Sleep Regression

Toddler crying

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Developmental Changes and Child Sleep

Sleep regressions can be one of the most common sleep challenges that parents encounter. Sleep and behavioral regressions can occur due to developmental or movement milestones. These normal sleep regressions can last for days, weeks, and even a few months.

The following are some of the most common baby and toddler developmental and movement milestones, and a few good ways to respond during these periods of big change.

Rolling to side or tummy

Your baby will continue to practice new rolling moves during sleep time. The general theory is that once your baby rolls to side or tummy during sleep time, it is safe for your baby to sleep in this position. However, you will want to be sure your baby is not swaddled, and that there are no loose objects, blankets, toys, or pillows in the area where your baby is sleeping. Some babies will sleep better from sleeping on side or tummy, while other babies will cry out panicked and uncomfortable. If your baby is awake and crying and sounds panicked, go to your baby and help your baby roll onto their back.

Expect a little bit of “Groundhog Day” as your baby continues to practice rolling off and on during the night. Be sure that during the day, you offer your baby plenty of floor-time so baby can really integrate the new rolling during the daytime, and can then use these new skills at night. After several evenings of helping your baby at night, begin to fade your help and watch as your baby begins to accomplish rolling during sleep time without needing your help.

Object permanence 8-11 months

As babies develop new movement skills, they may also become clingy, and may exhibit separation anxiety and stranger anxiety. The onset of object permanence ushers in a whole new perspective for your baby. For the first time in their first year, your little one is developing a picture of themselves, and as a result, experiences themselves as separate from you. While separation anxiety is a normal part of your baby developing, changing, and gradually becoming their own little person, separation anxiety can be very overwhelming for parents. Your baby will need you more as they go through these changes and may even become distressed if you leave the room or put them down.

Expect regressions with naps, bedtimes, nights, and possibly early morning waking during this phase. Try your best to meet your little one’s needs, and once your baby is through the phase you can get them back on their typical sleep routine if they have regressed during the phase.

Pulling up to standing, falling, and walking

Even parents of babies who are sleeping well at night have called to tell me that their baby is now waking all night long practicing walking at night. Some active babies will be so delighted by their new walking skills that they will continue to practice off and on through the night. Or, they wake themselves up in the walking position and can’t remember how to get back down to the sleep position. Remember that pulling to standing, falling, and walking are some of the biggest movement milestones that your baby will make in the first year.

It will take time for your baby to figure out how to get from standing and walking back to laying down and sleeping. During the first few days to weeks, some babies will need some more hugs at night and your help with getting back down from standing position. After a week or so of helping, fade your help away so your baby takes over and learns to lay back down from standing position.

Verbal learning 18-22 months

While the newborn stage is the most common time that babies will wake frequently at night, another common time is when your child is between 18 to 22 months of age. Due to big developmental changes that begin around the time a toddler is 18 months, your toddler may no longer be happy about being separated from you at night.

This period of development is largely focused on your toddler learning new words and wanting to communicate. It also happens to be the most common time for a toddler to climb out of the crib during the night as your toddler tries to find their way to your bed. If your toddler has climbed out of the crib at night, you may need to be more responsive to your child during this time. Some parents may even begin room sharing with their child because of the 18 to 22 months' developmental regression.

Once the phase has passed, usually just a few nights but also can be off and on for several weeks or even months(!!), your child will again be able to sleep with less of your help and sleep through the night.

Here are a few other ways your little one will let you know they are going through a phase:

Throws a tantrum when laid down on changing table for diaper change

Try offering your budding independent toddler a special job: “Will you hold this important rattle for mama while I change your diaper?” Or try an upright diaper change for your standing/walking toddler who never likes to slow down.

Abruptly falls apart when you initiate an end to an activity

I encourage parents to "talk" to their little one and help them with these very early lessons in transition and change. Before putting your "just started walking" baby down for a nap, spend a little more time cuddling and snuggling with your baby, reassuring and "talking" to them. This is called Parentese and can help babies and young children transition from active play to sleep time. Let them know that even when they are sleeping, you are never far away.

Wide awake in the middle of the night and seems wired

If you haven’t just returned from a trip and it isn’t jet lag, it is likely that your baby or toddler is going through one of the many developmental phases during 0 to 24 months. Eight of these phases have been identified in the first 12 months, and several more phases have been identified between 12 to 24 months. As we learn more and more about babies and toddlers and brain development, we now know that little ones will pass through these phases of immense brain and neuronal activity as they wire new skills and abilities. If your child seems wide-awake in the middle of the night and is otherwise a consistently good sleeper, chances are your child may be going through a phase.

Adjust your response and check on your little one but try not to turn on the lights and engage in active play in the middle of the night. Keep your response to a minimum. Finding a special way to "talk" to your baby or toddler about the changes they are going through will be building blocks for later when they begin to verbalize their wants and needs to you. It's also a good way to communicate emotional availability with your baby. In fact, a newly published study found that parents who were more emotionally available to their babies and young children at bedtime had children who slept better at night. Make it a practice during your bedtime routine to spend a few more minutes with your clingy or newly walking baby, letting them know that you are right there to meet their growing and changing needs.

Wishing your family peaceful sleep,

Dr. Angelique Millette

Family Sleep Consultant, Parent Educator, and creator of The Millette Method™

Traveling or Moving with Infants

How to Make Travel or Moving Easier for You and Your Little Ones

Infants

If your baby will be sleeping in a pack-n-play or other portable crib that you own, have her take a couple of naps in it for several days prior to your travel. The mattress in the portable crib will feel, sound and smell different than her regular crib so becoming familiar with it for several days may reduce the chances of sleep disruptions when you travel. If the hotel or house will be providing the portable crib, take a mattress pad, several crib sheets which will smell like your laundry with which your baby is familiar.

If you will be sharing a house, ask others if you can have a room that has a walk-in closet or an area away from where you will be sleeping where you can put the crib.

If there is no portable crib available, instead of co-sleeping make a palette on the floor with couch cushions or pillows around it to prevent the baby from rolling away. Use the mattress pad and sheets you brought to make a safe sleep space on the floor.

Remember to pack

  • Sound Machine. Even if you haven’t used one to this point, buy one or download an app. on your phone to play white noise. Hotel rooms and homes shared by more than one family can be noisy and disrupt night sleep and naps.

  • Two black towels and duct tape to put on windows to darken room.

  • Special blankets, swaddles, and loveys your baby is used to. Remember, blankets are never safe to be put in a crib with an infant.

  • Nightlight. Even if your baby doesn’t use one at home, having dim light in the room will help you see and tend to her without having to turn on a bright light.

Toddlers and older children

Changes in routines and environments can be unsettling for toddlers and older children. It’s important you talk with your children ahead of time about the upcoming changes. Some helpful books you can order on Amazon:

  • We’re Moving: A reassuring book about new beginnings (Birth-5 years)

  • The Berenstain Bears’ Moving Day (Ages 2-4)

  • Big Ernie’s New Home (Ages 2-5)

  • My Very Exciting, Sorta Scary, Big Move (Ages 5-7)

  • Moving Away Will Be Okay (Ages 4-10)

They may feel like they have no control over all that is happening, and they may not. However, you can help empower them so they feel they are in control of some things that will affect them. An example is, if possible, let them pick out their room in the new house or let them decide where their bed will go, their dresser, their toys, etc. This will help get their “buy in” and help them feel more secure. Show them pictures ahead of time of your new home, their room, and anything fun like a neighborhood playground or something else they can look forward to.

Let them pick out a new set of pjs for the new house and perhaps a new set of sheets or blanket. Also, let them pick out a new soft lovey or toy they can keep with them on the travel and to have with them during the transition and after.

They may feel your stress about packing, the move and everything in between so give them some grace, and yourself too. Take time outs from the “busy ness” and spend a little extra time reading or playing a game with them. They will feel more secure if they feel your calmness.

Handling Sleep When Changing Time Zones

infants

If it is just a one hour time difference, you don’t need to change anything. Just let them sleep and nap according to your old time zone and in a week or so, if they haven’t adapted and are off schedule, try moving naps and bedtime up or back by 15 minutes every couple of days.

If it’s a two or three hour time difference, try moving bedtime up or back (depending on whether you have gained or lost time) by 15-30 minutes every couple of days for up to a week or two before you move. This can help your baby adjust to the new time zone. Remember to look for sleep signs from your baby.

Sleep sIGNS YOUR BABY WILL SHOW

If your baby is showing four or more of these, they are likely ready:

  1. Putting their fingers and hands to their mouth

  2. Bringing hands to their midline like they were inside the womb

  3. Rubbing their face into you; your stomach, the crook of your armpit, your shoulder, trying to “get to” a dark place, away from stimulation

  4. Rolling to their side or tummy

  5. Grunting and fussing

  6. Rubbing a lovey around their face or head or pulling on their hair or ears

  7. 7Yawning, eyes and the area around the eyes turning red.

Toddlers and Older Children

For a one hour time difference, you can adjust bedtime by 15-30 minutes every couple of days for a week before moving. Naps will adjust, with just a little help from you, own their own. If not, change the time by serving lunch a little earlier (or later) and plan the nap accordingly.

For a two or three hour time change, try shortening the nap by 30 minutes after you move, to help reset their sleep rhythms and prepare them for the new bedtime. Also, waking them 30 minutes earlier in the morning can help with nap time as well.

Colic, Reflux, and High Needs Baby

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TIPS

Music/Sound: Traditional lullabies, classical music composed for infants, and heartbeat/womb sounds are very popular external remedies that relax many babies suffering from colic/reflux. Slumber Sounds, www.slumbersounds.com, has terrific options. Some parents have had great success by placing baby in a car seat on top of running dishwasher, washing machine, or dryer, or near running vacuum cleaner. A gentle shushing sound in baby’s ear can work magic, as can soft whispers and humming and singing.

Diet: Bottle-fed babies with colic may show improvement if switched to a different formula, such as soy. Mothers of breastfed babies may have to pay close attention to their own diet to make sure that baby is not having negative reactions to certain foods.

Gripe Water & Probiotics: Be sure to check the ingredients before buying a gripe water. Many claim to be natural but include artificial ingredients and preservatives. A colicky infant’s digestive systems does not need these potential irritants. There is a very effective and safe gripe water on the market called Colic Calm Gripe Water, which you can purchase online at www.coliccalm.com. It has the highest success rate on the market. Also, try using a probiotic. There is good research which shows that the right probiotic can reduce gassiness. A probiotic that practitioners recommend for babies is HLC Neonate Powder by Pharmax (purchase from Amazon).

Warm Aromatherapy Bath/Massage: Add a few drops of lavender to a warm bath and follow with the soothing touch of massage. Focus massage on the tummy area to relieve painful trapped gas. Research baby massage techniques online or read a book on the subject. A good one to try is The Practical Art of Baby Massage by Peter Walker (www.amazon.com). You can buy lavender, chamomile and fennel massage oils specifically designed for baby massage.

Swaddling: Babies are often soothed when swaddled or held close to a parent’s chest and heartbeat, or when swaddled and put to sleep in an upright position. Swaddling at the heart/midline is the preferred soothing position for babies.

Motion: Walking, rocking, and movement are very comforting to most babies. The good old rocking chair may be all it takes, or you can use an exercise ball for bouncing. Some parents have been known to push a stroller or drive around in car until baby falls asleep. Try putting baby in an infant chest carrier or sling so that your hands can be free. For colic, walk with baby facing down, across arm, with hand under the abdomen, while applying gentle pressure. This position is often referred to as the “colic hold”. For reflux, walk with baby in upright position, up over shoulder, or facing out with babies back against your chest, or in a Baby Bjorn carrier. Many babies like to be outdoors. Almost all babies love swings. Try a combination of the above to see what helps soothe baby the best.

Position: For keeping baby upright after feeding, use a Bjorn, bouncy chair, or your arms. Most importantly, when feeding at breast try to feed baby upright, by “The Monkey Hold Position”, or elevated with pillows, rather than feeding baby flat on back on a breast-feeding pillow or Boppy. When using a bottle, hold baby more upright, leaning up against a pillow, to help keep food down.

Medication: If you baby needs medication for reflux, you will want to know why the medications are being prescribed and their possible side effects.

Histamine H2-receptor antagonists (H2-Blockers)

  • Generic (Brand) Names: Cimetidine (Tagamet), Ranitidine (Zantac).

  • What they do: Reduce the amount of acid the stomach produces.

  • How they work: The chemical histamine causes certain cells of the stomach to produce acid by attaching to places on the cells called H2 receptor sites. H2-receptor antagonists attach to the H2 receptors and block the histamine from attaching to the receptors. This inhibits the productions of acid.

  • Side Effects: Headache, dizziness, malaise.

Proton Pump Inhibitors (PPIs)

  • Generic (Brand) Names: Omeprazole (Prilosec), Lansoprazole (Prevacid).

  • What the do: Reduce the amount of acid the stomach produces.

  • How they work: The cells of the stomach contain pumps that produce acid to aid in digestion. PPIs inhibit the production of acid from these pumps, reducing the amount of acid in the stomach.

  • Side Effects: Reported to be uncommon but can include allergic reaction, headache, stomach pain, and diarrhea.

Prokinetic Agents

  • Generic (Brand) Names: Metoclopramide (Reglan).

  • What they do: Keep the contents of the stomach from reaching the esophagus, reduce the amount of acid in the stomach.

  • How they work: Prokinetic agents make the valve between the stomach and the esophagus shut tighter. They also make the contents of the stomach empty quicker.

  • Side Effects: Reported in over 30% of patients. Include: nausea, diarrhea, nervous system side effects, drowsiness, restlessness, dystonic reaction. Can have interactions with other medications.

Parent support: Most babies are through the worst of their reflux by 4 months of age. Peak fussiness is between 6 and 12 weeks, so be patient, and remember that baby will get better. It might be helpful to hire a mother’s helper, nanny or doula to come over a few days a week to help with baby and give you a break! Or ask friends and family if they would be willing to help comfort baby, even for a few hours a week, so you can get a break. There are parent support groups as well as moms’ groups. Do your best to get out of the house every day, even for a short walk. Remember, you may have to make some allowances like holding baby more and putting baby to sleep in a swing in order to facilitate baby feeling and sleeping better, and you getting more sleep as well!

Dark and quiet sleep environment: Research is now showing us that some of these babies have a less mature regulatory system and need more of our help to settle, soothe and go to sleep. Darken up the room where baby is sleeping (very dark), use a sound machine, and be sure to swaddle baby for all sleep.

Introducing Solids

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  • Try to have a predictable routine associated with the beginning and ending of meal times.

  • Introduce changes in food texture slowly. Offer sippy cup of water often to aid in chewing and swallowing.

  • Children are much better at starting new foods or new textures when eating finger foods as opposed to being fed.

  • Avoid foods that have a safety risk, such as nuts, raw carrots, popcorn, and slices of hotdogs.

  • Introduce easily crunchable foods that do not require a lot of chewing, such as Cheerios and cheese curls.

  • Remember, the face is the most sensitive area of the body, so touching in or around the mouth can be over-stimulating to the child.

  • Minimize cleaning around the mouth during feeding if your child reacts strongly to it. When you must wipe, pat instead.

  • Give the child time to close the mouth on the spoon and remove food rather than scraping food off on the upper lip or teeth.

  • Limit meal times to 20–30 minutes. If your child shows signs of being finished, usually by pushing the spoon away or throwing food, offer food 1–2 more times, then end the meal.

  • Avoid power struggles with your child during meals.

  • Offer one food at a time, placing in front of your child and giving your child time to become interested in the food.

  • Serve yourself and enjoy a meal with your child! This helps your child to experience food/meal time as a social time.

  • Only offer two choices if you are asking your child what they would like to eat for a meal.

Self-Soothing Signs

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Is your baby showing at least four of these signs? If so, they may be ready to sleep train.

  1. Putting their fingers and hands to their mouth

  2. Bringing hands to their midline like they were inside the womb

  3. Rubbing their face into you; your stomach, the crook of your armpit, your shoulder, trying to “get to” a dark place

  4. Rolling to their side or tummy

  5. Grunting and fussing

  6. Rubbing a lovey around their face or head or pulling on their hair or ears

  7. Yawning, eyes and the area around the eyes turning red.