The child who does not sleep - First Aid

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Emergency intervention in children

Sunburn in children Diaper rash Febrile seizures The child who does not sleep Acute asthma access Dental trauma Head injury
  • Sunburn in the child
  • Diaper rash
  • Febrile seizures
  • The child who does not sleep
    • What to do to develop a good sleep attitude
    • How to treat sleep disorders
    • Some virtuous behavior
  • Acute asthma access
  • Dental trauma
  • Head trauma

The child who does not sleep

"Sleep disturbances" are very common in childhood and create significant discomfort for parents. It is estimated that at least 25% of children may have a sleep disorder at various times from childhood to adolescence. In most cases, it is a "self-resolving" disorder, but sometimes it can persist, causing emotional and behavioral disorders in school age and adolescence. The impact of the disorder is intensified by the effect it causes on the quality and rhythm of the parents' sleep. Infantile insomnia is the sleep disorder for which parents consult the pediatrician more frequently, generally because they are deeply disturbed by the problem and do not know how to deal with it.

It is important that so-called secondary sleep disorders are recognized early, that is, linked to a specific cause: chronic diseases, apnea from obstructive factors of the upper airways (for example, massive adenoids), etc. Removing the cause should resolve the sleep disturbance.

Many cases of childhood insomnia, however, do not have a recognized cause (primary disorders) and are often the result of a vicious cycle of behavior that occurs between the parents and the child in the first six to nine months of life, and which then self- It maintains. There are in fact profound differences between a nursing infant and another as regards sleep rhythms. However, there are many parents who are not aware of the physiological variations of the infant's sleep, that is, they do not know how many hours a child sleeps, what type of sleep they have (continuous, with interruptions), and they do not realize how deeply their behavior can reflect on the way to sleep the baby.

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What to do to develop a good sleep attitude

In view of the high number of small physiological awakenings, infants should be put to bed sleepy but still awake to develop the ability to "self-comfort" and to avoid dependence on the presence of a parent when they wake up. In these circumstances, the child will be able to fall asleep immediately, play a bit and then sleep or call the parents' attention with screams or crying. The parent should not intervene or, if he intervenes, should not pick up the child, but only make him feel his reassuring presence. If the parent does not resist the calls of the child and gets him used to falling asleep in his arms, he cradles him, drinks and / or eats, inevitably the child, in the case of the brief awakening at the end of each sleep cycle, will need the same. interventions to go back to sleep. As a consequence there are "nocturnal crying conditioned" by the habit of being held in your arms, being fed, being carried into the Latvian, being caressed and entertained or repeatedly fed at night to be able to go back to sleep.

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How to treat sleep disorders

The treatment of primary childhood insomnia consists mainly of a behavioral intervention. Parents are instructed to avoid intervening at each call of the child, with a more or less gradual path of "weaning" from the bad habits that have arisen. In the method of "extinction of the gradual disturbance" the child is put to bed sleepy but still awake and the parents leave the room when the child is calm; if the baby cries, they must wait a few minutes before returning to the room and making their reassuring presence felt without ever taking him in their arms. From night to night the parent will respond to the baby's calls at ever longer intervals. Already after a few nights a certain improvement is generally observed, and at some point the child will begin to fall asleep again without the assistance of his parents. There is also a method of extinction of the most radical disorder in which parents, from a certain moment on, systematically ignore the baby's calls, letting them fall asleep after crying for a very long time. Whatever path is chosen, there must be harmony of purpose not only between the parents but between all those who take care of the child. In fact, it is important to be aware that constancy is required in following a behavioral re-education program, and that the child would be disoriented and frightened by a hiccup path, made of evenings in which he is left to cry to the point of exhaustion, and of others in which he is picks up again immediately. If you are not sufficiently convinced of the program or if you are aware of not being able to resist the calls, it is better to make a reason for the problem and not to despair if you are not able to resist the baby's cry, always remembering that it is a transient disorder, destined in most cases to cease with age, and trying to accept / endure the nuisance.

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Some virtuous behavior

Some things parents should do to encourage good sleep hygiene:

  • establish regular sleep patterns;
  • establish appropriate habits: children should sleep from an early age in a situation of silence and penumbra or dark. An infant who is accustomed to sleeping in the kitchen or living room and who during a brief awakening finds himself immersed in familiar noises and in a bright environment, will find it hard to accept the silence and darkness of the night;
  • put the child to bed when he is sleepy but still awake;
  • leave the room before the child falls asleep so that he can acquire the ability to fall asleep even when the parent is not present;
  • do not rock it or walk it in a wheelchair;
  • do not take it for a walk in the car;
  • prevent her from falling asleep eating, drinking herbal teas, touching her parent's hair, in her mom and dad's Latvian bed, otherwise at the time of waking up at night she will need the same rituals used in the evening to go back to sleep;
  • during the night, unless it is an infant of the first months of life, do not offer food and drinks;
  • do not make the child's state of agitation, despair evident, do not worry and complain in front of him while he cries.

What if you are unable to do all this?

It is not so obvious that parents are able to implement all these measures and that therefore behavioral therapy alone can be successful. Many just can't resist the protracted crying of the baby and are struggling to establish a correct evening routine and good falling asleep practices.

It often happens that these parents ask the pediatrician for drugs to help them sleep better. The drug is seen by some parents as the fastest and perhaps most convenient solution for solving the problem. However, it must be considered that there is no truly effective and safe drug that will make children sleep, obviously excluding sedatives and sleeping pills that are unacceptable for age. Niaprazine (Nopron) is used a lot, an antihistamine that induces some sleepiness as a side effect (even this product, however, does not have certain proof of efficacy and safety).

Some medicinal plants such as passionflower, lemon balm, chamomile, valerian (not to be used under three years) have been used for millennia and popular tradition attributes them a good efficacy, without finding side effects. The pediatrician will always decide if and when it is necessary to resort to a product based on medicinal plants (of which it is able to evaluate the quality) or to a synthetic drug to treat childhood insomnia, in order to support parents during the period of re-education of the child to a more regular sleep, to bring relief by occasionally giving a few nights of sleep to the family, to meet the child's need for a more regular sleep. Medicinal plants or drugs represent complementary support to attempts at re-education, which can help parents to better accept the educational commitment and the load of tension that the behavioral path entails.

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