Current Problems in Pediatric and Adolescent Health Care
Sleep Regulation, Physiology and Development, Sleep Duration and Patterns, and Sleep Hygiene in Infants, Toddlers, and Preschool-Age Children☆
Introduction
Sleep is not just the absence of waking, but an active neurophysiological process and the primary activity of the developing brain. Sleep is necessary for survival, but the major function of sleep remains elusive. Sleep duration, quality, and architecture changes over the lifespan, particularly in the first 5 years of life. Newborns spend as much as 80% of their day sleeping, and most toddlers and preschoolers spend half or more of their day asleep. Sleep has been shown to be as important to animal survival as food. Animal studies show that rat life spans are decreased from 2 to 3 years to only 5 weeks if deprived of REM sleep, and to 2–3 weeks if deprived of all sleep. Human studies demonstrate that adequate sleep in children is essential to normal growth and development, maternal and family well-being, and child sleep is associated with significant predictors of adult health. In this review, we discuss sleep regulation, biological rhythms, and sleep architecture; the neurophysiology of sleep; the development of sleep patterns in infants and young children; sleep duration and patterns: normative data, recommendations and influential factors; sleep problems; and recommended sleep hygiene.1, 2, 3, 4
Section snippets
Sleep Regulation, Biological Rhythms, and Sleep Architecture
Sleep is regulated by two overlapping but distinct systems—the circadian system and sleep/wake homeostasis.5, 6 The circadian system endogenously synchronizes biologic rhythms, including sleep, cyclically with the 24-h day and is adjusted through the influence of exogenous factors. Sleep/wake homeostasis describes the body׳s internal neurophysiologic drive toward either sleep or waking. Homeostasis is governed by the principles of equilibrium; the body is driven toward a balance between sleep
Neurophysiology of Sleep
Arousal and sleep (both NREM and REM) are dynamic physiologic processes regulated through a complex, and only partially understood, network of activation and suppression of neurologic pathways from the brainstem through the cerebral cortex (Table 1).7 A basic understanding of the neuroanatomy and neurophysiology is important for understanding the development of sleep.
Development of Sleep Patterns in Infants and Young Children
Over the first year of life, infant sleep patterns change. Newborns usually sleep most of the day and night, waking only for feeding every 1–3 h, whereas a typical 1-year-old sleeps 10–12 h at night without waking, followed by two daily naps.1
Over the first few months, the ability to retain calories increases and caloric need and growth relative to size decreases. This allows infants to consume adequate calories during the day and require progressively fewer nighttime meals to sustain growth.
Sleep Duration and Patterns: Normative Data, Recommendations, and Influential Factors
In the first 5 years of life, many parents and children struggle with sleep and sleep-related behaviors. Adequate sleep duration is a topic that is frequently discussed among parents and pediatricians, and pediatric sleep research has clearly shown that insufficient sleep has negative impacts on neurobehavioral and cognitive functions, health and well-being.1, 20, 21, 22 Due to methodological difficulties, experimental evidence detailing best and most appropriate sleep durations in children is
Sleep Problems
Sleep problems are common and often behavioral in origin, due to factors such as child temperament and development, parenting style or affect, child–parent interactions, and environmental factors. There are also parasomnias, which are episodic, undesirable behaviors that occur with sleep.11 Nightmares occur during REM sleep, typically early in the morning, most commonly in primary school-age children, though do occur in 1.9–3.9% of preschool-age children.11 Management includes avoidance of
Recommended Sleep Hygiene
Healthy sleep patterns can be established and sleep problems can be prevented and managed through sleep-promoting parenting practices, or good “sleep hygiene.” Good quality sleep, particularly nighttime sleep, encourages full daytime alertness.51, 70
Routines are critical to good sleep hygiene, specifically consistent sleep schedules and pre-sleep routines. Routines benefit young children by providing them with a sense of predictability and security, and help with activity transitions. They also
Conclusion
There are many aspects of sleep that have significant effects on child and family health and well-being. Pediatricians report little formal training in sleep medicine, yet patients frequently report infant and child sleep problems. Basic physiology and development of sleep patterns, normative sleep durations, and the many influencing factors are important to understanding and diagnosing child sleep problems. Pediatricians should discuss sleep hygiene and early adoption of healthy sleep habits
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This research was supported in part by Grant UL1 TR000038 from the National Center for Advancing Translational Sciences, National Institutes of Health.