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Sleeplessness, Night Awakening, and Night Crying in the Infant and Toddler

1. Although nighttime awakenings are common in the second half year and beyond, this is not a developmental necessity; rather, most normal infants gain the capacity to "sleep through the night" by 6 months of age.

2. There is not a single cause of (or a single treatment for) nighttime awakenings and crying; many factors may be responsible, and these must be identified and individually treated if there is to be resolution.

3. What are often perceived as abnormal awakenings are really only the normal awakenings associated with normal sleep stage cycling, and, parents' "treatment" of these awakenings with interventions, such as rocking or feeding, only make it more difficult for the child to go back to sleep without them after subsequent awakenings.

4. No evaluation of a sleepless child is complete without a thorough understanding of the child's daily schedule. The child's sleep schedule may be consistent and his sleep normal, and only the timing may be shifted from that desired by the parents. The bedtime difficulties or early morning awakenings generated in this setting may be handled inappropriately by the family, creating even more complicated problems. Or, the schedule may be irregular, sleep/wake rhythms may not adjust, and any of a variety of apparent sleep disorders may appear.

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