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SLEEP AND BABIES AND CHILDREN: Third most asked question

Originally posted January 20, 2014.


is the third most asked about subject parents ask me about in my practice, behind question one – What is the effect of divorce on children? and question two – How to help children cope with anxiety!

I give this cheat sheet out in my office. It’s created from what my hundreds of clients and their children taught me, my experiences with my own child, all the post-graduate courses I’ve taken, all the chats I’ve had with colleagues over the years and all that I’ve read about infants, children and sleep.

And it’s just a starting point! I don’t promote any one size fits all therapies. All families are different and all children are different. It’s just a starting place to begin talking with parents about sleep issues with their children. When actually going through the process, input from the parents and the child’s personality is always taken into consideration.

First thing, we discuss that the most important thing is that your sleep method needs to work for the entire family. This means you, the adults in your family and your other children. The family bed is used in cultures across the globe and in the US and is a valid family lifestyle. If this method works for you and still works for the family, then that’s great! But if you’re feeling as if you’d like to transition out of the family bed as family members are starting to feel like they need more space or more sleep, and you want to re-evaluate family sleep arrangements…ok, we can walk this path together.

Next thing, we read through some relevant research information as background to the process so that we have some evidence-based facts to think about.

Next, we discuss your individual family dynamics and your individual situation. Every family is different and every child is different, so the process is tailored to fit individual family dynamics.

I like to infuse the process with some fun! It’s not deadly serious. It’s not a contest about your parenting skills or inherent self-worth.

Gaining flexibility and letting go of rigidity makes the process more enjoyable, fun and judgment-free.

Q: Are we born with an innate temperament?

Innate temperament is a concept researched and developed by Alexander Thomas and Stella Chess in the 1950’s, by studying infants and children across many years. They identified nine dimensions of temperament: activity (constant motion or less so), rhythmicity (internal biological schedule), initial reaction of approach or withdrawal in new situations, adaptability to change, intensity of emotion, general upbeat or downbeat mood, distractibility (tendency to be sidetracked), persistence and sensitivity to external stimuli.

Chess and Thomas discovered 65% of infants and babies are innately “easy,” “difficult” or “slow to warm up.” Easy babies tend to have regular sleep and eating schedules, adapt to change easily and don’t fuss a lot. Difficult babies tend to have irregular sleeping and eating schedules, and fuss a lot. Slow to warm up babies withdraw from new experiences. Chess and Thomas found that these traits are stable throughout childhood.

And these traits persist into adulthood, yet are modifiable through awareness, life experiences and training.

What is meant by a difficult temperament in an infant? Current research shows that 20% of infants are born with a tendency towards extreme fussiness and 56% of this 20% may develop/have this difficult temperament over time so this impacts infant/child patterns (Karp, 2003;Weissbluth, 2005).

Q: Is there only one way to be a loving parent and to foster a secure attachment bond?

No. As long as you are conscious of and developing a good emotional bond with your child, there’s room for different parenting behaviors. Develop flexibility and emotional intelligence in your parenting.

There are many ways to be a good parent and to create a loving home that is the safe container that allows stable attachment patterns to unfold in your child over the long-term.

Research show that human attachment is a long-term process, with challenges at different stages of development. You don’t just have one period of time to optimize the attachment bond. It’s flexible and plastic over time. Here’s an article about the myths of human attachment.

You get to choose from a range of safe behaviors about how you want to night-time parent. You can choose no-cry, some cry (graduated extinction) and gentler let cry (extinction) methods. I do not endorse harsher methods, whereas the baby/child is so upset s/he vomits. Not at all.

Instead, use emotional intelligence: tailor your night-time parenting to your individual baby and your family’s needs.

Develop confidence and emotional intelligence in your parenting. As long as you are developing and have a solid emotional bond with your child, there’s room for different parenting behaviors. Have fun as a parent! It doesn’t have to be so serious! Be loving and flexible and use different flexible methods regarding baby/child sleep management. I encourage you to develop confidence in your intuitive sense about what feels right to you and your family, in a loving way. I encourage you to develop emotional intelligence in parenting. Develop flexibility & freedom from adhering to a certain style of parenting, whether it be attachment parenting or cry-it-out parenting.

Q: Why protect the sleep?

Regarding sleep deficits: Lack of sleep is a global health issue due to overworked, over-scheduled, stressed-out, chronically tired and guilt-ridden society. Small but consistent sleep deficits wreak havoc on the brain, resulting in problems in growth, and behavioral and emotional instability (Weissbluth, 2005).

Preserve sleep, to preserve emotional and physical health!

This is from Dr. Weissbluth’s Sleep Lab:

Sleep deficits:

  • negatively impacts the optimal waking state

  • in mothers, causes or exacerbates postpartum depression

  • produces a mindbody state mimicking jet-lag syndrome (overall fatigue, general grumpiness, cognitive disorientation)

  • causes fatigue-induced tantrums

  • results in higher cortisol levels, in turn increasing the occurrence of obesity

  • in teenagers, results in daytime sleepiness

For infants, this helps a bedtime routine:

  • Respect the fourth trimester. Sleep training is not recommended by any baby experts in the fourth trimester.

  • After 3- 4 months, tailor your approach to your individual baby’s fussiness level & temperament type and to your parenting style

  • There is no one size fits all, you need to feel comfortable with your decisions and your life

  • Use small shaping behaviors to move slowly towards & achieve sleep consistency.

  • Practice consistency in parental approach and sleep times

  • Establish a sleep schedule based on child’s sleep cues

    • Sleep cues are subtle, a lull in activity, staring off, rubbing eyes

    • Don’t wait until the baby/child is overtired, as it will be harder for the baby/child to fall asleep easily or fall asleep at all

  • Stay connected and attuned to your baby throughout

  • Detailed Blog about Dr. Harvey Karp’s methods with infants is here

  • Detailed Blog about Mrs. Elizabeth Pantley’s methods with infants is here

  • Detailed Blog about Dr. Marc Weissbluth’s methods with infants is here

For children, this helps a bedtime routine:

  • Create and maintain a consistent soothing-to-sleep routine, using such cues as gentle massage, darkening the room, reading a book, put a glass of water by the bed, etc

  • The entire family is impacted by lack of sleep if one person does not sleep

  • Realize you can’t have it all: Working parents shouldn’t let their schedules to impact their child’s schedule. That is, if you get home really late from work every night for a month and let this change your child’s schedule, it will be very difficult to re-establish the child’s regular schedule

  • Over-scheduling activities impacts the entire family’s health. Research supports the culture of over-scheduling is way over-rated.

  • Separation anxiety is normal for many children, some may be more temperamentally inclined to it. Take this into consideration with your individual child.

  • If there are some deeper issues bothering your child, allow her to express these with play therapy. Let them free play and see what emerges; don’t force it. Children work out their fears and anxieties in play. Adults talk about their fears, children act them out.

Develop your own signature sleep ritual together:

  • Happy thoughts right before bedtime

  • Stuffed animals all around the bed

  • Use a white noise maker

  • Back rub

  • Consistent schedule seven days a week

Create a sleep bracelet (a fun suggestion from Mrs. Elizabeth Pantley)

  • Make two of them in case one gets lost

  • Keep it by the bed

  • It’s a special talisman to be put on only at bed-time, it becomes a sleep cue

Behavior shaping through gradual changes

  • Decide on your approach, and don’t change it for a week (“I will stay with you until you fall asleep, and then we will cuddle in the morning”.)

  • Make an effort to minimize night-time tension (arguments about school, etc.)

  • Stay connected and attuned to your baby throughout

  • When there’s fussiness or a break in routine, take into account growth spurts occur yearly/half-yearly (around the birthday date) or summer vacation schedule adjustment issues

  • Sleep Lady® says implement small changes for gradual behavior shaping

  • Create a deadline, but not too long. (It shouldn’t take a year to implement a new change, lol!) At least give it a month, try the new routine!

  • You can re-assess results of your plan after one week or two weeks and regroup

Gently manage your feelings and decide if you want to shape your behavior

  • “I’ll be back soon!” Leave the room for a few minutes.

  • If you emotionally can’t leave room, ok – then don’t. Sit by the window and look at the moon, or do some quiet yoga stretches.

  • Then go back to small shaping behaviors, leave the room for a few minutes, and say “I’ll be back.”

  • The Sleep Lady® Shuffle is a gradual moving away from child in the bed, move chair away slowly, reinforce each gradual move 3 nights or so (week if necessary)

  • Say “I’m going to my bed now and then we’ll both sleep in our beds until morning.”

Gently manage his or her feelings and use some gentle ways to guide behavior

  • With your child, create a chart depicting the bedtime routine and hang it in your child’s bedroom

  • Earn a sticker for going to bed easily at night (she can earn that easily), then two more if she stays in bed all night-time, or three for not waking anyone, two for getting back in bed tucked in.

  • For a week of stickers, maybe do a activity as a prize, like going on a mommy-child lunch on a Saturday

  • Spend some time with your child to fill her emotional cup during the day

  • With your child, create a night-time waking story for her to think about, as a distraction from middle of the night worries

  • With your child, create night-time waking ritual that she can use in the middle of the night to get back to sleep without getting up or waking you up (Ok – I’ll fluff my pillows, fix my covers, take a drink from the night-stand, and then go back to sleep)

  • Drape fun soft lights (snowflakes, flowers, dragonflies, etc.) on the wall next to the bed as a night light, comfort measure

  • You can try putting a sleeping bag in your room for your child to quietly crawl into when he wakes at night, if you want. Some people say this doesn’t help at all, others say it’s a good fail-safe method. It’s whatever works for you and your family.

Be gentle: don’t tyrannize yourself or your child with externally imposed expectations, you’ll find your way. And, as everyone says, these years truly do fly by….



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