Tackling Anxiety and Sleep Issues in Children: A Psychologist’s Perspective

[00:00:00] Welcome to the Sleep Edit, a podcast devoted to helping tired kids and parents sleep better. We focus on actionable evidence-based sleep advice, so everyone in your home can sleep through the night. Now, a quick disclaimer, this podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice.
[00:00:27] No doctor patient relationship is formed. The use of this information and the materials linked to this podcast and any associated video content are at the user’s own risk. The content on the show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay obtaining medical help for any medical condition they have or that their children may have, they should seek the assistance of their healthcare professionals for any such conditions. Nothing stated here [00:01:00] reflects the views of our employers or the employers of our guests. Enjoy the show.
[00:01:09] ​
[00:01:09] Craig Canapari MD: Welcome back to the Sleep Edit, and this is our first guest ever. I am pleased to welcome Dr. Danielle Garay to. Podcast. She’s a pediatric psychologist who has dedicated her career to improving the lives of children and families. Originally from the great state of California, she arrived to Yale in 2021 after competing a pediatric psychology fellowship at the Children’s Hospital in Los Angeles with a PhD in clinical psychology from Palo Alto University.
[00:01:38] Dr. Garay has a strong background in child psychology. Having worked with children in multiple medical specialty clinics, Dr. GRE’s passion for sleep medicine stems from her belief in the transformative power for both of sleep, for both parents and children with a focus on improving sleep quality. She has helped countless families overcome sleep related challenges and achieve better [00:02:00] overall health and wellbeing.
[00:02:02] And I just wanna say having. Dr. Garay joined our clinic here at Yale has been personally transformative because many of the patients that I didn’t know what to do with, now she is fixing, which is pretty great. And I’d also say this is this is going to air well after the Super Bowl, but she is a 49ers fan.
[00:02:19] So just to put that out there in the universe,
[00:02:22] Danielle Garay PhD: It is true. So I’m either celebrating wherever I am or in deep mourning that Taylor Swift took me down. But that’s okay.
[00:02:30] Craig Canapari MD: look, if you’re gonna get beaten by the best,
[00:02:32] Danielle Garay PhD: That’s right. That’s right. Yep. Can’t even be mad about it. Thank you so much for having me. I’m very excited to be here and talk about talk shop, about sleep and anxiety, all the good stuff.
[00:02:42] Craig Canapari MD: Yeah. We’re it’s funny like thinking about the, this topic because we started thinking about, first about separation anxiety because it’s pretty it’s been common on what we’ve seen in clinic, and I think it’s an underlying. Sort of theme in a lot of the more challenging patients we’ve seen lately in [00:03:00] sleep clinic, but I think there’s, Danielle, why don’t you start and just talk a little bit about the role of a psychologist in the care of children with sleep difficulties.
[00:03:09] Danielle Garay PhD: Yes. So coming into the sleep clinic I find that there are a variety of things that people come in for that psychology can be particularly helpful for. I would say the main camps are kind of kids who don’t sleep or can’t sleep, that have insomnia and need support to be able to do that. Kids who should be wearing their CPAP machines, if they have breathing difficulties, they don’t wanna wear ’em.
[00:03:32] So helping them to get used to that. And then we have the anxiety sleep training camp where there are kids who, for whatever reason, are not sleeping well and there is not a clear medical diagnosis that’s like underlying that. And they need some behavioral support to be able to get on track. And more often than not, that work is typically with the parents.
[00:03:53] ’cause the parents are the captains of the ship. And so it, it requires them to set the stage for their kids to be able [00:04:00] to be successful. And so the psychologist really helps to make a plan and be able to set the parents or the family up for success in order to help equip their children to build the skills to sleep more independently or just have more restful sleep at night.
[00:04:16] Craig Canapari MD: In sleep training, we’re teaching parents to change their behavior to shape the behavior of their children. And that’s actually a lot of the work that you do as well because I think that one of the frustrations that parents have is if children are having challenging behaviors, they are seldom the ones that want to change them.
[00:04:35] The parents are, you have the illusion of control when your children are small. But really once they get bigger, they have agency. And all you can do is to try to nudge them towards the behaviors you like.
[00:04:49] Danielle Garay PhD: Yes. I, there’s oftentimes parents come and they’ll like, bring their kids to me and say please fix their sleep. And they like push their chair towards me and I’m like, [00:05:00] why don’t you pull up alongside, this is gonna be definitely, you’re gonna be a part of this conversation too.
[00:05:05] there’s something that’s so reassuring as a parent to, to watch your child sleep and sleep well and it causes such anxiety for parents when their children aren’t sleeping well Kids can feel that. And so then that can feed into this frenzy where then no one is sleeping well and everybody feels upset.
[00:05:23] And and so it is such a powerful intervention to be able to help people with their sleep. I
[00:05:28] Arielle Greenleaf: A as intimidating as that sounds, I think it’s actually very empowering for parents. The idea that you can change your own behavior and that will help move things towards the outcomes you desire. I would say that in my world that, and of course, I. I deal with a lot of kids with sleep issues, but as a pediatrician, sleep problems and feeding problems are, I’d say the two domains that are cause the most anxiety for parents.
[00:05:55] Craig Canapari MD: it can be so disheartening when these, you feel that your child is not [00:06:00] doing well in these really basic domains.
[00:06:02] Arielle Greenleaf: I think that’s, you know what’s so difficult about that is it, they’re both are so important. To the health and wellbeing, physical health, mental health of the child and the entire family. But I feel that parents just don’t get enough direction with either of those things. We might get a handout
[00:06:24] So some will say my pediatrician said to nurse to sleep, or my pediatrician said to co-sleep, or my pediatrician said, shut the door and don’t go in no matter what. There’s no, digging behind is there a medical problem or what else is going on here?
[00:06:40] And similarly, I feel that feeding is something that I see all the time. Parents do not know how to feed their babies and children and it’s not their fault, but they feel like it is it’s something that should just naturally come to them that we can, obviously everyone should be able to teach their baby how to sleep or eat, [00:07:00] but it’s way more complicated and they’re just, it’s just frustrating.
[00:07:04] ’cause I wish there was more education for parents, all parents around this.
[00:07:10] Craig Canapari MD: Only very recently that we don’t. Children are not raised with grandparents in the house, right? Like in the last couple of generations. And that as an adult, you feel like you’re making it up as you go along. It’s because you are you don’t have multiple family caregivers helping you out.
[00:07:27] So we have a, we have an outline to go through and I just want to make sure we cover all these topics. And the first is a term that I think gets a lot of, it’s thrown around a lot in the sleep space in a rather imprecise way. So Daniel l I was wondering if you could comment a little bit on temperament and in, in your work.
[00:07:47] Is that a meaningful term or what does it mean? Is it helpful concept when you’re approaching a child with sleep difficulties?
[00:07:54] Danielle Garay PhD: Yes. So temperament is in its most [00:08:00] simple form. It’s just like the genetic or biological predisposition that you have that Defines how you act in the world or how you react to certain situations. And so it can be helpful in that it can help you feel less guilty if you have a child who just, t typically is more, has more of a negative affect, like a little bit more fussy, a little bit more anxious.
[00:08:20] It just helps you to conceptualize that as opposed to a baby who acts a little bit more happy or a little bit more carefree. But it can also be dangerous because then you start to just categorize the child as that and then start responding to them and socializing them that way.
[00:08:34] So I, I think that it is helpful in that it may help inform, if you know that your child tends to react a little bit more sensitively, think to things, or if your child tends to let things roll off of them, it may help you to formulate what interventions may be most helpful to them. But outside of that, I don’t find it to be super helpful.
[00:08:53] ’cause I think it just ends up creating stereotypes and unhelpful. Socialization practices for [00:09:00] kids.
[00:09:00] Yeah I agree. I’m always concerned about the narrative of this is, oh. My child is difficult.
[00:09:07] Arielle Greenleaf: My child is high needs, my baby is high needs and then many times we just find the baby’s hungry or tired, and once they start eating better or sleeping better, they’re no longer high needs.
[00:09:21] Craig Canapari MD: yeah, a Arielle, I think that is it’s so true.
[00:09:25] Parents come in and they just have this idea that their child is, their child’s a poor sleeper. And it’s this sort of reflexive negativity that nothing. I’ve tried everything, nothing’s gonna work. And I’d say to a parent who’s really struggling, you owe it to yourself to.
[00:09:39] Things can always get better. They may not be perfect, but just imagine a world where things can get 10% better. And that’s the start, right? ’cause honestly you fix the sleep problem and then something else weird, they’re gonna do something else weird in a week. That’s just life.
[00:09:53] So on our next topic I have Daniellele know we were talking a lot about, a little bit about this today. I had a colleague reach out [00:10:00] to me this summer and actually it was last summer and it was a really rainy summer. There were a lot of thunderstorms. This little girl, I think she was four or five, and they had a thunderstorm that was scary to the child.
[00:10:12] And after this. Little girl was absolutely obsessed with thunderstorms. She was, anytime there was a rainstorm, she would have to sleep in her parents’ room. She was obsessively asking them to check the forecast, which they were doing because they thought that was helpful. And it really was adversely affecting the life of the whole family.
[00:10:35] ’cause they they couldn’t make plans around, where the child might experience a thunderstorm. It was affecting everyone’s sleep in the home. And this was a kid that hadn’t really been particularly tightly wrapped or anxious before Then. How, when you hear a story like this, what do you, like, how common is it to hear a story like this?
[00:10:55] Danielle Garay PhD: It’s quite common because I, nighttime fears, which is what we would call this kind [00:11:00] of thing, where it’s, it sounds like the fear was mostly at night. Is that right? With the storms?
[00:11:05] Craig Canapari MD: Yeah,
[00:11:06] sure.
[00:11:06] Danielle Garay PhD: So nighttime fears are very common. And it, probably the most common one would be the dark monsters in your room or under your bed.
[00:11:14] And then also these things like storms or the noises that are going on in the house, kids as their imagination starts to come online in really beautiful ways. It also starts to fill in the blanks at night when there is really no visual stimulation. And so then they’re just like left to be hearing or imagining and thinking.
[00:11:32] And so it’s just a very fruitful place for kids to develop fears and anxieties. And for a lot of kids, this is just mild. And it’s something that they might just need a little bit of reassurance or an extra snuggle before bed, and then they’re able to successfully go to sleep. And then other kids need a lot of support and may need some intervention, either from a parent or a professional to be able to really navigate the fear and learn some skills to be able to either.
[00:11:57] Mentally learn some strategies to [00:12:00] distract themselves, to be able to fall asleep or perhaps learn some facts about things that are going to dispel whatever it is that they’re worried about. And yes, it’s a very common thing to be afraid at night. But it’s not something that necessarily is so uncommon or something that parents can’t do. Some very simple things to help their kids with.
[00:12:20] Arielle Greenleaf: So I actually have a question. So my, I have a nine, nine and a half year old and a very active imagination, but she must have seen something about ghosts. And all of a sudden she believes ghosts are real. And I guess, and this is terrible. I had white noise going one night. I don’t normally have it, so I don’t know why.
[00:12:41] It was on one night it was on, she was calling for me for an hour, she told me and started crying. And I felt horrible because I didn’t hear her and she was too afraid to get up. I’m across the house. So anyway, the ghost thing was a thing for a little bit, maybe a week or two. And [00:13:00] I, I don’t know that I handled it properly.
[00:13:02] I just kept telling her, ghosts aren’t real. That’s just for stories and make-believe. And, as a parent what do you say, what do you do if your child has seen something scary and they believe that I, that you’re, that the parent is wrong and they know better and there are ghosts.
[00:13:21] Danielle Garay PhD: Yeah. Yeah. So this would be an example of where I actually think temperament wouldn’t be the right word, but like thinking about the type of child that you have. But I would say that some kids benefit from the talking through it.
[00:13:34] I
[00:13:34] Arielle Greenleaf: so a lot of parents want to just assuage their kids’ anxiety by trying to ignore it or say things like you’re saying, like it’s not real, it’s not something that you need to worry about.
[00:13:44] Danielle Garay PhD: And for some kids that is enough, like just them hearing their parents say, this is not a real concern. I’m not worried about it. You shouldn’t be worried about it. That can be enough for them. Other kids are more of like truth seekers or fact seekers, and so then they want to know more how do you know they’re not real?
[00:13:59] What, [00:14:00] and they wanna ask questions. And I think parents may wanna go the other direction let’s just not even think about it. But that it, if you think about the things that we as adults worry about, sometimes more information helps to settle us because it’s like we’re adding data and it’s removing some of the question marks.
[00:14:15] So if your child is asking questions about the thing that they’re afraid of. Sit down and talk with them and be willing to enter the conversation with them because you modeling, I’m not too afraid for your scary feelings models to them. I can sit with my scary feelings and ask questions about it.
[00:14:32] So even just modeling, like how to approach something that’s scary, can be helpful. However, then on the other side, there are kids who might ruminate on it and they just wanna talk it over and over and over. And so one thing that’s has been. Shown in the evidence to be very helpful is something that’s called scheduled worry time.
[00:14:50] So it’s where you literally say, all right, like 10 minutes before bed, let’s go crazy with our worries. Tell me all of your scariest thoughts. Tell me all your worries, and really just let them get it [00:15:00] all out. And then at the end of that 10 minutes or however long you’ve taken for the worry time, then you say, alright, whew, shake it off, shake off your worries, and now we’re gonna go to sleep.
[00:15:09] We’re gonna put that out of our mind until tomorrow. And if you have, if you start to have any thoughts or worries while you’re going to sleep, just say, alright, I’m gonna put that tomorrow for my worry time. So it just gives them permission to be able to feel afraid. ’cause fear is a very normal thing, but it gives them permission to have it in a more contained safe space.
[00:15:28] Arielle Greenleaf: I’m pretty sure they tell adults to do that too. I feel like I Yes, a therapist tell me that one time.
[00:15:34] Danielle Garay PhD: Yeah. It really does work. It, or it’s, yeah it works for a lot of people.
[00:15:39] I like, it’s such a, it’s such a well-defined bucket to put your concerns into, right? As opposed to just having them, it spill over into every aspect of your day exactly. But it still is because one of the hallmarks of anxiety is avoidance. It’s like trying to shove it outta your mind, shove it outta your mind, shove it outta your mind. But the [00:16:00] more that it starts to creep in, the more afraid you get of letting it come into your brain and the more you wanna shut the door.
[00:16:05] But when you invite it in a way that you’re saying, okay, you can come into my space and let’s work together here. I’m not gonna just let you control me. It helps them to develop the skills to deal with it, as opposed to just avoiding it and always distracting yourself from it.
[00:16:21] Craig Canapari MD: Yeah, no, and I think specifically for Fear of the Dark, which is something that is common in our patient population. Things like flashlight, treasure hunts can be really helpful. And I know Danielle, you put some, I can link to some books in the show notes too that are really helpful specifically to the fear of the dark.
[00:16:37] It’s so common. And I’m familiar with Uncle Lightfoot. I don’t know these other ones, but it’s just a nice, it’s a nice, resource for families These are things that often parents can address on their own.
[00:16:48] Danielle Garay PhD: Absolutely. Yeah. The other two books that I think are really great one is Orion in the Dark and Orion. Have you heard of
[00:16:54] Arielle Greenleaf: Yes. And my clients love, love, love that book.
[00:16:57] Danielle Garay PhD: It’s so good. It’s just this boy who [00:17:00] hates the dark, and then the dark takes on like a physical form and comes and takes him on this adventure and makes him love the dark and become friends with the dark. And so it’s just a nice personification of the dark in a kind of a cute way.
[00:17:11] And then the other book is The Rabbit, the Dark and the Biscuit Tin. And that one is The Rabbit Hates the Dark so much, and so traps the dark into this biscuit tin and doesn’t let it ever become night. But then the carrots start to wilt because it’s always sunny and there’s never any dark, and his friends aren’t coming out because, like the fox is the nocturnal animals.
[00:17:31] And so the dark is talking to him from the tin you’ve gotta let me out. I promise I’m not so bad. There’s good things about the dark too. And so then he finally lets him out and it’s fine. So it’s, they’re both just cute or all three of those books are just good at again, not avoiding the conversation about the dark, but rather just like putting a different spin on it.
[00:17:50] Craig Canapari MD: So let’s talk a little bit about nighttime tantrums, right? And I can say this. My older son’s not gonna listen to this, [00:18:00] but I think I read my book that he had a black belt in tantrums, like the craziest knockdown, drag out tantrums about two hours of tantrum a day from between ages, like two and four.
[00:18:10] It was terrible. Usually not at night in his case, but I think a lot of families struggle if they’re trying to implement a behavioral plan at bedtime sleep training or something like that, and they have a toddler or a preschooler who just loses it and gets hysterical either around bedtime or with nighttime awakenings. How should parents be thinking about these episodes and what should they do either, either in the moment or kind of upstream of the moment to deal with this?
[00:18:43] Danielle Garay PhD: Do you wanna go first? Arielle?
[00:18:46] Arielle Greenleaf: For me, parents will come to me and say, my baby or my toddler or my preschooler is tantruming at bedtime, or, tantruming at bedtime or then waking in the middle of the night and having a tantrum. [00:19:00] And to me, I don’t see either of those as tantrums. I see them as a symptom of lack of sleep or lack of routine or, lack of consistency.
[00:19:16] So it, to me, a tantrum and a toddler, toddlers have tantrums. It’s just, it’s the way it works. Toddlers are supposed to have tantrums, right? That’s how they process their growth. But when people come to me and they’re paying money to talk to me, it’s because things have gotten, beyond just normal tantrum.
[00:19:37] And so the, it’s almost like a buzzword to me. So when people are like, oh, my, my kid tantrums at bedtime, and then all through the night, it’s something else is going on there. It’s not simply a toddler tantrum. There. There’s some, in most cases when I’m handling it, it’s because they’re overtired.
[00:19:57] I know Craig, you struggled with that term, [00:20:00] but what I experience is usually the bedtime is too late. And many times it’s in conjunction with, I say that bedtime’s too late. They say, I try to put him to bed earlier, but he’s running circles around the house and then the tantrum ensues when they try to enforce bedtime.
[00:20:20] To me, in my experience, that is not a tantrum, that is a incredibly overtired, overtired child. Like in most cases, if we can start to create a good bedtime routine give them ways to quiet their body and mind. ’cause some children really need time to quiet their mind. Maybe some, meditate, but me bedtime meditations or if they need to get their sillies out, as my dad used to say when I was a kid moving their body.
[00:20:53] So bedtime yoga, sometimes family yoga together. Or just simply, literally going for a walk [00:21:00] an hour or an hour and a half before bedtime. Just getting some energy out really helps with that. But in, again, in my experience, the child is probably overtired and it’s not a tantrum. They’re just, it’s a symptom of them needing more sleep or structure.
[00:21:17] Danielle Garay PhD: I would say my experience has been the same for sure. And I think also the word tantrum has a component to it. I think that already creates like a rise of frustration in the parent, almost like it’s a choice that the child is making to tantrum. And and so I, I think if parents can reframe in the moment that like take a deep breath and say, my child does not have the skills or the current physical capacity to handle this moment and I need to help them have the skills to get to sleep, that can help them to feel less like I’m, it’s me against my child.
[00:21:57] And more like I’m gonna come alongside my child to [00:22:00] help them build the skills that they need for this moment to be able to go to sleep. And hopefully as they learn these skills and as we do this enough times consistently, it will be less of a tantrum before they go to bed and they’re gonna be able to, it’s just gonna get better and better as time goes on.
[00:22:16] Arielle Greenleaf: Yeah, I think if they can control it at bedtime, it makes it much easier with consistency. With the overnight tantrums. I just think that tantrum has such a negative connotation, and it’s not like a child is choosing to have a tantrum, and I feel like sometimes parents see it as the child choosing to have that tantrum and cause chaos at bedtime.
[00:22:40] And it’s really just not the case.
[00:22:43] Danielle Garay PhD: one of my favorite things to do with parents is to show them like like an M-R-I-F-M-R-I picture of a child’s brain. And you can see that like the amygdala in the brain is like the place where all of the emotions are. Your fear, your joy, your anger, your, all of that.
[00:22:58] And that is nice and meaty, [00:23:00] even as like an infant. It’s coming online. It’s strong. And then the frontal lobe is just like a gray area that’s smooth, not at all developed. And it’s that’s the secretary of the brain. That’s the problem solver. And so the brain develops in this way to keep us safe where we, ’cause we need to feel fear, we need to feel these emotions to be able to keep us safe.
[00:23:19] And so that comes online much sooner. But the problem solving part that’s not fully online until you’re like in your twenties. So it’s when you think about it like that and you think my child is so good at having emotions, but so far behind in, in like solving problems, it just helps you to see your child less as the enemy.
[00:23:38] ’cause I know that they can just grow horns, right? Right around that six o’clock hour. It’s like how is my child a human? I don’t know.
[00:23:46] Arielle Greenleaf: I, I have a question about that. Just because, I think that people expect more out of their toddlers than toddlers are able to give them because they do become tiny humans. They really aren’t developed enough too. [00:24:00] Manipulate or tantruming isn’t done on purpose to upset you, but I think about self-regulation.
[00:24:08] I think that’s something that’s discussed a lot in the sleep consulting industry. People talk about self-regulation, so I’m curious from both of your perspectives, when can you start to expect a child to begin to regulate their emotions begin to understand rules and boundaries. For instance, think of, people who come to me and they’ve moved their 15 month old out of the crib and into a bed and they don’t understand why the child is getting out of their bed or out of their room.
[00:24:41] I am a pulmonologist, so I’m gonna let Danielle take this one.
[00:24:46] Danielle Garay PhD: I’m gonna give a classic psychologist response, which is, it depends. So I would s
[00:24:52] Craig Canapari MD: Tell me about your mother.
[00:24:53] Danielle Garay PhD: Take a seat on my couch. No I would say that I do think that it depends, and it also, it’s not as [00:25:00] simple as there’s a switch that is, I’m a good problem solver, I’m a bad problem solver, or I can regulate my emotions.
[00:25:05] I cannot, ’cause I’m sure right now it would take you less than half a second to think of adults in your life that have no idea how to regulate their own emotions. So it, it has less to do with age and more to do with the opportunities and the yeah, the opportunities to build skills and the templates that have been provided for them.
[00:25:22] My 2-year-old nephew is tremendous at taking deep breaths. His parents started doing that with him from such a young age. I have a 10 month old, so I watched them do it before before I was there, and it was like he was like nine months old and he’d be crying and they’d be like, take a deep breath.
[00:25:38] I was like. Are you crazy? He can’t do that. But lo and behold, he’s two years old and now he can take deep breaths. So they started so much earlier than he was able to do it, but they weren’t expecting him to be able to do it. Rather, they were just showing him what they like, what would be helpful so that then once he started to be able to develop the skill of breathing through his nose, then [00:26:00] they could say, breathe through your nose, out through your mouth.
[00:26:02] And so it’s, and it’s just getting, more sophisticated and better as it goes on. That being said, he’s still in a crib. they’re not ready to put him into bed. That’s a problem. That’s something that’s problem solving. That’s a little bit up the road. So I would say that it’s a graduated thing.
[00:26:16] And it also, it depends on how your child is the kind, like where they are at cognitively, where they’re at emotionally. Like boys tend to develop a little bit later than girls. So there’s just, there’s all of those little things. So I would say to get out of this, just “it depends” vagueness I would say that you can start building those skills really early and modeling those skills to them.
[00:26:35] And when you start to get frustrated in the kitchen, when something’s not working or whatever, say, Ooh, I’m frustrated, I’m gonna take a deep breath or whatever. Kids from a very young age can watch their parents do things and start to model that themselves. But then also, like probably the more like cognitive reasoning and through thinking about regulating your emotions and being able to talk about it, that’s probably closer to like.
[00:26:59] [00:27:00] Seven, like seven to eight to nine around that time. And then being able to develop a little bit more like theory of mind, thinking about how it’s making other people feel. When you act like that’s more like around like 10 to 12. So it’s, there’s like different stages to emotional development. So I think it’s not as simple as providing just one age.
[00:27:18] But I think you can start instilling skills in kids really early without expecting mastery.
[00:27:26] Craig Canapari MD: And I love that too, that the idea that you model these behaviors yourself, right? Because the journey of becoming an adult is learning self-regulation, right? Managing your own feelings. ’cause the feelings don’t go away as you get older, right? You just get you if you’re lucky and and you’ve been parented appropriately.
[00:27:44] You learn to manage these things yourself. And I love that anecdote, just teaching. ’cause the parents, the baby’s screaming and the parents are just like,
[00:27:51] Danielle Garay PhD: Yeah.
[00:27:52] Craig Canapari MD: just trying to like, like really let it go a little bit. That’s, it’s really valuable. And which is not to say [00:28:00] parents, I know you’ve yelled at your kids.
[00:28:02] It’s okay. I’ve done it too. Maybe Danielle hasn’t yet because Griffin’s small. I’m sorry. I would
[00:28:08] Danielle Garay PhD: No, that’s say your son’s name, I’ve got, because your son is small, your son is small and he looks really cute. He’s not quite at the age where he is gonna really start
[00:28:16] Oh no. He’s very advanced. We think he’s a genius ’cause he is already throwing tantrums or whatever we wanna say. He’s still building. He’s like learning. We’re learning. He needs his skills building. He was arching his back during dinner tonight to let me know he was not interested in what I was serving.
[00:28:32] Craig Canapari MD: And I was like, wow. So early. You’re such, you’re so advanced.man I remember those days and you feel like you’re a genius. ’cause like your two year old’s he like, oh my God, he likes everything. He eats avocado. He is eating salad and it’s two and a half and it’s like chicken
[00:28:46] Arielle Greenleaf: Yeah, wait till they’re still nine and a half eating like mac and cheese all the time.
[00:28:51] Danielle Garay PhD: Oh yeah.
[00:28:53] Craig Canapari MD: Got. The let, lemme tell you is my sidebar parenting struggle is that at [00:29:00] no point in my parenting career if I had two children who like eating pizza at the same time. And when my son, my older son was young, he went through a stage where he wouldn’t have cheese in his pizza. So I , an Italian man, had a go to the pizzeria like a jerk, and order a pizza with no cheese only for him.
[00:29:18] And then he started eating pizza normally. And then the younger one started picking the cheese off. And now when we have a weekly pizza night with our friends and they’re always like, oh, pizza, we don’t like pizza. And I’m like, come on,
[00:29:32] Danielle Garay PhD: Get in touch with your Italian blood. This is who you are. Just Eat the pizza.
[00:29:38] Craig Canapari MD: Everybody likes it.
[00:29:40] Anyway, let’s go on our next topic, which is, it’s funny I’m just editing a episode we did on, I cry it out, everybody’s favorite sleep training technique a couple weeks ago. So let’s talk about extinction sleep training in older kids, which is, I think, honestly, personally, it’s something I try to avoid if I, if [00:30:00] we can though often sometimes you have to have a little bit of this, right?
[00:30:04] Arielle Greenleaf: Ariel, I know this was on your mind. I think well, and we’ve talked about this with infants too. I think every parent’s desire is that they are going to soothe their child with their presence. And I, that being said, I would say age, I probably three and up. I cannot stand the term cried out. I start with more parental presence. With an older child, with a toddler because they have started to develop, they could have started to develop some fears of the dark. I’ve talked about the lobsters we had. I had a client whose kid was afraid of lobsters even though there would not be lobsters in his room in the middle of the night.
[00:30:51] But, kids get these weird things, and I think I’ve said this before, sometimes they don’t know how to even name what it is that they’re afraid of. [00:31:00] They’re not quite there yet. They just have a feeling of anxiety or, they, they’re scared and they don’t know why. So they’ll just, grab something, lobsters, cats, whatever it is.
[00:31:10] So my first course of action is to like, just really change up the routine of the evening. Start to settle things down an hour before, and then I. Again it depends, and I know we talked about temperament, but some kids are going to need to run around for a little bit and go outside and, burn off some steam and then come in and play some games and then change things up.
[00:31:35] And then mom and dad go in there and they lay out the rules and here’s how it’s gonna be and I’m gonna sit with you for a little bit and then I’m gonna go whatever it is. And for some children just shaking up the routine a little bit and stepping back and thinking about what does my child really need and how can I address that in a better way?
[00:31:55] That can, and sometimes it’s great. You go the child, the parent will sit with [00:32:00] the child and they say, I’m gonna sit here with you until you go to sleep. And the child is calmed by that and within 20 minutes they’re asleep.
[00:32:08] Sometimes children will take advantage of this. And having a parent there just either creates a power struggle where the child is getting out of bed and the parent keeps putting them back into the bed and then they’re, it becomes a game.
[00:32:24] I try to encourage parents to ignore that behavior. It’s hard as a parent not to want to pick them back up and put them into their bed. I’ve had, I remember one time I had somebody and their son got outta bed and was like crawling all over them and then playing with toys, even though I told them to remove the toys.
[00:32:44] Eventually it did work, but it took way longer than it should have. It took two weeks for him to realize, okay, they’re not gonna be very fun right now if they sit in my room and I’m tired, so I’m going to sleep. in some cases, children need a little more [00:33:00] space and sitting there is just way too stimulating for them.
[00:33:04] So in those cases, you might have to let them fuss or scream a little bit, yell at you. I think the most important piece about that is reassuring them that you’re still there, but this is bedtime. So it’s creating that boundary but reassuring them. And in the beginning, for some kids that can last. It can be a long night for a few nights.
[00:33:28] But if you’re consistent with it, like you said, kids learn quickly if you’re consistent with them. And so parents are like, the first night, oh my gosh, I cannot believe we were up all night. He fell asleep for this amount of time, but then woke up and it was the same thing all over again. It’s okay, but he fell asleep.
[00:33:49] At some point, so let’s keep going down this road. But I would say, crying is not my, and it sounds terrible. It’s oh, with babies, sure, cry it out is great. It’s just [00:34:00] different somehow with older children and where they are developmentally in my experience. So I would love to hear what you think about that.
[00:34:13] Danielle Garay PhD: Yeah, I agree. I think that that as. Kids are older and also more verbal and can express things like it, you’re just dealing with a different ball game than just like this graduated approach of putting them in their bed and then going and checking on them after eight minutes or, whatever it is.
[00:34:31] It does require a different level of approaching the issue. But I, what I like to tell parents is this will be uncomfortable. I think sometimes parents want to change their child’s sleep with. No discomfort. And it’s it’s currently not comfortable. That’s why you’re here and why you’re wanting some help and support.
[00:34:48] But we need to create a zone of change that is it’s big enough that it gives the child space to be able to develop the skill and be able to do it. But it’s also not so big that [00:35:00] it, it feels like it’s cavernous and they’re not gonna be able to it’s like too much to expect for them at that point.
[00:35:05] And so you wanna think about it like this scaffolding of I’m gonna help to support you and we’re gonna get through this together. And it’s exactly what you said. It’s like validating. I know that this is really hard, but then building their confidence. But I am, I know that you can do this.
[00:35:19] And so it’s pairing those two things together. I like to really with older kids, help parents develop a plan that is going to give them the right level of support, but also give them enough space that they can develop the skill. ’cause likely the problem is that they are needing their parent too much in the night and we wanna help teach the child you, it’s okay to need your parents, but it’s okay to need them.
[00:35:41] A little bit less and a little bit less. And a little bit less.
[00:35:45] Craig Canapari MD: I feel like I’ve seen the kids and these are often the kind of the mid to late toddlers, early preschoolers. Where the parents are just trying to go zero to 60, right? The child has never [00:36:00] slept independently and all of a sudden the parents like
[00:36:04] one, usually I think they can go about three years with terrible sleep, but they’re having, I’d say, there’s a new sibling coming or something like that, and they, all of a sudden they’re like, that’s it, you are now sleeping in your room tonight.
[00:36:18] And they’re like closing the door. And it’s a disaster, right? Because the child is hysterical. They’ve never really had, had too much of an expectation to do any of this on their own. And now they have to sink or swim and usually those kids, frankly, are a little bit more on the anxious side anyway, if the parents are still struggling at that point.
[00:36:39] And I’ve even, and I, Arielle I think you alluded to this in outline, we’ve had parents who like lock their kids in their room and there are context where it’s appropriate, I care for children with neuro developmental issues like with autism, who wander the house, get out of the house, turn on the stove, et cetera.
[00:36:57] There’s a real safety issue there. But [00:37:00] for neurotypical children who are younger I think that the safety issues are really not front of mind. And if a parent told me they, they had done that and they’re just trying to survive, I would not be calling up child services, but I feel like if you need to keep your child in your room you probably should be on the other side of that door talking to them.
[00:37:21] Like what? I feel, Daniellele, I think you may have seen this or anything like that. If a parent was asking you about should I close, should I lock my child in their room? What should they, like a desperate parent, what would you tell
[00:37:31] Danielle Garay PhD: Yeah. I would say generally speaking, it’s not my favorite intervention because it’s not really teaching them a skill, and especially since we’re talking about anxiety. If a child feels trapped in their room, like they cannot get out, that will only worsen their anxiety. And even if you’re saying like, you’re gonna be fine in there, whatever the, I don’t think any of us would like the feeling of getting locked in So if we think about how much we wouldn’t like that, kids wouldn’t really like that. Now, if you have child [00:38:00] locks on a door and you have an 18 month old or a 2-year-old, and they don’t know that they’re trapped, that’s not a bad thing. It’s not, then they aren’t experiencing the feeling of being trapped in as long as they’re, there are obviously all the safety precautions about you being able to get in the room or, fire, safety, all of that stuff, obviously.
[00:38:15] But there’s a difference between if you have a young child who you doesn’t know that they’re being trapped compared to a child who you’re saying, I’m locking the door so that you can’t get out. That’s a very different kind of experience. So it’s not I just find it to be I don’t wanna say lazy, but ineffectual way of fixing the problem because it’s not building any skill, it’s just containing them.
[00:38:37] And then as soon as the door is not locked, then they will come out and it hasn’t really gotten rid of the underlying issue.
[00:38:44] Craig Canapari MD: And I think this is a good segue actually, ’cause I love the idea of. change may be uncomfortable, especially in an an older child. You’ve gotta, you’ve gotta create a situation in which they can succeed, right? And you’re you’re you’re slowly moving [00:39:00] the window of what you’re expecting, but you’re allowing some discomfort for the child, but you’re also allowing them an opportunity to succeed. And I think nowhere is this more clear than with some of the children we see with pretty severe separation anxiety. I’m just trying to come up with a vignette for this. Imagine or 5-year-old who refuses to sleep without their mom present, she follows her mom from room to room when her mom’s in the house.
[00:39:27] If both parents are there, is not interested in the other parent and really struggles with issues like drop off at preschool et cetera, and can be very clingy at night. Would you say that’s a fair kind of depiction of what separation anxiety might look like? What are some of the other hallmarks of this?
[00:39:49] And I think since we’re talking about sleep stuff that, that, that
[00:39:52] manifest at night, separation anxiety is, it’s the. The anxiety of being separated from, I, [00:40:00] I don’t know how much explanation there is needed in that. it really
[00:40:04] so cleverly
[00:40:04] Danielle Garay PhD: straight to the point. But it’s typically between children and their parents. But it can also be, adults can have separation anxiety.
[00:40:12] Like it’s not something that’s only in childhood. It’s most commonly found by a landslide in childhood. But it is when you feel so uncomfortable that it is causing you significant distress in your functioning to be away from typically we’ll just say your caregiver or your parent.
[00:40:28] And so th this would. I think you hit all of the main points anytime that the parent tries to leave. not being able to sleep independently, sometimes not even being able to sit in their own chair, constantly having to have physical contact. And so it, it can really look a lot of different ways based on kids, but it’s when there is a deep distress when they are not in very close proximity to their parent.
[00:40:52] I, I saw one child who had separation anxiety about even their parent going out to the mailbox to get the mail. Like even [00:41:00] it’s the, it could be a fear that something bad is gonna happen to the caregiver or something bad is gonna happen to the child, and they just feel a lot safer when they are, when they can see ’em, keep eyes on ’em and feel like they’re close to them.
[00:41:12] So there really are varying degrees of intensity and how impactful it is on functioning.
[00:41:18] Arielle Greenleaf: I’m gonna recommend the show notes Eli Lebowitz book about dealing with child anxiety and OCD and the idea that children who are anxious, sometimes they’re, they appear fearful or anxious, but sometimes they can be very angry and aggressive.
[00:41:31] Craig Canapari MD: And this insight really struck me for when my kid was tantrumming a lot. I think he was just being anxious and he, he’s he’s a anxious dude. And just to remember that if your child is absolutely losing it when you leave the room or you wanna leave them at night they might be angry, they might be aggressive to you or to a sibling or something like that.
[00:41:53] It still can be a manifestation even if they don’t seem frankly
[00:41:57] fearful. there. There’s something about. [00:42:00] Tender sensitive anxiety that elicits more compassion than a kid who’s like thrashing around and really angry. But it’s, it often is coming from the same place, and some kids feel more comfortable to cry and feel and let out that more like sensitive, sad side of their fear.
[00:42:16] Danielle Garay PhD: And some kids feel more comfortable to take up space in the room or like to feel like they are, angry and upset. And it almost can for some kids, give them this sense of control over their fear, but really it is their fear still driving them. But it, but when it manifests so differently, it can be hard for parents to tell what’s going on, but it often is stemming out of anxiety
[00:42:37] Craig Canapari MD: what’s the
[00:42:38] Danielle Garay PhD: for separation anxiety. It can, it, it starts as early as I. Infancy. So like I, I think like the first time is it can be like around four to six months, and then it happens again, like around eight to 10 months is the next little peak. And then again, I think around two to three years it starts to, to peak again.
[00:42:55] But then if we’re talking about like the separation anxiety [00:43:00] where the, yeah the childhood separation anxiety it is like around like the five, six, 7-year-old range. And that’s often coinciding with when they’re starting in school, things are changing. But I will say that I, to just validate parents’ experiences right now for any parents that are listening, there is still a lot that we don’t know about how the pandemic impacted anxiety in kids, and especially separation anxiety in kids. And so if you’re looking for yourself to be reflected in, scientific studies or in books, it may not be out yet because we’re still doing research on finding out how this cohort of children was really affected by something completely out of your parental control, completely out of their childhood control.
[00:43:41] But I just recently spoke with a family who was saying that their child for the first two years of life barely saw anybody outside of them and their grandparents because there, there were some medical issues that really put them at risk to being able to socialize with other people.
[00:43:54] And so their anxiety looks uniquely different than other children from other [00:44:00] generations. And I think that’s also something to that, I wanna make sure to validate that parents are experiencing a part, particularly rough go of anxiety right now because of some of the things that have gone on in the world.
[00:44:10] Craig Canapari MD: I still feel like we’re seeing pandemic stuff shake out in children’s mental health Academically, socially, from a mental health standpoint, we’re still feeling those repercussions shake out. And I, I’m a, I’m an optimist. I’m, I believe in the resiliency of children, but I do think there’s sometimes some unique challenges that have come out of this. I really want to talk about accommodations because I feel like this is such an incredibly valuable concept for parents to understand in dealing with separation anxiety, dealing with fears, et cetera. And what parents need to think about when managing these things. Would you mind explaining what accommodations aresignificant accommodations are a term that is used typically to talk about anxiety and with parents [00:45:00] who have anxious children, or actually any children at all. Every parent makes accommodations for their kids. So let’s start there. Every parent makes accommodations for their kids. Your child might prefer that their sandwich is cut diagonally versus vertically.
[00:45:15] Danielle Garay PhD: Your child may prefer to eat off of the green plate versus the pink plate. Your child may prefer to sit on the right side of the car versus the left side. So there’s lots of accommodations that we do all day to keep our kids on their feet. And, it’s, and you do lots of those things to avoid power struggles.
[00:45:31] Accommodations in and of themselves are not a bad thing. We need them to be able to make our world spin and our children smile sometimes. Now there are unhelpful or unsustainable accommodations, and that is when the accommodation must occur for the child to be able to function.
[00:45:49] And it is . Parents do this to alleviate short-term distress. But then it creates long-term potentiation of the problem. So if you think about if your child [00:46:00] prefers their sandwich cut a certain way and you accidentally did it a different way or a parent that didn’t know, cut it a different way and we were out of bread, this is the only sandwich you have, and they absolutely
[00:46:09] cannot function if their bread is not cut that way or they cannot go to bed if mom is putting them down and, but they prefer dad or they like, it’s that kind of thing where the accommodation is something that cannot be done all of the time because sometimes mom needs to go to work and dad has to do it, or, sometimes the green sweatshirt is in the wash and so it has to be the red one today.
[00:46:31] It’s like when those accommodations are happening frequently enough and are at an intensity where it completely stalls the functioning of the home and they have to happen. So those are unhelpful accommodations or unsustainable accommodations. And so children who are anxious if parents look at their lives what I’ll do often when working with families is I’ll say I want you to take this week and just take stock of all of the accommodations that you find that you’re making.
[00:46:55] And parents will come back to me like, oh my goodness, I’m, I have so many accommodations that [00:47:00] I’m doing. I didn’t even realize like how many things I’m, I like how many different ways I’m bending over backwards and going through hoops to make my child’s day kind of flow. And so it’s, it doesn’t mean that you shouldn’t have any accommodations for your child, but we wanna think about how to reduce them and how to find the ones that are in this unsustainable pattern to be able to help your child learn.
[00:47:20] Like I can survive. Eating off the pink plate, I will continue to breathe if I wear the red sweatshirt, like it’s that kind of thing. But then generalizing it to bigger things I’m going to be okay to walk into school today without my mom, and I’m gonna be okay if my dad goes out to the mailbox.
[00:47:40] So taking a look at all of the accommodations and being able to to make some wise decisions about what is sustainable and what is not.
[00:47:46] Craig Canapari MD: the reason that this concept is so useful is because finding the right accommodations that parents need to address is the first step for parents to successfully manage these [00:48:00] issues. And it’s again, like I’m not an expert and I know you are, but just reading a bunch about this is, it’s like parents pick accommodations that actually, that you don’t like doing, right?
[00:48:10] Like that, that are difficult for you, that happen regularly. And then it’s really a parental behavior. It’s not the child’s behavior, right? you can you can tell your child you were leaving the room after five minutes. that’s making a change. The change can’t be, and your child has to stay in the room.
[00:48:28] you are expected just to change your own behavior as a parent.
[00:48:31] their behavior because they’re so used to making accommodations and they know that not making certain accommodations are going to be, it’s gonna be uncomfortable, and they just want to know that it’s okay. Then they wanna know, okay, how do I do it?
[00:48:51] Arielle Greenleaf: Then they need the support to enforce it and stay consistent with it. So I think that’s, I think that’s, it’s [00:49:00] very common with the people that I work with because it’s like they know what to do. It’s just hard. It’s really hard.
[00:49:08] Danielle Garay PhD: Y So hard. So hard. Yeah. And I I think. Really, it’s said all the time, but parents are the experts on their own kids. we’re sleep experts, respiratory medicine experts, like we’re, we all have our little, niches that we fit into, but their child that no one knows more than the parent.
[00:49:29] And so being able to empower them to say, no, you’re the expert. I’m gonna give you some skills here, but you have the permission and also you have the, yeah the skills and the power to be able to do this. And I’m gonna partner along with you, but really you’re the star of the show to help, to set some parameters here, but the parameters as you said, Craig, like true boundaries.
[00:49:47] Should require the other person to do nothing. It’s it’s you setting the boundary for yourself. So if your child is hitting you, obviously you don’t want your child to hit you, but you say, I’m not going to let you hit me. I’m gonna keep myself [00:50:00] safe and I’m not gonna let you hit me.
[00:50:01] Or if they’re hitting a sibling, I’m not going to let you hit your sister. But it’s then removing yourself from that situation or removing the other child from the situation or whatever it is. But it’s, it is generally speaking it can be very freeing to know I can’t fully control your behavior, but I can control my reaction to it and how I’m going to receive it.
[00:50:18] And then helping the child build the skills to then have a different situation next time.
[00:50:23] Craig Canapari MD: Yeah, and I think you, you make a good point, is that a lot of times sometimes when these patients are making it to you. These are complex behaviors that have evolved over years. And they’re not it’s not like sleep training is six month old, which, you do it, you can get it done in you can do get it done in a couple of nights.
[00:50:41] Really this takes a mindful approach and it takes a little bit of time for people to really unpack these things. And I think in a, I’ll put, I’m gonna put in the show notes Eli’s Parent book, which I think is for most people, but we have some sleep consultants and some physicians that listen as well.
[00:50:57] He has a book for providers and in [00:51:00] it I, I stole, he has this protocol for a child that’s not slept in their own bed for years and how they get them in their own bed. And all it is basically, first of all, step one, make sure the child has their own bed. ’cause some of these families they’ve just piled a bunch of, books or something on the kid’s bed, and have the child pretend to go to sleep just for a short period of time, and then go in their parents’ room every night and slowly build up the child’s tolerance for being by themselves. And it’s just so important to, e especially in this situation, there’s an expectation the child has a little bit of discomfort, but not a lot of discomfort, right?
[00:51:38] That we should put tasks in front of them where they can succeed
[00:51:42] Arielle Greenleaf: I can build that for older kids is being able to see that they. They were successful. And I do a lot of like behavior charts, just simple bedtime routine charts. I brushed my teeth, I read my books, [00:52:00] I got into bed. It doesn’t have to be overly complicated, but they start to see, oh, look did it.
[00:52:04] And they even two and a half year olds, they can get so excited by the fact that they’re completing things and the parent is praising them in the morning and in the beginning if there is an expectation, slept all night in their own bed or something like that. And they didn’t get the sticker for that particular thing.
[00:52:24] You can still celebrate everything that they did and say tonight you can get that sticker if X, Y, z. If you sleep in your bed and you don’t even have to, even if you wake up early, but you’re quiet, if it’s an early waking child and they’ve been waking the parents at four 30 in the morning, but then they stay quiet until, hatch light goes off or something like that, until six, you can celebrate that win and celebrate all the wins, even if they’re little, and then slowly but surely, they want to please you and also feel success themselves.
[00:52:55] Craig Canapari MD: Daniellele WI hink this is an interesting point because [00:53:00] I do think in all, like kids, three and up, like reward structures, incentives are, can be very effective. And the flip side is, and a lot of this literature about dealing with like anxiety, it’s more about parental behavior change and dealing with accommodations like parents just changing their own behaviors.
[00:53:16] What, in what context do you think more we want to re reward or incentivize certain behaviors from a child versus another situations we’re just gonna change the parent behaviors. Do you do those two things at the same time? Do you do one in one context, one in another context?
[00:53:34] Danielle Garay PhD: Yeah, when there’s like a lot of loop or there’s a lot of different, like if you do this, you get one sticker. If you do this, you get two stickers. If it gets too complicated, then it gets too convoluted for the parent to remember and it doesn’t feel as rewarding for the kid.
[00:53:48] It could, it should basically be like very clear if this happens, you get this. If this happens, you don’t get this. And one thing that I will say about reward charts, you never take something away that a kid [00:54:00] earned If they got it on Monday, but they didn’t do it on Tuesday, you never take away Monday sticker.
[00:54:04] If they got it, they earned it. So yeah. But in terms of when to have like rewards slash incentives versus like parental change, everything requires parental change. There’s no plan or no intervention that doesn’t require parental change. ’cause the parents are the captains of the ship or the. they’re the pilots of the plane, and so they will always be involved and it will always be parental if the child, I would say that I usually just, I don’t have a fast and like a hard and fast rule about when to use reward charts versus not. I think some kids just really like that visual and they really benefit from having a way to mark progress.
[00:54:45] Whereas other kids you’ll know pretty fast if you try to do it and they don’t really care, then you know that’s not really gonna be that effective. So I, yeah I don’t know that I have a hard and fast rule. Do you, Arielle?
[00:54:56] Arielle Greenleaf: No, absolutely not. And I, it depends [00:55:00] like some kids really, just like you said, they just. They wanna see the, they wanna see their progress. They wanna see their wins, and they also wanna feel celebrated by their parents. Wow, even though you didn’t do this, look at all the things you did. And again, it doesn’t have to be complicated.
[00:55:17] Brush teeth, read books, got into PJs, whatever. Other kids, they don’t give two craps about it. They really don’t care.
[00:55:27] one of the biggest things I talk about with parents is what motivates your child? What does your child get really excited about?
[00:55:33] And how can we incorporate that into whatever plan we’re going to make? But I agree that there is no plan without parental change. Like parents have to change their behavior and their methods and their boundaries in order to see a change in their children.
[00:55:54] Danielle Garay PhD: my kind of gut, I guess is, oh, some of the kids that I see, these are really just learned behaviors around bedtime. [00:56:00] Like curtain calls. Kids go in their room, they come out, they come in during the night ’cause they’re used to doing it. It’s not really that fraught or emotional, it’s just what they’re used to doing.
[00:56:09] Craig Canapari MD: And a situation like that, a simple reward system like the bedtime pass or something, can work really well if it’s a child that’s interested in that sort of stuff. Whereas if you have a child that is really they’re so anxious they’re just explosive. They re it it’s hard. There’s no way the child would succeed with that structure because there, it’s just too fraught.
[00:56:32] I think you really need to take more of a, more of an approach of really. Parental behavior management and removing some of these accommodated behaviors but in a stepwise fashion. Because the child really, because they’re so anxious, they’re unable to make those steps themselves. And you kind you do get a feel for it, right? You do this for a while and you’re like, the parents have a feel for what, some parents [00:57:00] have been like, how about a reward system? Would they like stickers? And the parents will say no, they don’t care about that. And then you gotta think about something else.
[00:57:06] But also I feel if I, am I hearing a narrative where the, where there’s so much emotion wrapped up in it and the child really just isn’t functioning well, right? Like they they’re not able to do basic stuff that kids need to do, be in a room by themselves for five minutes. When they’re coming from a place of fear, rewards aren’t gonna be helpful.
[00:57:25] in listening to this podcast there, I’m sure there are just constant wealth of information of things to try and tips and tricks and things like that. And if you’ve tried some things as a parent and you feel like you’re constantly coming up against a wall or like you feel like, as Arielle said, if you feel like I, I need to have the steps to take, like I want to take them, but I don’t know exactly what to do and I need some guidance on that.
[00:57:48] Danielle Garay PhD: Seeking out a psychologist or a good sleep consultant on those things, like there is no shame in asking for help. And also the idea that you should just know how to do it Is [00:58:00] bunk, like the, this sleep is a behavior and it is, and something that you can get better at and that you can learn. And teaching your child to sleep better is a whole different beast.
[00:58:09] And I would say that if. Any parent that is like struggling with their child’s sleep should feel like they can seek out extra help It may just be that one session is enough for you to feel like, okay, I’ve got it.
[00:58:20] Let me go try these things. And it may be something where it’s a little bit more ongoing, where you need more support depending on how your child is. From the perspective of anxiety, I would say that if you notice that your child is experiencing real distress when they’re trying to go to sleep and they’re not able to go to sleep or their worries are really bothering them and it’s not something that they can dismiss.
[00:58:40] And it’s something that’s becoming more ruminative for them if it’s starting to bleed into daytime and start to impact their daytime functioning. If you’re noticing that it’s, taking away from their sleep so then they’re overtired during the day and that’s having impacts on different things, those are signs that that maybe bringing in a professional could be helpful to be able to check out some of those [00:59:00] things and give the child and the parents some skills.
[00:59:02] And. And the degree to which they may need help will vary on the child. But I would say that the key word is distress. If you notice that your child is experiencing distress, and that could be, as we talked about, that could be like that sensitive tearfulness.
[00:59:15] Or it could also be like anger and fr and irritability and frustration. If you’re seeing those kinds of things in your kids then I would say seeking some help would be a, more than warranted.
[00:59:27] Craig Canapari MD: I had say also too for parents, if you’re at your wit’s end and like you are also not functioning well as a result that’s a good time to reach out. And, it’s great to start with your pediatrician. Make sure you’re not missing a medical disorder. Often your pediatrician will know that.
[00:59:41] Providers in the community who can be most available and most helpful for you. I will put a link in the show notes to, I know Dr. Garay has talked about some resources in Psychology Today. Can help you find a therapist for your child. I’ll put some stuff about the books. Dr. Garay, is there any place that people can [01:00:00] find you online or that you want to plug today?
[01:00:04] I really don’t, you can come on down to Yale and come see me through the sleep clinic if you would like. We, we have an email box too, the sleep edit show@gmail.com. If people have questions, I think we’re gonna do a question show once we accumulate enough of them.
[01:00:21] hey take it easy guys. Have a good night.
[01:00:25] Thanks so much for listening to the Sleep edit. You can find transcripts at the web address Sleeped show. You can also find video of the episodes at that address as well as in my YouTube channel. You can find me at Dr. Craig canna perry.com and on all social media at D-R-C-A-N-A-P-A-R-I. You can find Ariel at Instagram at Ariel Greenleaf.
[01:00:55] That’s [01:01:00] A-R-I-E-L-L-E-G-R-E-E-N-L-E-A. If you like the flavor of the advice here. Please check out my book. It’s Never Too Late to Sleep. Train the Low Stress Way to high Quality Sleep for babies, kids, and parents. It’s available wherever fine books are sold. If you found this useful, please subscribe at Spotify or Apple Podcast and share it with your friends.
[01:01:21] It really helps as we’re trying to get the show off the ground. Thanks.