Transition Issues: Sleep

The First Few Weeks
During the first weeks home, the exhaustion of jet lag may be the cause of sleep interruptions for both parent and child. First-time parents may also feel insecure in their parenting skills. Parents who already have children may  have concerns about the reaction of their older children to the addition of a new sibling. 

To help deal with the initial sleep deprivation and exhaustion, try to prevent unnecessary outside stressors. Spend those first few days at home without additional family and friends visiting. Postpone outside trips (errands, vacations, etc.). Take advantage of this “nesting” time and begin to get to know your child. It will take time to learn about her as an individual and how to respond to her needs. Rest during your child’s naps to keep up your own energy. Once you have gotten over this initial exhaustion you will be better able to cope with sleep difficulties that may arise for your child.

From your child's perspective, it is certainly understandable that she would have trouble settling down to sleep. Imagine the huge adjustments she will have to make in going from her sleeping situation in the orphanage or foster home to those first few nights sleeping in your home. A Korean or Guatemalan baby who is well attached to her foster mother and is used to sleeping in the same bed with her is suddenly placed alone in a crib in the United States, without the comfort of familiar smells and feelings. People are speaking a different language around her, and she is wearing different clothes. 

Learn as much as you can about your child’s sleeping arrangements prior to adoption. Has the child been sleeping in a crib or in bed with foster parents? Been put to bed with a bottle for comfort? Rocked to sleep or put to bed awake to fall asleep alone? How many hours a night is she/he used to sleeping? What was the napping pattern? The more information you have, the easier it will be to develop strategies for coping with sleep disturbances.

Assessing Appropriate Sleep Patterns
We consider several general developmental guidelines when we assess any child’s appropriate sleep patterns. However, these are only guidelines. Children vary in the amount of sleep they need.  A child who is going through a stressful time may need more sleep and may also have more sleep disturbances that keep him from getting the extra sleep he needs. 

Children 6 to 9 months old are only awake about 9 out of 24 hours. They usually take both morning and afternoon naps in addition to sleeping 10-11 hours at night. If sleep is interrupted, we can expect the child to become overtired, over-stimulated and fussy.

Children 10 to 24 months old are transitioning to one nap, usually in the early afternoon, and will sleep about 12 hours per night.

Children continue to need a nap or rest period until they start school. While they may not always sleep during that time, they should have a regularly scheduled rest period each day to give them time to unwind from the morning activities and to help them be rested and ready for the afternoon and evening. Preschoolers continue to need about 12 hours of sleep at night. 

By 4-5 years old, nightmares can be common. Many children suddenly awaken, crying and screaming. They often can’t recall the dream they were having. (See below for more on what to do when your child is having nightmares.)

All children alternate between periods of light and heavy sleep throughout the night. During light sleep children typically become alert for a moment before drifting off again. If the child feels uncomfortable or lonely when she/he wakes from light sleep, she/he may not be able to fall back asleep.

How To Establish Normal Sleep Patterns in Your IA Child
Regular sleep schedules and rituals help immensely in establishing desirable sleeping patterns. A child’s feelings of anxiety decrease when he knows what to expect. You want to help him establish a strong, secure parent-child attachment. Maintaining a regular, consistent sleep schedule when he arrives will help him feel secure and less anxious. To assist this process, it helps to know what kind of sleep schedule was set for him prior to adoption. For example, an institution is usually a scheduled, predictable environment, so the child who spent time in an institution learned to gain security from that sleep regimentation. Parents of children who have lived in an institution often report that their child initially went to bed immediately, with no resistance or crying, when they first arrived home (as this has been their established routine), but then started to experience sleep problems later on, usually after one or two months at home.

Changes In Sleep Patterns Are Also Normal
Children who were good sleepers on arrival may start to wake up at night and call out for attention, usually after one or two months at home. Do not be concerned about this change in sleep pattern. Just as a new baby cries out for a parent to come and pick him up when he feels uncomfortable, the newly adopted child may need to check in with her parents at night to be reassured of their presence. When you respond to your child’s needs, the newly forming attachment relationship is strengthened.  When you soothe the child who has awoken in bed, you are reminding her that she not alone and that her needs are being met.

Bedtime Rituals
Bedtime rituals are very important for young children. A period of time before bed when the child can relax and unwind will help prepare her for sleep. Some children require more time than others to transition from daytime activities to sleep. A bath, a snack or bottle for a younger child, and a bedtime story will help promote a restful night and also will strengthen your child’s attachment to you. Be consistent; repetition of the same routine each evening also decreases separation anxiety and promotes attachment.

Crib or Bed?
Whether a child sleeps in his own crib, his own bed in his own room or with his parents in their bed is a family decision. For a child who slept in bed with the foster parents, this arrangement may be most comfortable. However, some parents have difficulty sleeping themselves if the child is in their bed and need the child to sleep in his own bed. Either arrangement can foster attachment during the transition time.

The most important thing to remember is to be consistent and available to the child if sleep is disrupted. If the child wakes crying in her bed, go to her, soothe her, and let her know you are there. Try not to take her out of bed (which reinforces her waking), but settle her down again and stay with her for a few minutes. You may need to repeat this process many times during the night at first if she wakes often.

Most parents find that if they are consistent and loving in their approach, sleep improves. Be patient; this process sometimes can take several months. 

What To Do About Nightmares
The child who wakes from a nightmare or has night terrors needs to be comforted. The child who appears to be coping well in her new home and attaching to her family during the day may have severe night terrors at night, calling out for her former caregiver and resisting her parents’ attempts to comfort her (which can make the experience equally frightening from the parent's perspective). It is important to speak quietly to the child, to reassure her that everything is okay, and to gently make physical contact with her, perhaps by stroking her forehead. Don’t leave her alone. Wait for the terror to pass and then settle her back in bed.  

Nightmares and night terrors are usually temporary and should lessen after a month or two at home, though they may reappear during times of stress or illness. Discuss these issues with your primary care provider if the nightmares and night terrors do not improve over the first few months.