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The Afternoon Show
The Afternoon ShowRTÉ One, Weekdays, 4.00pm

Thursday, 26 November 2009

Today Grainne Ryan will be tackling that tricky problem of the bedtime routine and will be giving parents some great tips on how to keep their children happy in their beds.

Grainne Ryan, Public Health Nurse

Sleep problems affect many families. They are one of the most common reasons why parents pick the phone up and ask my help and advice. In many families bedtime is a major trigger for chaos and disruption. Getting the children to bed and keeping them there can take all night when there are no set routines and no firm control in place. The next day exhausted children and parents are like time bombs waiting to go off. A child or indeed a parent who is overtired has a short fuse the very next day which often results in more frequent tantrums, fighting and outbursts of poor behaviour.

Common causes of sleep problems in the young child include:

. Discomfort: colic, wet nappy, too hot or too cold
. Sleeping for too long during the day
. Over tired. This can delay sleep, many over-tired children appear irritable cross and overactive rather than sleepy
. Personality of the child. All children are individuals and have different temperaments
. Other distractions in the room (parents)
. Chronic illness
. Children with a disability may have difficulty with sleep
. Separation anxiety
. Travel
. Strange beds
. Fears and Phobias
. Nightmares
. Tension in the family
. New developmental stage
. Disruption to normal schedules

It can be difficult for parents to set up a bedtime routine for the following reasons:

Parenting issues

. Guilt - In families where both parents work there may be a lot of guilt confusing the issue.
. Tiredness- Looking after children can be exhausting at the best of times. If you are below par and haven't slept well yourself it will be difficult to enforce bedtime routine.
. Bad habits- You might have brought your son into the bed a couple of times and now he won't sleep anywhere.
. Convenience - It takes effort to enforce a bedtime routine and some of us parents may give up at the first hurdle.
. Anything for a quiet night- responding to bedtime tantrums.
. Anxiety- all parents are programmed to respond to their child's needs. Some parents can't bear to hear their child cry for a second.
. Lack of confidence- lack of confidence to assert their rules regarding bedtime.
. Different styles of parenting- Mum wants children in bed but dad says it's ok.
. Lack of consistency

The best way to ensure your child always sleeps in their own bed is to get them into a bed time routine before they are old enough to want to sleep in with Mom and Dad.

Top tips for encouraging your baby to sleep through the night

1. Last feed of the day is filling
As your baby is getting older (about 8 weeks) and is beginning to stretch the time between feeds, try and ensure that the last feed of the day is a real filling one. You may be too tired to make the effort to feed properly, but if you can get him to feed well at this time you should be both able to sleep longer.

2. A bedroom should be peaceful and warm
Ensure your baby's bedroom is a peaceful place, somewhere he can sleep well. Avoid too many distractions in the room. Make sure your baby isn't too hot recommended 16-20 degrees C.

3. Put baby down awake and do not pick up
Always try to put your baby down awake (from about 10 weeks), this will ensure that he will recognise where he is if he wakes up in the middle of the night and be more likely to re-settle himself independently. Do not pick your child up. Stay with your child until he settles and falls to sleep. This takes time and patience could take 35-40min at first, then the time will gradually reduce. 5 nights max.

4. Help your baby develop their internal clock
Maximize the difference between daytime naps and overnight sleep and help your baby to develop his internal body clock
The circadian cycle is our internal body clock that runs through the day and night. It is responsible for our reduced body temperature and hormone production overnight: it enables our bodies to relax and re-generate: maximizing its properties will help you lay the foundations of good sleep habits. Between 4-8 weeks of age, a baby can stretch his longest sleep from 4-8hours and by 2 months will be able to recognize that night time is the best time for the longer sleep to happen. Working with your baby's natural instinct is always the best way to help to develop, so try to ensure there are obvious differences between night time feeds and those that happen during the day. Night time feds can be done in bedroom, nursery with dimmed light and very little chat while daytime feds can be done in the busy kitchen in bright day light surrounded by familiar chatter.

5.Have Patience and try massage
Once your baby has started solids and is having a balanced diet he should be able to start sleeping through the night (provided he is in good health, was not preterm and is the appropriate weight for his age).
If he is still waking don't just leave him cry, you can try this little tip
You will need patience, Kneel by his cot stroking his tummy clockwise direction with one hand and stroking his feet from toe to heel with the other(hold the feed together as if you were about to change his nappy). Use your phrase for going back to sleep 'night night, sleep time. The clockwise motions causes the release of endorphins(happy hormones) . The stroking of the feet at the same time works on reflex points in the feet. This will give him as much reassurance as if you were cuddling and eventually allow his desire for sleep to overcome his desire for a feed.

6. Stick to a routine no matter where you are
Put in place a regular evening routine so your baby picks up on sleep associations, make this transferable so if he goes to stay at granny's the same routine can happen.

Older Children
For some parents setting up a bed time routine may seem impossible. Having bad habits from the word go, can lead to your toddler sleeping in with mum and dad. This can lead to sleepless nights for parents and it can affect mums and dads relationship with each other.

So for those parents who find themselves in this situation what stages can they take to try to reverse the problem and introduce a new bedtime routine:

STAGES:

1. You must see it as a problem
Parents must see it as a problem and must want to solve it.

2. Advance Warning
Give them advance warning that 'you are going to sleep in your cot tonight'

3. Instill a good bedtime routine

4. Explain clearly what's happening
Explain to your child that 'you are a big girl now and will be sleeping in her own bed'
It may help to have her favourite caricature duvet etc

Depending on the age you can use 'controlled crying' or 'stay in bed technique'


Controlled crying.
You will need a lot of support to get through the negative emotions you might feel such as panic and ignoring your child crying.

You need to know your child's different cries.

Cry for attention or pain has a different pattern
Put your child into the cot/bed, read bedtime story - say night night bed time in a firm voice, leave the room and remain outside. Wait one minute before you go back into her. Carry out the same routine, night night etc do not make eye contact and when settled but not asleep leave the room. Double the length of time you stay outside the door so 2 minutes before you go back into settle your child. Continue this process doubling the time to a max of 6 minutes the first night. Stick with it as it takes 5 nights to break a routine. This method can be modified to suit the parents (parents often do not like waiting outside the door listening to their child crying).

For an older child in a bed you follow the same routine, by putting your child back in bed when they get out retreat to the door and wait outside, if you are finding this difficult you can sit beside the bed the first night and gradually move away from the bed towards the door until eventually you are outside the door. The main point is to be consistent, do not make eye contact or talk to your child the only word allowed is night night, bed time.

If your child constantly wants to go to the toilet, just bring them out do not talk and return them to the bed.

If your child is waking because he thinks there are monsters around you could try 'magic Dust Technique' its a game where you shake magic dust and banish all monsters.

If your child goes to their own bed every night but ends up in yours and you don't hear them arriving you could hang chimes off their door and when they pass through chimes it should invariably wake you.

If your older child wakes early every morning and arrives into your room you could use the 'bunny clock' and set the clock for an acceptable time and tell your child when the alarm rings it is ok to come into your room.

Whatever method you decide you need to be consistent but most importantly you must want a solution.


Prices/Stockists/Relevant Information For The Item

Stockists
The Sleepytime Bunny Alarm Clock €30.00
Soothing Sounds CD €10.00
Cool Bananas CD €25.00
The Sleepy Fairy Book €12.00

All available to buy at www.sensationalkids.ie or from the Sensational Kids Shop in Kildare.

Sensational Kids Shop is a registered charity that sells toys that aid child development in order to raise funds for the charity's therapy centre for children with special needs. All proceeds from sales in the shop go straight back into funding the charity.

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