14 10, 2020

Sleep Debt & Sleep Training; What The Doctor Didn’t Tell You

October 14th, 2020|Categories: Baby Sleep, Preschooler Sleep, Toddler Sleep|

Getting enough sleep. Sleeping through the night. Avoiding a sleep debt.

As much as we try to not focus on it, having consolidated night sleep is for both parent and child, feels like winning some sort of prize.

But it can be hard to come by.

And getting sound advice, even from medical professionals, can sometimes be misguided.

For instance, when parents visit their child’s pediatrician and are asked about how sleep is going, and they say “not great”, my clients tell me often the response will be;¬† “you just have to let them cry”.

Without context, a proper sleep schedule in place, or without sleep hygiene habits being practiced, this is a recipe for disaster.

Want to get your baby or toddler on a better sleeping routine?

Download your free copy of

Baby Sleep Guides or Toddler and Preschooler Sleep Guides

Sleep Training Doesn’t Always Work

The problem lies in the fact that helping a child to sleep through the night is not limited to just one factor. And by extension, it’s not caused by one single issue.

This is why the idea of sleep training can and often does fail when parents try it.

It’s not that they picked the wrong method, it’s that they didn’t understand why the child was waking to begin with.

And that’s no ones’ fault. As parents, we aren’t taught much about our kiddo’s sleep!

In fact, even pediatricians have limited hours of training in regards to pediatric sleep. And my guess is, the focus is not about schedules and sleep windows. ūüėČ

Having three kids myself, (currently, my youngest is 11 months old) and helping hundreds of families achieve better sleep, I’ve seen this time and time again.

Let’s clear up any misunderstanding so our families can become well-rested and healthy.

So what IS a sleep debt?

Sleep debt, sleep deprivation, exhaustion, over tiredness.

They are all basically the same thing.

A sleep debt is the difference between how much sleep a child should be getting and how much they are actually receiving.

A (sleep needs) minus B (actual sleep quantity) = Sleep Debt

The sleep debt can be acute/recently acquired, or long term, chronic-lasting weeks or years.

If we think of sleep health similar to having money in the bank, then when our children (or ourselves) miss out on the required amount of sleep that their body needs, it’s like taking money out of the bank.

They now have a sleep deficit, or a sleep debt.

Side Effects of Sleep Debts

One of the MOST important factors, but yet the least known fact, is that sleep debts cause MORE sleep problems.

Mistakenly, I’ve heard my clients be advise (even from their pediatricians) to keep a child awake LONGER, in order to help them sleep better at night.

If you want your kiddo to sleep better, then please don’t follow this advice.

In general, to quote the famous pediatric sleep researcher, Dr. Mark Weissbluth; “sleep begets sleep”.

That is, the more a child sleeps, the better they will sleep.

Yes, there are limits to this, but when we are dealing with overtired babies, toddlers and preschoolers (which, if you’re reading this blog, you probably are), then we really want to work at filling up their sleep bank.

To summarize, here is what can occur with sleep debts

  • Frequent night wakings (not related to hunger)
  • Increased crying (during day, before and after sleep periods)
  • Short naps
  • Waking after 20-30 minutes of sleep
  • Resistance/protesting to going to sleep
  • Difficulty falling asleep
  • Early morning wake ups
  • Bedtime battles (toddlers and preschoolers)
  • Crankiness
  • Clingy
  • Unable to play independently
  • Refusal to eat
  • Easily falling asleep in highchair, car seat-anywhere other than in crib or bed
  • Risk of impaired health, immune function and memory

Fixing a Sleep Debt

In order to feel well and to maintain a strong immune system and overall health, this must be payed back.

Generally the thought is that you can never fully repay the sleep debt. Once that sleep is lost, it’s gone forever. But, it is possible to reverse the effects.

We start by getting our children to bed at the perfect time. Not too early and not too late.

How do we accomplish this? By following their *initial* sleep cues.

The trick here is to know what to look for.

If I asked you what does your child do to indicate when they’re ready for a nap or bedtime, you may say yawning, eye rubbing, or getting fussy.

But for the vast majority of children, these are their secondary tired cues. They are signals that indicate that your child is already approaching a state of overtiredness.

Instead,  what we should look for is much subtler, much less obvious.

Initial Tired Cues; “I’m Getting Sleepy”

For babies, watch for the following signs…

  • Zoning out
  • Turning away from caregiver
  • Loosing interest in toys
  • Quieting down
  • Eyes looking glassy
  • Looking relaxed and calm

For toddlers, watch for the following signs…

  • Wanting to cuddle
  • Sucking fingers/thumb/pacifier
  • Lying down or wanting to have a “rest” during playtime
  • Finding favourite blanket or stuffed animal
  • Getting quiet
  • Starting to whine/get fussy

When you see these indicators, you need to immediately respond and start their wind down process for sleep. This will give you the best chance of having minimal fussing and long, deep sleep.

Secondary Sleep Cues; “I’m Getting Overtired”

If you miss the initial sleep window, you will likely start to see overtired cues.

Since a sleep debt is building, you will likely have to work harder at helping your child settle down. That’s ok! Do what you need to do to help them.

For babies, watch for the following signs of overtiredness…

  • Yawning
  • Red under or around the eyes
  • Skin around eyebrows turning pink/red
  • Fussing
  • Crying
  • Jerky or erratic limb movements
  • Arching when being held
  • Fighting/resisting going to sleep

For toddlers, you will notice these cues when they are becoming overtired…

  • Defiant
  • Grumpy
  • Meltdowns
  • Temper Tantrums
  • Increased silliness or clumsiness
  • A burst of energy
  • Hyper
  • Demands for attention

Moving Forward And Avoiding The Sleep Debt

To avoid the same problem at the next sleep period, make a note of how long they were awake for prior to seeing the overtired cues.

Start documenting or sleep logging with little notes for yourself on their temperament and mood before sleep.

This will help you to start seeing patterns and anticipating in advance when they will be ready for nap or bedtime.

How Do I Know When My Child No Longer Has A Sleep Debt?

Once you have been able to identify your child’s initial sleep cues and are able to get them onto an age-appropriate schedule, the next question is when are they all caught up?

We often look to the child’s mood, temperament and patterns in sleep, as indicators of sleep health.

A few questions to ask;

  • Is my child waking less at night?
  • Is my child waking up in the morning happy and refreshed?
  • Is the morning wake up time after 6:00 am?
  • Are naps roughly two sleep cycles long? (One cycle is roughly 45 mins, age-dependent)
  • Is the nap consolidated, with no significant wake ups in between cycle transition?
  • Is my baby (over 4 months) sleeping a long stretch in the evening before their first feed?
  • Is my toddler or preschooler sleeping through the night?

If you answer “yes” to most of these questions, then it’s likely that your child is getting back on track.

It does take awhile to undo the effects of sleep deprivation, so please be patient with them and stick to your routine.

If you need more help or guidance, I can help you! I offer mini-consults (30 or 60 minute one-time calls), or full packages.

Remember your child WANTS to sleep as much as you want them to. They will feel better when their sleep debt is erased and everyone is getting the sleep they need.

 

23 09, 2020

Safe Sleep Tips for Babies and Toddlers

September 23rd, 2020|Categories: Baby Sleep, Toddler Sleep|

Safe Sleep Isn’t Always As It Seems

A sweetly sleeping newborn baby is one of life’s most precious gems. And it’s an image we often see in magazines, ads and in the movies.

Frequently, the baby is wrapped in a blanket, surrounded by stuffed animals, maybe on their tummy or side.

As serene as this image is for a stock photo, it sends a dangerous message; that this is a safe and protective sleep environment.

It’s not.

September is Infant Safety Awareness month which means it’s a good time to write a blog about something that should be practiced everyday of the year;

Safe Sleep.

Let’s start with the basics of safe sleep

Many people have heard of the ABCs of safe sleep. It’s a great and easy way to remember the fundamentals.

A-Alone

B-Back

C-Crib

A- Alone in a Crib

This first one sometimes confuses parents a bit since the recommendation for both Canada and the United States is to room share for the first 6 months of a baby’s life.

But the A for Alone, doesn’t mean that the child is alone in the room, rather they are alone in their sleep area.

Only a firm mattress and a fitted mattress sheet, over that mattress, should be in the crib or bassinet.

This means no;

  • Blankets
  • Stuffed animals
  • Toys
  • Pillows
  • Bumpers (Breathable or otherwise)
  • Mattress wedges
  • Baby positioners
  • Baby Nests
  • Loose bedding
  • Other people

We want the crib or bassinet boring and bare. That is beautiful for safe sleep!

B-On their Back

Always place a newborn down to sleep on their back.

This keeps their airway clear (newborns don’t possess the ability to move themselves away from dangers) and helps to reduce the risk of Sudden Infant Death Syndrome (SIDS).

There will be many people (perhaps from an older generation) that tell you that they use to lay babies prone (on their tummies) and never had an issue.

You may also be one of the many parents that have a baby that hates sleeping on their back.

I fully recognize that this may be the case as plenty of babies do enjoy tummy sleeping once they are older. But, the data tells us that there is a much lower rate of SIDs when babies are placed on their backs to sleep.

I go into more details on my TV interview with CTV Morning Live Winnipeg.

You can check it out here.

 

C- Certified Crib or Bassinet

Technically, the C stands for *crib*, but I always like to mentioned that it needs to be a certified one. Unfortunately there are many products on the market that subtly or even blatantly¬† mislead consumers into thinking that their product has been tested and given the “all clear” for babies to sleep in.

This is not the case.

Unless the crib or bassinet has met the standards to be labeled a crib, bassinet or play yard (in the U.S.), then an infant should not sleep in it.

If it is called a napper, changing station, bassinet “level”, or floor “level”, nest, baby nest bed, lounger, etc., it is NOT safe for sleep and has NOT undergone any testing.

Only the terms crib, cradle, bassinet and play yard (in the US only) have been tested and certified for safe sleep.

If you are not sure, look for the manufacture, model number and date of manufacture on the product.

Canadian regulations for cribs, cradles and bassinets from the Canada Consumer Product Safety Act Click here.

United States crib regulations can be found here.

United States bassinet and cradle regulations can be found here.

United States play yard regulations can be found here.

Mobiles, Toys, Wedges and Incliners

What about these common products? How many parents have purchased fancy gadgets and gizmos to help their little one catch a few more ZZZs?

The great news is that you can save yourself money by not purchasing them!

Any crib modifications that stay attached or remain in the crib during sleep time, are not needed and not safe for sleep.

Remember, bare is beautiful and safe.

Incliners/wedges are also not recommended, because a baby will slowly slide down.

This places their neck at an unsafe position, increasing the risk of positional asphyxiation which occurs when a baby can not get enough oxygen due to an abnormal position of their body.

(This is one of the reasons the Fisher Price Rock N Play was recalled. You can read how even this popular products was sold without clinical research and despite infants dying,  here.)

What About Safe Sleep For Toddlers?

This group sometimes gets forgotten about, but it’s still just as important!

The safest place for a toddler is still a certified crib until they are 35 inches or taller.

No pillows should be introduced until two years of age. When you do offer a pillow, it should be firm and flat.

A toddler is a curious being and they may attempt to explore their climbing skills. Prevent them from trying to climb out by lowering the mattress to the lowest setting and taking out any stuffed animals or blankets, that can be used to gain leverage.

Sleep sacks are recommend instead of blankets. Not only does this limit the ones that try to climb, but it is also safer than loose bedding in the crib.

Think your toddler is too big for a sleep sack? Guess what?

There are companies that make sleep sacks all the way up to 5T.

For the toddlers that are in a bed, if you are choosing to use guard rails, they should be used only with a bed that has a mattress and box spring, not on a toddler bed or bunk bed.

There have been incidents of toddlers becoming trapped between their rails and the bed, so you will want to preform regular safety checks to make sure they are attached as per the manufacture’s instructions.

Safe Spaces For Bigger Kids

Although we don’t have to worry about SIDS (Sudden Infant Death) for toddlers, there are still risks for suffocation and entrapment that we can watch out for.

Those growing bodies mean that they can reach and grab for items that previously were out of their reach.

So be sure to not place the crib near

  • any windows,
  • drapes and their pull cords,
  • electrical outlets
  • shelves
  • picture frames
  • anything that can be pulled into their crib

You never know what your toddler is going to try to investigate, so the safest approach is to remove all hazards ahead of time.

I Bought Bumpers (or any other product) That Says It’s Breathable! That’s Safe, Right?

Unfortunately, no.

I was surprised to learn that bumpers, even “breathable” are not safe for sleep.

I was even more surprised to learn that the term “breathable” doesn’t mean anything. It is a marketing term only.

There are no tests or standards that an infant sleep product goes through, to have that term applied to it’s label or advertising.

Anything can be called “breathable” without breaking any laws.

Safe Sleep is Easy Sleep

As much as we may be tempted to decorate our children’s room with fancy bedding, deluxe mobiles, and large stuffed animals, when it comes to sleep, these items aren’t needed-or safe.

In fact, the less you do, the easier it becomes to have a safe sleep environment.

Stick to the basics and save all the “extras” for playtime.

Have a safe sleep environment, but your little one won’t sleep in it? Book a mini-consult and let’s get your family sleeping!

 

 

 

 

15 05, 2019

Baby Sleep and Teething

May 15th, 2019|Categories: Baby Sleep|

We’re frequently told that teething and poor baby sleep go hand-in-hand. But is that always the case?

Teething and Baby Sleep 

When I had my first baby, and she wouldn’t sleep, teething was the frequent go-to reason.

Not napping at 4 months? Teething

Not sleeping well at 6 months? Teething

Waking up screaming at 4am at 13 months? Teething.

And of course, I did what every other parent does in these situations.  I tried all the homeopathic and medical solutions out there.

From cold facecloths to camellia capsules; we did it all.

I even remember getting my husband to go to someone’s house at night to get an “authentic” amber teething necklace.

(Please note: I do not advocate using these. When placed around the neck, they are an extreme choking hazard, even the “quick release” ones. You can read more on why they are not recommended¬†here,¬†¬†here, and¬†here, )

But not surprisingly, none of these seemed to work.

I wish I had known then what I know now.

Which is what, you ask?

Teething Isn’t Always to Blame for Poor Baby Sleep

I have been a pediatric sleep consultant for many years and have helped hundreds of families. I’ve seen kids pop teeth out in the beginning, middle and end of sleep coaching and it not impact their sleep at all.

Now, I understand that this isn’t going to be everyone’s experience.¬†But the truth is;¬†teething isn‚Äôt always to blame for baby sleep problems. In fact, most of the time it isn‚Äôt to blame at all.

If you find this suggestion unbelievable, I would like to offer this;

Teething not being the cause of all baby sleep problems is great news!

The idea that teething may not cause as many baby sleep issues as we think, means that we aren’t at the mercy of the teething gods for 2-3 YEARS while all 20 teeth pop out.

Yay!

So what could be real issue?

Sleep deprivation.

Sleep Debts

Now, I know it’s not as sexy to talk about.¬† In fact, it’s something that is rarely talked about.

At all.

It’s not discussed in mommy groups or on Facebook.

And I have rarely had my clients tell me that their pediatrician even asked about how much sleep their child is or isn’t getting.

But if your child is having issues sleeping, it is more likely that they are overtired and sleep deprived.

 This is also referred to as having a sleep debt.

Your Child’s Sleep Bank

So, what is a sleep debt, exactly?

We can think about it like this; say you’re financially in the clear and you have $500 in the bank. That’s a surplus. That is like a child who is well rested.

Now, imagine that child misses a nap or goes to bed too late. They will start to lose the sleep that’s in their sleep bank.

The part many parents don’t realize is; it doesn‚Äôt take a lot for children to get overtired.

That one missed nap or late bedtime can start the spiral. If it happens a few times in a row or throughout a week, the child quickly becomes sleep deprived.

When these overtired children fall asleep, their brain spends more time in a shallow sleep state, rather than a deep one.

And this shallow state allows for more wakings due to any disruption; wet diaper, cold room, dog barking or teething pressure.

Chicken and Egg: What Comes First?

Now, you may be saying to yourself; “but my child is overtired because they are waking due to teething.”

This may be true, but from my experience, it doesn’t happen as everyone tells us it does.

What is much more common is this…

Usually a sleep debt started to form before the teething occurred, however we didn’t notice it. The child slowly starting to lose more sleep in the weeks prior from whatever reason, and that in turn, left them more prone to shallow sleep.

Then, once any teething pressure started to emerge, because they were already having lighter sleep, they started to wake up more frequently. 

This made transitioning from sleep cycle to sleep cycle difficult, resulting in extra wakings.

Why does this happen?

It’s because when children are overtired, their bodies go into overdrive and extra stimulating hormones (cortisol and adrenaline) are released to try and fight the fatigue. This then suppresses deep sleep states from occurring.

If you want to imagine what it feels like, think of their lighter, more shallow sleep state as being similar to us when we watch a show on TV at night and begin to drift off.

Any sudden noise or disturbance will wake us up because we are only in the lighter stages of the sleep process. Usually, it feels uncomfortable to be jolted awake and not fully refreshed. 

Similarly, when an overtired child tries to transition through to another sleep cycle and is woken up fully, they usually cry because they feel uncomfortable and still tired. 

How To Help Reduce a Sleep Debt

Perhaps after reading the above, you start to suspect that your little one’s wakings are indeed primarily due to being overtired.

If that is the case, then the best way to help them feel better, is to work on putting more sleep into their sleep bank.

We do this by:

  • creating a relaxing wind down routine before each sleep period. This helps to cue the brain to release sleep hormones and set the stage for sleep.
  • Next, we ensure that the child is having age-appropriate length of naps each day.
  • And finally, we keep their wake windows age appropriate.¬† You can find a reference chart here.

I’m Sure Teething Is Causing My Baby’s Sleep Problems!

To help determine if teething is the issue, check what applies to your child;

  • The sleep issues are very recent; only in the last week
  • My child is not suffering from any illness, allergy or intolerance
  • My child has been on a solid nap routine for many weeks before the wakings started
  • Naps were over an hour on a consistent basis
  • My child could both fall asleep and transition through sleep cycles, independently
  • My child was recently sleeping through the night and just waking for 1-3 night feeds (age-dependent).

If you answered “yes” to all of these questions, then teething may actually be the cause of your baby sleep issues. (Woohoo?)

But, if you answered “no” to several statements, your child is likely waking due to another reason.

How To Help A Teething Baby Sleep Solidly

What can we do if our little ones are waking up due to teething? Here are a few suggestions;

  • Keep a regular nap routine¬†
  • Ensure consistent nap times each day. Sleep begets sleep.
  • If naps were shorter that day, move bedtime up earlier to help make up for the lost sleep.
  • If your parenting philosophy embraces the use of medications or homeopathic remedies, then with your healthcare practitioner’s advice, you may proceed as you feel is necessary. (Please note; if you are using medication and your little one is still waking well within the dose being in their bodies, then the wakings are not related to teething discomfort.)
  • If wakings occur, always give them a few minutes to see if they can return to sleep unassisted. Many children take about 20 minutes on average. However if this doesn’t feel comfortable for you, try 10.
  • Offer some reassurance and soothing after giving them time to return to sleep.

Baby Sleep After Teething; Back on Track

It generally takes less than a week for a previously well-rested baby to get back on track after a few bumpy nights.
However, if they were already overtired, then it may take closer to a week to fully recover.
 
We want to remember their sleep bank levels and if it has a large deficit, then it will take more time to replenish that lost sleep.
 
The best way to reestablish healthy sleep routines is to still follow the basics of healthy sleep;
 
  • Soothing wind down routine before all sleep periods
  • Placing baby down relaxed, fed, clean, but awake
  • Consistent nap times
  • Adjusting bedtime to quality of naps each day

Baby And Sleep And Teething; Oh My!

Whether your baby’s sleep is being disrupted by teething pressure, or a previous sleep debt, the good news is that no matter what; there is hope.

Either way, by focusing on your child’s overall sleep routine, nap quality and bedtimes will help both issues and get everyone back track as quickly as possible.

Want more tips to get back on track after a sleep debt or teething disruption?
A Mini-Consult is a great way for us to talk through the issue and get your family sleeping well again. You can book one here. 

 

 

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. 

16 10, 2018

The 8 Month Sleep Regression; What Causes it and How to Solve It

October 16th, 2018|Categories: Baby Sleep|

You Say Regression, I Say Progression

Raise your hand if you’ve ever heard of a sleep regression.¬†Likely, it was the 4 month sleep regression.¬†But what about other regressions? In particular the 8 month sleep regression? (Sometimes called the 8-10 month regression. But don’t worry, it doesn’t last that long, rather it can happen sometimes during those months. Whew!)¬† It’s not talked about as much, but can still impact your child’s sleep.

What is a Sleep Regression?

Sometimes the term ‚Äėsleep regression‚Äô is overused and we say it to explain any challenge with sleep that occurs. (I myself have been guilty of that in the past. I distinctly remember posting on a sleep forum to try and find out if there was such a thing as a 13 month sleep regression. Note: there isn’t!)¬†

But in the truest sense, a sleep regression describes a previously completely¬†independent sleeper in the weeks before that suddenly has gone off the tracks. However, if there were sleep associations, medical issues, poor sleep hygiene, and/or the challenges that were present in the few weeks leading up to the sleep disruption, it’s likely not a sleep regression.

The good news is; regression or not, changes can be made and solutions can be found to help you overcome this challenging period of development. 

What is the 8 month sleep regression?

If you had previously heard of the four month sleep regression, then it’s important to know that what happens at eight months is quite different. At four months,¬† your child underwent a biological and cognitive sleep shift. This was a development in the way that your child fell and returned to sleep. Sleep cycles developed and your child began to enter and exit these cycles all night long.

The development they undergo at eight months is slightly different.

This time, your child’s biological sleep patterns are not changing. However all the physical milestones that your baby may be experiencing at this time can start to impact their sleep.¬†

Additionally, this is a common period for children to experience nap transitions as well and a sleep debt can build up. There‚Äôs a lot going on for children development wise at this time in their lives. It’s like the perfect storm of sleep disruptions.

What Causes the 8 Month Sleep Regression?

As mentioned, there are a few reasons why this blip in your child’s sleep may happen. Let’s look a bit more closely at the reasons;

  • Cognitive developments: Your baby is developing a sense of object permanence. She is starting to understand that even though you are gone from sight, you have not actually disappeared. This means they may cry for you once you’ve put her down in the crib.

 

  • Language development: The brain is working overtime to practice moving the jaw, tongue and lips to form new sounds to communicate.¬†

 

  • Physical developments:¬† Developing more strength and motor skills. Children are starting to learn to crawl, sit up and pull up. They may decide to practice these skills during nap time or at night.

 

  • Nap transitions:¬†Baby is ready for slightly more awake time, a more regular schedule and might be ready to drop from three to two naps.

 

  • Overtiredness:¬†If a child has the wrong routine, too late bedtimes or all the new developmental changes are tiring them out, this can cause a regression in sleep as a sleep debt builds.

 

Can You Sleep Train During the 8 Month Sleep Regression?

The short answer is ‚Äėyes‚Äô. But understanding that sleep training is the last component to put into place, is important.

The long answer is, if you’ve read my articles or follow me on Facebook, you know that sleep training plays a very minor role in creating an overall healthy sleep routine for your child.¬†The priority should always be a well-timed daytime routine and an age appropriate bedtime.

Want tips for a great routine and a solid night’s sleep? Download your FREE copy of Baby Sleep Basics here.¬†

Many sleep issues can be completely solved with just doing the foundation work of having a wind down routine, well-timed naps and an age appropriate bedtime. In fact I would go so far as to say that many sleep regressions can be avoided altogether with this, somewhat, simple advice.

Sleep is essential for everyone, including your child. Helping baby to get more sleep that they need to be healthy, so don’t let a developmental spurt stop you.¬†

How Do You Handle a Regression While Baby is at Daycare?

Handling a sleep regression when baby is at day care can be tricky, but there are things you can do. First and foremost, make sure the day care has a good understanding of healthy sleep habits, and the sleep needs of your child. Communicate with them what you’re experiencing and make sure they are understanding of the situation.

Tweak your baby’s routine as needed and ensure that the day care is supportive of this. And always remember to be patient. Many day cares have policies they have to follow. If it seems like they‚Äôre being difficult, they‚Äôre probably just following a procedure.

Tips to Handle the 8 Month Sleep Regression

Sleep Needs

Know how much sleep they should be getting in a 24 hour period. See this chart.  This is an important place to start. If your child is clocking significantly less than recommended, they may not be experiencing the 8 month sleep regression at all, but rather just be overtired.

Sleep Accumulation

Log their sleep for 5-7 days to see what they’re actually getting. Divide the total amount of hours by the number of days and it will give you an average to compare to the recommended amount.

Identify Problem Areas

Is your child having disrupted night sleep? Or are naps the biggest challenge to your child’s sleep needs? Once you see where the main issues lie, you can tweak your baby’s daytime routine.¬†

If your child’s naps are too short,compensate with an earlier bedtime. But if night time is the bigger area of concern, you may need to tweak the routine to reflect their biological circadian rhythms and natural sleep windows.

And finally, if a nap transition is needed; follow this article for tips and move to two naps.

Give Practice Time

If your baby is enjoying practicing her new skills instead of sleeping, offer her some practice time during the day. While you don’t have to sit, prop, or pull her up, offering her the ability to naturally practice these skills during the day can help.

Sleep Train, If Needed

Once an age appropriate routine is in place, if you want to wean any habits your child has become dependent on, you can. Pick a method that you feel the most comfortable with and be consistent with it. There are a variety of methods outlined in this series. 

Be Patient

Sometimes, with new skills, comes blips in sleep. If your child’s routine is on track, bedtime is age appropriate and she’s an independent sleeper, all we can do is just wait for the cognitive or physical milestone to develop allow the novelty to wear off. In these cases, as long as we don’t start any habits we don’t want to maintain long term, this phase lasts one or two weeks.

Have more questions?

There are many ways to get answers. Make sure to like and follow the Baby Sleep 101 Facebook page to get notifications when there is a free Q & A session.
Download your copy of Baby Sleep Basics or book a one-on-one private consult to get detailed and specific help for your unique situation.