tag:theconversation.com,2011:/us/topics/sleep-training-42999/articlessleep training – The Conversation2023-12-24T20:54:28Ztag:theconversation.com,2011:article/2193902023-12-24T20:54:28Z2023-12-24T20:54:28ZRelax – having different sleeping arrangements over the holidays probably won’t wreck your child’s sleep routine<figure><img src="https://images.theconversation.com/files/564133/original/file-20231207-25-tzvzwq.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4743%2C3145&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-jumping-on-bed-bedroom-1024614475">Shutterstock</a></span></figcaption></figure><p>Sleep, along with diet and physical activity, is one of the three pillars of good health. Good sleep makes it easier to grow, learn, perform, be happy, stay in our best weight range and generally be in the best mental and physical health. This is true for all humans but is particularly important with children.</p>
<p>Regular sleep patterns are important for good sleep. But children and their families often stay with relatives or in holiday accommodation around this time of year. Parents may anxiously wonder: will changing sleeping arrangements during school holidays sabotage good habits formed and maintained during the school term? </p>
<p>For over 20 years, I have researched and treated children sleep problems. The research suggests changing sleep patterns over the summer break does not have to be a problem. And there’s a lot you can do to manage sleep issues during and after the holidays.</p>
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<a href="https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5184%2C3453&q=45&auto=format&w=1000&fit=clip"><img alt="A dad kisses his daughter on the head at bedtime as she lies in the bottom bunk." src="https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5184%2C3453&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564130/original/file-20231207-21-63vsqc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Changing sleep patterns over the summer break does not have to be a problem.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-kissing-goodnight-daughter-bedtime-627688967">Shutterstock</a></span>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/should-i-loosen-up-on-the-kids-bedtime-these-holidays-or-stick-to-the-schedule-tips-from-a-child-sleep-expert-192727">Should I loosen up on the kids' bedtime these holidays – or stick to the schedule? Tips from a child sleep expert</a>
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<h2>Sleeping as a skill</h2>
<p>In Australia, as in many western industrialised countries, parents often (but not always) expect their children to <a href="https://jcsm.aasm.org/doi/full/10.5664/jcsm.6284">sleep alone</a> in their own room and in their own bed. </p>
<p>Up to <a href="https://pubmed.ncbi.nlm.nih.gov/20582760/">40% of families</a> use behavioural sleep strategies to teach their child sleep alone. While such strategies are generally successful in achieving this, it can be hard work for all the family.</p>
<p>Many parents worry that having children share a room or even a bed with their parents over the holidays will become the habit during term time, too.</p>
<p>However, the science says once children have learned a skill, such as sleeping alone, they have a “<a href="https://eclass.uowm.gr/modules/document/file.php/NURED263/Pound%20How%20Children%20Learn_%20Educational%20Theories%20and%20Approaches%202014%20book.pdf">neural understanding</a>” of that skill. That means their brain has registered, recorded and filed the “memory” of sleeping alone and this is stored for quite a long time.</p>
<p>Short relapses or interruptions to using that skill will not eradicate it in the brief time of a holiday. The child will still know how to sleep alone. </p>
<p>However, <a href="https://theconversation.com/is-there-such-a-thing-as-too-old-to-co-sleep-with-your-child-the-research-might-surprise-you-188145">they may not want to</a>.</p>
<p>Children may may realise sleeping with parents or siblings is actually pretty great (for them). It may be less fun, however, for the parents (who may not necessarily want to share a bed with a wriggly child, or feel frustrated by seeing siblings who don’t normally share a room, muck around when they should be asleep).</p>
<p>Like many aspects of parenting, it helps for parents to remind their children of the rules at home and guide them back to their regular sleep pattern.</p>
<p>Helping children to understand the co-sleeping or room sharing arrangement may be temporary is helpful. Children can and do learn sleeping arrangements can be different in different places, but the rules stay the same at home.</p>
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<a href="https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two children peek out from a bunk bed." src="https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564137/original/file-20231207-23-tzvzwq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sometimes, being on holidays means sharing a room with your sibling or cousins for the first time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-happy-young-boy-brother-lying-140064361">Shutterstock</a></span>
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<h2>What if my child won’t sleep at the holiday accommodation?</h2>
<p>This is a problem not just because it keeps parents and others from a good night’s sleep. It also deprives the child of sleep.</p>
<p>For some children, particularly sensitive or anxious children, changing sleep routines and particularly sleep environments can really throw them off. These children <a href="https://pubmed.ncbi.nlm.nih.gov/29302831/">may find any change very difficult</a>. </p>
<p>When these children are faced with an unknown sleeping environment, they may keenly feel the separation from their parents (who make them feel safe). It can be very difficult and sometimes impossible for them to adjust quickly. </p>
<p>The result may be a child taking a longer time to get to sleep, or long and unsettled overnight wakings. Parents may need to mentally prepare and adjust their expectations.</p>
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<a href="https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young girl touches the light switch of a lamp on her bedside table." src="https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564136/original/file-20231207-31-8fzvvl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Like many adults, some children struggle to sleep in an unfamiliar environment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-child-girl-resting-on-bedturning-1847058961">Shutterstock</a></span>
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<p>It may help to prepare the child for the changes. Find out information about sleeping arrangements, <em>before</em> you go to your holiday accommodation. Talk to the child about the sleep set up, who will be there, look at pictures and share the excitement of a new place with the child. </p>
<p>Discuss being scared and anxious with the child and learn some strategies together to help them be brave and calm such as “You will have your favourite bunny with you. And we will just be in the next room”? Or, “We can take our night light from home?” Practise these before leaving on the holiday.</p>
<p>Encouraging and helping your child to be brave rather than expecting them to be brave alone is more likely to result in a <a href="https://psycnet.apa.org/record/2015-24314-010">smoother transition</a> from home to holiday and back again. Don’t shame them for feeling scared, but try to gently and empathetically help them learn some strategies to cope. Facing a difficult challenge such as changing sleep environments will also teach them resilience.</p>
<p>So parents don’t need to fear any negative repercussions from changing sleeping environments during the summer holidays. Bring on summer and enjoy.</p>
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Read more:
<a href="https://theconversation.com/many-parents-use-melatonin-gummies-to-help-children-sleep-so-how-do-they-work-and-what-are-the-risks-190129">Many parents use melatonin gummies to help children sleep. So how do they work and what are the risks?</a>
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<img src="https://counter.theconversation.com/content/219390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Blunden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For over 20 years, I have researched and treated children sleep problems. The research suggests changing sleep patterns over the summer break does not have to be a problem.Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1833682022-06-30T02:06:52Z2022-06-30T02:06:52ZWhy are parents told to put their baby to bed ‘drowsy but awake’? Does it work?<figure><img src="https://images.theconversation.com/files/470146/original/file-20220621-13681-c6cpcs.jpg?ixlib=rb-1.1.0&rect=59%2C29%2C4924%2C3288&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-cot-35040535">Shutterstock</a></span></figcaption></figure><p>Most new parents and caregivers will know the phrase “put your baby down when drowsy but awake”. But some parents may find this just doesn’t work for them. As soon as the baby goes into the cot, they start screaming!</p>
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<p>Talking with other parents about how to get a baby to sleep can be as divisive as talking religion or politics. It can feel as though there is only one “right” way of doing things. </p>
<p>But as researchers and clinicians supporting families with child and baby sleep, we can reassure you no one way suits all babies or families.</p>
<p>A baby’s natural temperament, age and feeding pattern are among many factors that influence its sleep. Babies often change their sleep patterns as they get older, and it can take time for them to learn how to settle into sleep. </p>
<p>A baby’s environment also influences how it sleeps – siblings, noise, what the family did that day and stress may all play a role. In turn, family circumstances can affect how a baby’s sleep is perceived.</p>
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Read more:
<a href="https://theconversation.com/1-in-3-new-mums-struggle-to-get-their-baby-to-sleep-but-some-women-have-a-tougher-time-102269">1 in 3 new mums struggle to get their baby to sleep, but some women have a tougher time</a>
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<h2>Understanding normal baby sleep</h2>
<p>Sleep happens in cycles. We start out awake, then fall into light sleep and then deep sleep, before moving into wakefulness and so on. For adults, one of these cycles lasts around 90 minutes. For babies and children, it is around half this time.</p>
<p>Every time we go into a light sleep cycle, we may wake briefly. A baby must learn to link sleep cycles to sleep longer. If a baby learns to self-settle, they can link their sleep cycles on their own. If not, they may need help after every light sleep cycle.</p>
<p>Before about six months of age, babies typically wake regularly during the night to feed and get enough nutrients to grow.</p>
<p>After the first few months of life, falling asleep will involve associations – things that are familiar to us – and these associations are learned. If a baby’s sleep associations are with feeding or being in a carer’s arms, they may need this association to fall back to sleep.</p>
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<a href="https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Baby in cot crying" src="https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466128/original/file-20220530-14-9fk5pe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Babies need help to set good sleep associations.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>It’s the same for us as grown-ups; if we wake, it can be hard for some of us to get back to sleep if we are missing our usual pillow or blanket, or if a light gets turned on or we can hear a noise.</p>
<p>When thinking about babies and sleep, it’s important to differentiate between the first and the second half of the first year of life. The reason is a key milestone in the baby’s development sometime beyond around four months of age: the understanding of object permanence. </p>
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Read more:
<a href="https://theconversation.com/controlled-crying-is-helpful-not-harmful-34529">Controlled crying is helpful, not harmful</a>
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<p>This is when the baby knows a caregiver is still around even when they are not visible or in the room with them. This means that if the baby wakes up at the end of a light sleep cycle and cannot go back to sleep by themselves, they will cry or call out. </p>
<h2>Does the ‘drowsy but awake’ advice work?</h2>
<p>Some babies will find it harder to self-settle than other babies. The “drowsy but awake” technique is often recommended as a way to help babies develop self-settling techniques. </p>
<p>The idea is to get them used to feeling drowsy when in bed to set up the association between bed and sleep. </p>
<p>Parents can use <a href="https://raisingchildren.net.au/babies/sleep/settling-routines/responsive-settling-at-6-18-months-reducing-settling-help">responsive settling techniques</a> (such as holding or patting) to help their <a href="https://raisingchildren.net.au/babies/sleep/settling-routines/patting-settling">babies</a> and children get ready for sleep. </p>
<p>While the “drowsy but awake” technique hasn’t been rigorously studied on its own, it has been well studied in the context of sleep training. </p>
<h2>So what’s the evidence for sleep training?</h2>
<p>Sleep training methods that reduce the level of support (incorporating the “drowsy but awake” technique) <a href="https://onlinelibrary.wiley.com/doi/10.1111/apa.15182">can help babies build independence</a> in self-settling. The evidence is based on healthy babies, who are typically six months and older.</p>
<p>One of the most widely known sleep training methods is called “controlled comforting” (also known as “controlled crying”). Parents put their baby to bed tired but awake, and leave them to settle for short, increasing periods of time, even if they cry. Parents choose which time intervals are best for their family – for example, two minutes, then four minutes, six minutes, then eight minutes; or two, five, ten minutes; or two, five, five, five minutes.</p>
<p>A more gradual method is called “camping out”. A caregiver lies on a camp bed or sits in a chair next to their baby’s cot to settle the baby when they cry. Over a couple of weeks, the caregiver gradually moves the chair or bed away from the cot and out the door, until the baby is falling asleep without the parent in the room. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/apa.15182">Studies show</a> these techniques help parents with their child’s sleep and their own well-being. However, the research is lacking when it comes to cross-cultural context, understanding the perspective of fathers, in children below six months of age, and in families experiencing higher social and economic adversity. </p>
<p>Not every technique works for every baby or every family. If caregivers want to try a new sleep approach, it’s important to have a plan A and plan B. Try plan A with the “ideal” situation but escalate to plan B quickly if plan A doesn’t work. Parents can decide whether to try again another time.</p>
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<a href="https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dad holding sleeping baby" src="https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466129/original/file-20220530-18-b8o1lt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If a baby is used to falling asleep in their parents’ arms, they will associate sleep with being held.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>What can I do to establish healthy sleep habits?</h2>
<p>Babies and children thrive on routines. <a href="https://raisingchildren.net.au/babies/sleep/settling-routines#:%7E:text=A%20bedtime%20routine%20can%20make,before%20it's%20time%20for%20bed.&text=See%20how%20to%20settle%20babies,ll%20find%20one%20that%20works.">Positive bedtime routines</a> can help children get ready for sleep. This means doing the same things every time before bed, so the baby knows it is sleep time. These may include things that help the baby calm down, like a warm bath or reading a story while keeping the environment calm and soothing to promote sleep. </p>
<p>Learning new routines is often easier for babies and children when they have more energy (typically earlier in the day) and harder when they are more tired. </p>
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Read more:
<a href="https://theconversation.com/should-i-roll-my-baby-back-over-if-she-rolls-onto-her-stomach-in-her-sleep-88153">Should I roll my baby back over if she rolls onto her stomach in her sleep?</a>
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<p>For more information about children’s sleep and how to manage it:</p>
<ul>
<li><p>the <a href="https://raisingchildren.net.au/?gclid=Cj0KCQjw1tGUBhDXARIsAIJx01lSKoUcXIZpd0EFhEyTUHb4GmWaClNo4WT5KRdJDATjEHb49DrymGoaAk8bEALw_wcB">Raising Children Network</a> website gives all the current evidence on children’s development and <a href="https://raisingchildren.net.au/babies/sleep/settling-routines/patting-settling">sleep by age group</a> and is government-funded and non-profit</p></li>
<li><p>the <a href="https://sleepwithkip.com/">Sleep with Kip</a> website offers a range of clinically validated, evidence-informed resources to help understand and support families with sleep. It includes a 90-second “sleep quiz”, which once completed will provide recommendations for simple, actionable sleep strategies to support your child’s sleep, plus information on sleep cycles and the science of normal sleep.</p></li>
</ul><img src="https://counter.theconversation.com/content/183368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Billy Garvey receives funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Nothing to disclose. </span></em></p><p class="fine-print"><em><span>Anna Price, Ashikin Mohd Nordin, and Valerie Sung do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Advice to put your baby down ‘drowsy but awake’ is an attempt to form good sleep associations.Anna Price, Team Leader / Senior Research Officer, Murdoch Children's Research InstituteAshikin Mohd Nordin, Honorary Community and Child Health Fellow, The Centre for Community Child Health, Royal Children's HospitalBilly Garvey, Paediatrician (Royal children's Hospital), Research Associate (Murdoch Children's Research Institute), Paediatric Clinical Teaching Fellow (University of Melbourne), Murdoch Children's Research InstituteSylvie Picker-Minh, Fellow in Community Child Health, Royal Children's HospitalValerie Sung, Paediatrician, Senior Research Fellow, Honorary Clinical Associate Professor, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653552021-08-04T21:42:01Z2021-08-04T21:42:01ZWhy your baby isn’t sleeping through the night yet … and how to teach them<figure><img src="https://images.theconversation.com/files/413980/original/file-20210730-23-12zygdq.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C4913%2C3268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies and young children have different sleep patterns. Not every one sleeps through the night at the same age, but social pressure is strong on parents to make sure that their children get enough sleep.</span> <span class="attribution"><span class="source">(Shutterstock) </span></span></figcaption></figure><p>A baby’s arrival often means sleep deprivation for the parents during their child’s first five years of life. <a href="https://doi.org/10.1016/j.cppeds.2016.12.001">Between a quarter and a third of parents</a> report sleep problems in children under the age of five. It is one of the most frequent reasons parents consult a pediatrician.</p>
<p>Parents are eager to learn how to regulate their child’s sleep and how sleep affects their development. Social pressure encourages parents to look for answers to the problem of “getting a good night’s sleep” as quickly as possible – or face parental guilt! </p>
<p>But what does good quality sleep mean for a baby? What are the winning conditions for making the most of the benefits of sleep in a child’s development? And what are the consequences of not getting enough sleep?</p>
<p>The science of sleep gives us lots to think about and act on, despite ongoing debates within the scientific community and among early childhood professionals. There is a significant gap between what science knows about child development and sleep, and what is conveyed in our society. For example, the myth of sleeping through the night by a certain age creates <a href="https://doi.org/10.5664/jcsm.9188">unrealistic expectations</a> among parents that can shake their confidence.</p>
<p>Catherine Lord, the co-founder and president of <a href="https://immerscience.com/home/">Immerscience</a>, and I have <a href="https://www.apprendreadormir.com/">created a project on sleep</a> for children aged five and younger, called “Learning to sleep is like learning to walk.” The project aims to help parents who are caught in a whirlwind of information, intermingled with advice, testimonials and expert recommendations.</p>
<figure class="align-center ">
<img alt="A woman picks up a baby from her bed, in an apartment, in the middle of the night" src="https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409143/original/file-20210630-17-1a141l9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A baby awake in the middle of the night. There’s no specific age a child should be able to sleep through the night, but many parents create unrealistic expectations.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Three realities about sleep</h2>
<ol>
<li><p><strong>Sleep is a pillar of health, just like healthy eating and exercise.</strong> <a href="https://doi.org/10.2147/NSS.S134864">A number of areas in a child’s development are linked to sleep</a>, including thinking (cognitive health), interacting with others (social skills), growing (physical health), feeling emotions (mental health) and healing (immune health). Sleep and health work in tandem, while the reverse is also true: being healthy promotes good sleep quality.</p></li>
<li><p><strong>Sleep development is specific to each child, just like learning to walk.</strong> Sleep needs vary with age and aren’t the same for everyone. <a href="https://sleeponitcanada.ca/all-about-sleep/sleep-a-personal-and-lifelong-natural-need/">A baby does not have the same needs for naps and night sleep as an adult</a>.</p>
<p>We grow at the same speed, on average, but we don’t all develop at exactly the same pace. Like walking, sleep develops at a different pace for each child. This period is called the sleep maturation stage. Sleep quality <a href="https://doi.org/10.1016/j.sleep.2020.01.009">varies greatly</a> until the age of two. Two studies that followed babies over time found that the time it takes to fall asleep decreases during the first six months of life, and that children wake less in the night during the second year of life.</p>
<p>By six months of age, a child <a href="https://doi.org/10.1016/j.sleep.2020.10.005">may experience variability in sleep</a>. And up to age three, <a href="https://doi.org/10.1542/peds.2017-4330">sleep varies from one child to the next</a>. To create the winning conditions to positively influence a child’s sleeping development, the important thing to consider is not their age, but where they are in their development.</p></li>
<li><p><strong>Falling asleep alone becomes possible with parental support if this is carried out one step at a time.</strong> There are a myriad of ways to raise children to support their development. The same is true for acquiring sleep autonomy, meaning a child’s ability to fall asleep and return to sleep alone with confidence.</p>
<p>This confidence can be acquired in different ways <a href="https://www.inspq.qc.ca/en/tiny-tot/baby/sleep/sleeping-safely">as long as safety</a> is respected: with or without crying, co-sleeping or not, with the breast or the bottle, with water or milk. Sleep is regulated by biology, but also by environmental factors, such as parental practices surrounding sleep.</p></li>
</ol>
<figure class="align-center ">
<img alt="A mother and her young child in a bed" src="https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=756&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=756&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=756&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409142/original/file-20210630-25-1u364y9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sleep autonomy can be acquired in many ways, and co-sleeping is one of them.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Two leading experts on child sleep, Avi Sadeh and Thomas Anders, <a href="https://doi.org/10.1002/1097-0355(199321)14:1%3C17::AID-IMHJ2280140103%3E3.0.CO;2-Q">have proposed a theoretical model of children’s sleep</a>. Based on a biopsychosocial approach, their perspective takes many factors into account including those associated with the child (such as temperament), the parents (such as mental health problems) and the parent-child relationship (such as parenting styles). All of these factors <a href="https://doi.org/10.1016/j.smrv.2008.12.001">influence a child’s sleep</a>.</p>
<p>Sleep is embedded in a <a href="https://doi.org/10.1016/j.appdev.2019.101057">social context</a> where parents play a crucial role in fostering sleep autonomy. An epidemiological study of preterm and full-term infants admitted to special baby care units after birth suggested that <a href="https://doi.org/10.1111/j.1469-7610.1995.tb01821.x">neurological immaturity is less important</a> in the development of sleeping problems than parental behaviours.</p>
<p><a href="https://www.doi.org/10.1001/archpedi.159.3.242">Studies have shown that parental actions</a>, such as staying near a preschooler until they fall asleep, can lead to more sleep problems. <a href="https://doi.org/10.1097/00004583-199701000-00012">A review of the studies on pediatric sleep</a> suggests that some types of interactions between parents and preschoolers at bedtime may predict sleep problems. Parents can support their child in learning to fall asleep and return to sleep on their own, as soon as the parent sees that the child is ready.</p>
<h2>Three ways to acquire sleep autonomy</h2>
<p><a href="https://doi.org/10.1016/j.infbeh.2017.02.002">A review of the scientific research literature</a> describes the advantages and disadvantages of different sleep intervention methods. Some are more appropriate than others, depending on the child’s age, development or the context of the child’s sleep difficulties.</p>
<ol>
<li><p><a href="https://doi.org/10.1016/j.psfr.2019.01.002">Behavioural sleep intervention methods</a> discourage parents from intervening when children wake in the night, so that the child can learn to fall asleep on their own. <a href="https://www.whattoexpect.com/first-year/sleep/ferber-method-sleep-training/">The three approaches — the standard “sleep extinction method” (“cry it out”)</a>, extinction with parental presence and gradual extinction technique (“camping out”) — include a pre-bedtime routine and putting the child to bed while awake. The parent leaves the child’s sleeping area so they can find sleep on their own.</p></li>
<li><p>Cognitive-behavioural sleep intervention methods change parents’ expectations, beliefs and perceptions about sleep. As the child gets older, additional components are added, such as relaxation techniques, thought modification related to worry and anxiety, positive imagery training and others.</p></li>
<li><p>Attachment-based methods are those that introduce a transitional object such as a blanket. In this category of sleep intervention methods, the key is to target “small steps” or “small goals” that are gentle and caring.</p></li>
</ol>
<h2>No magic method … but winning conditions</h2>
<p>There is no magic method, but parents can develop the winning conditions for sleep autonomy. Parents must make choices based on their child’s needs, which will vary over time, and their family context. Parents must be willing to adapt their methods but also be consistent in their individual interventions. <a href="https://doi.org/10.1016/j.sleep.2019.03.002">Parents must be consistent</a> so that the child will be confident.</p>
<p>The key message is to have confidence in your child and in yourself. Just like walking or potty training, falling asleep alone with confidence is a step toward autonomy. Helping your child in this learning process is helping them “grow up.”</p>
<p>Having realistic parental expectations about sleep is crucial. As a parent it is important to keep three things in mind: that your child sleeps enough for their stage of development, that your child’s sleep develops at their own pace, which can fluctuate, and that the parent must provide favourable and safe conditions to support their child in gaining sleep autonomy.</p><img src="https://counter.theconversation.com/content/165355/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evelyne Touchette has received funding from the Fonds de recherche du Québec (DIALOGUE program).</span></em></p>The sleep of young children varies a great deal. The myth of sleeping through the night at a specific age creates unrealistic expectations that can harm parents’ confidence.Evelyne Touchette, Adjunct professor, département de psychoéducation, Université du Québec à Trois-Rivières (UQTR)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1176382019-06-18T13:29:41Z2019-06-18T13:29:41ZSleep training for your kids: Why and how it works<figure><img src="https://images.theconversation.com/files/278998/original/file-20190611-32347-1t2w284.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting a baby to fall asleep can be exhausting.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/attractive-bald-latin-new-father-exhausted-188170451?src=GbHOJafMSQBB1MKRl3R7jQ-1-2">Marcos Mesa Sam Wordley/Shutterstock.com</a></span></figcaption></figure><p>For thousands of years, <a href="https://www.bbc.com/news/magazine-21035103">mothers have sung lullabies</a> to help their babies and children fall asleep. In more recent times, gadgets and devices have been invented and marketed to help the tired child – and weary parent.</p>
<p>One of these devices has been linked in recent years to the tragic deaths of 32 babies. Fisher Price <a href="https://www.consumerreports.org/recalls/fisher-price-recalls-rock-n-play-sleeper/">recently recalled</a> its Rock ‘n Play Sleeper after the deaths. </p>
<p>The popularity of the device and others shows the widespread desire for help getting babies and children to sleep. Consider that nearly <a href="https://doi.org/10.1093/sleep/29.10.1263">30% of young children experience sleep problems</a> that warrant clinical attention. </p>
<p>As behavioral sleep medicine specialists, we completed postdoctoral training in assessment and treatment of behavioral sleep problems in children and teens. Our knowledge of pediatric sleep research suggests children won’t outgrow sleep problems, and sleep problems may even <a href="https://doi.org/10.1016/j.pcl.2011.03.002">worsen over time</a>. Yet children with sleep problems are not destined to be sleep deprived forever. There are sleep training methods for babies and young children that can work.</p>
<h2>Sleep, my child … so I can, too</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/278999/original/file-20190611-32327-1tmdr01.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A mother rocks her baby to sleep.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-holding-her-newborn-child-329743067?src=TtMKlfeLNhjlohddWKwrjA-1-9">FamVeld/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>We sleep doctors have seen that sleep problems correlate with a host of daytime problems, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630973/">overactivity and attentional impairments</a>, <a href="https://doi.org/10.1016/j.smrv.2009.10.004">poor school performance,</a> and excessive <a href="https://doi.org/10.1016/j.smrv.2011.03.007">moodiness and irritability</a>. As many as 20% of adults experience <a href="https://doi.org/10.1177/070674371105600905">persistent insomnia</a>, and many can trace their sleep problems to childhood.</p>
<p>The most common sleep problems in young children are difficulties falling asleep at bedtime, disruptive nighttime awakenings, or needing special conditions to fall asleep, such as the presence of a parent. These problems, in turn, are likely to cause parental stress and next-day <a href="https://doi.org/10.1016/j.pcl.2011.03.010">impairments for the entire family</a>. </p>
<p>People often equate sleep with “tiredness” and “fatigue.” In fact, <a href="https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep#3">sleep is its own process</a>. It is an interaction of sleep-promoting brain chemicals and consistent daily rhythms of wake and sleep produced by bright light exposure in the morning. The bright light signals suppression of the sleep-promoting hormone melatonin.</p>
<p>Darkness, on the other hand, signals the brain via direct connection from receptors in the eye: “Produce melatonin; Go to sleep.” At the end of the day, there is nothing parents can do safely to make their children sleep. But there are many things parents can do to teach their children the skills necessary for good sleep.</p>
<p>Insomnia responds well to a number of <a href="https://doi.org/10.1016/S0022-3999(03)00061-8">behavioral treatment</a> interventions.</p>
<h2>From crying it out to teaching a skill</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/278995/original/file-20190611-32331-pt7yql.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Timed checks on a baby can be more effective than constantly watching him or her.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-parents-sleepless-newborn-baby-night-1012918264?src=ELf8_5kRm0stEyrN9O6UpA-1-27">Elnur/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Many families have heard of the conventional “cry it out” approach – formally known as <a href="https://doi.org/10.1093/jpepsy/24.6.465">unmodified extinction</a>. Although research supports the effectiveness of this method with infants and young toddlers, it is our clinical experience that few parents find this approach bearable. Furthermore, “cry it out” is not intended for use with older toddlers or preschool-aged children. </p>
<p>Instead, a method called <a href="http://dx.doi.org/10.4135/9781412950534.n2063">graduated extinction</a> is the mainstay of current behavioral intervention for bedtime resistance and sleep association problems. There are several approaches, used from toddlerhood through middle childhood, consisting of techniques such as timed checks, or the “walking chair.” </p>
<p>In timed checks, parents enter and exit the bedroom on a strictly timed schedule. This breaks the connection between problem child behavior, such as crying and calling out, and parental response. </p>
<p>The <a href="https://www.todaysparent.com/baby/baby-sleep/most-popular-sleep-training-methods-explained/">walking chair method</a> involves the parent moving further and further from the child’s bed until outside the bedroom door and, eventually, back to the parent’s own bed. Our clinical experience is that sometimes a combination of these methods is needed. </p>
<p>Although these procedures emphasize the importance of limiting attention to problem behavior, they differ from unmodified extinction by providing attention for positive sleep behaviors, such as lying quietly in bed.</p>
<p>Consider a child who has a longstanding history of needing parental presence to fall asleep. The child can be said to have a skill deficit of being unable to fall asleep on her own. Learning to fall asleep can be likened to learning to ride a bike, first with training wheels, then without, and then without the parent steadying the handlebar. Little by little, the parent takes away her hand, and the child learns balance and eventually pedals away on her own. </p>
<p>With sleep training, the parent teaches the child to practice behaviors that are compatible with sleep, such as lying still and quiet in bed with their head on the pillow. When the parent enters the room every five minutes to say, “Good job staying in bed and lying so still” and offers a quick kiss and pat on the back, the child knows exactly what is pleasing to the parent. Once the child learns to lie quiet and still in bed, sleep physiology takes over.</p>
<h2>Healthy sleep now, healthy sleep in adulthood</h2>
<p>Many parents may incorrectly believe that sleep training is damaging to the parent-child relationship or <a href="https://doi.org/%20doi:10.1542/peds.2011-3467">attachment</a> bond. In fact, we argue that healthy attachment bonds are formed by high rates of reinforcing parent-child interaction such as those used to teach behavior that is compatible with sleep. </p>
<p>Sleep training at younger ages may protect against more serious sleep problems later in life. For instance, at the onset of puberty, most <a href="http://www.nhlbi.nih.gov/files/docs/public/sleep/pslp_fs.pdf">teens</a> experience a natural biological shift that causes them to prefer later bedtime and later wake time. </p>
<p>For most, this preference does not subside until <a href="https://www.sleepfoundation.org/articles/teens-and-sleep">young adulthood</a>. If this natural shift in bedtime and wake time is paired with already problematic sleep habits learned in childhood, the results can be serious. Kids can get <a href="https://www.sleepfoundation.org/articles/teens-and-sleep">behind at school</a> because they fall asleep in class, or they may become truant. Furthermore, when teens attempt to self-correct problem sleep schedules, they often find themselves unable to fall asleep easily at an appropriate bedtime. Many end up spending excessive time awake in bed, placing them at risk for <a href="https://www.sleepfoundation.org/articles/teens-and-sleep">chronic insomnia</a> that could persist well into middle age. </p>
<p>So, that conversation that you are thinking about having with your child’s pediatrician: Have it. Your pediatrician also can help you decide when it might be time to seek specialty care with a <a href="https://www.behavioralsleep.org/">behavioral sleep specialist</a> or <a href="http://sleepeducation.org/find-a-facility">sleep medicine physician</a>. </p>
<p>If your child doesn’t sleep, don’t lose hope. Change is possible. You already have taught and will continue to teach your child many important lessons in life. With persistence, good information and willingness to try new things, healthy sleep habits and a good night’s sleep are within reach.</p>
<p>[ <em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/117638/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ryan Anderson is a licensed psychologist working in behavioral sleep medicine at the UPMC Children's Hospital of Pittsburgh. Dr. Anderson also provides autism services and receives funding from the Autism Treatment Network.</span></em></p><p class="fine-print"><em><span>Hannah Ford does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Adults are not the only people in the US who have problems with sleep – babies and children suffer from loss of sleep, too. Two pediatric sleep experts explain how you can help your little ones.Ryan Anderson, Researcher, Child Psychology, University of PittsburghHannah Ford, Researcher, Pediatric Sleep Disorders, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/830222017-09-18T00:09:37Z2017-09-18T00:09:37ZChildren and sleep: How much do they really need?<figure><img src="https://images.theconversation.com/files/186227/original/file-20170915-8125-1nrv7pn.jpg?ixlib=rb-1.1.0&rect=2%2C110%2C992%2C541&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows that night waking in infancy is associated with behavioural control challenges at three and four years of age.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>How much sleep, and what type of sleep, do our children need to thrive? </p>
<p>In parenting, there aren’t often straightforward answers, and sleep tends to be contentious. There are questions about whether we are <a href="https://doi.org/10.5665/sleep.2538">overstating children’s sleep problems</a>. Yet we all know from experience how much better we feel, and how much more ready we are to take on the day, when we have had an adequate amount of good quality sleep. </p>
<p>I was one of a panel of experts at the American Academy of Sleep Medicine to review over 800 academic papers examining relationships between children’s sleep duration and outcomes. Our findings suggested <a href="http://dx.doi.org/10.5664/jcsm.6288">optimal sleep durations to promote children’s health</a>. These are the optimal hours (including naps) that children should sleep in every 24-hour cycle.</p>
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<p>And yet these types of sleep recommendations are still controversial. Many of us have friends or acquaintances who say that they can function perfectly on four hours of sleep, when it is recommended that adults get seven to nine hours per night. </p>
<h2>Optimal sleep hours: The science</h2>
<p>We look for science to support our recommendations. Yet we cannot deprive young children of sleep for prolonged periods to see whether they have more problems than those sleeping the recommended amounts. </p>
<p>Some experiments have been conducted with teenagers when they have agreed to short periods of sleep deprivation followed by regular sleep durations. In one example, teenagers who got inadequate sleep time had <a href="http://dx.doi.org/10.1111/jcpp.12125">worse moods and more difficulty controlling negative emotions</a>. </p>
<p>Those findings are important because children and adolescents need to learn how to regulate their attention and manage their negative emotions and behaviour. Being able to self-regulate can <a href="http://dx.doi.org/10.1080/15402002.2015.1065410">enhance school adjustment and achievement</a>. </p>
<p>With younger children, our studies have had to rely on examining relationships between their sleep duration and quality of their sleep and negative health outcomes. For example, when researchers have followed the same children over time, behavioural sleep problems in infancy have been associated with greater difficulty regulating emotions at two to three years of age. </p>
<p>Persistent sleep problems also predicted increased difficulty for the same children, followed at two to three years of age, to control their negative emotions from birth to six or seven years and for <a href="http://dx.doi.org/10.1080/15402002.2015.1065410">eight- to nine-year-old children to focus their attention</a>.</p>
<h2>Optimal sleep quality: The science</h2>
<p>Not only has the duration of children’s sleep been demonstrated to be important but also the quality of their sleep. Poor sleep quality involves problems with starting and maintaining sleep. It also involves low satisfaction with sleep and feelings of being rested. It has been linked to <a href="http://dx.doi.org/10.1016/j.smrv.2009.10.004">poorer school performance</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186260/original/file-20170916-8121-1ncxtbv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Evidence has consistently pointed to the importance of parents’ behaviours in setting consistent sleep schedules.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Kindergarten children with poor sleep quality (those who take a long time to fall asleep and who wake in the night) demonstrated more aggressive behaviour and were <a href="http://dx.doi.org/%2010.1016/j.jpsychires.2009.08.012">represented more negatively by their parents</a>. </p>
<p>Infants’ night waking was associated with more difficulties regulating attention and <a href="http://dx.doi.org/10.1080/87565641.2014.973498">difficulty with behavioural control</a> at three and four years of age.</p>
<h2>From diabetes to self-harm</h2>
<p>The Consensus Statement of the American Academy of Sleep Medicine suggested that children need enough sleep on a regular basis to promote optimal health. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=410&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=410&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=410&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186231/original/file-20170915-8121-1ot84q7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Growing rates of obesity in children are linked to many lifestyle factors, including diet, physical activity and sleep.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The expert panel linked inadequate sleep duration to children’s attention and learning problems and to increased risk for accidents, injuries, hypertension, <a href="http://dx.doi.org/10.1038/ijo.2014.157">obesity</a>, diabetes and <a href="http://dx.doi.org/10.1007/s10964-014-0137-4">depression</a>.</p>
<p>Insufficient sleep in teenagers has also been related to increased risk of <a href="http://dx.doi.org/10.5664/jcsm.6288">self-harm, suicidal thoughts and suicide attempts</a>.</p>
<h2>Parent behaviours</h2>
<p>Children’s self-regulation skills can be developed through self-soothing to sleep at settling time and back to sleep after any night waking. Evidence has consistently pointed to the importance of parents’ behaviours not only in assisting children to achieve adequate sleep duration but also good sleep quality. </p>
<p>Parents can introduce <a href="http://www.pediatrics.org/cgi/doi/10.1542/peds.2013-1906"></a><a href="http://dx.doi.org/10.1542/peds.2013-1906">techniques such as sleep routines</a> and consistent sleep schedules that promote healthy sleep. They can also monitor children to ensure that bedtime <a href="http://globalnews.ca/news/3719531/how-much-sleep-do-children-lose-when-devices-are-used-before-bedtime/">is actually lights out without electronic devices</a> in their room.</p>
<p>In summary, there are recommended hours of sleep that are associated with better outcomes for children at all ages and stages of development. High sleep quality is also linked to children’s abilities to control their negative behaviour and focus their attention — both important skills for success at school and in social interactions.</p><img src="https://counter.theconversation.com/content/83022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendy Hall receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council. </span></em></p>Poor sleep in infants and children has been linked to an array of problems, from aggression to poor school performance to diabetes, obesity and suicide. Our expert reviews the science.Wendy Hall, Professor, Associate Director Graduate Programs, UBC School of Nursing, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779432017-09-11T19:41:21Z2017-09-11T19:41:21ZEssays on health: Australia is failing new parents with conflicting advice – it’s urgent we get it right<figure><img src="https://images.theconversation.com/files/181928/original/file-20170814-28487-1h0x1q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Much of the baby's distress, as well as that of the parents, can be prevented.</span> <span class="attribution"><a class="source" href="https://unsplash.com/search/photos/baby?photo=EpbIXGCrtK0">Janko Ferlič/Unsplash</a></span></figcaption></figure><p>Every year, hundreds of thousands of Australians embark on a disorienting, life changing journey. They have a baby.</p>
<p>What happens after a woman gives birth should be a matter of serious public interest. Screaming babies, breast pain, baby weight-gain worries, breastfeeding issues, wind, colic, reflux, allergies, tongue tie, sleep deprivation, and parental anxiety and depression. These are common concerns at the beginning of the life of every Australian citizen. </p>
<p>In reflecting on these, we’re actually considering the developmental origins of disease. This is so for many reasons, including that the infant gut microbiome <a href="https://www.ncbi.nlm.nih.gov/pubmed/26663826">affects</a> metabolism and immunity even as an adult, and that postnatal depression has <a href="https://www.ncbi.nlm.nih.gov/pubmed/25455250">long-term effects</a> on a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412485/">child’s cognitive potential and mental health.</a></p>
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Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
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<p>Throughout the developed world, <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/AFF3C1C460BA5300CA257BF0001A8D86/$File/NFUCFHS.PDF">non-communicable diseases</a> are now the <a href="http://adc.bmj.com/content/early/2016/08/29/archdischild-2016-310991">major cause of illness</a> and death in children, mirroring trends in adults. Among these, immune, gut, developmental disorders and mental illness feature prominently. All are shaped by environmental factors in very early life.</p>
<p>Yet, our health professionals often recommend approaches to behaviour problems in infants - such as with <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">breastfeeding</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">crying</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">fussing</a>, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/26555938">sleep</a> - that have been demonstrated to be ineffective. Some <a href="https://www.ncbi.nlm.nih.gov/pubmed/23905907">recommendations</a> actually <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">risk worse health outcomes</a> for both the mother and baby.</p>
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<img alt="" src="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179928/original/file-20170727-32584-1v89fu2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">What happens after a woman gives birth is a matter of serious public interest.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>From the moment their baby is born, Australian parents receive vastly conflicting advice from <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">different health disciplines</a>, or even from different health professionals in the one discipline. Confusion during an already challenging life transition drives parents to seek <a href="https://www.ncbi.nlm.nih.gov/pubmed/21679331">opinions from multiple providers</a>: the GP, paediatrician, midwife, child health nurse, pharmacy nurse, lactation consultant, dentist (yes dentist), and the emergency department. Many visit complementary and alternative medicine practitioners.</p>
<p>Yet <a href="https://www.mja.com.au/journal/2016/205/2/prioritising-general-practice-research">less than 2%</a> of the National Health and Medical Research Council funding goes to research into primary care, the first port of call for new parents. Research performed in hospitals or specialised settings, including concerning issues of early life care, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221610/">often isn’t relevant in the community</a>. We must take primary care research seriously if we want to ensure parents are provided with consistent, evidence-based advice that is beneficial to the baby, themselves and society at large.</p>
<h2>Breastfeeding confusion</h2>
<p>Up to <a href="http://www.health.gov.au/breastfeeding">96% of Australian women</a> want to breastfeed at the time of the birth. Women want to breastfeed so much that not being able to do so <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">affects their mental health</a>. Yet multiple studies demonstrate <a href="https://www.ncbi.nlm.nih.gov/pubmed/25864129">serious gaps</a> in health professional training in the two most common post-birth problems: <a href="https://www.ncbi.nlm.nih.gov/pubmed/28167998">breastfeeding difficulty</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/22951297">unsettled</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26257315">infant</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/24372749">behaviour</a>. Both <a href="https://www.ncbi.nlm.nih.gov/pubmed/25305429">increase</a> a woman’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/19432839">risk of postnatal depression</a> and are <a href="http://www.bmj.com/content/343/bmj.d7772">linked with</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26869575">poorer infant outcomes</a>.</p>
<p>Undiagnosed problems with the baby latching on to the breast and finding a stable position during breastfeeding (which I call “fit and hold”) can lead to a range of distressing infant behaviours. These include back arching, refusing or fussing at the breast, crying, poor weight gain and excessive night waking. These signs of positional instability are often thought to be signs of reflux and <a href="https://www.ncbi.nlm.nih.gov/pubmed/23495859">treated with acid medications</a>. But evidence shows these medications <a href="https://www.ncbi.nlm.nih.gov/pubmed/25556017">don’t help</a> the problem.</p>
<p>Existing approaches used to support fit and hold, including letting the baby find their own way to the breast, don’t <a href="https://www.ncbi.nlm.nih.gov/pubmed/27286289">improve outcomes</a> for many. Common advice, such as using one hand on the back of the baby’s neck while the other creates a particular shape of the breast, has been shown to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26895966">increase nipple pain</a>. </p>
<p>I commonly see women who have been told by multiple professionals their fit and hold is good, even though the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24075595">baby’s behaviour communicates</a> inability to fit stably into the mother’s body. That is, the baby is showing their <a href="https://www.ncbi.nlm.nih.gov/pubmed/18243594">position is uncomfortable</a> or there is a drag of breast tissue pulling in another direction in the baby’s mouth, in conflict with the inward pull created by the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">vacuum when the jaw drops</a>.</p>
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<a href="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183593/original/file-20170828-1539-1afavwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Australian mothers need more support to breastfeed.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<h2>Oral tie ‘epidemic’</h2>
<p>Then there’s the issue with tongue tie, upper lip tie, and buccal (cheek to gum) tie. This is another way health professionals are dealing with breastfeeding problems and unsettled behaviour – by referring the child for oral surgery. A classic tongue-tie needs a simple scissors snip. But normal <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas%20BFM%202013.pdf">variations of the frenulum</a> - the bits of connective tissue under the tongue and upper lip - are these days <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">often labelled abnormal</a> and blamed for problems. </p>
<p>If we put aside the situation of a classic tongue-tie, the belief cutting or lasering the frenula (called a frenotomy) helps breastfeeding is <a href="http://www.cochrane.org/CD011065/NEONATAL_surgical-release-tongue-tie-treatment-tongue-tie-young-babies">not supported by research</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">Our work</a> suggests that diagnoses of normal variants of connective tissue as abnormal are based on an <a href="https://www.ncbi.nlm.nih.gov/pubmed/26928319">outdated and inaccurate</a> model of how infants attach to the breast.</p>
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Read more:
<a href="https://theconversation.com/deep-cuts-under-babies-tongues-are-unlikely-to-solve-breastfeeding-problems-54040">Deep cuts under babies' tongues are unlikely to solve breastfeeding problems</a>
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<p>Parents are <a href="http://tonguetie.net/consequences/">sometimes warned</a> if the baby doesn’t have a frenotomy for the diagnoses of posterior tongue-tie or upper lip-tie, their baby is at risk of speech and swallowing problems, expensive orthodontic problems, sleep disorders and other developmental problems in later childhood, though <a href="http://pediatrics.aappublications.org/content/early/2015/04/28/peds.2015-0658">there is no evidence</a> to support these claims. </p>
<p>There are now studies demonstrating that the diagnosis of “oral ties” in breastfeeding babies has reached epidemic proportions in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28168891">United States</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27280112">Canada</a>. Exponential increases in frenotomy rates are also evident in our team’s analysis of early Australian Medicare data (yet to be published). Many, if not most, frenotomies are <a href="https://www.smartspeechtherapy.com/wp-content/uploads/2017/04/Three-experienced-lactation-consultants-reflect-upon-the-oral-tie-phenomenon.pdf">performed by dentists</a> using laser, and are not captured by Medicare. </p>
<p>I regularly see <a href="https://griffithreview.com/articles/tongues-tied-about-tongue-tie/">babies after laser surgery</a> with worsened breastfeeding problems. Sometimes their <a href="http://onlinelibrary.wiley.com/doi/10.1111/jpc.12773/abstract">wounds become infected</a>. I often see pale cords of scarred tissue under the tongue. I have also seen the underbelly of a little tongue somewhat separated by a too-deep cut. I have seen suture knots hanging from a newborn’s upper gum after scissors frenotomy. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179936/original/file-20170727-30152-1bs39l4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Breastfeeding problems are often blamed on the baby’s frenulum - the bit of connective tissue under the tongue and upper lip.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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</figure>
<p>The tongue-tie epidemic hasn’t come from a sudden burst of new congenital abnormalities in the mouths of infants in the English-speaking world in the past ten years, as <a href="http://mthfr.net/the-intersection-of-tongue-tie-mthfr/2014/05/23/">some proponents argue</a>. The epidemic parallels broader <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32585-5/abstract">international trends of medical overtreatment</a> and is, in my mind, a painful sign clinical breastfeeding support is in crisis.</p>
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Read more:
<a href="https://theconversation.com/how-to-rein-in-the-widening-disease-definitions-that-label-more-healthy-people-as-sick-76804">How to rein in the widening disease definitions that label more healthy people as sick</a>
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<h2>The importance of sleep</h2>
<p>Parents are also being advised their child’s healthy development and their own wellbeing depends on implementing sleep training. This includes strategies such as: don’t breastfeed your baby to sleep; don’t let the baby get overtired or overstimulated; put the baby down in the cot at the first tired sign; teach the baby to self-settle in the cot; make sure the baby is getting big blocks of sleep instead of catnapping during the day; and use feed-play-sleep cycles. </p>
<p>Technically known as <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">first wave behaviourism</a>, these approaches arose in the 1950s and 1960s. Girls like me were taught them in the 1970s in compulsory mothercraft classes at high school – a long time before the emergence of evidence-based medicine. </p>
<p>But now, <a href="https://www.nhmrc.gov.au/book/promoting-social-and-emotional-development-and-wellbeing-infants-nhmrc-report-evidence-5">high-level evidence</a> demonstrates these approaches do not <a href="http://www.smrv-journal.com/article/S1087-0792(15)00100-8/abstract">decrease night waking</a> or reliably improve women’s mental wellbeing in the first year of life, and especially not in the <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Douglas_Hill%20JDBP%20%2023_9_13.pdf">first six months</a>. </p>
<p>A <a href="http://onlinelibrary.wiley.com/doi/10.1111/bjep.12109/abstract">small subgroup of babies</a> with sleep problems go on to have sleep problems in later childhood. The evidence <a href="https://www.ncbi.nlm.nih.gov/pubmed/22748447">does not support</a> the idea that applying sleep training in the first year will prevent this, yet I hear parents are often told if the baby doesn’t get enough sleep, or if they let “bad habits” grow, their baby’s development and capacity to learn in later childhood will suffer. The threat they are doing the wrong thing if they don’t sleep train <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934563/">heightens parental anxiety</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179915/original/file-20170727-28585-akghxu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Parents are advised their baby’s healthy development depends on implementing conventional sleep strategies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/sleeping-baby?photo=WCbCRXk7nmU">Carlo Navarro/Unsplash</a></span>
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<p>In my experience in general practice, where I’ve had the privilege of following many families over months and years, first wave behavioural approaches cause parent-baby communication confusion, and also unnecessarily disrupted nights for many, due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312214/">disruption of the baby’s circadian clock</a>. </p>
<p>In Australia, many sleep-deprived mothers seek help from <a href="https://www.stayathomemum.co.uk/my-kids/behaviour/sleep-schools-in-australia">residential sleep schools</a>. Some are even referred there by health professionals if the baby just <a href="http://www.saveoursleep.com.au/free-reading/triggers-sleep-problems/">catnaps during the day</a> and doesn’t go to sleep alone in the cot, due to fear of developmental implications. Yet only families with the most severe problems should require this hospital-based solution, which is extremely expensive to the health system. </p>
<h2>So, what are the solutions?</h2>
<p>We have enough evidence to show what works. For instance, <a href="http://www.cppah.com/article/S1538-5442(11)00049-6/pdf">latest research</a> tells us it is important to respond to our baby’s cues for the baby to develop secure psychological attachment. Babies should not be left to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0113571">grizzle or cry</a> as a pattern over time, and breastfeeding to sleep is one sensible tool for making the days and nights manageable. </p>
<p>It’s also important to know about the young human’s biological need for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223372/">rich sensory nourishment</a>. This means encouraging parents to enjoy a social life outside the house, trusting that the baby’s biological sleep regulators will take whatever sleep he or she needs with minimal effort on the parent’s part.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185407/original/file-20170911-9406-gh0c5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Parents should trust the child’s natural sleep sensors will kick in when he or she is tired.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We’ve developed an <a href="https://education.possumsonline.com/sleep-film">alternative parent-baby sleep program</a>. This repairs <a href="http://www.pameladouglas.com.au/sites/default/files/pdfs/Whittingham2014_Optimising%20parent-infant%20sleep%20from%20birth%20to%206%20months%20a%20new%20paradigm.pdf">unnecessary disruption to night-time sleep</a> either by identifying underlying breastfeeding problems in younger babies, or by helping to reset the circadian clock, which is commonly disrupted by the first wave behavioural focus on long blocks of sleep during the day. </p>
<p>And breastfeeding problems can resolve when women are <a href="https://www.ncbi.nlm.nih.gov/pubmed/28614671">helped to stabilise</a> the way their and their baby’s <a href="https://education.possumsonline.com/programs/gestalt-breastfeeding-online-program">unique anatomies fit together</a>. This is when the baby’s breastfeeding reflexes are turned on, his or her face is symmetrically buried into the breast, and as much breast tissue as possible is drawn deep into the baby’s mouth without a drag in another direction. </p>
<p>Our programs have a well-developed and published evidence base, and <a href="http://www.publish.csiro.au/PY/PY13011">promising preliminary evaluations</a>. Obviously, these require bigger trials. But there is too little funding available for clinical primary care research. The UK’s <a href="https://www.nuffieldtrust.org.uk/">Nuffield Trust</a> recently issued <a href="http://adc.bmj.com/content/101/12/1084">a report</a> advising that if we are to care for our children’s health needs in a sustainable health system, models need to shift the focus from hospital-based care to integrated child health care in community settings.</p>
<p>Investing in primary health care <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12348/abstract">has been demonstrated</a> to be more effective, at a fraction of the price of treating problems in hospitals. Just a single visit to an Australian hospital’s emergency department costs the tax-payer <a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">ten times</a> the cost of a visit to a GP. </p>
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Read more:
<a href="https://theconversation.com/medicare-spending-on-general-practice-is-value-for-money-33948">Medicare spending on general practice is value for money</a>
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<p>We can’t expect hospital-based parenting support centres to improve outcomes when mothers and babies are seen there by health professionals who continue to offer conflicting advice. It would be much cheaper and more cost effective to invest in freely accessible, evidence-based, perinatal services in a family’s own community, co-ordinated by their own GP.</p>
<p>In view of the health system costs and tsunami of mental health problems and chronic disease, this is a matter for urgent political and health system attention.</p><img src="https://counter.theconversation.com/content/77943/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Pamela Douglas is Medical Director of a charitable organisation, the Possums Clinic <a href="http://www.possumsonline.com">www.possumsonline.com</a> (Possums for Mothers and Babies Ltd). Possums Education sells two educational products online, the Gestalt Breastfeeding Online Program and the Possums Sleep Film (also available as a DVD). All proceeds are invested into the development of further educational materials.</span></em></p>From the moment their baby is born, Australian parents receive conflicting advice on how to cope with newborn issues. What we are doing wastes our resources, but we’re not investing in alternatives.Pamela S Douglas, General Practitioner, Researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.