Sleep is an important routine of infants and toddlers which affects development. Impaired sleep routines increase the likelihood of delayed development in behavior, cognition, and growth (Bonuck et al., 2011). Children who are diagnosed with developmental delays are two to three times more likely to have a sleep disorder (Couturie et al., 2005). Often, early intervention providers are the first to identify sleep problems, and should address the impaired routine.
How much sleep does the American Academy of Pediatrics (2020) recommend?
Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps)
Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps)
Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps)
Sample Outcome for IFSP:
1. Child will improve sleep routines to sleep throughout the night.
Sample Goals for IFSP:
1. Child will sleep throughout the night, waking only 2 times or fewer, daily for 4 weeks.
2. Child will sleep throughout the night 4 out of 7 nights per week, for 4 consecutive weeks.
Suggested Skilled Interventions (Specific Activities) that are Evidence-Based:
1. Parent educational program for sleep preparation and participation
calming strategies - i.e. dim lights, no noise/white noise, swaddling of infant
sleep hygiene routines – i.e. avoid caffeine before bed, exposure to natural light during day and proper darkness during night, proper daytime play activities such as playing outside
sleep schedules – i.e. ensure child is sleeping the recommended hours each day/night, nap schedule
bedtime routines - i.e. regular and consistent schedule which may include bath time and reading a book before bed, discontinue screen time at least 90 minutes before bed time
environmental modifications - i.e. cool bedroom, appropriate lighting, consider black-out curtains/shades, comfortable and safe crib/bed
bedtime fading technique – i.e. slowly adjust/lengthen the bedtime schedule, slowly wean parent from sleeping with the child, slowly wean child from unhealthy bedtime habits
Research indicates parental education for sleep improves the child’s sleep, the quality of sleep, and promotes a healthy lifestyle (Wooster et al., 2015).
2. Massage Before Bed and Infant Massage
These are a touch-based interventions which can be utilized before bedtime and nap-time to improve sleep habits. In addition to improving quantity and quality of sleep, research indicates massage-before-bed may also improve impulsive behaviors and attention to task during daily routines (Escalona et al., 2001). The benefits of infant massage include stress reduction, improved weight gain, caregiver bonding, improved feeding abilities in newborns, neurodevelopment, and soothing (Pados & McGlothen-Bell, 2019).
3. Weighted blanket
A weighted blanket is a sensory-based intervention which can be used to soothe a child with autism spectrum disorder to help the child fall asleep faster and remain asleep for a longer duration (Gee, Mcomber, Sutton & Lloyd, 2017). Research regarding weighted blankets is limited; however, increasing as weighted blankets are becoming more popular, affordable, and accessible in stores and online. Weighted blankets should not be used in children under one year of age and should weigh no more that 10% of the child's body weight.
References
American Academy of Pediatrics SUPPORTS CHILDHOOD Sleep guidelines. (2016, June 13). Retrieved February 06, 2020, from https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/American-Academy-of-Pediatrics-Supports-Childhood-Sleep-Guidelines.aspx
Bonuck, K. A., Hyden, C., Ury, G., Barnett, J., Ashkinaze, H., & Briggs, R. D. (2011). Screening for sleep problems in early intervention and early childhood special education. Infants & Young Children, 24(4), 295-308. doi:10.1097/iyc.0b013e3182234444
Couturier, J. L., Speechley, K. N., Steele, M., Norman, R., Stringer, B., & Nicolson, R. (2005). Parental perception of sleep problems in children of normal intelligence with pervasive developmental disorders: prevalence, severity, and pattern. Journal of the American Academy of Child and Adolescent Psychiatry, 44(8), 815–822.
Escalona, A., Field, T., Singer-Strunck, R., Cullen, C., & Hartshorn, K. (2001). Journal of Autism and Developmental Disorders, 31(5), 513-516. doi:10.1023/a:1012273110194
Gee, B., Mcomber, T., Sutton, J., & Lloyd, K. (2017). Efficacy of Weighted Blankets for Children With Autism Spectrum Disorder, Sensory Overresponsivity, and Sleep Disturbance. American Journal of Occupational Therapy,71(4_Supplement_1). doi:10.5014/ajot.2017.71s1-po4116
Wooster, D., Gwin, H., Gwin, S., Hargis, L., Papania, J., Register, J., Rood, K. (2015). Efficacy of Sleep Education for Parents With Children With Autism Spectrum Disorder. American Journal of Occupational Therapy, 69(Supplement_1). doi.org/10.5014/ajot.2015.69S1-PO3058