What if I WANT my daughter to come visit me at night?

"Do you really care about him getting into bed with you at 3 a.m., or do you think you should care about it? At some point in American culture, we have decided that “good” children don’t stray from their beds once moved from a crib, but children regularly pop in and out of their beds well into elementary school (and sometimes beyond)."

Question of the Week #3

We put our son (at the time 19 months) into a toddler bed as he was climbing out of cot and he took to it brilliantly, however few months on he has become a nightmare, he won't settle and when he finally does he's awake within a few hrs and then continues to get up and out. I stay with him till he settled but still back up 20mins later. I'm at my wits ends as he's getting up every day between 4-5 as well. Plz help

The New Safe Sleep Guidelines - American Academy of Pediatrics - October 2016

Overall, I am happy with the Safe Sleep Revisions the American Academy of Pediatrics published last week. Of note, the AAP (and likely soon to be reiterated by the Canadian Pediatric Society) continues to discourage the practice of bed-sharing but seems to have realized that while this practice has been discouraged for years now, families continue to believe that this is a very healthy sleep setup, and will continue to do so regardless of their recommendations.

As with their recommendations regarding Media Guidelines (recently revisiting the "no TV under the age of 2 rule" which, at least in my house, is not realistic), the AAP finally seems to be more in tune to the realities of parenting in 2016. That with long interrupted nights, especially in the early months, not everyone is capable of following these guidelines.

 

A more open-minded approach?

I am hopeful that with this more understanding view of infant sleep in the first year of life, that parents will feel less shame if they do decide to bed-share. It has been reported that up to 80% of families bed-share at some point during their child's first year of life, but only a small portion of these families share this fact with others, including their pediatrician or family doctor, losing out on an amazing opportunity to discuss safety recommendations while bed-sharing.

In my practice, I would venture further to say that of these 80% of families who bed-share, only about 25% of them go into life with a newborn with the intention of doing so.  These are the families that take the time beforehand to research the ideals of bed-sharing . The remainder of families are what I call reactive co-sleepers.  The, "it's 2 am and I NEED sleep so I'll just bring baby into bed with us" or the "I'm so tired I fall asleep on the couch feeding my baby during the night" parents. And absolutely no judgement here - I did both of these with my eldest!  The point being, unless we are going into life as a new parent having researched the ideal conditions of bed-sharing, most of us are likely to end up putting our babies in even WORSE sleep environments (couch, chair, sitting up in bed). If parents weren't shamed into thinking there is something wrong with bed-sharing, would it possibly give us as healthcare practitioners, sleep coaches, and hopefully friends and family, a chance to ensure these new parents know how to bed-share safely and prevent many unnecessary deaths?

 

Advocating for mom's mental health...

The American Academy of Pediatrics also continues to encourage room-sharing for the first year of life (or at least the first 6 months of life) as it has been shown to decrease the incidence of SIDS by 50%. As most of you know, I began my career as a sleep coach and educator after suffering from severe postpartum anxiety with my first child. I have since become a huge advocate for women's mental health. And here lies my only concern. As a new mom, chronic sleep deprivation can increase your chances of postpartum depression, anxiety and other mood disorders exponentially. Babies are NOISY sleepers. Anxiety rises as you wake to each and every sound a baby makes. Some parents may even respond to a baby before it is even awake at times because they think they are hungry or need help getting back to sleep, when they are actually just little grunters moving through a phase of sleep where twitching muscles and irregular breathing patterns make them appear awake.

As these babies get older (closer to 6 months), they become more and more aware of our presence next to them and can occasionally wake more frequently between sleep cycles because of this. Many babies continue to wake multiple times a night until they are moved into their own rooms.

I have seen time and time again a sudden improvement in both baby's sleep, as well as mom's mental health, as soon as baby is sleeping in his or her own room and everyone starts getting the sleep they need to function as a healthy family unit.  Not everyone sleeps well with a baby right next to them.

So although I do strongly encourage families to attempt to follow the recommendations the AAP has provided us with, I fully support families with whatever sleep setup they feel works best for their unique family dynamics, and encourage them to makes the appropriate arrangements to maximize the safety of their sleep environments while doing so. What do they tell us during the in-flight safety announcement before departure on any flight? Put on your own oxygen mask before helping your children with theirs? This applies to sleep as well. We need to take care of ourselves before we can be expected to provide for these little monkeys.

 

Here are the AAP's new Safe Sleep recommendations:

1. Back to sleep for every sleep
2. Use a firm sleep surface
3. Breastfeeding is recommended
4. It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.
5. Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
6. Consider offering a pacifier at nap time and bedtime.
7. Avoid smoke exposure during pregnancy and after birth.
8. Avoid alcohol and illicit drug use during pregnancy and after birth.
9. Avoid overheating and head covering in infants.
10. Pregnant women should obtain regular prenatal care.
11. Infants should be immunized in accordance with recommendations of the AAP and Centers for Disease Control and Prevention.
12. Avoid the use of commercial devices that are inconsistent with safe sleep recommendations.
13. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly.
14. There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS.

Read the full article published by the AAP here for more details.

Tackling the Time Change

Spring was awesome, wasn't it?  The clock moved ahead one hour and all our little early risers were suddenly sleeping in til a more reasonable hour!

... But what does that mean for Fall??

Hate to be the bearer of bad news, but this is the harder time change of the two.  This time around, our clocks will move BACK an hour. The only excited yelps are coming from homes of people who don't have kids.

"An extra hour to sleep in!!" They say.

HA.

Not for us parents. Instead, we are suddenly going to have children who are going to want to start their day even earlier.

But don't despair. There ARE ways to make this transition easier. Read on for some of my most effective tips.

1. Make sure your child is getting adequate naps during the day.

A well rested child will be able to shift their schedule much easier than a child who is already overtired.

2. For younger babies and sensitive toddlers, approach the time change gradually.

A few days before the time change, start pushing bedtime later in small increments each day. For example, bedtime is normally at 7pm. Start by pushing bedtime to 7:10pm, then 7:20pm, then 7:30pm, etc, until you reach 8pm. By the time the clocks turn back, your child will be adjusted to an 8pm bedtime which will ultimately become his previous 7pm bedtime.
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3. For toddlers and older children who tend to be more adaptable to new routines, a quicker shift to the new time may work out just fine.

Complete the time change in one fowl swoop or break it up into 20/30 minute increments, whatever you feel your child can handle.

 

4. Don’t just shift bedtime, shift naps as well!

 

5. Shifting meal times will help your child’s body adjust quicker.

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And finally,

6. Don’t rush in to your child’s room in the morning.

Give them a few extra minutes as you will inevitably be dealing with some early risings for the first little while. This is completely normal and will take up to a week for your kiddo to get adjusted to the new time.

 

There are obviously some exceptions to these suggestions...

Children who are in daycare/school often have no flexibility with nap times and you will obviously have to make a quicker change. But you can still approach it gradually over the weekend prior. In this case, adjust naps and bedtime by 20 minutes on Saturday, another 20 on Sunday, and by Monday when they are back to daycare, they will now be on the new time.

 

In the end...

Regardless of which approach you take, it will take several days for your child’s internal clock to adjust. Early mornings, crankiness before bedtime, all normal and part of the deal. But hang in there; stay consistent with your new schedule and your little ones will catch on quickly.