Seasonal issues

At this time of year it is particularly important to ensure that our children get enough sleep. Excited children, fighting sleep in the hope of catching Santa leaving presents, seeing the reindeer, or just taking part in the more sociable aspects of Christmas and New Year make life more difficult as their accompanying sleep deficit makes them more active and often more confrontational. It is so important to have a quiet period before bed. To allow and encourage children to wind down and sleep.

At the same time many manufacturers are promising all sorts of "aids to restful sleep" and in the Christmas spirit we may be tempted to spend money on gadgets which offer this golden promise. Unfortunately there is no golden gadget which can fulfill the promise of a good night's sleep. Medication can acheive this, but who wants to become dependant on medication for a good nights sleep? Light therapy can help individuals with circadian rhythm disorders, but have little benefit for the rest of the population.

In order to acheive a good nights sleep routines of wake and sleep times are vital. Ensuring that one wakes at the same time and settles to sleep at the same time every night are the practical habits which reinforce our body clocks. Having some out door exercise in the fresh, albeit cold/wet air every day will also help. Sleep is something we learn to do. We learn by repetition and by habit, so it is important that our habits are good.

Having a quiet hour, making the last hour of wakefulness less stimulating, even boring, prepares our minds for sleep. Breathing excercises, yoga, or meditation may help adults to remove themselves from the stresses and cares of the day and quiet the mind. Children who are read to or who read or work on quiet activities are much more likely to go to bed happily than those who have had a busy time or participated in stimulating exciting activities before bedtime.

There are recognised "Good Hygiene Guidelines" which we should review and adhere to if we want our children to go to sleep and wake rested and bright in the morning.

If you would like a free copy of these contact Dream-Angus.com

Bed Wetting ( Nocturnal enuresis)

Bed wetting does not result from bad parenting or naughty children. Bed wetting is often seen as a private problem which occurs in the home at night and is seldom discussed outwith the family. This problem affects one in ten children at seven years of age. Some children may experience urgency, frequency or wetting during the day. Others who have managed to toilet well in day time, and progress from nappies to underwear, may still have difficulty in remaining dry overnight. This is something which can be overcome by bladder training.

If bed wetting occurs after 5 years of age, and there has been a period of 6 months of more being dry at night, then there may be a specific trigger factor which must be investigated. Children with ADHD are 2.7 times more likely than the rest of the children in the population to have problems staying dry at night. If one or both parents have been bed wetters then the risk of their children also having this problem is increased. Children with normal bladder function at 7 years of age should pass urine 5-7 times a day when their fluid intake, spread over 24 hours, is about 1.2 liters.

Some children sleep very deeply and are not aware of a feeling of bladder fullness. Others may not reduce urinary production at night. This is something our brain has overall control of. It is difficult to teach bladder control in sleep. Although the World Health Organisation defines nocturnal enuresis as bed wetting at 5 years of age or older, there is new evidence that this problem should be tackled before the age of 4 years. Statistically the odds against becoming dry at night after the age of 4 decreases slowly as the child gets older.

Children who bed wet are much more likely to experience urinary tract infections and this should be one of the first things that requires to be checked out. Untreated and unrecognised urine infections can result in kidney dammage and high blood pressure. Restricting fluids before bed time has no effect on reducing or eliminating bed wetting. Toileting the child before bed, and again before parents retire can be helpful. If the child has a bladder disfunction then the irritablity of the bladder can make it difficult to cope with a "normal" volume of urine.

Children who bed wet should be seen by their doctor and have a urine specimen checked for infection before any treatment plan is instigated. There are a variety of medications which can be used to help resolve nocturnal enureisis but these should be used along with behaviour modification or enuretic alarms. Enuretic alarms may be bed or body worn and have a lasting success rate of about 40%. They must be used every night for 6-8 weeks and at first may wake the whole family. The use of an alarm together with medication or behavioural management is more effective than the alarm on it's own.

Winter colds

It is inevitable that children get coughs and colds in winter time. When they start school for the first time, on their first time in creche or playgroup, they meet all kinds of infections which they may not have met before. These are usually mild illnesses which are of short duration. Many of them are viral and therfore do not respond to antibiotics. For most children keeping them well hydrated, giving plenty of fluids and keeping them warm and comfortable is enough to see them through the worst of this.

It is important that, should they develop a high temperature, this is treated. In small children prolonged febrile illness which is untreated can result in convulsions and this is something to be avoided. Tepid sponging has little benefit, it may give parents something to do, but it is seldom effective in reducing a child's temperature. The careful use of medication will reduce temperatures by 2-3 degrees. If the child is at home reduce the layers of clothing/bedding so that the child remains warm but does not become chilled. If you are concerned you should seek your Doctors advice. Better to be over cautious than lax about this.

Babies often become snuffly and it can be helpful to take smaller children into the bathroom while mum/dad has a shower. The steam will loosen secretions and then by simply tickling baby's nose with a little paper hanky or cotton wool cause baby to sneeze so that the secretions can be wiped away. Cotton buds and other external tools should not be inserted into a child's nostrils. Nostrils and ears are self cleaning. Poking things into noses can make the child move suddenly to remove themselves from the object, and result in the accidental dammage to the nasal septum. (Cartilage which separates the nostrils)

There are a variety of menthol rubs available for use in treating children. These assist in clearing the nasal passages and make breathing easier. Babies naturally breathe through their noses and have to learn to use their mouths to breathe when their nasal passages are blocked. This makes feeding more difficult and the careful use of menthol preparations before a feed may assist in making it easier for baby to take a feed.

Fresh air is important, both for general health and a good nights sleep, but in winter the temperature drops quite dramatically after 3pm. so small children benefit from being at home before then. When taking your child out, you should expect to clothe them in one layer more than you require yourself.

If you are trying to alter your child's sleep pattern and the child is unwell it is better to abandon the plan until they have fully recovered. Ill children require more attention and are more demanding. Once they have recovered they learn more easily and are less likely to react badly to alterations in the behaviour of their parents.