Close your eyes

The symptoms of sleep deprivation mimic those of depression –
irritability, feeling low and tearful, a lack of patience and poor
concentration. Little wonder then that parents whose baby, toddler
or even school-aged child keeps them up at night find it hard to

Little wonder too that children who don’t get enough sleep are
prone to tantrums and find it hard to learn. Claire Halsey, a
consultant clinical psychologist who works in five Sure Start
programmes in the Stoke on Trent area, says it is a myth that
children always get the sleep they need. “Children don’t
necessarily go to sleep when they need to for all sorts of reasons,
including poor sleeping habits or the feeling that they might be
missing out on family activities. When children have inadequate
sleep they tend to be more irritable and their eating and behaviour
is poorer.”

Although Sure Start works predominantly with families in
disadvantaged neighbourhoods, Halsey sees people in a variety of
circumstances who are struggling to deal with their child’s sleep
problems. She says: “Sleep problems compound other problems, like
worries about benefits, or having a roof over your head. Pressures
are incremental. If you have to spend your time queuing in benefit
offices you’ve got less time and energy for focusing on your
child.” And because problem-solving skills are affected by lack of
sleep parents find it harder to sort out their difficulties.

Terry Jones, a social work team leader at a Barnardo’s family
centre in Fulford, Bristol, finds that sleep problems in children
that go on for a long time can have a profound affect on family
relationships. She says: “Parents are likely to have a tense
relationship with the child whom they see as the cause of the
difficulties. The child then picks up on the tension and anxiety
and is less likely to be able to sleep.” She also finds that sleep
problems can cause conflict between parents, particularly if it is
always the mother who gets up while the partner stays in bed, or if
parents disagree on how to tackle the problem.

Jones believes that offering consistent support to help parents
find their own solution to the problem can be critical. She says:
“People are more likely to cope if they have someone to support
them. It’s especially difficult for single parents if they’re
living in a flat or have older children. It’s hard to follow advice
to leave a child to cry if you’re worried about disturbing the
neighbours or older children.”

Sleep problems in children are the most common behaviour difficulty
reported to health visitors. Often they arise because the child
lacks a consistent bedtime routine or because the parent may have
unwittingly taught the child to fall asleep in their arms or on the
sofa. In most cases they respond well to simple behavioural
techniques applied consistently by parents.

Ann Buchanan, reader in social work at the Department of Social
Studies at Oxford University, agrees that sleep problems are at the
root of a wide range of difficulties experienced by families.
Buchanan worked in child guidance clinics during the 1980s and
1990s and found behavioural programmes very effective in tackling
sleep problems. She says: “People have to be pretty desperate to
get family therapy. A lot of the psychiatrists would do family
therapy first and look for underlying problems.I found that once
the family got the child to bed a lot of other problems
disappeared. “

A simple behavioural approach advocated by Buchanan and widely used
by health visitors works well with children aged three or four who
only sleep for short periods but who are motivated by the idea of
getting stickers for co-operating (see below).

Giving parents the opportunity to swap experiences with other
parents can also be helpful. Jones says: “Most families have
experienced sleep problems at some time or another. So one of the
things that happens in groups is that the problem is normalised –
there’s always someone else in a similar position. It can also help
people to recognise the huge diversity in children’s behaviour,
including in their sleep needs.”

On the other hand, there’s also a danger of people making negative
comparisons between their child and other people’s, which is where
a professional facilitator can be helpful. “Drawing comparisons,”
says Jones, “is something that can make people feel particularly
vulnerable. Part of our role is enabling people to manage the
particular child they’ve got.”

Professionals are divided on the kinds of sleep programmes which
are most appropriate to use with babies. Research published in the
British Medical Journal in May found the “controlled
crying” technique effective in reducing sleep problems in babies
and in reducing depression in mothers.1 The method
involves visiting a child who is crying and then leaving them in
their cot to cry for increasing intervals.

The study looked at 156 babies with problems judged as “severe” by
their mothers including waking frequently at night and needing
their mothers with them to get to sleep. Nearly 90 per cent of the
problems were solved within two months.

However, Halsey regards controlled crying as a last resort for
children under 18 months. She says: “It’s distressing for the child
and there are attachment issues. The only proviso would be if
parents are fearful that they would harm the child. When children
cry excessively it can be a trigger for abuse.” Instead, she
advocates methods such as the “disappearing chair” where the parent
starts off sitting near the child and gradually moves it further
away over a period of time.

The Child Psychotherapy Trust encourages parents to take a more
accepting approach to babies waking in the night.2 The
trust points out that a baby who finds it hard to relax and let go
at night might have had a busy and stressful day, with insufficient
peaceful time with their parents. Or it might be that the family is
going through a worrying or unhappy time which is unsettling the

In older children too, sleep problems like persistent nightmares
and night terrors can sometimes be indicative of deep-rooted
problems, such as abuse or abandonment, where more therapeutic
approaches are needed. Or sleep problems may reflect tensions which
a child is experiencing because of changes in their routine or
care-setting or difficulties in the family. Jones believes it is
important to give parents the opportunity to look at what else
might be happening and to see the sleep difficulties as a symptom.
She says, “We wouldn’t assume that there was a deeper problem, but
where an older child is up and down a lot it could be a reflection
of deep-seated anxieties. We would want to look at it in a more
psychodynamic way.”

On the other hand, as Buchanan points out, if you start digging
around in people’s psyche you will always come up with something.
She says: “I would always try sleep programmes first. In about
three out of four cases it works and everything else falls into

Carrot and sticker

The worker draws a picture contract for the child that reflects
the bedtime routine. The reward is a smiley face – a sticker with a
face drawn on it. The child asks for it in the morning and the
parent sticks it on. If the child gets out of bed the parents are
encouraged to act “boring” and allow the child to sit with them
with minimal attention until the child can gently be put back to
bed. After a few days – the child may need to be encouraged with
half a smiley face for nearly succeeding – most children manage to
remain in their beds as long as the family routine remains
constant. After about a month the child’s biological clock ticks in
and the programme gets forgotten and is only re-introduced if the
waking behaviour returns.
Source: A Buchanan, What Works For Children With
Emotional and Behavioural Problems
, Barnardo’s,

1 H Hiscock H, M Wake, “Randomised controlled
trial of infant behavioural infant sleep intervention to improve
infant sleep and maternal mood,” British Medical Journal,
4 May 2002

2 J Shuttleworth, Understanding Childhood, Crying
and Sleeping in the First Months of Life
, leaflet from the
Child Psychotherapy Trust,

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