I frequently hear from parents that before their child was born, they thought they would never use a pacifier. Then once their baby arrived and had a strong urge to soothe by sucking, all those firm beliefs went out the window. Pacifiers can be a great tool, especially for babies who want to be sucking all the time, and it doesn’t have to be a problem unless it becomes a sleep crutch.
Here are some of the pros and cons of the paci and ways to figure out what to do about it and when to make a change if it has become a sleep crutch.
Pacifiers can be a great way to soothe your baby. Don’t forget that your baby was likely to be sucking on his hands when he was in utero. Sucking is one of Dr. Karp’s essential 5 Ss to help soothe your baby. In the first 3 months, your baby has very limited ability to soothe himself. Unless your baby has successfully figured out how to suck his thumb and then remembers that it makes him feel better, the pacifier can be a very helpful tool.
There is also research that suggests that pacifers can help prevent SIDS.
For young babies who are still being swaddled, the unfortunate news is that when your child doesn’t have access to their hands for soothing, you are going to be the human “rebinker.” Since children don’t typically have the pincher grasp required to put the pacifier back in their own mouth until about 8 months old (although I have seen some particularly determined children do it around 6 months), it is likely that until he is able to pop it back in on his own, you will need to do it for him.
If you keep the pacifer until your child is a toddler, inevitably, there will come a day when you have to get rid of it.
Pacifers have also been linked to higher rates of ear infections in children.
What to do when the pacifier that has become a problem
If your baby is not at an age when he is ready for sleep coaching, you will probably need to keep the paci until you can begin sleep coaching. This can happen as soon as 4 months for some babies while others need to be closer to 6 months. If your baby is ready for sleep coaching and you want to be done with the paci (at least at night), then I typically recommend getting rid of it at the same time you do sleep coaching. There is no way to wean the paci, it is either in or its out. I find that cold turkey is the only option. After 2 or 3 nights, your child won’t remember that he ever used it.
If your child is able to put the paci in his own mouth but just doesn’t do it (meaning you have seen him do it during playtime or he is able to pick up pieces of food and put them in his mouth), then it is time to encourage some paci independence. You can start with putting the paci in his hand and then guiding his hand up to his mouth, then just put it in his hand and eventually pointing to it on the mattress in his bed and saying “here is your paci, put it in your mouth.”
Hint: if he loses the paci in the crib during the night, put several in there and use a breathable bumper to keep the pacis from falling out through the crib rails.
Getting rid of the paci for an older child
I don’t typically recommend getting rid of the paci for a child over 15 months (children become very attached to things at about 15 months and will begin to experience another burst of separation anxiety) until he is 2 or 2½ and has a bit more ability to have a conversation about what to do about the paci (more on that in a bit). Truthfully, by about 9 months, the paci has become your child’s security object and taking it away will be likely to produce a great deal of distress. If you are going to do away with the paci between 9 and 15 months, introduce a security object or lovey.
If your child is an age when you can have a conversation about saying good-bye to the binkie (around 2 or 2 ½ or even 3 years old), begin talking about what is going to happen a few days before getting rid of the paci so that you can help your child prepare for the changes. Make sure that you are not choosing a time of new stresses like moving into a big bed, right before a trip, or when a sibling is about to arrive on the scene. You can read a few books that address the topic like Little Bunny’s Pacifier Plan by Maribeth Boelts, No More Pacifier for Piggy! by Sam Williams, or Goodbye Binky: The Pacifier Fairy Story by Sinead Condon.
Here are a couple of ideas of plans you can make with your child:
Whatever you decide to do, make a plan and stick with it consistently. Expect that there will be tears of frustration and a few rough nights ahead but trust that your child can learn this.
Please join me next Sunday, March 9 from 8-9pm (CST) for a FREE Sunday Sleep Chat. Go to www.facebook.com/SleepTightConsultants, “Like” the page, log on at 8pm and ask all your sleep questions. I will answer as many questions as I can in an hour.
One of the most common questions I hear from parents is regarding their children’s short naps. More specifically, naps lasting 30 minutes, sometimes (if you’re lucky), 45 minutes. Parents will say, “my baby can only sleep for 30 minutes and then he’s up, and he won’t go back to sleep.” This is a painful experience for everyone. Your baby is likely to still be tired and you are likely to be frustrated because you know he still needs more sleep but you can’t get him to sleep any longer. I know how you feel! I have been there. My son was also a 30 minute napper until he was about 7 months old. I would watch him on the video monitor and at exactly 30 minutes, I would see his fingers moving, then a leg and then he was up! I remember thinking, “Are you wearing a watch in there?” How did he know that it had been exactly 30 minutes on the dot? I now know that 30 minutes was the end of his first sleep cycle, and he had to learn how to get himself back to sleep when he went through that sleep cycle.
The good news is that it is possible to teach your child how to take longer naps and help him not be overtired. Before thinking about working on the naps though, you have to take into account what is happening at night. Children learn to consolidate their night sleep before day sleep. If your baby does not have the skill to put himself to sleep at night (when it is the easiest time to fall asleep), then it will be very hard to do it for naps when it is much, much harder. If the nights are going well, then you may be in a good spot to do some nap coaching. The key to your child learning how to take longer naps is that he has to put himself to sleep at the beginning of the nap so that when he goes through a sleep cycle, he has the skill to get himself back to sleep.
Another important component to taking good naps is for your baby to not be overtired when going down for a nap. When babies become overtired, their brain begins to produce cortisol which is the stress hormone that not only inhibits sleep but also give your baby a “rush,” leading him to be energized rather then sleepy. How long your child can be awake before becoming overtired largely depends on how old they are and how well they are sleeping in general. For instance, if your child is sleeping through the night, he is going to have a much easier time making it an hour and a half or two hours to his morning nap then if his night sleep is broken by frequently wake ups. So when your child is waking too early from naps, looking at whether he might have been overtired when he went down can help you understand what led to the short nap.
Lastly, if you want your child to learn how to take longer naps, then you are most likely going to need to do some nap coaching so he learns that when he wakes at 30 or 40 minutes, it is not time to be awake. Nap coaching is not very much fun and can be very frustrating. The reason for this is because naps happen multiple times a day and require persistence and consistency in order to improve. Also, often one parent is home alone with the child, doing the nap coaching so it can be more isolating and sometimes discouraging. With some focus on improving your child’s naps, however, it is absolutely possible to make changes so that your child is getting enough sleep for his developmental stage.
Have you been struggling with helping your child improve his or her day sleep? Contact me for a FREE 15 minute phone consultation to learn more about how to improve your child’ s naps.
Parents ask me all the time what reassurances I can give them that working with me and making changes in their child’s sleep will really work. My response is that making behavioral changes in sleep is very straight-forward once you know what to do. If you make changes, respond consistently and keep responding consistently over a period of time (that time period varies based on your child’s age, temperament and how much you have tried to sleep train-unsuccessfully, him or her before) then you will see results. The exception to this is if there is an underlying medical problem. No matter what behavioral changes you make, if your child is uncomfortable due to medical issues, you are not going to be successful at reaching your sleeping goals.
Sometimes it is clear that your child has a medical problem happening. For instance, he has a bad cold or a fever. To most parents, this is obviously not a good time to be sleep coaching. But sometimes medical problems can be harder to identify by parents and the medical problem can be the reason that their child’s sleep was suffering all along. Regardless of the issue, it is likely that parents of children with underlying medical complications have responded inconsistently to their child’s sleep troubles out of necessity and desperation. When a child’s sleep becomes so problematic and nothing the parents have done to change it works, we go into survival mode in order for everyone to just get enough sleep to get by—for both parent and child. For this reason, even when the medical problem is resolved, there is still work to be done to change the behaviors because your child will come to expect certain things to happen either at bedtime or when he wakes at night.
In young babies, the most common medical issue I see is reflux. Many babies these days are diagnosed with reflux. For some it resolves in the first few months, for others it can linger on for many months to years. When it is ongoing, I frequently encourage parents to go back to their pediatrician or GI specialist and ask further questions about what can be done to help their child be more comfortable and to resolve the reflux. If your child is in pain due to the burning in his esophagus caused by reflux, there is no amount of behavior modification that is going to solve your baby’s sleep problems. Reflux can be confusing in some instances and parents are often reading and receiving conflicting information that they are hearing from their pediatrician, GI specialist, internet, or from other parents whose children have had reflux. I will often recommend the book Colic Solved as a way to help parents get good, expert information about what is happening for their baby with reflux.
The other big medical issue I see complicating sleep in children is obstructive sleep apnea (OSA). In recent years, more parents are learning about OSA, identifying symptoms in their children, and seeking treatment. The most common symptom of OSA in children is snoring. Children should not snore and when they do, it can be an indication that their airway is obstructed, and they are not able to get enough oxygen when they sleep. This leads to troubles falling asleep at bedtime, frequent awakenings in the middle of the night and early wake ups in the morning. All of these things can have behavioral causes as well, but if parents are being consistent and have made behavioral changes to respond to their child’s sleep problems yet nothing is changing, this in combination with having other symptoms of sleep apnea, can be an indication that there is an underlying medical problem. Some of the other symptoms of OSA include restlessness, sweating (during sleep), mouth breathing, and unusual sleeping positions. If you suspect that your child may have sleep apnea, the next step is typically an appointment with a pediatric Ear, Nose and Throat specialist. They will often take X rays and potentially suggest that your child undergo a sleep study. Treatment for OSA in children often involves removal of the tonsils and/or adenoids. This video is an excellent demonstrates of what OSA looks like in children. If you are seeing these symptoms in your child, please seek medical help.
You and your child need and deserve good sleep. Your child deserves sleep that is undisturbed by medical problems. If you have questions about your child’s sleep and how to improve it, please contact me.
Sleep regressions are every tired parents big fear. Especially if you have completed sleep coaching your child and now things have gone off the rails, you are bound to be frustrated and discouraged if your baby begins waking again. Parents ask me all the time, “Once my child has learned how to sleep, what regressions may happen? What do we do when there is a sleep regression? How do I help my child without falling back into bad habits.”
What is a sleep regression? A sleep regression is when your baby was previously sleeping well (possibly through the night) for a long period of time and then, all of a sudden, without a known cause (such as the big sleep stealers: illness, teething, travel), their sleep suddenly goes downhill. Sleep regressions can last anywhere from 2 to 6 weeks and often coincide with cognitive or developmental milestones. Commonly sleep regressions tend to happen at 6 weeks, 3-4 months, 6 months, 8-10 months, 12 months, 18 months and 2 years old. Fear not, most children do not experience a full regression at each of these milestones.
Here’s what is likely to be going on at each regression
6 weeks: Newborns frequently go through a series of growth spurts leading to increase hunger and fussiness. Think about how rapidly your newborn is growing at this age! So much happens in a relatively short span of time and this all takes lots of work on your baby’s part.
3-4 months (referred to as the 4 month sleep regression): I often think of this as one of the hardest time periods. In addition to a growth spurt, your baby is going through bursts of brain development increased awareness of her surroundings leading her to being more distractible in months past. At the same time, many of the tricks (like Harvey Karp’s infamous 5 Ss) you may have used in the first several months to get your baby to sleep may stop working. Whereas previously you may have been able to put your baby to sleep while holding her and transfer her to her sleeping spot, now the minute you put her down she wakes. This is challenging because some babies are still really too young to soothe themselves from a wakeful state to a sleeping state so it may take several tries to get your baby into bed. Some babies will also begin rolling at this point, which means if you are still swaddling, you will need to stop so that your baby doesn’t roll themselves in the swaddle. Also, there are often a few days to weeks when your baby will roll from their back to front and get stuck (or vice versa) and not be happy in whatever position she is stuck in. Lots of tummy time is essential to help your baby become proficient at rolling during the day so less practice at night is necessary.
6 months: If your baby wasn’t an early roller, he may begin rolling more frequently by 6 months. With rolling and increased core strength comes crawling. Some babies will crawl as early as 5 or 6 months. Others wait until a bit later. Whenever it happens, it can become a big sleep stealer where you may see your baby up on all fours in his crib rocking back and forth, just practicing and getting ready for his upcoming mobility. Some babies also go through a growth spurt at 6 months so increased hunger can occur.
8-10 months (referred to as the 9 month sleep regression): This most often coincides with your baby’s new found ability to pull herself up to stand. When this happens, your first job is to make sure she knows how to sit back down. This can be practiced during play time when your baby is standing at a couch, coffee table, or ottoman height surface. Place something on the ground that is sufficient incentive for your baby to reach down for it. Maybe it is a favorite toy or something that is often off limits like your TV remote control or cell phone. Guide your baby down to reach for the object, at first helping to bend her legs and then letting her do it on her own. You can also practice this in the crib and can work on teaching your baby to walk her hands down the crib rails to a sitting position. It is essential that you ensure that your baby can sit herself once she can stand, otherwise she will have no way of laying down to return to sleep if she wakes and stands. You can end up in an endless game of “I lay you down, you stand up.”
12 months: Walking! Some babies will walk sooner then 12 months, some later. I see 1 year olds having less regressions than younger babies but whenever your child begins walking, it can easily throw your child’s sleep for a loop. This regression can crop up about 2 weeks before you see any significant skills emerge. As with the earlier milestones, be sure to give your baby lots of practice time during the day so his is a bit more tuckered out when it comes time for sleep and is feeling less of a need to practice in bed.
18 months: While many babies have been babbling away for months by now, words and direction following can really begin to emerge at this point. Your toddler will still have difficulty communicating exactly what he wants, which can produce much frustration for both parent and child. Remember, your child’s receptive language (what he understands) is likely to be move advanced then his expressive language (what he can articulate) so be sure to talk to him about what you are doing and when you are doing things that involve him. Toddlerhood often brings the obsessive need for predictability to help your child have some semblance of control of their environment. Being very consistent with your bedtime routine and in your response to any night wakings is essential to keeping any regressions short lived.
2 years old: Some children’s verbal skills may not increase until closer to 2 leading to a later regression. Some 2 year olds may also be potty training. When children potty train at a young age, it can sometimes throw sleep for a loop. Most children do not night potty train when they learn to stay dry during the day. This typically follows later (by months to years for some). Still, if your child potty trains early, it can lead to a few sleep troubles as she begins to master a new skill.
What to do during a regression
It may be that you don’t even realize that the regression is happening until your child masters his new skill and then you look back and think “So that is what was happening!” If you find yourself in the midst of a sleep regression, do your best to soothe your child by being responsive but not creating any new sleep crutches or falling back into old ones. Try to remind yourself that this is temporary, but if previously you didn’t need to step foot in your baby’s room at night, you may now need to make an appearance, even if it is just for a “parenting check.” When you establish that your child isn’t sick and that there is nothing that you need to “do,” you can go back to a spot of increased support if you have gone through a behavioral fading method and your child was once comforted by having you close by. Or you may need to do a few timed checks to reassure your child that you are nearby but that it is still time for sleeping. Recognizing that your child also is tired and frustrated with whatever developmental milestone is happening is also helpful to keep in perspective. Hopefully it will be short-lived and everyone will be back to sleeping great very soon. If not, feel free to contact me for a free 15 minute consultation and get to the bottom of whatever is going on.
Many families contact me when they move their toddler from a crib to a bed stating that their child slept great when in the crib but now that he is in the bed, it’s a circus all night long. This can be a tough move for some children. Many children are comforted by the familiarity and confinement of the crib and struggle with the loss of boundaries when the rails of the crib are no longer there.
Before moving your child out of the crib, be sure to seriously consider your child’s age and level of cognitive development. There is no reason to rush the move from the crib to the bed. Think about how well your child follows instructions. Does your child have the ability to understand the rules for sleeping in a big bed? Sometimes I hear from parents that their child wasn’t sleeping well in the crib so they thought they would try the bed. Other times there is a new baby on the way and the parents want to use the crib for the baby. Moving your child out of the crib before he is ready can backfire. If your child isn’t sleeping well in the crib and he is under 2½ years old, I would work on helping your child improve his sleep while in the crib before making the move to the bed. If your child doesn’t know how to fall asleep on his own in the crib, this will not become easier in a bed. If a new baby is coming along, consider having the baby sleep in a pack n play or bassinet before moving the baby to your toddler’s former crib.
Once you have determined that your child is ready to make the move, here are some helpful tips to make this transition as smooth as possible.
Good luck with your big transition! Your baby is growing up!
I can’t emphasize enough the importance of a bedtime routine. Children as young as 8 weeks old can appreciate a bedtime routine. Why is bedtime routine important? From a biological standpoint, opioids are created in the brain when entering a welcoming, cozy, or familiar space. This helps calm the brain and get ready it ready for sleep. The bedtime routine is designed to help your child go from an alert state to a calm and drowsy state. When you go through a bedtime routine, you are showing your child that their room is a safe and nurturing space and creating a foundation for comfort, thereby activating oxytocin and the sleep hormone melatonin.
From a cognitive standpoint, the bedtime routine is important because your child doesn’t know how to tell time. As parents, we do things throughout the day that help our children to understand what is happening next and to help their day start to have some order and predictability. Your child will begin to associate the things you do in your bedtime routine with going to sleep. Bedtime routines help children calm down and relax in order to be ready for sleep. Especially for alert children, making the transition between interacting and playing and quieting and down to go to sleep can be very challenging. The process you go through before bed will help your child be ready to go to sleep rather then continuing to play.
In large part, bedtime routine is a very personal process and individual to your family’s traditions (or the traditions you are creating). You can customize it in whatever way you choose so that your child has their special time before bed with you. Bedtime routines often involve taking a bath (although baths are not typically relaxing for children-it tends to be play time but children do make an association between playing in the bath and going to sleep soon after), infant massage, diaper changing, turning down the lights, turning on white noise. putting on pajamas, feeding (nursing or a bottle) for babies, a special bedtime song or short story. For many young babies, it can be a challenge to even get through the shortest of books before bed when a baby is already very tired. I often recommend saving books for other times of the day when you expect your child is more alert and interactive. As children get older and are no longer eating before bedtime, adding in a story can be a good way to substitute one comfort (feeding) for another (concentrated attention from parents during story time). Make sure to include your child’s special lovey or security object in the bedtime routine because your child also associates having his or her lovey as part of the process of going to bed.
When babies are little, bedtime routine may not take much longer then 20 minutes and much of that may involve feeding. I often encourage parents to keep bedtime routine on the short end when their children are younger because as they turn into toddlers, they love to add to the bedtime routine. Toddler shenanigans can often make a bedtime routine rather lengthy because they are famous for their stall tactics. It is important, however, that you keep the routine consistent, especially with regard to the order of events because the consistency is very comforting. Changing around a bedtime routine can throw a toddler into a tailspin.
Summer is finally here and you are probably looking forward to spending time outside, going for stroller walks, exploring the parks, going to the beach and taking a vacation. But if this is your first summer as a parent, vacation takes on a vastly different meaning then it once did pre-parenthood. Gone are the days of relaxing on the beach with your trashy novel or endlessly exploring a new city without any real plan. Like most things that were once simple before you had a baby, travel too has become more complicated. If you have finally figured out how to get your baby sleeping well, taking a trip can be a daunting prospect. In fact, travel is one of the top five sleep stealers followed closely by illness, developmental milestones, teething, inconsistency. Inevitably, travel will cause some sleep disruptions for your child. There is really no way around this. You can, however, with a little planning, do your best to minimize the challenges and get her back on track as quickly as possible when you get home. Here are some tips to help everyone have as restful vacation as possible.
Once you get home, spend a couple of days working on getting back to your usual routine and returning to your normal schedule. No matter where you are going or what the trip turns out like, just remember, it gets easier and someday, you will be able to go on an actual vacation again that doesn’t require time to recover afterwards.
No one likes nightmares. Even as an adult, nightmares are scary and can leave me awake for extended periods in the middle of the night while I try to remind my brain that it is safe to go back to sleep. In children, it is no different only they don’t have the ability to understand that the vivid images they just experienced were not real. Sometimes, however, children experience what looks like a nightmare but it is, in fact, a night terror. It is important to understand the difference, to know how to spot a night terror, and how to handle each of these circumstances.
Nightmares occur during REM sleep, typically during the end of our sleep period. When your child has a nightmare, she will seek comfort from you and may not want you to leave for a bit until she has recovered. She may be able to describe the dream in detail both at when she wakes and hours later the next day. It may take a while to go back to sleep. Nightmares can begin as early as age 2 when your child’s imagination starts to develop. They are very common after difficult events or when your child is reliving a trauma.
When your child wakes from a nightmare, it is important to go to her, offer comfort, help her understand that it was just a dream and she is safe. Use creative visualization to help her come up with happy thoughts to put into her head to replace the scary thoughts that remain after a bad dream. Avoid television shows or movies, even ones that, as adults, we think of as fairly benign and not scary at all. It is particularly important to screen the media your child is being exposed to, especially if your child is sensitive to these things and often gets “the scaries.” Even television or radio news can spark a bad dream.
Night terrors are very different from nightmares. Night terrors usually occur within the first two hours of the onset of sleep, during nonREM sleep. Your child is not actually awake even though his eyes may be open. He may be screaming, sweating, his heart is racing, and he is inconsolable. Typically, they last between 5-15 minutes unless you interfere with it and try to wake him. Night terrors are more common in boys and can start as early as 15 months old. They are often caused by sleep deprivation or sleep disturbances resulting from illness, travel, stress or sleep apnea. Your child will not remember the incident in the morning.
When your child has a night terror, less is more, when it comes to what to do. Make sure he is safe and can’t hurt himself but other then that, do as little as possible. Doing too much to interfere can prolong the episode. Research has recently come out that shows a link between screen time and night terrors. Limiting screen time sometimes altogether or at least in the later half of the day can reduce the incidences of night terrors. Also, helping your child get more sleep by moving bedtime earlier (even briefly) and regulating his sleep schedule so he is going to bed at the same time and waking at the same time is important. If your child is frequently experiencing night terrors, start keeping a detailed log for 7-10 nights. If they are always occurring at the same time each night, you can wake him briefly 15 minutes prior to the terror. Wait until he mumbles, moves, and rolls over before letting him go back to sleep. Do this for 7-10 days to 2 weeks to interrupt the sleep cycle.