Sleep Problems

NIGHT TERRORS

Is my child having a night terror?

It's the middle of the night and you are awakened by your child screaming from his bedroom. You rush in to see what's wrong and you find him sitting up in bed with a blank stare, but extremely agitated. You try to wake him, asking him what is wrong but he doesn't respond, he just keeps screaming. In fact, you may be incorporated into the night terror and he may try to fight you off. You are scared and don't know what to do. After a few minutes, your child goes back to sleep and in the morning he has no memory of the episode.

Characteristics of night terrors:

• Your child seems terrified, eyes open, but cannot be awakened or consoled.
• Your child may sit up in bed, or walk around the room, screaming or talking senselessly.
• Your child doesn't acknowledge you, his eyes may be open but he seems to stare right through you.
• Objects or persons in the room might be mistaken for dangers.
• Episodes usually last between 10 and 30 minutes.
• Usually occur in children 1 to 8 years old.
• Your child cannot remember the episode in the morning.
• Usually happens within 2 hours of falling asleep.
• Night terrors are harmless and each episode will end on its own.

Why does a child get night terrors?
Night terrors are an inherited problem and occur in about 2% of children. We do see a higher incidence of night terrors in our children who are adopted internationally and children who have experienced trauma. The reasons are unclear. Many experts say that night terrors are not caused by psychological stress, but they seem to be associated with being overtired. Other professionals and parents who have adopted internationally seem to think that psychological stress is a part the equation.

What should I do when my child is having a night terror?

Help child go back to sleep.

1. Do not try to awaken your child. You can turn on the lights so that your child won't be confused by shadows. Remain calm, talk in a soothing tone and try not to do things that increase the fear. Don't try to wake him with shaking or shouting, this will only agitate him more and prolong the attack.
2. Protect him from getting hurt.
   Keep you child away from stairs, windows or sharp objects. Try to gently direct him back to bed.
3. Educate your caregivers.
   Be sure to warn babysitters, family members, or others who might be caring for him at night. Explain to them what to do in case of an attack, so that they don't overreact. If they are unprepared, they can be very concerned.

Can night terrors be prevented?
Dr. Sears has noted that the following exercise has been shown to stop night terrors in 90% of children. For several nights, keep track of the time between falling asleep and the onset of the night terror. Then, wake him up 15 minutes prior to the expected time of the episode, get him out of bed and fully awake for 5 minutes. Do this for seven consecutive nights. If the night terrors recur, repeat the seven nights of awakenings.

NIGHTIME PARENTING DECISIONS

1. Develop a realistic attitude about nighttime parenting with your newly adopted child. The best thing you can do is to create a secure environment that allows your child to develop a healthy attitude about sleep: that sleep is a pleasant state to enter and a secure state to remain in.
2. Beware of sleep trainers. Most sleep-training techniques are just variations of the old cry-it-out method. Be discerning about using someone else's method to get your child to sleep. Parents of birth children had many opportunities to form secure attachments and trust before they began using these techniques. Before trying any sleep-inducing program, you be the judge. Run it through your inner sensitivity before trying them on you're your newly adopted child, especially if they involve leaving your child alone to cry. Does this advice sound sensible for a child who has dealt with multiple losses, trauma and change? Does it fit your baby's temperament? Does it feel right to you? Use discernment about advice that promises a sleep-through-the-night more convenient baby, as these programs involve the risk of creating a distance between you and your baby and undermining the mutual trust between parent and child that you are try to build. On the surface, baby training sounds so liberating, but it's a short-term gain for a long-term loss. You lose the opportunity to get to know and become an expert in your baby. Your baby also loses the opportunity to build trust in his caregiving environment. You cease to value your own biological cues, your judgment, and instead follow the message of someone who has no biological attachment, nor investment, in your child.
3. Stay flexible and decide where child sleeps best. There is no right or wrong place for babies to sleep. Wherever all family members sleep the best is the right arrangement for you and your baby. Some babies sleep best in their own crib in their own room, some sleep better in their own bassinet or crib in the parents' bedroom, other babies sleep best snuggled right next to mommy in the parents' bed. Many parents prefer a co-sleeper arrangement. Realistically, most parents use various sleeping arrangements at various stages during the infant's first two years. Be open to changing styles as baby's and child's emotional and developmental needs and as your family situation changes.
4. Consistent bedtimes and rituals. Babies who enjoy consistent bedtimes and familiar going-to-sleep rituals usually go to sleep easier and stay asleep longer. Yet, because of modern lifestyles, consistent and early bedtimes are not as common, or realistic, as they used to be. Busy two- income parents often don't get home until six or seven o'clock in the evening, so it's common for older babies and toddlers to procrastinate the bedtime ritual. This is prime time with their parents and they are going to milk it for all they can get. In some families, a later afternoon nap and a later bedtime is more practical. Familiar bedtime rituals set the baby up for sleep. The sequence of a warm bath, rocking, nursing, lullabies, etc. set the baby up to feel that sleep is expected to follow. Capitalize on a principle of early infant development: patterns of association. Baby's developing brain is like a computer, storing thousands of sequences that become patterns. When baby clicks into the early part of the bedtime ritual, he is programmed for the whole pattern that results in drifting off to sleep.
5. Calming down. Give baby a warm bath followed by a soothing massage to relax tense muscles and busy minds. Be careful, though, because this will stimulate some babies.
6. Tank up your baby during the day. Babies need to learn that daytime is for eating and nighttime is mostly for sleeping. Some older babies and toddlers are so busy playing during the day that they forget to eat and make up for it during the night by waking frequently to feed. To reverse this habit, feed your baby at least every three hours during the day to cluster the baby's feedings during the waking hours. Upon baby's first night waking, attempt a full feeding, otherwise some babies, especially breastfed infants, get in the habit of nibbling all night.
7. Daytime mellowing. A peaceful daytime is likely to lead to a restful night. The more attached you are to your baby during the day and the more baby is held and calmed during the day, the more likely this peacefulness is to carry through into the night. If your baby has a restless night, take inventory of unsettling circumstances that may occur during the day: Are you too busy? Are the daycare and the daycare provider the right match for your baby? Does your baby spend a lot of time being held and in-arms by a nurturing caregiver, or is he more of a "crib baby" during the day?Has your child been in close proximity to you during the day?

Copyright 2004. UAB / International Adoption Clinic. All rights reserved. No part of this work may be reproduced in any form without the prior written permission of the UAB / International Adoption Clinic.