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.

Loss of a pet or a relative

Grief and loss in childhood is a very specialist subject. Some families have pets to teach their children a sense of responsibility and caring. The loss of a pet is a lesson in life. It teaches the child that life is precious and not permanet. Learning to accept that loss is helpful in later life but explaining that loss to your child can be difficult.

There are a number of books written for children of different ages which can be useful in helping them to cope with the grief and loss of a relative or friend. These are books which should be read together, child and parent, and offer opportunites for discussion afterwards.

The level of understanding about grief and loss is also a part of the general development of a child. Even a baby will pick up on parental distress without any understanding of the cause. We often try to hide out fears from our children so that they do not experience the same fears, fear of spiders for example. We should be able to find a balance in sharing grief without overloading children. Loss is part of life, and if we want our children to be well balanced and confident, then we also want them to have an understanding of the many changes in a lifetime. This involves learning coping skills to help them deal with the many experiences they will have.

If you would like some titles of books to help you broach this subject with your child contact Dream-Angus.com

Anxiety in childhood

Anxiety in childhood is not unusual and in most cases with reassurance and time spent building the child's self esteem and self confidence this is short lived. Children can be anxious for a variety of reasons. It is normal for young children to be concerned about being separated from a parent or to be afraid of the dark, storms, animals, insects or strangers. With reassurance this can be overcome.

Some children are so anxious and uptight that this anxiety impinges on activities and they require a great deal of reassurance. Anxious children are quiet, compliant and eager to please and their anxiety may be overlooked.

Anxiety increases the heart rate and rate of breathing. This is part of our fight or flight mechanism and encourages good oxygenation of the arms and legs in case we have to run away or fight. This causes a feeling of pounding heart and breathlessness. The child may have diarrohea or be constipated. The divertion of blood from the internal organs causes a feeling of stomach churning or "butterflies". The mouth becomes dry, muscles tense, sweating increases and the child is very alert. This can lead to a feeling of lightheadedness and even fainting.

While a certain amount of anxiety is useful and even healthy when a child is exessively anxious they lead to panic. Panic attacks sometimes happen when there is no immediate threat to life. These panic attacks are one of the most common psychological problems in the Western World affecting 2-3% of the population. Young people experiencing these distressing feelings and events are often not fully aware of why they feel so frightened and they cannot always express this feeling or communicate it to their parents. This adds to their distress.

Parents often feel frustrated as they do not understand why their child is behaving in this way or what has caused this. It is important that they control and hide this frustration from the child. What then can parents do?

Be calm, relaxed and confident. Reassure the child but do not raise your voice you will only increase the child's discomfort and distress. Using positive language " I will keep you safe" "you will be all right" , distracting them by offering a focus that the child can use to think about instead of the frightening situation that they are in. Talk about normal happy things, remove the child to a quiet relaxing place and offer them a drink which does not contain caffine. Stay with the young person, ask them to concentrate on their breathing and to breathe deeply until they are calm and relaxed. People in a panic do not make good decisions as they cannot properly assess risk.

If these panic events occur more than once and are affecting school work or other activities then consult a Child Psychologist. There are effective treatments available and it is important that these events are not ignored.

Parenting skills

There are many decisions which have to be made when one becomes a parent. Some are comparatively easy and straightforward but the sense of responsibility that goes with parenting makes many very aware of the "guilt" experienced or immagined when things are less straightforward.

Parents are responsible for the safety of their children, for their first impressions of the world and their fellow humans. We all want our children to be able to be independant people and to have the necessary skills to cope in the complex world of relationships, with peers and authorities,and to be able to feel secure and confident in that world. There are as many different parenting styles as there are children and parents. No one style works for everyone. There are a rich variety of books on the subject, but even these often contradict each other. At the end of the day there is no perfect parent just as there is no perfect person we all seek to do the best we can with the knowledge available to us.

While many parents want to be their child's friend, they do their children a great disservice in following this path. Children require guidance and firm rules, which they will challenge as they grow. The very rules set by parents are important as a form of security. The certain knowledge that a particular behaviour or behaviours are unacceptable, and will be met with equally unacceptable outcomes, are part of the fabric of learning to live in society. While conflict is not always pleasant or positive, there are times when it is inevitable and should be met with understanding and with firmness which demonstrates that the caring person guiding the child is capable of fully accepting that responsibility.

Children who learn to live by the rules of their parents and to accept that there are consequenses when they behave badly are generally much happier. Setting limits for your child does not mean that you need to be particularly strict or harsh. It is always more comfortable to live within the bounds of known and accepted rules than to be in conflict where there appears to be little reason or no known guidelines to follow.

Quiet play.

How does one define "quiet play"? Well, for most mums' it is any activity which keeps a child or children working quietly on a project which is interesting, but not exciting or very stimulating. Many sleep experts define quiet play as reading or being read to, listening to music, drawing or colouring in. Quiet play is a good wind down activity which leads to bed time and doesn't over stimulate or over excite the child. That's fine as far as it goes.

If you are working, even with a child as young as three to six months, then reading a book to them is a pleasant activity which does not require any active response from the child. Starting this kind of activity at an early age is good because it encourages use of language and recognition of simple objects. Even reading nursery rhythms is useful as the learning of cadence, rhythm and phrasing helps with language development. Listening to music which is quiet and soothing without any sudden loud phrases or jarring noise, (this is surely a matter of personal taste) can be soothing to the child. In one so small being held comfortably and patted slowly or stroked gently can also be soothing.

Quiet play does not include computer games or games which require interaction at a high level. These undoubtedly have their place but it is not as a pre cursor to bedtime. It is important to stimulate immagination but bed time is not a good time for this particularly if your child has nightmares or fears of the dark or being alone.

Quiet time is a useful time in bonding with a parent who is always busy, or not available during the day. The last hour of wake time is a good time to spend listening to your child telling you about his/her day, enjoying close physical contact, and learning to relax and wind down together is good for both parent and child. The last hour before bed time is quality time for parents and children and we do all a disservice if we just switch on the television and expect that to be enough.

Swaddling.

Swaddling is the art of wrapping a baby or infant so that they are held firmly in cloth binding. This is a practice that has been carried out through the ages since biblical times. Originally swaddling was a method of restricting the movement of the child, and was thought to encourage strong, straight growth of the child's limbs. The degree of swaddling, which used to involve several different bindings altered in about the 17th century when it was decided that this was too restrictive a practice. Since then swaddling has been refined to the wrapping of the infant in a single piece of cloth or a shawl.

Many cultures still swaddle children until they are independantly mobile. In the west we swaddle newborn babies but some people think that swaddling should be discontinued at 8 or 12 weeks. There is no evidence to suggest that this is good practice, in fact the research completed in 2002 and 2005, and quoted in Pediatric journals, suggests that swaddling has a rich variety of benefits for the child and for the parents.

Swaddling a newborn makes the baby feel secure. While in mothers womb only limited movement was possible, baby was confined by mothers womb and abdominal muscles. Swaddling gives the baby the sensation of being held. Surrounded by the deep pressure of a breathable wrap, only baby's head is left free. This "holding", without physical contact, allows baby to relax and sleep on his/her back. The startle reflex, which causes baby to abruptly open arms and swing unco-ordinated hands and arms, can result in an unswaddled baby hitting themselves and can waken an otherwise settled baby.

Swaddling calms a fussy baby because it makes baby feel secure. One well recognised Pediatrican points out that this is one of the "four S's which calm and settle babies!" Today many mums are discouraged from maintianing swaddling after 12 weeks on the grounds that after this time swaddling impacts on a childs growth and motor development. Again, there is no evidence to back up this eroneous claim.

Swaddling has the following positive benefits;-

1) Swaddled babies sleep longer and better. Startles are reduced, there are fewer awakenings during deep sleep, and there are shorter arousals during REM sleep.

2) Swaddled babies are kept at a warm temperature without the risk of loose bedding covering their face and head.

3) Swaddling reduces fussiness and may even help eliminate colic.

4) Swaddling keeps baby sleeping on his/her back which is recommended for the prevention of Sudden Infant Death.

5) Swaddling is associated with increased awareness of environmental auditory stress, so although baby sleeps longer and deeper baby is also more alert to danger.

6) Swaddling makes it impossible for baby to scratch themselves or jerk their limbs and wake themselves by the unco-ordinated limb movement.

As babies grow stronger and more mobile they will wriggle free of the swaddle but there is no evidence that swaddling will inhibit a childs development in any way. Of course, as the child grows swaddling should only be done for naps and night sleep. The rest of the time baby should be able to use their limbs freely and experience the world.

As recently as July of this year researchers were being quoted as having further evidence of the benefits of swaddling even in older children. It is never too late to swaddle although some children do take a little time to get used to this if it has been discontinued earlier.

Bruxism, Teeth grinding in sleep

Bruxism (forceful teeth grinding during sleep) is thought to be the third most common parasomnia (partial arousal) experienced in the population. Parents notice this in their children and it can be a disturbing sound. Although parasomnia's tend to decrease in childhood, bruxism tends to remain for some children even at 13 years.

Approximately 20% of children are reported to grind their teeth during sleep and wake complaining of facial pains or headache. Stress has been considered to be a contributing factor but some studies have found no related day time stress reported in patients who grind their teeth.

Bruxism tends to be part of a chewing and swallowing process and a study in 2003 postulated that children with reflux may experience bruxism as a secondary effect along with increased saliva production. Sleep position also has an effect on the level and frequency of bruxism.

In 2008 further work on sleep disordered breathing showed a positive reduction in bruxism following tonsil and adenoid removal. Randomised Controlled Trials of occlusive dental splints have not conclusively demonstrated this device is sufficently effective in resolving sleep issues, although they may reduce wear and tear on teeth.

Perhaps the assessment of children with bruxism by Ear Nose and Throat Specialists would be worthwhile, particularly for those for whom sleep disordered breathing is an issue? There seems to be no current consensus on how best to resolve this parasomnia. Some authorities believe children may outgrow this but there remains an adult population who also experience bruxism.

Further research should lead to a better overview of both causes and the identification of effective treatment.

Childcare outwith the home.

Many mums have to work these days and this means that they must seek child care. Finding a suitable place which has a space to take your child involves considerable research. What are you looking for in a creche or day care centre? What recommendations have you had and what or where is the most convenient place for you?


No matter how caring the staff they are not going to do things as you would yourself. That's not possible when they have numbers of children to care for. If you have a good routine for your child there is every possiblity that this will be maintained, if you tell the staff about it. If you are still struggling to get your child to nap in the daytime, or if you really want your child up and awake by 3.30pm to avoid the knock on effect on night sleep, then you have to consider the routine within the care facility.

If you have the opportunity to develop a good routine for your child before you need child care then use that opportunity wisely. It can take 3-4 weeks to establish a sound daytime nap routine, once you have confidence in this it can be easier to allow your child to be cared for outwith the home. This is a big adjustment period for both parents and child. As long as the experiences the child has at home are loving and supportive, children will adapt reasonably easily to a child care facility. For most children day care can be a positive experience offering them the opportunity to play and interact with other children. Learning that there are some experiences which don't include mum and dad but are still enjoyable can help with a degree if independance before separation to start school.

When you have to find care for infants it is not so easy to explain to them that they cannot be with you all the time. The best you can do for your infant is to make the time you have together happy for both of you. Starting to make routines early in life can prove a touchstone for a little one. If the care facility can continue to maintain these routines then it is so much easier all round. If you are confident in the care provision you have set up for your child and confident that your child has the routines in place to calmly accept this new adaptation the whole experience can be so much simpler.

Breath holding in young children.

Young children who have limited language and cannot easily express their frustration in other ways, sometimes do so by breath holding. This is very alarming for the parents. The child may be crying and then stop suddenly, turn an unusual blue-grey colour, and flop back. This lasts only a few seconds but results in parental panic.

Children do and will grow out of this and as it becomes less effective it is used less. Limits must still be set and maintained but, recognising a child's frustration, and distracting them before they have the opportunity to hold their breath and scare the adult can be very effective.

This behaviour occurs in about 5% of infants and toddlers up to about age 5 -- children aged 1-3 are particularly at risk . This behaviour is usually associated with a need for attention, to express emotion or, in rare cases, to indicate an underlying medical condition. Breath holding is recognised as attention seeking behaviour which occurs when a child is extremely upset and has not learned other, more socially appropriate ways to express themselves.

Shock or surprise can also induce breath holding in very young children, exacerbated by, or as a result of accompanying crying or hyperventilating. However, most breath holding spells do not last longer than a few seconds. As soon as the child passes out, the respiratory centre in the brain kicks in and breathing returns to normal.

Breath holding can be associated with medical conditions such as seizure disorders, anemia or, rarely, cardiac disorders, and parents may want to rule out these conditions after their child's first breath holding event. At this stage children are rapidly evolving beings and medical problems can be expressed at this time.

Without a solid underlying problem resulting in breath holding, there is little treatment available. Children grow out of behavioural problems such as breath holding as they learn to express themselves in more sophisticated ways. If the breath holding is purely behavioural and parents fail to respond to these events with attention, the behaviour ceases.

When you give children lots of positive attention in other ways, it decreases the amount of time the child can use to obtain attention in a negative way. If the child is in a safe place and not going to fall off a table or chair, then you really just have to ignore it.

Daytime napping

When a child is born most of the day is spent in sleep. During sleep the brain is growing and although asleep the child is seldom completely quiet. During the first three months it is not usually difficult to settle an infant. As long as the infant is fed and comfortable sleep will usually follow.

Children who do not settle quickly and easily at this stage often have reflux to some extent, or are victims of "colic". Reflux should be treated, as the issues this causes are often prolonged and difficult to resolve otherwise. Colic usually peaks at 3/4 months and is seldom an issue after that time, with the notable exception of children who have allergies to lactose.

Children need to have regular daytime naps. At first three scheduled naps during daytime until they are about 6/7 months when two naps making a total daytime sleep of 4 hours is the goal. When night sleep is disturbed some parents think that removing a nap time will increase night sleep. Unfortunately this is far from the case. If daytime naps are reduced the child is too tired to settle properly at night so night waking may become more frequent.

By the 6/7 month stage baby should be sleeping through the night for 10 hours and having two naps, the second of which should be completed by 3/3.30pm if the child is on a "wake at 7am bed at 7pm" schedule.

Working on improving daytime naps is easier on parents who are more awake and more patient during the day, and has a knock on effect of improving the child's night sleep, which is easier for parents too.

By 3 years of age one single 1 hour nap is enough and by 4 years most children no longer require naps. As daytime naps reduce night sleep should be slightly longer and eventually even out at 10-11.5 hours.

If you need help to resolve your child's sleep issues, Contact Dream-Angus.com

Pacifiers/Dummies

Sucking is a soothing thing for most babies so many mums use pacifiers from birth. This is soothing and comforting for baby and can work really well in calming a fussy baby/child. While there is definately a place for these, too many babies, once started on using pacifiers become difficult to settle without.

There is no point in introducing a pacifier as an aid to sleep, if the baby is going to wake when it falls out, and demand that a parent return this to their mouth. By all means use a pacifier to calm baby but, baby should learn to fall asleep without this in place. When a child has developed the manipulation and co-ordination to find and replace the pacifier by himself/herself and has no problems doing so it becomes less of an issue.

Pacifiers should be regularly sterilised, and sucking a pacifier which has fallen on the pavement, before returning it to your child's mouth, is not a clean, hygienic or healthy thing to do. Nor should pacifiers be dipped in foodstufs such as honey, soup, chocolate or in fact any foods to provide "tasters". There are teaspoons for this! Introducing sugary foods to baby starts an early interest in sweet and not savoury foods and can dammage developing teeth.

If you feel you need to use a pacifier use it with some thought. It will reduce crying and help calm a fussy child but, allowing dependancy to develop encourages poor sleep associations and will not improve sleep habits.

If you need help to improve your child's sleep habits:- contact Dream-Angus.com

Sleep disordered breathing/apnoea in children.

Sleep Apnoea is a disordered breathing pattern which occurs during sleep.

Our brains have a respiratory centre within them which regularly check the level of oxygen circulating in our bloodstreams and control our rate and depth of breathing to ensure that good blood levels of oxygen are maintained. This is not something we think about, it is a naturally occuring phenomenon.

During sleep our breathing is slowed and can be shallower than during periods of wakefulness. We require less oxygen as we are not generally active at this time. For some children, because of upper airway infection, obesity, bone structure or differences in the internal structure of the nose, mouth and throat breathing may be slightly obstructed during sleep.

The respiratory center notes a drop in oxygen levels and "nudges" the response to breathe deeper until the levels return to acceptable limits.

Some children who experience morning tiredness, snoring, regular headaches, and a variety of other symptoms are actually suffering from sleep disordered breathing. Technically, where breath is held for 10 seconds, this is sleep apnoea. In daytime these children often breathe through their mouths and do not feel rested after sleep. Review by a Consultant Ear, Nose and Throat specialist should be carried out, as removal of enlarged tonsils and adenoids can resolve the breathing issues quite quickly.

If your child has an unusual sleeping position, with their head tilted well back to allow a clearer breathing pathway, has excessive night sweats, sudden awakings related to breathing or does not seem rested after sleep this is a condition that should be considered. If your child has this problem and is treated you may find that their learning also improves along with their sleep.

If you have concerns about your child's sleep pattern, Contact Dream-Angus.com we can help you to help your child to a better sleep.

Importance of sleep for memory consolidation.

For generations mums have been told that sleep is important for babies because it involves actively consolidating memories. Now a team at the Department of Neurology in Massachusetts have undertaken a study to look at learning and sleep.

We all know that memories evolve. After learning something new, the brain initiates a complex set of post-learning processing that facilitates recall (i.e., consolidation). Evidence points to sleep as one of the determinants of that change.

Previously whenever a behavioral study of episodic memory shows a benefit of sleep, critics asserted that sleep only leads to a temporary shelter from the damaging effects of interference that would otherwise accrue during wakefulness.

To evaluate the potentially active role of sleep for verbal memory, this study, by Ellenbogen, Hulbert, Jiang, and Stickgold, compared memory recall after sleep, with and without interference before testing.

They have demonstrated that recall performance for verbal memory was greater after sleep than wakefulness. When when using interference testing, that difference was even more pronounced.

By introducing interference after sleep, this study confirms the active role of sleep in consolidating memory.

This is yet another reason why we should encourage good sleep habits in our children. They are learning on a daily basis and a good sleep/wake pattern can only enhance that learning experience and help them to be "all that they can be".

If you need help to improve your child's sleep pattern, contact Dream-Angus.com

Sleep and adolescence

Sleep deficit in adolescence has been recognised and commented on for some time. It is well recognised that sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents.

Earlier this year, a study looked at this school population and their experience of sleep and sleep quality.

General education classes were randomly selected from a convenience sample of three high schools in the American Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviours and perceptions of sleep.

The findings showed that most respondents, (91.9%) obtained inadequate sleep. In many ways this is unsurprising as most adolescents seem to live in a "twilight" zone.

How much is due to poor sleep hyigene and bad habits around sleep is not explored. Nor is there any investigation of what type of sleep disturbance is most common in this group. Other studies suggest that school activities, jobs after school and other hobbies and responsibilities may impact on the sleep schedules of adolescents. One can only hope that in highlighting the difficulties some measures were put in place to address the sleep deficit that these individuals experience.

Australian study of sleep in primary school children.

It has long been recognised that adequate sleep optimizes children's learning and behavior. However, the natural history and impact of sleep problems during school transition is unknown.

This study was set up to determine
(1) the natural history of sleep problems over the 2-year period spanning school entry and
(2) associations of children's health-related quality of life, language, behavior, learning, and cognition at ages 6.5 to 7.5 years with (a) timing and (b) severity of sleep problems.

To acheive this data was drawn from the Longitudinal Study of Australian Children. Children were aged 4 to 5 years at wave 1 and 6 to 7 years at wave 2.
Parent-reported predictors included (1) timing (none, persistent, resolved, incident) of moderate/severe sleep problems over the 2 waves and
(2) severity (none, mild, moderate/severe) of sleep problems at wave 2.

Outcomes included parent-reported health-related quality of life and language, parent- and teacher-reported behavior, teacher-reported learning, and directly assessed nonverbal (matrix reasoning) and verbal (receptive vocabulary) cognition. Linear regression, adjusted for child age, gender, and social demographic variables, was used to quantify associations of outcomes with sleep-problem timing and severity.

Sleep data was available at both waves for 4460 (89.5%) children, of whom 22.6% (17.0% mild, 5.7% moderate/severe) had sleep problems at wave 2. From wave 1, 2.9% persisted and 2.8% developed a moderate/severe problem, whereas 10.1% resolved.

Compared with no sleep problems, persistent and incidental sleep problems predicted poorest health-related quality of life, behavior, language, and learning scores, whereas resolving problems showed intermediate outcomes. These outcomes also showed a dose-response relationship with severity at wave 2, with effect sizes for moderate/severe sleep problems ranging from -0.25 to -1.04 SDs. Cognitive outcomes were unaffected.

The final conclusion was that sleep problems during school transition are common and associated with poorer child outcomes.

(QUACH J, HISCOCK H, CANTERFORD L, WAKE M.
Pediatrics 2009;123(5):1287-1292.)

Sleep and behaviour in 2-3 year olds

This year in the Reid Hong and Wade, of the Department of Psychology in the University of Western Ontario, completed a study reviewing the relationship between common sleep problems and emotional and behavioural problems among 2- and 3-year-olds.

The contribution of sleep problems to emotional and behavioural problems among young children within the context of known risk factors for psychopathology was examined. Data on 2- and 3-year-olds, representative of Canadian children without a chronic illness, from three cross-sectional cohorts of the Canadian National Longitudinal Study of Child and Youth were analysed (n = 2996, 2822, and 3050).

The person most knowledgeable, usually the mother, provided information about her child, herself, and her family. Predictors included: child health status and temperament; parenting and any symptoms od maternal depression; family demographics (e.g., marital status, income) and functioning. Child sleep problems included night waking and bedtime resistance. Both internalizing/emotional (i.e., anxiety) and externalizing/behavioral problems (i.e., hyperactivity, aggression) were examined.

Adjusting for other known risk factors, child sleep problems accounted for a small, but significant, independent proportion of the variance in internalizing and externalizing problems. Structural equation models examining the pathways linking risk factors to sleep problems and emotional and behavioral problems were a good fit of the data. Results were replicated on two additional cross-sectional samples.

The relationship between sleep problems and emotional and behavioural problems is independent of other commonly identified risk factors. Among young children, sleep problems are as strong a correlate of child emotional and behavioural problems as symptoms of depression in mothers, a well-established risk factor for child psychopathology. Adverse parenting and depression in mums, along with difficult temperament all contribute to both sleep problems and emotional and behavioural problems.

Children's sleep problems appear to exacerbate emotional and behavioural problems.

If you struggle to help your child to sleep contact Dream-Angus.com

Sleep in children starting school

Sleep disorders in children starting school are associated with impaired performance and behavioural difficulties. This is not at all unusual and a recent study by Lehmkul G Fricke-Okermann L, Wiater A and Mitchke decided to look at the causes and effects of sleep disorders in this group. It is already recognised that these disorders manifest themselves highly variably among children of any given age, and even in an individual affected child, they need an appropriate diagnostic evaluation so that the many environmental and background factors that may be relevant to the further course of the problem can be assessed.

In order to look more closely at this extensive data was obtained on approximately 1400 children who were tested before beginning school in 2005. This was accomplished using a special sleep questionnaire and another screening instrument that is used to assess behavioral strengths and difficulties (the SDQ, Strengths and Difficulties Questionnaire).

Five percent of the children were found to have difficulty falling asleep, difficulty staying asleep, or nocturnal awakening. Less frequent problems included parasomnias such as pavor nocturnus (0.5%), sleepwalking (0.1%), and frequent nightmares (1.7%).

This study showed that sleep disorders increase the risk of daytime fatigue and of psychological problems in general, including both hyperactivity and excessive emotional stress.

These results imply that sleep problems and emotional disturbances are intimately connected and underscore the importance of diagnosing sleep problems in young children.

If you are aware that your child is having sleep difficulties contact Dream-Angus.com for support and advice.

Parasomnias

Parasomnias are unusual behaviours or strange experiences, which occur mainly or only when going to sleep, during sleep or when waking up. Parents are often very concerned about these events, however they do not mean that the child is psychologically disturbed or medically ill in any way. Very often these events will stop after some time and without any intervention but sometimes safety measures must be taken to protect the child. For example in sleep walking it is useful to ensure that the child does not injure themselves.

There are currently over 30 types of recognised Parasomnias in two main groups.

Primary Parasomnias can be grouped according to the time of night when they occur.

Secondary Parasomnias are the expression of underlying medical, behavioural or psychiatric conditions. Nocturnal epilepsy, nocturnal panic attacks

Parasomnias occur at all ages but are more common in children than in adults. Children may have more than one type of parasomnia as they may also have more than one type of sleep disorder. Sleep apnoea can be associated with sleep walking for example.

It is very important that the parasomnias are correctly identified as the treatment and interventions required are dependant on this. Accurate identification depends on a detailed account of the experiences both from a subjective and objective sequence of events, the timing of the event and the cicumstances in which the event occured. Audio visual recording, in the form of home video can be very helpful in this.

Specific medication is usually only required in a minority of primary parasomnias but may be required to treat the underlying problem in secondary parasomnias.
Research information on Parasomnias is quite limited at the moment.

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Coping with Clock changes and sleep patterns.

Most of us experience no problems when the clock goes back an hour or forward an hour in spring and autumn.
Unfortunately there are some individuals who find this a very difficult experience. They find that their sleep pattern is disturbed by this event for a good few weeks. This leaves these individuals struggling with all the associated symptoms of sleep deficit, and makes life for the other family members much more difficult. However, with a little planning these difficulties can be avoided.

If you know how long it takes to "recover" from the clock change then you can anticipate and plan a strategy that will avoid the process of sleep deficit and sleep disturbances. These clock changes occur at pre set calender dates. If you know, for example, that it will take three weeks to catch up with this change, then you can avoid the problems altogether by simply dividing the 60 minute change into 3 segments of 20 minutes.

Three weeks before the clock changes start to adjust pre bedtime routine by a few minutes so that by the end of the first week a 20 minute delay in bedtime routine (or an earlier start to this routine) is accepted.
Continue this over the following three weeks, and by the time the clock has moved, the brain and body will be in sync with this altered sleep/wake time.

This can be further enhanced by altering the supper snack before bed to ensure that it is rich in the chemicals which encourage the release of sleep hormones. The precursor to the release of Melatonin, the sleep hormone, is Tryptophan.

Tryptophan is a natural amino acid found in foods like turkey, chickpeas and a variety of other foods. Tryptophan is required to make Melatonin, the sleep hormone and to act as a precursor for Serotonin.

Serotonin levels affect our mood. Patients who suffer from depression may be given drugs which modify the uptake of this chemical.

Foods that help in serotonin production are foods high in B-vitamins, foods like brown rice, eggs, organic chicken, corn, green leafy veggies, legumes, nuts, peas, and sunflower seeds.

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The Golden Rules

These are the "golden rules" which, if observed, will help ensure a good night's sleep.

1. Make sure your child's room is quiet and dark.
2. Keep environmental noise to a minimum, no loud TVs.
3. If your child still needs a nap, schedule that nap for early afternoon, before 3pm.
4. Wake your child at a regular time every morning. This will strengthen the circadian rhythm.
5. Avoid drinks of tea, cola and drinks containing caffeine before bedtime.
6. Quiet play in the hour before bed is better than stimulating, exciting play.
7. Keep the room at a comfortable temperature. If the room is too warm sleep may be disturbed.
8. Use a short pre bed routine that your child will recognise and stick to it.
9. Make sure that your child does not go to bed hungry, but do not give children over 6 months feeds or drinks through the night.
10. Help your child to fall asleep without your presence. Use a favourite toy or blanket and put your child to bed while he/she is drowsy but still awake.

You may find you are already doing some of these things, or all of them. If your child is still having difficulty getting to sleep or staying asleep contact Dream-Angus.com we can help you to help your child.

Reflux/spitting up in infants

It is not uncommon to wind/burp a baby and have some altered milk returned with the process. Some babies are known as "happy spitters" and from the begining these babies return mouthfulls of altered feed when they are encouraged to release any wind they may have swallowed. If this is an occasional rather than an regular occurance then there is no need to take any action. Other children suffer from gastro oesophageal reflux (GERD) to a degree that makes them very uncomfortable. Imagine having persistent heartburn which worsens with feeding. This makes feeding a much less comforting and enjoyable experience.

What causes this problem?

In newborn babies, and especially in babies born before their due date, the gastric tract can be immature and the muscles at the top of the stomach are less efficient than they should be. These muscles are there to allow air out but keep feeds, which are mixed with the acids in the stomach, in their place. When they are less efficient semi digested food is returned with the acids of the stomach, to the oesophagus and to the outside world. Over time, if this is untreated, asthma can result. For many years thickeners were added to feeds in an attempt to reduce reflux but research shows that this is totally ineffective and only results in increasing the time that food remains in the stomach.

What are the symptoms?

The most common include :-

Frequent spitting up or vomiting
Irritability when feeding
Refusing food or eating only small amounts
Sudden or constant crying
Arching the back while feeding
"Wet" burps
Frequent hiccups
Frequent coughing
Poor sleep habits with frequent waking

Bad breath

What can I do about this?

Give baby smaller feeds more regularly.

Wind/burp baby regularly during a feed.

Keep baby upright for 30-45 minutes after a feed and gravity will help keep feeds down.

Put baby down to sleep on his/her back but raise the mattress by putting a pillow or folded towel underneath the mattress so that there is a slope keeping baby's head slightly higher than baby's feet.

Do not thicken baby's feeds. This does not work and can result in other problems. Starting semi solid feeds early does not help and can increase the risk of allergy or other gastric problems. If baby is consistently upset by reflux do see your Doctor because there are suitable medications which will help. By the age of one year many babies will no longer have symptoms.

Preparing your child for a new baby.

New arrivals mean major changes for the entire family. Children can be excited about the arrival of a new baby. They may be very gentle and caring and yet at other times they can be jealous and agressive towards a sibling. Preparing your child for a new brother or sister can help get this new relationship of to a good start.

Tell your child about the new baby about 3 months before the baby is due. Do not tell your child you are having a baby to give them a new friend. Children may be dissapointed when the new baby sleeps most of the time and does not play with them.

Explain a little about babies to your child. There are a variety of good books written for children about the arrival of a new baby. These can help you help your child to know what to expect. If you chose this time to move your child from a cot to a bed do not use the baby as a reason. It is far better to explain that "you are a big girl now so it's time for you to have a big girl's bed."
Avoid making any changes to your child's routine in the month before the arrival of the new baby.

Tell your child ahead of time where you will be going when baby is born and who will look after them until your return. When you do return after the birth be available to give your first child your full attention. Be consistent use the same approach as you used before baby arrived with the same rules and consequenses for unwanted behaviour. Try to mainitian the routines your child is used to. It is important that your older child is given some uninterrupted time and space for play away from baby each day.

If you need help in moving your child from cot to bed ;-
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Starting at day care or nursery.

All children have to learn to cope with temporary separations from their parents. Learning to be apart can be difficult for both parent and child however parents need time to themselves occasionally and children benefit from spending time with other people and other children.

Shyness around new people and anxiety about separation from parents is common in children of pre school age.

If your child is old enough to understand what is happening then, before starting your child at a child care center talk about this with your child. Visit the place together so that your child feels comfortable there. Stay close and allow your child to watch the other children. Don't force your child to join the activities and if possible make several visits gradually extending the time you spend together there. Invite other children from the group to your home so that your child can get to know them a little and look for them in the group.

On the day explain to your child where they are going where you are going and when you will return. Do this in terms that the child can understand. Make sure that the care giver has all they may need to take care of your child. Suggest that your child bring something to the group, a special toy or other comforting item from home. You could perhaps leave something of your own to reassure your child that you will return. For the first few times you may want to reward your child by spending time in the park on the way home, or playing a special game with mum or dad.

Develop a routine for the times when you leave your child with some one else. After a while your child will be able to say what the steps are, e.g.

Say hello to the care giver and other children.

Find something to do.

Kiss or say good bye to mum/dad.

Explain to your child that you will leave, even if they do not want you to, once you have said "goodbye".

When you return greet your child and spend some individual time with them. Ask about what they did while you were gone. If your care giver tells you about something interesting your child has done show an interest and praise your child. Be prepared for your child to be a little clingy this is normal after separations.

Remember;-

When practical, prepare your child ahead of time.

Tell your child where you are going and when you will return.

Develop a routine and explain the steps to your child.

Talk about rewards.

Prepare the care giver.

Introduce others to your child.

Help your child find something to do.

Praise your child for mixing or playing with others.

Say goodbye and leave ignore protests and do not go back.

When you return, greet your child and spend time with them ask about their activities.

Review the steps with your child in a way that they can understand

Hormones and sleep.

Deep sleep triggers more release of growth hormone, which fuels growth in children and boosts muscle mass and the repair of cells and tissues in children and adults.
Sleep’s effect on the release of sex hormones also encourages puberty and fertility. Consequently, women who work at night and tend to lack sleep are, therefore, more likely to have trouble conceiving or to miscarry.

During sleep, your body creates more cytokines cellular hormones that help the immune system fight various infections. Lack of sleep can reduce the ability to fight off common infections.
Research also reveals that a lack of sleep can reduce the body’s response to the flu vaccine. For example, sleep-deprived volunteers given the flu vaccine produced less than half as many flu antibodies as those who were well rested and given the same vaccine.

When we sleep less, our stomach secretes more of an appetite stimulating hormone, and we produce less of the hormone which reduces our desire for food consequently we gain weight. A recent French study of 1,138 children found that 26% of children in the sample who had a sleep deficit were overweight, and 7.4% were obese. Day time naps do not compensate for proper night sleep which is generally deeper and longer. This same study showed that 22% of children who slept less than 10 hours a night when they were only 2.5 years old were hyperactive at 6 years of age. This is twice the rate of those who slept 10-11 hours a night at 2.5 years of age.

Sleep is undeniably an important part of our daily lives. Sleep deficit has profound effects not just on our mental health but also on our physical health.

If you need help to resolve your families sleep issues Contact Dream-Angus.com

Extinction (Crying It Out)

Crying it out involves putting a child to bed at a set bed time and then ignoring the child's cries until a set time the next morning. While this method has been documented as successful in resolving settling issues it is seldom an acceptable choice for parents who must listen to their distressed child crying.

One study showed that although the child cries for a prolonged period there is no memory of this and perhaps the child cries for so long that they forget why they were crying. Other children may cry until they vomit, which is even more distressing for the parent. Parents are naturally concerned about the effects of this "treatment" on the child's emotional and psychological development. Feeling that this is unnatural and goes against the parents natural desire to comfort the child, makes this harsh type of "treatment" difficult to administer and difficult to be consistent with.

There are many other ways to resolve this issue. Allowing a child to become and remain distressed for a period of time does not teach the child to learn to soothe themselves to sleep and this is one of the most valuable lessons we can offer our children.

If you have tried, or are considering using this method to get your child to sleep, be assured there are other techniques which are very effective and much kinder to parent and child.

If you struggle to get your child to self soothe to sleep Contact Dream-Angus.com we can help you to help your child improve their sleep pattern.

Sleep and the newborn baby.

Most newborn babies will sleep 16-20 hours out of 24. They wake when hungry or uncomfortable and are fairly easy to soothe once the reason for crying has been established. For the first few weeks it would appear that there is no routine. Baby can demand a feed at intervals of bewteen 2-4 hours. Some times this interval varies throughout the day. During growth spurts more feeds are required. In these early weeks it is not possible to alter baby's sleep wake cycle and there should be no need to. A baby will wake and sleep as the infant's body requires.

Recognising when an infant is tired takes time. Some babies will rub their faces on the person holding them, yawning, closing their eyes and sometimes even stretching before a nap. In the early stages the infant lacks the co-ordination to pull at an ear or rub tired eyes. An upset baby can be soothed by low frequency noise. A washing maching, vacum cleaner, a radio not quite tuned in to the station, music which before was heard through the thick abdominal wall, now played softly may halp.

If you are holding an upset baby try patting slowly at slightly less than heart rate, about 60 pats a minute, this reflects a resting heartbeat and is reminiscent of the rhythm heard in utero.
Soothing a baby to sleep requires a general slowing down of everything. Voice interaction should be quiet and of a low pitch. Put your infant down in the crib before they are completely asleep will help them to accept that going to sleep does not require any adult intervention. This will prevent problems later.

Once the child is about 3-4 months a more definate pattern starts to emerge.

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Night Waking

Waking in the night is one of the most common difficulties that beset children. Recent studies looking at the age and stage of children who have difficulty in sustaining sleep show that 25-50% of 6-12month olds, 30% of 1year old children and 15-20% of toddlers 1-3 years old continue to have night wakings.

These night wakings occur for a variety of different reasons but persistent problematic night wakings are often due to inappropriate sleep onset associations. For some these wakings occur as regularly as every 45-90 minutes. This is of great concern to parents who are also deprived of sleep in order to settle the child.

There is often considerable variation in the night to night and week to week patterns and neither infants, nor parents, are consistent in the way they behave and interact at these wake times. Of course what one parent sees as a difficulty another parent or family accept as "normal" so night wakings are seldom addressed in the same fashion across the population.

Children or adolescents who experience persistant night wakings that are extermely disruptive to the family as well as the complainant should be seen by a sleep specialist. There are very effective ways to alter this night waking behaviour and to improve the night sleep.

If you are experiencing this difficulty within your family Contact Dream-Angus.com we can help you to resolve this issue and improve your night sleep.

Nightmares

Nightmares are frightening dreams that occur during Rapid Eye Movement (REM) sleep, which usually result in waking from sleep and seeking reassurance. The content of nightmares varies with the age and developmental stage of the child. They may coincide with a frightening event, trauma or stress. They are more prevelant when there is sleep deficit. On average 75% of children experience at least one nightmare and 10-50% of young children require parental intervention to reassure them in the night. Chronic nightmares are nightmares which occur regularly over 3 months or longer. One study shows that 24% of children aged 2-5 years and 41% of children aged 6-10 years experience chronic nightmares.

If a child has experienced frequent nightmares then this can make the child afraid to go to bed (bed time resistance) because they anticipate frightening dreams.

Children remember the scary content of the dream and they awake with feelings of impending harm and anxiety. Return to sleep following this experience is delayed. The child has this experience in the later part of the night whereas Night terrors usually occur within the first few hours of settling to sleep, do not result in a full awakening and return to sleep is much more rapid.

There are a variety of strategies which can be successfully used to reduce and eliminate nightmares. Where behavioural strategies fail or the nightmares are extremely disruptive and persistant referral to a mental health specialist for evaluation and treatment are worthwhile.

If you would like help to reduce your child's nightmares contact Dream-Angus.com.

Bed Wetting/Nocturnal Enuresis

Bed wetting or nocturnal enuresis, remains a common issue for parents and children.

Nocturnal Enuresis is defined as spontaneous emptying of the bladder during sleep occuring in children 5 years of age or older. In the USA this affects 5-7million children.

Restricting the amount of fluids given before bed,and/or toileting the child before the parents retire has little or no effect on this.

Medications are rarely appropriate before the age of 7 years and generally if the child is not distressed it is wise to wait and see if this does resolve over time. For many children resolution is a matter of maturity and by the time they have reached 7 years there is no problem.

If the child is 5 years old and distressed by wetting the bed then it is possible to look at methods of training the bladder. Studies show that the use of Enuretic alarms combined with behavioural therapies are effective when the child is motivated. Children should not be made to feel guilty about this problem and they should be reassured that it can be resolved.

There are a variety of theories about the cause of bedwetting and these are probably the most familiar;-

1) That there is a difference between the bladder's capacity and the production of urine overnight.

2)That the child sleeps so deeply that the normal "alert" of a full bladder is not disturbing.

3) That the child's bladder is smaller and with maturity this will change.

Various factors can potentially influence the balance between nocturnal urine production and functional bladder capacity. Different types of bladder dysfunction, resulting in a small nocturnal bladder capacity, probably contribute significantly. As different clinical subgroups may have different responses to treatment, it is necessary to distinguish these subgroups before a decision on the specific treatment protocol can be made. New insights have an important bearing in our future management strategy for bedwetting

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Babies and circadian rythm.

The hormone Melatonin produced in the pineal gland regulates sleep. It does so using the initial building block of tryptophan which is an omega 3 fatty acid. This initial and important building block is present in breast milk. Mum's circadian rythm is usually well established and it is interesting that a study looking at the levels of this important omega 3 in breast milk has found that mum's circadian rythm has an effect on the amount of "sleep related hormone" secreted in breast milk.
Sleep efficiency in babies of 12 weeks, both only breast fed and those who were formula fed was measured over a week and it was found that assumed sleep, actual sleep and sleep efficiency was significantly better in exclusively breast fed babies.
It follows that breast fed babies are already learning to develop a circadian rythm which is parallel to that of mum. The levels of tryptophan which fluctuate to follow mum's rythm are starting to "train" baby.

Another study investigated the relationship between exposure to light and 24-h patterns of sleep and crying in young, healthy, full-term babies living at home and following a normal domestic routine. Babies were monitored across three consecutive days at 6, 9 and 12 weeks of age. There was an early evening peak in crying which was associated with reduced sleep at 6 weeks. Across the trials there was a gradual shift towards a greater proportion of sleep occurring at night. Sleeping well at 6 weeks was a good indication of more night-time sleep at 9 and 12 weeks. Babies who slept well at night were exposed to significantly more light in the early afternoon period. These data suggest that light in the normal domestic setting influences the development of the circadian system.

Both of these studies demonstrate the ability of babies to "learn" a circadian rythm and confirm that encouraging naps in normal daylight will improve infants night sleep patterns.

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Research and Narcolepsy

In May of this year groundbreaking research about the key role the immune system plays in Narcolepsy was published. A team of international researchers led by Emmanuel Mignot, MD, PhD, and Director of Stanford’s Center for Narcolepsy found a tight association between narcolepsy and a genetic mutation in T cells, the immune system’s vehicle for identifying and attacking foreign bodies.

Although further research is needed to determine exactly how this mutation leads to narcolepsy, the research behind this highly technical article, titled, “Narcolepsy is strongly associated with the T-cell receptor alpha locus” is based on a study of the analysis of DNA samples from over 800 patients with narcolepsy and cataplexy. Dr Mignot stated that this is opening the door for preventive therapies. The implications of this research go well beyond the narcolepsy field. As the first of its kind to link a disorder associated with the immune system to the T cell alpha locus, it provides a model for the study of over 100 other similarly associated disorders including juvenile diabetes and multiple sclerosis.

Generally children with narcolepsy have a completely normal development although secondary narcolepsy is associated with underlying neurological disorders such as Nieman-Pick disease where there is developmental delay. In first degree relatives 10% may also have narcolepsy and up to 40% of narcoleptic patients may have a family member who has excessive daytime sleepiness.

Narcolepsy is fortunately one of the less common sleep disorders but has long been recognised as having a definate genetic link. Most sufferers are diagnosed in late teens although some younger children have also been identified as narcoleptic.

Narcolepsy is a lifelong chronic disorder that will always require management. The aims of "treatment" are adaptation to living with this disorder and improving quality of life.

Sensory integration and sleep.

What does it take to make your child comfortable? For some children light touch is irritating. They prefer firm contact. These children often have difficulty settling to sleep when the bed covers are light but offer a weighted blanket and they settle much more easily.
Our perception of touch, sound, colour and texture is part of what makes us who and what we are. Children who have difficulties with their sensory information often also have difficulties in other areas of their lives. When we recognise this we can address it and provide the comfort that the child needs to feel secure in their environment.

Some children who require "deep stimulation" like to be held firmly and this will also assist in settling them to sleep. Using a sleeping bag or a weighted blanket is comforting because there seems to be a defined place in the bed for them, they feel as if they are being held, without any danger of "falling out" or being left loose.

Small babies enjoy being swaddled because it replicates the space they came out of and being swaddled is like being held without mum or dad having to hold them. Most children grow out of the need for this but some do not.

Settling to sleep is a behaviour that we want our children to acomplish by themselves, without the need for our intervention. Looking at each child as an individual and identifying the measures that make that child feel secure can help in assisting that child to relax and go to sleep.

Sleep disturbances are much more common in children with sensory difficulties than in the rest of the population. This is well recognised, but it is also possible to alter their sleep behaviour. It may present more difficulties and may take longer but it is certainly possible.

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Relaxation before sleep (1)

Some older children have problems getting to sleep. They may already have a short pre bed routine, getting washed and toileted, brushing their teeth, getting dressed for bed and lying down ready for sleep, but it seems difficult for them to get over to sleep.

This can be for a whole variety of reasons. Their minds may still be busy, perhaps there is something special happening or the day has been exciting and they are still reveiwing the events. For others there may be concerns about tomorrow, a school exam, a big event or it may just be perceived as "normal" for that particular child to have this difficulty.

Ensuring that the hour before bed time is unstimulating, that the bedroom is seen as a safe place and that the pre bed routine is maintianed will all help but some children need a little more.

There are two basic relaxation techniques that are helpful, not just for children but also for adults.

The first is a visualisation technique which requires that the child close their eyes and breathe deeply. Keeping one hand on the diaphragm, to feel the movement of the chest during breathing, close the eyes and picture a wall of velvet. The velvet is black or navy blue and the true colour is only seen in the deep folds as it flows down from the ceiling.

In a corner above the velvet is a bright white light. As breathing in occurs the light gets brighter, on breathing out this light gets dimmer. After watching the light for five breaths, watch the velvet and the effect of the light on the surface.
Observe the deep colour and the softness of the fabric.

This exercise calms the mind and offers a different focus for intrusive thoughts. For some this offers a speedy relapse into the gentle arms of sleep. This is so simple that it can be used at any time and requires no other intervention. Learning to use this method offers a solution to some of the distractions which make sleep so difficult to obtain. It can be used to start a nap or a deep overnight sleep.

If your child has difficulty settling to sleep or staying asleep they are not alone. It is estimated that 37% of children aged 4-11 have difficulties with this. When these difficulties are not addressed they can become chronic.
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Teething and Sleep

Two recent studies have indicated that, contrary to many beliefs held by parents and professionals, the links between the emergence of teeth and significant physical symptoms are very weak.
The researchers compared signs of fever, sleep disruptions, irritability and other symptoms on days close to teeth eruption (before and after) and on days remote from teeth eruption.

The findings indicate that for most infants there are no links between the emergence of teeth and other behavioral or physical symptoms. In the minority of the infants tooth emergence was associated with some symptoms but these associations existed only for a brief period (4 days before teeth eruption, the day of eruption and 3 days after). In both studies, sleep disruptions were not associated with tooth emergence.

The authors suggest that parents' tendencies to blame teething for physical and behavioral symptoms is often unwarranted. Physical symptoms and distress are likely the result of other factors.

Sources:1) Wake, M., Hesketh, K., & Lucas, J. (2000). Teething and tooth eruption in infants: A cohort study. Pediatrics, 106, 1374-1379. 2) Macknin, M. L., Piedmonte, M., Jacobs, J., & Skibinski, C. (2000). Symptoms associated with infant teething: a prospective study. Pediatrics, 105, 747-752.

Sleep and the sensory strategies.

Every child can learn to sleep regardless of physical handicap or mental disability. Children with sensory impairment may require a more detailed plan and children with developmental delay or disability often experience more profound difficulties in settling and maintaining sleep.

Routine is a very important part of forming regular patterns in children's behaviour. Routines are reassuring touchstones in every child's day. Children who have a different understanding of the world value routines even more than average. In an uncertain world where every day brings new challenges, routine reminds the child of the time of day, and leads to the expectancy of fixed events. Bed and wake time should be the most fixed of all the events in the child's day. Routines built to ensure a calm and responsive reaction to bedtime and wake time help the child to cope and understand the actions that are expected and follow on from them.

For sensory impaired children a bedtime routine that starts at the same time EVERY night is vital. Ensuring that the hour before bedtime is spent in calming activities without recourse to playstations or television, enjoying quiet calming activities help cue sleep.

Using a weighted blanket, flannel sheets, giving deep pressure contact or making a snug place in the bed using pillows or, a sleeping bag makes a child feel "held" and comforted which is relaxing and prepares the body and mind for sleep. If a light is required it should not be bright but a soft dim light is more calming.

Limiting the time for each pre bed activity helps acceptance of that activity. White noise and story tapes have their place in this and are very soothing for some children. The child who learns to achieve simple tasks with encouragement and by themselves gains in confidence.
The rituals which form part of the cues for sleeping and waking also help instil a sense of confidence and self awareness in the child.

There is no reason to endure sleep deficit when it is entirely possible to alter a sleep behaviour with a good plan and committment to following through. Sleep deficit doesn't just affect the child but the whole family.

Contact Dream-Angus.com for information and support to improve your child's sleep

Routine, Routine Routine

A number of recent studies have looked at sleep behaviours and routines in both adults and children and throughout the investigations one thing has been highlighted as singularly important, and that is, routine.

Adults have a short pre bed routine which they complete regardless of where they are, at home, away on holiday or on a business trip. We all have a short pre bed routine which cue's our individual body clocks. This is our reminder to ourselves that it is time to sleep, time to rest and renew so that we can face the coming day. Adults can rationalise their behaviour, children are at the mercy of their parents.

We are our children's teachers and teaching children the cues to help them sleep and rest at appropriate times is one of life's important lessons. Children learn very early in life to expect certain things to follow from parents actions. Routine is part of a child's security in the environment and helps the processes of learning about the world and one's place in it. Children associate certain actions with outcomes and as they grow and gain awareness they find reassurance in the stability of home through the routines learned there. This makes the pre bed routine particularly important because if it is a good routine it encourages sound sleep. All is well with the world.

Children who have no regular pre bed routine are slower to relax into sleep and often wake regularly in the night. Sleep deficit in a child makes for confrontational behaviour, poor concentration and increased irritability. Some children who have had a long history of sleep deficit are even occasionally misdiagnosed as having Attention Deficit Hyperactivity Disorder (ADHD). Yet, once a simple pre bed routine is introduced and maintained, all the irritations of living with a sleep deprived child dissappear and an altogether much more social and pleasant being emerges.

The greatest difficulty for adults seems to be the introduction and maintenance of such a routine. This is why it is so much easier to start building a routine with a young child, even at 3-4 months children can recognise the difference between night and day, which makes this is a very good time to start a pre bed routine.

If you have a child who has a sleep deficit contact Dream-Angus we can help you resolve the issues and improve your child's sleep.

Last snack to promote sleep.

We give our babies a last feed before bed, and send our children off to bed, often with a last snack, to ensure that they do not go to bed hungry. After all a hungry child is unlikely to settle quickly to sleep. What we offer our children, and indeed what we choose for our own supper, can directly affect the nights sleep.
Recently it has been proven that a snack which is high in protein encourages us to stay alert longer than a high carbohydrate snack. This is because one amino-acid called Tryptophan, which calms the brain, promotes sleep is less available in some foods compared to others. When you pair tryptophan with carbohydrates and calcuim then you are offering the brain not only the calming effect of the tryptophan but the calcium which encorages it's uptake.

So, what does make a good bedtime snack?

• Warm milk and half a turkey or peanut butter sandwich.
• Whole grain,low sugar cereal with low fat milk (whole milk for children)
• A banana and a cup of camomile tea
• Granola with yoghurt

Odd Head shapes/Plagiocephaly

Plagiocephaly or flattening of the head occurs when a baby always lies with his or her head in the same position. This does not impact at all on the child's development or learning abilites except in severe cases, when it may contribute to visual and hearing problems.

For most children this is a mild condition simply resolved by positioning and encouraging the child to turn their head.
With simple repositioning techniques, you can prevent and correct 'flattened-head syndrome' and help promote your infant's neuromuscular development. Repositioning involves changing the position of your baby's head while he or she is sleeping and during activities. Changing head positions also helps strengthen the muscles in the neck, which is important when babies begin to hold their heads and sit up on their own.

Very simple measures like making some time for "tummy time", puting visual stimui on the opposite side of the cot, seat or pram will encourage baby to turn his/her head so that everything is seen from another angle than the preferred view.

There has been some work done on special "helmets" which have to be worn daily for the first year of life and are then supposed to alter the baby's head shape. Recent studies have shown no real advantage, for children with mild plagiocephaly, to using these appliances.

Sleepy, Dopey and Grumpy, (sleep disorders in puberty and adolescence).

Around the time of puberty onset the previous sleep wake cycle is known to be physiologically delayed by about 2 hours. This later sleep onset and wake time than in middle childhood is a result of the pubertal hormonal influences on the circadian sleep wake cycle and on the secretions of melatonin.
The child's sleep needs do not differ dramatically, this should still be 9-9.5 hours, but many children at this stage only have 7-7.25 hours of sleep. This results in a considerable sleep deficit. Adolescents are recognised as having a decreased daytime awareness and some studies suggest that many teens function for a good part of the day in a "twilight zone". This is not dissimilar from an individual with Narcolepsy.

External factors which impact on this sleep include;-

• Early school start time
• Homework
• After school jobs
• Extracurricular activities

High achievers and children with chronic medical issues or psychiatric problems such as depression, are at particularly high risk of developing sleep disorders. It is suggested that the prevalence of sleep disorders in this group may be as high as 20%. Chronic sleep deficit in this age group leads to significant negative neurobehavioural consequenses such as;-

• Negative impact on mood
• Vigilance
• Motivation
• Reaction time
• Memory
• Attention

It is very important that at this critical time children maintain good sleep hyigene and regular sleep wake times which will strengthen the circadian rhythm.

Children's Fears.

All children have different experiences and different reactions to the same situation. Some are fearful in situations that do not worry others. Children's fears change with the age of the child but are none the less very real. Children should be encouraged to cope with their fears and parents can help them to do this. Fears can come from watching others and many children fear the same things as their parents do. Fears are often unintentionally rewarded. For example a child who is afraid of the dark may insist that a parent goes with them and a light is left on. Given a lot of attention and reassurance the fear can be rewarded by leaving a light on. Rewarding a fear in this way allows that same fear to continue.
Help your child to manage fear by talking about their fears. Stay calm and let your child know that you understand that they are afraid. Everyone is afraid at some time. Try and keep your own fears under control.

Teach your child coping strategies such as ;-

• Breathing slowly as if they are filling a balloon full of air in their tummy.
• Go floppy like a rag doll so that all the muscles are relaxed,
• Distract themselves by thinking of a happy memory or using imagination in a positive way.
• Remain calm when your child is scared. If you are confident you empower them to be so too.
• Praise your child for facing their fears.
• Encourage your child to face new things.
• Help them to face things they must do.

Talk to your child about dangerous situations and have clear specific rules about what your child should do in these situations.
It can take some time for children to overcome their fears, particularly if they have held these beliefs for some time. Encourage children to gradually approach the things they fear and to cope with the unpleasant feelings they associate with them. Be prepared to seek professional help if the fears remain a problem.

Dealing calmly with night fears and helping your child to overcome these is important. Some bedtime battles are caused by being afraid of the dark, the boogie man in the wardrobe or under the bed. Help your child to be more confident about night time and then bedtime battles caused by such fears disappear.

www.dream-angus.com Working with you to improve your child's sleep

Tantrums

Temper tantrums usually start when a child is about 1 year old. The child is becomong more independant and may appear to be demanding, stubborn and unco-operative. Tantrums are common in two year olds but if managed well, are less common at ages three and four years.
Part of a parents responsibility is to teach the child to manage frustration and express anger in appropriate ways.

Tantrums may include ;-

• Crying (without being hurt)
• Screaming and yelling
• Stamping feet
• Breath holding
• Rolling arround on the floor
• Vomiting (usually only in severe tantrums)

These tantrums occur when children are angry or frustrated. They may be the result of being told No! Things may not be going as the child expects, the task they have been asked to do may be too difficult, they may lack the vocabulary to express how they are feeling, they may be overtired or there may be absolutely no obvious reason.

Every child is different. Some are quiet and easy going and seldom have tantrums. Others have quick tempers and tantrums are frequent. Children quickly learn that a tantrum may bring them the outcome they want and learn to escalate their behaviour until they acheive their goals. Managing these events so that they are not escalated and become less frequent is a challenge for many parents. How best to react to a child who is "bringing the house down" and get it right so that there is no reward for this behaviour is an important question.

The key steps to managing this behaviour are ;-

• Plan ahead to prevent the tantrums
• Give your child praise and attention when they are behaving well.
• If a tantrum occurs use planned ignoring (for younger toddlers.)
• For older children, tell them what to do and use "time out" if the tantrum continues.
• Praise your child as soon as they are quiet or behaving well.
• Return your child to an activity once the tantrum has resolved and praise them for good behaviour.

To help prevent tantrums it is necessary to have a few realistic rules. Decide if your child's requests are reasonable before you say "yes" or "no" and having made your decision stick to it. Keep your child busy with activities especially in situations where they may easily become bored and disruptive. Throughout the day let your child know what you are doing and what is going to happen so that they know what to expect. Watch your child and praise them for behaving well.

Night Feeds

Newborn babies need regular feeds whether breast or formula. Some will look for feeds 2-3 hourly others will accept a regimen of 4 hourly feeds. In the first few months, waking to feed a baby is an expected part of infant care.
By the time an infant is six months old fewer will physically require a night time feed. Some will perisist through habit and, most mums, don't mind this too much if it is simply a case of feeding the infant and re settling. If this can be done within a few minutes it can almost be accomplished in mum's sleep.
Other infants are more awake. Through habit they have developed a lighter phase of sleep at this time and they may also associate a feed as being the thing that helps them to return to sleep. There may be no real hunger and the breast or bottle may only be a plaything, an opportunity to interact with mum.
At this point it is up to mum to decide whether or not she is happy to continue to have her night's sleep interrupted. There are a variety of ways of stopping this night waking behaviour. As this is a habit, once the infant has slept through the night for a few nights usually the behaviour stops completely.


If you need help to change your infant's sleep pattern contact www. Dream-Angus.com
Working with you to improve your child's sleep.