[Getting the child to sleep: critical review of 12 years of experience]

Childhood insomnia due to disorderly habits affects 30 % of children between the ages of 6 months and 5 years. It is characterized by difficulty in falling asleep and multiple nocturnal wakenings. The problem is caused by lack of synchronization of the circadian rhythm due to irregularity of the endogenous sleep-waking rhythm. This irregularity is due to the incorrect application of zeitgebers (internal and external synchronizers) regulating this rhythm. This leads to deficient acquisition of sleep habits and persistent disordered rhythm with difficulty in getting to sleep and multiple nocturnal wakenings. In our book "Duérmete Niño", we recommend a method that consists of maintaining external synchronizers or periodic environmental conditions constant until the same sleep-waking circadian rhythm as that of the environment has been achieved. This method has been used in more than 300,000 children in Europe (Spain, Italy, Denmark, Portugal, Poland and Hungary) and America (United States, Argentina, Mexico, Brasil, Chile, Colombia and Uruguay). Based on our direct clinical experience and the communications received, we believe that the application of this method has resolved many cases of childhood insomnia. There are, however, limitations. The two most important ones are the difficulty of understanding the method and the inability of some parents to put the suggested measures into practice. Another undoubted limitation involves describing treatment for a patient without personal contact. All children are different but so too are all parents and it is the parents who have to apply the method. The pediatrician should have the last word on the need to apply our method, bearing in mind its proven advantages but also its limitations.