A bit of parental wisdom known to most moms and dads: If you want to get a good night’s sleep yourself, just keep your kids running all day long. An early night and undisturbed sleep are almost guaranteed. But is it true?

New research says it is. A study in the journal Archives of Disease in Childhood came to the following conclusion: Active children fall asleep faster and sleep longer than children who get less exercise.

The researchers followed nearly 600 New Zealand 7-year-olds. They had the parents answer a questionnaire on their children’s sleeping habits. They also had the kids wear monitors around their waists over one 24-hour period to measure their activity levels each minute of the day.

7 steps to better sleep

Here’s what the study found: It took an average of 26 minutes for a child to fall asleep. But for every hour a youngster was inactive during the day, it took three minutes longer. For active children, it worked the other way: The more activity, the less time it took to fall asleep.

Obviously, a child’s sleep pattern affects the parents too. A child who wakes up often during the night can wreak havoc on grown-ups’ need for rest. But there is also a significant impact on the child. Poor sleep habits have been associated with behavioral problems, low grades in school, and even an increased risk of being overweight.

According to the article, some 16% of parents of school-age children report that their kids have trouble falling asleep. The study, the authors noted, “emphasizes the importance of physical activity for children, not only for fitness, cardiovascular health, and weight control, but also for sleep.”

5 ways you can get a better night’s sleep

It seems logical that kids who run around all day are more tired and therefore sleep better. But consider: Perhaps it’s the other way around. Maybe children who get a lot of sleep have more energy to run around all the time. In fact, researchers are not sure what causes what in this chicken-egg scenario.

Still, we know exercise is good for kids, so encourage your children to be active-to run, play soccer, swim, hit a tennis ball, whatever will keep them moving. Even if it doesn’t knock them out at bedtime, they’ll be healthier, and that should let everyone in the household sleep easier.

Source: Dr. Ranit Mishori, PARADE

Anyone who grew up in a large family likely remembers hearing “Don’t wake the baby.” While it reinforces the message to older kids to keep it down, research shows that sleep also is an important part of how infants learn more about their new world.

Rebecca Gomez, Richard Bootzin and Lynn Nadel in the psychology department at the University of Arizona in Tucson found that babies who are able to get in a little daytime nap are more likely to exhibit an advanced level of learning known as abstraction.

Nadel, a Regents’ Professor at the UA, will describe the group’s work (Early Learning in Infants May Depend on Sleep) in a session at the American Association for the Advancement of Science annual meeting in San Diego on Sunday, Feb. 21, starting at 8:30 a.m., Pacific time.

In their research, Nadel and his colleagues played recordings of “phrases” created from an artificial language to four dozen 15-month-old infants during a learning session. Their methodology included repeatedly playing phrases like “pel-wadim-jic” until the babies became familiar with them.

These phrases contained three units, with the first and last unit forming a relationship. In this example, the first word, “pel,” predicts the last, “jic.” Even though these are nonsensical sounds, the language created for the test shares some similarity with structure commonly found in subject-verb agreement in English sentences.

Prior to being tested, some infants learning this faux language took their normally scheduled naps. Others were scheduled at a time when they would not nap following the session. When the infants returned to the lab, they again heard the recordings – along with a set of different phrases in which the predictive relationship between the first and last words were new.

By carefully watching the babies’ facial expressions as they listened to both old and new phrases, the researchers were able to rate their level of attention. They found that babies’ longer gazes at a flashing light that coincided with the phrases signaled attention, which indicated that they had learned a particular phrase or relationship.

Differences arose between the infants who had napped and those who had not. The infants who did not sleep after the sessions still recognized the phrases they had learned earlier. But those babies who had slept in between sessions were able to generalize their knowledge of sentence structure to draw predictive relationships to the new phrases. This suggests that napping supports abstract learning – that is, the ability to detect a general pattern contained in new information.

In follow-up work, the UA researchers have shown that infants must have their naps within four hours of listening to the artificial language in order for them to demonstrate this beneficial abstraction effect. Those who failed to nap within that time, but slept normally that evening, failed to show the abstraction effect the next day.

“It’s a fairly nuanced story,” Nadel said. “What we know is that infants have mostly REM sleep, given the type of sleep they have, given how their brains are developed at that point. And they have to get some of that sleep within a reasonable amount of time after inputting information in order to be able to do abstracting work on it. If they don’t sleep within four to eight hours, they probably just lose the entire thing,” he said.

What this should reinforce for parents, he said, is that while it obviously is important to give infants and young children the kind of stimulation that comes from reading, talking and exposing them to lots of words, thise stimuli need to happen within the context of a reasonably well-regulated daily cycle that includes adequate sleep.

In 2005, according to the CDC, 2,234 infants died of SIDS in the United States. Forty-four of those deaths occurred in New Jersey. The study notes that the incidence of SIDS has declined by more than 50 percent since the onset of public health initiatives during the 1990s, most notably the AAP’s “Back-to-Sleep” campaign, to raise awareness of infant care practices that elevate the risk of SIDS. However, the study indicates that risk-reduction education needs to be more comprehensive.

“It is important that health care providers communicate all of the risk factors of SIDS ideally during the prenatal period as well as at birth and throughout the first year of an infant’s life,” said Dr. Ostfeld, who also is program director of the SIDS Center of New Jersey.

“Risk-reduction education of new parents and all other caregivers, such as grandparents and babysitters should be detailed,” said Dr. Hegyi, who also serves as the medical director of the SIDS Center of New Jersey. “Parent’s questions and concerns should be addressed thoroughly.”

The authors note that guidance to parents regarding safe sleep practices should address the importance of “Back-to-Sleep,” the position associated with the lowest risk, but also should cover all other practices that have been identified as lowering the risk of SIDS according to the guidelines of the American Academy of Pediatrics. These include, but are not limited to, avoidance of exposure to tobacco smoke, elimination of the use of pillows, quilts and soft or loose bedding in the infant’s sleep environment, avoidance of any face covering, and avoidance of the use of a shared sleep surface during sleep.

SIDS is defined as a sudden and unexpected death of an infant before the first birthday that remains unexplained even after a comprehensive evaluation consisting of a complete autopsy, a death scene investigation and a review of medical history of the infant and the family. Many studies now suggest that one of the potential causes may be an abnormality in the brainstem that would prevent an infant from responding to breathing challenges, such as those posed by prone (on the stomach) sleep in soft bedding. However, until the biological bases for SIDS are fully defined and can lead to the identification and treatment of living infants who may be vulnerable, risk-reducing practices, often defined as safe sleep practices, remain the most effective intervention to date.

The SIDS Center of New Jersey (SCNJ) was established in 1988 and operates under a grant to UMDNJ-Robert Wood Johnson Medical School from the New Jersey Department of Health and Senior Services. An additional site based at The Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center receives funding from the CJ Foundation for SIDS. The program provides families with bereavement support and information about sudden infant death, educates the health care community about methods for reducing the risk for SIDS, and monitors the epidemiology of SIDS in New Jersey. Since the onset of the program, the rate of SIDS in New Jersey has declined by more than half and remains below the national rate. Compliance with risk reducing infant care practices has also improved.

UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL

As one of the nation’s leading comprehensive medical schools, UMDNJ-Robert Wood Johnson Medical School is dedicated to the pursuit of excellence in education, research, health care delivery, and the promotion of community health. In cooperation with Robert Wood Johnson University Hospital, the medical school’s principal affiliate, they comprise New Jersey’s premier academic medical center. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.

As one of the eight schools of the University of Medicine and Dentistry of New Jersey with 2,800 full-time and volunteer faculty, Robert Wood Johnson Medical School encompasses 22 basic science and clinical departments, hosts centers and institutes including The Cancer Institute of New Jersey, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate and postgraduate levels for more than 1,500 students on its campuses in New Brunswick, Piscataway, and Camden, and provides continuing education courses for health care professionals and community education programs.

Source: Robert Wood Johnson Medical School

The brains of infants who die of sudden infant death syndrome (SIDS) produce low levels of serotonin, a brain chemical that conveys messages between cells and plays a vital role in regulating breathing, heart rate, and sleep, reported researchers funded by the National Institutes of Health.

SIDS is the death of an infant before his or her first birthday that cannot be explained after a complete autopsy, an investigation of the scene and circumstances of the death, and a review of the medical history of the infant and of his or her family. According to the National Center for Health Statistics, SIDS is the third leading cause of infant death, claiming more than 2,300 lives in 2006.

The researchers theorize that this newly discovered serotonin abnormality may reduce infants’ capacity to respond to breathing challenges, such as low oxygen levels or high levels of carbon dioxide. These high levels may result from re-breathing exhaled carbon dioxide that accumulates in bedding while sleeping face down. The findings appear in the Feb. 3 issue of The Journal of the American Medical Association.

“We have known for many years that placing infants to sleep on their backs is the single most effective way to reduce the risk of SIDS,” said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that funded the research. “The current findings provide important clues to the biological basis of SIDS and may ultimately lead to ways to identify infants most at risk as well as additional strategies for reducing the risk of SIDS for all infants.”

NICHD’s Back to Sleep campaign urges parents and caregivers to place infants to sleep on their backs. Following the campaign’s launch in 1994, the rate of SIDS dropped by more than 50 percent. Widespread adoption of back sleeping appears to have reduced the occurrence of SIDS, but has not eliminated it.

For this study, senior author Hannah C. Kinney, M.D., of Harvard Medical School and Children’s Hospital Boston, and her colleagues examined small samples of tissue from the medulla, a region at the base of the brain that regulates basic functions such as body temperature, breathing, blood pressure, and heart rate. The researchers analyzed brain tissue from infants who died from SIDS and controls who died of other causes. Included in the analysis were 35 infants who died of SIDS, 5 infants who died unexpectedly of other causes, and 5 infants who were hospitalized and died for reasons associated with a lack of oxygen.

The researchers found that serotonin levels were 26 percent lower in tissue from infants who died of SIDS than in tissue from the group of infants who had otherwise died unexpectedly. Measurements of tryptophan hydroxylase, an enzyme needed to make serotonin, also were 22 percent lower.

In earlier work comparing SIDS cases with other infant deaths, Kinney and her coauthors showed that the brains of infants who died of SIDS had higher concentrations of cells that use serotonin in the medulla oblongata, a region of the brain stem. For the current study, the researchers set out to see if this meant the SIDS infants’ brains in fact had altered levels of the brain chemical.

This abnormality appears to fit into the triple-risk model of SIDS, which holds that SIDS occurs only when three elements come together: an infant with an underlying vulnerability, a critical period of development, and an external stressor. The researchers speculate in this case that the low serotonin level would cause the underlying vulnerability. The first year of life is the critical period of development for stabilizing vital functions such as breathing. The final element of the model, sleeping face down, might provide the external stressor.

“Our research suggests that sleep unmasks the brain defect,” Dr. Kinney said. “When the infant is breathing in the face-down position, he or she may not get enough oxygen. An infant with a normal brainstem would turn his or her head and wake up in response. But a baby with an intrinsic abnormality is unable to respond to the stressor.”

“It’s no one single factor but a culmination of abnormalities that result in the death,” Dr. Kinney said. In fact, in 88 percent of the SIDS cases they examined, the researchers found two or more risk factors, such as the infant’s sleep position, an illness, or exposure to cigarette smoke.

Kinney hopes these findings will one day lead to a test that measures infants’ serotonin levels in the blood or other tissues that reflect brain serotonin levels. Such a test might make it possible to identify those at the highest risk for SIDS so that additional steps could be taken to protect them. In the near term, the findings will provide the basis for the development of animal models with serotonin deficiencies, to mimic what occurs in SIDS in human beings.

Source: Robert Bock, NIH/National Institute of Child Health and Human Development

Multiple studies have shown that placing infants on their backs to sleep limits the risk of SIDS, the leading cause of death among children in the U.S. under the age of 1.

In a study available online and in the December issue of Archives of Pediatric and Adolescent Medicine, researchers, including Dr. George Lister, chairman of pediatrics at UT Southwestern and an author of the study, identify three reasons a caregiver might or might not follow the recommendation: concerns for an infant’s comfort; fear that the infant might choke while sleeping on his or her back; and whether a physician advised the caregiver to always place an infant on his or her back to sleep.

“We know that placing infants on their backs to sleep is by far the single most effective way to reduce the risk of SIDS, but the number of deaths has leveled off in recent years,” Dr. Lister said. “We wanted to know why in order to develop practical advice that caregivers will follow.

“Our findings suggest that a physician’s counsel makes a substantial difference when a caregiver is determining whether to place an infant to sleep on its tummy, side or back.”

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHHD) first launched the “Back to Sleep” campaign in 1994. Since then, the number of babies who are placed on their backs to sleep has jumped from 25 percent to 70 percent, while the rate of SIDS has plummeted by more than 50 percent. Despite the overall decrease, however, the rate of SIDS among African-American infants continues to be more than twice as high as among white and Hispanic infants.

For the current study, researchers analyzed data obtained from the National Infant Sleep Position Study from 1993 to 2007 to learn which factors influence a caregiver’s decision whether to follow the recommendation. The national phone study, which is conducted annually, involves interviewing caregivers of infants born within the past seven months. More than 1,000 interviews were conducted each year.

The researchers found that while the number of babies placed to sleep on their backs increased substantially between 1993 and 2001, this number has since stabilized. In addition, the study showed that between 2003 and 2007 only about 54 percent of study participants reported that a physician advised them to only put their infants to sleep on their backs.

Dr. Lister said families who adhered to the “Back to Sleep” recommendation were unlikely to express concerns about their baby choking or being uncomfortable sleeping in that position. These families were more likely, though, to report that a physician recommended the practice as the only option.

The study also found that African-American infants are less likely to be placed to sleep on their backs than either Hispanics or whites. “We estimate that there would have been at least 700 fewer deaths of African-American infants over a five-year period if they were placed on their backs to sleep at the same rate as white infants,” Dr. Lister said.

Dr. Lister said the findings indicate that a possible solution to further reducing the rate of SIDS depends on physicians promoting the “Back to Sleep” recommendation as the only option, while also addressing any potential concerns about choking and comfort.

“Physicians need to be proactive by consistently telling parents and caregivers that infants must always be placed on their backs and on a firm mattress to sleep, even for naps,” Dr. Lister said. “They must also continue to remind caregivers to remove extra blankets, pillows and stuffed animals from the crib during sleep time.”

The next step is for researchers to conduct face-to-face interviews with mothers both before and after delivery to gauge their intentions regarding sleep positions and whether those plans are modified after delivery.

Researchers from Yale University, Boston University and the Massachusetts Department of Health contributed to the report.

The study was supported by the NICHHD.

Source: UT Southwestern Medical Center

Led by SIDS researchers Rachel Moon, MD, a pediatrician, and Brandi Joyner at Children’s National Medical Center, the study analyzed pictures of sleeping infants in 24 magazines with wide circulation among 20- to 40-year-old women.

The authors evaluated pictures for sleep positions, including whether or not the baby was placed on its side or stomach rather than on its back, as well as hazards in infant sleeping environments, including soft bedding. The study reviewed photos in both articles and advertisements.

“There are major discrepancies between what doctors recommend to prevent sudden infant death syndrome and what moms may see in mainstream media,” said Dr. Moon. “The most important thing for moms to realize is that what they see in magazines may not be what’s best for their baby in real life.”

To reduce the risk of SIDS, the American Academy of Pediatrics recommends that babies be placed on their backs when sleeping, on a separate sleep surface from their parents, without blankets, pillows, or other soft bedding. Dr. Moon is a member of the AAP’s Task Force on SIDS, which issued revised guidelines for SIDS prevention in October of 2005.

The study, titled “Infant Sleep Environments Depicted in Magazines Targeted to Women of Childbearing Age,” appears in the September issue of Pediatrics.

Source: Jennifer Leischer/Emily Dammeyer , Children’s National Medical Center

The study evaluated 73 cases in which children younger than two years old were treated for obstructive sleep apnea through the removal of the adenoids, tonsils, or both (adenotonsillectomy). Those treated through surgery experienced significant improvement on the apnea-hypopnea index (AHI), an index that measures the severity of sleep apnea. Those treated medically, but not surgically, exhibited no improvement after treatment. The study’s authors also concluded that the rate and types of post-surgical complications were within acceptable levels.

Sleep disordered breathing (SDB) in children, from infancy through puberty, while similar to adult sleep apnea, actually has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition when they become an adult. The consequences of pediatric obstructive sleep apnea include snoring; sleep deprivation (which can cause moodiness and behavioral issues); abnormal urine production; slowed growth and development; and attention deficit and attention deficit hyperactivity disorders.

Source: Matt Daigle, American Academy of Otolaryngology — Head and Neck Surgery .

SIESTA II — Study of Infants’ Emergent Sleep Trajectories, Phase II — will study the role of parenting in the development of infant sleep patterns. Researchers will visit 150 homes in the Hershey, Harrisburg and State College areas to collect data and 25 percent of the homes will have minority families. Researchers will visit each home seven times in two years. Infrared cameras in participants’ homes will document several aspects of bed time and night time rituals for infants including daily bed time routines, use of close contact, soothing vs. arousing behaviors, parental reactions to infant sleep disruptions, parental emotional availability and infant emotional reactions. Parents will also keep infant sleep diaries.

“Most literature on infant sleep patterns comes from pediatric journals, but tends to ignore perspectives from developmental science — we hope to change that,” says Teti. “There’s probably not one universal formula that parents should use to promote sleep quality and well-being in infants. It’s more likely that how parents feel about their children’s sleep and how well they adapt emotionally plays just as large a role in the development of infant sleep as the parenting practices being used.”

The researchers will test whether consistent bed time rituals promote self-regulated sleep habits in infants; whether support from a partner enhances a mother’s ability to adapt to a temperamental infant; whether parents who do not adapt are less emotionally available to their infants and experience more stress, and whether parents’ stress increases the number of infant sleep disruptions. They will also test the idea that cognitive functions in infants, such as the capacity for information processing, are sensitive to and influenced by sleep quality.

As part of the project, the grant will be used to fund several graduate students who will work as researchers at the University Park or Harrisburg campuses.

SIESTA I, which was funded by Penn State’s Children, Youth and Families Consortium, was a pilot study and laid the groundwork that makes SIESTA II possible. Researchers established that infrared cameras would provide clear video and audio and accurately capture the emotional quality of infant and parental behaviors in the middle of the night. SIESTA I also gave the investigative team the opportunity to pilot a number of different measures and procedures currently being used in SIESTA II.

Co-investigators for SIESTA II include Pamela Cole, professor of psychology; Cindy Stifter, professor of human development and psychology; Mike Rovine, professor of human development, all from Penn State; Ian Paul, professor of pediatrics, Penn State Milton S. Hershey Medical Center, and Thomas Anders, professor emeritus of psychiatry and behavioral sciences, University of California, Davis.

Source: A’ndrea Elyse Messer, Penn State

Results indicate that the establishment of a nightly bedtime routine produced significant reductions in problematic sleep behaviors for infants and toddlers. Improvements were seen in latency and sleep onset and in the number and duration of night wakings. Toddlers were less likely to call out to their parents or get out of their crib/bed during the night. Sleep continuity increased and there was a significant decrease in the number of mothers who rated their child’s sleep as problematic. Maternal mood also significantly improved.

According to the study, sleep problems are one of the most common concerns of parents of young children; approximately 20 to 30 percent of infants and toddlers experience sleep difficulties. Previous studies have found that successful treatment of children’s sleep problems with behavioral interventions also result in improvements in parental well-being.

According to principal investigator, Jodi Mindell, PhD, professor of psychology at Saint Joseph’s University in Philadelphia, PA., creating a bedtime routine is an easy change that can significantly improve both the child’s sleep and the mother’s quality of life.

“There is no question that maternal mood and children’s sleep impact one another. The better a child sleeps and the easier bedtime is, the better a mother’s mood is going to be,” said Mindell. “In addition, a mom who is not feeling tense, depressed, and fatigued is going to be calmer at bedtime, which will help a child settle down to sleep.”

Data were collected from 405 mothers and their infant or toddler,(206 infants between the ages of 7 and 18 months and 199 toddlers between the ages of 18 and 36 months), who then participated in two age-specific three week studies. Families were randomly assigned to a routine or control group. The first week of the study served as a baseline, during which the mothers followed their child’s usual bedtime weeks. During the following two weeks mothers were instructed to conduct a specific bedtime routine, while the control group continued with their child’s normal bedtime procedure.

All children included in the study had a small to severe sleep problem, as identified by the mother. Problems included more than three nightly wakings, awakening for longer than 60 minutes per night, or having a total daily sleep duration of less than nine hours. All mothers completed an expanded version of the Brief Infant Sleep Questionnaire (BRISQ), and provided subjective data concerning their child’s sleep habits.

Parents in the infant routine group were given a three-step bedtime procedure to follow that included a bath, a massage and quiet activities (such as cuddling and singing); lights were to be turned out within 30 minutes of the end of the bath. Mothers then proceeded to put the child to sleep as they normally did, by either putting the child to bed while awake or rocking them to sleep. Thus, the only instituted change was the routine. The toddler group followed the same routine, except that mothers were instructed to apply lotion rather than give the child a massage.

Research shows that daily routines in general lead to predictable and less stressful environments for young children and are related to parenting competence, improved daytime behaviors and lower maternal mental distress.

Authors of the study were surprised by the fact that sleep during the night improved, with a decrease in the number and duration of wakings and improved sleep consolidation. Sleep may have improved because the use of a routine may have decreased arousal level, resulting in improved sleep throughout the night. Inclusion of the bath may also have positively impacted sleep quality, as previous studies have found that a bath before bed helped adults get to sleep by lowering the core body temperature.

According to the researchers involved in the study, primary care practitioners play a critical role in helping families implement positive sleep practices and improving sleep in infants and toddlers.

The results of this study highlight the importance of pediatricians emphasizing the importance and ease of creating a bedtime routine as a preventative measure and treatment option for young children with sleep problems.

This study was supported by Johnson & Johnson Consumer Companies , Inc. Participating families receive payment and products from Johnson & Johnson.

Results indicate that infants born to mothers with depression had significant sleep disturbances compared to low-risk infants; the high-risk group had an hour longer nocturnal sleep latency, shorter sleep episodes and lower sleep efficiency than infants who were born to mothers without depression. Although average sleep time in a 24 hours did not differ by risk group at eight two or four weeks, nocturnal total sleep time was 97 minutes longer in the low-risk group at both recording periods. High-risk infants also had significantly more daytime sleep episodes of a shorter average duration.

Previous studies have found that levels of cortisol, a hormone that is associated with stress, is increased during pregnancy and after delivery in depressed mothers, indicating that the mother’s hormone level may affect the infant’s sleep.

According to the lead author, Roseanne Armitage, PhD, director of the Sleep and Chronophysiology Laboratory at the University Of Michigan Depression Center, while maternal depression does have a negative effect on infants’ sleep, the damage may be reversible.

“We do think that we could develop a behavioral and environmental intervention to improve entrainment of sleep and circadian rhythms in the high risk infants,” said Armitage. “However, whether it is maternal hormones that “cause” the sleep problems in infants is not yet known. It could genetic, hormonal, or both. Regardless of the cause, they may still be modifiable since brain regulation is very plastic and responsive in childhood.”

The study involved 18 healthy full term infants, half of whom were male. Seven infants were born to women with no personal or family history of depression and 11 were born to women diagnosed with depression or with elevated levels of depression symptoms. Five women were experiencing a Major Depressive Disorder (MDD) episode during the beginning of the study.

Infants who were born to mothers who has past or present MDD according to the DSM-IV or who scored high for postnatal depression were placed in a high-risk group for depression; all other infants were considered to be low-risk. Both the mother and infants’ sleep was measured with light and motion sensor actigraphy over the course of seven consecutive days at two-weeks postpartum and monthly thereafter for six months. Mothers were also asked to complete daily sleep/wake diaries. Mothers were recruited during the last trimester of pregnancy through perinatal mood disorders or obstetrics clinics at the University of Michigan.

Authors state that findings of this study claim that future work should attempt to determine if sleep in infancy is modifiable and to define the optimal conditions for entrainment of sleep to the nocturnal period. According to previous studies, untreated infant sleep problems can become chronic, with implications for the mental health and well-being of both the child and the mother. The difficulties of mothers who are already vulnerable to anxiety and depression will be exacerbated if they also are deprived of sleep.