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Growing Healthy Podcast

Jan 18, 2018

We did a segment on a bit more advanced sleep training issues recently...but we thought we should do one on the basics....We are going to talk about the core principles of sleep training for your infant or toddler right after this quick reminder...

AP: Maria....Sleep...we all need it, it is such an important thing for our physical and mental know how crabby and exhausted I am physically and mentally when I don't get sleep.....

MK: are a bit of a crabster and you definetly don't preform as well at our workouts when you are dragging your butt after a long call night!!! 

AP:  That's for sure...and it is the same for our wee ones!! They need their sleep to be the best kiddos they can be ...and that is at the core of why we need to help them to learn this skill!

MK: Alicia, that is true.   We need to remember that sleep is a skill that needs to be learnt just like, walking, talking and having good manners, and it is our responsibility as parents to help guide our children in learning this important skill.   So much stuff happens when we sleep, we reconcile all we have learnt that day, we dream, our body heals itself.   

AP: Not only that, when our kids sleep, we as parents usually sleep.  One of the major contributors to mental health issues is lack of sleep, and that is not different in our moms and dads who are getting sleep deprived in those first months and years after they have kids.  Having an infant that does not sleep, doubles the risk of depression.  And at 6 months of age, 45% of moms report infant sleep problems....that is almost 1/2 of moms!!! 

MK: Wow....I'm not suprised though...I have a lot of parents who feel that they are going to cause damage to their kids by "sleep training" them, or by letting them cry.  They feel that their attachment to their baby will be harmed by these actions.  We have to remember the bigger picture though....we spend so much time during the day, loving our kids, attending to their needs, interacting, playing and reading to them that a few minutes of crying in a 24 hour period will not cause harm.  In fact there are quite a few studies out there comparing children who were sleep trained vs not and 5 years out there are no differences in the two groups, at 3 months and 2 years there are...there are benefits to sleep training in both moms and infants.  

AP: It's not easy to hear your baby cry....but putting it in the context of learning a new makes it more understandable....if you child was learning to write, and getting frustrated about wouldnt just say...well you don't need to learn to write....would you? 

MK: lets get to it!!!  We will chat about some generalities, that are the same regardless of what method you choose to use to help teach your child to sleep...we will then go into some of the different ways you can implement them. 

AP: What is the most important thing with sleep training?  The same thing with any parenting....Consistency.  Kids need routine, they need to know what to expect.  They need to have boundaries, which they may try to push, but that are consistent.  If they don't have this, they can never learn what to do. 

MK: That's pick a routine and stick to it....Same time to bed at night, and same time up in the morning, also try to keep your naptimes around the same time as well.  Generally speaking, around 3 months, you will notice a natural routine that your child will get into...this is generally a 3 or 4 hour cycle, of eat, play and sleep.  Try to reinforce this.  

AP: And then pick a bed time and nap time sleep routine.  Generally the bedtime routine should be about 20-30 min long, and the nap routine 5-10 min long.  As we said kids like routines, so you need to have something that you can maintain, and that can be replicated by all those taking care of your wee ones.   For bedtime routines we generally recommend some combination of bath, book, feed and then put down on their back sleepy but awake.  A cheery good night and out you go.  Now some babies fall asleep while feeding, so if that is the case, you may want to switch the feed and book/song in the order.  For a naptime you generally want to try to get your child to eat when sleep, eat, your naptime routine might be going into their room, putting them in their sleep sack etc, reading a quick book, putting them in their crib, on their back,  sleepy but awake, singing a song and saying a cheerful goodnap. 

MK: That is right....but lets remember different aged babies have different night time requirements....a baby that is 3-4 months of age still often needs a feed at night, but not more than two.  Most 5-6 month old babies, who have been gaining weight appropriately, are able to go through the night without a feed.  So, I agree we need to start working on routines, and allowing the baby to learn how to put themselves to sleep early on, but we should not be doing formal sleep training, which we are going to chat about next, until 6-8 months.  For those infants who are older than 6 months and still waking to feed multiple times at night, you may need to decrease feeds at night prior to doing full on sleep training.  they will naturally start eating more during the day to make up for it.  

AP: exactly...but lets remind everyone...that the longer you wait to do it, the harder it can be to do!! a 6 month old, usually gets it within 2-3 nights, where as a 1 year old or 18 month old will often take closer to a week....Also I think it is important to remember that all babies and children are different, some are naturally good sleepers, and other than reinforcing routines, they don't need much help.  Other children need a lot more help to learn this important stick to the basics, and it will work for most infants, but if not...get help....and we've posted a few books and local resources to contact should you need more advice.  Another thing we need to remember about sleep training is that this is a team event.   So all members of the household need to be on track with this for it to work....sit down with your partner, parent or friend, anyone who is willing to help you out with this and make a plan.  because like we said before children need they need to hear a consistent message between the actions of all caregivers....othrewise they will get confused.    Well Maria...shall we get down to the nitty gritty of it???

MK: Yup lets do it.   We will present you a couple of options, but you need to find a solution that fits your family, there are many ways to implement sleep training and not all will work in all families, so do some research and find a method that your family can implement together.  

AP: We discussed bedtime routine...this needs to be manageable, and repeatable wherever you are.  Kids thrive on consistency and knowing what to expect, so part of this is bonding with your child and helping them connect this routine with sleep, so they know that sleep is the next thing to come.  So choose one you can do, your partner can do or any significant caregiver can do.  One that you can do when you are at home or if you are travelling.  Like we said generally this involves some kind of feed, book, song and cheery but quiet goodnight.  

MK: Bedtime should also be relatively early for most kids in the infant or toddler stage, say somewhere between 6:30-7:30.  If you wait for your child to show signs of tiredness, or let them get overtired, it often becomes much harder to get them to sleep.  Some people notice that if their child naps too close to bedtime they will get harder to put to sleep, others dont notice this.  So if your child is one that a later nap affects their bedtime significantly, it is probably time to cut out that night if possible in favour of an early bedtime. 

AP: Sleep Environment is very important to baby's sleep.  You want the room temperature to be between 19-21 celsius.  If you need to put extra layers on your child because you cant control the temperature very effectively, use a sleep sack as they can not be kicked off.  We need to keep loose beddings, pillows etc out of the baby's bed to make a safe sleep environment.  
The room should be dark.  This can be challenging to achieve at some times of years, or during nap times.  Invest in a good pair of black out blinds for these times!.  

Background noise can be very helpful for infants and some toddlers, having a white noise machine (or pink, rain storm etc) as it drowns out any noise from the outside world but also can remain on all night (ie not on a timer) , so if the child awakens, it is a familiar sound that they can then fall back asleep to.  The goal of this is for children to be able to soothe themselves back to sleep when they wake in the night, which they will, because we all do....rather than need you to put them back to sleep. 

MK: So we have set the stage for good how do we actually make it happen...We have consistent routine, consistent dark environmnent, good white noise or fan....but a baby that is awake....

AP: now you just put the baby down, say a cheery goodnight and leave....easy as pie!

MK: HAHAHAHAHAHA.....I wish....Well that is the basics of it...but doesnt work for everyone.   Lets start with putting your child down....Some say put them down drowsy but awake, others say wide awake....What is the answer?  if your child is younger than 3-5 months..they can be drowsy when you put them down, but children older than that need to be a bit more awake...because those drowsy ones are have already started to enter that first stage of technically they are not learning how to put themselves to sleep.  

AP: put them down, awake and wish them a cheery good night and leave...what about soothers, blankies, stuffies etc...

MK: Well we want to try to avoid sleep props that they need to put them selves to sleep with that may not be present when they awake in the middle of the a soother.  If they cant get it...they will scream for you to come get it for them.  So no soother.  A loose blanket and stuffie in the crib is not safe when your child is young, but may be useful in those toddler years, but be sure to have a few of the same things in case one gets lost!  and also make sure you rotate them so they all look worn!

AP: When you say goodnight to your infant, and leave the room, they may not be happy, and certainly may start crying to get you, their best friend to come back in and keep them company.  They are smart little people, and of course want to hang out with their best friends as much as possible, but you have to remember why you are doing help teach them how to learn the skill of putting themself to sleep.  So the most important part of sleep training, is having a plan with your partner and sticking to it for a couple of nights at least.  Or resetting your plan together if you realize your original plan is not working.  But the more you do this, the more confusing it gets to your child, and the farther away from your goal you are going to get. 

MK: lets talk about a few different ways you can do this.

Generally speaking, the harder they are on our souls as parents, the more efficient they are!  The easier they are on our souls, the longer it takes..but that is fine, you need to be comfortable with whatever way you choose. 

1) You can stay in the same room with your child, and shoosh your child to sleep with out touching them, and then when they are asleep leave the room, you can expect when your child wakes up in the middle of the night, they will need you to shoosh them back to sleep, but over a few nights, you can make the shooshing time shorter while still remaining in the room until you get to the point you do not need to shoosh and just be present in the room.  You can then shorten the time you are in the room until you get to the point that you wish them a cheery goodnight and leave.  I expect this process would take a couple of weeks to get to the final point.  

2) You can say a cheery good night and leave.  If your child starts crying you can then return in, soothe/talk/pat your childs back to reassure them that you are there and leave again.  The next time you would wait a bit longer before returning.  This will give some children the confidence that you are there if they need you, but also more quickly teach them the skill to put themself to sleep.  Some babies get more riled up when you go in, and so this does not work for every family. 

3) You can say a cheery good night and leave the room, go sit on the couch and eat some chocolate...Your child will scream the first few nights, but probably only for a couple of nights.  If you have en enjoyable bed time routine, and dont get upset about things, anticipating screaming, they will still enjoy bedtime and generally will be happy to go to sleep.  This method is by far the hardest on us, but generally the most efficient way.  If after one week, the bedtimes are not getting easier, I would certainly try another method, as this one may not work for your child.  

AP: okay, so we've talked about how to deal with the first to bed of the evening, but what about if they awaken during the night.  Well depending on the age, and their need for a feed overnight you are going to do different things.  Some children between 6-9 months of age still need one feed over night, they will usually sleep between 6-8 hours and then awaken for a feed then sleep another 4-6 hours.  If your child, over the age of 6 months is awakening more than a couple of times a night, they do not need to feed.  It is very hard, if you are breastfeeding to not feed a child during then night, they often will not settle for you if you are the breastfeeding parent, so sending the other parent in is a good idea, if it is not a feeding time.  But don't run in right away, give your child the opportunity to settle themself.  The older they are the more time you should give them to settle.  Somewhere between 10-20 min from 6 months on. If they havent' settled you can go in and settle them, ideally without lifting them up from the crib, and then do the same routine you chose to do at the beginning of the night.  Remember consistency is key.  Children need to know what the rules are and they need to know what to expect.  

MK: The last thing we should chat about is how much sleep infants and young children need each day.  A 3 month old needs about 16-18 hours of sleep, and usually aren't awake for more than 1.5 hours at a time.  A 6 month old needs about 14-15 hours and usually arent awake for more than 2.5 hours at a time. A 9 month old needs about 14 hours total, and awake time is no more than 3 hours at a time.  A one year old needs about about 13.5 hours total, with awake periods being 3-4 hours at a time. A 18 month old needs about 13 hours with 1.5-3 hours of napping during the day.  A 2 year old needs about 12 hours a day, with 1-2 being a nap.  Sometimes kids give up naps at this stage and then get all their napping during the night, some children still continue to nap, which is fine, as long as they are not pushing back their bedtimes as a result. 


Solve your child's sleep problems: Richard Ferber
Healthy Sleep Habit's Happy Child: Marc Weissbluth
Happiest Baby on the Block: Harvey Karp

Consultants (Victoria, BC):