My Baby Is Sick And Now His Sleep Is Falling Apart...

I often get calls from parents who have fallen into a major regression from a small cold their child had months ago. Unfortunately, our kids will get sick many more times than we’d like and many times, depending on how sick they are, schedules, routines, and even sleep will fall apart. However, it doesn’t always have to be that case!

What to do when your child is sick

• Even when your child is sick, it is suggested to put your child down awake at bedtime.  Chances are, even though he is feeling sick, he will still be able to go down into the crib awake and put himself to sleep. Being able to fall asleep on his own makes his job of moving through sleep cycles in the middle of the night much easier. 

• If your child wakes up in the middle of the night (more then just moaning and fussing and then falling back to sleep relatively quickly) when he is sick, always respond because this is the only way you will know if there is something that needs more intervention.  Maybe he has a fever or has thrown up.  I always recommend doing a parenting check when children who, otherwise sleep well, suddenly wake in the middle of the night.

• If you have to do something to help your child be more comfortable in the middle of the night, you can! Sometimes with a coughing spell they need to be held upright, or with a fever, he may need Tylenol. As your child starts to feel a bit better, try putting him back in his bed so he can put himself back to sleep. In many cases, when children are good sleepers and are most comfortable in their own bed, they actually want to go back to bed after a wake up due to illness. 

• If your child is so sick that you feel like you can’t leave him on his own, I always recommend staying in your child’s room with him rather then bringing him to your bed.  While putting your child in your bed to sleep may not cause a problem if it happens once or twice, as he gets older, this can become a habit that is harder to break once he is feeling better.  I always say, it’s easier to remove yourself from his room, but not the other way around.

• If whatever illness your child has come down with is so miserable that any form of independent sleep throughout the illness is out of the question and you need to provide far more assistance with sleep then you normally would, then you will have a bit of work to dig yourself back out of the “illness hole” that you may have fallen into once your child recovers.  I find that the farther you fall, so to speak, the harder it is to get back on track.  For example, if your child was previously sleeping entirely independently before the illness and now has become accustomed to being held to sleep at bedtime and needs help going back to sleep overnight, you will have a harder climb to get on track. Once you are feeling confident that your child is feeling better, you will want to work on getting things back on track as quickly as possible!!! This may mean you need to return to whatever sleep training methods you used if you previously sleep trained your child.  While you will likely be met with some resistance initially, when your child remembers that you will respond consistently, things will start to improve and you will have your champion sleeper back. 

Have you found yourself in a “sickness regression”? Has it been weeks or months since your child is feeling better, yet sleep still isn’t restored? Call me and let’s talk!

How Much Sleep Does My Baby Need?

Day sleep is so important for our little ones! Not only do they need to rest their little bodies and minds, they also need to get in good day sleep in order to get in good night sleep. Studies show that if your child is taking short catnaps, that is less than 45 minutes where she isn’t reaching the deep sleep (Non-REM), chances are she will wake frequently have interrupted sleep at night. This is where the phrase “Sleep Begets Sleep” comes from.

But how much should my baby sleeping? It really all depends on her age. When they are younger they need more day sleep, and have less awake windows. As they get older, their awake window increases (meaning they can be awake for longer periods of time), and will need less day sleep overall. The most important thing to know is that your little one will need to nap up until the age of about 3-4 years old.

Here’s a friendly chart to help guide you with your child and her naps those first few years:

Age Wakefulness Window Number of Naps Total Daytime Sleep

0 – 5 Months 0 – 1.5 Hours 4 – 5 a day 8 Hours

6 - 8 Months 2 – 3 Hours 3 a day 3.5 Hours

9 – 11 Months 3 – 3.5 Hours 2 a day 3 Hours

12 – 18 Months 4 – 5.5 Hours 1 – 2 a day 2.5 Hours

2 Years 5.5 - 6 Hours 1 a day 2 Hours

3 Years 6 – 12 Hours 1 a day 1 Hour

4 Years 6 – 12 Hours 1 a day or quiet time 0 - 45 minutes

When Should I Move My Child To a Bed?

Transitioning your child from a crib to a bed is a big deal! Not only is she now a “big girl,” but going from being inside the crib with the comfort of the railings to keep her safe and secure, to an open bed, is a BIG change. Most parents rush to do this a little too quickly and then sleep starts falling apart.

A few things to know:

• First things first, do NOT move your child to a bed “to fix her sleep problems.” If your little one is having sleep issues, you will continue seeing them when she is in a bed and maybe even worse. It is suggested to address the sleep issues first, then transition her to a bed.

• Wait until she is at least 3 years old or older. Under the age of 3, it is very hard cognitively for your little one to understand that she has the freedom of getting in and out, but must respect the correct sleep habits of staying in her bed.

• The age that you transition your child to a bed does not determine how smart she is. Don’t rush in transitioning your little one to a bed, if she’s happily sleeping in her crib. If she moves to a bed at 3 or at 4 years old, it will NOT determine what college she’ll get into.

Need help in transitioning your little one to a bed? Call me and we can talk it over.

Sleep Associations: What they are and their impact on sleep

Sleep crutches, also known as sleep associations or sometimes referred to as sleep props, are anything that we do for or to our child in order to help her fall asleep at the onset of sleep.

Some examples of sleep crutches are:

• Rocking

• Feeding (both breastfeeding and bottle feeding)

• Holding your child’s hand to sleep

• Patting/rubbing her to sleep

• Laying down with the child to fall asleep at bedtime

(I do want to be very clear that if you are using a sleep crutch to get your child to sleep and it is working for you and/or your family, then this is not something that you have to change. It is only something to be changed if it is no longer working for you.)

Babies under 4-6 months often need sleep crutches

Babies are not born with the immediate ability to self-soothe and regulate themselves, this comes once they are older. In those first few months, you will need to help them do this, and by doing so you will NEED to hold, rock, feed, and anything else to get your child sleeping. This is normal and it important to do those things because this is how your baby starts to trust that if he/she needs something, you will be there.

When sleep crutches stop working

BUT…as children move past the 4-6 month mark, they start to become very capable of falling asleep independently. In many instances, these sleep crutches will stop working. This means that you may feed your baby and he/she falls asleep, but when you go to make the transfer to a sleeping space, your baby wakes up. Or, now your baby wakes after 30 or 45 minutes or every 2 hours throughout the night. Or rocking your child to sleep takes double the time. This is can be an indication that your child is starting to become capable of falling asleep independently. When this happens, you can start to teach your child how to fall asleep without the help of the sleep association.

How do you stop using sleep crutches?

This is where sleep coaching often comes in so that children can start to develop the skill of falling asleep on their own at bedtime and then use that skill repeatedly throughout the night to go back to sleep. Sleep coaching does not have to be a horrible and dreaded process. In many cases, parents can be involved in a way that is both supportive, nurturing and eye opening. Parents tell me all the time that they were amazed by the fact that they could see their child learning this new skill right in front of their eyes. 

Contact to schedule an initial call so we can talk about how to work together in removing those sleep associations, and start creating healthier sleep habits.

Sleepy Cues

How do you know your little one is ready to sleep?

When your child starts getting tired, he will start showing you signs that he wants to go to sleep. It’s his way of communicating with you that his melatonin started to kick in, and he is getting sleepy.

We all secrete melatonin when we are getting tired and ready to go to sleep. The thing is, with our babies they are secreting them more often, since they need more day sleep (and sleep overall). When they’ve hit their sleep window, they will secrete the melatonin, which is a calming hormone that helps their body calm down and get ready for sleep. 

A lot of times, we may miss the cue, so we have to be very careful to make sure we catch them at the right time, otherwise we will miss their sleep window, causing them to be overtired and making it harder for them to fall asleep. 

Some common sleepy cues to look out for are:

-       Rubbing eyes

-       Rubbing nose

-       Pulling ears

-       Red/droopy eyes

-       Yawning

-       Cranky and crying

Want to learn more about when your child should be showing sleepy cues? Contact me and we can talk about your child’s sleep windows.

Why Was My Child Up Last Night?

The act of sleep training teaches your child how to put herself to sleep and back to sleep on her own. If she does it at bedtime, she will be able to do it in the middle of the night. But what parents need to understand is that she will still wake up in the middle of the night, as we all do and that’s how our sleep rhythms work. However, with a sleep trained child, she will quickly go back to sleep on her own. There are some instances where your child will wake up more than usual, for either longer periods of times or more frequently. Parents go into panic mode and start responding inconsistently, which in the end can cause bad habits.  

It’s good to be prepared and know what may cause these long wake ups in your child in case you find yourself in this same situation.

1. Medical Issues – There are some medical issues that can cause sudden sleep disruptions. If your child comes down with a bad cough or cold, stomach issues, virus, flu, or anything like that, she will of course wake up more. However, sometimes there are other medical issues that can cause constant sleep problems, such as: allergies, reflux, apnea, and RLS. If you suspect your child is having any serious medical issue that can be causing frequent night wake ups, make sure to follow up with your pediatrician.

2. Sleep Crutches – Are you doing anything to or for your child to help him go back to sleep at night? Sometimes when our little one wakes up, we run in too quickly and respond right away or do too much. Are you finding yourself rubbing her back until she falls asleep? Are you taking her out to rock her a little? Are you just going to tuck her in or give her some water? Are you reinserting the pacifier for her, even though she can do it on her own? A lot of times we tend to do too much. Even though it’s a quick fix, what’s a short/quick solution can turn into a long-term problem.  

3. Schedule – Your child’s daytime schedule can really affect her nighttime sleep. While they need their daytime sleep, sometimes getting too much sleep can cut into their total required sleep and take away from their night sleep. Similarly, if they didn’t sleep enough sleep during the day, you will have an overtired child at night, which causes a lot of light sleep and frequent wake ups. Make sure to follow the required amount of day/night sleep as well as the correct awake windows to avoid night disruptions.

4. Sleep Regression – Your child will be going through a lot of changes those first couple of years. Everything from growth spurts to developmental milestones, which will affect her sleep. It’s important to remain consistent with her sleep habits through these regressions. For example, if they are learning how to go from standing to sitting, practice a lot during the day, but when it comes to night sleep, do not assist her too much, let them do it on their own.

If you find that your child is continuing to wake up at night, and you can’t seem to figure out why, contact me to set up your initial FREE call.

Infant & Toddler Sleep Development

You child’s sleep patterns are constantly changing the first few months. Right when you think you’ve got it, your child will go through another change in their sleep habits. It’s good to know the basics of the infant and toddler sleep development to help guide you along the process.  

0 to 4 weeks:

A newborn this age needs to sleep every hour or so, due to the high level of brain development and growth. She must shut down due to the stimulation that being awake creates. At this age, your baby can’t fully distinguish day from night until about around 8 weeks. There is no such thing as spoiling your baby too much. Holding her to sleep is mostly the norm.

5 to 8 weeks:

Night biorhythms begin to emerge and your baby’s brain starts organizing nighttime sleep. She can sleep up to 4 or 5 hour stretches at night. You can help her distinguish between day and night as she begins to establish her natural circadian rhythms. The brain takes longer in sorting out daytime sleep, so napping will remain a little disorganized until around 12 weeks. Make sure your baby doesn’t stay awake more than 2 hours, as this will over stimulate her.

9 to 12 weeks:

Her daytime sleep is more structured with regular naps, and she can be awake for 3-hour stretches. She now requires deeper sleep, which her brain can’t perform if she is in motion (e.g., in a swing or stroller). Begin to gently adjust and mold her rhythm into a flexible schedule and create a bedtime routine for nap and night. The routine helps create familiarity and structures a transition from awake time to sleep time.

Fourth and Fifth months:

Neurologically, the character of your baby’s sleep is changing as melatonin secretion begins to rise, increasing non-REM sleep. This means she now sleeps more deeply than a newborn. Her partial arousals are more distinct and she feels more awake during them. This is an excellent time to begin sleep coaching your baby, as bad sleep habits aren’t deeply ingrained, she is more receptive to a predictable schedule, and she has the ability to soothe herself.

Nine to Twelve Months:

Your baby now will need an average of 11 hours of uninterrupted sleep at night and 3 hours during the day. The length between waking from the last nap to going to bed at night should not exceed 4 hours. If your baby has more than 3-4 hours between the end of the last nap and bedtime, she can become overtired. She’ll have a harder time falling asleep at bedtime, she’ll wake up more often in the middle of the night, and she’ll more likely have early risings. By this age, you should have completely eliminated night feedings. 

Thirteen to Eighteen Months:

At this age your child needs an average of 11 hours of interrupted sleep at night and 2 – 2.5 hours of daytime sleep. Most children transition from two to one nap a day.

Planning Your Next Family Trip

It’s already starting to feel like summer around here in Miami. School’s almost out, and the days are getting longer and warmer. Most of you are already planning ahead for that summer trip (not vacation, as we know when we travel with our kids). Of course, traveling with younger kids is always harder, but doesn’t always have to be if you can prepare yourself accordingly. Here are my top 5 suggestions in helping make your travel plans smoother.

1.     Departure Travel Time: If you have a child that still naps, you want to try to book your flight (or departure time) around nap times. Having your child nap during the flight or car ride will not only make the travel time easier for you, but will help your child adjust to arriving to a new place without being overtired. Many parents are concerned with how to nap their baby. On the plane, anything goes! You can hold, rock, feed, or even put your little one in a carrier and walk the isle back and forth if you have to. This will not create bad habits, as it’s only a one-time scenario while traveling. Try to avoid flying in the later afternoon, which will bring them to a later bedtime in a new place. They will need time to adjust to their new sleep setting first (see below #2, and you don’t want to get there too late.  

2.     Sleep Space: When deciding on where you will stay, try to figure out where your baby will sleep. She does not need her own room, but if you can set up a pack-n-play in the corner or hallway of the room (away from the bed), it will help. If your child normally sleeps in a crib at home, find out if your hotel provides one, and if not make sure to bring your own pack-n-play. There are also companies that rent out baby gear. Once you get to your new sleep space, make sure to set hers up with her crib sheets, toys and blankies. Have her play in and around the area so she can familiarize herself with it before bedtime.

3.     Child’s Sleep Essentials: Because you will be an unfamiliar place you want to make sure to bring as much of her sleep essentials as possible. A few good items would be: crib sheets, blankies, pacifiers, her regular bedtime books, and even a few of her favorite toys. Think of what your bedtime routine looks like at home and try to bring all the essentials that are part of it. You want to make sure she feels comfortable in her sleep space.

4.     Adjust To New Time: When traveling to a different time zone, your little one will need to adjust her circadian rhythm to the new time. It is suggested to adjust to the new time immediately upon arrival. Make sure to feed and sleep her with the new time as soon as you arrive! If you arrive during the day, expose her to sunlight to help adjust her rhythm. Jetlag can last a good 3-5 days, so hang in there if those first few nights back home are rough.

5.     Remain Consistent Yet Flexible: Our kids thrive on routine and predictability. They like to know what’s coming up ahead without the surprise and the unknown. This is why it’s recommended to keep to a schedule and routine daily when at home. However, it’s very hard to keep to the exact schedule when traveling, so don’t worry! Try to at least keep to the same feeding and sleeping times as best as you can. If you’re out and about and it’s time for a nap, try to sleep your child in the stroller, car, or in any means possible. Just because you aren’t home doesn’t mean she doesn’t need a nap. Adjust bedtime earlier if it’s been a day where she hasn’t napped well. If you’ve spent too many days out where all naps were short, try to stay back one day so she can nap in her sleep space and catch up on sleep. And most importantly, continue putting your child down awake at bedtime and nap time and respond consistently. If she’s between the ages of 9 months - 2 years old, she may be a little scared of her new sleep setting, and not understand what’s going on. You can provide extra support, but make sure you don’t go back to old bad habits. You can sit by her crib to provide comfort, but allow her to put herself to sleep.

Common Sleep Regressions

Sleep regressions are very common with babies, especially the first two years of their lives. Primarily, your child was sleeping well for a while, and then all of a sudden their sleep starts falling apart. Most often, sleep regressions are caused by teething, travel, or when they get sick. Developmental milestones and leaps that your child will reach at certain ages will also cause them. They can last anywhere from a few days to a few weeks, which makes it even harder for those tired parents that were once sleeping well.

Below is a list of common sleep regressions by age:

3,6,9 weeks: Growth spurts During this time your newborn will be going through growth spurts, which lead to increase in hunger and fussiness, and in turn more wake ups at night. Their body is rapidly changing and adjusting those first few months, so the constant small feeds are sometimes necessary.

3 -4 months: “The 4-month regression” This regression is a big one for these little guys as they are going through a lot at this time. At about 3 months they go through another growth spurt, which can lead to more wake ups in hunger. They are starting to become more awake and alert at this time, which causes them to be more distractible. During this time they begin to reach their first milestone, which is rolling over. Some will do it sooner rather than later, and just practicing and trying to roll over can disrupt sleep. They will begin to roll one way and then get stuck and not be able to roll the other way. It’s suggested to do a lot of tummy time at this age to get them stronger and able to learn how to roll over both ways. Also, many parents at this age start seeing it harder and harder to get their child down to sleep. What used to work, no longer works. Some babies start breaking free from their swaddles, or the holding/rocking to sleep no longer soothes your baby. And finally, as they get closer to 4-5 months your baby will begin to secrete melatonin, which physiologically can cause some changes in their body as well.

6 months: At this age, there are quite a few reasons why your baby is going through a regression. First and foremost, they are going through another growth spurt. I know, many these first few months! Secondly, they are going through another developmental milestone that at this point is allowing them to begin to be more mobile. They have mastered the rolling over part, and now working on sitting up on their own, and perhaps beginning signs of crawling. When they go through a developmental milestone it can cause more wake ups as they are actually doing more light sleep (NON-REM) at night, rather than deep sleep (REM).  For example, many parents will find their baby sitting up in the crib at 3:00 a.m. crying because they want to go back to sleep, but just don’t know how to lie back down. When they are trying to master the crawling, they will get on all fours and rock back and forth, which can a disruption in their sleep. And finally, they will go through their first separation anxiety peak. With more mobility and awareness, your child is trying to understand the world around her and how you still exist even though she doesn’t see you (object permanence). Where she used to go down easily at bedtime, now will cry for a few minutes as you leave the room because she is going through a separation anxiety peak.

8-10 months: “The 9-month regression” Just like in the previous regression, your little one is going through her (last) growth spurt at 9 months. She is also going through another developmental leap of learning how to pull herself up, so now when you go to get her out of her crib, she may be already standing waiting for you. Pulling up and learning how to go from standing to sitting, and then laying down is a developmental leap that will definitely affect sleep. You want to practice a lot during the day. Have your little one hold onto the sofa or coffee table and play a game to teach her how to sit back down and stand back up. Make sure not to get into the habit of helping her too much in the middle of the night.

12 months: With yet another milestone comes another separation anxiety peak. Around the age of 12 months, your little one will begin walking, which causes the most disruption in sleep. A lot of parents will see sleep begin to fall apart even before they are actually walking. Like any other milestone, make sure you practice a lot during the day and leave her be in the middle of the night. She may want to start practicing at night and do it on her own.

18 months: Around this age your child’s vocabulary will start increasing. Their receptive language (what she understands) is likely to be more advanced than her expressive language (what she can articulate), so make sure to constantly talk to her and explain to her what’s going on. She is entering toddlerhood, which can bring a need for boundaries and rules as she goes about learning how things evolve around her. Your toddler thrives on predictability (in everything) so make sure to stay consistent in your bedtime and middle of the night responses.

2 years old: As your toddler becomes more verbal and more aware of her surroundings she will go through a regression often linked to this as well as a separation anxiety peak. Often at this age, toddlers will also be potty-trained, which can through a loop for the night sleep. Just remember that potty training is only for the day, and not for night sleep. This will happen on their own, so don’t try to enforce night training.

So by now you may be asking yourself, how do I handle so many sleep regressions those first two years? Not to worry, not all kids experience a full regression at each of these stages, and some won’t even last that long. When you do realize your child is going through a sleep regression, fear not, it will subside. The most important part is to keep calm and respond consistently without creating new sleep crutches. You can always go in and check on your little one, but once you have determined that your child is OK and there’s not much you can do, it’s sometime best to leave them be. More practice during the day with those developmental milestones so that it is easier for them at night. If you find yourself needing more help through these regressions, contact me and we can set up a time to talk.

How To Handle Holiday Travel

It’s that time of the year again! Holidays, New Year’s, school is out, and some are even taking vacations and family trips. While it’s great to take a break from the daily routine and get away, with the little ones this often means more work than not. Breaking from their regular routine can cause some hiccups along the way, especially with their sleep. It’s hard to keep to their schedule, but sometimes even the smallest things we can do to maintain normality will help avoid the major regressions and make it a little “easier” to travel.

Below are a few of my recommendations to help avoid major sleep regressions while traveling:

1. Book your travel around nap times: If your baby still naps, try to schedule the flight or drive around his naptime. Ideally he would nap on the go, so he can catch up on some of the day sleep that he needs.

2. Sleep Space: Often times when traveling it’s hard to accommodate everyone’s sleep space, especially when staying at a relative’s house. If possible, bring a travel pack-n-play for your little one so that you don’t start creating a new habit of co-sleeping. If there’s no extra room for your baby, try to set up a sleep space as best as you can. Perhaps a corner, a hallway, or even a breathable walk-in closet with the door open. Try to create the environment that is most conducive to sleeping; like making it dark, no screens/TV’s, and the right temperature.

3. Bring the essentials: Trying to replicate his sleep environment will help with the transition to the new space. Consider packing his crib sheets, a few extra loveys and pacifiers, his white noise machine and if possible, a few of his favorite books and toys.

4. Try to keep to the schedule with a little flexibility: Keeping to your child’s schedule and routine while being on vacation is hard, especially now with the holidays. We tend to be up later, have more family gatherings and meals; we’re even out sightseeing the whole day. You can still try to keep to his feeding and nap schedule as best as you can in order to avoid major tantrums. If there’s no time change, it should be easier to stop for a quick lunch when he needs it, or when it’s nap time, perhaps take him for a stroll in the car/stroller if you aren’t home. Ideally, the more naps you can offer your child in his crib, the better, as this will allow for longer/deeper sleep. If you know you’ll be out all day, try to squeeze in his morning nap at home before you go out. If his naps were short and on the go during the day, try to come home for an earlier bedtime.

5. Give some time to acclimate to new sleep space: When arriving to your new location, try to give your child some time to get used to the new space. Perhaps take out some toys and books, and allow your child to crawl/walk around the room, play, and familiarize himself so that when bedtime comes around, he’s already used to the new environment. 

Try to enjoy this time with your loved ones as best as you can. Travel and change will always cause some regression, but nothing that can’t be fixed once home. Try to stick to the tips mentioned above, and when you’re back home, more importantly, make sure to go back to your regular sleep habits.

Nightmares & Night Terrors

Watching your child wake in the middle of the night screaming and crying from a nightmare is hard to do. We want to be able to calm our child down and reassure them that everything’s OK. But often times, what your child may be experiencing isn’t a nightmare, but a night terror. Many of my Clients confuse night terrors and nightmares, and then in turn don’t know how to respond and avoid them from happening again. It’s important to know what causes a nightmare and night terror, and how to respond to your child for each scenario.

Nightmares:

Nightmares occur when your child is dreaming in REM sleep, which happens at the end of the sleep cycle. These often start happening between the ages of 2-5 when their imagination starts growing, and they are learning the difference between what’s real and what’s not. When your child is having a nightmare they will call for you, and seek for your comfort. They will be awake and able to communicate what is bothering them, and the following morning they can continue expressing their feelings about what happened the night before. It may take some time to comfort them in the middle of the night, but eventually with some reassurance they will calm down. Nightmares are very common and are apart of a child’s development. Of course, nightmares are more common after a scary situation or if your child has recently gone through a tough situation.

Make sure to:

1. Avoid TV and screens 1 hour before bedtime.

2. Avoid scary shows, videos, games, and books.

3. Respond to your child when she’s having a nightmare, quickly and reassure her.

4. Have your child get enough sleep, as being overtired can increase nightmares.

 Night Terrors:

Unlike nightmares, when your child is experiencing a night terror she will not be aware or conscious of it, nor will she remember it the next day. Night terrors occur during NON-REM sleep (coming out of the deep part of sleep), usually within 2 hours of her falling asleep. Night terrors are NOT nightmares; they are not bad dreams and do not occur during the “dream part of sleep.” It is mainly your child getting “stuck” transitioning from one sleep cycle to the next. Night terrors also sometimes occur during a developmental leap. They are more common in boys, and occur in 5% of all children.

Here your child will also scream or cry out and appear a little anxious. However in this case, your child is often inconsolable. Whatever you try to do to calm your child down just doesn’t work; she doesn’t seem to be responding to your voice or hugs. A night terror usually doesn’t last more than about 15 minutes. The good thing is your child will not remember this the next morning. Ideally, since your child isn’t really awake, you are to leave your child be and let her transition to the next sleep cycle on her own. Often interfering can cause more harm, so just monitor her from afar making sure she’s safe through the episode and not getting hurt (i.e. falling out of bed).

Make sure to:

1. Keep your child on a regular sleep schedule, as lack of sleep can cause night terrors.

2. Allow for an earlier bedtime (even if by only 30 minutes) so your child can catch up on sleep.

3. Avoid screens 1 hour before bedtime.

4. If your child is having consistent night terrors, keep a log to see if there’s a pattern.

5. If there’s a pattern to your child’s night terrors (always happening at the same time each night), you can wake her briefly 15 minutes before the time of night terror, in order to help her transition to the sleep cycle without experiencing a night terror.

As you can see night terrors and nightmares are very different, and require different responses. It’s important to understand the difference and be able to identify them in your children.

Dropping The Nap

This summer the time came for my third, and last child to drop his nap. Dropping the nap is always the hardest for the child and the parent. This was the time I would do phone calls, work, clean up the house, or even just take a break and eat a meal and shower. The truth is once my eldest dropped his nap almost 6 years ago, it’s never been the same, you’re “on” the whole day! But somehow this time around, I guess I was more resistant, maybe cause he’s #babyj.

The decision came two-fold; he’s over the age of 3, and he’ll be starting full day school now in August. Unfortunately, our school doesn’t allow for naps at this age, so it was time to remove. Also, I started to see the signs that he was sorta ready; not wanting to go to sleep (but eventually did fall asleep much later), and bedtime started getting later and later.

So how do you know when your child is ready to drop the nap?

1.     He is between the ages of 3-4 years old.

2.     He is fighting the nap.

3.     Taking longer and longer to fall asleep, which leads to a later naptime.

4.     Completely refuses the nap all together – even after leaving him in the crib for a full hour.

5.     Bedtime has now become an issue, where he is not ready to sleep and/or falling asleep much later and later (because nap started too late).

How do you remove the nap?

· Don’t go cold turkey: It’s very hard for your child to go from nap to no nap. Going 12 hour days can become exhausting and they will need a nap every so often to catch up.

· Shorten nap: If your child is falling asleep, just doing it later, make sure to cut the nap short. Don’t allow your child to take a 2-hour nap starting at 2:00 as that will definitely push bedtime much later. Wake him up after 45 minutes.

· Catch up naps: Offer a nap every other day so that your child can catch up on sleep. The full days can affect your child’s mood and they will get too tired and cranky. A nap every so often will help him feel rested.

· Quiet time replaces nap: If your child is no longer napping at all, he will still need some downtime. Have your child lay in his crib/bed for some quiet time every day. He can read books or play quietly (with legos, coloring books, or any calm activity), but the idea is that he is alone, in a quiet, non-stimulating space. TV and Ipad’s are not suggested. Quiet time doesn’t need to last a full hour, but even if it’s a few minutes (15-30 a day) it can really help him.

· Move bedtime earlier: When your toddler was napping, bedtime was probably closer to 8:00 p.m. or so. Now that he will no longer be napping, you will find that the afternoons will a little bit of a struggle. Do your best to get the evening routine done a little sooner and have him in bed earlier. By early I mean, anywhere between 6:00 – 7:00 p.m. Once your child is used to being awake the whole day, and is a little older, you can then adjust bedtime to later.

Remember: Removing the nap so he “can sleep longer and better at night” is FALSE. This can actually create the opposite effect. Also, make sure your child is completely refusing and showing signs of dropping his nap for about 1-2 weeks before you remove it completely.

What you need to know about Sleep Training

This is the most common question you will get as the parent of a newborn baby: Does your child sleep through the night? It's not about her favorite toy or whether she likes to take a bath. The first thing on people's minds is whether she sleeps.

We all know that sleep is important for our health. But it’s also important for our being. We can’t be our best selves when we lack sleep. Our relationships with our spouses, with friends, and even with our own kids are compromised when we don’t sleep enough.

The problem is that our babies aren’t born sleeping through the night for 12 hours straight. As newborns, they just can’t sleep for long stretches. And that means our sleep will be broken up too.

The good news is that this doesn’t have to last very long. Once your baby is of “sleep training age” you can work on getting her sleeping better. But how? What does that mean? When? With all these questions we turn to books, internet (be careful with what you read!), friends, pediatricians and then before we know it our heads are spinning because we’ve had so many different opinions thrown at us.  

Here’s what you need to know:

1. Your child might not be ready.  Every child is different, and we can’t expect them all to develop exactly the same way; so too with sleep. Still, there are some guidelines for when you can expect to start sleep training. Anything younger than 4 months is a definite no, and anything after 6 months is a go! Between 4 and 6 months, some parents will find positive results in sleep training their child, but not all. 

2. You don’t have to stop breastfeeding to do sleep training. Many nursing moms feel that they will have to give up nursing in order to get their child sleeping longer and better. This is not true. Speaking as a mom of 3 who nursed all while still doing sleep training, it is possible! You can definitely nurse as long as you want, while doing sleep training. What we work on is removing the nursing to sleep association.

3. Is my only option to do the “Cry It Out” method? No. You do not have to do this method. What you do need to know is that your child will cry for at least part of the learning process. But you do not need to leave her crying by herself the whole night with no response from you. Instead, you can be in the room to comfort your child, while removing all sleep crutches and helping her learn how to put herself to sleep. 

4. So, what does sleep training involve?  When you sleep train your child, you are having her learn how to put herself to sleep at the onset of sleep, so she can do it again--by herself--in the middle of the night. The key is putting her down awake in her crib, and responding consistently throughout the process. If she’s already asleep when she is put down in her crib, she will not have the opportunity to learn how to put herself to sleep. And if you start responding inconsistently (leaving her to cry one time, then later picking her up, and then feeding her, etc.) this will only confuse her more and will result in inconsistent sleep behavior on her part as well.

5. What if my child still needs to feed at night?  You can still improve her sleep! It is commonly recommended to remove all night feeds starting at the age of 6 months; however, there are parents that aren’t ready to do that, and sometimes a pediatrician might recommend keeping them. That’s OK! You can still have your child sleep longer stretches, and feed when needed.

So what’s my next step?

1. Rule out any medical concerns, and get your pediatrician’s approval.

2. Make sure your child is over the age of 19 weeks (adjusted age).

3. Contact me to set up your consultation and we can begin the process!

Here’s to more sleeping babies (and parents!)

How To Handle Daylight Savings

It’s that time again… when we change the clocks, but this time an hour ahead. This change isn’t as bad as when we moved our clocks back an hour last Fall. However, the 1 hour difference still makes an impact on our little one’s schedule.
 
Often times parents are happy with this change, as the early risers are now waking up later. For others, it may not have an effect at all. Regardless, you want to know what to do should it change your child’s sleep pattern.
 
What Can I Do?

• Gradual Approach: For the younger babies, or the children who have a harder time adjusting to the change, this option may be best. Starting the week before you want to make sure you start moving your child’s schedule by 15 minute increments. That means all feeds and naps should be pushed earlier by 15 minutes every couple of days. So that while you may have your child going to sleep earlier for a few days, by the time Sunday comes around your child will be adjusted to the new time.

• Cold Turkey Approach: With this approach, you automatically adjust to the new time on Sunday. As soon as your child wakes up that morning, you go by their regular schedule according to the new time.

Additional Tips:

• You can help adjusting your child’s circadian rhythm by the exposure to light. You want to make sure you avoid bright lights/sunlight in the evening ex: TV’s and screens. And in turn in the morning when they do wake up, you can begin your day any time after 6:00 a.m. and expose them to the sunlight outside.

• Extra shades/black out curtains are crucial this time around. It will get darker later at night, and brighter earlier in the morning. Try to cover as best as possible those windows, so that no sunlight comes in.

• Remember that with the new time change, we will be losing an hour, so those first few days when you put your child down at the new bedtime, they may not be ready to go to sleep just yet. Try to be a little flexible perhaps in the timing of bedtime those first few nights, and always remember to respond consistently.

DBA... What Does It Mean? How Do I Do It?

DBA means Drowsy But Awake. If you’ve read aaalllll the sleep books and blogs out there, you know they all talk about this concept: “drowsy but awake.” In order to have your child sleeping through the night, he must be placed into the crib drowsy but awake. The problem is that most people misunderstand this concept. Then, when they try to implement it, they don't even realize they're doing it wrong.

When sleep training your child, you are teaching him how to put himself to sleep at the onset of sleep so that he can do it again in the middle of the night. If your child isn’t putting himself to sleep at bedtime, it is unfair to expect him to put himself back to sleep at 2:00 a.m.
 
For your child to learn the skill of putting himself to sleep, you must give him the opportunity. Entering the crib fully asleep after being rocked to sleep defeats this purpose. This means your baby must be placed into the crib “drowsy but awake” so he can learn how to put himself to sleep.
 
How do I do it, and make sure I do it right?

1. You want to do the bedtime routine at the right time--not too late. Waiting till the last minute to start the process is already too late.

2. Once you are done with feeding and the bedtime routine, lay your child down in the crib awake, not asleep. Make sure not to rock or hold him too long, or feed him to a drowsy state.

3. If your child is awake when you are done with the routine, you don’t need to hold him until he gets to a drowsy state. In fact, the more awake, the better.

4. On a scale from 1-10 (1 being awake and 10 being asleep), your child should not be past a “6." So if your child is drowsy, make sure he’s not too drowsy where his eyes are closing and he’s struggling to stay awake.

5. Finally, if you child is falling asleep “within a minute,” he is entering the crib too drowsy. Often parents say, “oh, he was awake and as soon as I put him down he just turned over and fell right asleep.” If that's happening, he’s too sleepy when you put him in. On average, it takes up to 15 minutes for a child to put himself to sleep. So if he really fell asleep within a couple of minutes, then he was more asleep than drowsy but awake.

You can start practicing DBA with your baby as young as 2 months. At this point you will still need to assist your little one in putting himself to sleep, as he is still too young to learn how to self-soothe. But you can definitely start practicing!

When To Get Rid Of The Pacifier?

Many children use the pacifier to soothe themselves to sleep and end up keeping it around for a while. Parents then come to me and ask, when do we get rid of the pacifier?

I’ll start off by saying that if your child does take to the pacifier, it’s not necessarily a “bad” thing. For those first few months, the sucking sensation for newborns is calming and soothing, and crucial for a newborn. More importantly, the AAP has said that pacifiers are known to reduce the risk of SIDS. Once they know how to re-plug themselves (at around 9 months), they can do it often during the day and at night, and no longer depend on you.

So when’s the ideal time to get rid of the paci?

Before beginning sleep training, I often tell my Clients they have a choice to keep or remove the pacifier. If your child is 9 months or younger, it is OK to proceed with the sleep training without the pacifier. Once your child is 12 months or older, I don’t recommend removing the pacifier as they have already created a dependency on it. 

I usually recommend getting rid of the paci once your child is older, closer to age 3. At this point you can have a conversation with your child to explain what is going to happen, and chances are she’ll understand.

Getting rid of the paci

1. When you are going to get rid of the pacifier, make sure you don’t do it at the same time a new sibling has been born, you’ve moved, or any major change in your child’s life.

2. If your child is one to have the binky with her all day, you can start limiting it to sleep only and leaving it inside the crib. Once she awakes from naps or in the morning, the pacifier must stay inside the crib.

3. Make sure to have a conversation with your child to explain how big girls no longer use the paci. Perhaps have your child visit the dentist so he can explain it to her.  Make sure to have these conversations a few days before beginning, so as to prep her.

4. You can read some books that address this topic. A few suggestions are: Bea Gives Up Her Pacifier by Jenny Album, Little Bunny’s Pacifier Plan by Maribeth Boelts, or Goodbye Binky:  The Pacifier Fairy Story by Sinead Condon.

5. After having the conversation and reading some books, you can then sit with your child and decide what she’d like to do with it. She can “give it away” to a baby who needs it, trade it in for a special toy from the paci fairy, or even put it inside a special stuffed bear (like Build a Bear) and then she’ll always have it with her.

Whenever you do decide to remove the pacifier, just be prepared for a few rough nights. Make a plan and stick to it consistently. Try your best not to go back and stick to it for a few days.  Good luck!

Transitioning To The Big Boy Bed

Sometimes parents are rushing to get their child out of the crib and into a big boy bed. What parents don’t realize is that moving them too soon can really affect their sleep. It isn’t recommended to transition your child too soon. Removing the rails of the crib, and having the bed open is a very big change for your child. The familiarity and the confinement of the crib provides a sense of security that your little one has had since birth. You know your child best, so think about how much your child understands and can express themselves. Moving a 2-year-old into a bed, when he’s just not cognitively developed to understand the new bedtime rules while enjoying the freedom, will only cause more bedtime issues.

Before transitioning your son into a bed, I would make sure he is already sleeping well. Is he putting himself to sleep without any issues at bedtime? Is he sleeping through the night? Is he waking up at a reasonable time? If your child is having sleep issues, moving him into a bed won’t necessarily “resolve” the issue, it often can make it worse. While before you had a child crying in the crib, you will now have a child running out of the bed and into the living room, where you will find yourself having to bring him back and forth to bed.

Please do not consider moving your little one if and when…

• A sibling is born and you need the crib for the newborn

• Moving, so might as well transition him to a new house in a new bed

• Your friends are doing it, so you should too.

If your child…

• Is at least 3 years old

• Can put themselves to sleep with no issues

• Is sleeping through the night regularly

• Wakes up for the day at reasonable time and does not have early rising.

• Or of course, is jumping out of the crib and you have tried to safely keep him in there with sleep training methods that are now unsuccessful.

Then you can transition him to a bed. Below are 7 recommendations on how to make the transition smoother:

1. Involve your child in the room change. Have him pick out the new bed sheets, and any new décor/bed that is involved with his new sleep space.

2. Sit down with your child and have a “family meeting” to talk about this new step. Explain to him in a positive note what is happening and what the bedtime rules are. Perhaps leverage in an older sibling or cousin to explain how he too now is a big boy!

3. Create a manners chart. Make sure to create this together and keep it on a positive note. Discuss what the reward system will be for the sleep manners in his new bed. For example: At bedtime, I will lay down quietly. Reward: a sticker

4. Behavioral Tot Clock. This is great for the toddlers who can’t tell time yet, but know the difference between day and night. These clocks use programmed color lights/images to show the child when it’s bedtime and when it’s OK to wake up and get out of bed. Make sure that as parents you reinforce this daily. My favorite one is the Good Nite Lite.

5. Consider putting up a safety gate at the doorway of the room. With the crib railings down, you may want to consider putting the gate at the doorway to not only confine the space safely so your child can’t roam about the house in the middle of the night. But it also creates a crib like feeling to the entire room.

6. Make sure the bed has a railing as well. Until your child gets used to sleeping in a bed without the crib rails, you want to make sure you put up a bed rail. You can perhaps put the bed against the wall, so she'll have protection on both sides, and not fall out. The bed rail still allows the child to get in and out of his bed comfortably.

7. Respond consistently. With toddlers, unlike babies, they are constantly looking to test the boundaries, while still needing them. It is up to us as the parents and caregivers to provide those boundaries and respond consistently. They will soon learn how to push them and figure out “what is right and what is wrong.” Make sure that as he gets used to his new sleep space, you respond consistently giving him some time to adjust.

Security Object; What is it?

Loveys. Pacifiers. Sucking of thumb. Just a few examples of what's known as a security object. A security object is there to give your little one a sense of security and comfort while you aren't there with him. The sucking, holding, grabbing, smelling, squeezing of whatever that object is brings a sense of security and enables the child to self-soothe and self-settle without relying on someone.

It's suggested to introduce a security object to your little one as soon as you can. The more you expose your child to it, the greater the chances he will take to it and then will have it when you are doing the sleep training. As far as which one? Below I list the different kinds with the pros/cons of each. 

Pacifiers:

Pacifiers are great for newborns as the sucking really relieves the fussiness. The issue with pacifiers is that until your child can re-plug on his own in the middle of the night, you will have to do it for him. The pincer grasp comes around 9 months, and until then your child will depend on you to re-plug. The good thing about pacifiers, as opposed to thumb-sucking, you can limit/control when he has the pacifier as well as remove it at a later point. 

Thumb-sucking:

Contrary to the pacifier, the thumb (or fingers) are always accessible to your child. This makes self-soothing really easy for your child to do at any point during day or night. He will be able to decide when he needs to suck to soothe himself and when not to and not rely on you. The issue with this is that you can't remove/stop your child from sucking his thumb. While it is possible at a later age to have him stop sucking his thumb (just like the pacifier), until then he will be able to do it at any point. 

Blankies:

Blankets are most often used as security objects. Often times it's the special one grandma made or the soft one a friend gave us. With blankets you want to make sure that they are safe, first and foremost. Sometimes they are too big or too thick which can be hazardous. You also want to make sure that if it is a special blankie that you can get more of the same kind. Because if we lose the one, well then what? 

Loveys:

Loveys are small little blankies often with something attached- like an animal. They are often small and light, but very soft and cuddly. These are a "newer" version of the blankie, and often less hazardous as they are smaller and lighter than a blanket. 

Regardless of which security object you choose to give your little one, please remember the following:

1. Must be safe and not hazardous that can cause suffocation or strangulation. 

2. Purchase 3-4 of the same kind, so you have backups in case you leave one on the plane! 

3. Make sure you rotate them, so they are all equally "used" at all times. 

4. When introducing the security object try to perhaps sleep with it or hold it while feeding so the object attracts some of your familiar smell. 

5. Keep on introducing it to your baby. It takes more than 1 day for your child to get attached to it. 

Be advised that the AAP does not recommend anything in the crib under the age of 12 months. Choosing a security object for your child is a personal decision. Please always make sure that it is safe for your child.

Newborn Sleep

Bringing home a newborn can be overwhelming. Whether you are a first time parent or repeat, it’s exhausting. So many emotions combined with a lack of sleep can really take a toll on parents. I often get calls from desperate mothers on how they are ready to do sleep training ASAP. The thing is, your newborn can’t and shouldn’t go through any form of sleep training at such a young age. Those first few months (0-4), your baby does not produce melatonin (a calming hormone that helps control his awake and sleep windows), so they will need assistance in falling asleep and staying asleep.

Sleep is necessary for newborns (and really anyone), as they work on their immune system, growth, and memory. Newborns shouldn’t be awake for more than 1-1.5 hours at a time, as being awake for too long can overstimulate your child. That is why for those first few months while your newborn relies on you for EVERYTHING, I always tell parents do whatever you need to do to get your child sleeping. There is no such thing as creating a “bad habit” at this age. You want to take advantage and rely on all of those sleep crutches to assist your baby in falling asleep and staying asleep.

Dr. Karp’s 5 S’s:

Dr. Harvey Karp, author of Happiest Baby on the Block, developed the “5 S’s” method, which helps your newborn sleep. Try to use one (or all) of these methods in helping your newborn to fall and stay asleep as needed.

1.     Shushing

2.     Swing

3.     Side lying

4.     Sucking

5.     Swaddle

Your newborn will also wake often in the middle of the night. Research suggests that these frequent wake ups are essential for their survival, as they are a signal for a need to be met - for feeds, help in regulating their temperature, and regulating their breathing.

On average:

1 month – 3-4x a night

2 months – 2-3x a night

3 months – 1-2x a night

And remember, while these days and nights seem never ending, try to enjoy it all as much as you can because when your child gets older, it is recommended to remove these crutches and teach your child how to fall asleep (and stay asleep) without your assistance.

Why Is My Baby Waking Up So Early?

Remember the days when waking up early meant 7:00? That definitely changes with kids... 7:00 is sleeping in, and 8:00 a blessing!

What parents don't realize is that a baby who wakes up at 6:00 a.m. or after is considered normal (given that he has slept well at night and woke up rested and happy). The amount of sleep your child requires, differs per age. What shouldn't change is the fact that day starts at 6:00 a.m. or later; not before!

If your child wakes up before 6:00 a.m. and won't go back to sleep, you will and should work on it, as it's not only a behavioral aspect but also an adjustment of their circadian rhythm.

Causes of Early Rising:

1.     Bedtime is too late: This is the most common cause of early rising. Often parents think that if they put their kids to bed later, they will wake up later. This is actually not true for kids under the age of 7. Late bedtime means you have put them to sleep in an overtired state which won't allow for a restful sleep and will cause early rising.

2.    Not enough day sleep: In order for your baby to sleep better and longer at night, he will need to get in good naps during the day.

3.     Large wakeful window: Your child shouldn't be awake for more than a certain amount of hours (depending on age, requirements differ). Keeping them up longer will only cause them to be overtired.

4.     Going to bed too drowsy: Some parents will often do a little too much at bedtime such as: rocking, holding, or even feeding their child until they are to the point of falling asleep, or too drowsy. Doing “too much” at the onset of sleep will only make it harder for your little one to learn how to put themselves back to sleep in those early morning hours. 

5.     Obstructive Sleep Apnea: This is a medical condition that is usually caused by enlarged tonsils and adenoids. Some common symptoms that your child may have OSA is: restless sleeping, sweating, loud snoring, mouth breathing, and even frequent ear infections. Because this is a medical condition that affects your child’s breathing at night and throughout the early hours, you should follow up with a pediatrician or pediatric ENT.

Adjusting Early Rising:

1.     Sleep Space: Determine if the sleep environment is conducive to sleep. Check if the curtains keep the room dark and that no sunlight is coming through. Do you have a white noise machine that can perhaps keep out the outside noise?

2.     Hunger: If your early riser is 6 months or younger, you may want to determine if it’s a hunger issue. Is your child getting enough feeds during the day? Does your baby perhaps need an extra feed to carry him over those last few hours?

3.     Coach back to sleep: If your child awakes before 6:00 a.m. you must treat it as it’s the middle of the night, and try to get him to go back to sleep. Quickly respond to your child and tell him it’s time to go back to sleep. Make sure you respond consistently as you do at bedtime.

4.     Keep your child in bed: Try your best not to take your child out of his crib until 6:00 a.m.

5.     Dramatic wake up: When you do take your child out of his crib, make sure to do what’s called a “dramatic wake up” to split the coaching to sleep, and him out of the crib. Go back in, turn on lights, and take him out to the living room common area space. Make him believe he is starting his day because you believe it’s time, not because he cried enough to get it.

6.     Hold off on feeds right away: Try not to immediately feed him. If possible wait a little before doing so.

7.     Morning nap not too early: If your child is still taking a morning nap, make sure you wait until 8:00 a.m. or later to put him down.

Early rising is very common with children, but unfortunately it’s the longest sleep “issue” to correct. It can take anywhere from 2-3 weeks or even months in the older kids. Make sure to follow these suggestions, respond consistently, and give it some time. This too shall pass….