Medicinal products and external applications for sleep disorders in early childhood

Typical Symptoms

Difficulty falling asleep: falling asleep is often only possible with a lot of help from the child’s parents.
Difficulty sleeping through the night: the child falls asleep normally but wakes up soon or frequently and may remain awake for long periods of time.
Indicators of fatigue: restlessness, increased irritability and whining, drowsiness in the normal waking phases.

A sleep journal (1), which records actual times of sleeping, wakefulness, and feeding or being cared for over 24 hours, is the only way to determine the actual time spent sleeping and enables an objective view, since parents perceive their children’s sleep disorders very differently. Because sleeping must be learned by infants and toddlers, it is difficult to give any definition of sleep disorders in the first weeks of life.

See also the short video “Schlafen lernen” (“learning to sleep”) at: https://www.anthromedics.org/PRA-0547-DE  

Causes

To make a differential diagnosis, one should consider the following triggers, especially if the sleep disorder has recently appeared:

Tooth eruption , typical, temporary worsening at night in the middle of the sleeping time, typical age: 6–24 months.

Adenoids and allergies can persistently interfere with sleep, due to blocked nasal breathing. A typical pattern is an open mouth, with a sagging lower jaw.

Food changes and intolerances, especially when introducing cow’s milk or soymilk, particularly during the period of weaning. Symptoms such as stool irregularities, digestive problems and failure to thrive can be associated with it.

Parental stress, fatigue/exhaustion , especially of the mother, parental psychiatric illnesses, such as postpartum depression, and parental conflicts can in some cases severely impair a child’s sleep. In these cases the treatment must be as systemic as possible; it is important to provide effective treatment of parental, especially maternal, exhaustion. For this reason, counselling and, if necessary, treatment of the parents is often the most effective therapy.

Gastroesophageal reflux , the children often have a sour smell in their mouth and show signs of discomfort or pain which clearly increases when lying down.

Rickets, vitamin D deficiency and thus lack of sunlight absorption can trigger sleep disorders with night sweats, usually also associated with increased susceptibility to infections.

Sleeping needs and sleep promotion

The sleeping needs of children vary from child to child. In infancy, the ratio of sleep time to wakeful time is normally about 2:1 at the beginning of life, and reaches about 1:1 by the age of three. Coherent sleep, in which the child goes through several deep sleep phases yet can become more restless and awake in the transitional phases between them, only really develops during the first full year of life.

  • To promote sleep: rhythms, rituals and regular sleep times have proven reliable.
  • Also: reduce noise and light.

Warmth

In the rhythm of sleeping and waking, a child’s individuality releases from and unites with the body’s processes to varying degrees. This is directly reflected in the child’s warmth organization. At night bodily warmth is more concentrated in the outer areas of the body, so appropriate warmth protection – e.g., using blankets or a sleeping sack – is important so that the child does not get too cool. During the day, the warmth centralizes itself and increases in the center of the body. Consequentially, it is important to pay attention to the warmth conditions needed for falling asleep. The process of falling asleep is associated with an increased outflow of warmth from the center to the periphery. This means that children will have difficulty in falling asleep if the periphery (arms and legs, especially the feet!) is cool and cannot get warm on its own, due to either active warmth centralization (which happens during stress) or because of a low body temperature.

Every infant, every toddler is dependent on parental perception and support for help in regulating their body temperature. Since warmth conditions vary greatly from person to person, it is important to train the parents’ perceptive faculties through guidance and questions. Everybody should know that cold feet make it hard to sleep.

  • Parents should perceive their child’s warmth in a differentiated way and, if necessary, use appropriate warmth-regulating measures to promote sleep.

External applications

Evening oil rubs (body and limbs) have a sleep-promoting effect on infants and toddlers. The effect is much more lasting than that of a hot-water bottle, which can be problematic at this age (for several reasons, such as safety, risk of burns). Hot-water bottles should preferably be used to preheat the bed. Carrier oils in early infancy can also prevent eczema. When selecting oils for premature and newborn babies, one will be cautious about the addition of essential oils and, if possible, use just carrier oils, whose effects have been described in detail by Natalie Hurst (see also https://www.anthromedics.org/PRA-0861-EN ):

  • For infants after premature birth, or for children who appear to be sensitive or injured:
    Almond oil

  • Warming, analgesic, and to promote the regeneration of the skin:
    Olive oil
    For infants, we can dilute commercially available therapeutically effective oils, such as those made by WALA and WELEDA, with a carrier oil to a concentration with a ratio of 1:10–1:2. For toddlers and children of kindergarten age, undiluted use is most often recommended.

  • Lavender oil has a calming, releasing, sleep-stimulating effect as
    Lavandula, Oleum aeth. 10% WALA/WELEDA
    For infants, use 1–5%. It is very suitable for chest rubs and compresses in case of dry cough and pseudocroup (stenosing laryngitis).

  • An even stronger enveloping treatment, e.g., with peat extract, is suitable, e.g., for small children with chronic illness, in hospital or in stressful situations:
    Solum oil WALA

  • A particularly warming oil composition for toddlers and kindergarten aged children is
    Mallow oil WALA
    which can be used especially in the cold season on the extremities or as a whole-body rub. In rare cases, skin irritation may occur, if this happens then dilute or change to a different oil as necessary.

  • After shock or trauma, in cases of sensitivity to pain, or a tendency to colic, wood sorrel oil extract (also available as an ointment) is suitable for infants and small children:
    Oxalis oil WALA, or Oxalis, Folium 10% ointment WELEDA

The application of moist warmth, especially on the feet, can have a very calming and sleep-promoting effect on early childhood sleep disorders.

  • For children of kindergarten age, a warm evening footbath of approx. 8–10 minutes can have a warming and calming effect, e.g., with:
    Lavender Relaxing Bath Milk WELEDA (also available as Lavendel Entspannungsbad)

  • When a child is tired, yet resists sleep, and has a sweaty head:
    “Milk socks” have proven themselves for children 1-year-old and older.
    This treatment directs the child’s body warmth gently towards the periphery. The drying of the milk on the skin causes a slight contraction. A pair of wool socks (sheep’s wool) and approx. 100 ml of warm whole milk are needed. 
    Instructions: Place a terrycloth hand towel underneath to protect the bed, soak the wool socks in warm milk (40°C or 104°F), wring them out well and then pull them over the feet and calves all the way up to the knees. Leave the socks on overnight. Usually they are dry in the morning. (They can be washed out with a little wool detergent).

  • Not all children tolerate wool on the skin, but we should keep in mind that wool’s unique warmth and moisture-regulating, dirt-repellent properties are particularly ideal at this age:
    A wool sleepsuit can make a noticeable contribution to warmth stabilization and thus also to a child’s sleep. Individually correct body clothing, preferably made of wool, and appropriate blankets or a sleeping sack can be effective sleeping aids.

Light and dark

Parental counselling and pedagogical measures are rightly currently being given priority over the use of drugs in the treatment of childhood sleep disorders; specialist literature on child and adolescent psychiatry warns against allopathic sleeping pills. In our opinion, the use of the “sleep hormone” melatonin should be very cautious and limited to specific disorders (2). Infants generally have the highest nocturnal melatonin levels in their blood, whereby darkness always plays an important role in melatonin secretion. Noise and light pollution have been shown to disturb sleep. The same applies to the light from screens (television, smartphone, PC), to which babies are often exposed. Such light has an unfavorable influence on falling asleep and on the depth of sleep.
In contrast, sunlight during the day stimulates a proper sleep-wake rhythm, so that active play in the open air is an essential prerequisite for a good night’s sleep.

Nature-based medicinal products of Anthroposophic Medicine

The medications listed below are derived from medicinal plants and other natural substances (e.g., oyster shell calcium carbonate). They have no serious side effects and do not interfere with child development or daytime alertness. On the contrary, working to stabilize a child’s sleep has a beneficial effect on mental and physical development.

  • For “thin-skinned” children who are hypersensitive to sense impressions, easily excitable and anxious. At night, there can be conspicuous thirst as a sign of mental overactivity, as well as frequent sweating on hands and feet:
    Bryophyllum Argento cultum Rh D3 WELEDA (aqueous, alcohol-free solution)
    5–10 drops 1–3x/d, especially given before bed and as needed during the night
    This preparation is a diluted plant extract of Bryophyllum, a stonecrop plant originally native to the dry regions of Madagascar. To counter the threat of dehydration in the daytime heat, Bryophyllum shifts its carbon assimilation processes into the night and then opens the stomata of its leaves, which it closes during the day. The plant is thus able to reverse the normal day-night rhythm of a plant. Pharmaceutically, Bryophyllum plants are treated with a fertilizer containing silver. The plant absorbs traces of the silver and livingly organizes, “potentizes” it. The medicinal product is made from these specially pre-treated plants. This medication affects the child’s life organization in such a way that it regulates and stabilizes the rhythm of the child’s metabolic activities and has a calming effect on the vegetative nervous system. It can be very helpful for toddlers who have been exposed to severe stress in utero, at birth, or after birth, which may also be the case with Caesarean delivery.

  • A widely applicable medication for childhood problems with falling asleep and sleeping through the night is:
    Valeriana comp. pill. WALA, 3–7 pill. in the evening, repeat during the night if needed.
    In addition to the well-known solubilizing effect of valerian root, this product contains potentized extracts of oyster shell calcium carbonate, phosphorus and sulfur, which promote falling asleep and sleeping through the night.

  • For difficulty in falling asleep and for nervous agitation in children:
    Passiflora comp. pill. WALA, 5 pill. in the evening
    Suppositories for children WALA (available as Kinderzäpfchen WALA), 1 suppository in the evening
    This compound contains extracts of oats, passion flowers, hops and valerian root that have been rhythmically treated with light and warmth.

  • Potentized oyster shell calcium carbonate is suitable for small children with sleep disorders, who tend to frequent colds and catarrhs, adenoids, tonsils enlargement; who sweat considerably when falling asleep; who tend to fears, or react to media or exciting stories with disturbed sleep:
    Conchae D6 trit. WELEDA, 1 saltsp. (~¼ tsp.) powder 1–3x/d before meals, especially in the evening.

  • In contrast, potentized belladonna preparations are particularly suitable for difficulty in sleeping through the night. They have a calming effect on children who wake up after the first deep sleep phase, sometimes startle violently (pavor nocturnus) without waking up completely and tend to have sweaty heads and cool hands and feet:
    Atropa Belladonna ex herba D 10 pill. WALA, 5 pill. in the evening

  • During the teething phase, chamomile root extracts can help a baby sleep through the night:
    Belladonna/Chamomilla pill. WALA, if needed 3–5 pill. several times daily
    or
  • Fever and teething suppositories WELEDA (available as Fieber- und Zahnungszäpfchen), 1 suppository in the evening

  • Sleep disturbances after acute shock or shock experiences (e.g., accident) can be well treated with potentized extracts of aconite root tubers:
    Aconitum e tub. D 20 pill. WALA, 5 pill. in the evening

1 Example of a sleep journal chart for children, available in German at kindergesundheit-info.de:https://www.kindergesundheit-info.de/fileadmin/user_upload/kindergesundheit-info.de/Download/Schlafen/Schlafprotokoll-BZgA_kindergesundheit-info.pdf (12.4.2019).

2 Hunkeler P. Melatonin bei kindlichen Schlafstörungen. Paediatrica 2013;24(4):17–19.


Glöckler M, Michael K, Goebel W. Kindersprechstunde. Ein medizinisch-pädagogischer Ratgeber. 21. Aufl. Stuttgart: Urachhaus; 2018, Kap. Beachtung und Pflege der Rhythmen.

Soldner G, Stellmann HM. Individuelle Pädiatrie. Leibliche, seelische und geistige Aspekte in Diagnostik und Beratung. 5. Aufl. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 2018, Kap. 7.1.

Soldner G, Vagedes J. Das Kindergesundheitsbuch. 7. Aufl. München: Gräfe & Unzer;. 2018