Chapter 1 At the End of Your RopeThe most frequent calls I receive at the Center for Pediatric Sleep Disorders at Children's Hospital in Boston are from a parent or parents whose children are sleeping poorly. When the parent on the phone begins by telling me "I am at the end of my rope" or "We are at our wits' end," I can almost predict what will be said next.Typically, the couple or single parent has a young child (often their first), who is between five months and four years of age. Their child does not fall asleep readily at night and/or wakes repeatedly during the night. The parents are tired, frustrated, and often angry. Their own relationship has become tense and they are wondering whether there is something inherently wrong with their child, or if they are unfit patents.In most cases the parents have had lots of advice on how to handle the situation from friends, relatives, even the pediatrician. "Let him cry; you're just spoiling him," they are told, or "That's just a phase; wait until she outgrows it.
" They don't want to wait but begin to wonder if they will have to, since despite all their efforts and strategies the sleep problem persists. Often the more the parents do to try and solve the problem, the worse it gets. Sooner or later they ask themselves, "How long do I let my child cry -- all night?" And if he or she gets up four, five, and six times at night, "Will this phase pass before we collapse from our own loss of sleep?"Everything seems pretty hopeless at first. If your child isn't sleeping well or has other problems -- such as sleep terrors, bedwetting, nightmares, or loud snoring -- which are sources of worry and frustration, it won't take long for you to feel as if you're at the end of your rope too.Let me assure you there is hope. With almost all of these children we are able to at least reduce the disturbance significantly, and often we can actually eliminate the sleep disorder entirely. The information in this book will help you to identify your child's particular disorder and will give you practical ways of solving the problem.At the Sleep Center I meet with the family -- parents and child together -- and learn all I can about the child's problem.
How frequent and long-lasting has it been? What are the episodes like? How do the parents handle the child at bedtime and during the nighttime wakings? Is there a family history of sleep problems, and are there social factors that might be contributing to the problem? With this detailed history, a physical examination, and, in certain cases, after laboratory study, I can usually identify the disorder and its causes. At that point I can begin to work with the family to help them solve their child's sleep problem.Our methods of treatment for the "sleepless child" rarely include the use of medication. Instead, I work with the family to set up new schedules, routines, and ways of handling their child. Sometimes the child's biological rhythms may need normalizing or he may have to learn new conditions to associate with falling asleep. The family may have to learn how to set appropriate limits on the child's behavior, and the child may need an incentive to cooperate. I always negotiate the specifics of the plan with the family. It is important that they agree with the approach and feel confident that they will be able to follow through consistently.
If the child is old enough, we include him in the negotiating. Thus we use a consistent, firm, but fair technique, tailored to the child, the family, and the particular sleep disorder. This works, time after time.Usually the sleep problem has nothing to do with poor parenting. Nor are the episodes (with a few exceptions) part of a "normal phase" that must be waited (and waited and waited) out. And finally there is usually nothing physically or mentally wrong with the child himself. Most parents are immensely reassured to know that sleep diso.