Safe Sleep Guidelines

As a sleep coach, I promote a safe sleep environment with all the parents I talk to. But as a mom, I can see why not all parents are aware of and/or choose to follow these specific recommendations. Just as it took a few decades for everyone to get on board with always wearing a seat belt to address car safety, I believe sleep safety is on it's way.

But we are not quite there yet.

 

Wanting a Martha Stewart nursery

Store flyers and display windows are constantly selling beautiful cribs filled with cushiony bumpers, fluffy blankets and soft cuddly teddy bears for our kiddos. Before having my first, I admit I wanted to buy it all! But in the back of my mind, I'd remembered hearing that newborns shouldn't have these things in their crib. Surely these stores wouldn't be selling anything that was not recommended and could put my baby in danger??  Pottery Barn and Babies R Us are notorious for this. With no warning signs or recommendations for safe sleep practices, they send millions of new parents home with these items that only serve to increase the chances of suffocation and strangulation.

Can you guess from the photos below which one represents a safe sleep environment? Unfortunately, it's not what catalogue covers are made of, but it IS what we should be creating at home for our little bundles.

  RIGHT

RIGHT

  WRONGGGGG

WRONGGGGG

 

"We used to..."

I have much less anger directed towards this next group as I know their recommendations are coming only out of love, but our parents. Ahhh our parents.

99% of the time, I marvel at how amazing my mom is. How she knows what to do to get poop stains out, how to help decrease a fever, how to get marker out of the microsuede couch. But there are a couple of things that our parents generation did that are just not recommended this day and age.  Hearing "We put you to sleep on your tummy and you were fine!" only adds to our overwhelming body of contradicting advice.  Google says this but mom says that. And I'm not surprised that a lot of people trust mom more than Google.

But there has been extensive research in the last couple of decades showing that putting a child to sleep on his back is best and that the number of SIDS related deaths has decreased exponentially since the initiation of the "Back is Best" program. No one is saying that your child will stop breathing the minute you place them on their tummies to sleep, but if you could do something to lower those chances, I know most parents wouldn't do it in a heartbeat.

So without further ado, let's get to the nitty gritty.


AAP Guidelines for Infant Sleep Safety and SIDS Risk Reduction - 2011

 

  • Always place your baby on his or her back for every sleep time.

  • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep.

  • The baby should sleep in the same room as the parents, but not in the same bed (room-sharing without bed-sharing).

  • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets, and bumper pads.

  • Wedges and positioners should not be used.

  • Pregnant woman should receive regular prenatal care.

  • Don’t smoke during pregnancy or after birth.

  • Breastfeeding is recommended.

  • Offer a pacifier at nap time and bedtime.

  • Avoid covering the infant’s head or overheating.

  • Do not use home monitors or commercial devices marketed to reduce the risk of SIDS.

  • Infants should receive all recommended vaccinations.

  • Supervised, awake tummy time is recommended daily to facilitate development and minimize the occurrence of positional plagiocephaly (flat heads).


I think it's important to point out that the AAP has been working on updating this list of recommendations and will be publishing it in 2017. I will keep you all updated with any changes are soon as they are known.

For more information about Safe Sleep Guidelines, go to

www.healthychildren.org/safesleep

8 Tips When Dealing With An Early Riser

Is your child ready to start the day before 6am? Do you end up bringing him into bed with you in order to get a couple more hours of sleep? My day never starts off on the right foot if I wake up to the sound of my babies calling out for me, sluggishly roll onto my side to check the clock, and rub my eyes in disbelief as I see a blurry 4 or 5 AM.

Sound familiar?

One of the most frequent questions I get as a sleep coach is "Why is my child waking so early!?" and "How can I fix it?"

In keeping with our bodies' natural circadian rhythm, an ideal wake up time for children and infants is anywhere between 6 and 7:30am. Obviously there are some who wake up even later than this, but those aren't the parents who are reading this blog right now, are they?

 

Here are 8 common reasons why your child may be an early riser.

1. Bedtime is too late.

It may seem counter-intuitive, but an earlier bedtime can often help your child sleep in longer in the morning. If your child is overtired at bedtime, his body will have already secreted increased levels of Cortisol (a hormone like Adrenaline!) which makes it harder for him to fall asleep and results in a less restful slumber.

2. Daytime sleep deprivation (aka: insufficient naps)

Sleep begets sleep. If your child is overtired during the day from skipped or short naps, this will carry over to his night's sleep and likely create a more fragmented night. Purposely keeping your child up during the day in hopes that he'll be more tired at bedtime and sleep better, just does not work.  Getting your child down after an age appropriate wakeful window will help you achieve optimal naps and set your child up for a better night's rest.

3. Going down too drowsy at bedtime

As a sleep coach, I actually prefer to use the term "Awake and Aware", rather than focusing on the "drowsy". When parents do TOO much of the soothing at bedtime, children may then need that same help when they wake throughout the night, including the early morning hours. Breaking sleep associations at bedtime (for example nursing, bottle, rocking, singing) can help teach your child to return to sleep on his own when his body is not yet ready to wake for the day. On a scale from 1-10 (10 being asleep), aim to have your child in his crib at a 6-7/10. Other factors such as timing, sleep environment and a good bedtime routine will set the stage and help your child do the rest himself.

4. An inconsistent response to their early wakings

Any waking before 6am should be considered a night waking. An easy way to understand this is that you should be responding to your child at 4 or 5am EXACTLY the same way you would respond at 11pm. Which means he is expected to go back to sleep.

Be careful not to give your child mixed messages at these early hours - this can only make things worse! Remember, an infant or young child cannot read time yet so all he knows is that when he wakes in the morning and calls out for you, A, B or C may happen. For example, A) mommy will bring me into bed with her! B) Daddy will rub my back until I fall asleep again or C) I get to go downstairs and start my day!  If he is getting inconsistent messages like this, he will not know what is expected of him and will likely assume that what happened yesterday might happen again today. Over time, this early rising will just get earlier and earlier.

How you respond to your child depends on his temperament and what you feel comfortable with as a parent. I recommend going in to check on him immediately, make sure he is ok (no fever, poop, etc), and let him know that it's still sleepy time. You can stay in the room until he falls asleep, or for those really alert kiddos, you may even choose to leave them alone as your presence may be too stimulating. Either way, no one should be leaving their cribs or beds before 6am.

5. Staying awake too long between the day's final nap and bedtime

Similar to having a bedtime that is too late, going beyond the ideal wakeful window just before bedtime can also contribute to early risings. A 6 month old may only be able to tolerate 2 hours of being awake before bedtime whereas a 3 year old may be able to stay up for 6 hours. Learning to read your child's sleepy cues can help you determine when their ideal bedtime is. Somewhere between 6-8pm is where that sweet spot is hiding.

A simple shift in schedule can correct this with toddlers who are down to only one nap a day. If that nap is happening too early in the day, the gap before bedtime might be too large for them to handle without becoming overtired. Making sure that the nap doesn't start before 12pm is a great way to address it!

6. Hunger

If your child is on the younger side and/or going through a growth spurt, it is very possible that they are simply waking because they are hungry! Sleep patterns fluctuate a lot in babies under the age of 6 months, as do overnight feeding demands. So never rule out an early waking that may indeed be signalling a hungry hungry hippo.

7. Underlying medical conditions

If after addressing any behavioural issues and adjusting your schedule to an age-appropriate routine, your little monkey is STILL having issues with early rising, you might want to consider if there may be an underlying medical condition affecting his sleep.

Obstructive sleep apnea, reflux, allergies, constipation are but a few conditions that can make falling back to sleep in the early morning hours difficult for our little ones.

If you notice that your child snores at night, is a mouth breather, is a restless sleeper and even sweats in his sleep or constantly has a stuffy nose, I would bring this to your pediatrician's attention. They will be able to guide you further in diagnosing any common childhood health issues that are known to disturb slumber.

8. Sub-par sleep environment

Babies sleep best in cool environments. Their bodies are designed to wake when overheated as a survival instinct! Between 17-20 degrees Celcius is an ideal temperature. If you aren't able to control the temperature in their room, make sure you are dressing them accordingly.

Have you ever noticed how bright your child's room is once the sun rises? Aim for a 10/10 darkness, and if it is significantly brighter, consider purchasing some black out blinds or curtains. Don't have it in the budget? Black garbage bags do an amazing job cutting out the light!

Finally, how stimulating is your child's room. Mobiles and toys that attach to crib slats should be removed and only used during wakeful play hours. For children who are in beds, having a room full of toys can be distracting and keep children up when they should be sleeping. A bedroom should be calm, soothing and designed for sleep. Take into consideration things like glow-in-the-dark stickers on the ceiling, flashing lights from electronics (including the little light on your monitor camera over the crib!), stimulating patterns on the wall and on crib sheets, etc. They can all add up to create a lot of stimulation in what should be a very boring room at night.

 

Consistency is KEY

Early risings are one of the trickier sleep problems to resolve and it is not a quick fix. The younger you address the eight tips above, the faster you will see results. In toddlers, it can take weeks to resolve. But as always, patience and consistency is the key!