What is childhood insomnia and its symptoms?
Insomnia is a pervasive sleep disorder in children. Given that, in most cases, it is a consequence of erroneous sleep habits, this article will emphasize the importance of behavioral patterns in the treatment of this problem, which affects 30% of the population between 6 months and five years.
In the background, reference will also be made to the pharmacological and non-pharmacological treatment options that the therapeutic approach to this alteration admits.
Before addressing what sleep disorders in the pediatric age are, it is worth knowing childhood sleep patterns.
INFANT SLEEP GUIDELINES
To understand what infant insomnia is and why it occurs, it is helpful to know how the sleep-wake cycle of the newborn evolves until it reaches the normal circadian cycle (a biological phenomenon that occurs rhythmically around the same time in the succession of the wake-sleep period).
Likewise, each stage of the child’s life requires several hours of sleep necessary for the normal development of the child, which must be respected.
According to Eduard Estivill, a medical specialist in sleep disorders, in the newborn, the sleep-wake rhythm is 3-4 hours, with short alternating periods in which the child is asleep or awake (ultradian rhythm).
Some babies do not have these constant cycles. Generally, after 2-3 months, the first nightly sleep periods are initially 5 hours, after 6, 8, until reaching a nightly sleep period equal to 10-12 hours. The suprachiasmatic nucleus of the hypothalamus is in charge of synchronizing the wake-sleep rhythm, making it equal to the period of the environment (24 hours).
The best way to put the child’s sleep on track towards the correct timing of the circadian cycle is through the internal and external synchronizers.
The internal synchronizers are the ones that most influence the regularity of the wake-sleep cycle and are the least adaptable. They influence the suprachiasmatic nucleus of the hypothalamus, also known as the biological clock. They are the melatonin rhythm, body temperature, and other elements such as cortisol.
Light times of the day correspond to low melatonin production, and at dusk, when the sun goes down, its production begins. The circadian rhythm of melatonin is the internal synchronizer that most influences the suprachiasmatic nucleus of the hypothalamus.
Body temperature also cycles throughout the day. It decreases a few hours before falling asleep and increases a few hours before waking up. The deviation of body temperature can be as much as half a degree.
The circadian rhythm of the internal synchronizers is established between approximately 3 and 5 months, an age that generally corresponds to the onset of a period of prolonged nocturnal sleep.
The most influential external synchronizers in establishing the circadian rhythm are light and dark, noise and silence, and routines: mealtimes, external elements associated with bedtime (always the same and same way), and most importantly, caregivers’ attitude to teaching a sleep habit.
The child can associate noise and light with wakefulness and silence and darkness with sleep in a few months.
The joint action of internal and external synchronizers (on which we can act) will allow a child of 6-7 months to establish the 24-hour wake-sleep rhythm.
Each age needs a few hours of sleep distributed at different times. For example, a 6-month-old child, in addition to the long night break (11-12 hours), usually takes three more naps: one after breakfast (1-2 hours), another after lunch (2-3 hours), and one third after snack, shorter. In most cases, food intakes have also been reduced to 4 (breakfast, lunch, snack, and dinner).
The first nap to disappear is the one after snack: it is possible that from 7-8 months, the child no longer needs to sleep it. Instead, the nap after breakfast is reduced over time until it disappears around 15 months. The only nap that persists is the midday one which, in any case, is recommended up to 4 years of age.
Thus, the hours a child should sleep decrease as the months go by. However, some reference values have been obtained by averaging. For example, an increase or decrease of 2 hours concerning these values is considered correct (Table I). Generally, newborns usually sleep between 16-17 hours a day.
At six months, they usually do about 14 hours. Between 12 and 24 months, they sleep approximately 13 hours, and from 5 years, a night’s rest of 11 hours is considered appropriate.
These brief awakenings correspond to a change of position, with the act of covering ourselves, scratching ourselves, etc. hence the importance of a small child always starting his night sleep in his crib or his your bed and not in other places (in your arms, in the stroller or on the sofa, for example).
Insomnia is a physiological need disorder called sleep, which, in turn, corresponds to a resting state of brain activity and metabolism of all our cells. It is, therefore, an essential recovery function of life. Insomnia that appears at an early age, from months of life, is called childhood insomnia.
Any of the following situations characterize childhood insomnia:
- Difficult for the child to fall asleep alone.
- Frequent nocturnal awakenings (up to 15 times) with the inability to return to sleep without the help of caregivers.
- Very shallow dream.
- Sleep duration is less than normal based on your age.
In 98% of cases, the cause of childhood insomnia is the wrong acquisition of sleeping habits. All babies sleep, but not all know how to do it well, so sleeping well is learned.
Children must learn it from their parents or caregivers. Childhood insomnia due to incorrect habits affects 30% of the child population between 6 months and five years. A limit of 5 years is set because a child usually reasons and understands what his parents tell him at this age.
Suppose the child has not overcome his insomnia problem after this age, compared to others who have learned to sleep correctly. In that case, he will be more likely to suffer from sleep disorders (nightmares, sleepwalking, fear of going to bed, etc.) during bedtime—childhood, and from adolescence, insomnia for the rest of his life.
Only in 2% of cases does insomnia occurs for psychological reasons. In this situation, the cause of insomnia is not a lack of sleep habits but some emotional problem.
Any maturational process of the baby can produce excitement and an alteration in the child’s routine (learning to crawl, to walk, a move, a change of room, the birth of a sibling, the beginning of daycare, separation or absence from parents, illness, anxiety, depression, parental stress, etc.).
Young children are very perceptive and sensitive, and sleep problems are usually the first sign that something is wrong with the child.
Generally, he will go back to sleep without difficulty once the situation normalizes or when he manages to adapt to the novelty. Sometimes it will be necessary for the child to receive psychological treatment, and in some situations (separations, abuse, etc.), it is advisable that the parents also receive it.