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Sleep disturbances are extremely common among international adoptees, especially in the first few months after adoption. Children often display anxiety at bed or nap times. Nightmares, "daymares" (during naps), and night terrors are common among this group of children, but these usually subside over the first few weeks after adoption. Most children have never been alone in a bed and definitely not alone in a room. The American custom of placing children in their own rooms to sleep may be frightening. Some children (notably those from Korea and Cambodia) have become accustomed to sleeping with caregivers and are inconsolable when expected to sleep alone. Some children awake crying and become alarmed when their parents arrive to comfort them -- some parents have felt the children were expecting someone else (a previous caregiver, for example) -- and are disoriented to find someone else responding to them. For some children, sleep states seem to be associated with grieving for lost caregivers; some children cry sadly and deeply when going to sleep or awakening.

Psychological processing of the immense changes in the child's life may manifest as sleep disturbances, although this is difficult to prove. Parents must recognize that insecurity and anxiety underlie most of these "early-onset" sleep disturbances among internationally adopted children. This is in contrast to manipulative behaviors related to sleep and bedtime that sometimes develop in young children. Management of these sleep problems requires specific attention to the underlying psychological issues. Many parents find that co-sleeping for the first few weeks or months after adoption greatly reduces the child's anxiety. Transition to more conventional sleep arrangements is easily accomplished when bonding to the family is more firmly established. Repeated expressions of love and provision of needed attention and security are key methods to manage sleep problems in newly adopted children.


From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.


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