Ask us anything #1 (Ep 6)

[00:00:00] Craig Canapari MD: 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.
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[00:01:09] Okay, welcome back to the sleep edit. This is going to be our first, I don’t know if it’s ask us anything.
[00:01:16] Mailbag episode. I am Dr. Craig Canapari.
[00:01:20] Arielle Greenleaf: I’m Ariel Greenleaf, certified Pediatric Sleep Consultant.
[00:01:24]
[00:01:25] Arielle Greenleaf: Oh
[00:01:25] Craig Canapari MD: we asked you these few questions and my son said these
[00:01:29] Arielle Greenleaf: Yeah.
[00:01:30] Craig Canapari MD: which I think is actually incorrect.
[00:01:32] Arielle Greenleaf: deese nutz, yeah.
[00:01:34] Craig Canapari MD: But
[00:01:34] Arielle Greenleaf: he has a lot to learn.
[00:01:36] Craig Canapari MD: it was the only one like that I got. We solicited questions on Instagram via email.
[00:01:42] We also have a email for the show people can send questions to for future episodes, the Sleep Edit show@gmail.com. Let’s get into it. Let’s go through these Instagram ones first. They’re short and
[00:01:57] Arielle Greenleaf: All right.
[00:01:59] Craig Canapari MD: [00:02:00] Okay. What should the light set up be in a toddler’s room?
[00:02:04] Arielle Greenleaf: The light set up.
[00:02:06] Craig Canapari MD: You know what, I get this a lot actually. And what I would say to parents is, pitch black is the best but a lot of toddlers and younger kids like nightlights my kind of rule of thumb is first of all, it should be dark enough in your kid’s room that you can’t read while you’re sitting in the room.
[00:02:23] Read a book. And second of all, if your child insists on having a light, make it so the light is not shining directly in their eyes, you can sometimes put a lamp behind a piece of furniture, et cetera. The less the better.
[00:02:35] Arielle Greenleaf: Yeah, I think sometimes people come to me and Their problem is, oh he has to sleep with the light on And obviously that’s just not conducive to healthy sleep.
[00:02:47] Craig Canapari MD: Yeah. And there’s lots of different things you can do. I think in the last episode with Dr. Gray, we talked a lot about resources for fear of the dark. Can be very useful.
[00:02:57] Arielle Greenleaf: Yes, absolutely. I [00:03:00] think It’s best to say as dark as possible until your child says something about it. And they may never say something about it, but it may become a thing around the toddler years. But certainly an infant is not afraid of the dark.
[00:03:15] Craig Canapari MD: Yeah. So Ariel, this is a good one for you. Can you immediately stop using pacifier when sleep training?
[00:03:23] Arielle Greenleaf: So pacifiers can become a dependency. And if they’re a problem at night, then it’s best to just eliminate them for all sleep. And saying that it’s scarier for a parent than it is for the child. So the sooner you can eliminate the pacifier, the better.
[00:03:43] I would say it’s very hard to eliminate a pacifier. With a child over the age of 12 months, probably until age three. And sometimes it can really backfire. So in those cases, I often say let’s keep it until the child [00:04:00] has a more, has a better understanding of, reason you could reason with them a little bit better.
[00:04:05] That’s also the time, age three is like the time that we recommend for transitioning to a big kid bed or a toddler bed. Similarly, I just find it’s very difficult to get rid of the pacifier before age three, but I, so I would recommend doing it as young as possible. And no, after the newborn stage, obviously, ’cause it’s, it is a preventative measure for sids, but after the newborn stage, let’s get rid of it.
[00:04:32] Craig Canapari MD: Yeah, I was gonna say we missed that six month window. So then we had to do this elaborate pantomime with the Binky Fairy coming. And I remember my younger son just, he’s okay, you’re taking my pacifier. I’m taking my nap away from you. And that was
[00:04:47] Arielle Greenleaf: Ugh,
[00:04:47] Craig Canapari MD: so yes, sometimes there’s retribution, but I think it’s a lot harder to take it away from like an 18 month old or a 2-year-old.
[00:04:54] That being said, there’s two concerns. One are you having to replace it a million times in the middle of the night? [00:05:00] Then you might need to get rid of it. The second is, is there any concern about the child’s dentition? And really, it’s not a concern typically until your child starts losing baby teeth,
[00:05:10] Arielle Greenleaf: yeah, absolutely. I also, I missed the memo on getting rid of the pacifier, so my daughter had one until about age three, and then I was able to show her that there was like a crack in it, and she saw that it was dirty and that grossed her out, and she was done with them. She was a little fussy like the first night, but after that it was like, it didn’t even matter.
[00:05:32] Craig Canapari MD: Well, there you have it. Just swap your child’s fear of not having the pacifier with germophobia and you’re all set.
[00:05:38] Arielle Greenleaf: Yeah.
[00:05:39] Craig Canapari MD: the here’s a good one. How to introduce room sharing. And I think there’s a question a little bit further on about this, but I’d say that in general, parents overestimate the difficulty of room sharing.
[00:05:51] It’s a relatively recent idea and in only in really western countries that kids are gonna have their own room. And that often [00:06:00] parents I think, worry about this more than. think they need to.
[00:06:05] The idea is that you room share but not bed share with your infant for at least the first six months of age. So it’s not like when there’s a new baby that you’re necessarily moving them right into the older siblings room, which is the hot button time when parents are worried about it. Most parents do just fine with room sharing and the parents really shouldn’t feel guilty about it.
[00:06:23] Arielle Greenleaf: I see the question is more about introducing room sharing to siblings. Is that correct?
[00:06:31] Craig Canapari MD: yeah, I it’s a short
[00:06:32] Arielle Greenleaf: Yeah, I know, it can’t possibly be introducing it with parents. So I would say from my perspective, when I’m in a situation where, for instance, there’s a baby and there’s a three-year-old or something and they want the baby, they wanna move the baby out of the room into the siblings room.
[00:06:50] ’cause I’ve had this a lot, a lot of times people are like, I need the baby to sleep better so I can move them into the toddler’s room or the big [00:07:00] kid’s room. And so I always recommend doing the sleep training in the parent’s room and then moving once that’s done, moving the ch the baby into the older child’s room
[00:07:12] In many cases, what we do is remove the parents from that room. If, sometimes they’re sleeping on a couch, it’s just a couple of nights, and then they go back into the room, baby’s sleeping better, and then they can make that transition to the older child’s room. So I don’t recommend sleep training the baby in the older child’s room with the older child there.
[00:07:33] Craig Canapari MD: Yeah it is. I think it, it is possible especially if the older child goes to bed later. Sometimes I’ve had parents sleep train the if they’re already in the room, have actually move the older child who’s sleep, right? It’s usually the older child who’s sleeping better into the parents’ room for a few nights is another way to do it.
[00:07:54] For the middle of the night awakenings, they tend to actually disturb the older siblings less than parents think [00:08:00] they will, because, little kids sleep so deeply. It tends to be less of an issue than people anticipate.
[00:08:06] Arielle Greenleaf: And that’s similar to multiples. So if you have multiples, parents are always freaked out that the twin or the, whatever is going to wake the other. And in almost all cases I’ve experienced that’s not the case. They sleep right through it.
[00:08:24] Craig Canapari MD: Here’s a good one without a really clean answer. Tips for jet lag when flying overseas. Kids waking up at midnight to have dinner.
[00:08:31] Arielle Greenleaf: Ooh, I’ll let you take the first stab at that one.
[00:08:37] Craig Canapari MD: Sure. First of all, in my experience, a lot of the times the kids adjust more quickly to the new times than the parents do anyway. For parents on relatively short trips. if you’re flying east, so all of a sudden your child’s natural bedtime is at eight, you fly to Europe, their natural bedtime, is like midnight or one in the morning.
[00:08:58] It can actually be, if you have a short [00:09:00] trip, like three or four days it can be fun to just stay in the later schedule. European hotels and homes tend to have these really wonderful shutters where you can keep it very dark and just to have your kids stay up later and stay on this home schedule is often the easiest thing to do.
[00:09:17] It’s actually a little bit harder to fly west because all of a sudden your kid wants to go to bed really early and get up really early. That’s less fun for parents than being like, oh, we’re going out to dinner in Paris at, at nine o’clock at night, it’s oh, we’re we’re seeing California at three in the morning.
[00:09:34] I would say that generally there’s no kind of magic solution here. If you know your kids are going one way or the other, you can try to habituate them a little bit. Melatonin honestly is tricky. Jet lag questions are hard because you really need to know the time zone someone’s originating from and where they’re ending up and what their sleep schedule is to provide granular information about the timing of melatonin or light exposures.
[00:09:59] There are calculators for [00:10:00] this online, and it’s more, it’s same for kids and for adults, but I’d say most of the time, if you’re going for a really short trip, keep them on the same schedule if you can. If you’re going for a longer trip, they’re probably gonna habituate pretty quickly.
[00:10:10] Arielle Greenleaf: You? Yeah, I usually just suggest getting them outside and into the sunlight if they’re able to and try to. Not force the schedule like a normal schedule. It depends. Again, it depends on how long they’re going for. So if they’re going for a longer trip, I just encourage getting outside into the sunlight, trying to reset the clock.
[00:10:32] ’cause sometimes I’ve had people who, they go visit family for a month in the summer or something like that. And so in those cases, sunlight is your best friend, in my opinion, when it comes to adjusting to any time differences.
[00:10:46] Craig Canapari MD: Natural light is very helpful. And also just being a little bit careful with screensI think in general, light can be tricky if you’re doing longer trips, like going 12 hours or more, light can sometimes push you the wrong direction. But that’s prob that’s [00:11:00] like a whole discussion.
[00:11:02] For most vacations people are traveling. three to five hours where it’s enough that they may feel it a little bit, but it’s not so far that it’s a complicated math problem to figure out what to do.
[00:11:14] Arielle Greenleaf: Okay. Okay, here’s one. How much movement during sleep is typical in an elementary schooler and how can I tell if my child is getting quality sleep? Solid bedtime routine and appropriate bedtime are in place?
[00:11:30] Craig Canapari MD: Oh, I’ve got this one. This is I think this is a very interesting question. Generally little kids move more than grownups. If a child’s got a solid bedtime routine and going to sleep without difficulty, that’s one box you want to check because some children who move a lot at night do have a condition called restless leg syndrome.
[00:11:51] They will complain that their legs bother them at night, but sometimes they’ll just say, my legs are, my feet are hot, [00:12:00] or I feel like there’s ants on my legs. Sometimes they may not say anything about them, but the parents will just notice they’re fidgeting, they’re kicking a lot, et cetera. But the key is they’re having problems falling asleep as well.
[00:12:11] If a child is falling asleep at bedtime without complaint, they probably don’t have restless leg syndrome. The other thing to think about is there is a newly described disorder called restless sleep disorder. This is adjacent to restless leg syndrome, but there’s no sensory phenomenon in the evenings.
[00:12:29] But parents will describe their kids flopping around like a fish or helicoptering around the bed, like sort of kids whose blankets are everywhere. The key part of that diagnosis is that children are also struggling during the day.
[00:12:44] They may be, have difficulty getting out of bed, which is again, not typical of a younger child more typical with adolescents or have having irritability during the day, et cetera. If you’re concerned about that, typically it’s a good idea to see a sleep physician. [00:13:00] Usually is a sleep test involved in the diagnosis and the treatment is usually checking a blood mi iron marker called ferritin and treating that if it’s low.
[00:13:08] So yeah, if your kid flopping around a lot at night they’re getting what seems to be an appropriate amount of sleep, but they’re having problems getting up, but they’re irritable during the day. It’s probably worth talking about with your pediatrician.
[00:13:19] Arielle Greenleaf: That’s interesting. I think a lot about my clients of younger, on the younger side, so infants young toddlers and parents are always concerned about children moving in their sleep. She must not be sleeping. She’s moving around and I. I would say probably 90% of the time it’s just they’re moving in their sleep.
[00:13:44] And I think there’s definitely, you see the ones who are cause for concern, but I would think that, how, what percentage of children suffer from that particular, medical diagnosis?
[00:13:59] Craig Canapari MD: [00:14:00] Yeah, I think they restless leg. It’s not uncommon. It’s probably 3% of kids which doesn’t sound like a lot, but most kids don’t have any problems. Restless sleep disorder is newer, so it’s more like the prevalence of kids presenting to sleep clinic, which of course is a highly selected group of people that have access to a sleep clinic.
[00:14:20] Somebody’s concerned enough to ask for a referral. They’ve waited long enough for a clinic and the prevalence, there was like 10% of kids referred to a sleep clinic. I would say yes, most of the time your kid seems to be sleeping and they just move and you don’t know it unless you go on a vacation and share a bed with them.
[00:14:37] typical history of these kids when I see them in clinic is oh yeah, there’s one kid in the family. No one wants to share a bed with them when they go on vacation.
[00:14:43] Arielle Greenleaf: yeah, I’m thinking more of, modern technology and parents, you and I both have feelings about video monitors but parents really just freaking out because of what they can see on their monitors.
[00:14:58] Craig Canapari MD: Yeah. It’s [00:15:00] one of those things. Sometimes ignorance is bliss.
[00:15:02] Arielle Greenleaf: All right. Do you wanna get into melatonin?
[00:15:05] Craig Canapari MD: yeah. Let’s get the melatonin.
[00:15:07] Arielle Greenleaf: talk about melatonin. About seven weeks ago, we began giving our daughter melatonin each night at the suggestion of her pediatrician. After years of having trouble falling asleep and being a restless sleeper, she is now falling asleep quickly and sleeping soundly.
[00:15:23] But how long do we continue this? Our daughter doesn’t want to stop taking it.
[00:15:28] Craig Canapari MD: That one’s from Christina. And you know what, Ariel, why don’t you read the next one too? ’cause I think these are related actually.
[00:15:36] Arielle Greenleaf: Kenzie says, what are your thoughts on melatonin? Our pediatrician said, if your child is not sleeping well, the benefits of melatonin for a short time probably outweigh the risks. But what does the data say about long-term usage? That’s a great question.
[00:15:52] Craig Canapari MD: And that’s from Kenzie. So I think this is A really important topic. the background is melatonin is a hormone that your [00:16:00] body naturally makes. Typically melatonin is undetectable in the blood till about an hour before your habitual sleep time. It starts to rise up when it’s first detectable in the blood.
[00:16:10] We call that the dim light melatonin onset. And melatonin secretion continues throughout the night until an hour after you wake up.
[00:16:20] When you take melatonin over the counter, it is way over the amount of the physiologic amount that is being secreted in the blood and melatonin, if you take it the fancy word is exogenous. If you take a melatonin preparation has two effects. Most people who are giving their children melatonin, are looking for the hypnotic effect, which is the sleep inducing effect.
[00:16:42] That does not happen in every person. But it happens in a substantial number of them. So some parents will try melatonin and be like, oh, it didn’t work. There’s no reason to keep escalating the dose. The other is the chronobiotic effect, which is the effect on sleep schedule adjustment. M relief, [00:17:00] dosing for that.
[00:17:00] That’s if someone is staying up super late, you wanna move the schedule earlier, we’ll use a very low dose of like quarter to half a milligram at dinner time. So talking about hypnotic dosing and melatonin, first of all, I would applaud both of these parents because they discuss this with their children’s pediatrician.
[00:17:18] Certainly I can tell you that melatonin, although it’s over the counter, it’s a hormone and I can’t, the only other hormone I can think of that is taken over the counter is, believe it or not, vitamin D is also a hormone. But, other hormones we think of that people may be prescribed are things like testosterone or progesterone or estrogen.
[00:17:38] because of some. Complicated issues about the way melatonin is reg regulated.
[00:17:43] It’s treated as a food supplement and the quality is not that good. Sometimes the dose is high, sometimes it’s low. Short term melatonin dosed appropriately seems to be totally fine, like safe if you’re giving it with the advice of a medical provider. You’re also working [00:18:00] on behavioral sleep issues at the same time because it’s not magic, it’s not anesthesia if there’s other stuff going on.
[00:18:07] If your bed bedtime is mistimed it can be very helpful. The appropriate dose for someone who’s less than 40 kilograms, which is about 88 pounds, is one to three milligrams for children over 88 pounds or 40 kilograms in the uk. Or else, anywhere else in the country, in the world, would be up to five milligrams really.
[00:18:28] I start people on half a milligram of melatonin. I like ones that have third party testing. for example, say NSF tested start at half a milligram and slowly titrate up by a milligram a week. And I’d say use it for a couple of months while you’re also making sure your child doesn’t have a device at bedtime.
[00:18:49] Making sure the bedtime is age appropriate. In situations like this, for Christina a child having long-term difficulty struggling asleep, one of the terms for this is chronic insomnia of childhood [00:19:00] and melatonin is well studied in it. It definitely can be helpful and it sounds like it may be with the other child for a short term trial, it’s less clear what the background history is. We actually don’t know what the effects are of long-term melatonin, but the limited data we have Beth Malow, who has done a lot of research on, melatonin in autism.
[00:19:22] It did trials of about a year showing that it did not lead to premature puberty or changes in hormone profiles in children with autism taking melatonin for about a year. That being said, I think like with any medication, we use it for the, that we use the minimum dose we need for the shortest period of time.
[00:19:41] So when parents are interested in coming off of melatonin after they’ve been using it for a while, often I’ll just ask ’em and be like, just see if you can cut the dose in half. If it’s more than a minimal dose, more than half a milligram or a milligram, and see how that goes. Try it for a little bit and then try skipping it.
[00:19:56] And it may be a disaster in which case I think [00:20:00] you could restart and then try again in a month or two. Recognize though, there is also a psychological dependence when somebody said, our daughter doesn’t wanna stop taking it. And I think it’s worth with, I don’t know how old that child is, but it’s worth thinking about.
[00:20:12] To talk about your child, be like, oh, some, we’re gonna, we’re gonna use this for a while. We’re not gonna stop it without a warning. But think about when you feel comfortable, we might try without it and see how it goes and enlist the child in making a plan. And now we’re gonna get a guest on to talk about melatonin in detail.
[00:20:28] Arielle Greenleaf: Yeah I, it’s what concerns me is how readily available it is and how quickly parents just grab it off the shelves at Target or CVS Without understanding it really. And a lot of times I’ll see in Facebook groups moms who say, I’ve been giving my child melatonin and they fall asleep right away, but they’re still waking up all night.
[00:20:57] Why is that happening? And again, [00:21:00] it’s like people don’t understand. I think you make a good point that you need to be looking at the behavioral at the same time because I think people see that as the only solution to whatever their problem is.
[00:21:14] ’cause there have been several, another article about. Overdoses in young children because they find the gummies and they’re taking too many but sometimes parents just don’t know what they don’t know. And like you said, the dosages are totally different on, you could take four different brands and they’re gonna be totally different from each other.
[00:21:35] So that’s concerning to me. And it is just a bandaid in many cases. So that’s, concerning from that perspective.
[00:21:43] Craig Canapari MD: I would say that there’s some important things you just said. First of all, yeah, it’s basically candy, right? It’s a gummy. We used to think that it was pretty, the overdoses weren’t serious, but there was a big trial. It’s definitely one of the most common reported accidental ingestions.
[00:21:57] And a small subset of children were getting hospitalized, and they even [00:22:00] reported a few deaths associated with it. So it is not totally benign. The other thing is that the melatonin dose is too high, can cause nighttime awakenings and nightmares. So parents are like, oh my God, my kid’s falling asleep great, but they’re waking up in the middle of the night and you’re like you probably need to cut your dose back. And sometimes it actually works better at a lower dose. So that’s why starting at a lower dose and stepping up, it’s much more helpful. Now, there are a subset of conditions that. It’s very helpful in, and there’s a lot of evidence for one is attention deficit hyperactivity disorder, another is autism.
[00:22:30] So as a pediatric NP nurse practitioner, I frequently get questions on how to help parents of children with autism, especially regarding themgetting them to stay in their bed, calm down and sleep through the night.
[00:22:44] Arielle Greenleaf: What advice, meds, or resources do you recommend, and that’s from Jen.
[00:22:49] Craig Canapari MD: so we talked about melatonin and there is a lot of evidence. I think the first key is. I guess for the next question to you is behavioral methods do work as well in children [00:23:00] with autism. But they often need more time and they need to go more gradually. And should back up if anyone’s not, most people are familiar with the term autism, but autism is a neurodevelopmental disorder associated with like rigid and behavior and kind of stereotype behaviors like repetitive behaviors and social difficulties.
[00:23:18] It’s becoming more and more common for reasons we don’t understand. And it really, from a sleep standpoint, it can be incredibly challenging. Every child with autism has sleep problems, but many of them do. In my world, often kids will present to my clinic at age one or two. The parents are doing everything right and their sleep is totally dysregulated.
[00:23:39] It’s all over the place. And often I feel like those kids tend to go on, especially if there’s developmental or language delay to have an autism diagnosis. So often parents are actually even struggling with the sleep issues before they even get an autism diagnosis.
[00:23:56] Arielle Greenleaf: I’ve definitely seen that in my experience and you can [00:24:00] see it from early stages and in every case that I’ve been suspicious about. The parent has come back later and said that the child has is on the spectrum.
[00:24:12] Craig Canapari MD: There are some children that only have minimal impairments and there are some children that really are struggling quite a bit. Physical activity during the day, especially vigorous physical activity is incredibly helpful.
[00:24:25] So parents will say my kid’s in school during the week. and they struggle with sleep. And on the weekends we go to the playground, the trampoline park, and they sleep a lot better. So I think thinking about ways to get physical, a lot more physical activity is helpful.
[00:24:40] I think that a lot of parents of children with autism resort to screens which is understandable, but it can be toxic to sleep at bedtime. And actually a lot of autistic children also have sensory issues.
[00:24:53] So a sound machine can be helpful. Some children like to be hugged or squeezed. Like parents will say, my kid [00:25:00] comes into my room and they want, they press against me really hard. They want me to hug them really tightly. In that situation, sensory measures like a weighted blanket or my preference is actually for a Lycra sheet, like a stretchy sheet around the bed can be quite helpful.
[00:25:14] I prefer a Lycra sheet because they’re not hot compared to the weighted blanket, they don’t fall off. And they’re a lot cheaper. You can get one for 20 bucks on Amazon. I’d also just plug this book Solving Sleep Problems in Children with Autism Spectrum Disorders. This came out in 2014.
[00:25:32] I think they should update it. It is literally the only book on the market. And Beth Melow, who’s at Vanderbilt, who actually, I really want Beth to come on our podcast soon. She’s great. She has two daughters with autism, so she knows personally what she speaks of as well as professionally. The book is great for parents and for providers.
[00:25:51] Arielle Greenleaf: So the next question is my three-year-old autistic son used to sleep through the night until he started needing someone in the [00:26:00] room with him. Are cried out methods, okay, for toddlers age three and up, or is it considered abusive? We tried the chair method, but daylight saving time disrupted our progress.
[00:26:12] This is from Chris M.
[00:26:14] Craig Canapari MD: Yeah daylight sa it’s funny, a couple years ago we tried to do a research project. We never got off the ground in the autism clinic to look at sleep disruption from daylight savings time, which seems to be far exceed what you would expect in terms of sleep disruption. In this pot clinic population they are very, they do tend to be very sensitive.
[00:26:36] So to tackle this, I think first of all, cry out in a 3-year-old is tough and would not be my preference. I wouldn’t call it abusive, but I also feel in children with autism who have a lot of difficulty with self-regulation, especially. They could cry for an infinite amount of time. They could cry all night.
[00:26:57] And it’s not that I hear the [00:27:00] desperation I’m reading between the lines here. The chair method could be difficult as well. I think you might have to go very slowly. The other thing is, if he started needing things in the room with them, it may be worth exploring. is there a sensory issue or there’s some nighttime fears?
[00:27:13] Is there some anxiety? Certainly in the US at least before age three, birth to three will help children like Chris’s son after age three. It’s often through the school district. Some children also are receiving ABA therapy for autism. And working on some of these issues during the daytime can help at nighttime.
[00:27:33] He may, this child may or may not be verbal if he isn’t maybe worth exploring if there’s some nighttime fears and trying some other strategies, this child might well do well with a huggy puppy style intervention. I would say just go very slowly, predictably with the child. One intervention my colleague described once, Arielle, we’ve talked about this bedtime charts can be really helpful and provide real predictability and for nonverbal kids actually.
[00:27:59] I had one [00:28:00] colleague just had a Velcro strip in the bedroom. And every time the child did one of the activities, like they had a toothbrush, they had a little tiny book, they had a little tiny blanket. The child would pull it off, the Velcro, put in a bucket, and that was the signifier, that it was time to transition to bedtime.
[00:28:16] But Chris, yeah, I would say absolutely the daylight savings time stuff give it time. Hopefully it will get better in a week or two. Right now when we’re taping this, we’re about a week out. So by the time you listen this, hopefully it’s better. But I encourage you to have a team and to have people help you work on this.
[00:28:33] It is a challenging set of issues. Okay. The next theme is night nursing and weaning. “My 4-year-old baby woke up almost every other hour at night due to a cold and I bed shared and nursed her back to sleep each time.
[00:28:47] Now she demands two to three feedings a night. How can I reduce her night feeds so she can sleep for longer stretches?”
[00:28:55] Arielle Greenleaf: That’s tricky. The first issue [00:29:00] right off the bat is I. If I was looking at this, first of all, I’d wanna know what does daytime feeding look like? ’cause I don’t wanna say, oh, you shouldn’t feed your child that many times without knowing if the child is getting enough during the day.
[00:29:13] Let’s say that the baby is getting enough during the day and they’ve just become, the sickness kicked off around the four month mark, which is tricky anyway. And now the child is just dependent on a parent coming in and maybe not even hungry, but now is dependent upon that feeding to fall back asleep.
[00:29:37] Now, I would say though, if, and did they say, have the feedings increased? Was that included?
[00:29:46] Craig Canapari MD: It sounds like it increased reading between the
[00:29:49] Arielle Greenleaf: So if the feeding is increased, then. You’re probably not dealing with hunger. It’s more likely that it’s a dependency. So I think you [00:30:00] have to start from scratch.
[00:30:01] And, several of you know our other episodes addressed sleep training, and I would definitely say this is a good case for sleep training. I would also take a look at your daytime feedings, make sure there’s enough going on there. Young infants often need to be nursed eight times a day, and if they’re only nursed five times a day or four times a day, they may be hungry overnight.
[00:30:27] But then I would pull back and look at how is this child falling asleep? Are you nursing her sleep, or are you putting them down independently and walking away? If you are nursing, there’s some sort of a dependency here. So if you are nursing to sleep, you’ll wanna look at ways to back off of that and help your child learn to fall asleep independently.
[00:30:51] That’s ultimately the goal. We have to start at the beginning of the night and stay consistent throughout the night. And that’s not to say don’t feed your [00:31:00] baby, it’s just to say that you don’t need to feed your baby every hour overnight, as long as they’re healthy and regularly developing, and you don’t need to attend to them, every hour during the night if they’re normally developing and healthy.
[00:31:16] Craig Canapari MD: It is such a nuanced question, right? Because I’d say that if you’re changing your kid’s diapers multiple times during the night, it’s probably really a full feed. Whereas it might be also just nursing for comfort. not every four month old is quite ready for sleep training, but I think that yes, this would fall under what a lot of people call a regression, right?
[00:31:32] Your kid gets a cold. And the interesting thing about what Xiaofan says here is it like. The child was sick and then the mom changed her behavior and then the child responded to that. And this is parenting, right? It’s a, it’s a dance
[00:31:45] Arielle Greenleaf: It’s interesting that you say that ’cause that makes me think of our episode that’s about to drop with Dr. Garay and talking about how, a lot of our sleep troubles are our own [00:32:00] faults because we’ve changed our behavior and in doing so, we’ve created a new habit or accommodation as we were talking about that the child becomes dependent on.
[00:32:11] Craig Canapari MD: Oh yeah, no, I think I we’ve all seen the kids where ev the kids where the kid was sleeping great. Then they went on vacation, they bed shared, and then you see them two years later and they’re like, yo, this is how it works now. But yeah. Xiaofan, eo, this is your child is so young. This is likely gonna get better.
[00:32:30] I suspect the time anyway, but more, yeah, the things to do as Arielle talked about might speed this up a little bit for you. Here’s another one. This is actually from my pal, Dr. Michelle Caseta, who’s a a local pediatrician where I work. What are your thoughts on mom’s breastfeeding? They’re three month old to insert age here, I think it probably 24 month old, 36 month old all night from their bed.
[00:32:53] If no one is complaining, is there an age at which breastfeeding should stop to prevent dental caries [00:33:00] or can it continue until a parent wants their bed back?
[00:33:03] Arielle Greenleaf: I think that’s a really tough question because, we have to look at different cultures have different ways of doing things and raising children. I particularly follow the AAP guidelines of safe sleep. And so I personally never recommend bed sharing. I know it happens.
[00:33:23] I’m not judging anybody. I’m just saying I would never work with somebody that wanted to bed share. I would certainly help someone get away from bed sharing, but to me that’s just a no go. If they’re happy, then I’m probably not hearing from them.
[00:33:40] Yeah. If they’re happy, and I don’t think we can make that decision for people, because in my opinion, it should never have started. ‘but again, if they’re happy with what they’re doing, then we’re not hearing from ’em.
[00:33:55] Craig Canapari MD: Dr. Caserta is a primary care doctor and they are. And I think a couple of things to [00:34:00] shade this for. So let’s to take the safe sleep out and say this is like a nine month old or a 12 month old. I think that sometimes when these patients come into my clinic, it’s because the nursing parent is happy and the nursing parent’s partner again, ’cause I don’t wanna be too gen heteronormative here is not happy.
[00:34:18] And sometimes it can create some conflict.
[00:34:22] Arielle Greenleaf: I think that you just need to look at when is it appropriate for a child to stop feeding overnight? And it’s very difficult to stop feeding overnight if the child is bed sharing with you. So I would often get questions. I’m not con, I don’t wanna stop co-sleeping, but I wanna stop nursing all night.
[00:34:45] And it, I don’t know how, I’m sure there are people out there that work with this, but it’s like getting back to the idea of you’re you are right in front of them. They can smell your breast milk and you’re saying [00:35:00] no.
[00:35:00] But I would definitely say that if a child is old enough to not need to be eating overnight, certainly there’s a cutoff age for you.
[00:35:07] Craig Canapari MD: Yeah. And I think also too about the dental caries is an important point.
[00:35:12] Arielle Greenleaf: it’s absolutely true. I think that this kind of is a little bit of a throwback to the heyday of attachment parenting, right? The sort of Dr. Sears idea that you should just essentially be nursing your, have the family bad, nursing your children until they go to college or what have you.
[00:35:26] Craig Canapari MD: I feel like I’m seeing this a little bit less than I used to. But maybe just ’cause those families don’t want to hear from me. I think that it’s. Yeah, as pediatricians, just like you, Ariel we’re like very sensitive to safe sleep topics, but, different strokes for different folks, right?
[00:35:43] My kind of take on it is everyone, is that bed sleeping well at night? Then it’s probably okay. But if somebody is not sleeping well it’s probably worth addressing.
[00:35:55] Arielle Greenleaf: Yeah, I totally agree.
[00:35:58] Craig Canapari MD: So here I [00:36:00] got, I, okay, I got some more for you. Under the heading of sleep training challenges, my 2-year-old son still requires a bottle and rocking to go to sleep and sometimes wakes in the middle of the night crying for us. How do we break the cycle? Cycle of bottle feeding and rocking to sleep? From Eli.
[00:36:17] Arielle Greenleaf: You have to just stop doing it.
[00:36:20] Craig Canapari MD: Eli, we’re not making fun of you. You’re reaching out, which is the first step to fixing this. But yeah, sometimes you just have to stop doing things you don’t like
[00:36:26] Arielle Greenleaf: Yeah. And I always hear, my child requires, and it’s,
[00:36:31] Who’s the parent sometimes. But I get also that you’re tired, like you just resort to what is working, even though it’s not really working. Ultimately, you just, you have to stop the behavior that’s causing the problem, and that is the rocking and the bottle. A 2-year-old does not need a bottle overnight.
[00:36:51] And again, we’re talking about the teeth. But from a nutrition standpoint, again, if your child is normally developing and healthy, they do not need a bottle [00:37:00] overnight. So this would be a case of investigating the various sleep training methods to start down a path of teaching your child to sleep independently.
[00:37:12] so yeah, I think all you just, you’re gonna have to stop the behavior and figure out the best method that feels right for you and your family.
[00:37:23] Craig Canapari MD: Eli did mention if the child is also receiving calories during the middle of the nightI’ll start, I agree that it’s 2-year-old. You should probably just throw your bottles out. Maybe hide them in the attic or something if you’re not gonna have another kid.
[00:37:35] But you know what? Burn your ships, right? Just be like, okay, we’re not doing bottles anymore. Your child is not gonna starve to death. If you want to go more gradually, you could keep the bottle, but move it earlier being like, okay, we’re not doing a bottle in the bedtime, we’re having our last bottle at dinner.
[00:37:50] You can have a sip. I, again, I’m like, just get rid of it, but
[00:37:53] Arielle Greenleaf: Yeah, I think that method works. I usually encourage parents to move to sippy cup, or a straw, like a straw cup, [00:38:00] which is what the dental community recommends And.
[00:38:04] Craig Canapari MD: Yeah. I always hated those though. ’cause they’d be like, all the little pieces would get lost in the
[00:38:08] Arielle Greenleaf: Yeah, just any of them. Sippy cups are the same way. Water bottles are the same way. So you’re right. If you want, you can say, if it’s hard to know how far into two your child is, because on the earlier side, they’re not gonna understand as well if your child is two and a half, close to three, it’s possible that you can say, you can talk to them, you can have a conversation or at least tell them what’s going on and what you’re planning to do.
[00:38:35] And then just consistency is really key.
[00:38:40] Craig Canapari MD: consistency is key. And it is. I think as parents Eli, I don’t want you to think we’re coming down too hard on you. Sometimes it just comes out, if you don’t like something, you just gotta fix it and your kid will probably adapt pretty quickly. Burn the bottles. Outside, you don’t want to inhale them like an outdoor fire
[00:38:55] Arielle Greenleaf: You can add the pacifiers too.
[00:38:59] Craig Canapari MD: here’s [00:39:00] one will removing a middle of the night sleep crutch for a toddler result in split nights as they adjust to falling back asleep on their own. I’m guessing this is a pacifier. Natalie, this is a question from Natalie. She did not specify,
[00:39:12] Arielle Greenleaf: a bottle
[00:39:13] Craig Canapari MD: A bottle, maybe.
[00:39:15] Arielle Greenleaf: a bottle. Middle of the night. Sleep crutch or rocking or, it could be anything really.
[00:39:22] Craig Canapari MD: No. Yeah, I think it’s really, it’s something that you have to deal with as a parent, right? So if you have to replace, if you have to rock your child, as you said, if you have to get a bottle, if you have to, find the pacifier that they have flung out of their crib and put it back in their mouth. if you get rid of that, they probably will complain for a little bit. But you are probably gonna be sleeping better within a week if you
[00:39:49] Arielle Greenleaf: Yeah, I think that’s the thing that a lot of people are afraid of. Like they’re scared, these children are demanding things and they’re afraid [00:40:00] that what if they change their behavior the child is gonna complain for a very long time. And the truth of the matter is, children adapt quickly if we are consistent in what we’re doing and they’re on an age appropriate schedule, A lot of times people are transitioning out of the Merlin sleep sack or something, or out of the SNOO, SNOO is a lot harder. But it’s much easier than you ever anticipate and I always like to say, your choice is you can change the behavior and have some complaining probably for a week or so, or you continue down this path and there’s no end in sight.
[00:40:38] So that’s ultimately your choice, but those are the two options that you have.
[00:40:44] Craig Canapari MD: I think, yes, sometimes as parents, we are so afraid to make these changes because the reason these things have evolved is because it is the way that we are surviving. When you like I remember doing this with my kids being like, I hear the first stirring in the monitor, and I would be flying out of my bed to [00:41:00] stuff the pacifier back and to one of my son’s cry holes, right?
[00:41:04] Just because I did not I was afraid that they would be awake for longer. And I manufactured this problem for myself. And Natalie, I encourage you, Take that crutch away, everything’s gonna be fine.
[00:41:18] Arielle Greenleaf: Yeah. Truly just have faith in yourself and have faith in your child. Children learn so quickly.
[00:41:25] Craig Canapari MD: So here’s another sort of bete noire for many parents. When I experienced my myself, early morning awakenings. How do you deal with early morning awakenings? Four 30 to five in the morning in a 10 month old
[00:41:41] Arielle Greenleaf: Okay oh, early morning wakings are so challenging. There are so many different things that can cause early morning wakings. One of them is, we talked about having a dark room. Some chill are just extra sensitive to light. And if the sun is rising early, they will [00:42:00] open their eyes, see that it’s light and wanna wake up.
[00:42:03] If this is something new, then it’s probably related to something else. And one of the things Dr. Canapari and I talked about was, I don’t know how many naps this child is on. Is there a nap transition happening? Do you need to drop a nap? Is there too much daytime sleep? A lot of times I, what I usually look at is sleep totals.
[00:42:26] How much is this child usually sleeping overnight? How much is this child usually sleeping during the day? And someone just texted me today asking, it’s actually a colleague just asking for some advice about a six month old who is only sleeping 13 hours a day. Now 13 hours is still within normal, but it’s lower in the sleep needs.
[00:42:48] So we had to look at it and really get a limit daytime sleep to two or two and a half hours if you wanna expect at 11, 10 and a half or [00:43:00] 11 hour night. So looking at when is bedtime, what’s happening during the day is really important. One of the biggest mistakes I think parents make with early wake up is just getting your kid up.
[00:43:14] So I think what can be helpful is, I don’t know if you’ve done any sleep training, but I would recommend. treating it like a nighttime awakening because 4:30 is it’s nighttime. That’s really early.
[00:43:29] Craig Canapari MD: If someone tells me five 30 to six, I’m like, your kids, you have to live with that. Four 30 to five. That’s.
[00:43:37] Arielle Greenleaf: That’s too early. Yeah. So those are the things that I look at. It’s often a scheduling issue and s Yeah, so it, I would say it’s usually a scheduling issue or the light, having the room not completely pitch black can really make a difference.
[00:43:55] Craig Canapari MD: The, to amplify what you said, I’d say if this child is falling asleep [00:44:00] independently at bedtime. This is probably a scheduling issue. If the child is not falling asleep independently at bedtime, working towards independent sleep at bedtime, AKA sleep training, we’ll likely address this. The other thing is looking at what you’re doing, it is very easy to take your 10 month old into your bed at 4:30 in the morning and that will perpetuate this.
[00:44:21] Arielle Greenleaf: Exactly.
[00:44:23] Craig Canapari MD: so we dealt with this, with my younger son. I didn’t know you then. he would just wake and talk and I would
[00:44:31] bring him downstairs ’cause he was waking everybody up, lie down next to him on the ground with a pillow and he would. Just look at me and talk and stick his hands in my mouth for 45 minutes.
[00:44:44] Arielle Greenleaf: What were you thinking?
[00:44:46] Craig Canapari MD: we have just,
[00:44:47] Arielle Greenleaf: Oh my gosh.
[00:44:48] Craig Canapari MD: I was tired, I guess what should I have done?
[00:44:50] He was falling asleep independently at bedtime. Should I have just ignored him, turn off the alarm, or, I think that’s what we ended up
[00:44:56] Arielle Greenleaf: what, like how early was he waking up?
[00:44:59] Craig Canapari MD: [00:45:00] Oh, 4:30 in the
[00:45:00] Arielle Greenleaf: Oh, yeah. So again, I treat that as a night waking. It sounds like you did sleep training with him because he was falling asleep independently at night. So I would recommend treating it with your method. It’s hard to get them it’s hard to be like a, a check and console method where you’re going in and outta the room at that hour. So if you have the stomach for it it would just not go in until it’s.
[00:45:23] Craig Canapari MD: I think that’s what we did. I think we ended up doing extinction because I’m old school but also because we just don’t wanna be messing around. That’s, the trap of the chair method, right? If you’re doing the chair method, doing it five times in the middle of the night is pretty
[00:45:35] Arielle Greenleaf: Yes, absolutely.
[00:45:37] Craig Canapari MD: Here’s another one From Gabrielle, my 22 month old daughter wakes for one to three hours in the middle of the night, several times per week. How can we help her get back to sleep faster?
[00:45:48] Arielle Greenleaf: To three times per week
[00:45:50] Craig Canapari MD: No sorry, forgive me. One to three hours in the middle of the night.
[00:45:54] Arielle Greenleaf: every night,
[00:45:56] Craig Canapari MD: I, several times per
[00:45:59] Arielle Greenleaf: several [00:46:00] times.
[00:46:00] Craig Canapari MD: It’s actually easier to understand if it’s, I. I, I feel like the first thing you have to do, Gabrielle, is some really careful sleep diaries because of some nights the, she is up for hours in the middle of the night and some nights she’s not.
[00:46:17] I feel like she’s getting some naps you don’t know about during the day or she’s falling asleep and the car in the way home from daycare, or she’s napping more at daycare. I feel like there, there is we’re missing a part of the story for those prolonged nighttime awakenings. It’s usually not a behavioral problem.
[00:46:36] It’s usually what Brett Kuhn calls too much time in bed syndrome.
[00:46:41] And this might be a kid where you think about, if it was happening every night, I hate to say it, but you might wanna see if getting rid of this nap made this better.
[00:46:49] Arielle Greenleaf: yeah, so I would say. I totally agree with the sleep diary, ibel. I believe in that for everybody that’s having struggles, particularly overnight, looking at [00:47:00] daytime sleep, looking at what the, what is the average amount of sleep your child is getting in a 24 hour period, and then how do you break that up between naps and night?
[00:47:09] So I would say this child might be having a really crappy night and then the next day, like catching up on sleep and then have a good night. And then they don’t need, they may still want a nap for three. You may let the child nap longer on a, after a bad night. And then the next day they sleep well ’cause they’re tired the next day.
[00:47:32] You let the child sleep as long as they want again during the day, but they’ve already caught up on the sleep that they missed and so then it’s affecting the overnight. I see that a lot flip-flopping. Sometimes daycares or, nannies or whatever. Caretakers don’t log all the sleep the right way or appropriately.
[00:47:53] Craig Canapari MD: Yeah. And I think that this is a situation where if your kid’s in daycare, for example, you have to be like, [00:48:00] okay, I’m working on my child’s sleep. I can, you just really be, gimme some detailed stuff about what, what’s happening.
[00:48:06]
[00:48:07] Here’s another one. My son refuses to sleep in his own room since his sister was born. He gets out of bed multiple times a night and doesn’t sleep for more than a couple of hours in a row. What do we do? This is from Hyglak,
[00:48:19] Arielle Greenleaf: I mean, it sounds like the child probably slept well previous to this because it’s in
[00:48:25] Craig Canapari MD: Let’s assume
[00:48:25] Arielle Greenleaf: Yeah. And I would say it’s very common because I, I’m assuming it’s probably a younger, maybe like 18 months, two, two and a half, something like that. 18 months don’t fully understand So I like to do a lot of work around hyping up the things of why is this baby getting more for the parents even, it doesn’t matter which parent giving that child one-on-one time every day, even if it’s for 20 minutes, if it’s outside at the playground for 20 minutes, if it’s reading books [00:49:00] together for 20 minutes, but one-on-one time without the baby. And then, you
[00:49:04] Craig Canapari MD: Absolutely
[00:49:05] Arielle Greenleaf: back to the, you get back to that idea of charts and say, you have to be a big kid and. And sleep in your own bed. Explain why the baby needs to sleep in the room. Tell them their role and have them model what it means to be a bigger sibling. And so turn it into a positive versus and I get it, if you have a newborn, you’re exhausted.
[00:49:29] So it’s tricky, but I think that those are the things that I would recommend.
[00:49:35] Craig Canapari MD: Yep. Praising the child for even attempts to stay in their room. How would you use a chart? Let’s get this talk specifics here.
[00:49:44] Arielle Greenleaf: so I just same, similar to what you were describing. I would use a, I like to call it like a behavior chart or I don’t like to say reward or whatever. ’cause you don’t necessarily need to use a reward because we know. That [00:50:00] children thrive on positive reinforcement. So it could just be a celebration at breakfast or something.
[00:50:06] I like to include just very simple stuff, got ready for bed brushed teeth, read books got into bed quietly. And then the most important thing is stayed in bed all night. Now, in many cases, the first couple nights they don’t get that sticker or pull that piece of Velcro, whatever it might be, but explaining to them and saying, you did great.
[00:50:30] Look at all of this, and tonight, if you do this, you get all your stars or whatever it is. And so they can visually see that. But I think also oh man, oh like a visual clock out of their room. Is also extremely helpful. And I use that in conjunction with one of those bedtime charts.
[00:50:51] Craig Canapari MD: and I would say the bedtime chart, especially for me, that’s like a three and up kind of intervention for a younger kid. And I guess we’re making some [00:51:00] assumptions because if they’re, if the child’s coming outta theirroom, it’s probably, they’re probably sleeping in a bed.
[00:51:06] Arielle Greenleaf: Yep.
[00:51:07] Craig Canapari MD: you know, definitely for a younger kid who’s waking up more at night, I think, yeah, the key is more attention during the day.
[00:51:13] It will get better. So here’s some napping questions. Should we try to match our six month old daytime naps, daycare nap schedule on weekends or continuing following his cues?
[00:51:27] Arielle Greenleaf: there’s so much that I need to know about that, I think having a schedule is important. So just I don’t love like napping whenever you see them yawn or whatever. ’cause that can cause issues.
[00:51:41] Craig Canapari MD: at six
[00:51:41] Arielle Greenleaf: Yeah. Yeah. So I think, trying to follow some sort of a schedule is important. And I do, if they’re there five days a week, it’s probably helpful to follow it loosely.
[00:51:50] However, I also find that children that go to daycare can sometimes be tired a little bit earlier at home from their long week [00:52:00] away. And so if nap time is nine 30 at daycare and they seem tired at nine, okay, that’s totally fine. I think there’s a window going each direction. 30 minutes. Beyond that, if you’re just like they’re on two naps at daycare and you’re doing four naps at home, I definitely wouldn’t recommend that consistency.
[00:52:21] In schedule and like number of naps is important. However, I will say when children are forced to drop naps at daycare or drop from two naps to one nap or something, they may need two naps at home, or they may need a nap. There are ways to compensate for that over the weekend.
[00:52:39] However, for a six month old, I would just try to stick within that schedule 30 minutes each direction.
[00:52:46] Craig Canapari MD: Yeah, that sounds perfect. I had a patient in New York City who was kicked out of his daycare ’cause he gave his nap up early. Some daycares are more flexible than others about these sorts of things. And again, this is an older kid like I think he was maybe two, [00:53:00] two and a half.
[00:53:00] From Michelle, do you have any recommendations for a 3-year-old that is inconsistent in taking a nap? Arielle, do you want to break the bad news to Michelle or do you want me to do it?
[00:53:10] Arielle Greenleaf: you can do it.
[00:53:11] Craig Canapari MD: Michelle, I think your child is giving up the nap. It is a sad day as a parent when your child gives up the nap because it’s great when they nap. It’s not like a 3-year-old will just raise their hand and be like, Hey, I don’t think I’m gonna nap anymore. They’re gonna nap some days.
[00:53:28] Some days they won’t. Some days they’ll fight you on it. And then they’ll be miserable. But until bedtime it’s never that smooth a transition. I think you offer a nap at the appointed hour. There you can have an expectation that the child be quietly in their room for say, 30 minutes even if they’re not napping.
[00:53:49] I had one month where my kids napped at the same time. It was bliss.
[00:53:53] Arielle Greenleaf: one month of bliss,
[00:53:55] Craig Canapari MD: A month of bliss in my life.
[00:53:57] Arielle Greenleaf: in my life. I [00:54:00] would also say that if that nap is affecting bedtime, absolutely do not offer the nap. And sometimes I know the quiet time is great, and I do love quiet time. However, if the nap is causing problems at bedtime or overnight.
[00:54:14] You might have to keep them more occupied and be with them and doing pu a puzzle or something, or watching a 30 minute cartoon or, I don’t know, a couple bluey episodes, something like that, just to keep them awake. And I would also suggest backing up bedtime a little bit earlier for a bit, because they can, it’s a big transition to go from napping to not napping.
[00:54:39] Compensating with an earlier bedtime for a little while can be very helpful.
[00:54:44] Craig Canapari MD: So, okay. I think this next one’s for me.
[00:54:48] Arielle Greenleaf: Okay. Let me see. I can read it to you. So in your book you mentioned that both parents need to be able to do the bedtime routine. What do you do if your baby [00:55:00] shows a strong preference for one parent, and this is from Lauren.
[00:55:04] Craig Canapari MD: this is pretty common and usually it’s if it’s a mom who’s nursing, it’s for that parent. Again, I think that sometimes this falls into gender stereotypes ’cause in my clinic I’d have a lot of parents come in with a man and a woman. And the dad is she won’t go to bed for me.
[00:55:22] And it’s like this learned helplessness. I think that it’s very, and in situations like that where the other parent might feel a little bit left out or being sidelined first of all, don’t feel bad. It’s normal for children to sometimes prefer one parent or the other.
[00:55:38] But the reason for the recommendation is that recommendation. it can’t just fall to one parent to always be responsible for bedtime. And if this becomes very rigid, things fall apart.
[00:55:49] If that parent wants to go out for an evening and then they get a phone call when they’re out having fun with their friends, the, their child won’t go to sleep and it just isn’t fair.
[00:55:58] [00:56:00] heard, In situations like this, it’s okay for the other parent to go for a walk if the weather’s nice and be out there.
[00:56:06] I just think it’s really, the other part of the recommendation is don’t have your bedtime routine so complicated that you need two people to do it, because that works with your first kid. It doesn’t work for your subsequent kids.
[00:56:18] Arielle Greenleaf: Yeah. I was just gonna say, you mentioned single parents and I was thinking of shared custody. That’s a real reason why both parents would need to be on board and be able to do the bedtime routine because it’s a true challenge. So I, I also just think it’s important to have someone else, not even necessarily the other parent a babysitter, because you can’t be the only one that can put the child’s bed.
[00:56:48] Craig Canapari MD: Yeah. And it’s, the fact is. For a lot of the parents, we see bedtime’s a stressful time, but with a little bit of effort, it can be a wonderful time. And it’s awesome to [00:57:00] put your kid to bed and read stories. it’s adorable.
[00:57:03] Arielle Greenleaf: I’ll read this. My 6-year-old son was born with congenital heart disease, has never managed to sleep alone due to various issues, including my health and his anxiety. He has never slept through the night, wakes with bad dreams and does a little sleep talking.
[00:57:16] Craig Canapari MD: What can we do to help him sleep better? This is from Natalie and Arielle. Can I say that I see this all the time. So congenital heart disease. Many. This is true of many children with issues like this.
[00:57:28] A child with congenital heart disease might need multiple surgeries in infancy, and there might actually be situations where they can’t let the child cry. For parents of children with complicated medical issues, say there were a NICU baby who needed to be fed multiple times overnight or needed oxygen, all of a sudden you, you end up with a four or 5-year-old where their health issues are better, but they have never learned to sleep independently. And I think that’s what she’s getting at. I would say in a situation like this, first of all, if your [00:58:00] child is involved with medical specialists, just sit down with them and be like, Hey, I’m struggling a little bit with this. Can you just let me know that all of these medical issues are now resolved?
[00:58:09] And if that is the case, I think sometimes this is a situation where working with a consultant, a sleep physician, or even a psychologist, if this kid is a little bit older, like a 6-year-old, ’cause there is very likely this child, and it sounds like this mom has some unresolved anxiety for good reason.
[00:58:28] If your child has had to have multiple surgeries and hospitalizations, it’s incredibly stressful. But it is a wonderful thing now if your child is doing better and this is a great time to work on this. So I would say that working very gradually towards independence at bedtime, very gently praising your child for making step towards independent sleep.
[00:58:50] Et cetera. And I’d say if there’s a lot of bad dreams, waking through the night, sleep, talking, if there’s snoring, a sleep test, may be worth exploring [00:59:00] some conditions. I see commonly like children that were born early in the neonatal ICU premature infants turn into three or four year olds with sleep apnea.
[00:59:09] Just a medical evaluation is part of that is a good idea.
[00:59:12] Arielle Greenleaf: Yeah, I say anytime I get anybody with more complicated medical issues, I always recommend getting clearance essentially from their care team. And. It sounds like mom is also dealing with health issues and that is contributing to the six year old’s anxiety. I don’t know if there’s a great way to address that, but that actually makes me think of working with possibly a psychologist to address any anxieties that could be causing issue.
[00:59:46] Craig Canapari MD: And a lot of times actually clinics, like congenital heart disease clinics actually will have a psychologist or social worker as part of the care team who can help you with these [01:00:00] issues.
[01:00:01] But hey, I gotta pop off.
[01:00:02] Arielle Greenleaf: Got a dinner
[01:00:03] Craig Canapari MD: take a kid to a fencing lesson. And then I gotta go have a birthday
[01:00:06] Arielle Greenleaf: Is your birthday?
[01:00:08] Craig Canapari MD: Today’s my
[01:00:09] Arielle Greenleaf: birthday.
[01:00:11] Craig Canapari MD: What? Why?
[01:00:12] Arielle Greenleaf: Oh my goodness.
[01:00:13] Craig Canapari MD: I think so. This has been The Sleep Edit thanks so much for listening. I’m Craig.
[01:00:18] Arielle Greenleaf: And I’m Arielle.
[01:00:19] Craig Canapari MD: Give us a shout if you have questions for future shows at the Sleep Edit show@gmail.com.
[01:00:25] We’ll put what we talked about in the show notes and thanks for all the parents who submitted their questions. This was a lot of fun.
[01:00:33] Arielle Greenleaf: 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 [01:01:00] Ariel at Instagram at Ariel Greenleaf.
[01:01:03] Craig Canapari MD: That’s 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.
[01:01:29] It really helps as we’re trying to get the show off the ground. Thanks.