Sleep and Sick or Hurt Kids

I've been meaning to write on this topic for a while, but I never managed to get around to it.  There always seemed to be a more pressing issue to address.  Then, one of my 2.5 year-old twins made it personally relevant.  A little over a week ago, she fell off the top of a playground set at school, and she broke her leg – badly.  The officially diagnosis is a “displaced oblique fracture of the tibia.”  Basically, the larger, weight bearing bone in the lower part of her leg broke into two pieces, and the two pieces were not lined up.

Needless to say, she was in A LOT of pain, and it affected her sleep.  She needed her pain medication every 6 hours, and the medication didn’t fully cover the pain so didn’t sleep soundly even when she was medicated.  So, what did I do?  I did what any mommy would (and what I have told my clients to do); I took care of my baby!  I slept on the floor in the twins’ room (thank you Aerobed Inflatable mattress), and I set an alarm on my phone to make sure I gave her pain medication as soon as she was due.  I didn’t end up needing that alarm – she woke up crying.  Each time she woke, I held her hand, rubbed her back and head, and I reassured her that I was there.  Did I comfort her back to sleep? Yep!  It wasn’t appropriate to expect her to do it herself while in pain, so I didn’t.  That’s actually why I spend so much time going over client histories. We have to make sure the child isn’t hurting before we can expect independent sleep. 

 If you look at Maslow’s Hierarchy of Needs, it’s clear your child’s physical and security needs have to be satisfied BEFORE they can learn self-soothing and independence!

Playing in her chair

Thankfully, my little one is doing a lot better now.  

Getting a cast seemed to provide enough stability that she was finally able to relax, and she loves that it is bright pink (even if my husband thought she needed something more subdued!)  She is only taking Ibuprofen now, and she doesn’t even need that all the time.  She’s not going to be swimming for about 2 months, and she has a little wheelchair to use at school now, but she’ll be ok.

For a lot of families, the story would end there, and it’s very possible that they’d have a sleep problem.  The two nights of sleeping on the floor, soothing and comforting at every wake-up, may have caused the child to want to see Mommy in the middle of the night.  That was certainly the case with my little girl.  She asked me to sleep in her room, and she asked me to help her fall asleep.  So, how did I get her back to falling asleep independently and sleeping through the night again?  Extinction, also known as “cry it out” would certainly work.  She already had the skills, so it wouldn’t even take very long, but I wasn’t comfortable with a lot more crying after all she had just been through.  So, I did a modified version of the fading approach known as “The Sleep Lady Shuffle,” which allowed me to sit next her while she fell asleep on her own initially and then move away from her gradually.  Normally, this process takes about 2 weeks, but when you’re “reminding” a child how to sleep independently again, it’s only a couple days.  For my daughter, it took three days to get her back on track, and there weren’t many tears, just a lot of complaining. 

To answer the question I get regularly, please go to your child in the middle of the night if there is really something wrong!  If it's a minor issue with a clear resolution, like teething or a leg stuck in the rail, help him and then let him fall back to sleep on his own.  If it's something more significant that isn't easily resolved, like a broken leg or the stomach flu, parent through it.  Do what you need to do to make your baby feel better (even if your baby is 6 years old)!  As parents, loving and caring for our little ones is our primary responsibility.  (I'm sure I don't have to tell you that part though!)  Once the crisis has passed, however, it is critical that you help him return to sleeping independently.  Yes, he'll still want you to hold him and cuddle all night, but he doesn't NEED it anymore.  If you make it clear that the expectations haven't changed, your child will pick up on that very quickly, much faster than the first time you taught this skill.  Once again, it’s about consistency.  

Middle of the Night Toddler Nursing

Meg asks:
I have (almost) 18 month-old twins. They still nurse once a day...which I shope to be stopping soon. My question is, they wake at least once a night to nurse. They will NOT go back to sleep without nursing and will stand and scream in their cribs, waking our other two children in the process. How can I help them get through the night? How do I know they aren't hungry?

Meg,

Start by taking the question about eating in the middle of the night to your pediatrician.  Most kids are fine going all night without additional calories at 18 months, but I'd ask just to be sure that there's no medical need for a night feeding.

Once you have the go ahead to wean them at night, make sure you have a soothing bedtime routine that doesn't end with nursing them to sleep.  If you nurse them to sleep, that's going to be the only way they know to fall asleep, and they'll need you at every night waking!  Also, make sure you are choosing a developmentally appropriate bedtime.  At 18 months, the average child needs 13.5 hours of sleep, with at least 11 hours at night (Note - this is the actual time sleeping, not the time in the bed!).  In most families, this means that bedtime is between 7 and 8 pm.

For the middle of the night wakings (and for falling asleep at bedtime too if this is an issue), I really like the "Sleep Lady Shuffle" as a way to gradually decrease your role in putting the child to sleep and increase their role in falling asleep on their own.  You start out right next to the crib, and you move your chair every few days until they are doing it on their own!  It may get worse before it gets better, but you should see the boys putting themselves to sleep at night and the disappearance of the night wakings in 7 to 10 days!

Sleeping Through the Night

How can I get my child to sleep through the night?  If I had to name the biggest question people ask when they find out that I’m a sleep coach, that would be the hands-down winner, and I completely understand why!  When my oldest daughter was small, I would’ve given anything for a good night of sleep!  There’s not an easy, one size fits all, answer that I can give people. (Otherwise, I wouldn’t have a job!)  There are, however, some hints that can really help!

Be consistent.  There are so many different ways to help a child sleep well, and there isn’t a one-size-fits-all answer to which one is the best.  Just pick the one you can follow.  If you change your response to wake-ups (alternating among cry it out, feeding, and bringing him to your bed) your child does not know what to expect, and it will be much harder on everyone. 

Have reasonable expectations.  Many parents come to me with 3-month-old children, wondering why they don’t sleep through the night.  Unfortunately, a normal 3-month-old can only sleep for one 6-hour stretch.   A 6-month-old, on the other hand, is usually capable of 11 to 12 hours of uninterrupted sleep.

Make your child’s sleep a priority.  Children, like adults, sleep better in low noise and low light environments.  Yes, many kids can sleep on the in a carseat or stroller when needed, but this is NOT ideal.  It is fine every once in a while, but a child who consistently naps “on the go” will become overtired, and additional sleep problems will usually result.  Young children also need an early bedtime, around 7pm, even if it is a logistical challenge for most parents.

Don’t rely on sleep crutches.  It’s so easy to just rock the child until he falls asleep or feed him.  They are quick and effective!  Unfortunately, they are also things he can’t do for himself, so if he wakes up in the middle of the night, he’s stuck.  He needs you to come back and make him sleep with that rocking chair or bottle again!

Put them down drowsy, but awake.  Children need to learn how to fall asleep on their own.  Otherwise, normal partial awakenings lead to a fully awake and very upset, child.  The easiest way to help your child learn this skill is to get him really tired at bedtime, but allow him to do the work of actually falling asleep on his own.

Do you have suggestions or questions that you’d like to see me cover on this blog?  If so, please post a comment to this post.  :-)