Sleep schedules – Miles To Go Before I Sleep


I just came back from a wedding in the Bay area. Just going to visit friends would have been enough. But it was 40 degrees cooler than Phoenix. Quite a bonus! The weather was great over the week-end and we got some much-needed rest.

Miles to go before I sleep is a line from a poem by Robert Frost. It is also the title of a book by Dr. Tom Dooley. Please contrast the two lives and times of these two Americans. Both were people of vision, hope and passion.

We should all bring poetry and the spirit of hope that each of these men had.

Caring for the health care needs of my patients and in turn the needs and questions of their parents is what I do every day. A most common and recurring question is about sleeping. I cannot get my child to sleep. Does my child get enough sleep. I cannot get my child to sleep in her bed.

I am not an advocate of any particular get to sleep method. However; I do try to get an idea of what the families needs and expectations are. I try to take into account the child’s temperament. I try to understand the family dynamics. I realise that all children will respond to different methods and even different siblings will respond differently.

The first night home from the hospital your child may not sleep at all. He will sleep all day and be awake almost all night. The 3 hr. schedule in the hospital is a thing of the past. Usually by day 4-5, he is awake more and may be feeding better during the day. Most babies are sleepy day 3-4 and if receiving adequate fluids may start to feed better day 4-5 . He will lose 8-10 oz during the first 3-4 days and start gaining day 4-5. Most children have returned to their birth weight by day 10-14. Most of my mom’s who delivery vaginal will have breast milk by day 4, Prior to that the baby will be getting colostrum which is a protein rich milk. If the infant is formula feeding he will take 1-2 oz every 1-2 hrs. In either case feeding is on demand and schedules are unrealistic until 4-8 wks. My moms who do the best are those who are relaxed and go with the flow. Rarely do kids sleep through the night within the first 2 weeks. Most will sleep through the night by 4 months. Each baby is different. The early introduction of cereal rarely helps with sleep problems. It may predispose to allergies and excessive weight gain.

During the first 4 mo your child may nap after every feeding. Many by 4 months are taking 1 morning and 1 afternoon nap.. They may sleep through the night or still wake 2 times. By 9 mo. most have given up their morning nap and sleep 8-12 hours at night. Most children will stop their afternoon nap at 4-5 years of age. Each child’s sleep needs are different. Try to adjust your schedule around your child.

Once you have reached school age, keeping the same schedule 7 d a week is in the long run best for every one. I am concerned about the intense schedules that many of my patients adhere to. I too did sports with early morning and late afternoon practices. Be reasonable with expectations and realize that activities are supposed to be both fun and educational for your child.

As the kids go through growth spurts a dichotomy occurs. Due to the physiology of puberty they will go to bed later and sleep later in the morning. Studies show that adolescents who start their school day later do better. However a lot of students have “A” hour and although they need 8-10 hrs. sleep only get 4-6 hrs..

TVs should not be in their room and should have no video game or computer access for 1 hr. prior to bed time. They should turn over cell phones and other communication devices to their guardian.

We should recognize that stress and anxiety affect our childs sleep and most of my families are dealing with a lot of personal and financial issues. Most of our adolescents stop communicating. (Girls at 12-13 and boys at 14-15) Be aware of their interests, activities and school progress. No matter how big they are they still need our help and advice. Just be patient with them. Choose your battles wisely.

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