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.