
In part two of our discussion on helping kids sleep through the night, pediatric sleep expert Dr. Craig Canapari and sleep consultant Arielle Greenleaf tackle night wakings and feedings. (You can find part 1 here, including a video of both episodes). They provide guidance on when night feeds may or may not be necessary, how to handle night nursing for comfort vs nutrition, and tips for transitioning toddlers away from nighttime calories.
Key Takeaways:
– Only a small percentage of sleep issues are caused by medical problems. Most kids need some type of sleep training or behavioral intervention.
– Check with your pediatrician before dropping night feeds – make sure your child is getting enough calories during the day first.
– Night nursing is about more than nutrition – it also provides comfort. Wean slowly if desired.
– Toddlers generally don’t need extra calories at night. But there is little guidance given on transitioning from milk feeds to solids at this age.
Notable Quotes:
“I always like to say I am not, if a sleep consultant starts working with someone and says, without any digging, we’re going to eliminate all feedings overnight really fast, we’re just gonna take ’em all away, run for your life.” – Arielle Greenleaf
“Honestly, a normally growing child over a year of age doesn’t really need those calories at night. And if you find that you are meaning to give milk or anything else during the night you, I give you permission to cut it out and you may want to wean it slowly.” – Dr. Craig Canapari
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- 00:02 Introduction and Disclaimer
- 01:18 Understanding Sleep Disorders in Children
- 02:03 Medical Problems and Behavioral Interventions
- 05:14 The Role of Bedtime and Nighttime Awakening
- 05:18 Feeding and Sleep Patterns
- 13:44 Adjustment Issues and Sleep Disruptions
- 18:02 Addressing Nighttime Fears
- 20:24 Imagining Bedtime Stories
- 20:41 Addressing Children’s Fears
- 21:13 The Huggy Puppy Intervention
- 21:55 Dealing with Trauma and Sleep Difficulties
- 23:18 Environmental Causes of Nighttime Awakening
- 24:44 The Impact of Light and Shadows
- 25:14 The Creepy Doll Story
- 25:53 Technology and Sleep
- 26:40 Sensory Disorders and Sleep
- 27:54 Too Much Time in Bed Syndrome
- 36:14 The Importance of Independent Sleep
- 38:28 Closing Thoughts and Contact Information
Questions or feedback? Email us here. We are collecting questions for future Q&A shows!
Links:
- Huggy puppy intervention for night time fears
- Brett Kuhn Ph.D
- Why is your toddler waking up at night
- How much sleep does your child need at night?
- How to address night feedings
[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.
[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.
[00:00:52] 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 employees of our guests. Enjoy the show.
[00:01:09]
[00:01:09] Craig Canapari MD: Welcome back to the sleep edit. I’m Dr. Canapari. I’m a pediatric sleep expert and author. This is the second part of. The episode with never really Greenleaf, my friend, and the very wise sleep consultant. About the important topic of how to get your child to sleep through the night. The first episode, we discussed the definition of sleeping through the night and what you expect at different ages, sleep onset association disorder, which is the problem that we are generally trying to treat with any sort of behavioral sleep intervention. How having the wrong bedtime can wake your baby up during the night. And medical problems that wake your child up. During the night. So, if you haven’t heard that episode yet, I suggest you go back and listen to that, one first, before continuing with this episode.[00:02:00]
[00:02:03] Arielle Greenleaf: Well, Craig, I have a question for you. What percentage of children have actual medical problems, and then what percentage of normally developing healthy children have need some sort of a behavioral intervention
[00:02:25] Craig Canapari MD: The first one was what percentage of children presenting have actual medical problems? And it’s a really good question, right? Because I could tell you like 1- 3% of children will have sleep apnea, right?
[00:02:38] If they’re obese and they snore, it’s closer to 50%. All comers like presenting to the sleep lab, I’m not sure if anyone has those numbers. But what we see in the, in sleep world is a lot of these problems are multifactorial. And that’s just a fancy way of saying there’s actually more than one cause.
[00:02:54] In medicine we love Occam’s Razor. We’re like, it’s the most which is just stating that simplest single [00:03:00] explanation is the cause of what’s going on. Butnever reallyally as one of my mentors used to say, the patient can have as many problems as they damn well please. So don’t get hung up on that.
[00:03:10] There has to be just one explanation though often, usually there is most children are pretty healthy and, sorry, what was the second part of your
[00:03:17] Arielle Greenleaf: I guess the second part of my question is. There’s there, having been in this industry for almost a decade and seeing such a rise in the industry and a need for sleep support, behavioral, non-medical, I’m wondering what percentage of the average developing child in the United States needs some sort of what, or maybe it’s the parents, maybe the question is, do you think it would be beneficial for parents to have more of an understanding of how to handle sleep to avoid things spiraling out of control?
[00:03:59] [00:04:00] Because I feel like there’s a surge in the need for behavioral sleep specialists like myself.
[00:04:08] I would agree, and there’s a lot of different studies that have looked at this but I’ve seen anywhere between 20 and 50% of parents being concerned enough to talk to their child’s pediatrician at some point during their childhood about their child’s sleep. So you think about that’s a huge number of people and in some ways there’s more information available, but I feel like there’s also a lot the.
[00:04:33] Craig Canapari MD: The quality of information coming in is less, right? Like it’s harder for parents to know what’s what’s good information and what’s not. That’s why I started writing online. Know, that’s why you do some of your work too, is there’s a lot of misinformation. Look, anybody’s promising a quick fix or their own technique that they invented or their own terminology, which we see a lot online with things like wake windows, which [00:05:00] I’m not even gonna get into right now.
[00:05:01] Which isn’t based a lot in sort of science. Before we get sidetracked on one of my favorite hobby horses, of all these weird stuff that goes on I just wanna make sure we cover a couple of
[00:05:12] Arielle Greenleaf: Sure. Let’s do it.
[00:05:14] Craig Canapari MD: of nighttime awakening. So nighttime feeding and learned hunger. What’s your what’s your take on this?
[00:05:20] Arielle Greenleaf: Oh gosh. I feel so, I always like to say I am not, if a sleep consultant starts working with someone and says, without any digging, we’re going to eliminate all feedings overnight never reallyally fast, we’re just gonna take ’em all away, run for your life. It is not my job to determine. Whether your child needs a feeding overnight.
[00:05:50] Now that being said, if your child is normally developing, there are no health issues. And say this, you got a seven month old baby and they’re [00:06:00] waking every an hour and a half to eat, we gotta look at that because there’snever reallyally no need for a seven month old to be waking up and eating, every hour and a half.
[00:06:11] And I think that comes back to what we were talking about with learning how to fall asleep independently. In many cases we see that those children are falling asleep on the bottle or on the boob and nursing to sleep. And when they wake up, that’s the way they’re falling back asleep. I do also think, you talk about learned hunger I always try to equate it.
[00:06:34] I think it’s important for parents to understand we have all these terms, but what does that mean? So I see it as this I got hungry for lunch at 11:00 AM today. Normally I eat at midnight or midnight at noon. And today I was hungry at 11, and then tomorrow, oh, I’m hungry at 11 again.
[00:06:52] And then the next day. And so I, I eat and I, and then I’m hungry at 11. Again, it’s very similar to a child that maybe [00:07:00] doesn’t even need a feeding, but they’re waking up and their metabolism they get fed and then their metabolism’s oh, okay, that, that was nice. Maybe I am hungry at 11:00 AM every day or 11:00 PM every night.
[00:07:12] I think it’s for my, what part of my job is, first of all, I wanna know what the pediatrician has to say. If you’re working with Lact, a lactation consultant, I wanna know what they have to say. I think it’s also important to look at how much are they getting throughout the day, because. In many cases, feeding is another area where parents often don’t know what’s going on.
[00:07:33] Like they’ll ask the pediatrician. The pediatrician will give them a handout. Not all pediatricians, but some, this is how you’re supposed to feed your baby. And a lot of times I have clients that are switching from breastfeeding to formula or vice versa and not usually vice versa. But usually it’s breastfeeding to formula and it, it’s important for parents to understand that’s not a one-to-one ratio.
[00:07:55] So of, an average bottle size for a breastfed baby is four [00:08:00] ounces, but that’snever reallyally three quarters or a half of what a formula fed baby bottle is gonna look like. And they get confused, and then the babynever reallyally is hungry overnight. So looking at how many feeding sessions, how many ounces, things like that.
[00:08:13] Let’s ensure that this baby is getting fed throughout the day. And if they are, and they’re normally developing in other ways, we can look at ways to at least get down to one feeding, something like that. I’d love to hear what you think about that in general,
[00:08:30] Craig Canapari MD: sure. I think that I think a couple of things. First of all, it is certainly, it’s trickier with moms that are breastfeeding, especially if they’re breastfeeding exclusively. Because the breast is such a powerful, so soothing, right? There’s a lot of dimensions to breastfeeding. ’cause a lot of times the, and I tend to see kids that are older, right?
[00:08:49] So someone’s like nursing their toddler, they have no milk supply. They’re nursing their toddler five times a night. It’s not a nutritional problem at all. It’s, it what they’re providing there is physical contact and comfort, [00:09:00] and you don’t need to worry about weaning those calories there. I’d say that certainly with a child that is growing well and moving along their growth curve a lot of parents who are breastfeeding, especially the moms, are back to working full time.
[00:09:14] They’re happy to nurse once during the night, and that’s sustainable. And it helps them maintain their milk supply. So I don’tnever reallyally rush people to get rid of that if they’re happy with how things are going. In my world, a lot of times I am seeing older kids they’re nursing, they’re drinking bottles, they’re drinking they’re drinking juice during the night and they’re obese.
[00:09:36] So I’d say as a rule of thumb, honestly, a normally growing child over a year of age does notnever reallyally need those calories a night. And if you find that you are meaning to give milk or anything else during the night you, I give you permission to cut it out and you may want to wean it slowly.
[00:09:54] That’s what Ferber talks about in his book. And I’ve had good luck with that. Other parents have wanted to just. [00:10:00] They don’t want to be like measuring out different aliquots of milk during the night and they just wanna go cold Turkey again. It may be a little bit more, a little bit more conflict. But it could be the right fit.
[00:10:09] But again, this is why you have to work with your pediatrician. ’cause I think it’s very hard to sort this in the first six months of life in the six to 12 months. It’s a little bit easier, but it’s not a slam dunk that you can necessarily just get rid of this after a year. Honestly, if you don’t want to do it anymore, you don’t have to do it anymore.
[00:10:29] Would you say that’s fair?
[00:10:30] Arielle Greenleaf: Yeah. And I think what, but yes, and I think that it’s another area where education is needed for parents because, the switch from nursing all day or giving formula all day to solids is a strange one. Nobodynever reallyally guides you through that. And a lot of what I find is parents are concerned that their child is not getting enough milk and they think that it’s [00:11:00] still this mandatory thing that they get 24 ounces of milk.
[00:11:05] Every day. So they’re like the only time he will take a bottle is at bedtime in the middle of the night and as soon as he wakes up. So they’re like very concerned about that piece. So I feel like that’s where more education might be needed so that parents can understand a healthy normally developing toddler does not need that.
[00:11:28] Does not need that. And I also think it’s important to note that toddlers grow that their growth is so much slower than an infant from birth to age 12 months. It slows down exponentially compared to an infant or a child who’s born at five pounds and by, 12 months, they’re 20 pounds or 25 pounds.
[00:11:50] That’s a huge growth. And they need lots of. Breast milk and formula. But as they get into toddlers, they become pickier and they don’t need they’re not [00:12:00] gaining 20 pounds the second year of life. And so I had
[00:12:04] Craig Canapari MD: Hope, hopefully not.
[00:12:05] Arielle Greenleaf: no, yeah, hopefully not. And so I’ve had actually Dr.
[00:12:08] Porto was one of those people that I’ve talked about this with.
[00:12:13] Craig Canapari MD: And just Anthony Porto who I work with at Yale, who’s a pediatric GI doctor, who’s written a wonderful book on. I’m feeding in unm, feeding in children.
[00:12:23] Arielle Greenleaf: yes. He’s
[00:12:24] Craig Canapari MD: highlynever reallycommend, I don’tnever reallymember the title of it, but I’ll put it in the show notes.
[00:12:27] Arielle Greenleaf: Yeah. It’s, oh man,
[00:12:30] Craig Canapari MD: guide to feeding or something.
[00:12:31] Arielle Greenleaf: pediatrician’s guide to feeding babies and toddlers. Yeah, we can put that in the notes. But point being is, I’ve had my own pediatrician say this. I heard, I’ve talked to Dr. Porto about this, and toddlers, it’s like. Parents will be like they only ate a handful of this and a handful of that.
[00:12:48] And basically that’s normal for toddlers. It’s normal for them. Like basically if they have an one good meal in 36 hours, you’re doing just fine. So understanding that is [00:13:00] important.
[00:13:00] Craig Canapari MD: everybody thinks they’re a feeding genius with their like 10 month old be like, oh look, he eats avocados. And then a year later and you’re like. You’re just like, screw it. Let’s just give ’em chicken nuggets again.
[00:13:12] Arielle Greenleaf: yeah. Oh yeah
[00:13:14] Craig Canapari MD: the toddler diet. It’s just, it’s all tan, right?
[00:13:17] French fries, chicken nuggets. I know that. That’s it, basically. Yeah. Don’t it is what it is. Don’t judge anyone till you’ve been there. Yourself. Oh man. You could do a whole show about things I never thought I would do as a parent.
[00:13:32] Arielle Greenleaf: yeah, for
[00:13:33] Craig Canapari MD: Yes, just feeding my child salami from the from the bag
[00:13:36] Arielle Greenleaf: sure.
[00:13:37] Craig Canapari MD: Yeah,
[00:13:37] Arielle Greenleaf: Here, take the bag. Take the bag for yourself. Walk away with it.
[00:13:41] Craig Canapari MD: throw it on the floor if I’m distracted for a little bit. So I. I wanted to talk a little bit about adjustment issues. I don’t know if this is a terminology that is used a lot in, in, in your practice.
[00:13:54] We,
[00:13:54] Arielle Greenleaf: withnever reallygard to changes in life or changes in, for [00:14:00] instance, transitioning from the crib to the toddler bed or adding a sibling.
[00:14:06] Craig Canapari MD: So I’d say that adjustment, insomnia. There is a technical definition. It’s less than, it’s less than 30 days of disruption of sleep when there’s a major life change. So you mentioned a big one, new baby in the home. Moving to a new home is one. Certainly it can be things like, if parents separate is one, and that tends to be a little bit more complicated to unravel or deal with, obviously. ’cause it’s a mu it’s a, it’s an ongoing stressor for children. A lot of the times, for most of these things that are not as significant, a life change, like I’m, again, having a new sibling is a big deal, but children tend to habituate it pretty quickly.
[00:14:43] I think the key is with a lot of these is making sure that your child is getting more attention during the day to support them through these changes. ’cause otherwise they’re gonna be looking for that attention during the night
[00:14:55] Arielle Greenleaf: Yes.
[00:14:56] Craig Canapari MD: And it is okay to give that to them during the night. One thing I [00:15:00] will say that parents I think worry about too much is a new baby or another child disrupting their children’s sleep.
[00:15:06] In my experience, if a 2-year-old is sleeping well, when the baby is born, that, when that when the baby is crying, they’re probably gonna sleep through it. A lot of the time it’s less of an issue that parents think it’s ’cause parents worry about things like sharing rooms. If your kids have to share, I wrote an article in New York Times, I’m like, if your kids have to share a room where you want ’em to share a room, it’s fine.
[00:15:25] That’snever reallyally, until verynever reallycently it was unusual for children to have their own rooms. It’s a luxury right. For that to happen. So I’d say
[00:15:34] no. I was gonna say if you’ve got these big changes on the horizon, don’t be surprised if there’s a little bit of disruption, but it shouldn’tnever reallyally last that long.
[00:15:42] Arielle Greenleaf: Yes, and I wholeheartedly agree with more attention during the day. You mentioned the sibling thing, and I find you’re absolutely right with, they’re always worried that the crying is going to wake up the older sibling, but I find that the bigger issue that I see [00:16:00] is a little bit of jealousy because the older child wants to be sleeping in the room as the same room as the baby.
[00:16:10] Why does baby get to sleep in the room? But I don’t. And so having. I, with the sibling thing, I always try to encourage, make sure the child is getting a little bit of extra attention from one or both of the parents during the day where it’s one-on-one. It’s not, there’s, if you can, obviously it’s, this isn’t always doable, but one-on-one attention, even if it’s 15 minutes at the playground or something just quick.
[00:16:37] But it’s meaningful. That’s important. But I also find that playing up the role of Big Sibling and making it an exciting thing and giving the child a job to help you. Oh, you’re helping, could you go grab me those diapers? That’s so helpful. You’re helping what a great big sibling you are. Like in involving them in the daily mundane things that seem like nothing [00:17:00] that can make a huge difference.
[00:17:01] And I agree with you that it if if you start to, the child just want, wants to feel included and as though they’re still important. So making sure you’ve got that, andnever reallyestablishing that if needed. That should help with overnight.
[00:17:17] Craig Canapari MD: Yeah I think the best single piece of advice I got when I had young children was give your child a job. Like in any situation, like when they are bored they will do some, they will give themselves a job, and it is often a job that you wish they did not have.
[00:17:34] Arielle Greenleaf: Yeah, sure.
[00:17:36] Craig Canapari MD: I don’t know. I, when I perhaps I’m hallucinating, but I feel like my younger brother stuck pieces of cheese in the VCR back when VCRs were things that people had.
[00:17:47] Arielle Greenleaf: Oh,
[00:17:48] Craig Canapari MD: I was trying to think of an analogous, I’m like, CD player. I’m like, I’m really dating
[00:17:51] Arielle Greenleaf: DVD player.
[00:17:53] Craig Canapari MD: Yeah,
[00:17:53] Arielle Greenleaf: Yeah,
[00:17:54] Craig Canapari MD: Kids these days, even the parents these days are less familiar with some of these ancient technologies. [00:18:00] So let’s talk about nighttime fears. That’s a that’s another one that can, some often is more emergent at bedtime, but can also emerge during the night. What, how often, when do we, are you seeing nighttime fears or dealing with them?
[00:18:13] Arielle Greenleaf: I don’tnever reallyally see a lot of nighttime fears. I do. I think that sometimes children want to name anever reallyason why they feel they need the assistance of their parents. So they may say, I’m scared of something so silly, like lobsters I’m scared of lobsters. And it’s okay, we know that there are going be lobsters in your bedroom.
[00:18:43] But they, it’s like, why are you calling me in here? What is thenever reallyason? And I think that a lot of times they can’t name what the fear is. And if you look at child development, I. Around that toddler age, that 3-year-old, 4-year-old thing, their biggest fear is really being separated from [00:19:00] their parents, sonever reallyassuring them that you’re going to be there.
[00:19:03] I love using things like a bedtime book that you make with the child that hasnever reallyal photos of you sleeping in your bed, the child sleeping in their bed, nothing going on overnight, everyone waking up happy from their own bed and doing thatnever reallypetitively. I think almost there’s a lot of fomo going on at this age.
[00:19:28] And but withnever reallygard to fears, I know you’re not a huge fan of Monster Spray. I like to use it as like Safe Sleep Spray or Happy Sleep Spray.
[00:19:38] Craig Canapari MD: Why don’t just explain what that
[00:19:40] Arielle Greenleaf: so yeah, so like how, so a Monster Spray is. No, you basically fill up a jug of, a spray bottle with water and you say, spray this to keep the monsters away.
[00:19:51] We don’t wanna really feed into their whole belief that there’s a monster in the room. Although I will find that, I do find some [00:20:00] children want it to be that way, versus this is just for happy sleep. They like having control over their fear. So I’m spraying this and I’m keeping away the lobsters.
[00:20:10] Okay, great. But it, for other children, it’s just going
[00:20:14] Craig Canapari MD: Here’s the thing about that spray. It totally works. You start spraying this stuff around. Hundred percent guarantee
[00:20:19] Arielle Greenleaf: No lobsters. No lobsters in the room. So it works. And then,
[00:20:25] Craig Canapari MD: I’m just I’m just imagining the bedtime book. And then they’re flipping through and all, there’s a picture of the child sleeping and then a picture of the child with a lobster like a lobster on top of
[00:20:33] Arielle Greenleaf: oh gosh. Sound asleep.
[00:20:36] Craig Canapari MD: iT would be funny, but don’t traumatize your kids, Dr.
[00:20:40] Kids
[00:20:40] Arielle Greenleaf: Yeah. And then, the flip side is instead of like playing up the idea that these fears arenever reallyal, just using the sleep spray to spray the room and say, this is for, this is hair, happy fairy sleep spray or something like that that can be helpful for some children.
[00:20:58] It, and these tactics don’t work for [00:21:00] everybody, but those are certainly some of the things that I utilize with my toddler and preschool clients,
[00:21:06] Craig Canapari MD: a lot of the time when you can present a couple of these options to parents and they have a feel for what’s gonna work with their
[00:21:12] Arielle Greenleaf: absolutely absolutely.
[00:21:13] Craig Canapari MD: One thing I like for this is a huggy puppy, which is a, it’s an intervention where you give a child a stuffed animal. And there’s a story that goes with it about how this is a lonely puppy and, he’s a little bit scared, so can you take him and have him stay with you and comfort him at night?
[00:21:30] And they found the children, even children who have experiencednever reallyal trauma. This is and I’ll put a pin on that for a second was very helpful with them sleeping through the night and then helping somebody else made them feel braver. But, there are some kid, this works great for a kid that likes stuffed animals.
[00:21:48] I’ve had some parents be like, yeah, my kid doesn’t wanna sleep with a stuffed animal. She doesn’t like stuffed animals. This is not gonna work for them. And I would say as, just to come back to the trauma aspect, we know that people have [00:22:00] experienced trauma in their lives.
[00:22:01] And unfortunately it’s common in the us it’s common in other parts of the world. It can manifest the significant sleep difficulties. And sometimes it’s a very clear trauma, like a child being in a car accident. I’m not gonnanever reallypeat some of the stories I’ve had, the children have told me that are surprising andnever reallyally terrible things, the witnessing terrible things.
[00:22:22] And sometimes it’s something like a near miss car accident where nothing bad happened, but they can’t stop thinking about it. And I say in a situation like that, if a child isnever reallyferencing something in their experience that happened to them, or even something they heard about happening in another family member, usually to unpack that, younever reallyally need some professional help for that.
[00:22:40] That’s not something you tackle on your own. So in that scenario again, I don’t want parents to be like, oh, my kid’s waking up at night. I ha the, I’m worried that there’s something hidden as horrible has happened to them. You’d almost always know what this event was, and older kids are gonna be telling you.
[00:22:56] About it. This is really an opportunity to work with your pediatrician and a [00:23:00] mental health provider to unpack that sort of stuff. That is not I’m not a psychiatrist. I have a psychologist that I work with. It’s notnever reallyally even a primary care doctor or sleep consultant. This is not in their wheelhouse to, to deal with those sorts of things.
[00:23:14] Arielle Greenleaf: Agreed.
[00:23:15] Craig Canapari MD: So I think we have two more on our list. One is one is environmental causes. These are slam dunks if you can find them like environmental causes of nighttime awakening.
[00:23:27] Arielle Greenleaf: well, environmental causes. It’s interesting that you bring that up because I, I remember working one time with this family and it was twin 9-year-old girls and a five-year-old girl. And they all ended up in bed with their parents, all of them. eVery night since the nine year olds were born, they all ended up in their parents’ bed by the end of the night.
[00:23:49] And I went, I actually went into their house. I don’t do that frequently, but I did. And we sat in the bedroom where the two older siblings [00:24:00] shared, they were twins. They shared a room. And I said it, what in here bothers you? What if we’re shutting the lights off, we’re gettingnever reallyady for bed?
[00:24:08] Is there anything in here. That bothers you? And she said yeah, that doll is always staring at me. And the mom’s you never ever told me that. And she said yeah, it freaks me out. And I said okay, we cannever reallymove the doll. And she said, and I don’t like it when the light is on in the closet and the door is slightly a jarred.
[00:24:26] She’s like, why haven’t you ever said that or changed it? And she’s I don’t know. I guess I nevernever reallyally thought about it. Now she’s a lot older, so she’s nine and she can tell us that. I think there are things that, that bother us and then bother children and we need to be looking at that.
[00:24:44] And I also think so for light is an interesting thing because a lot of times we’re like, don’t bother with a nightlight when they’re little like babies. You don’t need to worry about it. They’re not afraid of dark at that age. But I think that some children do get afraid of the [00:25:00] dark as they get older.
[00:25:01] And adding the nightlight can be a game changer. Others, they don’t like the light at all. They don’t wanna see shadows, so that’s certainly something you can control. But what would you, what other things do you think about?
[00:25:14] Craig Canapari MD: Yeah I just have a question about this doll. Was it like that creepy clown doll in Poltergeist?
[00:25:19] Arielle Greenleaf: wasn’t that scary? It was like an older, I think it was like the mom’s doll. It was definitely an older doll that looked a little creepy.
[00:25:27] Craig Canapari MD: wAs it Annabelle from
[00:25:29] Arielle Greenleaf: No.
[00:25:30] Craig Canapari MD: or the
[00:25:30] Arielle Greenleaf: Close.
[00:25:31] Craig Canapari MD: movies or something like that?
[00:25:33] Arielle Greenleaf: No. And my daughter has this stuffed unicorn. It
[00:25:36] Craig Canapari MD: Jigsaw movies.
[00:25:39] Arielle Greenleaf: yeah, my daughter has this unicorn that has big eyes, and she’s this doll, this unicorn just staring at me all night. I’m like let’s get rid of it. What? If it’s bothering you, why are you keeping it in here?
[00:25:52] Craig Canapari MD: Yeah. No I think look, technology is a big one, right? Don’t have. Televisions, [00:26:00] smartphones, tablets in your kids’ room? No. No. Look, no matter what, right? This, most of the people listening this probably have younger kids, but don’t start if there’s a sibling in the room, do the, does the sibling snore?
[00:26:10] I’ve had kids come in to see me and they’re like, oh yeah, my sibling is up snoring all night and be like never reallyally, it’s the sibling that needs to come to see me for their sleep apnea. The neighbors, right? Like a lot of, I live in the suburbs, but a lot of people live in cities and they live in apartments with thin walls.
[00:26:24] So the neighbors get up at a certain time. The trash collection comes at a certain time. Things like sound masking like with a sound machine can be helpful. Again, don’t put it near your kid’s ear, but like running a fan can help mask some of those signs. Blackout curtains are great. And one thing I wanna say too is, I see some kids who have problems they have sensory disorders. They’re common in children with autism, but also in children without autism where say certain tags on their clothes will bother them. They’re very finicky. They have to have certain socks without seams, et cetera. And sometimes those children will actually never [00:27:00] reallyspond well to if they like to be wrapped up tightly.
[00:27:03] I like a, lycra sheet, which is like a sheet that will wrap around the child’s mattress like a sock and they will slide into it. I say this is clearly not for an infant or even a young toddler, but for an older kid that can be very helpful. Andnever reallyally for me, those kids, I’m showing them a picture in this, in the be in the clinic, does this look comfortable to you?
[00:27:25] And they’re like, oh yeah, I’d like to try that. It’s 20 bucks. Whereas a good weighted blanket, honestly, I. What I like way you get the same benefit as a weighted blanket, but weighted blankets are hot so they don’t work well in the summertime and they’re expensive and they fall off of your head like they fall right off.
[00:27:41] Also if your kidnever reallyally is having a lot of sensory issues, struggles, loud noises, bothering them, et cetera, working with an occupational therapist can actually be game changing. So I think that’s an important thing to, to think about. And then our last cause we are gonna talk about is something called too much time in bed syndrome.
[00:27:59] So [00:28:00] this term comes from a sleep psychologist named Brett Kuhn, who works out in Nebraska. He’s written a lot of, done a lot of good work in the sleep, behavioral sleep space. And this is where parents are having their child in bed for a period of time that it’s too long for their sleep needs. So you mentioned like Mark Weissbluth, like he likes early bedtimes, which younever reallyally do work well for some kids, but we know that as you get older, your sleep needsnever reallyduce.
[00:28:31] So if you had a one-year-old that was sleeping great from 6:00 PM to 6:00 AM so they’re sleeping 12 hours a night, everybody’s high fiving and singing kumbaya like mission accomplished, right? And then all of a sudden at age three or four. The parents have kept the same schedule and this kid will start waking up in the middle of the night for an hour or two, quietly playing in the room.
[00:28:53] Not that quiet ’cause the parents are waking up and calling me about it. But they’re, and the key with this condition is [00:29:00] the sleep opportunity is in the long side for their age and their bedtime is good. They’re falling asleep independently, and they’re not necessarily going to get the parents at night.
[00:29:11] They’re just playing in the room quietly because the problem is not that they can’t fall asleep on their own, the problem is they just have insufficient sleep. So another way this can manifest is when children are getting to the age when they’renever reallyady to drop a nap. So like you have a three-year-old, and all of a sudden, when they take a nap at daycare, they’re falling asleep at 10 o’clock at night after three hours of arguing with their parents, and on the weekends theynever reallyfuse to nap and they’re falling asleep at seven or eight o’clock at night.
[00:29:37] And that is often a signal that it is time for that child to drop the nap. And again, naps are a whole other domain of agony to talk about. Because if you think bedtime, if you think nighttime’s tough, naptime is like the wild West for lots of differentnever reallyasons, but I know what are your what’s your take on this?
[00:29:56] And the kids that like, there’s a disconnect between how [00:30:00] much time they’re spending in bed and how much time theynever reallyally need, how much sleep theynever reallyally need.
[00:30:03] Arielle Greenleaf: Sure. I think it’s interesting ’cause you mentioned earlier that you don’t tend to work with infants and a lot of the people that I see are on the younger side. I definitely see the older side and I hundred percent agree with you about, the dropping of the nap. It gets so frustrating because, we’re so limited with childcare and daycare centers. You know that this child needs to drop this nap. It’s affecting their nighttime, it’s affecting the parents’ nighttime, the whole family is suffering, but the daycare center can’t accommodate dropping the nap because they don’t have anybody to actually watch the kids that don’t nap.
[00:30:47] It’s a very tricky situation and frustrating. And as a, working parent, I understand that frustration, but it’s frustrating when I get a client like that, that they can’t [00:31:00] control what’s happening during the day. Because it absolutely, you’re absolutely right. They max out on their sleep.
[00:31:05] They no longer need. A two hour nap and a 12 hour night, they might need a 10 hour day total. And that’s okay, and they’re doing just fine with it. But you sometimes you can’t control that in today’s society. But I see that a lot and absolutely agree with you that’s a sign that it’s time to drop the nap.
[00:31:25] We either see it, I usually see it either at bedtime, the kid naps, bedtime’s a disaster, or on the other end kid naps falls asleep just fine, but is up at four in the morning suddenly and can’t go back to sleep. wIth infants, I find that the opposite is often true. Parents don’t know a lot of times how just how much sleep infants need and just how important an age appropriate schedule is.
[00:31:51] And so I’ll get parents that, they wanna take their children out until 11:00 PM and they don’t understand why this isn’t working for their child. [00:32:00] And, and you explain that, infants need 12 to 16 hours of sleep in a 24 hour period. But that again goes back to what you’re talking about because for a 12 hour total sleeper you’re looking at, that includes naps.
[00:32:16] So the baby might be sleeping two hours total and naps during the day and they’re only going to sleep only 10 hours overnight. Whereas the child, the baby that needs 16 hours of sleep is getting four hours of sleep during the day and 12 hours overnight. And, going back to wake windows, those wake windows are wildly different.
[00:32:35] You’re looking at 12 hours of awake time versus eight hours of awake time during the day. And, that’s a big variance. So I see, I definitely agree with the too much time in bed and having the over expectation that your child should be sleeping way more. But I also see on the other end that parents just don’t know.
[00:32:54] How much sleep their child should be getting and what does anever reallystorative nap look like? How long should that [00:33:00] be in order to keep them allnever reallysted throughout the day and get them to a bedtime? But but parents also often want a bedtime that is too late for their child and that then
[00:33:14] Craig Canapari MD: Yeah. Because when, so both parents can see them when they get home and stuff like that. Yeah, no, this is so very this is valuable to me because the nature of my practice is we have a long wait list and we see a lot of medically complex children. So when people come to see me, they’ve been struggling for a while.
[00:33:31] And I’d say my clinic population is enriched for kids who have some layer of medical complexity here. But it is, so the first year is so hard and it’snever reallyally hard to make blanketnever reallycommendations. I’m, we’re gonna put in the show notes, the link to the the normal sleep ranges for age.
[00:33:50] But with babies, it’s a huge, it’s a huge range of normal. What we do know is kids who are a high sleep need in infancy, they’re gonna be higher sleep needs throughout childhood. [00:34:00] And a lot of times, honestly, you’re talking about the population of people who kids have high sleep needs and the parents are struggling.
[00:34:08] In my experience, a lot of the times, especially if it’s a first kid, those parents feel like they’re geniuses, right? They figured it out. All their friends are hysterical and they’re like, I don’t know, my kid sleeps great no matter what I do. But then if they have, if they have a second kid and that kid cannot just nap ad-lib and they have to pick, take that kid out of the crib to pick up the other kid at preschool, then things fall apart.
[00:34:31] My older kid was one of those long sleepers and we brought him home from the hospital after four days. And back then there was notnever reallyally anever reallycommendation that they stay in the room with you. That’s likenever reallylatively new. He’s 16 now. Be for SIDS prevention. And he slept for eight or nine hours a night our first night home.
[00:34:48] And I woke up and I’m like, oh my God he’s dead. Like I went, I can joke about it now ’cause he was fine. But I was like, I spread it into his room. So I think to just [00:35:00] bring this all together, if we were, if we wanna try to generalize this for what are, what do parents, what are the take homes for parents?
[00:35:09] I would say that the first thing is make sure there’s not a medical problem, right? If you, your child is not sleeping through the night, meet with the pediatrician, make sure they’re growing normally, developing normally, and that the, any, the common garden variety problems they have, like eczema are well addressed, right?
[00:35:26] I think that’s step one, right?
[00:35:27] Arielle Greenleaf: Absolutely medical. Get medical clearance, step one. Absolutely.
[00:35:32] Craig Canapari MD: I think step two is actually getting some data, right? Track your kid’s sleep for three days. Again, it’s not, you just write it down. When they’re falling asleep, when they’re waking up, know when the awakenings are and look at what, where their sleep duration is. Are they falling in the middle of that?
[00:35:48] Those sleep needs by age, if that, if not, if they’re like way less than it, they probably need more sleep. If they’re on the high end or higher, they might actually benefit from a later bedtime or dropping a nap. [00:36:00] Again, it’s hard to generalize, right? ’cause we’re talking about kids from three or four months of age to I don’t know, age 10 here.
[00:36:05] Butnever reallyally knowing where your child is falling. Is your child falling in the normal sleep range or not? That isnever reallyreally important clue. And I thinknever reallyally working working towards independent sleep at bedtime. That’s that’s the third step. That’s that is sleep training.
[00:36:23] Whether your kid is six months age or six years of age, there’s a million different ways to do it and we can talk about it. But and there, I guarantee you there is a technique as a parent that you will feel comfortable doing if I don’tnever reallycommend cry it out with a 4-year-old, right?
[00:36:38] But it might work well if you’ve got a seven month old. But it has to feel in accord with your parenting values. I Dunno, what am I missing? What are any other big top line take homes for people?
[00:36:49] Arielle Greenleaf: No, I don’t think you’re missing anything. I think. The independent sleep, first of all. Yeah. The medical clearance tracking is really important. And [00:37:00] if you’re confused about your tracking, talk to your doctor. Ask if it’s, if it looks normal and if it’s not, if it doesn’t and then absolutely the next step is figuring out how can I help my baby or child fall asleep without needing me to do something extra.
[00:37:21] And again, we can talk about that. You can talk about that at another time, but that doesn’t, again, it does not mean to be, you just plop them in the crib and walk out and let them scream. You can be there with the child to help them learn to feel safe and secure there. And then, like you had said, once you’re able to.
[00:37:41] Once a child is able to fall asleep that way, they’re usually going, that’s going to overlap throughout the night. And then during the day it’s going, they are going to catch on and realize that they’re safe, secure, happy, healthy, all of that and fall back asleep without much assistance or any assistance.
[00:37:58] Craig Canapari MD: When you think [00:38:00] about it as a parent you help your children are gonna learn to do stuff on their own, right? But you can help them. You can help them. You help them by introducing solids at the right time. You help them, when they’re learning to walk, you’re like holding their hand and it, this is another situation.
[00:38:15] You are teaching your children an incredibly valuable life skill to be good sleepers, right? I’m always like, some good sleepers are born and others are made. So if you’re struggling, let’s make your child a good sleeper. So Arielle, anything you wanna plug? Anything? Where can people find you online?
[00:38:33] Arielle Greenleaf: I’m not actively practicing at the moment, but if you want to reach out out with me with any questions, concerns, thoughts, or ideas, I can be reached at arielle@arielgreenleaf.com. I,
[00:38:45] Craig Canapari MD: Okay, you look forward to a bunch of emails now.
[00:38:47] Arielle Greenleaf: whatever. That’s fine.
[00:38:49] Bye.
[00:38:49] Craig Canapari MD: Thanks so much for listening to the Sleep edit. You can find transcripts at the web address Sleeped [00:39:00] 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.
[00:39:20] 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.
[00:39:46] It really helps as we’re trying to get the show off the ground. Thanks.
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