from the bedroom, and rewards for good behaviour.

"In these kinds of cases, the child has found that poor behaviour, making a fuss, gets results - and that's why behaviour techniques are used, and why it works so brilliantly,'' says Dr Lyn Quine.

"I don't recommend it until after a child reaches 12 months. The therapy involves ignoring bad behaviour, and rewarding good behaviour with social praise and so on. There is also controlled crying, where the child is left for lengthening periods of time.

"We also need to teach children to go to sleep without parents being there. A lot of the problems arise because, if the child wakes up in the night and you are not there, and he is used to you being there, he wants to get the conditions back to when he fell asleep, so he cries until you go back.''

One of the tactics is to make the bedroom a happy place that is solely associated with sleep. Having a bedroom which doubles as a playroom, for example, can confuse a small child. But one of the worst strategies is to use the bedroom as a punishment. Those parents who dispatch their child to bed as a form of chastisement, will risk many sleepless nights themselves.

Tips For A Good Night's Rest

n Establish a pre-sleep winding-down ritual of supper, bathtime, quiet playtime, and bed, so that the baby gets into a fixed routine.

n Put in a night light if the baby is anxious.

n If the baby cries during the night, check the nappy, or whether a drink is needed, but do it quickly, and don't stop to play, or the child will learn that waking at night can mean fun.

n If that fails, try controlled crying, going back to check on the child at pre-determined intervals. First, let the crying continue for five minutes before going in to give reassurance. Slowly extend the periods to 10, 20, and 30 minutes.

n Go to bed with the child, but ignore the cries and pretend to be asleep. Next time, try the same tactics sitting on chair by the cot or bed, and on subsequent occasions move the chair nearer to the door, until finally the child goes to sleep when you are not in the room.

n If all else fails, talk to your health visitor

or GP.