The Sleep Edit Episode 1: Sleeping through the night
Sleeping Through the Night: Practices, Problems, and Solutions
Join pediatric sleep expert, Dr. Craig Canapari, and sleep consultant, Ariel Greenleaf, as they navigate the complexities of children’s sleep. They debunk common misconceptions parents have and discuss challenges faced by parents of medically complex children. Topics range from nighttime awakenings, nurturing independent sleep, addressing nighttime fears, to understanding the diversity in babies’ sleep needs. The discussion provides practical solutions such as sleep scheduling, sleep tracking, and embracing sleep training in line with your parenting style. The videos serve to improve family sleep health and educate parents on their children’s unique sleep habits.
00:00 Introduction and Guest Introduction
02:09 Understanding Sleep Issues in Children
04:31 Defining ‘Sleeping Through the Night’
08:27 Common Sleep Problems and Their Causes
17:36 Understanding Sleep Onset Association Disorder
27:07 Addressing Sleep Regressions
36:04 Medical Issues Causing Sleep Disruptions
42:05 Understanding Sleep Problems in Children
42:44 The Role of Parents in Managing Children’s Sleep
43:56 The Impact of Misinformation on Sleep Management
44:37 Nighttime Feeding and Learned Hunger
46:36 The Importance of Pediatrician’s Input in Sleep Management
48:19 Understanding the Sleep Needs of Toddlers
53:07 Addressing Nighttime Fears in Children
53:12 Environmental Causes of Nighttime Awakening
57:32 Too Much Time in Bed Syndrome
01:00:29 The Importance of Independent Sleep
Note if you prefer to listen as a podcast you can find the show here, along with all the links mentioned:
https://drcraigcanapari.com/podcast/ep-1-sleeping-through-the-night-part-1/
My book It’s Never Too Late to Sleep Train, which will help with your child’s sleep problems, whether they are 6 months or 6 years of age
https://amzn.to/2PfthnX
** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. I am not your child’s pediatrician and this is not medical advice.**
I am a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means to earn fees when linking to Amazon.com and affiliated sites.
Let’s kick this off. Welcome to the Sleep Edit with Dr. Canapari. I’m Craig Canapari. I’m a pediatric sleep doctor and author, and I’m here to explore one of the most mysterious and sometimes troubling aspects of being a parent.
How to make sure your child sleeps well, so that you can sleep well, so everybody in the family can sleep well. My goal is to provide practical and evidence-based informations for parents, pediatricians, educators, sleep consultants, and anyone who’s interested in this topic on today’s inaugural episode, I am so excited
To have my friend Arielle Greenleaf to come and talk to us today. Before we get in the topic, Arielle do you wanna just introduce yourself and t talk a little bit about your expertise in sleep? Sure. I’m Arielle Greenleaf. I’m a former, formerly sleep deprived, mom turned pediatric sleep consultant.
I’ve been in the industry for the last eight years and it has changed quite a bit since I started in 2016. Gosh, is it 2016? Yeah. And I’ve trained more than 60 pediatric sleep consultants to help others, other families get the sleep that they need as well.
I became a sleep consultant because a sleep consultant changed my life when my daughter was five months old and I had not slept a regular night in I say five months, but more like. Probably two months prior to having her too. So I probably hadn’t slept in about seven months.
And hiring a sleep consultant and working with her for two weeks truly changed my life. And so from that point forward, I dedicated my life to helping others in that same situation. That’s great. That’s one of the things I like about working in the sleep field because I wear two hats.
I’m a sleep doctor and I’m also a pulmonologist, and I’ve clearly are important, right? Breathing is also very important. But I feel like in, in sleep often just by providing good information to people, Can make impactful changes like I your child’s asthma. may still need some flovent, right?
But sometimes not always sleep issues can be addressed or at least improved with just uh, good information and good support. absolutely. So today I, we are gonna talk about one of the most burning questions that parents have, which is specifically, how do I get my child to sleep through the night?
The thing is, struggles at bedtime are annoying, but middle of the night awakenings and their close cousin, early morning awakenings, they’re soul destroying.Arielle ally that is what impacts parents so much. If you’re arguing with your toddler for two hours a night, you can still
Go to bed and sleep for seven or eight hours, but if your child is waking up multiple times during the night, even if you get them back to sleep quickly, you are gonna still be up awake, wanting when they’re gonna get up again.
What Ariel would you say this is the most common thing that people would come to you with? Absolutely. The majority of the families that come to me are waking multiple times a night. And I think, the biggest thing we talk about, how I was personally, it was the disrupted sleep more than anything.
Because even if, for instance, my daughter had only woken twice overnight, it was disturbing my sleep enough that then two, it took time for me to fall back asleep. And so I think absolutely the number one problem that people come to me with is multiple night wakings and or difficulty falling asleep
At bedtime or early morning wake. I think all of those kind of go together. IAriellemember being a pediatric resident and where I would, I. They don’t,Ariellesidents don’t do this anymore do work a 36 hour shift. And there was no guarantee of sleep whatsoever then.
And I still felt more tired when my first son was a couple months of age than I did as a resident Because the thing is, as a resident there were, I was on call every third or fourth night. So those other nights I was footloose and fancy free and could catch up.
But as a parent you don’t usually have that luxury. It, hopefully parents have a partner that, that actually participates in dealing with nighttime awakenings. Not everybody is that fortunate. Whether or not they have a partner or another adult in the house can help or not.
But the fact is if your kid is crying and your partner is going to get them, you still wake up. It, it does take a toll. So I think we should start with a definition of what, how do we even define sleeping through the night, which is surprisingly less straightforward than it seems
Yeah, absolutely. I think it would be helpful to hear the definition from a medical perspective because Sure. like you mean like me? yeah someone who went to med school and not just anecdotally and there are plenty of definitions out there for, and on social media and in mom groups and things like that.
And I think that many of the clients that come to me believe that sleeping through the night will mean that even their two month old is going to sleep 12 hours through the night. So I think it’s important to hear from your perspective what isAriellealistic and what is sleeping through the night.
It’s funny, I was rushing right before this to text a colleague who doesAriellesearch in sleep in young children. ’cause I had, I was going back through books and articles and I could not find actually uniform definition, which I immediately attributed to my ignorance and stupidity.
One, and what she said to me is look, practically it means if your kid goes to sleep. Then you don’t hear from them till the morning that’s sleeping through the night. They may even wake up and be quiet. So that’s one definition.
But I think sometimes you make an important point, comes down to what is aArielleasonable expectation at different ages, because this change is so rapidly in the first year of a child’s life and just going back and forth with my colleague, Monica Ordway, who I’m sure I’m gonna have on the show, for
An infant, if you could get ten eight hours of sleep, I think that’s pretty good for, so for young infants, we might talk about putting them to bed on the early side, but then they get up and have, say, a dream feed at 10 o’clock
At night, and then if they sleep to six in the morning, I think most of us, at least people working in the field, would be pretty happy with that as an outcome. I’d say that biologically most infants have the physical capacity to sleep through the night by six months of age.
It’s more likely to happen younger for infants that have some formula feeding because it takes them longer to digest it. But obviously there’s a lot of benefits to breastfeeding as well. I’d say six to nine months is a pretty reasonable expectation but I wanna
Say is, I don’t wanna get hung up on the definition because the fact is. If you’re tired and your child is waking up three or four times a night, what we’re gonna talk about today is how youArielleduce that number, right?
It may not be perfect, and we’re not gonna go from four awakenings a night to no awakenings a night in one step, but we can start moving that needle to fewer and fewer disruptions because it’s hugely impactful to start peeling back some of those nighttime awakenings.
So I’d say that for parents in general, if you’ve got a one month old, they’re gonna be waking up at night. Once you get halfway through your child’s first year, . It’s a reasonable expectation by six months that you’re gonna get a pretty good night of sleep there.
And certainly by a year of age, absolutely. And then sometimes people will come to see me. They’ve got like a three-year-old that’s taking three bottles of milk a night. I’m like, yeah that, you should want to fix that.
The other thing I would say is if you feel like you’re doing well and your child is doing well and your child’s waking up once or twice a night, you also don’t have to make a change if you feel good and your child is doing well. That’s the other side of it.
But I imagine most people listening to this probably aren’t that excited about how their child is sleeping. Yeah. But I do want to validate is if you’re happy with how things are going, you feel good in the morning. Everybody in the house feels good in the morning.
Your child’s growing well, developing well, it doesn’t have to be perfect. I totally agree with that. Totally. So the next thing I wanted to talk about is the timing and the nature of these nighttime awakenings, because I think often there are
Clues baked into this that help us figure out exactly what’s going on. And Ariel, when we’ve talked about this in the past, I just wanted to start with those early evening awakenings because you’ve said something to me that is so interesting and useful that I wanted toAriellevisit this.
So what I’m talking about here is when parents say, I put my baby down at seven o’clock or eight o’clock, and they wake up within 30 or 45 minutes and they’re crying and they’re, it’s difficult to console and I’m never quite sure what to do with that.
But you, I have someArielleal insight into this. Yeah, in my experience, it depends on the age. I know I, I’ve shared that with you before because I think a lot of times as newborns are becoming infants, so if we’re looking at three months, four months, maybe even
Into five months, sometimes as we begin working with ’em, we’re experiencing this, what some people call false starts. I don’t personally look at it as a false start because in my, again, in my experience, what it generally means is the bed timing is off.
So in most instances with the people that I’m working with, it means that bedtime is too late. And when we start to pull bedtime back a little bit, even if it’s 15 or 20 minutes earlier, we can start to see some big changes inAriellectifying the. That 30 that early waking the quick waking.
That almost seems like a nap. And I will say though, going back to that 3, 4, 5 month age group sometimes they are still maturing and sometimes it is it appears to be, I used to be like, oh no, they’re not, they don’t think it’s a nap. That’s not what this is.
But I’ve seen it enough that I do think that sometimes their bodies just aren’tArielleady for bedtime at whatever time it may be, 6 37, 7 30. But eventually it does start to pull back earlier, give them, you can even
Check in with one of these people, one of these families two weeks later, and the baby is going to bed much earlier. But I would say with beyond five months, six months, usually the situation is that bedtime has gotten too late. The child’s overtired going to bed.
And then this also goes in with other things that we’re gonna talk about, which would be what are they doing? What do you need to do to help your child fall asleep? Are they waking up because they fell asleep in your arms and they woke up
And they’re in their crib and you’re no longer there in their crib and you’re not there, you’re not rocking ’em, you’re not feeding them or whatever. So that they’re not falling asleep independently. But I think in the two in conjunction. So if you’re working on eliminating something like that, you wanna be
Looking at the schedule and you wanna be looking at helping your child learn to fall asleep independently. And one other thing that I would say too is that ensuring that your child is getting fedAriellegularly throughout the day and is taking full feedings throughout the day.
Which can be tricky because a lot of the families that I work with are, both parents are working, so the child is in the care of someone else. They’re taking bottles. In some cases, if it’s a breastfed baby, they may not want to take a bottle.
They, they’re just, they wanna breastfeed and so their bottles are much smaller and then they may actually be waking up of hunger. But I would say the topArielleasons together would be the schedule com combined with that dependency on someone or something to fall asleep and back to sleep.
So let’s tease this out a little bit. Let’s say I’m a parent, be like my three month old. We’ve been making progress in the sleep I’m putting to bed at eight 30. He wakes up at nine o’clock and he’s inconsolable for 30 Tell me what to do to fix this.
So for my first go-to, and I think you and I have discussed this a little bit because I have. Originally, way back when I studied a lot of Weissbluth and he is the biggest, like propo, he is all about early bedtime.
So I have always been a big fan of early bedtime, and I have seen, I would say more times than not, that backing up bedtime solves a lot of problems. And that is true for a lot of children, but it’s not true for all children.
However, in a situation like this one that you’re explaining, I would wanna know how is the baby falling asleep? I wanna see their feedings throughout the day. And then IArielleally wanna see let’s back up the schedule. What time is this baby waking for the day and then going to bed at nine o’clock?
A lot of times a parent will say she was up at five 30 and took. Six 30 minute naps throughout the day, and then I couldn’t get her to go to bed until nine o’clock. But a lot of times, because they’re not getting a resorative nap or
They’re taking really short naps, they’re just growing more and more overtired, and that makes ’em fight sleep even more and can lead to those false starts like we’re talking about. I struggle a little bit with the term overtired ’cause I know
What you mean, but I don’t think there’s a good definition for it. Sometimes, and I think in the future we can talk about bedtime battles. There, there is that sort of circadian second wind that people get where and this is more com really common in parents, right?
You lie down with your toddler, you fall asleep with them in their bed at eight o’clock at night and you’re like, oh my God, I’m so tired, I could go to bed right now. And then you wake up and you’re awake till 11:00 PM watching TV or reading a book or something.
And some of what’s going on there is that there are definitely circadian windows where it’s easier to fall asleep and there are windows where you have the surge of wakefulness. And it’s pretty common in someone with a mature circadian system, which really is not an infant, right?
The mature, the maturation of the circadian system happens over the first year of life. But having that sort of second wind is pretty common. I always joke with my kids is they have to be in bed by a certain time
Or they’re gonna be out for an hour and a half when they’re younger. aNd the other thing is if the bedtime slips a little bit later bad stuff is gonna happen When they’re trying to, you get, trying to get them to rush to sleep, brush their teeth. I have two boys.
They’d be slapping each other running around with their pants off. It’s just chaos. So we wouldArielleally do everything we can to just get them into bed at that time. I think another thing to talk about is sleep, stages of sleep, right? There’s a circadian cycle, that’s the timing of your sleep
And wake over a 24 hour period. Then there’s what we call the ultradian cycle, and that is the cycle through different stages of sleep. So the way this manifests in in adults is we will go to, we will go to bed and we will have our biggest chunk of slow wave sleep.
If we’re lucky, about two hours shortly after we fall asleep. And then during the night, we will cycle through lighter stages of sleep, which is like stage one, stage two in REM and then deeper stages of sleep, stage three or slow wave sleep with a cycle length of about, about two hours.
So we’re children, those cycles are shorter and they happen more quickly. And the reason this is germane to nighttime awakenings is that long period of slow wave sleep. If you’ve ever. It’s the holidays, you’re driving home, your kid falls asleep in the car seat, you transfer them to the crib.
You feel like a parenting genius. They’re in slow wave sleep. Nothing was going to wake them up. alSo sometimes for older children, if they’re waking up during that time and they’re absolutely inconsolable or they’re wandering the house acting weird, that is a parasomnia, right? What we call a non-REM parasomnia.
The most common are night terrors or sleep terrors which can be 30 to 45 minutes of screaming and inconsolable being inconsolable. Children are sweating, they’re crying, nothing you do works and they don’tAriellemember them the next day. It’s hard to interrogate like a nine month old, but like a, an older child
Can’tArielleally tell you what happened. Sleepwalking is pretty easy to get right ’cause they’re actually leaving the bed and walking around the house. My older son does this once in a while and I’m a little bit concerned when he goes to college that, ’cause it does happen when he’s stressed.
And then there’s a confusional arousals, which are, they’re not quite a night terror, but someone may sit up, talk in a nonsensical way, go back to sleep. These are all nonArielleM parasomnias, most likely in that couple of hours after sleep onset. And then the sort of REM related phenomenon. So there’s nightmares, right?
Like nightmares have a narrative. If your child wakes up and says, the mouse was chasing me and he had a big hammer and I was just trying to get some cheese. That’s a nightmare that came out of REM sleep. ’cause it has a clear story to it.
But the other thing that is so common in, in kids are what we call sleep onset association disorder. Ariel, I don’t know if you wanna explain this a little bit here, this is such a common cause of nighttime awakenings and it’s an. It’sArielleally when we’re talking about sleep training, we’re talking
About addressing this problem sure. I think that’s probably in when I’m thinking about working with a client again, it’s, let’s look at the schedule and then let’s figure out how is your child falling asleep? So what did you call it?
’cause I, ’cause you, you have like more of the medical term for it. It’s it. So the it, it used to be called, I’m not gonna get into the international classification of sleep Disorders version two, version three, but the common term Sleep Onset Association Okay. Yeah,
Was a subset of behavioral insomnia of childhood. All of these have been lumped under the rubric of chronic insomnia. Now, whether you’re like age three or like 93, you had three months of sleep difficulties. You’re meeting that definition, but I still think it’s a useful
Term because it’s explains a little bit what’s going on. That’sArielleally interesting that would even be classified as insomnia, but I suppose, it’s a dependency on something. And it’s disrupting that dependency is disrupt disrupting your, either your ability to fall asleep or your ability to fall back asleep.
So essentially what that means is what we’re trying to do is teach babies and children to fall asleep independently. So without any sort of sleep onset dependency really rocking. Walking, bouncing, driving in the car feeding to sleep. We want to help the child or baby feel safe and comfortable
In their own sleep space. So whether that be a bassinet or a play yard or a their crib, helping them to learn that they don’t need to. One of the biggest things, and I’m sure you’ve heard this, is my baby falls asleep so easily in my arms.
I place her down in her crib and she just screams and she’s up for hours. And it’s we need to teach baby how to fall asleep comfortably in her own space. And that doesn’t mean you have to place her in there, let her scream and walk away.
It can be a slow progression out of the room. You slowly get her in there while she’s drowsy and then she might get a little upset and you can put your hand on her or maybe even pick her up and put her back down again.
It could take a little bit of time, but, eventually they do learn, okay, I am comfortable here and I can, and I’m safe and I can fall asleep without you. And I can also wake up in the middle of the night as we all do and turn
Around,Ariellealize where I am, and then fall back asleep without having to say mom, come save me, dad, come save me. So that’s really in my opinion, that’s really the definition of sleep training is let’s get rid of the dependency on someone or something. It could be a pacifier.
It doesn’t even have to be a parent. It could be pacifier falls out, the baby freaks out. You have to go back in and plug it back replug the baby. And so that’s, yeah, right? Boop. But there’s so many people that play what we call passy pong all night long,
And it’s disrupting the parent’s sleep, and it’s disrupting the child’s sleep. So ultimately the goal is to help the child fall asleep independently, feel safe and secure in their own sleep. Sleep space. And that leads to, in, in general, at least, to better sleep, both during the day and overnight.
Yeah, I think that it is so important and I just want to tease out a few parts of what you brought forward. The fir. The first is that these are the, what we’re talking about are circumstances. Your child needs to fall asleep that are absent in the middle of the night.
So if you rock your child to fall asleep, unless you are rocking them all night long, they are going to wake up and want to be rocked again. And the timing of this is with those bouts ofArielleM sleep becauseArielleM sleep is actually a pretty light stage of sleep.
If you look at the EEG, like the brainwave pattern, it looks a lot like wakefulness. And if you’ve ever been woken up from a dream, you actually feel pretty awake, like you’re lucid. You can tell the story of what happened in that dream.
Whereas if you wake up out of slow wave sleep, you feel very groggy. And there’s a lot of what we call sleep inertia. So the timing of these events is usually parents get their child to fall asleep. They may even, there might be some struggles around it.
They might be arguing with their toddler eventually, say they rock them to sleep, they lay down with them, they give them a bottle, then the child has that nice bout of slow wave sleep for an hour and a half, two hours. Then when the parents are getting into bed.
The children cry out for them, right? Like they call for them and then the parents have to go and do it again. They have to rock them or feed them or what have you. And that can happen anytime there’s an episode of REM sleep, which is again,
After that first part of the night can happen every one to two hours. It doesn’t have to happen every time, right? Like we’ve all seen those parents who are like, just, they’re dying ’cause their kid’s waking up every hour. But more common, it’s a couple of times and it may also manifest as
An early morning awakening with that last REM period of the morning. There’s a, again, the second half of the night is weighted with moreAriellem and then the parents get in the habit of bringing the child into bed with them. And guess what?
Your 2-year-old is not gonna raise their hand and be like, mom, I seemArielleally tired since I’m getting up at four 30 every morning. And then as my younger son used to do, would stick his whole hand into my mouth. If he was trying to sleep next to me we called it mouth hands.
They’re not gonna stop doing that on their own. So I think thatArielleally, and this is where it can be so helpful, working with a sleep consultant, working with your pediatrician, you actually need to go through the story of what you’re doing at bedtime. Usually these things are obvious, but occasionally they’re not.
It might be something like oh, I, back when people used to have CD players or something, right? They’d play their dream time cd, their baby Einstein or whatever, and thatAriellecording was 30 minutes long. The kid falls asleep when it’s on and the parents have to go in and turn this
On multiple times during the night. So anything that you don’t wanna have to do in the middle of the night, you shouldArielleally try to avoid doing that in your child’s bedtime. When they’re infantsArielleally aged three to four months of age, you try to put your
Child down drowsy, but awake so they can start to learn, fall asleep independently. If it doesn’t work, you can just then soo them back to sleep and try again a couple of weeks later. They develop so quickly.
And I would say that in general just ’cause we want to go through all the other causes when we talk about sleep training, we are talking aboutAriellemoving the dependency on a of a child for their parents or caregivers at bedtime and in the middle of the night.
And a lot of times where my mentor, Judy Owens is like, people are tired in the middle of the night. So you just have to teach them to do their, whatever they’re doing for sleep training and it’s not necessarily cry it out, it’s a behavioral plan to get them
To fall asleep independently and then in the middle of the night they can just do what they need you to soothe their child. Because if they establish independent sleep at bedtime, often, not always, but often, those middle of the night awakenings drop out. Over the course of four to six weeks.
Because the fact is, we live in a country where parents don’t have a lot of parental leave. ThereArielleally aren’t a lot of great supports. People don’t have family members living in their house who can help them. A lot of parents have to go to work, with when they’ve got a six
Week old at home and they just need to survive during the night. So I think in the future we can talk about different sleep training techniques. ’cause there’s a million of them, right? It’s not just cry it out. And this always bothers me, right?
My book’s called Never, it’s never Too Late to Sleep Train. And I didn’t want the term sleep training in the title. Like it has a certain valence to it. Like I don’t have a problem with it. A lot of people do.
And the fact is, well, my agent was like, nobody’s gonna know what you’re talking about if you don’t have sleep training They were they were right about that. But that it has a, in some circles it has a sort of a negative Oh, absolutely.
And I feel like that’s part of the mommy wars it’s this dividing conversation. And it doesn’t need to be, I don’t think it, I just don’t think it needs to be aNd to come back to the definition of insomnia, a component of insomnia is not just what your sleep pattern is.
It can be problems falling asleep, problems staying asleep. It’s also IT impairment or unhappiness the next day. So for an adult, if an adult came in to, I don’t see adults, but I see 22 year olds, they came in, they’re like I sleep six hours a night.
I have no problems getting outta bed. I’m not sleepy during the day. I’m a straight A student in school. But someone told me this, there’s a problem here. I’m like, there’s not a problem. That’s not insomnia. Insomnia has the definition of being unhappy with how things are
Going, and the way that manifests in young children is usually not, the kids are fine the next day, right? They can sleep in the car, they can sleep in the crib. The, they’re not like driving minivans or giving presentations at work.
They’re just like, they can catch up, but it’s the parents that are unhappy, and that’s included in the definition of insomnia and childhood. If the parents are struggling as aAriellesult, that gets you to that insomnia definition. Very interesting. sO let’s talk about, let’s talk about other causes of nighttime awakenings.
And I know this is one of your favorite topics, Ariel, I think maybe we are gonna just name this after you. And that’s it’s sleep regressions Ugh. So that’s a reaction to, but I would love you to explain why, because we’re on the same page
So I’m in, I’m a mom, so I’m in mom groups and I’m in parenting groups and I’m on social media. And anytime a child suddenly has some sort of a sleep disruption, is there an 11 month sleepAriellegression? Is there a 10 and a half month sleepAriellegression? Is there a 13 month?
50 every month Apparently has a sleepAriellegression. But the truth of the matter is that in many cases when a child is developing, so progressing, notAriellegressing sleep might be disturbed. So for instance, there is science to sh that shows that learning to crawl, it affects particularly naps.
And babies might be practicing their new skill in their crib, gross motor developments also learning cognitive developments. So it’s language development often. A lot of times people talk about their 21 month old, their 22 month old, what is going on. And in many I’ll ask, I ask lots of questions.
You have to ask lots of questions to get to the root cause of things and they’ll say, yeah, suddenly the child is speaking a full sentence. And it just started happening last week. And I’m like, when did the sleep disruption start? And they’re like, two weeks ago.
And so it’s okay, a lot of times when they’reAriellegressing in the sleep department, they’re progressing in other ways. And also anytime a child gets sick and you’re, of course you should be attending to them if they’re waking in the night. Rules go out the window.
If your child has a fever or they’re throwing up or they’re sick, they’re not comfortable you’re going in there a lot. And they may get used to that. And when they’re better they’re like, wait, I liked it when he used to come in here and rub my back all night long.
And then travel, we’ve got these. Progressions. We’ve got sickness. Travel is a huge one. Parents go away, they come back and they’re like, I don’t get it. My kid was sleeping so well and now we’re home and I’m trying to get back on track. And the child is just not falling into place.
Things are all over the place. Those are probably the top three things that I see with regard to sleep falling off the rails. But the problem becomes, you might have a bad night or two, and then as a parent
You start second guessing yourself and you’re like maybe what I was doing is not working anymore and my child is upset. They’re not feeling well. Or they’re sad. Or they’re scared, or they’re this or they’re that. and really what it is the child has grown accustomed to whatever new thing
You’ve done to help them fall back asleep when they’re having these arousals that they haven’t had previously. So you might. Suddenly start going in and rocking again. Or they were waking up at four 30 in the morning all of a sudden and you’re like, oh, you are tired.
So you’re like, come to bed with me. And then you’re like, why is he still waking? I thought this would be one thing. And it in my experience, it starts to spiral. You do one thing and then all the other parts start to fall to the wayside and nobody’s sleeping.
So sleep disturbance can happen at any age, depending on when a child is going through anything. And it can happen after sickness and travel. Those are the top things that I see the most. Yeah, travel is one. And I’m definitely seeing the kids where sleep was great and then we took
A trip, shared a shared a room or shared a bed with our 15 month old and then they come back and they justAriellefuse to sleep in another situation. I wanna say also to you, it’s funny ’cause yeah. The, I agree with you. What bothers me about the term sleepAriellegression is that yeah,
If you Google the 3.17 year born in Mercury in retrograde sleep regression you’re going to find it online. And this is just not how it works. Another thing is a lot of parents who had children that were, theyArielleally struggled with their child’s sleep. They worked hard.
They, they read a book, they went to see you, they went to see me, they fixed their kid’s sleep. Six months later, their kid gets a cold or or. Stubs their toe at school or nothing happens and they’re awake for one or two nights and the parents are panicking.
They are it’s like PTSD. They’re like, I didn’t sleep for three years. Now we’ve had six good months and I can’t go back to the way that it was. And it’s almost like you can’t hold on too tightly, right?
Like you can’t white knuckle it too much because it’s just gonna make things worse. And the other thing is sometimes with time we do get a little bit sloppy as parents, right? Like we’re so we’re very regimented And our kids, it’s the holidays.
Our kids stay up a little bit later, we lie down with them ’cause it’s sweet and it’s nice when they do that. And then just you just need to tighten up your bedtime routine like a tiny bit. And you can get back to where you were.
Yeah, tightening it up and then staying consistent with it. I’m just thinking about it. I justAriellecently had aArielleturning client and I worked with her older son and he did great. And then she had a second child. And it’s funny, parents are like, oh, I, this is my third kid and
I should know how to do this. And every kid is so different from the next. And second child, first child could travelArielleally easily and now second child is a toddler. And they went and they traveled and. Quite literally, this child was like just not sleeping at all when theyArielleturned.
And mom was just so desperate. And she knows what to do, right? She knows what’s right. She knows. She knows what’s worked. And you’re just so tired. At some point you start forgetting like, who’s in charge? Is it the kid that’s in charge or is it me?
And like you’re, you start listening to this 22 month old who’s no, we’re gonna walk around the house from one in the morning till five in the morning, and I want some snacks and I want a bottle. And then mom is like the next day like, what am I doing wrong?
And sometimes you just need to step back and have someone say okay. I know it’s scary, but what’s scarier? Or getting up all night with your kid or staying consistent for a few nights, she might get upset, but. If you don’t do this, then you’reArielleally gonna be stuck in a bad place.
But it, it happens a lot. And I agree with you about the PTSD because I certainly had that anytime. ’cause my daughter, sure. I got her sleeping well at five months, but I would say at least once a year until she was about four, we would have maybe a six week period that
I would just let things fall apart. And I’m going, what do I do? What do I do? And then I finally talked to a colleague and they’re like what would you tell your client to do? And I’m like, fine. And two. And then, it takes two days.
I get it done and I’m like, why did I get myself to this place for six weeks of like newborn sleep, but it’s just, it’s hard to be a parent, period. It is. And you know what do we call it?
You, as I learned in medical school, the definition of a phase is when a patient is doing, when a child is doing something annoying, and we don’t know why, but it’s probably gonna go away. Kids. That’s not theArielleal medical definition, but I feel as a parent
And as a doc, sometimes if I’m like, sometimes your child is gonna do something annoying for a finite period of time and you’re not gonna know why. Here’s, I wrote on my website about how my we have a guest bedroom
And my younger son who at the time was like 11 or how old was he? He was like 10 or 11. He just started going to bed and sleeping the other night in the guest room. WhIch is a little, it was a little bit annoying to me because I was like we
Have, it’s another bed to make or what have you ’cause he’s not gonna do it. But itArielleally irked my older son because he felt like. The his younger brother was getting over on something. And I can tell you as an older sibling, it is absolutely intolerable.
Intolerable if you feel like your younger sibling is getting away with something. Still, it bugs me with my brother. I’m looking at you Matthew. yoU know what you did. I think sometimes also we get annoyed by little things that kids do. And then you have to ask yourself like, would an impartial
Observer find this annoying? And is thisArielleally causing a problem? Do they wanna sleep with 10 stuffed animals, let them sleep with 10 stuffed animals? Like it’s, even if it’s annoying to you, if it’s notArielleally causing aArielleal problem, if you explain to your friends, be like, they’re
Doing this is so annoying, and they’re like, what’s the big deal? Maybe you can let some things go. Yeah, definitely. So I wanted to turn to something else you mentioned, which is our medical issues, which is is. Something that, again, we’re not usually talking about serious medical issues, but
Sometimes parents come in and they think they’ve got a behavioral problem, but what theyArielleally have is a medical problem. And the problem, and a lot of common problems will manifest at night. Just to go through the list obviously ear infections are very painful
When you lie down, but there are also kids who have chronic otitis. They have just persistent fluid in their ears. Often that if that’s treated with ear tubes, the sleep will get better. AcidArielleflux, if your child is spinning up a lot at night, treatment of theArielleflux may improve things.
Eczema is actually a big one. And they shown even in older kids with eczema who are itching a lot at night, their sleep is disrupted to the point that they are impaired. Like some, a child with a ADHD is impaired in terms of being able toAriellegulate their own mood, behavior, and attention.
Yeah, no, it’s it’s and it’s worth knowing that this can actually, anything that when you, we all wake up during the night, right? Usually we roll over, go back to sleep. But any, anything that triggers more awakenings from your child may trigger them calling out to you.
Asthma’s one as well, a child with poorly controlled it’s asthma will be coughing during the night and wheezing. And a lot of times kids come to see me for sleep problems and I’m like, this kid does not, I. Has occult or they have hidden asthma. I treat the asthma, the sleep gets better.
And the final thing I want to cover there is actually snoring. Snoring is, we all know what snoring is, right? Because if somebody else is doing it around you, it’sArielleally annoying. And but the irony is that if you ask anyone, they will never tell you that they snore. But. Snoring is not normal.
Like snoring once in a while is fine, but children who snore loudly andAriellegularlyArielleally deserve an evaluation with their pediatrician. They could have a condition called obstructive sleep apnea, which is where the airway, which is the tube that goes from the nose and
The mouth down in the throat gets closed periodically during the night. Oxygen levels can drop, et cetera. And I always tell the parents, this is not, the danger here is not that your child is gonna just stop breathing in the middle of the night.
The problem is that every time your child stops breathing, their brain has to turn on and wake them up a little bit so they breathe normally again. So it’s notArielleally dangerous in the short term, but it is dangerous in the long term to development and sleep quality. Lots of different treatments for it.
Some kids need an overnight sleep test. A lot of kids just need to have their tonsils evaluated. But it’s funny, during the pandemic we saw no sleep apnea, right? Because one of the things that was driving kids tonsils and adenoids. The most common cause of sleep apnea in young children are when their
Tonsils, which are the tissue in the back of their throat or the adenoid, which is similar in the back of the nose, would get big and they get big withAriellecurrentAriellespiratory infections and then they tend to stay big. When kids weren’t having any breathing illnesses, nobody was having sleep apnea.
But now it’s picked up again. And that’s probably a whole other topic for a thing. But I’d say don’t take, don’t ignore snoring. That’s happening more than a couple times a week, and especially infants infant snoringAriellegularly is not normal. Worth talking with your pediatrician about.
I think it’s so important for me to ask those questions right at the beginning before I even start working with somebody because it’s, so I, I try to explain to them also. cHildren who are struggling to gain weight, I would say that’s another one that can cause sleep problems.
Only because in those cases, many times a parent is, has to wake the child up to eat because they can, they only are taking two ounces every few hours. Or failure to thrive, those sort of things. That’s something else that I always screen for, but I try to explain
To the parent, I can’t do anything behaviorally if the child isn’t if the child’s ears are hurting, I, you’re not going to leave them to be alone. And we always need to make sure that health is addressed before doing any sort of behavioral work, because it just won’t, it’s not gonna work.
That’s why it’s don’t waste your money with me because it’s definitely not gonna work unless you have that everything’s cleared. I think there’s a couple of really good points here. The first is your child has to be screened for a medical problem before you start with a significant behavioral plan.
And globally, if they’re not developing normally, if they’re not growing normally , you’re not looking at a behavioral problem, you’re looking at a medical problem first. And I would say the other part of this is to me. If a child is falling asleep on their own and waking up in the middle of
The night, I’m taking a hard look at them for a medical problem. It isn’t always a medical problem, but I’m ruling those things out because that’s aArielleally common manifestation of a medical disruptor of sleep is nighttime awakenings. When the parents have everything dialed in with their bedtime, they’re doing
Everything perfectly at bedtime, the child’s falling asleep independently. The kid’s waking up at night and they don’t know why. Well, Craig, I have a question for you. What percentage of children have actual medical problems, and then what percentage of normally developing healthy children have need some sort of a behavioral intervention
The first one was what percentage of children presenting have actual medical problems? And it’s aArielleally good question, right? Because I could tell you like 1- 3% of children will have sleep apnea, right? If they’re obese and they snore, it’s closer to 50%. All comers like presenting to the sleep lab, I’m not sure
If anyone has those numbers. But what we see in the, in sleep world is a lot of these problems are multifactorial. And that’s just a fancy way of saying there’s actually more than one cause. In medicine we love Occam’s Razor. We’re like, it’s the most which is just stating that simplest single explanation
Is the cause of what’s going on. ButArielleally as one of my mentors used to say, the patient can have as many problems as they damn well please. So don’t get hung up on that. There has to be just one explanation though often, usually there is most
Children are pretty healthy and, sorry, what was the second part of your I guess the second part of my question is. There’s there, having been in this industry for almost a decade and seeing such a rise in the industry and a need for sleep support, behavioral,
Non-medical, I’m wondering what percentage of the average developing child in the United States needs some sort of what, or maybe it’s the parents, maybe the question is, do you think it would be beneficial for parents to have more of an understanding of how to handle sleep to avoid things spiraling out of control?
Because I feel like there’s a surge in the need for behavioral sleep specialists like myself. I would agree, and there’s a lot of different studies that have looked at this but I’ve seen anywhere between 20 and 50% of parents being concerned enough to talk to their child’s pediatrician at some point during their
Childhood about their child’s sleep. So you think about that’s a huge number of people and in some ways there’s more information available, but I feel like there’s also a lot the. The quality of information coming in is less, right? Like it’s harder for parents to know what’s what’s good information and what’s not.
That’s why I started writing online. Know, that’s why you do some of your work too, is there’s a lot of misinformation. Look, anybody’s promising a quick fix or their own technique that they invented or their own terminology, which we see a lot online with
Things like wake windows, which I’m not even gonna get into right now. Which isn’t based a lot in sort of science. Before we get sidetracked on one of my favorite hobby horses, of all these weird stuff that goes on I just wanna make sure we cover a couple of Sure. Let’s do it.
Of nighttime awakening. So nighttime feeding and learned hunger. What’s your what’s your take on this? Oh gosh. I feel so, I always like to say I am not, if a sleep consultant starts working with someone and says, without any digging, we’re going to eliminate all feedings overnight Arielleally fast, we’re just gonna
Take ’em all away, run for your life. It is not my job to determine. Whether your child needs a feeding overnight. Now that being said, if your child is normally developing, there are no health issues. And say this, you got a seven month old baby and they’re waking every an
Hour and a half to eat, we gotta look at that because there’sArielleally no need for a seven month old to be waking up and eating, every hour and a half. And I think that comes back to what we were talking about with learning how to fall asleep independently.
In many cases we see that those children are falling asleep on the bottle or on the boob and nursing to sleep. And when they wake up, that’s the way they’re falling back asleep. I do also think, you talk about learned hunger I always try to equate it.
I think it’s important for parents to understand we have all these terms, but what does that mean? So I see it as this I got hungry for lunch at 11:00 AM today. Normally I eat at midnight or midnight at noon.
And today I was hungry at 11, and then tomorrow, oh, I’m hungry at 11 again. And then the next day. And so I, I eat and I, and then I’m hungry at 11. Again, it’s very similar to a child that maybe doesn’t even need a feeding, but
They’re waking up and their metabolism they get fed and then their metabolism’s oh, okay, that, that was nice. Maybe I am hungry at 11:00 AM every day or 11:00 PM every night. I think it’s for my, what part of my job is, first of all, I wanna know
What the pediatrician has to say. If you’re working with Lact, a lactation consultant, I wanna know what they have to say. I think it’s also important to look at how much are they getting throughout the day, because. In many cases, feeding is another area where parents often don’t know what’s going on.
Like they’ll ask the pediatrician. The pediatrician will give them a handout. Not all pediatricians, but some, this is how you’re supposed to feed your baby. And a lot of times I have clients that are switching from breastfeeding to formula or vice versa and not usually vice versa.
But usually it’s breastfeeding to formula and it, it’s important for parents to understand that’s not a one-to-one ratio. So of, an average bottle size for a breastfed baby is four ounces, but that’sArielleally three quarters or a half of what a formula fed baby bottle is gonna look like.
And they get confused, and then the babyArielleally is hungry overnight. So looking at how many feeding sessions, how many ounces, things like that. Let’s ensure that this baby is getting fed throughout the day. And if they are, and they’re normally developing in other ways, we can
Look at ways to at least get down to one feeding, something like that. I’d love to hear what you think about that in general, sure. I think that I think a couple of things. First of all, it is certainly, it’s trickier with moms that are breastfeeding, especially if they’re breastfeeding exclusively.
Because the breast is such a powerful, so soothing, right? There’s a lot of dimensions to breastfeeding. ’cause a lot of times the, and I tend to see kids that are older, right? So someone’s like nursing their toddler, they have no milk supply. They’re nursing their toddler five times a night.
It’s not a nutritional problem at all. It’s, it what they’re providing there is physical contact and comfort, and you don’t need to worry about weaning those calories there. I’d say that certainly with a child that is growing well and moving along their growth curve a lot of parents who are breastfeeding, especially the
Moms, are back to working full time. They’re happy to nurse once during the night, and that’s sustainable. And it helps them maintain their milk supply. So I don’tArielleally rush people to get rid of that if they’re happy with how things are going.
In my world, a lot of times I am seeing older kids they’re nursing, they’re drinking bottles, they’re drinking they’re drinking juice during the night and they’re obese. So I’d say as a rule of thumb, honestly, a normally growing child over a year of age does notArielleally need those calories a night.
And if you find that you are meaning to give milk or anything else during the night you, I give you permission to cut it out and you may want to wean it slowly. That’s what Ferber talks about in his book. And I’ve had good luck with that. Other parents have wanted to just.
They don’t want to be like measuring out different aliquots of milk during the night and they just wanna go cold Turkey again. It may be a little bit more, a little bit more conflict. But it could be the right fit. But again, this is why you have to work with your pediatrician.
’cause I think it’s very hard to sort this in the first six months of life in the six to 12 months. It’s a little bit easier, but it’s not a slam dunk that you can necessarily just get rid of this after a year.
Honestly, if you don’t want to do it anymore, you don’t have to do it anymore. Would you say that’s fair? Yeah. And I think what, but yes, and I think that it’s another area where education is needed for parents because, the switch from nursing all day or giving formula
All day to solids is a strange one. NobodyArielleally guides you through that. And a lot of what I find is parents are concerned that their child is not getting enough milk and they think that it’s still this mandatory thing that they get 24 ounces of milk. Every day.
So they’re like the only time he will take a bottle is at bedtime in the middle of the night and as soon as he wakes up. So they’re like very concerned about that piece. So I feel like that’s where more education might be needed so that
Parents can understand a healthy normally developing toddler does not need that. Does not need that. And I also think it’s important to note that toddlers grow that their growth is so much slower than an infant from birth to age 12 months.
It slows down exponentially compared to an infant or a child who’s born at five pounds and by, 12 months, they’re 20 pounds or 25 pounds. That’s a huge growth. And they need lots of. Breast milk and formula. But as they get into toddlers, they become pickier and they don’t need they’re not
Gaining 20 pounds the second year of life. And so I had Hope, hopefully not. no, yeah, hopefully not. And so I’ve had actually Dr. Porto was one of those people that I’ve talked about this with. And just Anthony Porto who I work with at Yale, who’s a pediatric GI doctor,
Who’s written a wonderful book on. I’m feeding in unm, feeding in children. yes. He’s highlyAriellecommend, I don’tAriellemember the title of it, but I’ll put it in the show notes. Yeah. It’s, oh man, guide to feeding or something. pediatrician’s guide to feeding babies and toddlers. Yeah, we can put that in the notes.
But point being is, I’ve had my own pediatrician say this. I heard, I’ve talked to Dr. Porto about this, and toddlers, it’s like. Parents will be like they only ate a handful of this and a handful of that. And basically that’s normal for toddlers. It’s normal for them.
Like basically if they have an one good meal in 36 hours, you’re doing just fine. So understanding that is important. everybody thinks they’re a feeding genius with their like 10 month old be like, oh look, he eats avocados. And then a year later and you’re like. You’re just like, screw it.
Let’s just give ’em chicken nuggets again. yeah. Oh yeah the toddler diet. It’s just, it’s all tan, right? French fries, chicken nuggets. I know that. That’s it, basically. Yeah. Don’t it is what it is. Don’t judge anyone till you’ve been there. Yourself. Oh man.
You could do a whole show about things I never thought I would do as a parent. yeah, for Yes, just feeding my child salami from the from the bag sure. Yeah, Here, take the bag. Take the bag for yourself. Walk away with it.
Throw it on the floor if I’m distracted for a little bit. So I. I wanted to talk a little bit about adjustment issues. I don’t know if this is a terminology that is used a lot in, in, in your practice. We, withAriellegard to changes in life or changes in, for instance,
Transitioning from the crib to the toddler bed or adding a sibling. So I’d say that adjustment, insomnia. There is a technical definition. It’s less than, it’s less than 30 days of disruption of sleep when there’s a major life change. So you mentioned a big one, new baby in the home.
Moving to a new home is one. Certainly it can be things like, if parents separate is one, and that tends to be a little bit more complicated to unravel or deal with, obviously. ’cause it’s a mu it’s a, it’s an ongoing stressor for children.
A lot of the times, for most of these things that are not as significant, a life change, like I’m, again, having a new sibling is a big deal, but children tend to habituate it pretty quickly. I think the key is with a lot of these is making sure that your child is
Getting more attention during the day to support them through these changes. ’cause otherwise they’re gonna be looking for that attention during the night Yes. And it is okay to give that to them during the night. One thing I will say that parents I think worry about too much
Is a new baby or another child disrupting their children’s sleep. In my experience, if a 2-year-old is sleeping well, when the baby is born, that, when that when the baby is crying, they’re probably gonna sleep through it. A lot of the time it’s less of an issue that parents think it’s ’cause parents
Worry about things like sharing rooms. If your kids have to share, I wrote an article in New York Times, I’m like, if your kids have to share a room where you want ’em to share a room, it’s fine. That’sArielleally, until veryAriellecently it was unusual for children to have their own rooms.
It’s a luxury right. For that to happen. So I’d say no. I was gonna say if you’ve got these big changes on the horizon, don’t be surprised if there’s a little bit of disruption, but it shouldn’tArielleally last that long. Yes, and I wholeheartedly agree with more attention during the day.
You mentioned the sibling thing, and I find you’re absolutely right with, they’re always worried that the crying is going to wake up the older sibling, but I find that the bigger issue that I see is a little bit of jealousy because
The older child wants to be sleeping in the room as the same room as the baby. Why does baby get to sleep in the room? But I don’t. And so having. I, with the sibling thing, I always try to encourage, make sure the child
Is getting a little bit of extra attention from one or both of the parents during the day where it’s one-on-one. It’s not, there’s, if you can, obviously it’s, this isn’t always doable, but one-on-one attention, even if it’s 15 minutes at the playground or something just quick. But it’s meaningful. That’s important.
But I also find that playing up the role of Big Sibling and making it an exciting thing and giving the child a job to help you. Oh, you’re helping, could you go grab me those diapers? That’s so helpful. You’re helping what a great big sibling you are.
Like in involving them in the daily mundane things that seem like nothing that can make a huge difference. And I agree with you that it if if you start to, the child just want, wants to feel included and as though they’re still important. So making sure you’ve got that, andArielleestablishing that if needed.
That should help with overnight. Yeah I think the best single piece of advice I got when I had young children was give your child a job. Like in any situation, like when they are bored they will do some, they will
Give themselves a job, and it is often a job that you wish they did not have. Yeah, sure. I don’t know. I, when I perhaps I’m hallucinating, but I feel like my younger brother stuck pieces of cheese in the VCR back when VCRs were things that people had. Oh,
I was trying to think of an analogous, I’m like, CD player. I’m like, I’mArielleally dating DVD player. Yeah, Yeah, Kids these days, even the parents these days are less familiar with some of these ancient technologies. So let’s talk about nighttime fears.
That’s a that’s another one that can, some often is more emergent at bedtime, but can also emerge during the night. What, how often, when do we, are you seeing nighttime fears or dealing with them? I don’tArielleally see a lot of nighttime fears. I do.
I think that sometimes children want to name aArielleason why they feel they need the assistance of their parents. So they may say, I’m scared of something so silly, like lobsters I’m scared of lobsters. And it’s okay, we know that there are going be lobsters in your bedroom.
But they, it’s like, why are you calling me in here? What is theArielleason? And I think that a lot of times they can’t name what the fear is. And if you look at child development, I. Around that toddler age, that 3-year-old, 4-year-old thing, their biggest fear isArielleally being separated from their parents, soArielleassuring
Them that you’re going to be there. I love using things like a bedtime book that you make with the child that hasArielleal photos of you sleeping in your bed, the child sleeping in their bed, nothing going on overnight, everyone waking up happy from their own bed and doing thatAriellepetitively.
I think almost there’s a lot of fomo going on at this age. And but withAriellegard to fears, I know you’re not a huge fan of Monster Spray. I like to use it as like Safe Sleep Spray or Happy Sleep Spray. Why don’t just explain what that
So yeah, so like how, so a Monster Spray is. No, you basically fill up a jug of, a spray bottle with water and you say, spray this to keep the monsters away. We don’t wannaArielleally feed into their whole belief that there’s a monster in the room.
Although I will find that, I do find some children want it to be that way, versus this is just for happy sleep. They like having control over their fear. So I’m spraying this and I’m keeping away the lobsters. Okay, great. But it, for other children, it’s just going
Here’s the thing about that spray. It totally works. You start spraying this stuff around. Hundred percent guarantee No lobsters. No lobsters in the room. So it works. And then, I’m just I’m just imagining the bedtime book. And then they’re flipping through and all, there’s a picture of the child
Sleeping and then a picture of the child with a lobster like a lobster on top of oh gosh. Sound asleep. iT would be funny, but don’t traumatize your kids, Dr. Kids Yeah. And then, the flip side is instead of like playing up the idea that these
Fears areArielleal, just using the sleep spray to spray the room and say, this is for, this is hair, happy fairy sleep spray or something like that that can be helpful for some children. It, and these tactics don’t work for everybody, but those are certainly
Some of the things that I utilize with my toddler and preschool clients, a lot of the time when you can present a couple of these options to parents and they have a feel for what’s gonna work with their absolutely absolutely.
One thing I like for this is a huggy puppy, which is a, it’s an intervention where you give a child a stuffed animal. And there’s a story that goes with it about how this is a lonely puppy and, he’s a little bit scared, so can you take him and have him stay
With you and comfort him at night? And they found the children, even children who have experiencedArielleal trauma. This is and I’ll put a pin on that for a second was very helpful with them sleeping through the night and then helping somebody else made them feel braver.
But, there are some kid, this works great for a kid that likes stuffed animals. I’ve had some parents be like, yeah, my kid doesn’t wanna sleep with a stuffed animal. She doesn’t like stuffed animals. This is not gonna work for them.
And I would say as, just to come back to the trauma aspect, we know that people have experienced trauma in their lives. And unfortunately it’s common in the us it’s common in other parts of the world. It can manifest the significant sleep difficulties.
And sometimes it’s a very clear trauma, like a child being in a car accident. I’m not gonnaAriellepeat some of the stories I’ve had, the children have told me that are surprising andArielleally terrible things, the witnessing terrible things. And sometimes it’s something like a near miss car accident where
Nothing bad happened, but they can’t stop thinking about it. And I say in a situation like that, if a child isArielleferencing something in their experience that happened to them, or even something they heard about happening in another family member, usually to unpack that, youArielleally need some professional help for that.
That’s not something you tackle on your own. So in that scenario again, I don’t want parents to be like, oh, my kid’s waking up at night. I ha the, I’m worried that there’s something hidden as horrible has happened to them. You’d almost always know what this event was, and older
Kids are gonna be telling you. About it. This isArielleally an opportunity to work with your pediatrician and a mental health provider to unpack that sort of stuff. That is not I’m not a psychiatrist. I have a psychologist that I work with. It’s notArielleally even a primary care doctor or sleep consultant.
This is not in their wheelhouse to, to deal with those sorts of things. Agreed. So I think we have two more on our list. One is one is environmental causes. These are slam dunks if you can find them like environmental causes of nighttime awakening. well, environmental causes.
It’s interesting that you bring that up because I, IAriellemember working one time with this family and it was twin 9-year-old girls and a five-year-old girl. And they all ended up in bed with their parents, all of them. eVery night since the nine year olds were born, they all ended up in their
Parents’ bed by the end of the night. And I went, I actually went into their house. I don’t do that frequently, but I did. And we sat in the bedroom where the two older siblings shared, they were twins. They shared a room. And I said it, what in here bothers you?
What if we’re shutting the lights off, we’re gettingArielleady for bed? Is there anything in here. That bothers you? And she said yeah, that doll is always staring at me. And the mom’s you never ever told me that. And she said yeah, it freaks me out. And I said okay, we canAriellemove the doll.
And she said, and I don’t like it when the light is on in the closet and the door is slightly a jarred. She’s like, why haven’t you ever said that or changed it? And she’s I don’t know. I guess I neverArielleally thought about it.
Now she’s a lot older, so she’s nine and she can tell us that. I think there are things that, that bother us and then bother children and we need to be looking at that. And I also think so for light is an interesting thing because a lot of times
We’re like, don’t bother with a nightlight when they’re little like babies. You don’t need to worry about it. They’re not afraid of dark at that age. But I think that some children do get afraid of the dark as they get older. And adding the nightlight can be a game changer.
Others, they don’t like the light at all. They don’t wanna see shadows, so that’s certainly something you can control. But what would you, what other things do you think about? Yeah I just have a question about this doll. Was it like that creepy clown doll in Poltergeist? wasn’t that scary?
It was like an older, I think it was like the mom’s doll. It was definitely an older doll that looked a little creepy. wAs it Annabelle from No. or the Close. movies or something like that? No. And my daughter has this stuffed unicorn. It Jigsaw movies.
Yeah, my daughter has this unicorn that has big eyes, and she’s this doll, this unicorn just staring at me all night. I’m like let’s get rid of it. What? If it’s bothering you, why are you keeping it in here? Yeah. No I think look, technology is a big one, right? Don’t have.
Televisions, smartphones, tablets in your kids’ room? No. No. Look, no matter what, right? This, most of the people listening this probably have younger kids, but don’t start if there’s a sibling in the room, do the, does the sibling snore?
I’ve had kids come in to see me and they’re like, oh yeah, my sibling is up snoring all night and be like Arielleally, it’s the sibling that needs to come to see me for their sleep apnea. The neighbors, right?
Like a lot of, I live in the suburbs, but a lot of people live in cities and they live in apartments with thin walls. So the neighbors get up at a certain time. The trash collection comes at a certain time. Things like sound masking like with a sound machine can be helpful.
Again, don’t put it near your kid’s ear, but like running a fan can help mask some of those signs. Blackout curtains are great. And one thing I wanna say too is, I see some kids who have problems they have sensory disorders. They’re common in children with autism, but also in children without
Autism where say certain tags on their clothes will bother them. They’re very finicky. They have to have certain socks without seams, et cetera. And sometimes those children will actually Ariellespond well to if they like to be wrapped up tightly.
I like a, lycra sheet, which is like a sheet that will wrap around the child’s mattress like a sock and they will slide into it. I say this is clearly not for an infant or even a young toddler, but for an older kid that can be very helpful.
AndArielleally for me, those kids, I’m showing them a picture in this, in the be in the clinic, does this look comfortable to you? And they’re like, oh yeah, I’d like to try that. It’s 20 bucks. Whereas a good weighted blanket, honestly, I.
What I like way you get the same benefit as a weighted blanket, but weighted blankets are hot so they don’t work well in the summertime and they’re expensive and they fall off of your head like they fall right off. Also if your kidArielleally is having a lot of sensory issues, struggles,
Loud noises, bothering them, et cetera, working with an occupational therapist can actually be game changing. So I think that’s an important thing to, to think about. And then our last cause we are gonna talk about is something called too much time in bed syndrome.
So this term comes from a sleep psychologist named Brett Kuhn, who works out in Nebraska. He’s written a lot of, done a lot of good work in the sleep, behavioral sleep space. And this is where parents are having their child in bed for a period of time
That it’s too long for their sleep needs. So you mentioned like Mark Weissbluth, like he likes early bedtimes, which youArielleally do work well for some kids, but we know that as you get older, your sleep needsArielleduce. So if you had a one-year-old that was sleeping great from 6:00 PM to 6:00 AM
So they’re sleeping 12 hours a night, everybody’s high fiving and singing kumbaya like mission accomplished, right? And then all of a sudden at age three or four. The parents have kept the same schedule and this kid will start waking up in
The middle of the night for an hour or two, quietly playing in the room. Not that quiet ’cause the parents are waking up and calling me about it. But they’re, and the key with this condition is the sleep opportunity is in the long side for their age and their bedtime is good.
They’re falling asleep independently, and they’re not necessarily going to get the parents at night. They’re just playing in the room quietly because the problem is not that they can’t fall asleep on their own, the problem is they just have insufficient sleep.
So another way this can manifest is when children are getting to the age when they’reArielleady to drop a nap. So like you have a three-year-old, and all of a sudden, when they take a nap at daycare, they’re falling asleep at 10 o’clock at night after three
Hours of arguing with their parents, and on the weekends theyAriellefuse to nap and they’re falling asleep at seven or eight o’clock at night. And that is often a signal that it is time for that child to drop the nap. And again, naps are a whole other domain of agony to talk about.
Because if you think bedtime, if you think nighttime’s tough, naptime is like the wild West for lots of differentArielleasons, but I know what are your what’s your take on this? And the kids that like, there’s a disconnect between how much time they’re spending in bed and how much time theyArielleally need, how
Much sleep theyArielleally need. Sure. I think it’s interesting ’cause you mentioned earlier that you don’t tend to work with infants and a lot of the people that I see are on the younger side. I definitely see the older side and I hundred percent agree with you about, the dropping of the nap.
It gets so frustrating because, we’re so limited with childcare and daycare centers. You know that this child needs to drop this nap. It’s affecting their nighttime, it’s affecting the parents’ nighttime, the whole family is suffering, but the daycare center can’t accommodate dropping the
Nap because they don’t have anybody to actually watch the kids that don’t nap. It’s a very tricky situation and frustrating. And as a, working parent, I understand that frustration, but it’s frustrating when I get a client like that, that they can’t control what’s happening during the day. Because it absolutely, you’re absolutely right.
They max out on their sleep. They no longer need. A two hour nap and a 12 hour night, they might need a 10 hour day total. And that’s okay, and they’re doing just fine with it. But you sometimes you can’t control that in today’s society.
But I see that a lot and absolutely agree with you that’s a sign that it’s time to drop the nap. We either see it, I usually see it either at bedtime, the kid naps, bedtime’s a disaster, or on the other end kid naps falls asleep just fine,
But is up at four in the morning suddenly and can’t go back to sleep. wIth infants, I find that the opposite is often true. Parents don’t know a lot of times how just how much sleep infants need and just how important an age appropriate schedule is.
And so I’ll get parents that, they wanna take their children out until 11:00 PM and they don’t understand why this isn’t working for their child. And, and you explain that, infants need 12 to 16 hours of sleep in a 24 hour period.
But that again goes back to what you’re talking about because for a 12 hour total sleeper you’re looking at, that includes naps. So the baby might be sleeping two hours total and naps during the day and they’re only going to sleep only 10 hours overnight.
Whereas the child, the baby that needs 16 hours of sleep is getting four hours of sleep during the day and 12 hours overnight. And, going back to wake windows, those wake windows are wildly different. You’re looking at 12 hours of awake time versus eight hours of awake time during the day.
And, that’s a big variance. So I see, I definitely agree with the too much time in bed and having the over expectation that your child should be sleeping way more. But I also see on the other end that parents just don’t know. How much sleep their child should be getting and what does
AAriellestorative nap look like? How long should that be in order to keep them allAriellested throughout the day and get them to a bedtime? But but parents also often want a bedtime that is too late for their child and that then Yeah.
Because when, so both parents can see them when they get home and stuff like that. Yeah, no, this is so very this is valuable to me because the nature of my practice is we have a long wait list and we see a lot of medically complex children.
So when people come to see me, they’ve been struggling for a while. And I’d say my clinic population is enriched for kids who have some layer of medical complexity here. But it is, so the first year is so hard and it’sArielleally hard to make blanketAriellecommendations.
I’m, we’re gonna put in the show notes, the link to the the normal sleep ranges for age. But with babies, it’s a huge, it’s a huge range of normal. What we do know is kids who are a high sleep need in infancy, they’re gonna be higher sleep needs throughout childhood.
And a lot of times, honestly, you’re talking about the population of people who kids have high sleep needs and the parents are struggling. In my experience, a lot of the times, especially if it’s a first kid, those parents feel like they’re geniuses, right? They figured it out.
All their friends are hysterical and they’re like, I don’t know, my kid sleeps great no matter what I do. But then if they have, if they have a second kid and that kid cannot just nap ad-lib and they have to pick, take that kid out of the crib to pick up the other
Kid at preschool, then things fall apart. My older kid was one of those long sleepers and we brought him home from the hospital after four days. And back then there was notArielleally aAriellecommendation that they stay in the room with you. That’s likeAriellelatively new. He’s 16 now. Be for SIDS prevention.
And he slept for eight or nine hours a night our first night home. And I woke up and I’m like, oh my God he’s dead. Like I went, I can joke about it now ’cause he was fine. But I was like, I spread it into his room.
So I think to just bring this all together, if we were, if we wanna try to generalize this for what are, what do parents, what are the take homes for parents? I would say that the first thing is make sure there’s not a medical problem, right?
If you, your child is not sleeping through the night, meet with the pediatrician, make sure they’re growing normally, developing normally, and that the, any, the common garden variety problems they have, like eczema are well addressed, right? I think that’s step one, right? Absolutely medical. Get medical clearance, step one. Absolutely.
I think step two is actually getting some data, right? Track your kid’s sleep for three days. Again, it’s not, you just write it down. When they’re falling asleep, when they’re waking up, know when the awakenings are and look at what, where their sleep duration is. Are they falling in the middle of that?
Those sleep needs by age, if that, if not, if they’re like way less than it, they probably need more sleep. If they’re on the high end or higher, they might actually benefit from a later bedtime or dropping a nap. Again, it’s hard to generalize, right?
’cause we’re talking about kids from three or four months of age to I don’t know, age 10 here. ButArielleally knowing where your child is falling. Is your child falling in the normal sleep range or not? That isAriellereally important clue. And I thinkArielleally working working towards independent sleep at bedtime.
That’s that’s the third step. That’s that is sleep training. Whether your kid is six months age or six years of age, there’s a million different ways to do it and we can talk about it. But and there, I guarantee you there is a technique as a parent that you will feel
Comfortable doing if I don’tAriellecommend cry it out with a 4-year-old, right? But it might work well if you’ve got a seven month old. But it has to feel in accord with your parenting values. I Dunno, what am I missing? What are any other big top line take homes for people?
No, I don’t think you’re missing anything. I think. The independent sleep, first of all. Yeah. The medical clearance tracking isArielleally important. And if you’re confused about your tracking, talk to your doctor. Ask if it’s, if it looks normal and if it’s not, if it doesn’t
And then absolutely the next step is figuring out how can I help my baby or child fall asleep without needing me to do something extra. And again, we can talk about that. You can talk about that at another time, but that doesn’t, again, it does not
Mean to be, you just plop them in the crib and walk out and let them scream. You can be there with the child to help them learn to feel safe and secure there. And then, like you had said, once you’re able to.
Once a child is able to fall asleep that way, they’re usually going, that’s going to overlap throughout the night. And then during the day it’s going, they are going to catch on andAriellealize that they’re safe, secure, happy, healthy, all of that and fall back asleep without much assistance or any assistance.
When you think about it as a parent you help your children are gonna learn to do stuff on their own, right? But you can help them. You can help them. You help them by introducing solids at the right time. You help them, when they’re learning to walk, you’re like holding their
Hand and it, this is another situation. You are teaching your children an incredibly valuable life skill to be good sleepers, right? I’m always like, some good sleepers are born and others are made. So if you’re struggling, let’s make your child a good sleeper. So Ariel, anything you wanna plug? Anything?
Where can people find you online? I’m not actively practicing at the moment, but if you want toArielleach out with me with any questions, concerns, thoughts, or ideas, I can beArielleached at ariel@arielgreenleaf.com. I, Okay, you look forward to a bunch of emails now. whatever. That’s fine. Bye.
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