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Children's Health

How much sleep is not enough for 8 month old?

12/21/2009

Question:

Our sweet little 8 month old girl sleeps 9-12 hours a day. Not straight, but 8-1, 2-5:30, and if she naps at all, which often she does not, it is one 2 hour nap, or two 30 minute naps, adding no more than 2 hours to her night sleep. This owrries me because she is clearly more tired (as are we) than she ought to be.

Despite our best efforts, we still have no schedule. Some days she will go to sleep for a nap, other days, she just simply refuses. Most days she does not object to our effort, she simply looks at us and grins sleeplessly for the entire hour we spend trying to get her to sleep. I kept a sleep log of her activity once and was shocked to find she was only sleeping 9-12 hours a day. Twelve is a very, very good day, and not often.

We have tried every single formula on the market, from soy to organic, both lactoce and lactose free, sensitive and with and without DHA/RHA hoping to find something that would explain a food allergy or sensitivity to formula ingredients. We see very little variance in her reaction, with the one exception being Similac Sensitive, which seems to cause her to be much, much worse. I thought it might be the corn syrup, and switched to organic, with not much difference. I make all of my own baby food from organic vegetables, and she does not get additives or spices, and does not drink juice.

We have also: - established a nighttime ritual, both with and without warm baths; - honor room darkening during what is supposed to be sleep time; - engage in quiet activity, and both bottles and not-bottles at "bedtime" and before "nap time;" - tried both letting her fuss it out, and rocking her to sleep. She dislikes both. Her preference is to lie in the bed prone to me, curled into me, to fall asleep; - scheduling her, and letting her dictate her schedule, with no variance between the two; - car rides, dryer vibrations, seats, swings, swaddling, white noise, and an endless host of other suggestions by well-intentioned observers. None of these are successful in lulling her into slumber if she is not interested in sleeping, and if she does submit, any disturbance (turning the car off, moving the seat or her, adjusting her blanket) wakes her again. I have even tried sleeping in the car in my driveway after a ride home!

I would appreciate any advice you can offer as to what else causes sleep problems in infants outside of the normal sleep spectrum. All of us are dreadfully in need of sleep. The circles under her eyes have begun to match my own, and I am worried a lack of sleep may start to hinder her development. She already seems as though she is a little behind her peers, and even her older sister and cousins, developmentally, though by no means delayed. We are just simply so exhausted.

Thank you!!

Answer:

The answer has several points:

1. The amount of daily sleep of 9 month old infants reported by their parents varies widely with 96% of infants sleeping between 10.5 to 17 hours based on a recent publication. In addition most 9-month-olds nap during the day with a total duration of the naps totaling between 20 minutes to 5 hours in 96% of children. So the variability in what may be normal is quite large at this age. More concerning is that your daughter seems tired and may be a "little behind" peers.

Generally, the causes of "not sleeping" in infancy fall within 2 broad categories medical and behavioral with some occasional overlap. Medical causes for insomnia/"not sleeping" include problems like gastroesophageal reflux, snoring and obstructive sleep apnea, or a family history of restless leg syndrome or family members with short sleep (typically requiring < 5 hrs. of sleep/day).

Behavioral causes of insomnia/"not sleeping" in infants fall into 2 broad types:

1. Sleep association type disorder

2. Limit setting type disorder

1. Sleep association type most commonly occurs when the infant only falls asleep under a specific set of conditions (like contact with mother). Unless this condition occurs the infant will not sleep easily and complain excessively.

Sleep associations are learned behaviors. So new sleep onset associations can be learned but it takes time and training. It is generally advised that a new sleep association not involve parental presence.

From what you describe your child "likes to snuggle with you" before falling asleep. This suggests a possible sleep association disorder. Limit setting type disorder generally occurs in older children.

I would suggest that you talk with your child's doctor to determine that there are no intrinsic medical reasons for your child's sleeping difficulty. If there are none, then would suggest proceed with a behavioral treatment plan outlined by your physician if it appears that a sleep association type disorder may be present.

A helpful reference book for learning more about insomnia in infants and sleep association disorder is Solve your child's sleep problems by Dr. Richard Ferber, which is available in most public libraries.

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Response by:

Mark   Splaingard, MD Mark Splaingard, MD
Clinical Professor of Pediatrics
College of Medicine
The Ohio State University