Articles

Getting Baby to SleepOctober 18, 2011

 

For Getting Baby to Sleep, Sticking to a Plan Is What Counts

 

The New York Times

 

By DAN HURLEY

 

Published: December 12, 2006

 

After years of colicky debate over which method is best for getting babies to fall asleep by themselves, experts have a soothing new message: just about all the techniques work, so pick one you are comfortable with and stick with it.

 

Despite their apparent differences, most of the behavioral approaches reviewed in the October issue of the journal SLEEP were supported by evidence that they resulted in infants and toddlers learning to fall asleep independently at bedtime and when they woke during the night. Of the 52 studies examined in the review, 49 showed positive results, with 82 percent of the infants and young children in the studies benefiting significantly.

 

“The key to this whole thing is parents being consistent,” said the senior author of the review, Dr. Jodi A. Mindell, a psychology professor at Saint Joseph’s University in Philadelphia and chairwoman of the task force organized by the American Academy of Sleep Medicine to assess the techniques.

 

She added, “They need to pick a plan they can absolutely follow through on.”

 

Even Dr. Richard Ferber of Children’s Hospital Boston — so strongly linked in the popular imagination with the so-called cry-it-out method that it has come to be known as “Ferberizing” — agreed in an interview that no single approach worked for all children.

 

“Clinicians should try to make a diagnosis for a given family as to why that youngster is having problems, and then try to tailor the choice of treatment to fix that problem,” he said. “When an intervention is chosen that works not only for the child’s problems but for the family’s philosophy of child-rearing, it’s going to work that much better.”

 

Still, some methods in Dr. Mindell’s review were supported by stronger evidence than others. The strongest evidence was found for the toughest and the easiest approaches.

 

Perhaps not surprisingly, the easiest option is preventing sleep problems in the first place, through simple parent education, whether one-on-one training, group classes or booklets. Such programs typically encourage parents to have a peaceful, consistent evening routine in which children are placed in bed “drowsy but awake” to help them develop independent sleep skills. Three well-designed randomized trials have found that the babies of parents who had such training slept significantly better than those whose parents did not.

 

At the tough extreme is the cry-it-out method, formally known as “unmodified extinction,” in which parents are taught to put a child down for bed, close the door and ignore all crying unless the baby is in physical distress. Despite 23 studies showing its remarkable effectiveness, most parents find the technique too emotionally grueling, the task force found.

 

Dr. Ferber, despite his link to the technique, said he rarely used it.

 

“It’s not a pattern that most parents will do,” he said.

 

Instead, he said he relied on a variety of gentler approaches, including one called graduated extinction. Rather than entirely ignoring a child’s cries, the method teaches parents to briefly check on the child on a regular schedule, staying for just a couple of minutes. Each night, the time between the visits grows longer, until the child learns to fall asleep independently. The task force called the approach an “effective and recommended therapy.”

 

For all their effectiveness, all the methods reviewed by the task force defined success as having children fall asleep independently. And no matter how gentle the technique, once children become accustomed to falling asleep in the presence of a caregiver, they almost always respond tearfully to being left alone — for at least three to five nights.

 

And there’s the rub.

 

“It’s not a lot of fun for parents,” said Dr. Ralph Downey III, director of the Sleep Disorders Center at Loma Linda University in California.

 

“The child acts like it’s the end of the world,” he said. “Nobody wants to see their child suffer. The biological blueprint in us says we need to be there, to comfort and soothe them.”

 

Still, Dr. Mindell argues that it’s worth it. “What parents really need to focus on is the big picture,” she said. “In the end, you’ll have months and years of everyone sleeping through the night and functioning better through the day.”

 

The only popular method not reviewed by the task force was co-sleeping, in which children sleep in the same bed with parents, because Dr. Mindell’s team could find no scientific studies of the approach. Although many experts support the method, so long as parents are happy with it, the American Academy of Pediatrics advises against the practice because it raises the risk of sudden infant death syndrome, or SIDS.

 

The Academy also urges parents to put their infants to sleep on their backs on a firm surface to reduce the risk of SIDS, though sleeping belly down is not the only risk factor for the syndrome. A recent study in the Journal of the American Medical Association found that many babies who die of SIDS have a defect in the portion of their brain that controls breathing, heart rate and arousal.

 

Co-sleeping also raises the risk of a parent’s unintentionally smothering a baby. A report released last year by Betsey Gotbaum, Public Advocate of New York City, found that 15

 

children, all less than a year old, died in New York in 2004 while co-sleeping with a caregiver who accidentally rolled over on them or wedged them against the wall.

 

Despite the risks, Dr. Ferber came out in support of co-sleeping, for parents who prefer it, in the latest edition of his book, “Solve Your Child’s Sleep Problems” (Fireside, 2006). “To me, whether a family chooses to co-sleep should be their decision, and we work with them either way,” he said.

 

One of the most prominent advocates of co-sleeping, Dr. Robert Sears, who co-authored “The Baby Sleep Book” with his father, mother and brother, is a strong critic of “cry-it-out” methods. “We’re all for routines and consistency, so long as the baby isn’t left to cry it out alone,” Dr. Sears said in a telephone interview from his family’s pediatric clinic in Capistrano Beach, Calif.

 

“Certainly most methods do work, no matter how harsh it is on the baby,” he said. “But what happens to these babies left to cry it out for hours, if not weeks on end? What kind of trauma is inflicted on the babies, and what is their psychological and emotional makeup 3, 5, 10 years down the road?”

 

In fact, longterm studies have shown that children who never learn how to fall asleep independently are at increased risk of continuing sleep problems as they grow up, Dr. Mindell said.

 

Even on a short-term basis, the task force reported, “Infants who participated in sleep interventions were found to be more secure, predictable, less irritable and to cry and fuss less following treatment.”

 

While teaching a child to sleep independently can be emotionally wrenching for all those involved, Dr. Mindell said, “Parents need to understand that they’re not doing it for selfish reasons. Their children benefit greatly.”

 

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THE CORK NEWS INTERVIEWOctober 11, 2011

Thanks to Maria Tracy for this fab article that appeared in The Cork News on 7th October.

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Sleep Tips For New DadsOctober 10, 2011

SLEEP TIPS FOR NEW DADs

Featured on www.dad.ie

After you are handed your precious bundle of joy, the journey begins and often we know very little about how to put our babies to sleep or how to define realistic expectations about sleep and if we don’t foster good sleep habits early on it can become a real household problem.

What a lot of us don’t realise is that sleep is a learned skill, and we have to teach our babies to develop healthy sleep habits. This can be done early on, without compromising your parenting values. Sleep is vital to health and development. Getting enough sleep will help your baby grow, learn and stay well.

In the first few months of life, while you get to know and bond with your new baby you can also concentrate on establishing basic sleep rhythms and routines that will help babies learn to sleep better from the start.

The following are some useful tips and suggestions to help your infant sleep longer and wake less during the night as soon as they are able:

1. Create a flexible feeding and sleeping routine. Sometimes the word routine, strikes fear into the Parent’s heart and they think that they will be confined and defined by the new baby, but I don’t mean a rigid minute by minute “must do” routine; more a predictable framework of feeding, sleeping and waking.

In the very beginning, it’s important not to underestimate how much sleep your infant really needs-as much as 16.5 hours in a 24 hour period when they are one week old and still 14.25 hours when they are 6 months. In the beginning they don’t have much stamina to stay awake for long periods of time and when they do stay awake for too long, sometimes 45 minutes is enough, this can result in extreme fussiness and crying, that is often plain old over-tiredness masquerading as symptoms of colic.

2. Establish some soothing techniques other than feeding; this is helpful too for those extreme fussy times. When your new baby cries, it is not always an indication that they are hungry. Given the chance our babies will develop a host of ways to soothe themselves. You could try:

• Swaddling
• Carrying your baby
• Swinging or rocking
• Repetitive sounds: white noise, hairdryer, washing machine can instantly calm them
• Massage
• Sucking-on a pacifier

3. Sometimes feed your baby when he wakes up. A nice long feed at sleep time is great to encourage sleep, but you want to weaken the feeding and sleeping association so your baby doesn’t always need to be fed to go to sleep. You could try to get into the habit of feeding them after they wake up from their nap instead of before, at least once or twice a day.

4. Put your baby down drowsy but awake at least once a day. As I’ve already mentioned, learning to go to sleep is a skill your baby must develop. They won’t be able to master this if you always feed them or rock them or walk them to go to sleep.

The benefits of a having some sort of predictable schedule is that you will have a good idea when your baby is hungry and when they are tired. At least once a day you could aim to put your infant into his moses basket when its sleep time and let him learn how to go to sleep unassisted. This is a great learning experience for him and will help him be able to sleep for longer periods at night as soon as he is able.

5. Create a soothing bedtime routine-it’s never too early to start to teach your baby the difference between day and night. A pre-sleep ritual, one that you can adapt and lengthen as he gets older, can be implemented in the early day and he’ll soon learn to connect the steps of what happens “when it’s time for me to go to sleep” consider:

• Bath
• Baby massage
• Soft music
• Dimmed lights
• Snuggles and kisses

Mums have built in bonding opportunities particularly if they are breast feeding. But you Dads don’t need to feel left out. Here are some ways for you to get closer:

• Feeding. Breastfeeding mums can express milk and give dad the chance to feed, maybe for the last feed to give Mum the chance for some extra sleep at night. Or you could do the nappy change half way through the feeding.
• Bath-time. This intimate activity is a great opportunity for Dad and baby. You could learn a little baby massage or baby yoga too.
• Carry the baby. Get a front carrier and take baby for a walk on your chest-perfect!

Sleep Tight!

Lucy Wolfe is a Certified Gentle Sleep Coach and Owner of Sleep Matters-Help your Child Sleep which helps families who are struggling with their children’s sleep issues. Sleep Matters offers a gentle approach to get children to sleep with a customised plan specific to each child and family.

For further information log on to www.sleepmatters.ie, or email lucy@sleepmatters.ie / call 087-2683584 to book a consultation.

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Solve your Problems in a Parent Workshop. New Dates Announced;September 28, 2011

I am pleased to announce some workshop dates for parent’s struggling with their children’s sleep.

Glanworth Community Centre-15th October-Places limited contact me for more information

South Douglas Road, Cork-22nd October–Places limited contact me for booking information

Fully Booked-Contact me for future dates

Sleep Success Parent Workshop

Just €75 per family.

Sleep Matters Questionnaire

This workshop provides a comfortable environment where a group of parents can get together and learn how to gently solve their child’s sleep problems.

You will hear stories from other parents who are facing some of the same challenges as you, learn some gentle strategies you can use to help your child overcome these challenges and have the opportunity to develop a personalised sleep plan that you can start using the same night!

Here’s what you can expect from the workshop:

  • Upon registration you will be emailed a history form that you will be asked to complete and email back to lucy@sleepmatters.ie at least 5 days prior to the workshop.
  • General education about sleep- the science and the behavioral “must know”
  • The secret to sleep coaching success!
  • Common sleep problems and how to fix them- both for nights and naps.
  • Create a Gentle Sleep plan for your child.
  • Families will be able to create their sleep plan while I guide you through creating your plan and answering your questions.
  • Possible pitfalls you might encounter and how to successfully deal with them.
  • 2 follow up phone calls per family with me (to be completed within 3 weeks of the workshop).

Cost: €75 per family
Time: Four hours
Who:Parents of children ages 5 months to 5 years – maximum 2 adults per family.

***If you feel your sleep situation is unique or complicated, a 1:1 consult with me may be more appropriate for you than a group format.

Book Now 087 2683 584 or Enquire Online

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Bedtime Habits May Cause ADHD-Like Behaviour to ChildrenSeptember 20, 2011

A new study published in the American Journal of Family Therapy showed for the first time a direct link between bedtime routines and behavior that mimics Attention Deficit Hyperactivity Disorder (ADHD) in children.

The findings propose that of the over 5 million children who are now being treated with ADHD medication, a majority may be suffering from Faux-ADHD, a disorder linked to irregular bedtimes and bed sharing, and does not require medication.

The study, consisting of 704 parents of children, ages 2-13 and were being seen in pediatricians’ offices, was conducted by researchers at the New England Center for Pediatric Psychology and the Rhode Island College Department of Special Education. It suggests that simple adjustments to bedtime habits, rather than medication, can eliminate ADHD-like behavior, such as poor attention and hyperactivity.

Here are other key findings from the study:

Children who did not sleep in their own beds

Had ADHD-like behaviors 7 times more frequently than children who always slept in their own bed; and

Hit, pushed, or kicked their parents 13 times more frequently than children who always slept in their own bed

Children Who Did Not Have a Regular Bedtime

Had ADHD-like behaviors 8 times more frequently than children who had a regular bedtime

Hit, pushed or kicked their parents 10 times more frequently than children who had a regular bedtime; and

Lead researcher of the study, Dr. Robert M. Pressman, said:

“Pediatricians, therapists, and parents need to reassess the questions asked when diagnosing ADHD. Bedtime habits must be reviewed at intake and bedtime problems explored before ADHD medication is considered.”

So, before jumping into conclusion on ADHD, consider Faux-ADHD.

Written by Dominic Rivera
The Inquisitor
20th September 2011

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Knowing When (and how) to Ask For HelpSeptember 20, 2011

One of my fellow Gentle Sleep Coachs wrote this recently and I thought that I would share with you as I think it will resonate with many…
In my line of work, I keep meeting parents who say either, “where were you 5 years ago”, “I should have called you 3 months ago”, and “I thought I could go it alone”. This piece is not a big I TOLD YOU SO nor is it a plug for my business. Rather I am asking my faithful and few readers to consider why we wrap ourselves up with hard work and suffering when we could look for support. And by support, I mean a glass of wine with a friend, an honest conversation with a doctor, or a sit down brain storming session with a partner to ask for help.

I am guilty in each of the above situations – all of the time. Rather than have a mature conversation with my husband, I will act angry and put upon, hoping that almost by osmosis he will know I need help and somehow read my mind and give me exactly what I want and need. When I go to the doctor, I always say, “I’m fine”, when sometimes I am far from fine. Certainly as a parent, I have tuned my spirit to suffer first and enjoy later. When my son was an infant, I just assumed that sleeplessness was normal and would always be a state of being for our entire family. Three years later, my daughter needed me and only me for all bedtimes because I never took a moment to say, “help, you do this, I need a break.” Any of my friends would tell you that I am very good at bringing up and complaining about my problems. However it takes a lot for me to reveal that I am not just complaining and that yes, I actually could use a little assistance.

How does this connect to sleep and sleeplessness for parents and families?

I am asking you to pause for a moment and make a decision for the good of the family. This does not mean hire me (or maybe it does). Rather, decide to deal with your suffering constructively – tell your pediatrician and your ob what is going on, actually truly happening. Call a friend and say I need you to talk and to … babysit, cook, fold laundry, whatever it is. Trust me, they will say YES. During a power outage recently (thanks Hurricane Irene), my friend did all of my laundry, all of it, and she has two boys to take care of, plus a husband, a job, cats, etc. In another example (there have been quite a few lately), even with the power back on, my life was growing more and more busy with not enough time to take care of my responsibilities. After a few days of mucking about and being mean to my husband and probably my children, I reached out to another parent in my school community and asked her for some help. She said, YES. Here is the thing; people like to help each other, it is our nature.

To that end, I must mention my incredible experience speaking to the moms at babybites Westchester yesterday afternoon in Larchmont. I commend these women because they were at lunch with their babies, looking great, and helping each other. They asked such good questions of me. However I was even more impressed by their willingness to help each other. They listened to each other so attentively and so sensitively; it made me feel confident and lucky to be in a place personally and professionally where I can ask for help and get it. That feels great.

Written by fellow GSC Brooke Nalle, Sleepy on Hudson, USA

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Parent Sleep Counselling May Improve Kid’s Shut EyeSeptember 12, 2011

NEW YORK (Reuters Health) – Screening kids for sleeping problems and discussing sleep strategies with parents could help youngsters settle into school with better nighttime routines, suggests new research from Australia.

Researchers found that when they had sleep-related consultations with parents, kids tended to have fewer sleep problems and better bedtime habits than children whose parents didn’t get counseled.

The study was small and didn’t demonstrate that the sleep improvements led to changes in kids’ academic achievements later in the year.

Still, the findings show that “sleep problems are common in young school children and are treatable using … a brief behavior-based intervention,” study author Jon Quach, from the University of Melbourne, told Reuters Health in an email.

“Parents should seek advice for their child’s sleep if they are concerned,” he added.

In five- and six-year-olds, most sleep problems are related to kids’ behavior, researchers say.

“Some of them still have poor sleep habits where they are going to bed too late, they don’t have a bedtime routine, and many of them are still having parents stay with them when they go to sleep at night,” said pediatric sleep specialist Jodi Mindell, from St. Joseph’s University in Philadelphia, who was not involved in the study.

“You also get in this age group some night-time fears,” she said, and anxiety might increase as those kids start school.

The current study focused on that back-to-school time frame and included kids who were headed into their first year of elementary school. That’s an important window for addressing sleep problems, Quach said, because kids who don’t sleep well might have more trouble making the transition to school, which sets them up for worse academic performance and poorer relationships later on.

Quach and his colleagues surveyed about 1,500 parents of kids starting at 22 different elementary schools in Melbourne. Of these parents, 161 said their child had a moderate or severe sleeping problem and 108 were recruited for the study. Kids with more serious sleep-related breathing problems, for instance, were excluded.

Half of the participating parents had a private consultation at school, followed by a telephone call two weeks later, to discuss behavioral sleep strategies based on their kid’s specific issues. The other half weren’t offered any extra help.

Over the next year, the researchers surveyed parents again about their kids’ shut-eye. Six months after the initial consultation, they also gave all kids a learning assessment.

Sleep issues tended to resolve in both groups, the researchers reported in Pediatrics. Still, kids whose parents had sleep-related counseling generally did better.

After six months, 26 percent of kids in the consultation group and 47 percent in the no-consultation group still had moderate or severe sleep problems. By one year, however, there was no difference and about one-third of kids in both groups had sleep problems.

Kids in the consultation group had less resistance at bedtime and took less time to go to bed, according to their parents’ reports. But there was no difference in how well they did on academic tests designed to measure reading, math and spelling skills.

Quach and colleagues noted that the study was small and that a follow-up including more kids will be needed — including one that tracks students’ progress for more than a year. It may be that sleep improvements would take a while to translate into better academic skills, they explained.

Mindell said “there’s no question” that this sort of program could work in U.S. schools, with school counselors or nurses doing the sleep consultations. “I think this is a wake-up call to teachers and school psychologists that they need to always be looking for sleep problems,” she told Reuters Health.

For now, she pointed to a few key tips for parents of young kids who have sleeping trouble.

The “really simple changes,” she said, include: “Making sure your child goes to bed before nine — we know that that’s the tipping point; including reading as part of that bedtime routine — it helps calm children down, it gives them a focus, it helps with literacy, it’s all good; then encouraging children to fall asleep on their own.”

Finally, make sure there are no distracting electronics in kids’ bedrooms, she said. “Get rid of the Game Boys, get rid of the computers, get rid of the cell phones.”

SOURCE: http://bit.ly/pXdFNv Pediatrics, online September 2, 2011.

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CORK EVENING ECHO INTERVIEWSeptember 2, 2011

I am very pleased to share a fabulous interview that I did with Sandra Quinn of the Evening Echo…Enjoy

WOW sleep coach page 1

WOW sleep coach page 2

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Parent’s QuestionsAugust 30, 2011

Will there be No crying?
I cannot guarantee that your child will not cry. I can assure you that the methods we use are as gentle on both you and the child as possible, and there will be fewer tears.
Our gentle, gradual approach aims to have as little crying as possible. I encourage parents to be loving and responsive, but to allow the child to fall asleep unassisted. The parent responds and stays with their child and offers physical and verbal reassurances, without putting the child to sleep. This supports the development of a secure attachment between the parent and child.

Does one size fit all?
The plan is customised specifically for you, we can adapt parts of the method, or the whole thing, or use it for nights and not naps. This is especially useful for children in childcare.

Do I have to give up breastfeeding?
I am a big supporter of Mothers who breastfeed and personally have nursed all of my own children. It is not necessary to end breastfeeding to successfully sleep coach your child. I will help you gently move away from using nursing as your sole and primary crutch.

When is it too late to solve a sleeping problem?
It is never too late to change your child’s sleep. My training has prepared me to work with parent’s of children from newborn to 5 years old.

If I want to co-sleep can I still improve sleep?
If you as a family have decided to co sleep, or room share, I can assist you in making sure that the whole family gets great sleep and still maintain the parenting style that you have chosen for your unique family unit.

I have read many posts and articles that say sleep training is not right, that is doesn’t work and that eventually the sleep problems will go away by themselves..
Despite being as important to humans as food and water, sleep is a learned behaviour and not a natural instinct. Some children-maybe yours, need assistance to help them learn this skill, as somewhere along the way they have developed “sleep crutches” that help them to fall asleep, but do not keep them asleep for as long as necessary.
It is behavioural science, so therefore, if the parent is consistent and keeps helping the child to sleep unassisted, they will learn, quite quickly, this important life skill. Sometimes, as parents we get overwhelmed and overtired, worn out by continuous broken sleep and cannot alone fix the problems-however, with the assistance of a child sleep consultant like me, it can be made easier. We can help identify what may be causing the problem and find a solution that suits you.

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Could Sleep Deprivation Be Changing Your Child’s Personality?August 23, 2011

It’s becoming more widely known that sleep disordered breathing leads to poor behavior in children. Estimates show that as many of 25 percent of children diagnosed with ADD or ADHD may actually have an underlying sleep problem that can be treated — resulting in better behavior and improved learning skills.

Most often a sleep problem is identified in children and then health providers, researchers and parents look for behavior issues. A new study at the University of Michigan approached children, behavior and their sleep with a new twist: the study first looked for children with certain behaviors, and then looked at the sleep patterns of those children.

The cross sectional survey at the University of Michigan showed some very intriguing results: kids who show aggressive behavior in school are twice as likely to have symptoms of sleep disordered breathing as children that do not exhibit aggressive behaviors. Of the 341 students surveyed by the researchers, about 32 percent were assessed by their parent or teacher as having a conduct problem via a standardized behavior questionnaire. Parents of these children also completed a standardized pediatric sleep questionnaire, and scores for identification of symptoms for sleep disordered breathing (snoring, stopping breathing, daytime sleepiness, etc.) were collected. The results from the study abstract were as follows:

Children with conduct problems, bullying, or discipline referrals, in comparison to non-aggressive peers, more often had symptoms suggestive of sleep-disordered breathing. However, a sleepiness subscale alone, and not a snoring subscale, predicted conduct problems after accounting for age, gender, a measure of socioeconomic status and stimulant use. Results were reported to be statistically significant.
I spoke with Dr. Louise O’Brien, one of the sleep researchers at the University of Michigan. She told me that these results were surprising. “While many people thought that it would be snoring that was driving this aggressive behavior it appeared to be the daytime sleepiness that was driving it.” Unfortunately, Dr. O’Brien’s landmark study was not designed to determine what was causing the sleepiness during the day: behavioral factors, environmental issues or actual diagnosed sleep disorders. Another study will be in the works to look at some of these outstanding questions. While the questionnaire used in the study did not include cyberbullying, a case might be made that this type of behavior would fall under these results as well.

So aggressive kids appear to be sleepy kids, and it is not always because they are snoring (which might make you think they are not getting good quality sleep). What could be the culprits?

• Not getting kids to bed on time

• Kids rooms not being conducive to sleep

• Formal sleep disorders

So what is a concerned parent to do?

Step #1: Get your child to bed on time!

Step #2: Make sure their bedroom is conducive to sleep! Remove distractions and televisions and make it cool, dark, quiet and comfortable.

Step #3: If you think that your child may be suffering from a sleep disorder, speak to your pediatrician immediately. Kids should not snore, stop breathing in their sleep or regularly walk, talk or show any other abnormal or unusual behaviors in their sleep! Don’t just think that they will grow out of it. Speak to your physician about these types of behavior.

As parents, it is our responsibility to pay attention to the safety and health of not just our children, but those children who our kids interact with everyday. Based on this new study, looks like a well rested kid is less likely to get you that call from the principal.

Michael J. Breus, PhD
The Huffington Post

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Sleep-A Learned BehaviourAugust 15, 2011

Following birth, sleeping patterns evolve rapidly and become consolidated in early childhood. Parental behaviours at bedtime — especially their response to their child’s nighttime awakenings — play a big part in consolidating their child’s sleep patterns. This according to findings published in the Archives of Pediatric and Adolescent Medicine.

The study investigated the sleep patterns of 1741 children in Quebec, at ages five, 17, and 29 months, and collected data from the mothers via interviews and questionnaires. Three major conclusions emerged from the results:

Sleep behaviour evolves rapidly and consolidates by 17 months of age.
How parents behave at bedtime and during nighttime awakenings can determine how their child’s sleep pattern evolves and how fast it consolidates.
Children not sleeping six consecutive hours by 17 months of age have greater difficulty consolidating a healthy sleep pattern as they grow older.
These findings make intuitive sense to Dr. Ian MacLusky, head of respiratory medicine at Children’s Hospital of Eastern Ontario (CHEO) in Ottawa. The key to solving many common sleep problems in young children is to teach them to fall asleep, says Dr. MacLusky, who was formerly the Sleep Lab director at the Hospital for Sick Children. “Sleep is a learned behaviour, like talking. And since the plasticity of the brain is greatest at infancy, infants can be more easily taught to fall asleep by themselves than older children can.”

Insufficient sleep is an issue-
The Quebec study addresses a prevalent, but often overlooked issue of insufficient sleep in children. A poll conducted in 2004 by the National Sleep Foundation in the U.S. looked at the sleeping habits of children aged from infancy to 10 years old. Results showed that most children do not get the daily required amount of sleep, most parents are not satisfied with their children’s sleep pattern, and most doctors do not ask about a child’s sleep habits. Childhood sleep disorders are one of the most common complaints brought to family doctors, with nearly half of new mothers complaining of infant sleep problems. However, less than 15% of children with sleep problems had it on their medical charts.

Doctors are not the only ones overlooking the sleep issue: one study found parents significantly underestimated the length and quality of their child’s nighttime sleep.

Dr. MacLusky explains that although nighttime awakenings may be disruptive, they are normal. “We all wake up three or four times a night. Most of us just roll over and go back to sleep again. But children who haven’t learned to fall asleep on their own call on their parents.”

If a baby or young child does not sleep well at night it can disturb not only the child but the whole family, causing lack of sleep and stress for the parents and older siblings as well. Fragmented sleep in older children has been correlated with problems in learning, emotional development, and growth.

Techniques to help a baby sleep-
Recommended hours of sleep per day for children have remained constant over the past few decades, beginning with about 15 hours of sleep for infants, gradually reducing to 13 hours by two years of age, 12 hours by three years of age, and coming down slowly to 10 hours by 10 years of age.

Results of the Quebec study found support for the following general recommendations to parents for quickly establishing a good sleeping pattern in their healthy child:

Put the child to bed while sleepy but not yet asleep.
Try to avoid nighttime feedings.
Do not bring the child into the parent’s bed.
While these recommendations may sound simplistic, several studies have shown their usefulness. Other studies have emphasized routine and an organized environment: children put to sleep at the same time and place every night fell asleep more easily and had more regular sleep. One study specifically focused on educating parents on such positive behaviours to use with regard to their child’s sleep and found the results to be very successful in improving the sleep of their child.

Sleep problems as a result of a health disorder-
Most sleep problems in children are like the ones looked at in the Quebec study. They involve difficulty falling asleep, are behavioural in nature, and can usually be solved by changing the parents’ responses. Some sleep problems, though, are resistant to behavioural modification and can indicate a health problem that requires further investigation.

Tourette E, Petit D, Paquet J, Boivin M, Japel C, Tremblay RE, Montplaisir JY. Factors associated with fragmented sleep at night across early childhood. Archives of Pediatric and Adolescent Medicine. 2005;159;242-249

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Sleep: a wake-upAugust 3, 2011

Sleep: a wake-up
Hyperactivity, even ADHD, may be caused by late nights, says Tessa Thomas

Most children feel a little ratty after a poor night’s sleep. But some sleep experts now suggest that sleep deprivation is actually the cause of many forms of hyperactivity, including ADHD.

“Sleep problems have always been recognized as a symptom of ADHD, but they are as likely to be a cause,” says Dr Stephen Sheldon, director of sleep medicine at the Children’s Memorial Hospital in Chicago and author of Paediatric Sleep Medicine, a medical textbook.

“It has long been observed that children have a paradoxical reaction to stimulants and are effectively sedated by them, which is why a stimulant like methylphenidate (Ritalin) is used to calm them down.” But, he says, it is actually the symptoms that are paradoxical: “Children become hyperactive rather than sleepy when they are severely sleep-deprived.”

If he is right – and there is a growing body of opinion to support his view – then Ritalin works for an overtired child much as a jug of coffee works for an underperforming office worker: their behaviour improves in response to stimulation.

It’s not just ADHD that is misinterpreted as a behavioural rather than a sleep problem, says Dr Luci Wiggs, research fellow at the Oxford University child and adolescent psychiatry unit. This is evident among children who would not be clinically labelled as disruptive. “Children appear to be getting less sleep overall, and we’re seeing a major effect on their learning, thinking, behaviour, relationships and susceptibility to accidents that can be labelled as hyperactive,” she says.

Research has indicated that just and hour’s extra sleep can have a big impact on children’s behaviour. Dr Avi Sadeh, a psychologist at Tel Aviv University, compared a group of 9 to 11-year-olds who had slept for an hour longer than usual with those who had an hour less than usual. When he tested the children after five nights on this new regime, he found that the extra-sleepers scored much higher for memory, recognition and reaction.

As he explains: “There are good reasons to believe that with the nightly temptations such as television and computers in their bedrooms, many children are chronically sleep-deprived – and it shows in their behaviour.” The fact that none of these children had difficulty falling asleep an hour earlier than usual was equally telling.

We are too ready to blame children’s behaviour on a medical condition, suggests Professor Lyn Quine, a health psychologist at Kent University and author of Solving Children’s Sleep Problems. She has worked with children with physical and behavioural problems and says: “You can readily judge the existence of a sleep problem from the child’s daytime behaviour. If it is disruptive, parents need to address the sleep issue first because over activity and poor concentration are often signs of tiredness.”

Quine says there is inadequate training in sleep problems for frontline health professionals, and even when they recognize sleep deprivation in a child they are ill equipped to give practical advice. “Meanwhile, the child’s disruptive daytime behaviour and lack of sleep feed off each other and parents get caught in a vicious circle.”

Quine takes a dim view of the widespread prescription of Ritalin (about 25,000 children in Britain take the medication, with the number rising). “It’s terrible that children are tagged with a medical condition before the simple behavioural solutions for what might be simple sleep deprivation have been contemplated.”

Many parents are now aware just how much sleep their children require or how badly a deficit can affect their behaviour, according to Mandy Gurney , a sleep therapist and co-founder of Millpond Sleep Clinic, a specialist children’s sleep service.

“They think babies are sleeping the whole time and of that need rapidly declining, especially between the toddler and school years. But a four-year-old needs on average only two hours less than a two-year-old,” says Gurney, who this week appears in a BBC documentary about sleep.

It is the shift of daytime to nighttime sleep that really changes as they grow. So a one-year-old will take 2.5 hours out of is 14-hour quota in the day, while a five-year-old will just have 11.5 hours at night. Minorities of children do appear to need less sleep, but in most cases their performance improves with more.

It is not always lack of parental knowledge that causes children to sleep badly. About 10 per cent of children have their sleep interrupted by snoring and 3 per cent by sleep apnoea (where the airways are temporarily blocked). Night-time breathing problems are increasingly caused by obesity, but more commonly by enlarged tonsils or adenoids.

Significantly, a study at the University of Louisville found that a quarter of five to seven-year-olds diagnosed with mild ADHD also had mild sleep apnoea in the night. Once the night-time breathing difficulties were treated, usually with surgery, their behaviour improved.

The Times, 1 February 2005

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Lack of night sleep in infants can lead to childhood obesityJuly 20, 2011

Schwarz E, Brown J, Creasman J, Stuebe A, McClure C, van Den Eeden S, Thom D. Lactation and maternal risk of type 2 diabetes: a population-based study. American Journal of Medicine, 2010; 123(9): 863.e1-863.e6.

Insufficient amounts of night time sleep among infants and preschool-aged children may be a significant risk factor for developing childhood obesity, say US researchers. To test associations between daytime and night time sleep duration and subsequent obesity in children and adolescents, the researchers studied 1930 children aged nought to 13 years in 1997, and again in 2002. The children were separated into a ‘younger’ group (age nought to 59 months) and an ‘older’ group (age 60 to 154 months).

At follow up, 33% of the younger cohort and 36% of the older cohort were overweight or obese. For the younger children, short duration of night time sleep at baseline was associated with an increased risk of subsequent overweight or obesity. In the older age group, baseline sleep was not associated with subsequent weight status, though contemporaneous sleep was associated with increased odds of a shift from normal weight to overweight or from overweight to obesity at follow up.

The authors conclude that sleep duration is a modifiable risk factor that has potentially important implications for obesity prevention and treatment. Napping had no effects on the development of obesity and is not a substitute for sufficient night time sleep.

YOUR CHILD MAY NEED 2 HOURS MORE SLEEP EACH NIGHT!

A survey carried out by the National Sleep Foundation (NSF) in 2004 in America found children are getting less sleep than experts recommend for their age group and that parents do not always know how much sleep their child needs.

The Sleep in America Poll shows that children from newborn to 11 years were getting one to two hours less sleep in every twenty four hours than they need.

Two-thirds of all children experienced one or more sleep problems a few nights a week. Common problems included; difficulties falling asleep, resisting going to bed, sleep walking, snoring and breathing difficulties. Nearly one-third of children needed attention from a parent during the night.

Richard L Gelula the NSF Chief Executive Officer, said in a statement, “What is troublesome is that sleep problems start in infancy”.

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