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6 02, 2019

Tongue Ties+Lip Ties; A Hidden Cause of Poor Sleep?

February 6th, 2019|Categories: Baby Sleep|

Tongue ties and lip ties; are they causing sleep problems for your baby?

A mom emails me to say that she’s considering sleep training.  Her baby is around four months old and she’s wondering if he’s hit the four month sleep regression. We book our consultation and the time comes for us to chat.

After we exchange pleasantries, I get down to business. I have already seen her intake form, and a detailed multi-day sleep log. I ask questions and find out that this baby was never a good sleeper.

This is pretty common with my clients. But in these situations,  mom will tell me that when her baby was a newborn, baby was colicky and/or had reflux .

This is often the first red flag I see.

When I ask if baby was put on medication for the reflux, the usual answer is “yes, but I’m not sure if it worked.”

Second red flag.

I will then ask about breastfeeding and find out that there is a history of pain, bleeding, cracked nipples, over or under supply or supplementing with formula because she felt (or was told) that she wasn’t producing enough.

Third red flag.

As I go through my now standard questions that help me get to the bottom of where the sleep issues are stemming from, (I firmly believe every child can sleep well, but there is always *something* that is preventing it from happening) I will come across issue after issue that usually leads me to asking;

“Was your child ever evaluated for a tongue or lip tie?”

Silence.

And then either I hear;

“what’s that?” or,

“yes, but the ___ (insert doctor, doula, midwife, lactation consultant, nurse) said there wasn’t one.”

I will then spend some time explaining why I think their child may have some sort of oral restriction.

They are often in disbelief or frustrated that something so simple may have been missed by the multiple health professionals they’ve seen.

And although they came to me believing there was a sleep issue, in situations where oral restrictions are present, it’s a feeding issue that is the root cause. 

We will further examine the relationship between feeding, sleeping and ties in a bit. But first, let’s look at the basics of tongue, lip and buccal ties. 

The Name Game

The first thing we need to know are some of the terms commonly used.

Frenum: This is the general term given to any fold, band of tissue or mucus membrane, in the body that attaches or anchors to a semi-mobile organ in the body.

Frenulum: A small frenum. The terms “frenum” and “frenulum” are often interchanged.

Lip Ties: This is when the lip (labial) frenulum is restricted or tight. Referred to as; upper labial tie (ULT), maxillary (upper) or mandibular (lower) or a combination of the terms.

Tongue Ties: Also known as ankyloglossia,  or lingual ties.

Cheek Ties: These are often called buccal ties.

Tethered Oral Tissues (TOTs): A term referring to any ties located in the mouth.

Tongue, Lip and Buccal Ties-What Are They?

An oral tie, is a condition that refers to restricted movement of either the lip, tongue or cheeks due to a short, thick or tight frenulum. While we all have frenulums, they are only considered “tied” when movement or function is prevented or impaired.

Tongue Ties

Medically known as Ankyloglossia, a tongue tie is identified when the tongue’s movement and function  is restricted due to a tight, short or thick lingual frenulum. A list of symptoms also needs to be present in order to make the diagnosis.

When the lingual frenulum is normal, it doesn’t hinder the full movements of the tongue; side to side, up, down and out. This means that there are no issues with children sucking, eating, swallowing and speaking.

But when there are tongue ties present, they can negatively effect a baby’s ability to latch, suck, feed and swallow. (Older children may also have difficulties with eating, chewing, nasal breathing, speech and dental alignment).

Classification of Tongue Ties

While the term “tongue and lip tie” is beginning to become more common, there are still many components that are misunderstood. One such example is identification.

Dr. Larry Kotlow, a pediatric dentist and one of the leading experts in TOTs, has devised a classification system based on the location of where a tie attaches, that many (but not all) TOTs experts use. However, this is not a classification of severity, but location only.

Classes 1 and 2 are anterior tongue ties. Classes 3 and 4 are posterior tongue ties. And in case you were wondering what’s the difference is, read on…

Anterior tongue ties – This type of tongue tie is very much visible and most commonly detected.

  • It is either at the tip of the tongue (Class 1) (sometimes resulting in a heart-shaped tongue tip) or, just behind the tip of the tongue (Class 2).
  • Class 1 ties are usually the only ones that some medical professionals consider a “real” tie, leading to many parents’ concerns being dismissed. However, some leading experts feel that every anterior tie also has a posterior component to it as well.

Posterior tongue ties – This type of restriction is under the tongue and not as easily identified.

  • Here the membrane is less visible (Class 3), or hidden completely (Class 4).
  • It is under the tongue and in the case with Class 4s, needs to be gently pushed down at the base and sides to be seen.
  • Unless a health professional has specific training in tie identification, posterior tongue ties are most often missed. 

How about Lip Ties?

We get a diagnosis of a lip tie when the labial frenulum  attaches under the top lip to somewhere on the gums near the front teeth, causing restriction and tightness, along with an array of symptoms to both mother and child.

While many children have prominent labial frenulums, not all are considered restricted. This is why it takes an expert to assess how tight the restriction is, location of attachment in combination of symptoms noted by parents.

Similar to tongue ties – some professionals use a lip tie classification system. Again, this does not define the severity of the lip tie, but rather where the frenulum attaches to the lip.

  • Class 1 – This type of lip tie is very rare and has little to no visible attachment.
  • Class 2 – The attachment occurs somewhere on the gum line but above the edge of the gum line.
  • Class 3 – The tie attaches to the edge of the gum line in line with a structure called the anterior papilla
  • Class 4 – This type of tongue tie wraps right around to the hard palate.

Many parents will be confused as to whether or not their child has an actual lip tie, and not just a normal upper labial frenulum. For further readying, this is a wonderful article from Dr. Bobby Ghaheri, an ENT and another leading expert on ties, that talks in depth about the difference; The Difference Between a Lip Tie and a Normal Labial Frenulum.

Buccal Ties

Buccal or cheek ties are the least known of all the restrictions. This is when a small piece of tissue is attached from the inner cheeks to the gums.

They can be located anywhere from way in the back beside where the molars will eventually erupt, to closer to the front of the mouth. To identify these, a practitioner may have to gently hook their finger into the side of the mouth and lift up and outwards.

They don’t seem to cause as much trouble, however, they are the least known of all TOTs, and therefore, the least studied.

The Mighty Tongue

How many of us think about our tongue?

Not many, I would guess.

It may seem rather unimportant, but it is anything but. The tongue is comprised of eight muscles that connect to various parts including the hyoid bone and the skull, but it is the only muscle that isn’t connected to bone at both ends. (Want to know more about the muscles in the tongue, check out this video!)

Although we think of our tongue as primarily used for tasting food, it is also important for speech, sound formation and aids in chewing.

Lesser known, but also extremely important is that the tongue helps to shape our airway by always resting against the palate (roof of the mouth) keeping it wide and flat.

Proper resting oral posture should always be; lips closed and tongue fully against the roof of the mouth. But when a tongue is restricted, it may prevent this from happening leading to a high and narrow palate and potentially constricting the airway.

Tongue Tie and Lip Tie Symptoms

Since breastfeeding (and bottle feeding as well) requires the middle of the tongue to lift up to form a seal and suction, many tied babies are not able to feed efficiently due to the restriction of the tongue. This can be happening even if the child is gaining weight.

(This can be for several reasons. In the newborn stage, often mom’s supply is being maintained by hormones, so the baby doesn’t have to work very hard to receive milk, but issues can develop closer to four months of age when supply begins to be regulated by baby.
Older babies may start to increase the amount of feeds during the day and night in an effort to meet their needs.)

To a similar extent, the lips also play an important role in proper feeding. When one of these two components aren’t functioning properly, we can see a whole host of problems begin to emerge. 

Here is a list of common symptoms tied babies may experience.

Tongue Ties and Sleep; What’s the Connection?

Many of the children that come to me who aren’t sleeping well, particularly around the fourth month, exhibit symptoms of having oral restrictions.  It has become a chicken-and-egg scenario that looks like this;

  • Baby can’t nurse or drink properly due to poor seal/suction on bottle or breast.
  • Baby falls asleep feeding, but only sleeps enough to take the “edge” off, not to fully satisfy their sleep needs
  • Baby wakes crying and mom feeds but baby can’t control flow from breast or bottle and pulls off, cough, chokes or gags
  • Baby tries to compensate by using lips, cheeks or gums to extract milk
  • Mom is experiencing painful nursing sessions, but has been told this is normal.
  • Baby tires easily from working hard to drain breast or bottle, falls asleep before feed is complete
  • Since they aren’t taking in the proper amount of calories at each feed, very short naps (usually under 30 minutes) and multiple night wakings result.
  • Baby also may inhale a lot of air when feeding, leading to discomfort
  • This causes excess air being ingested that results in reflux-like symptoms, the need to burp frequently and/or a gas that hinders the child from sleeping well due to discomfort.
  • Baby is continually tired from the lack of restorative sleep
  • To counter the building sleep deprivation, the brain increases the amount of cortisol and adrenaline that is released, further leading to shallow and unrestorative sleep
  • A combination of severe sleep deprivation, insufficient calorie intake, discomfort from excess gas, lead to the inability to sleep deeply or fully.
  • This causes short naps, multiple night wakings (more than what is considered “average” for the age) and early morning starts.
  • Parents are dismissed and may be told this is all normal and “just how babies are”, leading to extreme sleep deprivation on the part of the parent.
  • Parents may fall victim to risky behaviours, in an effort to cope with a wakeful baby and their exhaustion.

How Sleep Problems Escalate

As parents become desperate to help their babies sleep, they begin to try all sorts of props, gadgets and methods. Unfortunately, this then develops the child’s dependency on sleep associations.

Overtime, these sleep associations become habits that are deeply entrenched in the child’s sleep routine and it becomes a murky issue for parents to try and make sense of.

Further challenges erupt when the pediatrician has given the all-clear to night wean, either because the child’s weight gain is high or the baby has reached the six to eight month mark. Parents try, and it results in a very stressful night for all involve.

Can a Tied Baby Be Sleep Trained?

I help children sleep better by having a holistic approach rooted in sleep hygiene and sleep science. This means that my focus is always on when and how naps and bedtime are starting and lasting.

Timing and quality of sleep is a crucial component for a strong sleep foundation.

The actual sleep training method (ie Timed Intervals, Chair Method, Extinction, Pick Up, Put Down, No/less-Cry), is the LAST consideration.
If a parent chooses to sleep train, it is only appropriate for four months and older, and only to wean sleep associations.

Sleep training does not fix wakings due to sleep deprivation or hunger.

My focus is always primary based on making sure our little ones are not sleep deprived. So if you’re asking if a tied baby regardless of age, can learn to sleep better; absolutely yes. 

But if you’re asking if a tied baby can learn to sleep completely through the night, without any feeds, then I will say “usually not”.  And almost definitely not if they are under six months of age.

Of course each child is different and the severity of restriction needs to be taken into account. But as a general rule, I usually ask families of suspected tied babies to add more night feeds, not less. 

If a baby is waking out of hunger, then trying to wean those feeds is unfair and unrealistic. (However, I am not a consultant that pushes night weaning even in untied babies. I know that sleep training and night feeds are not mutually exclusive.)

So if you suspect your baby may have an oral restriction; fear not. We can we get them on a more healthy sleep routine, reduce (but likely not eliminate) the amount of times they are waking at night, and help them to nap longer.

How To Help a Tied Baby Sleep Better

Ok, so the next question is, how?

We do this by following the basics of healthy sleep hygiene. That is, create good sleep habits.

Good day, sunshine: Start with having regular morning wake up times, which after four months of age, tends to average somewhere between 6-7:30am. 

Sleep Ritual: Create a soothing wind down routine that is relaxing and comforting. This helps the child to associate the routine with sleep.

Location, location, location: Have your child nap in a location that is comfortably cool and very dark. Doing so kick starts the natural melatonin production and encourages the wonderful deep sleep that the body and brain craves.

Encourage restorative naps: This means that on average, your baby’s naps are lasting longer than an hour. If your child is on three nap-a-day routine, the first two tend to be the long naps, and the third nap is shorter; about one sleep cycle.

Don’t worry about trying to lengthen this third nap-just let it be short. Want to know how many of hours of daytime sleep your child should be averaging? See below…



Timing is important: We also want to have naps that are well-timed with the child’s sleep circadian rhythms (if older than four months old) so that the sleep that they do take is as refreshing as possible.

Keep wake periods age-appropriate: If we keep babies up too long in between naps on a regular basis, it will further add to their sleep debt levels. This will cause extra crying and resistance during the wind down. 

Early bedtime: Finally, to help manage the sleep debt, we must make sure to adjust bedtime to the quality and quantity of daytime sleep. That means, if naps have been short and unrestorative, bedtime must be earlier than usual to accommodate for the missing sleep. Sometimes this may only be twenty minutes and sometimes it’s two hours. It really depends on the child’s age and nap quality.

What To Do If You Suspect Your Baby Has a Tongue or Lip Tie

If you are nursing, an International Board Certified Lactation Consultant (IBCLC), who has taken additional studies in tethered oral ties, should be seen to assess latch, position, form and structure as they can often offer mothers ways to help baby feed more efficiently (even with bottles!).

In some parts of Canada and the US, Speech-Language Pathologists or Oral-Myofunctional Therapists may also be certified to do oral assessments. Alternatively, there are a number of pediatric dentists becoming tie savvy and performing exams.

Regardless of the practitioner, a comprehensive exam of the baby’s mouth including upper and lower lips, cheeks, tongue mobility, lift and reach should be checked.

Sometimes I hear of practitioners only checking if a baby can stick their tongue out. However, proper oral resting posture, nursing and later, speech, all require the mid part of the tongue to freely lift up, not out. 

Feeding should be assessed, as should body structure to evaluate for any tension or tightness. Finally, all of mom and baby’s symptoms should also be documented.

After the evaluation, the IBCLC, SLP or OMT will refer you to a release provider. In addition, usually some sort of bodywork is prescribed to help baby with any tension they may be experiencing from trying to compensate with the restriction. This may be cranial sacral therapy, osteopathy, or pediatric chiropractic care.

I have seen many posts in social media groups asking for other members (who are not certified practitioners) to identify tongue ties based on a picture. However, to have an accurate diagnosis, an examiner should do a full investigation on function, not just form. Just because you see a frenulum in your child’s mouth, does not mean they have a tie.

While social media can help point us in the right direction,  a well-trained professional must still fully assess your baby’s mouth, including upper and lower lips, under the tongue and cheeks.

Many practitioners will also use one of more assessment tools/forms/checklists that have been established to help diagnose a restriction. Some common ones are;

Carole Dobrich’s: Frenotomy Decision Tool for Breastfeeding Dyads

Carmen Fernando’s Tongue Tie Assement Protocol (TAPs), 

Alison Hazelbaker; Hazelbaker Assement Tool For Lingual Frenulum Function (HATLFF)

Lingual Frenulum Protocol by Martinelli and Marchesan 

Where Can I Find More Information?

Knowledge is power. The more you know, the better.

 Here are some further resources for you….

Dr. Bobby Ghaheri: Website, Facebook Page 

Dr. Larry Kotlow: Website, Facebook Page 

Dr. Soroush Zaghi: Website

Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding and More

Tongue Tie: From Confusion to Clarity 

Tongue Tie Babies Facebook group has links to local chapters and providers. American based, but has links to other countries.

Canadian Tongue Tie Facebook group also has resources and information on providers, categorized by province.

Research:

You and Your Family Can Sleep Again!

The world of tethered oral tissues can seem overwhelming at first. I know, I’ve been there first hand with my own children, and with countless other parents who have sought out my help.

It can be confusing to try and sort things out. You may have just come to terms with thinking your child has some challenges with sleep, but now may realize that it may be rooted in a different issue altogether.

However, the good news is, you are not alone! Whether tongue, lip or buccal ties, there are more people becoming aware of their impact.

There are many parents going through what you are.  And while, it can be tricky to find them, thanks to the wonders of the internet, there are many professionals that can help you on this journey. 

If you suspect a TOTs issue, seek out a practitioner near you and have your little one examined. That way, you and your family can get the sleep you all deserve and need. 

Need more help with getting your child’s sleep on track, even if they have tongue ties or other oral restrictions? You don’t have to suffer with sleep deprivation. Here are some free resources for you…

Newborn sleep? Download your free newborn guide here.

Baby sleep? Download your free baby guide here.

Toddler and Preschooler sleep? Download your free toddler and preschooler guide here. 

28 01, 2019

Crib To Bed Transition

January 28th, 2019|Categories: Preschooler Sleep, Toddler Sleep, Transition Tips|

Here it comes; the crib to bed transition. Are you ready?

There comes a time in every child’s life when they outgrow their crib, both physically and developmentally. As much as we may want them to stay little forever, this can be an exciting milestone in your child’s life.

The crib to bed transition is when a child is ready to make the move out of their crib and into a more traditional ‘bed’ style sleeping surface. Whether they are cognitivally ready or developmentally, it has to happen sooner or later.

Tip One: Timing is Everything

As with everything in child sleep development, there’s no ‘one-size-fits-all’ for tackling this transition. And while, many parents will move their toddler between the ages of two and four, I recommend waiting as long as possible. Personally, I find that when this transition happens after three years of age, it goes very smoothly.

Older and Wiser

The reason I recommend waiting until your toddler is three years old before making this transition is three-fold.

First at this age, your child’s impulse control is more developed.

They have learned, and are still learning, to control their impulses. At a younger age, they will act without thinking, which will not make for a smooth transition. At three years old, they might have the desire to get out of bed, but they are learning to rationalize and control these impulses.

Second, at three years old, most children have a pretty firm understanding of rules.
Threenagers have a much better understanding of boundaries and consequences should rules be broken, than their two year old counterparts.

Setting firm limits that your child can understand and adhere to, will help make the crib to big kid bed transition smoother for the both of you.

Lastly, kids can feel overwhelmed when their familiar crib is gone.

A crib can provide a  familiar sense of security, even to those kids who are physically outgrowing it.  When we remove them from it, it can feel a bit unusual and somewhat disrupting to a young child.

Waiting until they are three years old can help avoid this as they are more developed and emotionally equipped to deal with the transition into a new sleep setting.

How to make the crib to bed transition

As with any transition, there are steps to follow to help the situation go smoothly. Once you have decided your child is ready to transition to a big kid bed, here are more tips to consider.

Tip Two: Talk to them

In the lead up to this transition, you can talk to your child about it and explain what is going to happen. Keep it fun and upbeat so that they are excited about the move.

This will help them prepare mentally and emotionally for the switch, rather than having their crib disappear all of a sudden. When talking to them, it’s kind of like you’re trying to ‘sell’ them on the idea of a big kid bed.

Whatever you feel your child will respond best to, use it. You may want to say that it means they’re more grown up, they’ll have more room in the bed as opposed to a crib and/or it will be more comfortable for them.

Tip Three: Activities to Prepare

Another fun activity to help sell them on the idea of moving beds is to select some new accessories together.

You can go shopping for new bedding and sheets, and maybe some new cuddly toys for the bed too.

Countdown calendars can be good fun and a great way to prepare your child, but if you choose to use a countdown calendar, don’t let it go on for more than a few days.

Tip Four: Taking Ownership

Allow them to take ownership, within reason, of this transition. You could let them choose where in the room they would like their big kid bed to be placed, which stuffies to have on their bed, or which sheets and pillows they want.

Try and let this transition happen in a way that feels fun and exciting and like they have control over the transition.

Tip Five: Set Your Child Up for Success With Expectations

Are you familiar with the story; If You Give A Mouse a Cookie? It can serve as a cautionary tale of what happens if you give a toddler a bed without rules. 😉

Bedtimes can easily spin out of control as toddlers are notorious for trying to test limits (and your patience).

Want to keep bedtimes on track before make the crib to bed transition? Get tips on bedtimes, night wakings and more by downloading your copy of : Sleep Solutions for Toddlers + Preschoolers: Easy Tips for Exhausted Parents

To cut down on the requests for multiple glasses of water, stories and hugs, I highly recommend setting up a simple list of expectations.

Not only does this help your little one again take ownership of their sleep routine, but it creates a very specific outline for them to follow.

When creating the the rules or expectations, make it into a fun activity with your child get their input into it.

Make sure that you give clear instructions on what is expected, but don’t over complicate the rules. They need to be simple and unambiguous.

Tip Six: Good Day Sunshine!

While it’s important to set rules and expectations around bed time and going to sleep, don’t overlook the morning and waking up.

Does your child know what to do when they wake up in the morning?

What time is acceptable to start the day?

Should they come out of their room by themselves?

Should they call for you?

When creating rules around morning wake up, remember to keep them realistic! If they tend to wake up around 6:00am, asking them to wait until 7:00am is too long for most young children.  You can always work towards that as a goal, but in the beginning, to help them feel successful, keep the interval much shorter.

Tip Seven: Consistency is Your Friend

It’s very important that you stick to the rules strictly in the first two weeks of the transition from crib to bed. This is the time where your toddler will test you and the boundaries that have been set.  

If you give in or give up, you set the tone for them to continue that behaviour in the future. They can only be as consistent as you are. 

Tip Eight: Follow Through With Logical Consequences

When (not, *if*) they break the rules follow through and employ logical consequences. However keep in mind, this is very different from a punishment.

Punishments breed shame and resent and never help the child to learn.

Consequences are respectful ways for the child to realize the direct impact their choice has.

When deciding on consequences, in order for them to be relevant, respectful and a teaching opportunity, they should be directly related to the mistake the child made.

For example, if they came out of their room at night, the logical consequence may be that they don’t go to the park the next day because they didn’t get a good sleep and are too tired.

While it’s important to ensure there are consequences for their actions, don’t shame, blame or manipulate. Avoid getting into power struggles with them, just have respectful consequences and they will catch on very, very quickly. 

Conquer the Crib to Bed Transition

No transition is easy for you or your child.

Believe me.

Been there, done that, got the t-shirt.

However, at three years old, your toddler is more developed and able to cope with and understand transitions. Unlike a the two-to-three nap transition which happens at a much younger age, you can have more rational conversations with your three year old to help them understand what is happening and why.

The crib to big kid bed transition can be an exciting one for your child, as long as you present it that way. If you’re stressed about it, your child will pick up on that and be worried too.

Remember that while this has every possibility to be an exciting time, it’s still a new way of doing things, so rules and boundaries need to be set.
Set clear expectations, and follow through with helping your child learn through logical consequences.

Kids are quick learners and before you know it, your toddler will easily be going to sleep in their new bed each and every night.

Need more help getting your toddler’s sleep on track? Grab your free copy of Sleep Solutions for Toddler + Preschoolers; Easy Tips for Exhausted Parents.  

Tired of reading?

Ready for action?

Schedule your consultation today, so you can start sleeping better tomorrow.

27 01, 2019

Crib To Bed Transition

January 27th, 2019|Categories: Preschooler Sleep, Toddler Sleep, Transition Tips|

Here it comes; the crib to bed transition. Are you ready?

There comes a time in every child’s life when they outgrow their crib, both physically and developmentally. As much as we may want them to stay little forever, this can be an exciting milestone in your child’s life.

The crib to bed transition is when a child is ready to make the move out of their crib and into a more traditional ‘bed’ style sleeping surface. Whether they are cognitivally ready or developmentally, it has to happen sooner or later.

Tip One: Timing is Everything

As with everything in child sleep development, there’s no ‘one-size-fits-all’ for tackling this transition. And while, many parents will move their toddler between the ages of two and four, I recommend waiting as long as possible. Personally, I find that when this transition happens after three years of age, it goes very smoothly.

Older and Wiser

The reason I recommend waiting until your toddler is three years old before making this transition is three-fold.

First at this age, your child’s impulse control is more developed.

They have learned, and are still learning, to control their impulses. At a younger age, they will act without thinking, which will not make for a smooth transition. At three years old, they might have the desire to get out of bed, but they are learning to rationalize and control these impulses.

Second, at three years old, most children have a pretty firm understanding of rules.
Threenagers have a much better understanding of boundaries and consequences should rules be broken, than their two year old counterparts.

Setting firm limits that your child can understand and adhere to, will help make the crib to big kid bed transition smoother for the both of you.

Lastly, kids can feel overwhelmed when their familiar crib is gone.

A crib can provide a  familiar sense of security, even to those kids who are physically outgrowing it.  When we remove them from it, it can feel a bit unusual and somewhat disrupting to a young child.

Waiting until they are three years old can help avoid this as they are more developed and emotionally equipped to deal with the transition into a new sleep setting.

How to make the crib to bed transition

As with any transition, there are steps to follow to help the situation go smoothly. Once you have decided your child is ready to transition to a big kid bed, here are more tips to consider.

Tip Two: Talk to them

In the lead up to this transition, you can talk to your child about it and explain what is going to happen. Keep it fun and upbeat so that they are excited about the move.

This will help them prepare mentally and emotionally for the switch, rather than having their crib disappear all of a sudden. When talking to them, it’s kind of like you’re trying to ‘sell’ them on the idea of a big kid bed.

Whatever you feel your child will respond best to, use it. You may want to say that it means they’re more grown up, they’ll have more room in the bed as opposed to a crib and/or it will be more comfortable for them.

Tip Three: Activities to Prepare

Another fun activity to help sell them on the idea of moving beds is to select some new accessories together.

You can go shopping for new bedding and sheets, and maybe some new cuddly toys for the bed too.

Countdown calendars can be good fun and a great way to prepare your child, but if you choose to use a countdown calendar, don’t let it go on for more than a few days.

Tip Four: Taking Ownership

Allow them to take ownership, within reason, of this transition. You could let them choose where in the room they would like their big kid bed to be placed, which stuffies to have on their bed, or which sheets and pillows they want.

Try and let this transition happen in a way that feels fun and exciting and like they have control over the transition.

Tip Five: Set Your Child Up for Success With Expectations

Are you familiar with the story; If You Give A Mouse a Cookie? It can serve as a cautionary tale of what happens if you give a toddler a bed without rules. 😉

Bedtimes can easily spin out of control as toddlers are notorious for trying to test limits (and your patience).

Want to keep bedtimes on track before make the crib to bed transition? Get tips on bedtimes, night wakings and more by downloading your copy of : Sleep Solutions for Toddlers + Preschoolers: Easy Tips for Exhausted Parents

To cut down on the requests for multiple glasses of water, stories and hugs, I highly recommend setting up a simple list of expectations.

Not only does this help your little one again take ownership of their sleep routine, but it creates a very specific outline for them to follow.

When creating the the rules or expectations, make it into a fun activity with your child get their input into it.

Make sure that you give clear instructions on what is expected, but don’t over complicate the rules. They need to be simple and unambiguous.

Tip Six: Good Day Sunshine!

While it’s important to set rules and expectations around bed time and going to sleep, don’t overlook the morning and waking up.

Does your child know what to do when they wake up in the morning?

What time is acceptable to start the day?

Should they come out of their room by themselves?

Should they call for you?

When creating rules around morning wake up, remember to keep them realistic! If they tend to wake up around 6:00am, asking them to wait until 7:00am is too long for most young children.  You can always work towards that as a goal, but in the beginning, to help them feel successful, keep the interval much shorter.

Tip Seven: Consistency is Your Friend

It’s very important that you stick to the rules strictly in the first two weeks of the transition from crib to bed. This is the time where your toddler will test you and the boundaries that have been set.  

If you give in or give up, you set the tone for them to continue that behaviour in the future. They can only be as consistent as you are. 

Tip Eight: Follow Through With Logical Consequences

When (not, *if*) they break the rules follow through and employ logical consequences. However keep in mind, this is very different from a punishment.

Punishments breed shame and resent and never help the child to learn.

Consequences are respectful ways for the child to realize the direct impact their choice has.

When deciding on consequences, in order for them to be relevant, respectful and a teaching opportunity, they should be directly related to the mistake the child made.

For example, if they came out of their room at night, the logical consequence may be that they don’t go to the park the next day because they didn’t get a good sleep and are too tired.

While it’s important to ensure there are consequences for their actions, don’t shame, blame or manipulate. Avoid getting into power struggles with them, just have respectful consequences and they will catch on very, very quickly. 

Conquer the Crib to Bed Transition

No transition is easy for you or your child.

Believe me.

Been there, done that, got the t-shirt.

However, at three years old, your toddler is more developed and able to cope with and understand transitions. Unlike a the two-to-three nap transition which happens at a much younger age, you can have more rational conversations with your three year old to help them understand what is happening and why.

The crib to big kid bed transition can be an exciting one for your child, as long as you present it that way. If you’re stressed about it, your child will pick up on that and be worried too.

Remember that while this has every possibility to be an exciting time, it’s still a new way of doing things, so rules and boundaries need to be set.
Set clear expectations, and follow through with helping your child learn through logical consequences.

Kids are quick learners and before you know it, your toddler will easily be going to sleep in their new bed each and every night.

Need more help getting your toddler’s sleep on track? Grab your free copy of Sleep Solutions for Toddler + Preschoolers; Easy Tips for Exhausted Parents. 

15 01, 2019

How To Get Your Child to Sleep (More) This Year

January 15th, 2019|Categories: Where to Begin|

How to Get Your Child to Sleep (More)

With the New Year upon us, comes the perfect time to begin to implement healthy changes for ourselves and our family. One of the most fundamental, but often overlooked cornerstones of health, is sleep.

As moms, we often could sleep very well, if only some little person would let us. However, bedtime battles and multiple night wakings can really impact the quantity and quality of sleep that we get.

The good news?

That you can improve your child’s sleep rather quickly, and therefore yours as well.

Start 2019 off right with a resolution to help get your child to sleep more solidly than last year.

Unlike popular resolutions that add more to-dos to your already busy life, instilling a sleep routine for your baby or child will actually simplify your life by creating a daily rhythm.

Why Start a Sleep Routine?

Routines give definition and structure to your day.

They allow you to plan outings when your child will be the most content.

They also leave you with more time to do nothing but relax, instead of trying to get your child to sleep.

Either way, a child who sleeps better, will make your life easier.

And as a mom, that’s always a great thing.

To get started with a new sleep routine for your child, follow these 5 tips for starting a new sleep routine;

On Your Mark…

Look at your calendar and pick a time when there will be few interruptions.

To help your child get used to the new routine, it’s important to be home for naps (for the majority of the time), rather than in the car or at someone’s house.

Not only does this help to instill the routine, but it also encourages healthy and restorative sleep that isn’t taken on-the-go or prone to interruptions.

Plan and Write Out a New Routine

When trying to help your child to sleep better, the primary focus should be their daytime routine.

If you’re unsure what routine is best for your child, start with documenting their day. This includes wake ups times, their mood throughout the day, meals, diaper changes or potty times, naps and bedtimes.

After 4-5 days of documentation, review the information and see what patterns you notice.

What Do You Notice?

Compare your child’s wake periods (and the resulting nap lengths) with this wake time infographic.

If you are noticing many naps that are only about 40-45 minutes in length, your child is going to sleep easily and waking up content, she may need a touch more play time (AKA: activity or wake time) before her nap the next day.

However, if the documenting reveals naps that are only 20-30 minutes in length and are loaded with crying-both before and after a nap-then the wake time may be too long.

There are other factors that can contribute to short naps, such as sleep associations and overtiredness, but this is a general guideline to start with.

Write out a new routine and post it in a highly visible location. For toddlers and preschoolers you can add pictures and make it into a poster for their room.

Develop a Soothing Pre-Sleep Routine

Develop a simple pre-sleep (often referred to as a wind down) routine and do it before each sleep period. Keep is short, simple and easily to adapt between caregivers.

When a wind down routine is performed before every sleep time, it helps to cue your child’s brain to settle down for nap or night time.

This makes your job so much easier as the wind down routine helps your child understand that sleep is about to happen. They will begin to look forward to their naps and bedtime, thus ensuring a much smoother sleep time process for everyone!

Start in the Morning

The best place to start a new overall daily routine is at the beginning of the day.

Does this mean you have to wake your child up?

Yes, it might.

If your child is 4 months or older, sleeping past 7:45am  and you’re trying to establish a new routine, then regulating morning wake up time may be needed.

This may surprise some parents who think that bedtime is the best time to start, but that’s usually only for changing sleep habits. When we alter an overall routine, however, starting early is an easy place to set the tone for the rest of the day because of how daylight interacts with your child’s brain throughout the day.

The sun has a powerful influence of our internal rhythms (sleep, hormones, temperatures, etc.) and it’s easier to work with it, than against it. By regulating the morning wake up time, you will keep your day on track, rather than starting at bedtime.

Be Consistent

Like any changes we make this year, we must continually work at them in order to see the results. Getting your child to sleep is no different.

Being consistent will help your family quickly adopt the routine so it becomes second nature. In only a few weeks of sticking with your child’s new routine, life will be easier as your child will quickly and easily go to sleep.

Moving Forward

If you have one day that goes off track (or several weeks!), don’t worry about it! Get back to the new routine when you can.

Any change you make toward’s your child’s sleep health is better than no change at all!

Tired of figuring out on your own?

Don’t have the time to figure it out on your own?

Book a consultation and I’ll help you start the year off right-healthy, happy and well-rested! Don’t forget to also join the Baby Sleep 101 Facebook page and have access to weekly live (and FREE) Q and A events!

 

7 11, 2018

Toddler Early Morning Wakings;Causes + Solutions

November 7th, 2018|Categories: Toddler Sleep|

Toddler Early Morning Wakings

Toddler early morning wakings…We’ve all been there…

Fast asleep, all warm in your bed. Between dreams, you glance at the clock and see it says 5:00 am.

Happy knowing you have another hour to sleep, you nestle down into your fluffy covers and cozy pillow. You are about to drift off into lala land, when, all of a sudden, you hear your toddler calling for you.

You groan as you get out of bed, fumble to find your slippers and make your way to your child’s bedroom. You try your best to convince them that it’s not time to get up yet.

Rubbing their back, lying down with them, getting stern with them-none of it works.
Giving up, you bring them back to your bed and try to catch a few more zzzs, which, by this time is only a few more minutes.

If this sounds familiar, you’re not alone. Many of my clients with toddlers and preschoolers experience variations of this scenario. The good news is that there are many things we can do to help stop toddler early morning wakings.

What Exactly Qualifies as An Early Waking?

It is quite normal for children between the ages of one and four to wake early, but it’s important to know what is categorized as age-appropriate and what is too early.

The typical or average wake up time for toddlers is between 5:30am – 7:00am (but often 5:30am can still be moved out a touch later).

An early waking or rising is defined as waking up for the day prior to 5:30am. Parents tend to define early morning wakings when the child is suddenly waking up more than 45 minutes earlier than they normally would, but *technically* it needs to be earlier than 5:30 am.

Toddler Early Morning Wakings; Why Do They Happen?

There are many reasons why children might experience early morning wakings. No two children are the same, but let’s explore the most common reasons (and solutions) for each.

1. Not Getting Enough Sleep

By far, the number one reason toddlers wake up too early is because they’re overtired. Which leads to the next logical question of…

“Why don’t kids sleep in then, if they’re overtired?”

I know, it seems so irrational, right? But that’s because as adults, our sleep functions differently than a child’s. When we are tired, given the opportunity, we will often sleep in the next morning to catch up.

However, with children, when they are overtired, their body releases extra stimulating hormones to fight the fatigue that accumulated the day before. In turn, their sleep isn’t as deep or restorative and they are more prone to night wakings.

Then, as they approach the early morning hours, and their body naturally reduces the amount of melatonin (the sleep hormone) being produced, it gets increasingly harder for them to return to sleep. So, not only are they not sleeping as deeply during the night, they are also more prone to night wakings and early risings.

You can see the difference between a well-rested child’s sleep (thick, solid line) and an overtired one here (dotted);

 

Are Naps Contributing?

Similarly, early wakings can occur if your child has had too little daytime sleep. Contrary to popular belief, many toddlers don’t drop their nap until closer to 3-4 years of age. Others will nap until full-day school begins.

If their nap is shorter than needed, or dropped completely, then come bedtime, the body, in an effort to try and sustain itself, goes into fight or flight mode. 

If a child’s wake time between the end of a nap until bedtime is too long, this could also encourage early morning waking in toddlers. The nap itself might be the correct length of time, but if bedtime is too late, the child could catch their “second wind” and go to bed too late.

On the flip side, if the child is having too much daytime sleep, this can be a cause of early morning wakings as they no longer require as much sleep at night. This effects children of 3 years and up in particular. If nap is too long, then bedtime becomes too late and the restorative night time sleep is shortchanged.

Every element of the child sleep routine has a knock on effect that could cause early morning wakings.

2. Changes to the Toddler’s Life

Just as sleep debts can accumulate in various spots, there are different areas in a child’s life that can also impact early wakings. Just as something like stress could affect our sleep, changes to their routine can have an effect on your toddler’s sleep as well.

As you may have discovered when they were a baby, milestones can mess with sleep. This is still true for toddlers.

If they happen to wake early in the morning, they might begin to practice their new skills when they wake, instead of going back to sleep. Most notably, this happens around 18 and 24 months. 

Entering daycare for the first time, can also be a difficult adjustment for them, both emotionally and physically. If this transition causes the child stress, it could cause early morning wakings.

Equally, if a new sibling enters the family, this change can be difficult for children and may take some time. Not only are they trying to adjust to new noises, new routines, but  shifting family dynamics as well. 

3. Sleep Hygiene and Healthy Sleep Habits

Just like we try to teach good overall hygiene habits to our children, (brushing their teeth properly, washing their hands after using the potty, etc.), sleep hygiene is an critical component to their overall sleep success.

Overstimulated and wound up kids will struggle to fall asleep. When they do, it’s more likely to be shallow and not refreshing. Their bodies need to be relaxed prior to a sleep period.

And remember; the sleep that children experience in the early hours of the morning is quite light. Any  stimulus such as light, temperature may prematurely wake the child.

4. Are You The Reason?

As parents, we play a very significant role in our children’s sleep habits. This includes early morning wakings. It means that we have the ability to help the toddler overcome them, and be aware of our behaviours that might have a negative impact.

If parents themselves are feeling insecure or unsure with a routine they might inadvertently be spending too much energy trying to get the child to sleep. Ironically, by trying to get them to sleep, this can end up keeping the child awake as there is too much engagement and stimulation.

Another aspect to consider is communicating expectations. When I talk to new clients about what they have done to try and change their child’s early risings, majority of the time, they have missed a significant piece; talking to the child about what they expect.

We often focus on telling kids what they can’t or shouldn’t do, but we forget to tell them what they can or should do.

Many of my clients assume their toddlers know better, but I’m here to tell you, they don’t. If the child knows what you expect from them and what to do when they get up, we are then setting them up for success.

5. Hidden Medical Issues

By now, you know that early morning sleep is very light. The body reduces melatonin production and the desire or sleep pressure, is significantly reduce.

Any disturbance or stimulus can result in them waking early. However, if all of the preceding issues have been resolved and your toddler is still waking early, I have found the final missing piece may be a medical one.

Children with airway issues, breathing difficulties, allergies, restless leg syndrome, or sleep apnea, among other things may still continue have shorter nights, until these underlying root causes are addressed.

Toddler Early Morning Waking Solution #1; Tweaking the Overall Sleep Routine

The key to eliminating these wake ups due to over-tiredness, is to fix your child’s sleep routine. To start, begin by logging their overall sleep for 5-7 days. Then look for the shortfalls.

  • Are their naps too long or too short? A one year old may need about three hours of sleep. This may or may not be split between two naps. (For more information on the 2-1 nap transition, see here.) But a two or three year old may do better with less than that. If an older child is napping too long during the day, it may short-change their night time sleep which then sets up a cycle of over-tiredness.

 

  • Is bedtime too late?If your little one is still napping, then it’s important to consider the distance between the end of the nap and bedtime. Most of the time, they can only handle about 4-5 hours after they wake up from that nap. More than that, you risk a sleep debt starting to build.

Want more valuable tips to help your toddler or preschooler sleep better? Download your free copy of TODDLER & PRESCHOOLER’S SLEEP SOLUTIONS; EASY TIPS FOR EXHAUSTED PARENTS.

 

  • Are naps starting too early or too late? Sleep cycles are based on the body’s response to light and dark signals throughout the day, along with social cues.There are certain times that their body is more ready and able to nap, but if we miss those sleep windows, they will catch their second wind and make it hard to settle into the deep stages of sleep needed to fully recharge the body.

Once you know where the problems lie, you can start to make adjustments and help get them back on track. But be patient, usually early morning wakings take a little while longer to adjust than night issues do.

Toddler Early Morning Waking Solution #2; Coping With Life Changes

Although there can be some large routine shifts, the good new is, we have a way to tackle it!

When it comes to milestone development, although it can be exciting to witness because it means they are getting older, my recommendation stay on top of your child’s schedule. Just because they are older, doesn’t mean they suddenly need less sleep.

Be strict with making sure naps are happening at the right time each day and if they aren’t, that bedtime is adjusted accordingly. Be preventing a sleep debt to form before bedtime, helps to ensure they sleep to their regular wake up time in the morning.

If your toddler early morning wakings start as a result of beginning daycare, then it’s important to talk to the staff. Communicate your concerns, ask them to record all sleep periods and help them work on strategies to ensure proper naps are being taken. You can read more about naps and daycare here.

And finally, if a new sibling entering the picture has thrown your toddler’s mornings out of whack, keeping the lines of communication open, empathizing with them and spending one-on-one time together can help.

If the noise of the new baby is causing your toddler to wake early, then investing in a good quality white noise machine can be an easy solution.

Toddler Early Morning Waking Solution #3; Create Healthy Sleep Hygiene

Create a soothing and relaxing wind down for your toddler prior to each nap and bedtime. It doesn’t need to be long or elaborate, it’s not the actual steps that matter, rather the act of repeating it each day, that’s important.

With repetition, the brain comes to recognize that it’s time to sleep and begins the internal process of winding down. As long as you are leaving while your child is still awake (be careful they aren’t too drowsy or it will become a sleep association), a short and simple routine is great.

Technology is great, but it has its place. If your toddler is watching the TV or an iPad before bedtime, the blue-based LED lights emitted from screens suppress melatonin release which can have negative effects on children’s sleep habits, so avoid this 60-90 minutes before bedtime.

Some ideas to include in your child’s wind down routine are;

  • reading books
  • singing songs
  • saying prayers
  • shutting off lights
  • massage
  • kid-friendly yoga poses
  • saying good night to various family members
  • talking about favourite parts of their day

 

To help your little one sleep later in the morning, keep the room nice and dark. If they absolutely need a night light, get the lowest wattage possible with a warm bulb colour such as amber, orange or pink. Stay away from LED or blue-based lights as this suppresses melatonin, which is the exact opposite of what we want.

Just like light, temperature also has an effect on children waking early. If the room is too hot or cold, children can be sensitive to room temperature which will cause them to wake. Keep the temperature between 17-21 C for maximum comfort. 

Toddler Early Morning Wakings Solution #4; Set Expectations and Reduce Engagement

The easiest solution here is to be preventative!

To help your toddler know what to do in the morning if they wake early, lovingly and respectfully set ground rules and expectations ahead of time.

So, how do we do that?

With their help, create a fun and colourful poster/chart/picture/graphic that lists a specific set of rules or steps to be followed at each sleep period. 

You can also make a “rule” chart for yourself at the same time. 

Find a special place to hang their chart in their room where it’s clearly visible. Likewise, you can place yours in your room as well.

This helps to set them up for successful sleep habits and show how the whole family values sleep. It also gives you a plan and timeline to follow.

If part of the “rules” are that the child gets 2 kisses and 3 hugs, stick to that. Don’t get engaged in power struggles or repeated requests, especially during your toddler’s early morning waking. 

(This is an added bonus of making sleep rules! You get to blame the chart, as a reason to get going. “Sorry honey, I would love to stay and cuddle, by my rules say I have to leave so that you get the sleep your body needs to be healthy.”)

Toddlers are notorious for trying to endlessly engage with parents, so they need you to be consistent. Say what you mean and mean what you say.

The other important component of having an expectation chart, is to follow through with logical consequences later on. If there are no repercussions for their choices, the pattern will continue.

But please note; logical consequences are very different from punishments. Consequences help to teach, punishments tend to shame and come out as anger.  We want to avoid taking things away like favourite TV shows, stuffed animals, not being able to play outside, etc., if they have no relationship to the sleep rule that wasn’t followed. Always keep in mind that A must equal B to see the quickest changes with your child’s behaviour.

Toddler Early Morning Wakings Solution #5; Consider Underlying Root Causes

The best way to solve this issue is to take it to the medical professionals. Before doing that you may want to record your child’s sleep and note any of the following.

  • Does your child snore (or, even breath audibly)?
  • Do you ever hear pauses in their breathing while sleeping?
  • Do they breathe with their mouth, or have open lips when sleeping?
  • Are they chronically stuffed up (or, during certain parts of the year), have runny noses or dark (or red) circles around or under their eyes?
  • Does your child have any allergies; environmental, seasonal or food that you suspect?
  • Do they ever rashes, bumps that aren’t attributed to anything?
  • Do they get several ear infections a year?
  • Do they have a narrow jaw and high, arched hard palate?
  • Does the child’s parents have a history of allergies, sleep problems, snoring, chronic sinus issues?
  • Does one or more parents or grandparents snore or use a CPAP machine?
  • Did the parents have ear infections, adenoids or tonsils removed as a child or tubes put in their ears?
  • Does your child get very hot and sweaty during sleep periods?
  • Do they sleep with their head arched back?

Taking an investigative approach to your child’s sleep can help aid the pediatrician to rule out one of more issues that could be causing your child to wake up early. Record and mention any of the above questions that match your family history. Sometimes a pediatric dentist that specialize in airway issues can also be helpful.

Toddler Early Morning Wakings Can Be Fixed

Waking too early can be difficult for both parent and child. Not only do they leave the child feeling tired, but it’s hard to parent well when we’re exhausted too. However, by using the above information to help narrow down the cause, early morning wakings are nothing that you and your toddler cannot overcome.

Too tired to do it on your own? Join the Baby Sleep 101 Facebook page and participate in one of the frequent Q &A sessions.

Remember to pick up your free copy of TODDLER + PRESCHOOLERS SLEEP SOLUTIONS; EASY TIPS FOR EXHAUSTED PARENTS.

Want to get help faster? Book a mini-consult and I will analyse sleep logs, routines and sleep patterns and give you quick, actionable advice that you can start to use right away.