Hello brave parents and caregivers!
Have you settled into the back-to-school routine? Our household has definitely struggled to get back into the swing of things. Recently, my daughter may or may not have had several meltdowns coupled with an unwelcome dose of disagreeability and a dash of oppositionality. I couldn’t help but think of how well we had been doing prior to winter break; getting homework done with down time to spare, having fun playing games together, even a couple exclamations of “you’re the best, Mom”. These days seem a dim memory.
I know that any transition is inherently stressful and that transitions back to the daily grind are challenging for kids and parents alike. But I keep forgetting (read: completely blocked out) HOW difficult they can be. And they always last much longer than I expect!
Poor Sleep and Children
Fellow parents, as we shift back into the school routine, we are contending with an uptick in energy expenditure and earlier wake-up times, which adds up to overall less sleep compared with winter break and, well, tired kiddos. Welcome to Meltdown Central. For anyone who knows me, you know I am a stickler when it comes to my daughter’s sleep. I have definitely annoyed a person or two arranging get-togethers around my daughter’s sleep schedule, but my psychiatrist self knows that sleep is essential to her healthy development.
Childhood is a time of dramatic brain development that is influenced by genes and environment. Chronic exposure to stress (yep, this includes inadequate sleep) may affect a child’s brain development; simply put, chronic poor sleep can disrupt how children’s brains grow. This can lead to disruption in cognitive, behavioral, or emotional functioning. For starters, poor sleep quality is linked to poor attention, working memory, and impulse control. Similarly, inadequate sleep is associated with disturbances in children’s emotion and behavior regulation, as well as decreased academic performance, diminished creativity, and deficits in reasoning and executive functioning skills, like planning and organizing. If this weren’t enough, to the extent that poor sleep leads to daytime sleepiness, sleep deprivation can challenge a child’s ability to engage with and learn from his environment, with the downstream effect of disrupting his overall development. This is all to say, friends, that sleep is important.
I should take this opportunity to explain my struggles after my daughter was born. I had thought that the physical and mental endurance required to journey through medical school, then residency and fellowship would have prepared me for the grind of what it is to care for an infant. Adding to this my expertise in child development, I figured , “no problem, I’ve got this”. Nope. Notwithstanding that I was an older first-time mother status post urgent c-section, my sweet baby did not start out as an easy sleeper. As I became wild-eyed and exhausted, her sleep and mine became essential, if only for my survival.
Infant and Toddler Sleep: What Helped Me
I first committed myself to making my daughter’s sleep a priority; then, stemming from this organizing principle, this is what worked for me:
- Sticking to an early bedtime. For me, the key takeaway of Healthy Sleep Habits, Happy Child was that sleep begets sleep. The more sleep a child gets, the more rested she’ll be, and the more she’ll sleep. When I put my daughter to bed earlier, she did not wake up earlier. In fact, she slept later into the morning and increased her total sleep duration.
- Protecting naps. It’s so tough—how do you have a semblance of a life or get anything done if you’re constantly carving out time to put your child down for a nap? Like a lot of kids, I learned quickly that my daughter is pretty sleep-sensitive. So, I chose living with a more pleasant and easygoing child over my personal life (just kidding…sort of). I also found that naps were the linchpins holding the entire sleep schedule together; if she skipped a nap, sure enough I’d have trouble putting her down at bedtime, which would lead to less overnight sleep, an earlier morning awakening, and a tired and cranky baby. And a tired-er and crankier mommy.
- Maintaining sleep quality. Further bolstering my social life, I tried my best to make naps happen at home in the safety of a stationary bassinet or crib. Napping in motion, such as in a stroller or car, reduces restorative sleep and leads to poor-quality sleep. Both sleep quantity and quality are important components to healthy sleep.
- Teaching my daughter how to fall asleep on her own, a.k.a .where the controversy sets in. Not without my usual overthinking, when she was 9-months-old, I decided to give my daughter the opportunity to learn self-soothing skills by putting her to bed drowsy but awake and then letting her cry for 5 minutes before going in to soothe her. I was so nervous the first night that I sat outside her door counting down the minutes while I shed a tear or two myself. Thank goodness, it ended up not being such a dramatic process. After 5 minutes, I soothed her briefly then left the room; I sequentially increased the time by 5 minutes. I probably got lucky, but it took much less time and back-and-forth trips than I had expected for her to fall asleep. In a week or so, after our usual bedtime routine, she was falling asleep on her own. By putting her to sleep awake (but sleepy) and giving her time to figure out how to self-soothe, she eventually learned how to fall asleep on her own. And, the greatest reward of all, when she awoke in the middle of the night, she used these new skills to settle herself to back to sleep.
Let me add a couple important words about this method. I understand that many do not agree with it and that it may not be a good fit for your child or parenting style. You do you; this is just what worked for me. Obviously, if your child is ill, hungry, in need of a diaper change, etc. it is important to respond appropriately so as not to be neglectful. Also, as a general rule, you know your child best, do what you think is best for him regardless of what you read in a book or a blog. For instance, I modified what I read in Healthy Sleep Habits, Happy Child, and waited until my daughter was a bit older (generally speaking, this method should not be considered until after at least several months of age) and chose response time intervals that were comfortable for me.
- Remembering that tired kids can look hyperenergetic. Tired children release cortisol, a stress hormone, which gives them a burst of energy. Kids who are very tired can actually appear full of energy and wide awake, which may confuse parents. A child in a hyperenergetic overtired state has more difficulty falling asleep, which leads to decreased sleep duration that perpetuates an undesirable sleep cycle. By restoring healthy sleep habits, a child becomes more rested and, paradoxically, falls asleep more easily. Which, my friends, brings us full circle: sleep begets sleep.
- Never mentioning to anyone that my child is sleeping well. Seriously, it is universal law that as soon as you brag that your baby is sleeping well, the glorious sleep streak will stop. Just don’t do it.
I do not intend for these to be recommendations on how to approach sleep in children. I only aim to relay what worked for me. I understand deeply that what works for one family may not work for another and that it is dependent on many factors including but not limited to: family structure, dynamics, and a child’s temperament. As always, as you read, feel free to disregard what does not make sense for your family. And please consult with your pediatrician about any concerns you have about your child.
Am I suggesting you sacrifice your entire life for your baby’s sleep schedule? Of course not; a healthy amount of flexibility is in order. In our house, sleep routines give way to holidays, vacations, Bengals games, mother-daughter fun time with friends, you name it. After all, it’s chronic, habitual poor sleep that can become problematic, not missing a nap here or there. For me, good enough is enough.
Brave parents and caregivers, have a wonderful holiday weekend, and, for those who are past the baby stage, stay tuned for future posts about sleep in older children.
Until next time,