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