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.