Solve Your Child's Sleep Problems

Does your child

• Have difficulty falling asleep?
• Wake in the middle of the night?
• Suffer sleep terrors, sleepwalking, or nighttime fears?
• Have difficulty waking for school or staying awake in class?
• Snore, wet the bed, or head bang?

In the first major revision of his bestselling, groundbreaking classic since it was published twenty years ago, Dr. Richard Ferber, the nation's foremost authority on children's sleep problems, delivers safe, sound ideas for helping your child fall and stay asleep at night and perform well during the day.

Incorporating new research, Dr. Ferber provides important basic information that all parents should know regarding the nature of sleep and the development of normal sleep and body rhythms throughout childhood. He discusses the causes of most sleep problems from birth to adolescence and recommends an array of proven solutions for each so that parents can choose the strategy that works best for them. Topics covered in detail include:

• Bedtime difficulties and nighttime wakings
• Effective strategies for naps
• Sleep schedule abnormalities
• A balanced look at co-sleeping
• New insights into the nature of sleep terrors and sleepwalking
• Problems in setting limits
• Sleep apnea, narcolepsy, bed-wetting, and head banging

Solve Your Child's Sleep Problems offers priceless advice and concrete help for a whole new generation of anxious, frustrated, and overtired parents.

In this first major revision of his bestselling groundbreaking classic since it was first published 20 years ago, Dr. Ferber provides parents with important new information on children's sleep problems and options and techniques for dealing with them successfully.

Based on six years of intensive research in a top medical facility, "Solve Your Child's Sleep Problems" is packed with tips, suggestions, sample problems and solutions, and a bibliography of children's "go-to-sleep" books.

Does your child

• Have difficulty falling asleep?
• Wake in the middle of the night?
• Suffer sleep terrors, sleepwalking, or nighttime fears?
• Have difficulty waking for school or staying awake in class?
• Snore, wet the bed, or head bang?

In the first major revision of his bestselling, groundbreaking classic since it was published twenty years ago, Dr. Richard Ferber, the nation's foremost authority on children's sleep problems, delivers safe, sound ideas for helping your child fall and stay asleep at night and perform well during the day.

Incorporating new research, Dr. Ferber provides important basic information that all parents should know regarding the nature of sleep and the development of normal sleep and body rhythms throughout childhood. He discusses the causes of most sleep problems from birth to adolescence and recommends an array of proven solutions for each so that parents can choose the strategy that works best for them. Topics covered in detail include:

• Bedtime difficulties and nighttime wakings
• Effective strategies for naps
• Sleep schedule abnormalities
• A balanced look at co-sleeping
• New insights into the nature of sleep terrors and sleepwalking
• Problems in setting limits
• Sleep apnea, narcolepsy, bed-wetting, and head banging

Solve Your Child's Sleep Problems offers priceless advice and concrete help for a whole new generation of anxious, frustrated, and overtired parents.

Richard Ferber, M.D., is an associate professor of neurology at the Harvard Medical School and director of the Center for Pediatric Sleep Disorders at Children's Hospital Boston. He lives in Newtonville, Massachusetts.

Contents

Acknowledgments

List of Figures

Preface to the Second Edition

PART I: YOUR CHILD'S SLEEP

CHAPTER 1: At the End of Your Rope

Can a Child Just Be a "Poor Sleeper"?

How to Tell Whether Your Child Has a Sleep Problem

Starting with a Basic Understanding of Sleep

CHAPTER 2: What We Know About Sleep

Non-REM Sleep

REM Sleep

How Sleep Stages Develop in Children

Children's Sleep Cycles

Sleep and Waking Patterns

The Importance of Biological Rhythms

CHAPTER 3: Helping Your Child Develop Good Sleep Practices

The Importance of Your Child's Bedtime Routines

"Back to Sleep": Reducing the Risk of SIDS

Should Your Child Sleep in Your Bed?

Specific Issues Related to Co-sleeping

The Sleep Challenges of Multiples: Twins and Triplets

The Special Toy or Favorite Blanket

Developing Good Schedules

PART II: THE SLEEPLESS CHILD

CHAPTER 4: Sleep Associations: A Key Problem

A Typical Sleep Association Problem

Why Sleep Associations Matter

Wrong Sleep Associations

How to Solve the Problem: The Progressive-Waiting Approach

Making the Changes in One Step or Several

Associations to the Breast, Bottle, or Pacifier

Co-sleeping and Related Considerations

If Things Are Not Getting Better

General Observations

CHAPTER 5: The Problem of Limit Setting

Who's in Charge?

Difficulty Setting Limits

Limits, Associations, Feedings, Schedules, and Fears

Setting Limits at Night

Limit Setting Problems: Some Examples

CHAPTER 6: Feedings During the Night: Another Major Cause of Trouble

Is Your Child's Sleep Problem Caused by Nighttime Feedings?

How to Solve the Problem

Other Points to Keep in Mind

Medical Considerations

CHAPTER 7: Nighttime Fears

The Anxious Child

Bedtime Fears

Evaluating Your Child's Fears

How to Cope with Nighttime Fears

Techniques to Help a Child Feel Less Frightened and Fall Asleep Quickly

Final Considerations

CHAPTER 8: Colic and Other Medical Causes of Poor Sleep

Colic

Chronic Illness

Nocturnal Pain

Medication

Abnormal Brain Function and a True Inability to Sleep Well

PART III: SCHEDULES AND SLEEP RHYTHM DISTURBANCES

CHAPTER 9: Schedules and Rhythms

Sleep Phases

The Circadian System and the Forbidden Zone for Sleep: Why You Can Stay Awake Until Bedtime — and Sleep Until Morning

Setting the Biological Clock: How Do You Know What Time Zone You Are In?

Individual Differences: Are You a Lark or an Owl?

Society, Sleep Deprivation, and the Adolescent

Specific Sleep Problems Affecting Different Parts of the Sleep Cycle: A Summary

CHAPTER 10: Schedule Disorders I: Sleep Phase Problems

Sleep Phases

Sleep Phase Shifts

Sleep Phase Shifts in the Adolescent

CHAPTER 11: Schedule Disorders II: Other Common Schedule Problems

Problems in Regular Schedules

Irregular and Inconsistent Sleep-Wake Schedules

Travel

CHAPTER 12: Naps

Problems with the Length and Timing of Naps

Trouble Giving Up a Nap: Transition Problems

Nap Time Sleep Association Problems

Napping (or Not) at Home and at Day Care

You May Have to Accept What Works

PART IV: INTERRUPTIONS DURING SLEEP

CHAPTER 13: Partial Wakings: Sleep Talking, Sleepwalking, Confusional Arousals, and Sleep Terrors

I. What They Are and Why They Happen

The Normal Transition from Deep (Stage IV) Sleep Toward Waking

More Intense Transitions: A Spectrum of Confusional Events

What a Confusional Event Feels Like

Why Confusional Events Happen: The Balance Between Sleep and Waking

The Variability of Arousals over Time

Evaluating Confusional Events: When to Take Action

II. Treatment

What You Should Do and What Else to Consider

How We Helped the Children Described Earlier

CHAPTER 14: Nightmares

What Nightmares Are and Why They Occur

How to Help Your Child If He Is Having Nightmares

Nightmares and Confusional Events

Nightmares or " 'No'-mares"?: "I had a bad dream"

CHAPTER 15: Bedwetting

The Impact of Enuresis

What Causes Enuresis?

Approaches to Treating Enuresis

Final Words

CHAPTER 16: Head Banging, Body Rocking, and Head Rolling

When Do These Behaviors Occur?

What Do These Behaviors Look Like?

Is Head Banging Dangerous?

When Should You Be Concerned?

What Causes Rhythmic Behaviors?

Treating the Problem

Outcomes

PART V: THE SLEEPY CHILD

CHAPTER 17: Noisy Breathing, Snoring, and Obstructive Sleep Apnea

What Happens in Sleep Apnea

What Causes the Obstruction

Treating Sleep Apnea

Some Words of Caution

Getting Your Child the Help She Needs

CHAPTER 18: Narcolepsy and Other Causes of Sleepiness

Is Your Child Abnormally Sleepy?

Causes of Sleepiness Other Than Narcolepsy

Treating Simpler Causes of Sleepiness

Evaluation at a Sleep Disorders Center

Narcolepsy

The Cause of Narcolepsy

The Treatment of Narcolepsy

Future Treatments

Index