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Grab Bag | Sweet Dreams | giggle Blogs

Archive: Grab Bag

April 6, 2011

Further Support for Back Sleepers

A study published on February 28th, 2011 in the online version of Pediatrics Journal adds weight to the recommendation that babies be laid to sleep on their backs.  The study looked at tissue oxygenation in babies who sleep on their backs, as compared to babies who sleep prone.

The study concluded, “In healthy infants cerebral oxygenation is reduced during sleep in the prone position. This reduction may underpin the reduced arousability from sleep exhibited by healthy infants who sleep prone, a finding that provides new insight into potential risks of prone sleeping and mechanisms of sudden infant death syndrome.”

In addition to reduced oxygenation, sleeping prone also increases a babies risk of suffocation, overheating and re-breathing in exhaled air, which is lower in oxygen.  Each of these is an important risk factor to weigh when laying your baby down to sleep.

I regularly consult with clients who claim that their babies sleep better in the prone position, which is often true, however the risks associated with sleeping in this position are significant and should outweigh the temporary benefits of longer stretches of uninterrupted sleep.  Most full-term babies are able to sleep soundly on their backs by 16 weeks of age and the earlier they learn to sleep on their backs, the better they sleep that way.  A quick tip for babies who awaken frequently on their backs is to swaddle them snugly to minimize the startle reflex that often awakens babies sleeping on their backs.

March 11, 2011

sleep tips for springing ahead

I’m already enjoying the longer stretches of daylight at the end of the day with my daughters. We are eager for this weekend when, despite losing an hour of sleep, we gain an hour of daylight. And after the loooong winter we’ve all endured, this is definitely good news!

Following are some tips on managing the time change with your wee ones. To some this is very welcome news as it will mean that your early riser will awaken an hour later. And for others, correcting for the time change is very simple, so negotiating this loss of an hour should be minimally disruptive.

Tips for Early Risers
1. Put your child to bed on Saturday night at the usual time.
2. Change the clocks ahead one hour when you go to bed.
3. Wake up with your child(ren) in the morning at the usual time (though the clock will read on hour later).
4. Proceed as usual but put your child(ren) down for naps and bedtime one hour later (per the clock). The timing will feel the same to their bodies. (i.e. 7 p.m. bedtime becomes 8 p.m. and 6 a.m. wake up time becomes 7 a.m.).

Since your child is sleeping at the same times they are used to sleeping, there should be no adjustment period.

Tips for Families Wanting to Keep the Same Schedule
1. Put your child(ren) to bed on Saturday night at the usual time.
2. Change the clocks ahead one hour when you go to bed.
3. Set your alarm for your usual wake up time
4. Wake your child(ren) up at the usual wake up time per the new clock (this will mean that s/he is getting one less hour of sleep overnight).
5. Proceed with your regular schedule using the new time.

It can take the body a few days to get into the groove with the new schedule. Be consistent and patient!

January 30, 2011

transitioning from a crib to a bed

Here is a pretty common scenario: your wee one arrives at the foot of your bed one night or yells out to you from the bedroom door to your total amazement and horror.  How did he get out of his crib? Is he ok? How should you handle this? Is he safe in the crib?  Unfortunately, like most sleep issues, the advice is mixed.

Here is my two cents…

Unless your child is knocking on the door of his third birthday, I can promise you that he most likely is NOT ready for a toddler/big bed.  Children under three-years-old generally lack the capacity to understand and abide by rules such as staying in their bed all night long.  They simply cannot resist the impulse to get up and explore.  And so, we should not expect them to and get frustrated when they cannot.  This of course, leads to a vicious cycle of sleepless, often frustrating nights and days.

The solution is simple.  Leave all four walls of your child’s crib in tact and run to the nearest baby supply store or website and order a crib tent suitable for your crib.  Contrary to many parents fears, crib tents often give children a feeling of cozy comfort.  (Just think about all the forts you are building with couch cushions and blankets!)  Most children react very positively to this new addition to their sleeping quarters.  And, of course, the manner in which you present it really sets the tone and level of acceptance.  This is NOT a punishment. This is a safe, smart solution to a problem that could otherwise lead to unsafe outcomes (falling out of the crib or getting into things in the room/home while wandering around at night).  Plus, everyone sleeps better again.

January 6, 2011

ruling out medical sleep problems

The good news regarding most children’s sleep problems is that they are behavioral and therefore can be resolved with thoughtful and consistent interventions.  However, approximately 10% of children have a true sleep disorder or have their sleep disturbed by asthma, allergies or an acid reflux problem.  Listed here are some symptoms that you should take your child to the doctor to explore further:

  • loud and/or regular snoring
  • restless, noisy sleep
  • mouth breathing when sleeping
  • choking, snorting, gasping or wheezing during sleep or holding breath while sleeping
  • persistent night cough
  • trouble falling asleep even when tired
  • waking every hour or two throughout the night
  • appearing tired even after a good night of sleep
  • heavy sweating while sleeping
  • frequent and intense nightmares or night terrors
  • sleeping in strange, contorted positions
  • often waking with a headache, heartburn or sore throat
  • nasal sound in voice; regular mouth breathing
  • over six years old and still wetting the bed
  • difficult to wake; groggy after waking
  • sometimes has muscle weakness when laughing or crying
  • often inattentive, irritable, depressed or hyperactive during the day
  • frequently falls asleep in the car or in front of the TV

Keep in mind that not all doctors are familiar with sleep disorders.  You may wish to seek out a sleep disorders clinic for further investigation.  Again, most sleep problems are behavioral and therefore easily treated by changing your behavior (shaping your response to your child).  And for those sleep problems that are medical, where there are professionals who can help you there, too.

December 3, 2010

holiday travel with tots

Is anyone else in my boat — blindsided by the holidays and wondering where October and November went?!  Since we just had Thanksgiving and Hanukkah is here, it’s time to talk about travel, holidays and breaks in routines and sleep schedules. Here are a few of my tips for traveling with tots.

Prepare your child for the trip: It can be hard to know exactly how much our children understand at a young age because their receptive language skills (what they understand from us) develop in advance of their expressive language skills (what they communicate to us). As a general rule, I would argue that most children understand more than we give them credit for.

I raise this point because I find it very important to let children know that there is a change of routine coming. Invite their participation in preparing for the trip as much as you can, given their age. For tots 12-18 months this means just talking about going on a trip and saying bye-bye to the pets or house as you leave. With a slightly older child you can help to prepare them by letting them share the responsibility of packing their bag, specifically the things they need for sleep. This might include a cherished blanket, pacifier, tub toys, white noise machine and favorite bedtime books.

Bring the unwashed crib sheet: A familiar scent can be particularly comforting for children when they are away from home. As such, I often recommend bringing along the unwashed crib sheet from home for your baby to sleep on. For older toddlers, this is not nearly as important.  If you’re planning to use a pack n’ play, sleep with the fitted sheet that fits the pack ‘n play mattress.

Unpack together: When you arrive at your destination, spend a few minutes getting the room where your child(ren) will sleep ready. This means setting up the crib/pack ‘n play with the sheet you brought from home and any other sleep aids you may have brought with you. Have your child with you while you do this. Explain to them that this is where they are going to be sleeping.

Also, take a few minutes to unpack the toys and books you brought along. Play with your child in the room for at least 10-15 minutes so they develop a positive association with the space.

Leave extra time for your bedtime routine: Since most children are at least a little uneasy about falling asleep in a new environment, it is helpful to devote extra time at the end of the day winding your child down for sleep. Ten or fifteen extra minutes should suffice. While the order of the routine should remain the same, you might spend a little extra time reading and snuggling.

Stay on schedule: I know that one of the great things about being on vacation is being spontaneous and free from scheduling. Unfortunately, children really do much better when they have a schedule that is predictable every day. Therefore, it works best when you are able to keep the routine of your daily schedule when you’re away from home. Of course, you should be able to have a late night here and there, but to the extent that you can preserve your schedule, the better your child will sleep and behave.

November 2, 2010

tips for daylight savings

For better or worse, it’s time to change our clocks back to eek out a little more sunlight before winter is upon us. At 2 a.m. on Sunday morning, November 7th, we will officially fall back one hour (which means we gain an extra hour overnight). Before children that was often a welcome thought.  Now you might be concerned that this will lead to an even earlier start to the day. Worry not, these simple tips for babies (*6 months and older), toddlers and preschoolers will help you stay on track with your good sleep habits. Give your children a few days to settle in to the new time.

1. Put your child(ren) to bed on Saturday night (11/6) at the regular time.

2. Wake up with your child(ren) at the normal wake up time on Sunday morning (11/7).

3. Set your clocks back one hour. This is where you stretch.

4. Put your child(ren) down for the first nap at the regular time per the clock.** This will mean that s/he has been awake a full hour longer during this window and may need some help to stretch. Going outside and getting lots of sunlight and fresh air is a great way to keep kids awake when you’re stretching them.

5. Follow the clock for naps and bedtime from here forward. It can take a few days for your child to fully adjust, so be patient and consistent.

*Younger children may have a harder time stretching a full hour without becoming overtired. In this case it may be better to stretch them 30 minutes in the morning and 30 minutes in the afternoon or to stretch them slowly over several days.  For babies under six months I recommend pulling the entire day’s schedule earlier by 15 minutes for the four days leading up to daylight savings.

October 28, 2010

sibling preparation + sleep

I recently facilitated a webinar on sibling preparation and fielded many questions about sleep. Contrary to what you might think, most questions were about the big sibling’s sleep, not the newborn!

The birth or adoption of another child definitely brings about many big transitions and adjustments for families.  At the heart of many of those changes is sleep.  And while parents often worry about keeping up with a newborn and a toddler/preschooler while they are getting such little sleep themselves — the biggest worry is the disruption to their oldest child(ren)’s sleep habits.

Here are a few helpful guidelines for dealing with this new, big change.

1. If your older child is a toddler under three-years-old, keep him or her in their crib. A crib is a safe, predictable, comforting place for your child.  Moving to a bed will bring about unnecessary anxiety and uncertainty at a time when there is plenty of change to go around.  This may mean needing to purchase or borrow another crib for your baby.

2. If your older child is nearly three-years old or simply too big for a crib, then I recommend moving your child to a big bed either well in advance of the birth of the baby (say three months or so) or waiting until a few months after the birth of the baby. Ideally the latter as many children show signs of regression when a baby enters the scene.  Staying in a crib allows them to regress and be more baby-like at night with all their familiar comforts and security, while having to adjust to this new role as “big” brother or sister during the day.  After a few months of having the baby at home, things will settle down and become more routine and that transition will be easier for everyone.

3. If your older child starts to awaken frequently at night, have your spouse/partner sleep in the room with your child (separate bed) for a week while s/he makes the transition. The reassurance that will come from having someone in the room can make a huge difference and will often mean that your older child is able to continue sleeping well at night.

October 7, 2010

separation anxiety and sleep

My eldest daughter started nursery school a couple weeks ago.  She simultaneously began to awaken at night. I also started receiving many calls from weary parents concerned about this new change in their preschooler’s sleep as well.

And when you think about it, it all makes sense.

Nighttime is the longest separation our children have from us.  And, it’s quite significant — 11 to 12 hours in many cases.  So, when children are doing the difficult work of separating during the day (even if they gleefully run from you shouting ‘see you later!’), they can have a much harder time doing so at night. It’s a lot like working a new muscle that is sore.  There needs to be some healing before further progress can be made.

So, if you find yourself in the same boat as me these days, rest assured that this is a very normal part of development.  The best thing you can do is continue to reassure your child and validate his/her feelings.  This is definitely not a time to push. Here are a few quick tips that can help:

1. Give your child a lovey to sleep with. This could be a t-shirt you wore to bed last night or a favorite teddy bear or blankie.  Something that smells like you will bring more comfort and ease the pain of the separation at bedtime.

2. Invite your child to bring a lovey to school. Having a connection such as this to their home life can help children with the transition.  (Check with your teachers first to ensure this is ok with them.)

3. Make a book about your child’s school day. Offer concrete examples of things children do at school (i.e. circle time, snack time, story time, etc).  Let your child fill in some of the blanks.  Having something like this will allow your child to process their feelings and gain a sense of mastery over this new adventure, which may ease their anxiety.

4. Give your child permission to have and talk about all of their feelings. Sometimes it can be so hard for us to tolerate feelings like sadness or loneliness so we try to tell children to feel another way (i.e. “How can you not like school?!  School is a fun place.  You have lots of friends there.”).  If this doesn’t match your child’s experience, then they learn not to trust their own feelings or your understanding of them.

Lastly, as my mother always reminds me, this too shall pass.  When things get hard, stick right there with your child and don’t worry that you’re creating any bad patterns.  Sometimes our kids just need more of us, and that’s perfectly ok!

September 27, 2010

sleepless in boston?

I had the pleasure of attending the grand opening event for giggle in the Boston suburb of Dedham this past weekend!  I totally enjoyed getting to meet the expectant moms and couples who attended my sleep talk and q&a.  Best wishes to all of you!

As I mentioned in my talk, my best advice to new parents is to embrace and enjoy the first several weeks at home with your baby without worrying that you are doing something wrong.  There is no such thing as spoiling a baby or establishing bad sleep habit for a newborn.  The most important thing for families to focus on is adjusting to life as a family of three or four or five+!

September 10, 2010

eliminating night terrors and nightmares

Exactly when we begin to dream is debated in the scientific community, but it is believed that children begin to have nightmares (“bad dreams”) at a greater frequency from ages 3 to 5 years-old. This is likely due to their increasing exposure to scary themes in books, television, social interactions, etc.

We know that dreaming takes place during REM sleep and babies spend the most time in REM sleep as it required for their rapid brain development.  We progressively spend less time in REM sleep as we age (fetuses spend 100% of the time in REM sleep whereas the elderly spend 15%).

When I consult with families of preschoolers the topic of nightmares and night terrors often comes up.  The two are not the same and the response to each is nearly polar opposite.

Nightmares are another word for scary or bad dreams. Nightmares happen during REM sleep. When children are having a nightmare they can be awoken and will usually remember the nightmare the next day.  Often times nightmares are a reflection of a child’s feelings of anxiety or powerlessness in a situation.  They can happen when there is a new change in a child’s life or when they are exposed to scary situations from peers, books or television.

Solution: If you know that your child is experiencing a nightmare, try to gently awaken your child and offer reassurance and comfort.  Stay with your child until they are calm and relaxed.  Help your child imagine a happy ending to their nightmares and/or spend time during the day acting out the scenario with a positive ending.  Let your child be in the role of the scary character so s/he feels more power and control in the situation and will be able to overcome the underlying fear.  In some cases a very dim night light may also help.

Night terrors, on the other hand, tend to be genetic (includes sleep walking/talking, etc) and are often triggered by stress (including sleep-deprivation).  Night terrors occur within an hour or two of going to sleep during deep sleep and can last 5-20 minutes. Children who are experiencing a night terror may appear to be awake (eyes open), but in fact are in a very deep sleep.

Solution: Do not attempt to awaken your child.  It is natural to want to comfort or awaken your child, but this is not helpful.  Stay near your child to ensure that they stay safe.  In the bigger picture, it is imperative that you work to minimize your child’s stress and/or get your child more sleep if they are sleep deprived.  A good place to start is usually with an earlier bedtime.