BEHAVIOR:
ASK THE EXPERTS

SLEEP PROBLEM—IS IT MORE THAN IT SEEMS?

Q I am inquiring about a very active, intense 12-month-old boy who sleeps in his parents' bedroom on a mattress on the floor. During infancy, he was breastfed on demand every hour to hour-and-a-half throughout the night. He was allowed to nurse himself back to sleep. This was exhausting to his parents, especially his mother. To give her some relief, his father tried sleeping between them and would get up about three times a week to make a bottle for him in the middle of the night.

The child goes to sleep only during a car or stroller ride and has never been able to fall asleep with the aid of stories, a bath, or rocking. The parents are afraid that if they put him in his crib at night, he might climb out because he is so active. The mother's philosophy leans toward attachment parenting, and she finds letting her son cry himself to sleep unacceptable.

Do you have any fresh ideas for helping this extremely active, alert toddler sleep at night?

Name withheld on author's request

A This 1-year-old boy has a most devoted set of parents! Wishing to give their child a secure start in life, the parents have tried to anticipate, understand, and respond to his every imaginable need. I assume that the child's growth, health, and development are reasonably good except for the behavioral challenges centered around sleep and waking. Indeed, his sleep pattern of staying awake after nighttime feeding interactions appears age-appropriate for a young toddler who has learned to control, not just his own, but his parents', sleep-wake patterns.

I sympathize with both parents and child because I think a paradox may be at work. Out of loving concern for their son's emotional well-being, the parents may be denying the child sufficient opportunities to experience the pride and comfort that come with learning self-regulating behavior at an early stage of development (and wearing themselves out in the process). I realize that the decisions of the well-intentioned mother stem from an "attachment" orientation, but she must also keep in mind that healthy autonomy sprouts around 1 year of age and develops from a secure sense of trust during infancy. Are these possibly hypervigilant parents giving their child an unintended message: I am not competent to attend to my own hunger, sleep, and exploratory interests and learn safe, acceptable limits?

A 1-year-old child is able to understand verbal direction and emotional expression. This child's parents could show their dedication to child rearing by beginning to trust their son's emerging neuromuscular, sensory, communicative, and self-regulatory skills. They might ask themselves which parental behaviors teach their child to feel more relaxed and confident and which leave him wondering if he could ever survive beyond arm's reach.

I expect this capable young toddler is working hard to help his parents understand that he needs a little more independence. Their job is to set safe boundaries within which their son feels free to regulate his own behavior and seek help only when he needs it.

Peter A. Gorski, MD

DR. GORSKI is director, the Lawton & Rhea Chiles Center, and professor of public health, pediatrics, and psychiatry, University of South Florida, Tampa.

 

Behavior: Ask the experts. Contemporary Pediatrics 2003;4:23.