All new parents expect some
nights but when a child's
wakefulness becomes excessive it can lead to exhaustion and even
marital breakdown. Sleep counsellors can help but are often in short
For the past seven years community nursery nurse Annette Faamausili has
worked alongside a team of five health visitors helping families whose
children do not sleep through the night.
Ms Faamausili estimates that as many as one in four families with young
children experience difficulty establishing a successful sleep routine,
and the number is increasing. 'There are huge pressures on mothers to
return to work and for parents to juggle work and family life. They
want to enjoy time with their children in the evening, but do so to the
detriment of a good, consistent bedtime routine.'
Up to the age of five, children need between 11 and 12 hours unbroken
sleep at night. Until they are around two-and-a-half they normally
still need a nap during the day, for anything up to two hours or more.
If they are deprived of this sleep, the effects on the family can be
Demand for Ms Faamausili's services is such that for the past five
years she has run a regular sleep clinic every Friday afternoon.
Families with children aged between six months and five years can be
referred by their health visitor or GP. Occasionally, they self-refer.
Ms Faamausili prefers to see both parents on their own at the clinic.
This is partly because a sleep-deprived child is not good company. 'You
can immediately tell when a child is sleep-deprived by looking at him
or her,' she explains. 'They are often hyperactive, manic and
irritable, with poor concentration levels.'
But more importantly, seeing the parents on their own gives them the
chance to focus on the problem and talk about their situation without
the need to concentrate on the child. By the time they reach the
clinic, Ms Faamausili's adult clients may also be suffering from
depression, feelings of isolation and relationship problems. Coping
with the demands of day-to-day life can become impossible.
She first asks the parents to talk her through a typical evening,
making a note of when the children have tea and bath time, when parents
return home and events leading up to bedtime. Then, using charts, she
explains the different phases of sleep.
Ms Faamausili encourages parents to view the night through their
child's eyes. If she has been rocked to sleep with the aid of the
breast or bottle, the last thing she will remember is being in her
mother's arms feeling safe and secure with the taste of warm milk in
her mouth. If the child then wakes up an hour or two later to find
those things have gone and is alone in her cot, she may become
distressed and unable to return to sleep unless the parent reproduces
Ms Faamausili emphasises the need to establish a good bedtime routine.
'I stress the importance of taking the child upstairs at the same time
each night, giving him or her a bath and then going straight into the
bedroom - there is absolutely no going back downstairs.
'They should have a bit of quality quiet time - a drink of milk and a
story. Even small babies can enjoy a simple story. But after that the
child should be tucked up in bed, with a teddy or a blanket. And then
mum or dad should leave the room while the child is still awake - that
is very important and the key to a successful sleeper.'
The most important aspect of developing a good sleep routine is for the
child to learn to fall asleep by him or herself. Most of Ms
Faamausili's clients are advised to use a controlled withdrawal
routine. To begin with she recommends that they leave the room for no
longer than five minutes. If the child is still crying after this, the
parent should return, calmly reassure the child that he or she has not
been abandoned and then leave the room again.
This routine then needs to be repeated every five minutes for as long
as it takes for the child to eventually fall sleep. The parents must
not shout or punish their child, but talk calmly and firmly and leave
the room confidently.
Like many new clients, Nikki Robson was sceptical that Ms Faamausili's
advice would be effective. 'When Annette told me that if I did what she
said my daughter Holly would be sleeping for 12 hours a night within a
week, I simply did not believe her,' she says. 'But I knew I had to
give it a go because we could not go on as we were.'
To begin with, her scepticism seemed well founded. 'The first night it
took until about midnight to get Holly to sleep,' she recalls. 'I was
going in and out every five minutes for hours. Basically, it was hell
for the first two or three nights - it is far worse getting in and out
of bed every five minutes, rather than just leaving her to scream. But
I knew I had to do it and be really strict.'
On the fifth night there was a breakthrough. 'I gave Holly her tea,
bathed her and put her to bed as usual. Then I started tidying things
up, waiting for her to start crying. But things suddenly went quiet. At
first, I wondered if Holly was all right. Then, to my amazement, I
realised she was fast asleep.'
Within a week Holly was a reformed character, sleeping for 14 hours.
For the Robsons, this meant a return to something approaching a normal
family life. 'Holly was just so happy,' says Ms Robson. 'She was like a
completely different child.'
Ms Faamausili estimates that around 92 per cent of her clients achieve
total success after a period of just seven to ten days. Word has spread
and she is overwhelmed with pleas for help.
'I did a presentation to a group of nursery nurses in our neighbouring
trust,' she says. 'They wanted to hear what I had been doing, because
they have been inundated with cases of children who have sleep problems
and they did not know how to tackle them. There is a huge amount of
interest out there. I believe this sort of service should be more
Tips for a
- Avoid daytime sleeps after
- Set a structured bedtime
routine and keep to the same time each
- Do not let children come
downstairs after bath time.
- Put the child to bed awake
at bedtime and ensure he or she falls
asleep without you being present.
- Leave the room before the
child falls asleep. Do not creep out
without the child knowing.
- Avoid rocking or cuddling
your child to sleep at night.
- If the child does cry or
wake in the night, wait a few minutes
before going in and then just go in briefly to give reassurance and
leave calmly and swiftly.
- Avoid offering milk or
drinks during the night.
- Keep room temperature at a
- Encourage the child to have
a teddy or a blanket to cuddle in bed.
Nursing Standard, Volume 19(44), 13 July 2005, pp 22-23
(C) Copyright 2005 RCN Publishing Company Ltd.
Used with Permission. Do not reproduce without express permission from