Sleepwalking

About Sleepwalking

Hours after bedtime, do you find your little one wandering the hall looking dazed and confused? If you have a sleepwalking child, you're not alone. It can be unnerving to see, but sleepwalking is very common in kids and most sleepwalkers only do so occasionally and outgrow it by the teen years. Still, some simple steps can keep your young sleepwalker safe while traipsing about.

Despite its name, sleepwalking (also called somnambulism) actually involves more than just walking. Sleepwalking behaviors can range from harmless (sitting up), to potentially dangerous (wandering outside), to just inappropriate (kids may even open a closet door and urinate inside). No matter what kids do during sleepwalking episodes, though, it's unlikely that they'll remember ever having done it!

As we sleep, our brains pass through five stages of sleep — stages 1, 2, 3, 4, and REM (rapid eye movement) sleep. Together, these stages make up a sleep cycle. One complete sleep cycle lasts about 90 to 100 minutes. So a person experiences about four or five sleep cycles during an average night's sleep.

Sleepwalking most often occurs during the deeper sleep of stages 3 and 4. During these stages, it's more difficult to wake someone up, and when awakened, a person may feel groggy and disoriented for a few minutes.

Kids tend to sleepwalk within an hour or two of falling asleep and may walk around for anywhere from a few seconds to 30 minutes.

Causes of Sleepwalking

Sleepwalking is far more common in kids than in adults, as most sleepwalkers outgrow it by the early teen years. It may run in families, so if you or your partner are or were sleepwalkers, your child may be too.

Other factors that may bring on a sleepwalking episode include:

• lack of sleep or fatigue
• irregular sleep schedules
• illness or fever
• certain medications
• stress (sleepwalking is rarely caused by an underlying medical, emotional, or psychological problem)

Behaviors During Sleepwalking

Of course, getting out of bed and walking around while still sleeping is the most obvious sleepwalking symptom. But young sleepwalkers may also:

• sleeptalk
• be hard to wake up
• seem dazed
• be clumsy
• not respond when spoken to
• sit up in bed and go through repeated motions, such as rubbing their eyes or fussing with their pajamas

Also, sleepwalkers' eyes are open, but they don't see the same way they do when they're awake and they often think they're in different rooms of the house or different places altogether.
Sometimes, these other conditions may accompany sleepwalking:

• sleep apnea (brief pauses in breathing while sleeping)
• bedwetting (enuresis)
• night terrors

Is Sleepwalking Harmful?

Sleepwalking itself is not harmful. However, sleepwalking episodes can be hazardous since sleepwalking kids aren't awake and may not realize what they're doing, such as walking down stairs or opening windows.

Sleepwalking is not usually a sign that something is emotionally or psychologically wrong with a child. And it doesn't cause any emotional harm. Sleepwalkers probably won't even remember the nighttime stroll.

How to Keep a Sleepwalker Safe

Although sleepwalking isn't dangerous by itself, it's important to take precautions so that your sleepwalking child is less likely to fall down, run into something, walk out the front door, or drive (if your teen is a sleepwalker).
To help keep your sleepwalker out of harm's way:

• Try not to wake a sleepwalker because this might scare your child. Instead, gently guide him or her back to bed.
• Lock the windows and doors, not just in your child's bedroom but throughout your home, in case your young sleepwalker decides to wander. You may consider extra locks or child safety locks on doors. Keys should be kept out of reach for kids who are old enough to drive.
• To prevent falls, don't let your sleepwalker sleep in a bunk bed.
• Remove sharp or breakable things from around your child's bed.
• Keep dangerous objects out of reach.
• Remove obstacles from your child's room and throughout your home to prevent a stumble. Especially eliminate clutter on the floor (i.e., in your child's bedroom or playroom).
• Install safety gates outside your child's room and/or at the top of any stairs.

Other Ways to Help a Sleepwalker

Unless the episodes are very regular, cause your child to be sleepy during the day, or your child is engaging in dangerous sleepwalking behaviors, there's usually no need to treat sleepwalking. But if the sleepwalking is frequent, causing problems, or your child hasn't outgrown it by the early teen years, talk to your doctor. Also talk to your doctor if you're concerned that something else could be going on, like reflux or trouble breathing.

For kids who sleepwalk often, doctors may recommend a treatment called scheduled awakening. This disrupts the sleep cycle enough to help stop sleepwalking. In rare cases, a doctor may prescribe medication to help a child sleep.

Other ways to help minimize sleepwalking episodes:

• Have your child relax at bedtime by listening to soft music or relaxation tapes.
• Establish a regular sleep and nap schedule and stick to it — both nighttime and wake-up time.
• Make your child's bedtime earlier. This can improve excessive sleepiness.
• Don't let kids drink a lot in the evening and be sure they go to the bathroom before going to bed. (A full bladder can contribute to sleepwalking.)
• Avoid caffeine near bedtime.
• Make sure your child's bedroom is quiet, cozy, and conducive to sleeping. Keep noise to a minimum while kids are trying to sleep (at bedtime and naptime).

The next time you encounter your nighttime wanderer, don't panic. Simply steer your child back to the safety and comfort of his or her bed.

"I pray that this article empowers you to Get A L.I.F.E."

Preschoolers Need Sleep!

Establishing a Bedtime Routine
Preschoolers sleep about 10 to 12 hours during each 24-hour period, but there's no need to be rigid about which 10 to 12 hours these are. The most important thing is to help kids develop good habits for getting to sleep.

A bedtime routine is a great way to ensure that your preschooler gets enough sleep.

Here are a few things to keep in mind when establishing that routine:

Include a winding-down period during the half hour before bedtime.
Stick to a bedtime, alerting your child both half an hour and 10 minutes beforehand.
Set fixed times for going to bed, waking up, and taking naps.
Keep consistent playtimes and mealtimes.
Avoid stimulants, such as sugar, near bedtime.
Make the bedroom quiet, cozy, and conducive to sleeping.
Use the bed only for sleeping — not for playing or watching TV.
Limit food and drink before bedtime.
Allow your child to choose which pajamas to wear, which stuffed animal to take to bed, etc. Consider playing soft, soothing music.
Tuck your child into bed snugly for a feeling of security.

A Note on Naps

Most preschoolers do still need naps during the day. They tend to be very active — running around, playing, going to school, and exploring their surroundings — so it's a good idea to give them a special opportunity to slow down. Even if your child can't fall asleep, try to set aside some quiet time during the day for relaxing. (And you'll probably benefit from a break too!)

The best way to encourage napping is to set up a routine for your child, just as you do for bedtime. Your preschooler, not wanting to miss out on any of the action, may resist a nap, but it's important to keep the routine firm and consistent. Explain that this is quiet time and that you want your child to start out in bed, but that it's OK to play in the bedroom quietly if he or she can't sleep.

How long should naps last? For however long you feel your child needs to get some rest. Usually, about an hour is sufficient. But there will be times when your child has been going full tilt and will need a longer nap, and others when you hear your child chattering away, playing through the entire naptime.

Sleeping Problems

Preschoolers may have nightmares, or night terrors, and there may be many nights when they have trouble falling asleep.

It may help if you create a "nighttime kit" to keep near your child's bed for these times. That kit might include a flashlight, a favorite book, and a cassette or CD to play. Explain the kit, then put it in a special place where your child can get to it in the middle of the night.

Objects like stuffed animals and blankets also can help kids feel safe. If your child doesn't have a favorite toy and getting to sleep has become consistently difficult, then it might be worth going out together to pick out a warm, soft blanket or stuffed animal.

Some parents get into the habit of lying down next to their young kids until they fall asleep. While this may do the trick temporarily, it won't help sleeping patterns in the long term. It's important to provide comfort and reassurance, but kids need to fall asleep independently for when parents aren't around. If you establish a routine where you have to be there for your child to go to sleep, then it will be difficult for both of you — and unfair to your child — if you start leaving beforehand.

If you're worried about your child's sleeping patterns, talk with your doctor. Although there isn't one sure way to raise a good sleeper, most kids have the ability to sleep well and work through any sleeping problems. The key is to try from early on to establish healthy bedtime habits.

"I pray that this article empowers you to Get A L.I.F.E."

Positional Plagiocephaly

Passage through the birth canal often makes a newborn's head appear pointy or elongated for a short time. It's normal for a baby's skull, which is made up of several separate bones that will eventually fuse together, to be slightly misshapen during the few days or weeks after birth.

But if a baby develops a persistent flat spot, either on one side or the back of the head, it could be a sign of document.write(defpositional_plagiocephaly244) positional plagiocephalypositional plagiocephaly. Also known as flattened head syndrome, this can occur when a baby sleeps in the same position repeatedly or because of problems with the neck muscles.

Fortunately, positional plagiocephaly can be treated without surgery and does not cause lasting cosmetic problems.

About Positional Plagiocephaly

Positional plagiocephaly is a disorder in which the back or one side of an infant's head is flattened, often with little hair growing in that area. It's most often the result of babies spending a lot of time lying on their backs or often being in a position where the head is resting against a flat surface (such as in cribs, strollers, swings, and playpens).

Because infants' heads are soft to allow for the incredible brain growth that occurs in the first year of life, they're susceptible to being "molded" into a flat shape.

Causes of Positional Plagiocephaly

The most common cause of a flattened head is a baby's sleep position. Because infants sleep so many hours on their backs, the head sometimes assumes a flat shape.

In almost all infants with plagiocephaly, there is some limit of active neck movement that leads to a preference to turn the head to one side and not to the other. The medical term for this is torticollis. The cause and effect relationship between torticollis and plagiocephaly goes both ways. Many infants are born with torticollis — perhaps related to fetal positioning in the uterus during late pregnancy — and subsequently develop plagiocephaly after birth.

But infants with severe flattening on one side must expend much more energy than normal to turn the head to the other side, so they do not do so, and their necks become stiff from disuse. In many infants with torticollis, their head will be turned to one side (usually to the right, for unknown reasons) while their chin is tilted toward the other.

Premature babies are more prone to positional plagiocephaly — their skulls are softer than those of full-term babies, and they spend a great deal of time on their backs without being moved or picked up because of their medical needs and extreme fragility after birth, which usually requires a stay in the neonatal intensive care unit (NICU).

A baby might even start to develop positional plagiocephaly before birth, if pressure is placed on the baby's skull by the mother's pelvis or a twin. In fact, it's not at all unusual to see plagiocephaly in multiple birth infants.

If your infant has a misshapen head, your physician will need to decide whether the cause is plagiocephaly, which is very common and does not require surgery, or a condition called craniosynostosis, which is much less common and generally requires surgical treatment.

Craniosynostosis happens when adjacent skull bones become fused together ahead of the normal developmental schedule. This fusion limits the growth of the head in the direction perpendicular to the fused border between the affected bones, and the head grows excessively in other directions. This produces distinctive patterns of skull deformity that look very different from plagiocephaly.

Plagiocephaly is usually easy to recognize, because the deformity affects the back of the head most severely.

Signs and Symptoms

Positional plagiocephaly is usually easy for parents to notice. Typically, the back of the child's head (called the occiput) is flattened on one side, and the ear on the flattened side may be pushed forward as viewed from above.

In severe cases, there may be bulging on the side opposite from the flattening and the forehead may be asymmetrical (or uneven). If torticollis is the cause, the neck, jaw, and face may be asymmetrical. But although other aspects of the head and face may be affected, in positional plagiocephaly the back of the head is always most involved.

Diagnosis

Most often, a doctor can make the diagnosis of positional plagiocephaly simply by examining a child's head, without having to order lab tests or X-rays.

The doctor will also note whether regular repositioning of the child's head during sleep successfully reshapes the growing skull over time (craniosynostosis, on the other hand, typically will worsen).

If there's still some doubt, consultation with a specialist — a pediatric neurosurgeon or a craniofacial plastic surgeon — may be needed. X-rays and CT scans play no role in the management of plagiocephaly and are not necessary to distinguish it from craniosynostosis.

Treatment

Treatment for positional plagiocephaly caused by sleeping position is usually easy and painless, entailing simple repositioning of babies during sleep to encourage them to alternate their head position while sleeping on their backs.

Even though they'll probably move around throughout the night, alternating sides is still beneficial. Wedge pillows are available that keep babies lying on one side or the other, but be sure to check with your doctor before using one to ensure that it's appropriate and safe for your baby. The American Academy of Pediatrics (AAP) does not recommend routinely using any devices that might restrict the movement of an infant's head.

In addition, you will want to consider how you lay your baby down in the crib. Most right-handed parents carry small infants cradled in their left arms and lay them down with the heads to their left. In this position, the infant must turn to the right to look out into the room — and, indeed, torticollis to the right with flattening of the right side of the head is far more common than the left.

Whichever side of your infant's head is flattened, you will want to position your baby in the crib to encourage active turning of the head to the other side.

Always be sure your baby gets plenty of supervised time on the stomach while awake during the day. Not only does "tummy time" promote normal shaping of the back the head, it also helps in other ways. Looking around from a new perspective encourages your baby's learning and discovery of the world. Plus, it helps babies learn to push up on their arms, which helps develop the muscles needed for crawling and sitting up. It also helps to strengthen the neck muscles.

As most infants with plagiocephaly have some degree of torticollis, a course of physical therapy and a home exercise program will usually be part of the recommended treatment. A physical therapist can teach you exercises to do with your baby involving stretching techniques that are gradual and progressive. Most moves will consist of stretching your child's neck to the side opposite the tilt. Eventually, the neck muscles will be elongated and the neck will straighten itself out. Although they're very simple, the exercises must be performed correctly.

For kids with severe positional plagiocephaly, doctors may prescribe a custom-molded helmet or head band. These work best if started between the ages of 4 and 6 months, when a child grows the fastest, and are usually less helpful after 10 months of age. They work by applying gentle but constant pressure on a baby's growing skull in an effort to redirect the growth.

But never purchase or use any devices like these without having your child evaluated by a doctor. Only a small percentage of babies wear helmets. The decision to use helmet therapy is made on a case-by-case basis (for example, if the condition is so severe that a baby's face is becoming misshapen or the parents are very upset). Although helmets might not improve the outcome in all children, some kids with severe torticollis can benefit from their use.

Prognosis

The outlook for babies with positional plagiocephaly is excellent. As babies grow, they begin to reposition themselves naturally during sleep much more often than they did as newborns, which allows their heads to be in different positions throughout the night.

After babies are able to roll over, the AAP still recommends that parents put them to sleep on their backs, but then allow them to move into the position that most suits them without repositioning them onto their backs.

As a general rule, once an infant has attained independent sitting, plagiocephaly will not get any worse. Then, over months and years, as the skull grows, even in severe cases the flattening will improve. The head will never be perfectly symmetrical, but for a variety of developmental reasons the asymmetry becomes much less conspicuous as well. In later childhood the face becomes more prominent in relation to the skull, hair thickens, and children grow into lives of continual motion. Experience and clinical research have shown that by school age, plagiocephaly is no longer a social or cosmetic problem.

It's important to remember that plagiocephaly itself does not affect a child's brain growth or cause developmental delays or brain damage.

Prevention

Babies should be put down to sleep on their backs to help prevent sudden infant death syndrome (SIDS), despite the possibility of developing an area of flattening on the back of the head.

However, alternating their head position every night while they sleep and providing lots of tummy time and stimulation during the day while they're awake can reduce the risk of positional plagiocephaly.

"I pray that this article empowers you to Get A L.I.F.E."

Children & Nightmares

It's not clear at what age kids begin to dream, but even toddlers may speak about having dreams — pleasant ones and scary ones. While almost every child has an occasional frightening or upsetting dream, nightmares seem to peak during the preschool years when fear of the dark is common. But older kids (and even adults) have occasional nightmares, too.

Nightmares aren't completely preventable, but parents can set the stage for a peaceful night's rest. That way, when nightmares do creep in, a little reassurance and comfort from you can quickly restore your child's peace of mind.

Helping kids conquer this common childhood fear also equips them to overcome other scary things that might arise down the road.

When Do Nightmares Happen?

Nightmares — like most dreams — occur during the stage of sleep when the brain is very active and sorting through experiences and new information for learning and memory. The vivid images the brain is processing can seem as real as the emotions they might trigger.

This part of sleep is known as the rapid eye movement or REM stage because the eyes are rapidly moving beneath closed eyelids. Nightmares tend to happen during the second half of a night's sleep, when REM intervals are longer.

When kids awaken from a nightmare, its images are still fresh and can seem real. So it's natural for them to feel afraid and upset and to call out to a parent for comfort.

By about preschool age, kids begin to understand that a nightmare is only a dream — and that what's happening isn't real and can't hurt them. But knowing that doesn't prevent them from feeling scared. Even older kids feel frightened when they awaken from a nightmare and may need your reassurance and comfort.

What Causes Nightmares?

No one knows exactly what causes nightmares. Dreams — and nightmares — seem to be one way kids process thoughts and feelings about situations they face, and to work through worries and concerns.

Most times nightmares occur for no apparent reason. Other times they happen when a child is experiencing stress or change. Events or situations that might feel unsettling — such as moving, attending a new school, the birth of a sibling, or family tensions — might also be reflected in unsettling dreams.

Sometimes nightmares occur as part of a child's reaction to trauma — such as a natural disaster, accident, or injury. For some kids, especially those with a good imagination, reading scary books or watching scary movies or TV shows just before bedtime can inspire nightmares.

Themes of a nightmare tend to reflect whatever the child is going through at that age, whether it's struggles with aggressive feelings, independence, or fears of separation. The cast of characters might include monsters, bad guys, animals, imaginary creatures, or familiar people, places, and events combined in unusual ways.

Young kids might have nightmares of being gobbled up, lost, chased, or punished. Sometimes a nightmare contains recognizable bits and pieces of the day's events and experiences, but with a scary twist. A child might not remember every detail, but can usually recall some of the images, characters, or situations, and the scary parts.

Encouraging Sweet Dreams

Parents can't prevent nightmares, but can help kids get a good night's sleep — and that encourages sweet dreams.

To help them relax when it's time to sleep and associate bedtime with safety and comfort, be sure that kids:

have a regular bedtime and wake-up time
have a sleep routine that helps them slow down, and feel safe and secure as they drift off to sleep. This might include a bath, a snuggle from you, reading, or some quiet talk about the pleasant events of the day.
have a bed that's a cozy, peaceful place to quiet down. A favorite toy, stuffed animal, night-light, or dream catcher can help.
avoid scary movies, TV shows, and stories before bed — especially if they've triggered nightmares before.
know that nightmares aren't real, that they're just dreams and can't hurt them.

After a Nightmare

Here's how to help your child cope after a nightmare:

Reassure your child that you’re there. Your calm presence helps your child feel safe and protected after waking up feeling afraid. Knowing you'll be there helps strengthen your child's sense of security.

Label what’s happened. Let your child know that it was a nightmare and now it's over. You might say something like, "You had a bad dream, but now you're awake and everything is OK." Reassure your child that the scary stuff in the nightmare didn't happen in the real world.

Offer comfort. Show that you understand that your child feels afraid and it's OK. Remind your child that everyone dreams and sometimes the dreams are scary, upsetting, and can seem very real, so it's natural to feel scared by them.

Do your magic. With preschoolers and young school-age kids who have vivid imaginations, the magical powers of your love and protection can work wonders. You might be able to make the pretend monsters disappear with a dose of pretend monster spray. Go ahead and check the closet and under the bed, reassuring your child that all's clear.

Mood lighting. A night-light or a hall light can help kids feel safe in a darkened room as they get ready to go back to sleep. A bedside flashlight can be a good nightmare-chaser.

Help your child go back to sleep. Offering something comforting might help change the mood. Try any of these to aid the transition back to sleep: a favorite stuffed animal to hold, a blanket, pillow, night-light, dream catcher, or soft music. Or discuss some pleasant dreams your child would like to have. And maybe seal it by giving your child a kiss to hold — in the palm of his or her hand — as you tiptoe out of the room.

Be a good listener. No need to talk more than briefly about the nightmare in the wee hours — just help your child feel calm, safe, and protected, and ready to go back to sleep. But in the morning, your child may want to tell you all about last night's scary dream. By talking about it — maybe even drawing the dream or writing about it — in the daylight, many scary images lose their power. Your child might enjoy thinking up a new (more satisfying) ending to the scary dream.

For most kids, nightmares happen only now and then, are not cause for concern, and simply require a parent's comfort and reassurance. Talk to your doctor if nightmares often prevent your child from getting enough sleep or if they occur along with other emotional or behavioral troubles.

"I pray that this article empowers you to Get A L.I.F.E."