Infants, toddlers and preschoolers aren’t the only ones who struggle with sleep. Especially when sleep issues in those earlier age groups aren’t fully resolved.
Other high risk (for sleep challenges) populations are children diagnosed with autism and/or ADHD (they often occur together) as well as children diagnosed with anxiety, depression, obsessive compulsive disorder and similar diagnoses. And of course, many children with autism/ADHD (I’ll refer to them as ND or neurodiverse) are at higher risk for depression, anxiety, and OCD. In the case of one family, the nine-year-old boy had always fallen asleep in his mom’s bed and then been transferred to his own bed later in the night. Recently he started waking up in his own bed and not surprisingly, needing to return to his mom’s bed to fall back to sleep. This might be fine except it was wreaking havoc on his mom’s sleep, which made work and parenting doubly hard. And this child’s anxiety made falling back asleep in the middle of the night especially difficult, because he would worry about his inability to fall back asleep. Here are some tips I offered this mom and other parents in similar situations: 1. No screen time in the hour before bed except if your ND child can’t wind down without it. There are some kids who have this paradoxical effect from screen time. You’ll know if you have one of these. Some NT kids simply can’t wind down without screen time. Their brains are just too wound up. 2. Keep bedtime and awake times incredibly consistent. I know it’s tempting to keep your school aged child up later on weekends – I am guilty of the same – but consistency is especially important for kids who struggle with sleep. This means not letting them sleep late on weekends, either. Yes, I said to wake your sleepy child. 3. Get them outside or at least exposed to natural light as quickly as you can on weekends. This helps their body clocks, too. Please don't let them hang out on screens first thing in the morning. Movement is greatly beneficial for regulating the body clock, too. 3. Ask your doctor about melatonin. Some ND kids simply can’t fall asleep without it, or not until hours later than they need. I otherwise do not recommend melatonin… but if the only other option is chronic insomnia, it may be the best choice. This should only be considered as a long term strategy if all sleep hygiene options have already been exhausted, no pun intended. (As a short term strategy to deal with challenges like jet lag, I have fewer concerns.) If your school aged child struggles with sleep, whether neurotypical or neurodiverse, it’s not too late to change things up! You can still create great sleep habits. Schedule a free consult and let’s talk about how we can get your family well-rested and feeling great.
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Help! My Eight-Month-Old Twins Are Stuck In A Early Waking, Long First Nap, Short Second Nap Cycle4/8/2024 Hi Abby,
My twins are stuck in this crazy cycle. They wake up at around 5:10 am, take a long first nap around 7:30 am, and then there afternoon nap at 2 pm is only about 45 minutes. We gave up the third nap a few weeks ago because it was hit or miss anyway. Then they are cranky and miserable by 5:30 pm but I don’t want to put them to bed too early and perpetuate the cycle. We are all exhausted! Please help! Mary These twins are caught in several reinforcing negative cycles. The first is overtiredness. As you have probably heard me say, in the same way that sleep begets sleep, overtiredness creates more overtiredness. That’s because when children are overtired, the production of a stress hormone, cortisol, makes it harder for them to fall asleep at the right time, sleep all the way through the night without wakings, and wake up at at the appropriately restful time in the morning. The second issue is nap timing. The first nap is too early and too long. It is reinforcing the early morning wakings. (But without it, the twins are exhausted!) The third is the transition from three naps to two. Nap transitions are never easy. And the fourth, well, not issue but challenge, is that fraternal twins often have very different sleep needs. So while it’s ideal to have them sleeping at the same times, we can’t always expect them to sleep the same amount. Here’s what I suggest:
If the details are making your head swim because, you know, you’re tired… the TLDR: don’t move naptime too early (after about 6 months) to compensate for an early waking. A too-early first nap will reinforce the early waking. Likewise, avoid a too long first nap, because that can also reinforce the early waking cycle. And finally, fraternal twins’ can have very different sleep needs. If you’re family is struggling with too-early wakings, schedule a complimentary sleep consult and let’s get you back on track so you all wake up feeling amazing. Valentina just learned to pull herself up to standing the other night. Well, technically at 4:30 am. What better time, right? Well, the problem was that she didn’t know how to let herself back down again. So she was stuck yowling at the crib bars. It reminded me of the many questions I have received over the years about if babies can get head injuries in the crib. What if they fall asleep standing? What if they deliberately head bang? What if, like Valentina, they don’t know how to let themselves down? Many parents spend a lot of time going back and forth to the crib. And babies, of course, like to just pop back up again. Well, Valentina eventually figured it out. Either her legs sort of buckled or she consciously decided to let go (I was watching on the monitor but didn't interfere). She landed in a sitting position, none the worse for wear. I have never, in all my years of pediatric practice and then child sleep coaching work, heard of a child hurting themselves in their crib (since drop side cribs were abolished). Babies and toddlers have well designed skulls to withstand falls without causing brain damage. So while I know it’s nerve wracking to watch their hikinks in the crib, no, you don’t need to worry about crib safety. A safe crib is safe for your healthy child, without reservations. Want some help getting your little one to stay in the crib all night long? Schedule a free consult and let's get your little one sleeping all night, every night. Guaranteed. This is how Katie started our session today.
Then she explained. Her credit card bill was $9000 instead of its normal $2000. “And I have nothing to show for it,” she said, “just a trip to Milwaukee to see my aunt." "What’s more, “ she continued, “my room is a mess and I have 401k accounts from every job I have ever been at. I have no idea what they are doing. Some of them probably aren’t earning anything. Maybe they are even losing money. And I haven’t unpacked and my room is a mess.” Do you ever feel like Katie? I know I do, sometimes. Adding to her overwhelm is the fact that her ADHD brain, as she says, requires a “long runway” to get started on tasks. Sometimes it’s really hard for her to find the energy to just get going. One of the ways that I support Katie is by helping her organize her overwhelm and then break down her to do list to manageable bites. Today, we started by processing the despair she was feeling over her finances. There was guilt and shame and frustration, all rolled up into one. Feeling all those feelings was the last thing she wanted to do, but she agreed to try it, and was surprised to find that she was breathing easier after a few minutes of that. Afterwards, she made her bed while we talked and then we created a strategy for her to move forward. Just the simple act of making her bed and laying down a towel for her suitcase and opening the suitcase gave her relief. The dreaded first three steps were done. They weren’t the hardest, but they required the most energy. By the end of our session, she was feeling a lot better about herself. She had a plan to move forward, and energy to execute it. Do you ever need help getting started with overwhelming tasks? You’re not alone. I know I do. It’s part of the human experience, at least if you live in Western culture and have children. And if you have ADHD or are a single parent, the overwhelm can be all the more daunting. If you are struggle with overwhelm or beating yourself up on the regular, support can be life changing. Schedule a free consult (scroll down past sleep coaching to life coaching) and find out how we can get you on the road to conquering your own overwhelm. There’s no sales technique and no pressure to commit. Just an opportunity to see what coaching is all about. I can’t wait to meet you. PS Here’s what Katie just messaged me two minutes ago, “I'm taking my unused checkbook register that is in my file cabinet where I store my extra checks and I'm writing my current checking account balance in it. And I am going to have to record everything I spend w/ my debit card so I can make sure I have enough to cover whatever I am buying. When I use the Amex card I don't have to keep a close eye, and that is how it's gotten so out of control.” Can you believe that her mindset switched from “everything is hopeless,” to this in the space of an hour? In my last parent coaching blog post, I mentioned that writing out a daily schedule – and even assigning times for things – can be very reassuring for anxious young children.
But writing about this also reminded me of the time I wrote out a schedule like this for my niece.. And then we had to leave the pool, where we were all having fun, at a set time because my completely arbitrary schedule had assumed we would be done by that time. So while it’s great to help lessen anxiety by planning ahead, it’s also great to help children learn to be more flexible sometimes. Schedules inevitably have to shift occasionally. It's best to to practice this ahead of time so that your child isn't melting down at the same time you have to make a stressful exception to the schedule. To that end, I would actually plan on an occasional low stress exception to the rules. Do you always go straight home from daycare? One day, offer to stop for an ice cream. Another day, swing by the playground. I wouldn’t make these exceptions too frequent, because you don’t want to be constantly negotiating your trip home. But once or twice a month might be a fun amount of freedom. Try to time your exceptions to the rule with some thoughtfulness. For example, when my kids used to get screentime right after school on Fridays, planning a stop by a playground on a Friday after school might have really stressed them out. Better to pick a different day in that case. Likewise, if your child missed a nap that day, or slept badly the night before, better to stick to the schedule. Maximize your odds of success with these children who are anxious about schedule changes. With repeated positive exposure to fun exceptions to the schedule, your child can learn to become somewhat more flexible to schedule changes. If you have a child who is less flexible than you wish, I would love to talk to you about how you can make life less stressful for the entire family. Schedule a free parent coaching session (scroll down past sleep coaching to life coaching) and find out how we can work together to make family time more enjoyable. If the onset of daylight savings time has meant that your child is waking up at a more human hour, congratulations! Enjoy!
If you want to maintain that later waking time, here’s what you need to know: You need to keep your child’s schedule on the OLD time zone/clock, NOT on the new one. It’s probably obvious to you that you need to keep bedtime an hour later in order to keep the waking time an hour later. What may not be obvious is that you ALSO need to keep meal times (and naptimes) an hour later as well. If dinner was at 5 before, you need to have dinner at 6 pm now. If nap was at 12, move it to 1 pm. The other challenge with DST is that the days are typically, depending on your location, getting a LOT longer. If it’s light out late, it’s a lot harder for your kid to go to sleep at the same time in June as she does in December. (With my own kids, I also find that they typically sleep less in the warmer months.) To prevent this from happening, blackout shades become increasingly important. If your child’s room is too bright either at bedtime or in the early morning, it’s going to be really hard for you to get your desired results with your child’s sleep. Invest in blackout shades and consider blackout curtains or something else to cover the edges and top of the blackout shades if your child is struggling to fall asleep at night or is waking up too early in the morning. Those little cracks can add up to a lot of light leakage. Let me know if you have success with keeping your child on the new schedule! And if you are struggling with bedtime struggles or early morning wakings, schedule a free consult and find out how to get your family the sleep you need to truly enjoy your time together. “We have a kid with… very strong preferences. She is miserable if she is with anyone but me (Mom), and has a huge meltdown. We need two parents to do bedtime because she'll be very upset if she doesn't have one on one time. And she can't wait her turn while I put her brother to bed first. But what is weird is that she doesn’t have this problem at school. She does great at school!
She’s also highly verbal compared to her peers.” One thing I have heard many times from parents is that their extra smart kiddos have extra big feelings. Some people call this being a Highly Sensitive Person, or a Deeply Feeling Kid. I call it “more anxious than your typical preschooler… because all of them are anxious!” Whatever you call it, these wonderful kids require some extra parenting skills. Here one tip that I gave the parents I spoke to yesterday. Make your schedule and your expectations very clear. A child like this, even at 3 or 4 years old, may benefit from a written schedule. Even if she can’t tell time, you can tell her “when my phone says seven zero zero, we will have breakfast.” You can write out a schedule for her, for example: 6:30 Wake up 7:00 Breakfast 7:30 Get dressed, use the potty, brush teeth and hair 7:55 put on shoes 8:00 leave the house And so on. For the entire day. Note that the times and the tasks are very specific. Having all this detail actually gives these kids a sense of control, because they know what to expect, which helps them to feel less anxious. You can also invite your child to decorate the schedule, if he would like. That is a way to give him a sense of ownership, which will also lessen his anxiety. Setting expectations would look like, "Mommy will help you get dressed, and Daddy will make you breakfast while Mommy showers." It's important with these kids, that once you set these expectations, that you stick with what you said. Do not change plans so that Mommy makes breakfast to avoid your preschooler's meltdown. The more you try to accommodate her preferences, the more rigid and prone to meltdowns she'll actually become. This means there is no shortcut to peace, and in fact, things will get more stressful in the short term. But in the long term, you'll find she becomes more calm and patient. If you'd like some help figuring out how to reduce tension in a household with a child with strong preferences, you are not alone. Schedule a free consult to discuss how parent coaching (scroll down past sleep coaching to parent coaching) can help reduce stress and increase family happiness. Many breastfeeding parents wonder if it's possible to sleep train if they are breastfeeding. After all, isn't it important to breastfeed around the clock in order to maintain supply?
Well, first off, I always support breastfeeding for those who want to do it. I also support bottle feeders while sleep training. Your body, your choice. You will have a fabulous kid either way. The advice that many parents get from lactation consultants is to feed frequently around the clock, especially in the early weeks and months. This is excellent advice for supporting a breastmilk supply but less than ideal for sleep. Here’s what i recommend, to optimize both breastfeeding and sleep. You will not get this controversial advice from your ICBLC, but with in almost all cases, I have found that it works beautifully for sleep while also preserving the breastfeeding relationship. (In those couple of cases, breastmilk supply was negatively impacted and those parents decided to supplement with formula... but in both cases, they have supplemented with their older children, too, and had planned to do so with these newer babies.) For the first six weeks of life, or longer if your baby was born early, breastfeed around the clock, on demand. At age 6-8 weeks old, if your milk supply is well established, start to gently encourage a schedule of eating every 3 hours during the day and same at night. This change doesn't need to happen overnight. Take it slowly, monitor your baby's wet diapers as well as your milk supply. Consider pumping once a day or more if you have supply concerns or if you want your baby to take a bottle sometimes. At eight weeks and older, if breastfeeding and milk supply are continuing to go well, start gently encouraging the feedings to be on an every four-hour-schedule during the day and at night. You can add in an extra feeding in the late afternoons if you have any concerns about your baby getting enough to eat. Continue to count wet diapers -- you should have at least six in a 24-hour period. You may find that your baby starts to sleep a longer stretch at night when you switch to an every-four-hour schedule during th day. If this is the case, and if your pediatrician has no concerns about your baby's weight gain, congratulations! Please take advantage of this and get some extra sleep yourself! This is exactly what happened with all three of my babies, and it was glorious. My oldest was sleeping an 8-hour stretch by 8 weeks old, and my middle was sleeping 10 hours by 10 weeks. My youngest was born very small after fetal growth restriction so she didn't sleep through the night until 4 months old. In every case, there was minimal to no crying. Want to get your newest member of the family sleeping longer stretches at night? You've come to the right place. Book a complimentary sleep consultation today and find out how you can have a well-rested family in two weeks or less, guaranteed. This is a frequent question from families interested in sleep training. They want the benefits of great sleep but don’t want to have to commit to being home for every nap.
Like so many things, the answer is: it depends. My daughter Valentina ended up being out to dinner not once but twice this weekend. The first time was planned, and we returned home at 7 pm. The second time was because she fell off the couch and hit her head while being babysat by my older daughter. My partner swooped home to pick her up and then joined friends and I at dinner. She was, luckily, in a great mood despite her dramatic fall. Since we hadn’t planned on attendance at dinner, she didn’t get to bed until more than an hour after her regular bedtime. Both evenings, she was an excellent dinner companion and I got lots of compliments about how she never cries. We got lucky. She slept great that night. But last night, the following night, she was up for 90 minutes in the middle of the night, apparently starving. Or overtired. Or probably both. In my experience, well-rested babies who are almost always on a schedule are the easiest going ones. Babies who don’t have a regular schedule are more fussy because their little bodies never know when the next nap is coming. Just like regularly scheduled meals, regularly scheduled sleep means happier kids. Some of this is luck, too. But with all three of my kids, I saw a drastic shift in their behavior when they were on a sleep and feeding schedule. They got much happier and more easy going. They were more comfortable with strangers. They were more curious and engaged in their environments. So the irony of this all? A regular sleep schedule may actually give you more flexibility. Beyond that, I learned to embrace the requirement of being home for naps. It forced us to get up and out in the mornings, and then we were able to enjoy planned laziness in the middle part of the day. I’m not a sleeping late kind of person, so that works well for me. My older kids do best if screen time is a deferred pleasure – if they start the day with it, we may never leave the house. My advice is to use school days for schedules and then one of the weekend as well, then let your family be flexible on the other weekend day. You’ll see how your child does with missed, delayed, or on-the-go naps, and then can make an educated decision from there. Of course, during a sleep training regimen, I always recommend sticking to the recommended schedule. But that’s only a couple of weeks and then you can return to “regular life.” But don’t be too surprised if you discover that you mostly enjoy sticking to the prescribed schedule! One other thing, if you have more than one child and more than one parent/adult caregiver, I highly recommend a divide and conquer strategy of parenting. Let one adult stay home with the napping child while the other takes the older one to the birthday party or sporting event. The next weekend, swap roles. And then in the evening, have some restorative adult time. If you’d like better sleep at night but are worried about tying yourself down with a schedule, you aren’t alone. Schedule a free consult today and let’s discuss your concerns. There’s no commitment and no sales pressure. Not long ago, the American Academy of Pediatrics (AAP) changed its recommendation for roomsharing, dropping their recommendation to at least 6 months of rooming-in with your baby instead of 12 months.
But many families I work with wonder if they can stop sooner than that. Why? Well, most babies and adults sleep longer, and more deeply when they are not sharing a room. We hypothesize that that is because we aren’t waking each other up with those little noises we all make while sleeping, babies too. But is it safe? Although it’s annoying, it seems like too-deep sleep for young babies might be a risk factor for SIDS, right? Emily Oster (Cribsheet) did a deep dive into the literature and found that room sharing actually only significantly reduces the risk of SIDS during the first four months of sleep. In fact, she says, “the choice of sharing a room, or even sharing a bed, does not seem to affect SIDS risk after three or four months, at least for parents who are nonsmokers.” (Smoking is a known risk factor for SIDS.) Moreover, she says, room sharing after 4 month has a significant negative effect on child sleep after 4 months old. And certainly, we can all agree, doesn’t have a positive impact on parents’ sleep (no one sleeps well with a crying baby in one’s bedroom!). In fact, she says, babies who slept alone at 4 months also slept longer alone at 9 months old, even longer than babies who started sleeping alone later than 4 months. And “these differences were still present when the child was two and a half years old.” At 9 months old, babies who slept alone slept 45 minutes longer per night than those who were still room sharing. If we consider that sleep is just as important for healthy brain development as food – and I, personally, do – than we can see that not room sharing after 4 months old is often the healthiest and best choice for a baby as well as her parents. Of course, I always recommend that parents read the literature for themselves! This is not a decision to make lightly. But I found Oster’s conclusions quite surprising and compelling. (Chapter 6, Recommendation 3, from Cribsheet -- check it for yourself.) Are you thinking about moving your baby out of your room but feeling a bit nervous about tromping down the hall to his room multiple times a night? Let’s talk on a free consult call about how we can reduce your baby’s night wakings – maybe even gradually but fully night weaning, if you’re ready for that! – so that the move to a separate bedroom means better sleep for everyone, not just your baby. |
AuthorAbby Wolfson is a pediatric nurse practitioner, certified child sleep consultant and certified life coach for parents. She divides her time between Brooklyn, NY and San Miguel de Allende, Mexico. Archives
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