Ask the Doctor - Answers to your Parenting Questions

Dear Nina,
Some kids just have a harder time relaxing and falling asleep than other children. 

It could be that your daughter just doesn't need that much sleep.  But I suspect the opposite.  You say that she is exhausted during the day and is acting hyperactive and revved up.  it sounds to me like your daughter may be over-tired, which actually makes it harder to relax. 

When humans get over-tired, we have to keep ourselves going by releasing stress hormones like cortisol and adrenalin into our bloodstreams.  So when a child is over-tired, she might be swamped by those biochemicals, which stay in the bloodstream for a long time (meaning more than 24 hours.)

So what can you do?

1. Aim for a much earlier bedtime. How early?  If you have to wake her up, she is not getting enough sleep.  Since your goal is a 6:30am wake-up, and kids her age need an average of 10.5 hours of sleep, you want her asleep by 8 pm. 

If she's one of those kids who doesn't need as much sleep, then maybe it can be a bit later, but if you have to wake her in the morning, then she is not getting enough sleep.  So use her morning waking as a guide, meaning that you should keep moving her bedtime earlier until she is able to wake up on her own at 6:30am.

2. To get from here to there, keep waking her earlier (aiming for 6:30am).  It's true that this increases her over-tiredness, but it will get her onto the schedule you need more quickly.  You will just have to be patient and understanding when she is cranky.  (Personally, I would just bite the bullet and start waking her at 6:30am now to get her onto the schedule, because that would make her exhaustion outweigh her stress hormones.  But that may be too hard for your family.)

3. Start the bedtime routine MUCH earlier. Since you want her asleep by 8pm, you want lights off by 7:30pm.  I know that right now that sounds like a terrible idea, since she is not falling asleep until 10:15pm.  But I suspect that since you aren't starting the bedtime routine until after 8pm, she is having to keep herself wired just to keep her eyes open.  So I suspect that if you wake her at 6:30am, start the bedtime routine at 7pm, and turn lights off at 7:30pm, she is likely to fall asleep by 8pm with little trouble.

4.  Think through your routine.  To help your daughter relax, make sure that your bedtime routine includes sleep associations that you can trigger.  Also, begin thinking about the way her entire day contributes to her sleep readiness.  It might go something like this:

Afternoon-

1. Physical activity.  Kids NEED to be physically active, and research shows that they really do sleep much more readily when they've had an hour or three to run around outside and breath fresh air.  (By comparison, mental stimulation gets kids wound up and keeps them from falling asleep.)

2. Keep things calm once she comes inside.  Any kind of tension will put her on edge.

3. No screen time.  You want her body to begin making melatonin.  The light from TVs, Ipads, Computers and Mobile Phones keeps the body from making melatonin. 

6pm- Dinner.  I urge you to NOT serve dessert except on weekends.  Many kids cannot handle sugar in the evening without getting wired.  Fresh fruit in moderation is probably ok for most kids.

6:30pm- bath

7pm-
1. Tuck in stuffed animals

2. Read two stories or a chapter.  Make sure the stories are not too exciting.  They need to be enjoyable but not anxiety-producing.


7:30 pm- 

1. Turn off the light.

2. Give her a relaxing back, hand and foot rub while you ask her to tell you one good thing about her day, and something she is looking forward to tomorrow.  

3. Tap her acupressure points and give her positive messages about how relaxed she is: "Even though you're a little wound up, now you are relaxing."  See the page on my website on using EFT with kids for more on how to do this.  EFT has been proven to be very relaxing; I personally have often used it with my family members to help them sleep:  http://www.ahaparenting.com/parenting-tools/raise-great-kids/emotionally-intelligent-child/EFT-with-kids

4. Tell her to notice her feet, "how heavy they feel.  Now notice your ankles, they are so heavy...."  Work your way up her body in a relaxed voice.

5. Turn on a lullabye CD so that she forms a sleep association and when she hears it she begins to get sleepy. Choose carefully.  She will use this for years, so you have to like it.  Get the longest one you can find, so it won't end just as she falls asleep.

The music will form a sleep association that helps her fall asleep every time she hears it. 

Some people, though, find that their mind still races and they can't sleep, even with music.  If your daughter turns out to be one of those people, you might try a guided relaxation CD.  These are designed to help the child fall asleep, unlike other (exciting) books on tape.  If you haven't tried a good guided relaxation CD for kids,  I would think it is well worth a try. 

Stress-Free Kids sells guided meditations for kids that are designed to be used at bedtime:
http://www.stressfreekids.com/category/cds/children-cds

The Floppy Sleep Game also has a good reputation:
http://www.brainplayground.com/hypnosis-meditation-mp3-cd/kids/sleep/the-floppy-sleep-game/view-details.html

And here is one on that is on Amazon that has lots of reviews, so you can see more about it before you buy it.

http://www.amazon.com/Guided-Meditation-Children-Journey-Elements/product-reviews/B000G5SB4Q/ref=cm_cr_dp_synop?ie=UTF8&showViewpoints=0&sortBy=bySubmissionDateDescending#R2H7D8XJVSEB36

There are probably many others, these are just three I know about.  I would recommend investing in a couple and trying out different ones.  If they work, they are worth their weight in gold.

5. Snuggle up with her.  (Kids always fall asleep faster when an adult lies with them.)  You won't have to do this forever.  Once she gets used to falling asleep quickly, you won't even have to lie down with her.  But while you are getting her past her over-tiredness and onto a good schedule, I think it is essential.  If you fall asleep, don't worry about it.  You'll get up early, well-rested, and can do the dishes then!

6. If she is having a particularly bad night, you could consider melatonin.  I am not a medical doctor, so I cannot recommend it to you, but I have used it with my own child when she had a hard time sleeping.  I called it a sleep vitamin.  My research did not turn up any bad side effects at all, and I know many families with ADHD or autistic kids who use it regularly.  However, this is not something you want to do regularly, obviously, because we just don't know enough about the effects. If you do try melatonin, be aware that some brands are delicious (orange flavored) and some taste like chalk.  Also, unless it is a high-quality brand, it may not work.  And of course I must tell you to check with your pediatrician. 

I hope this is helpful, and I wish you and your daughter Sweet Dreams.  Please let me know how it goes!

warmly,
Dr. Laura