The Fourth Shift

While a great deal of research has looked at sleep and children's sleep patterns the sociological effects of childrens sleep on that of their parents, has been largely ignored. Last year a sociological study examined how couples with children have their sleep influenced by caring for their child or children.

The key concerns were not only related to caring for young children and their physical needs at night, but also how the nature of caring for older children impacts on parents sleep. A number of couples aged 20-59 with both younger and older children took part in the study which involved completing auditory sleep dairies, individual in depth interviews, and follow up interviews.

It is not really a surprise to find that the physical and emotional care of young children at night was largely provided by women, with a lack of explicit negotiation between partners about who should provide this care, even when the woman returns to work. Overall considerably more women than men continued their daytime and evening employment, as well as undertaking a third shift, or sentient activity, for their family into the night. This resulted in a fourth shift where physical caring and sentient activities continued.

As a consequense mothers were more likely to subjugate their sleep needs to those of the family. Fathers, in general, did not undertake this fourth night time shift. Those fathers who did, were more likely to be fathers of older children who were staying out late at night, with their focus of concern being the safety of the children.

If you find your children are demanding during the night and you would like to alter this behaviour, Contact Dream-Angus.com

Migraines and Sleep Related Breathing Disorders.

Children who experience migrane headaches are more likely than the rest of the population to have sleep disorders, which are related to how they breathe while asleep. Obstructive Sleep Apnoea, where breathing is discontinued for 15 seconds or more while the child is asleep, is a recognised sleep disorder. Often this can be simply resolved by removal of large tonsils and/or adenoids. Other children experience this problem because they are overweight, or for other physical reasons.

Children with sleep related breathing disorders may wake suddenly in the night, when the brain announces a lack of oxgyen, and demands a breath be taken. This can result in a sudden, and to the child, inexplicable and terrifying waking, and may be accompanied by an associated gasp as the required breath is taken.

A study by Dr. S. Kothare looked at children who reported having regular headaches. The study found that children with migrane were twice as likely to also have obstructive sleep apnoea. This same study found that children with tension headache also grind their teeth at night.

Migraine in children, is a big and separate subject. It is not always reported as headache, and can, depending on the age of the child, be reported as abdominal pain. The relationship between sleep disordered breathing and headache, migraine and tension headache should be brought to the attention of parents so that appropriate investigations, advice and treatment can be obtained. Migraine is associated with a shorter total sleep time, a longer total time to fall asleep and a shorter period of Rapid Eye Movement sleep.

Obstructive Sleep Apnoea occurs in 2% of children. It can develop at any age, but is most common in pre school children (3-6 years). At this stage of life the tonsils and adenoids are large compared to the throat. The rate of occurance is the same regardless of gender. It is more common where another family member has the same disorder, and it is common in obese children.

If your child regularly wakes suddenly, with a sharp cry in the night, you should consider your family's sleep patterns and possibly seek advice regarding Obstructive Sleep Apnoea.

If you would like more information Contact Dream-Angus.com

Calming babies and children under 1 year.

The most difficult thing in getting a young child to sleep when they are resisting, is getting the child to be calm enough to relax and become drowsy. There are a number of simple techniques which can help with this.
If the child is still a baby and not yet mobile, there are the much lauded "4 S's"

Swaddling a baby is conforting, gives a feeling of being held without the need for a parent or carer to hold the child. It provides "deep pressure", avoids waking from the startle (moro) reflex when hand coordination is not fully developed, and for a majority of babies helps to calm.

Shuushing, providing background noise which reduces the effects of sudden loud noise and replicates the noises heard by baby while in the womb.

Sucking is calming for most babies unless they have reflux and associate this with pain. Using a comforter/pacifier/dummy to calm a baby is good but they should not be left in the mouth until the child is asleep or they may become dependant on this aid.

Shoogling, the short gentle movements which replicate the gentle movements felt as mum went about her day before delivering baby. Some parents use a swing, stroller, or rock baby in their arms.

All of the above in a variety of intensity and combinations will soothe a distressed baby. Unless a child is calm getting them to sleep is virtually impossible. Having a recognisable routine which is always done in the same order at the same time is reassuring for every child and the older the child the more important that routine is. This makes some certainties in the child's life. If a certain set of circumstances occur, then the anticipated response is also familiar and it is easy for the child to give the appropriate response. Our children want to please us and having at least one thing which they recognise and know how to respond to, helps build confidence in an otherwise uncertain world.

Some parents, who struggle with settling and sleep issues resort to the use of medications, or homeopathic, or herbal remedies. These may help but do not address the root cause of the undesirable behaviour. Adults come to rely on the administration of these products to acheive a calm and sleepy child. The child also learns that sleep can only be accomplished by the use of such substances. This is not a healthy route to sleep. It does not allow the development of independant abilities to self soothe to sleep. This can become a long term issue which, when behavioural interventions are used would be short lived.

There are very few occasions when it is appropriate to medicate to sleep. While there are treatments which will achieve this they are not without side effects and they do not address the problem, they only treat the symptoms.

If you have difficulties settling your child, Contact Dream-Angus.com

Depression in teenagers

Professor Gangwisch, of Columbia University College in New York, is the lead author of a recent study published in the journal Sleep which looked at the theory that inadequate sleep is a risk factor for depression.

Those of us working with children and families have always been aware that many young people spend their formative years chronically sleep deprived. As a result they are tired and inattentive and more prone to obesity,hypertension and depression.

Researchers now believe that sleep deprivation is directly linked to depression and suicidal thoughts, making it much more difficult for these young people to cope with daily stresses and making it more difficult for them to engage with their peers and with adults.

Teens allowed to stay up to midnight are 24% more likely to suffer depression and 20% are more likely to consider self harm than those who have set bed times of 10pm. Adolescents who sleep for five or fewer hours per night are 71% more likley to suffer from depression and 48% are more likely to consider suicide than those who reported getting eight or more hours of sleep per night.

The more sleep adolescents and teenagers get the lower the rate of depression, and the better this is for both their mental and physical health. Nine hours of sleep per night is the recommended level for adolescents. Of the 15,000 students, aged between 12 and 17, who took part in this study, the average sleep duration was only 7hours and 53 minutes. Those with a bedtime of 10pm or earlier slept on average 33minutes longer than those who went to bed at 11pm and 40minutes longer than those who went to bed at midnight.

This highlights once again the important part a good nights sleep plays in mental and physical health and wellbeing. Teaching your children good sleep habits is vitally important. Recognising when things are going wrong and working to resolve sleep issues at an early stage is worthwhile from a health perspective. Ensuring that young people get regular exercise, fresh air and have a regular sleep pattern gives them the optimum start in life.

If your child has difficulties developing a good sleep pattern contact Dream-Angus, we can help you to help your child to a better sleep.

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.