What Are the Differences Between Bipolar in Children and Bipolar in Adults?

In the past five to ten years, bipolar disorder has been identified in more and more children. Up to 5% of American children suffer from bipolar disorder.

Bipolar disorder is a mood disorder that affects 2.6% of American adults–about 5.7 million people–according to the National Institute of Mental Health. The disease is characterized by mood episodes: “highs” called mania and “lows” known as depression.

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A picture of four white toddlers seated next to each other. Credit to flickr.com user rjp. Used with permission under a Creative Commons licen

In past posts, I’ve looked at how bipolar disorder specifically manifests in women, how men and women have different brain biomarkers, and how the illness shows up in children. But what are the differences between bipolar disorder in children and bipolar disorder in adults?

Let’s dig in.

Symptoms of Mania and Depression in Children and Adults: A Side-by-side Comparison

Check out the following chart to see a side-by-side comparison of symptoms of bipolar disorder in children and adults:

Adults Children
Depression
  • Sad, empty, or hopeless feelings
  • Anhedonia – Loss of interest in pleasurable activities
  • Insomnia or sleeping too much
  • Fatigue, loss of energy
  • Weight gain or loss
  • Feelings of worthlessness
  • Guilt
  • Inability to concentrate
  • Thinking about, planning, or attempting suicide
  • Sad, empty, or hopeless feelings
  • Anhedonia – Loss of interest in pleasurable activities
  • Insomnia or sleeping too much
  • Irritability
  • Failure to gain weight
  • Change in grades, getting into trouble at school, or refusing to go to school
  • Frequent crying
  • Withdrawing from friends
  • Acting out suicide in play
Mania
  • Excitement, or abnormal cheerfulness
  • Decreased need for sleep
  • Euphoria, exaggerated self-confidence
  • Increased energy
  • Pressured speech
  • Racing thoughts
  • Distractability
  • Hypersexuality
  • Spending sprees and other poor decisions
  • Irritability
  • Decreased need for sleep
  • Silliness or excessive goofiness
  • Grandiosity, including statements about superpowers
  • Distractability
  • Hypersexuality
  • Aggression

These symptoms are similar, but the way they manifest is different for children than adults. For example, during both manic and depressive phases, children are much more likely to be irritable and aggressive.

Let’s take a detailed look.

First Symptoms

Childhood-onset usually refers to children who develop bipolar disorder at age 12 or younger. The first signs of bipolar disorder in adults are usually manic or hypomanic episodes. But in children, depression is often the first indication that anything is wrong. Studies show that up to 30% of children who suffer from clinical depression will develop manic symptoms later in life, which can lead to a diagnosis of bipolar disorder. For a more detailed overview of what depression looks like in children, even toddlers, click here.

Pattern of the Disorder

The most striking difference between childhood-onset and adult-onset bipolar disorder is the patterns of the illness. Adults generally vacillate between defined episodes of mania and depression that last weeks or months. They can also have periods of wellness that last from months to years in between.

Kids are the opposite: they experience prolonged periods of rapid cycling, which means they bounce between mania and depression daily, if not multiple times per day. And there are no periods of respite in children with bipolar disorder; they are always suffering from a mood episode.

One study of pediatric bipolar patients examined children with bipolar disorder who suffered more than one hundred mood episodes over a short period of time. The manic periods were called “mini-manias.” According to the study, none of the patients under 9 years old endured a single mood episode lasting two weeks or more. Short, frequent episodes was the way the illness presented in the children.

Genetic Predisposition

Kids who end up with bipolar disorder were usually genetically predisposed to develop the disease. One of the many causes of bipolar disorder can be family history of the illness, though sometimes the disease can occur without any history present. But, in the case of children who develop the disorder, there are typically more family members with bipolar in their lives than those children without the disorder. The kids are also much more likely to have relatives–such as parents, aunts and uncles, and grandparents–on both sides with the disorder.

Adults who develop bipolar disorder may or may not be genetically predisposed. Genetic loading is less common in adults than children. If the adults are predisposed, the disease may or may not be more severe. It’s a lottery.

Difficult Time Adjusting

Pediatric bipolar disorder presents unique difficulties compared to the adult-onset form of the disease. Kids are still developing mentally and physically, so when they suffer from the rapid cycling moods of bipolar disorder, life can become very difficult. These children are establishing their identities, and enduring vacillating episodes of bipolar disorder makes that very hard.

Adults usually have their identities established, or at the very least, are set in their ways, so figuring themselves out is not as much of a struggle. Adults are also more emotionally mature than children, and can better handle shifts in mood.

Chronic Irritability and Mixed States

Instead of the euphoric highs of mania typically experienced by adults, kids are much more likely to suffer chronic irritability, a state where they are grouchy all of the time. This is because children tend to suffer from mixed states, where they endure extreme episodes of mania and depression at the same time. Treating mixed states can be very difficult. Even lithium, the gold standard medication that is used to treat bipolar disorder, is often ineffective at handling mixed states. Lithium is able to treat both depression and mania in bipolar patients, but it’s totally ineffective at handling mixed states.

Adults can also suffer from mixed states, but children are much more likely to experience them.

Difficulty Diagnosing

Often, childhood-onset bipolar disorder is missed or inaccurately diagnosed until the kid becomes an adult. Children are also more prone than adults to conditions that occur at the same time, such as attention deficit hyperactivity disorder (ADHD), learning disabilities, or anxiety disorders, which can make accurately diagnosing bipolar disorder difficult. If you weren’t diagnosed with bipolar disorder until adulthood, but suspect you have had it since you were a child, this information may help you sort out your own childhood.

The Bottom Line

If your child suffers from two or more of bipolar disorder symptoms, call your pediatrician to get a referral to a pediatric psychologist. Refer to the symptom chart to present daily examples of bipolar disorder symptoms to the doctors. Anhedonia is especially important to note, as it’s not typical of most healthy children. If you have a family history of bipolar disorder, make sure to bring that up.

When children with bipolar disorder grow up, their diseases are worse than people who suffer from an adult-onset version of the illness. The mood episodes are more intense in childhood. But early therapy and other interventions can help your child deal with their condition. The earlier a treatment team can intervene, the better.

Related:

How to Spot Depression in Children, Even Preschoolers

Trigger Warning: Brief discussion of suicidal ideation.

Preschool depression is often overlooked, because the symptoms are difficult to spot or may be explained away by hopeful parents and teachers. Depression in adults is widely known, but can preschoolers suffer clinical depression? Science says they can.

Scientists began studying depression in preschoolers 20 years ago, and the research continues today. According to the conclusion of a new study led by Dr. Joan Luby of the Washington University School of Medicine in St. Louis, preschoolers suffer depression. Luby’s team examined 306 children ranging from 3 to 6 years old. This study demonstrated that 23% of the 3-year-olds endured depressive symptoms every day for two consecutive weeks. As the age of the child increased, the rate of major depressive disorder diagnoses also increased. The 4-year-olds suffered depressive symptoms at a rate of 36%, while the 5-year-olds showed a rate of 41%. The children who had suffered extremely stressful or traumatic events in their lives also had a higher incidence of depression than the controls.

Preschoolers generally can’t describe their emotional states. They’re still learning what emotions are and they lack the ability to vocalize them. This is the difficulty in diagnosing depression in preschoolers, and why you may need help spotting it. In order to allow the study participants to express how they perceive themselves and get a sense of what young children were feeling, Dr. Luby’s team asked a series of questions using puppets. How the children responded gave the researchers a clue about how the kids were feeling.

Further complicating the picture is the prevalence of other conditions along with depression, like Attention Deficit Hyperactivity Disorder (ADHD). In Dr. Luby’s study, about 40% of the study participants also dealt with ADHD, which tends to drown out symptoms of depression, because the symptoms are similar. This can even persist later in life. Children who suffer depression are more than four times as likely to suffer an anxiety disorder later in life than kids who don’t suffer depressive symptoms.

preschooler
A preschool-aged boy in blue hoodie sprawling on a parent’s lap. Credit to flickr.com user Quinn Dombrowski. Used with permission under a Creative Commons license.

But what does depression look like in a 3-to-6-year-old?How can you, as a parent, spot it? Well, depression in children looks a lot like depression in adults. For example, anhedonia, the inability to experience pleasure from normally enjoyable activities, can show up in adults as a lack of enjoyment in things like golfing or writing. Preschoolers with anhedonia find little to no joy in their toys. Both adults and children with depression are restless and irritable. Depressed kids whine a lot, and don’t want to play.

When they do play, children may decide that their stuffed animals decided to “die” today and decide to bury them. Anytime you see a preschooler demonstrate methods of suicide or death with a stuffed animal without mimicking an episode of your life, such as a death in the family, your antennae need to come up. That could indicate suicidal thoughts.

But the most common symptom of depression in children is deep sadness. Not someone who’s sad for a day, but all the time, no matter who he or see is with or what he or she is doing. Sadness in the face of goals that have been thwarted is normal. But depressed children have difficulties resolving the sadness to the point where the misery affects their ability to function regularly. If your child appears to be sad to the point of inability to enjoy anything or regulate their other emotions, then get a recommendation from your pediatrician for a child psychologist or a behavioral therapist.

Other notable symptoms of childhood depression are an exaggerated sense of guilt, shame, and insecurity. Depressed preschoolers generally feel that if they do a naughty thing or disobey, that means they are inherently bad people.

Here’s a breakdown of the symptoms of depression in children of any age, including preschoolers:

  • Deep and persistent sadness
  • Irritability or anger
  • Difficulty sleeping or focusing
  • Refusing to go to school and getting into trouble
  • Change in eating habits
  • Crying spells
  • Withdrawing from friends and toys
  • Fatigue
  • Anhedonia – inability to derive pleasure from enjoyable activities, like playing with toys
  • Whining
  • Low self-esteem and insecurity
  • Shame and guilt
  • Timidity

Preschoolers may be especially vulnerable to depression’s consequences. Young children are sensitive to emotions, but lack the ability to process strong feelings. Early negative experiences–including separation from a caregiver, abuse, and neglect–affect physical health, not just mental. Multiple studies have linked childhood depression to later depression in adulthood.

This is why properly diagnosing and treating these children early is so vital. One established intervention for treating childhood depression is called Parent-Child Interaction Therapy, or PCIT. Originally developed in the 1970s to treat violent or aggressive behaviors in preschoolers, PCIT is a program where, under the supervision of a trained therapist, caregivers are taught to encourage their children to manage their emotions and stress. The program typically lasts from 10 to 16 weeks.

The Bottom Line

Dr. Luby’s research is met with resistance. Laypeople typically think the idea of preschoolers suffering depression ridiculous, and even some doctors and scientists don’t believe children are cognitively advanced enough to suffer from depression. Preschool depression remains a controversial topic, which makes it harder to diagnose in your child.

But depression in children 6 years and older has been well established by decades of data. Is it really so hard to think that preschoolers might suffer depression as well? Dr. Luby and her team have been looking at the data for 20 years, and have concluded that preschoolers can suffer depression, just like older children and adults.

Admitting that your child is depressed may make you feel like you’re a failure. After all, if you can’t protect your children from depression, who can? But clinical depression is chemical. This is not your fault. You may have been told that depression doesn’t exist in preschoolers, or that you’re overreacting. You may be called a helicopter or hovering parent. But trust your instincts. You know your child better than anyone else. Don’t be afraid to go against stigma for your child’s benefit.

Up to 84,000 of America’s 6 million preschoolers may be clinically depressed. If your child is one of them, you are not alone. There is no shame to depression. The condition is not your child’s fault, just as in adults. No parent likes to see her child suffer, and getting help for depressed children is vital to their well-being.

If your child suffers depressive symptoms, especially anhedonia, ask your pediatrician for a recommendation for a behavioral therapist or child psychologist. Typically, the earlier the intervention, the more successful the results.

Good luck.

Related:

 

Children with Bipolar Disorder May Be Diagnosed with Vitamin D Blood Test In the Future

blood test
Credit to flickr.com user CEHURD CEHURD. Used with permission under a Creative Commons license.

Researchers at Ohio State University are searching for a way to and quickly and accurately test for bipolar disorder in children. The scientists think they may have found it: a blood test which looks for a protein associated with vitamin D.

 

Finding a blood test could reduce the current average diagnosis time of ten years, said Ouliana Ziouzenkova, the study’s lead author and an associate professor of human nutrition at Ohio State.

In the study of 36 young people, levels of the vitamin D binding protein were 36 percent higher in those with bipolar disorder than in those without a mood disorder. The study appears online in the journal Translational Psychiatry.

Ziouzenkova said it made sense to look at vitamin D binding protein because it potentially plays a role in brain inflammation. The researchers also looked at inflammatory markers in the blood, but found no significant correlations. Looking for the nutrient vitamin D in the blood, as opposed to the binding protein, appears to have low diagnostic power, she said.

Confirming that the blood test works will take time, but Ziouzenkova and her colleagues are excited about the potential to help kids and their parents.

Materials provided by Ohio State University.

Children at High Risk for Bipolar Disorder Genetically Vulnerable to Stress

children
Credit to flickr.com user tanitta. Used with permission under a Creative Commons license.

Genetic alterations that regulate stress have been found in children at high risk for bipolar disorder, according to research done by scientists at The University of Texas Health Science Center at Houston (UTHealth). The study was published in Translational Psychiatry, a Nature Publishing Group journal.

 

Researchers have long known that children who experience stressors in their lives are more likely to develop bipolar disorder. Parents with bipolar may struggle with their disorders, thus placing stress on their children. But this study shows that children at a high risk for developing bipolar–due to having family members with a history of psychiatric illness–are genetically vulnerable to stress.

The scientists at UTHealth took blood samples from eighteen children, consisting of a set of bipolar patients, a set of apparently neurotypical patients with bipolar parents, and a set of neurotypical controls with parents that have no history of mental illness. The blood samples revealed that, compared with the control group, bipolar children and unaffected kids with bipolar parents have genetic alterations that regulate the response to stress.

So, children with bipolar parents are more vulnerable to stress, and when stressed, tend to develop the disorder. This may sound like bad news all around, but there is a positive approach to this study. Future research may reveal the effects of reducing stress, as well as whether medication might be able to reverse the genetic alterations in children before bipolar disorder matures.

What to do if Your Child has Bipolar Disorder

So you’ve discussed your child’s symptoms with a pediatric mental health specialist, and have a diagnosis of bipolar disorder. What now? Thankfully, there are some suggestions you can take, and taking care of your child with bipolar disorder is similar to taking care of an adult with the disorder.

1. Pay attention to medications and therapy appointments

As a parent, you are responsible for making sure your child follows their treatment plan. Use whatever reminders you can to remember to give him or her the medication that he or she needs.  If your child must take their pills at school, then open a line of communication with his or her teachers and school nurse. Appointments with his or her therapist are also important. Make sure your child attends their appointments

children2
Credit to flickr.com user Cristyan González Alfonso. Used with permission under a Creative Commons license.

2. Monitor side effects

Some side effects of atypical antipsychotics, like weight gain and blood sugar changes, are awful in adults–and children do seem to be more prone to them. These drugs were originally formulated for adults, and few have been tested on kids. Ask your child’s psychiatrist what side effects you need to keep an eye on.

3. Work out agreements with your child’s teachers

Some children with bipolar disorder need more help at school, such as more breaks during manic episodes, or less homework. During especially bad episodes, your child may need to be removed from school until he or she stabilizes. Talk to your child’s teachers. Keeping an open line of communication is the best way to ensure your child has success at school.

4. Keep a schedule

Try to be consistent with mealtimes and bedtimes, as well as waking your child up at the same time every day. This will help keep stress in the home to a minimum. Try to be patient with your child as they adjust to new routines.

5. Go to family therapy, if needed

Taking care of a child with bipolar disorder may put a lot of stress on the family as a whole. Your marriage might suffer, and the child’s siblings might be jealous of all the attention he or she gets. Attending therapy as a family may help you handle these issues.

6. Don’t ignore threats of suicide

Suicide threats are extremely serious, even in young children who may not understand what it means. Talk to your children, and if they do have suicidal ideation, give them a safe environment. Remove all the weapons or pills from the house. And talk with their mental health specialists. Crisis lines are always open.

7. Communicate with your teenager

Teenagers may become irritated or resentful if they feel that you’re compelling them to be treated. Talk to them about why you’re giving them medication and taking them to therapy appointments. Educate your kids about their mental illness. Also, it’s important that your teenager avoid substance abuse, as the risks of developing a problem are much higher in teens with bipolar disorder. Alcohol and drugs can interact with medications poorly and worsen mood episodes, so it’s important that your teenager be made aware of the risks.

All in all, taking care of your child with bipolar disorder requires an extra level of parenting. But you can do it. There are steps you can take to help you.

Bipolar Disorder in Children

Bipolar disorder affects people of all ages, including children as young as six. The disorder has periods of elevated mood, called mania, as well as periods of depression.

Common symptoms in children are:

  • Mood swings ranging from depression to irritability to elation, sometimes up to several times a day
  • Racing thoughts (while manic)
  • Hyperactive or aggressive behavior
  • Casual sex or spending sprees that are out of character
  • Decreased need for sleep
  • Inflated ego
  • Suicidal ideation in older children
  • Separation anxiety
  • Carbohydrate cravings
  • Difficulty waking in the mornings
  • Oversensitivity to emotional situations
  • Bed-wetting (especially in boys)
  • Obsession with gore or other socially inappropriate topics
  • Night terrors

 

children
Credit to flickr.com user Vladimir Pustovit. Used with permission under a Creative Commons license.

Symptoms in children look slightly different than those of adults. Children can be more irritable than adults during a manic phase, with less elevated mood, and are more likely to experience psychotic features, such as auditory hallucinations. As for depression, children are more likely to complain about physical pain. Between episodes, kids return to their normal mood. Something of note is that they cycle between these episodes several times a day, as opposed to weeks or months.

Some experts believe the disorder is rare and thus over-diagnosed; others believe the opposite, so there’s little agreement. It’s also difficult to diagnose the disorder in children, because symptoms can overlap with other diagnoses like conduct disorders or Attention Hyperactivity Deficit Disorder (ADHD)–which can occur in conjunction with bipolar disorder, making an accurate diagnosis even more tricky.

So, if you suspect your child has bipolar disorder, please speak with a mental health professional specializing in disorders in children. Ask your pediatrician for recommendations.

Stay tuned for next week’s post: What to do if Your Child has Bipolar Disorder.

How to Talk To Your Kids About Mental Illness

“Mom, are you crazy?” my eight-year-old son, Ryan, asked after reading over my shoulder while I worked on my book. My memoir, Committed, is about my stay in a mental hospital one week after Nolan’s birth, and the page he read demonstrated a particularly erratic behavior from me.

talking.jpg
Credit to flickr.com user Evan Long. Used with permission under a Creative Commons license.

“No, honey,” I said. My heart sank. I was not ready to have this conversation yet, but Ryan’s question made me think otherwise. “I do have bipolar disorder, which is a mental illness.”

“What’s bipolar disorder?” he said.

“Bipolar disorder is when I sometimes feel depressed–like nothing in the world matters anymore,” I said, patting him on the arm. “But it also means I feel super energetic sometimes, and can’t control myself very well.”

“Will I get it?” he said, his eyes widening.

“I don’t know,” I said. “You might. It comes when you’re a teenager or young adult. But there are medications available to help manage it, so don’t worry.”

“Oh,” he said, giving me a hug. “I’m sorry you have bipolar disorder, Mama.”

And that was that.  The dreaded conversation–the start of many–was over.

Arming your kids with age-appropriate information about your mental illness can help them feel secure. If you talk to them about your disorder, they will know what to expect when you have a down–or up–day. They’ll also learn to separate you from your illness, and from any negative feelings that might occur. If you don’t talk to then, they’ll invariably draw their own conclusions, which can make them feel unsure about you and their position in the world.

Here are some tips for talking about mental illness with your kids.

1. Keep it Simple

Children only need to know the basics of mental illness: it’s not contagious, they are not destined to have a disorder, there are treatments available, etc. Another important factor that goes into talking about mental disorders with your kids is stressing that it’s not their fault. They can’t make their parent better, nor should they try. They can only support their mother 0r father by checking in on them, watching movies with them, and generally being their awesome selves.

2. Reassure Them

Explain to your children if they ask that they might get your disorder, but reassure them that there are treatments available and that you’re getting help yourself, if you are. Tell your kids that you still love them, and no amount of mental illness will change that.

3. Know Your Child’s Maturity Level

All kids are different, and mature at different rates. Preschoolers will only want very basic information about why you’re sad. Preteens will want more information, so give them as much as you think they can handle. Teenagers will often turn to their friends when seeking information about things that bother them, so make sure they’re well-informed.

4. Address Their Fears

Ask your children if they have any worries now that you’ve brought up the topic. Reassure them that their needs will be met and that you’re not going anywhere. Repeat information if they appear confused. It may be helpful to bring their fears up with a mental health professional, so you can make a plan to address them.

5. Make Yourself Available

Make sure you don’t end the conversation there. Children will have questions as they grow, and it’s important that you be available to answer them. Explain to your kids that they are always welcome to ask questions of you about this topic.

Talking with your kids about mental illness can be tough. But if you’re open to it, they’ll appreciate your candor and feel more secure knowing what’s going on with their parent.

Pregnant While Bipolar

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Photo by Nuno Ibra Remane. Used with permission under a Creative Commons License.

Going through pregnancy while bipolar is tricky. Bipolar disorder symptoms can worsen during pregnancy. According to WebMD, “Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions compared to pregnant women who do not have bipolar disorder.” As I’ve stated before, depression can lead to low birth weight in newborns, and stopping medications abruptly can harm both the bipolar sufferer and their unborn child. Manic episodes can contribute to poor decision making, such as smoking cigarettes or drinking while pregnant. And there are several medications which treat bipolar which can harm infants both in utero and while breastfeeding, contributing to neural tube defects as well as others.

People with bipolar disorder who wish to become pregnant need to closely monitor their health, even more so than people without mental illnesses. Especially because there is a clear link between bipolar disorder and post-partum psychosis.

Thankfully, there are steps you can take. There exists medication that can be safely taken during pregnancy which treat depressive and manic episodes. Lithium needs to be closely monitored, as it can cause a rare heart defect in the first three months of pregnancy for about 1 in 2000 births. Talk therapy poses no risk to the baby. Added structure during the day can contribute to good sleep habits, which can be disrupted during pregnancy. Sleep is a serious factor in whether a bipolar sufferer will succumb to a mood episode, so it’s important that a pregnant woman gets enough. Exercise, which is crucial in maintaining good mental health, will aid a pregnant woman in controlling her moods.

If you are planning a pregnancy, talk to your obstetrician and psychiatrist to make a comprehensive plan. Your treatment team will help you. Good luck!

Executive Dysfunction and Bipolar Disorder

students
Credit to flickr.com user Jeff Peterson. Used with permission under a Creative Commons license.

Do you constantly abandon projects and leave messes around the house, such as unfinished crafts or dirty dishes? If you have bipolar disorder, you may be suffering from executive dysfunction. Executive dysfunction is used interchangeably with a lack of cognitive control, and is the inability to set and meet goals and to self-monitor.

When people’s brains work without dysfunction, they can analyze tasks and create timelines in which to complete them. People with executive dysfunction stemming from bipolar disorder, however, are often overwhelmed because they can’t break tasks into steps. Judging from the chaos around the house and the missed doctor’s appointments, people might sometimes blame laziness. But executive dysfunction isn’t laziness; it’s a symptom of a broken brain.

In individuals with bipolar disorder, executive dysfunction appears most prominently during in the manic phase. Racing thoughts, a hallmark of bipolar, tend to interfere with recall and thought organization. The manic person might also have trouble prioritizing important details. Everything is perceived to be important. And for sufferers of bipolar disorder with a history of psychosis, managing executive functioning is even more difficult because their brains are wired differently.

Symptoms of executive dysfunction manifest in children similarly to adults. For example, children often don’t know when they’ve overstayed a welcome at a friend’s house, while adults sometimes can’t function at the workplace due to an inability to read social cues. Children usually can’t follow instructions, and may change to a new task before completing the first one. Adults are frequently late and misplace possessions. If you have trouble remembering the names of people you’ve known for years, you might be suffering from executive dysfunction.

The good news is that executive dysfunction can be managed with ideas like these:

• Consciously break projects up into steps.
• Use time management tools such as colorful calendars and stopwatches.
• Schedule repeating reminders on your computer, using sites like Remember the Milk.
• Set goals in advance to coincide with ingrained habits, such as flossing your teeth right after brushing.

With tips like these, executive dysfunction can be coped with. Many people with bipolar disorder learn to successfully deal with their executive dysfunction.

How to Get Your Much-Needed Forty Winks

As everyone knows, hitting the sack is crucial for mental health. Sleep deprivation—a form of German torture in World War II—worsens depression and directly contributes to manic episodes. After a few days of working double-shifts, even neurotypical people start to hallucinate.

It is for these reasons that the recommendation for daily sleep is an eight hour period, give or take. All right, parents of newborns, say it with me: “Hahahaha! Yeah, right!”

Whew. Now that we’ve gotten that out of our systems, let’s discuss how we can get as much sleep as we can so our mental health isn’t compromised.

In short, do what works best for you. A crib in the room, a crib out of the room, or a playpen somewhere nearby—all of these choices are good ones. I know one mother who slept in a recliner for several years. Just make sure to cover your newborn with a light blanket, and introduce heavier ones more cautiously. Before bed, you can gently massage your child, and then feed them as much as they’ll take. If you have a partner, set a time to discuss who covers which blocks of baby care.

When my son, Ryan, was an infant, I co-slept with him to make nighttime breastfeeding easier—despite his having a beautiful, untouched crib in the next room. I was lucky that he enjoyed feeding while reclined, so I didn’t have to leave my bed, and was even able to doze. These snatches of sleep helped me regain my sanity during his first two years.

Studies demonstrate a causal link between bed-sharing and the prevention of sudden infant death syndrome (SIDS). Children who slept with their mothers also appear to have a higher self-esteem, possibly because the infant’s signs of distress were more quickly addressed due to the parent’s proximity.

If you’re interested in trying co-sleeping, please take safety precautions. According to research, most fatalities are due to alcohol, cigarette smoke, soft mattresses, or heavy bedding. Older children may also endanger a newborn that they cannot sense while asleep.

Speaking of older children… Kids thrive in a structured environment, so they will usually go down easier—and sleep better—with an established routine. These three things may help:

  • A place to call their own. If you can afford a permanent shelter, lay them down in the same bed every night. If not, give them a portable comfort object, like a favorite blanket or toy.
  • A set bedtime. Ryan, now a preschooler, goes to bed at 8:30pm.
  • One last hurrah. Books, playing, and baths are all wonderful choices. I sing one or two songs while tucking Ryan in. If you’re shy about singing, don’t be! Your babies will love your voice until they turn thirteen.

I hate to offer this advice, because my inconsistent behavior has made this process extremely difficult for me. Like cooking regular meals, enforcing a bedtime requires me to be on the ball night after night—a topic which will be covered in a future post. But despite the snags, maintaining at least this much structure has been the best action I have taken for Ryan.

When he gets his rest, I get mine—and then my whole family benefits.

What lengths have you gone to get your shut-eye? Any advice for surviving the first year with an infant?

Not to be taken in lieu of a treatment plan crafted with medical professionals.