Sleep
Problems
Seen
in Pediatric
Practice
Betsy
Lozoff,
MD, MS
Abraham
W. Wolf,
PhD,
and
Nancy S. Davis, MSW
From the Departments of Pediatrics and Psychiatry, Rainbow Babies and Childrens
Hospital, Cleveland Metropolitan General Hospital, Case Western Reserve University School of Medicine, Cleveland
ABSTRACT. To determine whether sleep problems
corn-monly seen in pediatric practice, such as conflicts at bedtime and night waking, are associated with more
pervasive disturbances in the child or family, two groups of healthy children were studied. Interview data from a pilot sample were examined to identify factors that might be important in sleep problems, and then the results were validated with data from the second sample. The two samples included 96 white children between 6 months
and 4 years of age. In each group, approximately 30%
had a sleep problem by the criteria that night waking involving parents or bedtime struggles occurred three or more nights a week for the month preceding the inter-view, accompanied by conflict or distress. Five experi-ences distinguished children with sleep problems from those without: an accident or illness in the family, unac-customed absence of the mother during the day, maternal depressed mood(s), sleeping in the parental bed, and maternal attitude of ambivalence toward the child. These
experiences correctly classified 100% of pilot and 83% of
validation sample children as having a sleep problem or
not. The similarity of findings in the two samples attests to the potential importance of sleep problems as an early
childhood symptom. Bedtime conflicts and night waking
seem to be quantifiable, easily ascertainable behavior patterns that could alert pediatric health professionals to the existence of more pervasive disturbances in child and
family. Pediatrics 1985;75:477-483; sleep, sleep problems,
behavior problems, ambulatory pediatrics.
Common sleep problems, such as bedtime
strug-gles and night waking, occur regularly in at least
20% to 30% of children in the first four years of life.’’2 The causes and significance of these prob-lems are matters of renewed interest and debate.
Among some developmental authorities such as Gesell,’3 they are considered nearly universal and
transient developmental phenomena in the first two
or three years oflife. Among pediatric professionals, a common explanation is that parents are not
man-aging the child’s sleep appropriately. Some
psycho-therapists such as Mahler et a!14 and Sperling,15
however, view persistent sleep problems as one of
the hallmarks of psychological disturbance in early
childhood. For instance, Sperling writes,15
“Dis-turbances of sleep in children are the first reliable signs of emotional conflicts, and . . . precede any other overt indication of such conflicts in the be-havior of the child.” Yet, the health professionals who examine young children are generally
pediatri-cians and pediatric nurse clinicians, rather than psychotherapists. Are sleep problems in pediatric patients indicative of more pervasive disturbances
in the child or family, or are they usually transient phenomena which resolve either spontaneously or
in response to changes in parental management?
In order to answer these questions, an analysis of
data from a study describing sleep practices’6 was
undertaken.
MATERIALS AND METHODS
Subjects
Received for publication March 19, 1984; accepted May 21, 1984. Preliminary results were presented in a poster session at the Society for Research in Child Development meetings, Detroit, April 1983, and in a paper session at the Society for Behavioral Pediatrics-Ambulatory Pediatrics Association meetings,
Wash-ington, DC, May 1983.
Reprint requests to (B.L.) Department of Pediatrics, Rainbow Babies and Childrens Hospital, 2101 Adelbert Rd, Cleveland, OH 44106.
PEDIATRICS (ISSN 0031 4005). Copyright © 1985 by the American Academy of Pediatrics.
The analysis was conducted in two phases. First,
interview data from a pilot sample were examined
to identify factors that might relate to sleep
dis-turbances and to develop the study measures. Data from another group of children were then used to validate the results of pilot analyses. The subjects
were healthy children less than 4 years of age who were enrolled solely on the basis of “well-child” care
fa-cilities in the Greater Cleveland area. The two samples, pilot and validation, were demographically similar to each other and approximated 1980 census data on more than 21,000 births in the area. Moth-ers were interviewed by an experienced social worker (N.S.D.) at their pediatric facility to obtain information on sleep patterns and practices, the child’s behavior and development, and family struc-ture and stresses. Details of sampling strategy, par-ticipant characteristics, and interview measures are
reported in the original study on sleep practices,16
but the measures pertinent to the present research question will be briefly summarized.
Measures
The study’s definition of a sleep problem included problematic behavior at bedtime or during the night. Although several published reports have fo-cused on night waking,5 none has determined whether problems during the night were more up-setting to families or more revealing about other more pervasive problems than were bedtime con-flicts. Therefore, we decided at the outset of the study to consider that bedtime struggles or
disrup-tive night wakings constituted sleep problems, without prejudging their relative importance. (The approach was thus similar to that contained in the Behavior Screening Questionnaire of Richman et al.7 The Behavior Screening Questionnaire is an
instrument that has been used in a number of epidemiologic surveys of behavior problems in
pre-school children6’#{176}.) A sleep problem was defined as night waking that involved the parents, or bedtime struggles, which occurred three or more nights each week for the preceding month, accompanied by conflict or distress. Night waking or bedtime
pro-tests that were less frequent or brief and nondis-ruptive were therefore excluded by the definition.
Difficulties at bedtime that were sufficiently fre-quent and intense to be considered sleep problems included behaviors such as more than one hour of active protest, calling parents back multiple times, or refusal to allow parents to leave the room.
Dis-ruptive behavior during the night generally
in-volved waking the parents multiple times a night or wakefulness that kept the parents up for longer than half an hour, even if not more than once a night. In each instance the problematic behavior occurred regularly and was disturbing to the child or parents. Infants less than 6 months of age were not included in this analysis of sleep problems because we felt unable to label a sleep pattern disturbed in such young babies (the average age of this group of infants was 2 months).
Other relevant interview measures assessed sleep practices, maternal attitude toward the child, and
potentially stressful life events. Sleep practices were coded in relation to approaches frequently recommended in the child care literature, with Spock serving as a reference.17 The degree to which each mother held an accepting or rejecting attitude toward her child was also rated, using Ainsworth’s one- to nine-point scale. (M.D.S. Ainsworth, Uni-versity of Virginia, personal communication). To obtain a measure of life stresses, mothers were asked about the occurrence and severity of 17 po-tentially stressful events in the child’s lifetime us-ing a modified version of Richman’s scale.5 The present paper, however, analyzes only whether or not an event occurred, in order to remove any bias that might be introduced by using maternal esti-mate of severity; only one of the potentially stress-ful experiences-maternal depressed mood or marked emotional upset-depended on maternal assessment and the clinical judgment of the social worker-interviewer. In the case of five mothers who had received some form of psychotherapy or coun-seling, this judgment could be confirmed by exter-nal criteria. Depressed mood is the symptom on which we focused because some of its manifesta-tions are directly observable and a high prevalence has been noted in mothers of young children.18”9
Statistics
The interviews were coded by two independent
coder-raters with a mean agreement per item of 95%. Disagreements were conferenced and codes
thus agreed upon were used in data analysis. Chil-dren with sleep problems in the pilot sample were compared with those without sleep problems by means of the Fisher exact test on categorical van-ables and by means of ttests for independent means on continuous variables. Two-tailed probability val-ues were used in all tests of significance. Because we wished to identify variables that might be im-portant factors in sleep problems but the pilot sample was small, a significance criterion of P
<
.10 was used to select variables with respect to
racial differences in sleep management’6 and be-cause the number of blacks in the pilot sample was too small to generate a separate set of discniminant function coefficients, the present analyses consider white children only (32 in the pilot sample and 64 in the validation sample).
RESULTS
Pilot Results
Ten of the 32 pilot children (31%) had a sleep problem (ie, night waking involving the parents and/or bedtime struggles, occurring three or more nights a week for the preceding month and accom-panied by conflict or distress). Three of these chil-dren had a bedtime problem without disruptive night waking, four had disruptive night waking only, and three had both. Their disturbances had lasted an average of 12 months. There were no statistically significant differences between chil-dren with sleep problems and children without sleep problems with regard to demographic characteris-tics such as sex, age, birth order, family size, history ofbreast-feeding, parental education or occupation, paternal presence, maternal work status, or source of pediatric care. All of the children with sleep problems in the pilot sample had been healthy, full-term infants, without prenatal or postnatal compli-cations.
There were also no differences between the two
groups in the proportion of children whose parents
followed recommended sleep management ap-proaches, with one exception: sleeping in the paren-tal bed. Seventy percent of children with sleep problems had slept in the parental bed all or part of some nights in the preceding month compared with 23% of the group without sleep problems (Fisher exact: P = .02). With respect to maternal
attitude, fewer of the mothers of children with sleep problems were rated as showing an accepting
atti-tude toward their child than were mothers of chil-dren without sleep problems (Fisher exact: P =
.006). Because only one mother was rated as
sub-stantially rejecting, the mothers of children with sleep problems could best be characterized as am-bivalent, ie, positive toward their babies but ex-pressing resentment or hurt as well. The potentially
stressful events that seem to have been experienced
by more children with sleep problems than children without sleep problems included maternal preg-nancy (P = .06), family accident or illness (P =
.02), unaccustomed maternal absence during the
day (P = .06), and maternal depressed mood or
marked psychological upset (P = .09).
A discniminant analysis was performed in order to determine how well children could be classified as having a sleep problem or not on the basis of this set of variables. With the exception of preg-nancy, which did not contribute to the classification of these children, all variables discriminated be-tween the two groups at a statistically significant level. Of the children with sleep problems, 100% were correctly classified on the basis of maternal ambivalence, depressed mood, unaccustomed day-time absence, family accident or illness, and sleep-ing with parents. The discniminant analysis also correctly classified all of those children without sleep problems (Table 1).
Validation
Results
Data from the second cohort of children were analyzed in order to assess the validity of pilot results. The prevalence of sleep problems was corn-parable. Eighteen of the 64 children in the valida-tion sample (29%) were rated as having a conflic-tual sleep problem, averaging 17 months in dura-tion. Nine of these children (50%) had conflicts at bedtime, five had disruptive night waking, and four had problems both at bedtime and during the night. Once again, there were no differences between
chil-TABLE
1.
Classification of Children With and Without Sleep Problems*Discriminant An alysis Prediction
Pu ot Sample Validation Sample Sleep
Problem
No Sleep Problem
Sleep Problem
No Sleep Problem
Actual class Sleep problem
No sleep problem
Overall correct classification
10
0
0
22
100%
14 7
83%
4 39
* The set of five variables as a whole discriminated children with sleep problems from those without sleep problems at
a statistically significant level (F(5,26) = 9.39, P = .0001), corresponding to a difference in discriminant group centroids
TABLE 2. Experiences Differentiating Children With and Without Sleep Problems
Experience Children With Sleep Problems (n = 28)*
68%
39%
Children Without Sleep Problems
(n=68) 29% 21%
4 The numbers shown are for the pilot and validation samples combined. The table gives the percentage of
children who had had a given experience. dren with sleep problems and those without sleep
problems with respect to background characteris-tics, except that children with sleep problems were, on the average, significantly older than those with-out; almost all children in the validation cohort with sleep problems (89%) were between 2 and 4 years of age, compared with 32% of those without sleep problems (P = .0003). A similar age difference
had been observed in the pilot sample, but it had not been statistically significant (P = .25).
The discniminant function coefficients obtained from the pilot sample data were applied to the validation sample data. Because the derivation of the coefficients optimizes classification for the par-ticular subjects in a given sample, a predictable feature of such a procedure is that the percent correctly classified in a different sample will drop. Despite the anticipated decline in classification ac-curacy, the set of variables that correctly classified all of the pilot sample also correctly classified 83% of the validation sample (85% of all children with-out a sleep problem and 78% of those with sleep problems) (Table 1).
The fact that three of the 17 potentially stressful life events differentiated children with sleep prob-lems from children without sleep problems caused us to examine in detail the specific nature of these events, in the pilot and validation samples corn-bined. The definition of accident or illness in the family required that the episode receive hospital treatment or entail disabling symptoms treated at home for more than 1 week. Hospitalization of a family member or a motor vehicle accident was involved in all but four cases, in which the mother herself was bedridden at home for more than 1 week. Unaccustomed separation from the mother during the day was a result of her return to work or school in 88% of the children who had this experience. The sources of maternal depressed mood were varied, but always entailed marked and prolonged reactions to marital problems, death in the family, postpartum depression, or caring for children. Only two mothers of children with sleep problems had received some psychotherapy or counseling.
None of these stressors nor the ratings of mater-nal attitude and sleeping with parents in isolation correctly classified children with sleep problems as well as they did in combination. For instance, in the two samples together, sleeping in the parental bed all or part of some nights misclassified 22% of children without sleep problems and 32% of those with a sleep problem, whereas the entire set of variables misclassified only 10% ofchildren without sleep problems and 14% of those with problems. Other variables by themselves misclassified even
more children. Children with sleep problems had had an average of three of the five experiences (family illness or accident, sleeping with parents, unaccustomed daytime absence from the mother, maternal depressed mood, and maternal ambivalent attitude) that differentiated them from children without a sleep problem, who averaged only one of the five experiences (Table 2). No particular corn-bination of the five experiences predominated, and all were approximately equally weighted by the discniminant analysis. Children with sleep prob-lems had also experienced an average of six poten-tially stressful events in addition to some of the three discriminating stressors, whereas children without sleep problems averaged four additional potential stressors. This difference, however, was not statistically significant when the effect of the older age of the children with sleep problems was controlled.
An examination of misclassified children was revealing. Of the seven children in the validation sample without sleep problems whom the discnim-inant analysis predicted would have a sleep prob-lem, two had had severe disturbances that had been recently resolved, and one was only 6 months old, perhaps too young to be sure that a sleep problem would not develop. The sources of sleep problems in the four children in the validation sample whom the discniminant analysis incorrectly predicted to be free of disturbance seemed reasonably easy to identify: a 15-month-old boy had night waking that had started following a recent trip and continued during several episodes of otitis media; a 26-month-old boy was having an acute reaction to being moved out of his crib; a three-year-old girl who apparently needed little sleep came from a family with three children less than 5 years of age, and the mother, exhausted herself, could not tolerate the child’s failure to nap or fall asleep when her siblings did; and finally, a 3-year-old girl with an imperforate
Family accident or illness
Unaccustomed maternal absence during the day
Maternal depressed mood 46% 19%
Lack of maternal accept- 71% 34%
ing attitude
anus developed a sleep problem after a terrifying
nightmare, a few months after surgery when she
was 2 years old. (This child was included in the study because the sole entrance criterion had been good health at the time of the well-child care visit.) None of the mothers of these four children had
reported episodes of depressed mood and all were rated as having an accepting attitude toward their child.
Of the combined total of 96 children, only one
had been referred for psychological evaluation. This 3#{189}-year-old boy, with both bedtime and nighttime disturbances, had had a hospital admission for
fail-ure to thrive at 10 months of age and was seeing a speech therapist and a psychologist, the latter for severe tantrums and other disruptive behavior.
DISCUSSION
The results of this study, with the observation of
similar findings in two samples, attest to the
poten-tial importance of a sleep problem as an early childhood symptom. The presence of such a behav-ior problem should not, however, be equated with mental disorder or illness. Rather, the results of
this study suggest that if a sleep problem has lasted
for more than 1 month, it is likely to persist and be
associated with several of the following experiences:
an ambivalent mother (one whose positive feelings toward the child are mixed with resentment or hurt), a hospitalization or accident in the family, a mother with an episode(s) of depressed mood,
mother’s return to work or school, and sleeping with parents for all or part of some nights.
That sleep problems may be indicative of more pervasive disturbances in child and family is sup-ported by the few other studies which applied some-what similar approaches. Richman5 noted that the
families of British 1- to 5-year-old infants with
severe night waking problems had been faced with more stresses and their mothers had more psychi-atric illnesses. Furthermore, because the definition
of a serious waking problem used in that study
included sleeping with parents, it provides indirect
support for the association between cosleeping and
disturbed sleep which we observed. In another study of healthy US 2-year-old infants, Ragins and Schachter6 found that a mother’s ongoing concern about her child’s sleep behavior was a significant
indicator of potential psychopathology.
Most previous studies of sleep problems have
focused on night waking. While not minimizing the significance of night waking, we found that only one third of the children with sleep problems in the two samples had disruptive night waking in the absence of bedtime conflict, another 25% had both bedtime and nighttime problems, and 43% had
trouble at bedtime without regular night waking. A mother’s description of bedtime seemed particu-larly revealing of the interrelationships among fam-ily members. To elicit such information in pediatric practice, however, specific inquiry about sleep after early infancy would be needed, since the sleep prob-lem was not necessarily the aspect of a child’s behavior that worried the mother most. Stimulated by the work of Richman et al,7 we included several questions that, because of their helpfulness in the present study, might also be useful in pediatric
practice. In addition to asking about the frequency,
duration, and handling of night waking, we
ap-proached bedtime as follows: “A lot of children
don’t like going to bed or going to sleep. What about your child? How do you handle delays or protests?
How long does it take to settle him or her?” Night wakers have also been reported to have
more problems at birth,2’4 an association not found in pilot or validation sample, and to have more behavioral and temperamental difficulties and more irritability in the early months,”35 problems not assessed in the present study. Nevertheless, the frequency of sleep problems in both samples was
within the range previously described,’’2 and the increase in problems among toddlers and
preschool-ers, especially at bedtime, is consistent with earlier
observations. 12,13
SPECULATION AND RELEVANCE
Any causal relationships between sleep problems and particular life stresses, maternal ambivalence, or sleeping in the parental bed cannot be proved by
this study because of its cross-sectional descriptive nature, even though results similar in the two sam-pies may have identified crucial elements in the
creation or perpetuation of sleep problems.
Never-theless, the pattern of life events, which occurred
more often in the groups of children with sleep
problems, suggests a hypothesis about when young
children may be likely to have sleep problems. Specifically, disturbances of sleep seemed to occur in children whose mothers’ psychological attention
had been withdrawn from them. Illness or accident affecting another family member, unaccustomed
separation from the child during the day, and
de-pression all constitute situations in which a moth-er’s emotional investment may be directed away from her child. These stressors discriminate
be-tween children with and without sleep problems, however, on a bedrock of a variety of other
poten-tially stressful experiences (children with sleep problems had experienced an average of six addi-tional stressors). The ratings of maternal attitude
children’s sleep problems. Although maternal am-bivalence could be the result of a child’s sleep problem, and sleep-related conflicts inevitably af-fect a mother’s attitude, especially when her own
sleeplessness is involved, ambivalence and sleep
problems were not synonymous in the present
study; one third of all children without disturbed
sleep had mothers rated ambivalent, and 29% of those with sleep problems had mothers rated as accepting. Maternal ambivalence might therefore
be considered either as one of several indicators of
inaccessibility or as a reflection of the accumulated
stressful events in the mother’s life.
The role of sleeping in the parental bed in sleep problems may be seen in a somewhat different light. Sleeping with parents may occur in reaction to the child’s sleep problem and/or to the mother’s
aware-ness of her partial emotional withdrawal from the child. Such bed-sharing may be one avenue via which an ambivalent, stressed mother expresses both her positive feelings toward her child and her
own needfulness. The hypothesis that children with
sleep problems typically have mothers who are
stressed and partly inaccessible can best be tested
in a prospective study in which the temporal pat-tern of life stresses, sleep practices, and changes in
maternal attitude can be described and their
rela-tion to a child’s sleep problems determined.
Another finding of the study particularly relevant for clinicians is the relatively long-standing nature of the sleep problems. Pediatric health profession-als and parents work with many toddlers and pre-school-aged children who have disruptive behavior
at bedtime or during the night, not all of whom
develop persistent problems. Such behavior pat-terns would seem to be common, often associated
with increased separation anxiety, and transient if
child, mother, and family are doing well in other respects. The present study suggests that such be-haviors become different phenomena under less
favorable conditions. A sleep problem may then
signal more pervasive disturbances in child and family and persist for months or even years. The long duration of sleep problems, averaging more
than 1 year in the present study, is consistent with
previous research.3’4’20’2’ Over the course of such a
time period there usually is contact with a pediatric
health professional, and this might permit the prob-lems of child and family to be identified.
This study, however, did not assess the
effective-ness of pediatric interventions. We had the
impres-sion that the interview itself was therapeutic for some mothers, as they reflected on their child’s behavior and family circumstances, but a
random-ized controlled trial of various interventions would
certainly seem warranted in view of the ubiquity of
sleep problems and the frequency with which tired, troubled parents seek advice (although often not from pediatricians). Despite a number of articles on children’s sleep and several articles with helpful
suggestions about management,2123 research to
evaluate therapeutic approaches has thus far been restricted to case reports24’25 or uncontrolled stud-ies.26 The present study also did not determine the natural history of sleep problems to their resolu-tion, although the issue of whether such problems predict later troubles is interesting and important.
However, as signals of current distress, bedtime
conflicts and night waking seemed to be behavior patterns that can be easily described and quantified
and that can alert pediatric health professionals to
the existence of more pervasive disturbances in the child and family.
ACKNOWLEDGMENTS
This research was supported by grants from the Charles Rieley Armington Research Program on Values in Children, The Cleveland Foundation, a gift from Ross
Laboratories, and a Research Career Development Award
(K04 HD00509) to Dr Lozoff.
We acknowledge the coding of the interviews by Lois
Klaus and Stephen Malone, the use of computer facilities
of Information Systems of Cleveland Metropolitan
Gen-eral Hospital, and the cooperation of the study families and pediatric professionals. We thank Naomi Ragins,
MD, Joseph Schachter, MD, and Naomi Richman, MD,
for sharing their interview protocols; Steven Robertson,
PhD, for his advice on using discriminant analyses to
confirm pilot findings; and Jane Kessler, PhD, for her
support.
REFERENCES
1. Carey WB: Night waking and temperament in infancy. J
Pediatr 1974;84:756-758
2. Moore T, Ucko LE: Night waking in early infancy: I. Arch
Dis Child 1975;32:333-342
3. Bernal JF: Night-waking in infants during the first 14 months. Dev Med Child Neurol 1973;15:760-769
4. Blurton Jones N, Ferreira MC, Brown MF, et al: The association between perinatal factors and later night waking.
Dev Med Child Neurol 1978;20:427-434
5. Richman N: A community survey of characteristics of one-to two-year-olds with sleep disruptions. J Am Acad Child Psychiatry 1981;20:281-291
6. Ragins N, Schachter J: A study of sleep behavior in two-year-old children. J Am Acad Child Psychiatry
1971;10:464-480
7. Richman N, Stevenson JE, Graham PJ: Prevalence of be-haviour problems in 3-year-old children: An epidemiological study in a London borough. J Child Psychol Psychiatry
1975;16:277-287
8. Coleman J, Wolkind 5, Ashley L: Symptoms of behaviour disturbance and adjustment to school. J Child Psychol
Psy-chiatry 1977;18:201-209
9. Jenkins 5, Bax M, Hart H: Behaviour problems in pre-school children. J Child Psychol Psychiatry 1980;21:5-17 10. Earls F: The prevalence of behavior problems in 3-year-old
children. J Am Acad Child Psychiatry 1980;19:439-452 11. Chamberlin RW: Management of preschool behavior
12. Beltramini AU, Hertzig ME: Sleep and bedtime behavior in preschool-aged children. Pediatrics 1983;71:153-158
13. Gessell A, Ilg FL: Infant and Child in the Culture of Today.
New York, Harper and Row, 1974
14. Mahler MS, Pine F, Bergman A: The Psychological Birth of
the Human Infant: Symbiosis and Individuation. New York, Basic Books, mc, 1975
15. Sperling M: Sleep disturbances in children, in Howells JG (ed): Modern Perspectives in International Child Psychiatry.
New York, Brunner/Mazel, 1971, pp 418-453
16. Lozoff B, Wolf AW, Davis NS: Cosleeping in urban families with young children in the United States. Pediatrics 1984; 74:171-182
17. Spock B: Baby and Child Care. New York, Pocket Books, 1976
18. Richman N: Depression in mothers of preschool children. J Child Psychol Psychiatry 1975;17:75-78
19. Brown GW: Social class and psychiatric disturbance among
women in an urban population. Sociology 1975;9:225-254 20. Minde R, Minde K: Behavioural screening of pre-school
children: A new approach to mental health, in Graham PJ (ed): Epidemiological Approaches in Child Psychiatry. New York, Academic Press, 1977, pp 139-164
21. Bax MC: Sleep disturbance in the young child. Br Med J
1980;280:1177-1 179
22. Zuckerman BS, Blitzer EC: Sleep disorders, in Gabel S (ed):
BehavioralProblems in Children: A Primary Care Approach.
New York, Grune & Stratton, 1981, pp 257-272
23. Schmitt BD: Infants who do not sleep through the night.
JDBP 1981;2:20-23
24. Inglis S: The nocturnal frustration of sleep disturbance.
Matern Child Nurs J 1976;1:280-287
25. Weissbluth M: Modification ofsleep schedule with reduction of night waking: A case report. Sleep 1982;5:262-266
26. Jones DPH, Verduyn CM: Behavioural management of sleep problems. Arch Di.s Child 1983;58:442-444
MAKE-A-WISH FOUNDATION OF DALLAS
Dreaming is one of the simplest joys of living. Many times, however, we take
our dreams for granted. But there are many children whose dreams have been
clouded by terminal illness. For these children, fulfillment of the simplest wish
is enough to brighten their day.
The Make-A-Wish Foundation of Dallas is a non-profit organization founded
in 1982 to fulfill the special wishes of children under 18 who have a poor prognosis for outliving childhood. Wishes may range from a child’s desire to visit a favorite uncle 700 miles away to chatting with Mickey Mouse at
Disneyland. For each child, Make-A-Wish ensures the special wish is granted
regardless of expense.
Make-A-Wish of Dallas is one of over 30 affiliate Make-A-Wish organizations
throughout the country. This particular chapter has received a J. C. Penney
Golden Award for Volunteer Service in addition to recognition and a Certificate of Appreciation from the Governor of Texas.
The Dallas chapter has given one boy a horse, leukemia victim Jessie was able to dance on Soul Train, and Eric fought against cancer after a visit with
wrestler Kevin Von Erich.
Yet, it is the community of doctors, nurses, social workers, friends, business-men and parents who support Make-A-Wish through referrals and donations of time, service or financial assistance.
For further information about Make-A-Wish, call (214) 445-7626 or write P0
