Altering a sleep pattern

While most children manage to soothe themselves to sleep, and to sleep through the night without the need for any intervention, there are a number of children who take a long time to learn to do this.

Some children have never learned to put themselves to sleep. They rely on a parent holding them, rocking them, feeding them or simply being with them until they fall asleep. These children come to believe that this is the only way to get to sleep and the parents are often very tired and frustrated. There is no time left to be an individual, to maintain a healthy relationship with a partner. Every evening is spent with the child, just as the day has been. There is no quiet time, no time to exchange comments about the day and often no private time between parents at night. Someone must remain with the child so that the child will sleep.

Altering a child's sleep pattern is possible. It requires an understanding of exactly what has happened to cause the difficulty. A sleep history helps clarify this.
What is the pre bed routine like, how do the parents react to the difficulty and what priorities do the parents have in mind when they want things to change? Sleep diaries illustrate exactly where the difficulties are, and completing these throughout the work to change things can also show what is working, and what is not.

Once the issues have been clearly identified, and the parents priorities decided, it is possible to work using graded techniques to improve the child's sleep. Cry it Out, a method that allows a child to cry with a parent checking at extending intervals, has long been discredited by sleep professionals.

This method does work but it teaches the child that being upset is not going to be met with comfort. The child learns to suppress such emotions and this is not healthy. Cortisol, the stress hormone, floods the body systems of parents and child so neither are happy with the situation. The parents may have been told that this is the way it has to be, but this is not so.

There are other ways to support a child who is afraid, who lacks confidence in their ability to fall asleep or remain asleep without mum or dad being nearby.

Altering a sleep pattern can be really hard work for both parent and child. It requires consistent repetition and demonstration of behaviour and consequenses so that things can and do improve. Most sleep difficulties can be resolved within a few weeks. Perseverance, persistance and calm confidence are atributes which are vital to success.

Once a child has learned to sleep and to remain asleep, their appetite and mood imnprove and parents find things so much easier.

If you would like help to improve your child's sleep, Contact Dream-Angus.com

Teaching our children

I am often asked if resolving one sleep issue, means that there will be other issues to be worked on later.
Most pre school children who have a difficulty in getting to sleep, or staying asleep, and who then learn to sleep and to remain asleep have no further difficulties. Learning to sleep independently is a gift for life. Children who have difficulties and do not have them resolved often continue to have difficulties with sleeping.

Do children "grow out" of sleep difficulties?
Sometimes, but this depends on the reason for the difficulty. Children whose imagination is particularly active, and who cannot differentiate between dreams and reality may "grow out" of sleep difficulties if this is the cause. For many children the causes are multi factorial. Sometimes there is an obvious reason, and sometimes there is no obvious cause of the child's difficulty.

We teach our children many things, and teaching them to sleep is often done without being conscious of it. If we always allow a child to fall asleep on the couch in front of the television, then move them into a bed, that child comes to believe that this is what he or she needs in order to relax and fall asleep. Teaching this child that they can, and should fall asleep in their own room, in their own bed can take some time and perseverance. However, once the child has learned a new behaviour and repeated it on successive occasions it becomes the new norm. This is what altering sleep behaviour is about. It is about altering the perceived needs and demonstrating a better way to achieving a good nights sleep.

There are many ways to alter children's behaviour. Sometimes this is about giving the child confidence in ourselves as parents. Sometimes it is about giving confidence in the child's independence or in the child's ability to cope in new situations. Often the pace of change has to be slowed or hastened depending on how well the child copes with the changes.

Just as every adult is an individual, so is every child. What works well for one may not be as effective for another. Your child has to grow up within your home, living with your ideas and this has to be taken into account. No one knows your child as well as you do. Professionals can indicate good practice and direct your efforts.

The biggest single thing that parents need to identify is the difference between what your child needs and what your child wants. Children's needs should always be met unconditionally. This gives children a secure base, a belief in their parents ability to nurture and protect. We all want our children to have faith in our abilities to protect and care for them.

We all have "wants". Children who are secure can cope with wants not always being met as long as their needs are addressed. In the wider world we do not always get what we want, we hope we always get what we need. This is a difficult lesson for children and often it is difficult for parents to identify when something is needed, and when another thing is desired.

Speech and Language skills

Overall about 5% of children entering school have significant speech and langauge difficulties without any additional sensory or cognitive impairments. When sensory and cognitive impairment is an additional feature this number rises to 25-35%.

For the majority of children speech and langauge develops without any problems and by the age of 6 years children are relatively sophisticated users of language. Speech and language skills incorporate a number of elements including;-

• Structure of language
• Use of language
• Understanding of language
• Vocabulary
• Speech sounds

Some signs which may indicate that a child has a speech and language problem include;-

• Inability to follow simple, everyday instructions at age 2years.
• Restricted vocabulary development at 30 months. (70% of children have at least 500 words by this age)
• Sentence structure of 2-3 words at the age of three years.
• Family cannot understand the childs speech at 3 years of age.
• Difficulties in attentionm understanding, development of play or with the social aspects of language.
• Failure to use grammatical endings such as ing, ed, and plurals at 4 years of age.

It is important to ensure that the child has good hearing as missing a pitch or tone can result in poor speech. Language difficulties are pervasive and early intervention and support can make a considerable difference to the child's learning and speech and language development. Referral to a speech and language therapist for assessment and support can be invaluable.

Feet First

The Human foot is a complex structure of 26 bones, which have usually hardened by about age 18. In a nweborn the foot is mainly made up of relatively soft cartilage which converts to bone as the child grows and matures. During this period of growth and development the foot is at risk of injury and deformity. For this reason children's footwear has special importance.

Babygrows and sleep suits should not cram little toes. Pram shoes are best avoided as it is very difficult to size appropriately, bootees which do not constrict the toes and ankles are much more suitable. Ideally a child does not require shoes until they are walking competently out of doors. In order for the foot to develop normally and naturally the child should be barefoot for as long as possible within the realms of safety.

On average a child's foot grows two sizes a year in the first four years of life, and one size a year after this, until growth is complete. Sometimes a childs foot seems not to grow for a considerable period then suddenly grows several sizes. It is a good idea to have a trained shoe fitter measure your childs feet every 8 weeks, more frequently if you are aware that the child is actively growing taller.

Children enjoy being barefoot, but if their feet are noticeably cold, or they complain of this, some form of protection may be neccessary. Socks alone may be dangerous if there is a danger of the child slipping. Slippers are only a short term solution as they are not held properly on the foot. Long term use may result in future deformities.

The age at which a child first walks unaided is variable. For girls the average age is 12 months and for boys 15 months, but some perfectly normal children do not walk unaided until 24 months. Nearly all babies appear to have flat feet when first they walk unaided. This is partly because of posture adn partly due to the deposits of fat which can make the foot look flat. The first time walking baby has to balance a relatively large head on a short body and in order to do so baby walks with knees bent, legs wide apart and feet turned outwards. The nervous gait control is still developing and so the child appears to be flat footed.

Baby walkers encourage loading of the joints before nature intended, often resulting in unusual walking patterns. Research has demonstrated that using baby walkers may cause baby to walk later than he or she normally would.

Keeping children warm

It is generally accepted that an infants bedroom should be kept at between 18-20 degrees C. At this temperature the room is cool enough to allow baby to be warm and to sleep without being overheated. As winter cools the outside air there is a temptation to increase the temperature inside homes, as much for the comfort of the adults as the comfort of children. The ambient temperature of your living room is chosen for your comfort and that is a personal choice.

Children do not make these choices so what should we consider for them?

Toddlers should have one layer more clothing on, than their parents, to ensure that they remain warm and comfortable. Wearing a hat out of doors is helpful, as babies and small children lose a fair amount of body heat through their scalp. Where there isn't a great deal of hair, this loss is increased. Toddlers are notorious for wriggling out of hats shoes and gloves, which is why strollers have warmly lined "suits" or cosies to keep them warm.

Children's body thermostat is not as efficient as an adults, so it is important to ensure that they remain warm and dry despite the winter storms and snows. When ever possible parents should avoid taking very young children out after 3.30pm/4pm as this is when the temperature outside is most likely to start it's evening fall. Although the baby/child may have been warmly enough dressed earlier in the day this fall in temperature can make it more difficult to remain warm.

Is it healthy to encourage babies to sleep through in early life?

Although we know that babies, from as early as two months, have a definate sleep pattern developing, how healthy is it to have an infant sleep through the night?
You may argue as a parent that you need your night sleep, and wake only to feed or comfort your child. That it is better for you, and makes it easier to cope, if your child sleeps through the night and lets you sleep too.

While this has become the accepted standard, and parents are particularly proud when they can tell others that their child sleeps through the night from as early as a few months old, we know that breast fed babies wake several times through the night and that this encourages milk production.
Breast fed babies usually feed quickly and with minimal disturbance to their own or their mothers sleep, depending on the sleeping place.

There is another school of thought that says babies who are encouraged too soon to sleep too deeply are more likely to overcome their bodies natural "protective" impulse to wake, may be more likely to succum to Sudden Infant Death.
This arousal mechanism is the primary means by which infants defend themselves against potentially fatal breathing or cardiac perturbations. Encouraging early sleep consolidation may be placing arousal-deficient infants at increased risk of sudden and unexpected death.

When the "experts" disagree it is confusing for parents who want to do the best they can for their baby. Perhaps parents whose children do not sleep through the night before 6-9months should take heart that, although they may have a sleep deficit as a consequense, they are not necessarily doing anything wrong.

The truth of the matter is, that what is a problem for one set of parents, is not necessarily viewed as a problem by other parents. We should be prepared to work with our children. Supporting them through life and encouraging the behaviours we find acceptable. At the same time accepting that we all develop at different paces and there is some joy in the differences too.

There is no "one rule suits all" nor should there be.

If you have concerns about your child's sleep, Contact Dream-Angus.com

When do babies start to sleep through the night?

A new study suggests that babies should be able to sleep through the night from about three months old. From about five months, parents should be able to expect a longer period of sleep.

Previous studies show that a sleep pattern develops before a real feeding pattern and this is usually at about 60 days (two months) of life.

Jacqueline M. T. Henderson, PhDa, Karyn G. France, PhDb, Joseph L. Owens, PhDa, and Neville M. Blampied, MSc of the Department of Psychology and Health Sciences Centre, University of Canterbury, Canterbury, New Zealand set the objective of investigating the consolidation of infants' self-regulated night sleep over the first year.
The idea was to determine when infants first sleep through the night from 24:00 to 05:00 hours, or for 8 hours, or between 22:00 and 06:00 hours. These times were chosen as the times that most parents would love to have babies sleep through without waking.

Parents of 75 typically developing infants completed sleep diaries for 6 days each month for 12 months. The accuracy of the parent reports were assessed by using videosomnography. (time lapse video of the sleeping child)

The researchers found that the most rapid increase in uninterrupted sleep occurred between one and four months, during which the babies gradually stretched their sustained snooze time by nearly three hours.

At five months of age, 50% of infants were sleeping from 10 p.m. until 6 a.m. Babies reached the easier milestones earlier. Half of the babies slept from midnight to 5 a.m. by three months of age and 8 hours a night by four months, according to the October 25th online report in Pediatrics.

By 12 months, 85% of the babies met these two criteria -- but one of every four still wasn't sleeping from 10 p.m. to 6 a.m.

This study found that the most rapid consolidation in infant sleep regulation occurs in the first 4 months. Most infants are sleeping through the night at 2 and 3 months, regardless of the criterion used.
The most developmentally and socially valid criterion for sleeping through is from 22:00 to 0:600 hours.
At 5 months, more than half of the infants were sleeping concurrently with their parents.

Many infants have difficulties in consolidating their sleep and frequently wake during the night, which is a source of distress for the family. Understanding normal maturation may help in developing interventions and early prevention tools.

Sleep-promoting routines should include creating a sleep environment that is quiet, dark and at an appropriate temperature; maintaining consistent routines and sleep schedules; encouraging a baby to fall asleep and resume sleep in their cribs with little help; and gradually increasing intervals between night feedings.

If you would like help to improve your child's sleep Contact Dream-Angus.com