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Establishing Sleep Patterns

by Elaine E. Schulte, M.D., MPH

Sarah, a 12-month-old adopted internationally, is to my pediatrician’s eye, healthy. Her parents report that she slept well abroad, but since her arrival in the U.S., things have changed. She now has difficulty falling asleep and wakes frequently through the night.

Sarah’s mother has been rocking her to sleep while giving her a bottle. As soon as the baby is put down, she begins to howl. When she wakes up crying, her mother goes to her with a bottle. Sarah returns to sleep but is up again two hours later. She eventually winds up in her parents’ bed. She’s happy during the day, usually taking two 90-minute naps.

What’s going on?
Sarah’s sleep problems are not unusual for a recently adopted child who must establish new sleep routines. Previously, the child may have been in an institution where she was left alone to cry, or she may have been in a foster home where she slept  on her mother’s back. Even domestically adopted children must adjust to a different environment—new caretakers, new odors, foods, and sensations, perhaps a new time zone. New parents and newly adopted children quickly learn that middle-of-the-night comforting is mutually rewarding. How nice finally to have a baby to hold!

Unfortunately, after a reasonable adjustment and bonding period, the thrill wears off for most parents for whom bringing the child into the parents’ bed is a short-term solution.

Remember that most adopted babies are not used to having their needs met quickly; they know how to get themselves to sleep. The introduction of a transitional object (e.g., a stuffed animal, blanket, or parent-scented article of clothing) will help the child comfort himself. Also, keep in mind  that children who’ve lived in an institution may be used to lots of noise and become frightened in a silent, dark environment. White noise and/or a night-light may be helpful. 

Establish a Sleep Routine
Children love routine; establishing one at night is critical and usually well received. A typical routine consists of a bath, diapering, reading books, lights out, then some soft music. Don’t panic if your system doesn’t work at first. You may need to modify it based on behavior. Once you find your ritual, stick to it.

If your child is waking frequently, reassure him that he is safe and that you are close by. Initially, you may want to hold hands in the dark, or lie on the floor or on a daybed in his room until he falls asleep. Check with your pediatrician to make sure the baby is getting the right amount of sleep. After an adjustment period, with lots of love and understanding, most children become great sleepers.

Elaine E. Schulte, M.D., MPH, is Associate Professor of Pediatrics and Medical Director of the International Adoption Program at Albany Medical College.


Tips for Establishing a Post-Bonding Bedtime Routine:

* Remember what’s familiar to the baby
* Don’t allow the baby to fall asleep in your arms
* No bottle in the crib
* Consider a night-light

If the Child is Waking in the Middle of the Night:
* Reassure the child with your voice
* Don’t turn on the lights
* Use a transitional object

And Consider:
* Waiting a bit longer each time before deciding to go into your child’s room in the night
*
Decreasing daytime sleep by shortening nap time

©2002 Adoptive Families magazine. Reproduction in whole or part without permission is prohibited.

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