Preschool Sleep Disorders

Q. I hope you can give us some help. I have a 3 year old grandson who was premature. The problem is that when they finally get him in bed and he goes to sleep he will sleep for about 2-3 hours and then he is up in the middle of the night for another 2-3 hours and then sometimes he will go back to sleep and sometimes not. His mother takes him to the sitter when she goes to work. Sometimes the sitter can get him to take a nap and sometimes not. I have never seen a kid that can go on such little sleep. It is really disrupting the whole house hold and his mother is expecting her second child in about 6 mon. Someone told us that this happens quit often in premature kids, is that true and if so can you recommend a Pediatrician in Omaha, NE that deals with this kind of disorder? Bonnie, Kennard, Nebraska

A. Sleep is important for all children and at age 3 years, he should be sleeping about 11 hours at night and also taking about a 1 hour nap during the day.

By age 3 years, unless he had a lot of other problems and delays associated with being premature, his sleep problems may not have anything to do with his being born premature. Instead, especially if this is a long term problem, he may just have poor sleep associations and doesn't know how to easily go to sleep on his own.

Does he fall asleep with a cup or bottle of milk still?

Does he fall asleep being rocked or watching TV and is then put in bed?

Infants and children with these kinds of sleep problems often fall asleep being rocked or drinking a bottle and simply don't know how to go to sleep on their own.

To prevent and fix this type of problem, it is usually best to teach children to fall asleep on their own. This involves having a bedtime routine that is the same every night, and which can include some quite time or a winding down period during which your child isn't actively playing or watching TV. A bath and reading books and bedtime stories are a common part of a bedtime routine for many parents.

A comfort object, like a blanket or stuffed animal, can also be a good part of a bedtime routine.

And the key feature of a good bedtime routine is that your child falls asleep on his own, so that if he does wake up again later, everything will be the same and he can quickly fall asleep again without your needing to give him a bottle of milk, pacifier, or rock him to sleep. Remember that if a child falls asleep with something like a mobile or music playing, then he really isn't falling asleep on his own.

Another important part of a good bedtime routine is that you don't often return to your child's room after you say goodnight. If you are not comfortable leaving your child's room because he cries too much, you might sit next to his bed and simply tell him that 'it is time to go to sleep' if he continues to fight going to sleep. Don't discuss anything further or give any more explanations, just keep saying that 'it is time to go to sleep.'

Working to fix sleep problems is not usually a quick or easy thing, especially at this age. There are many books that can help retrain a child with poor sleep habits, and they would likely be very helpful for his mother and babysitter:

• the no-cry sleep solution
• Solve Your Child's Sleep Problems
• AAP Guide to Your Child's Sleep
• Healthy Sleep Habits, Happy Child

If you need extra help, it does look like the Children's Hospital in Omaha has a behavioral health and family support clinic that deals with sleep problems. That might be a good place for an evaluation.

And if he has other kinds of developmental problems, a Pediatric Neurologist might also be helpful.