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January-February/2000

AMERICAN ACADEMY OF PEDIATRICS
GUIDE TO YOUR CHILD'S SLEEP

George J. Cohen, MD, editor-in-chief
New York: Villard Books, 1999
209 pages, paperback, $12.95
ISBN 0 679 76981 1

Reviewed by Lynne Lamberg
Children as well as adults with trouble sleeping need solutions tailored to the person as well as the problem. In this book, the American Academy of Pediatrics offers a broad range of helpful choices for children from birth through adolescence, focusing primarily on the early years.

The book encourages readers to weigh options as individual circumstances dictate. On widely-debated topics such as how to get a crying baby to sleep, for example, a nice chart compares the pluses and minuses of different methods, including checking and patting the baby at 5- to 10 minute intervals without picking it up, checking the baby at progressively longer intervals without touching it, and letting the baby cry it out.

The Academy advocates breast-feeding of babies, but it takes a strong stance against co-sleeping, that is, allowing a baby to share the parents' bed. The Academy says that this practice increases the risk of smothering the baby, and that "roll-over deaths may account for some of the deaths reported due to sudden infant death syndrome (SIDS) each year."

There is less consensus on this topic than this book implies. Expecting babies to sleep alone is a Western custom of fairly recent origin. Around the world, breast-feeding mothers traditionally sleep with their babies, and it has not been proved that these babies have higher rates of SIDS. Wherever the baby sleeps, however, parents need to use a firm sleeping surface, and put the baby to sleep on its back. The "back to sleep" strategy adopted in several countries in the past decade has cut the number of SIDS deaths dramatically.

This book is written in an easy-to-read conversational tone. It includes boxes with common "ask the doctor" questions and substantive answers. Highlighted text throughout the book offers practical tips on topics such as selecting a crib, coping with colic, and dealing with nightmares. The book also addresses parents' sleep, providing a concise summary of sleep needs, and the effects of irregular schedules, medications, smoking, anxiety, and depression (pp. 28-30; it's not listed in the table of contents).

The editor's introduction acknowledges that the book repeats information "as it applies to the different ages and stages of childhood." That sounds reasonable, as readers may dip into sections of special interest at various times. Much of the repetition, however, involves the same age children. It is both needless and grating.

In Chapter 1, for example, the reader learns, "Typically, however, by 2 or 3 months of age, most infants are sleeping for longer periods during the night, and staying awake for much of the day....(p. 13) In Chapter 2, "By about 16 weeks, many babies ....sleep more at night and remain alert for increasingly longer periods in the daytime." (p. 17). Moving on to Chapter 3, "After 2 or 3 months, healthy babies usually settle into a routine in which they sleep for longer stretches at night--say 5 or more hours--and are awake and active more during the day...."(p. 34)

Similarly: "The American Academy of Pediatrics cautions against co-sleeping in a family bed...." (p. 80), and "The American Academy of Pediatrics cautions against routine co-sleeping in a family bed...." (p. 90). "....Teenagers need, on average, 9.2 hours of sleep a night." (p. 26). "Teenagers need between 9 and 10 hours of sleep a night." (p. 187).

Despite this flaw, the book provides a state-of-the-art review of current thinking about children's sleep problems. It will serve as a useful supplement to conversations with your child's pediatrician or your family doctor. Its paperback format and attractive price should make it accessible to a large audience.




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