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14 PARENTING ESSENTIALS

SLEEP - THE PARENTING ENIGMA SLEEP THE PARENTING ENIGMA Sleep…the elusive enigma of parenting...

As you will discover, sleep, or lack thereof, will become the most widely talked about issue in your home once you become a parent. Your child’s sleep needs (and your own) will likely rule your entire life. There is no small reason for this. Sleep is involved in so many essential functions such as brain development, hormone regulation, immune system, stress management, appetite regulation, behavior management, and executive function. It may surprise you to hear that lack of sleep does not always display itself as lethargy in children, but can mimic ADHD symptoms. Thus it is essential that we both understand the importance of sleep for the healthy functioning of many systems, and why we recommended that parents place a high priority on helping children to develop heathy sleep patterns, also known as sleep hygiene. Learning how to fall asleep and stay asleep are life skills your child will need for their entire life and will contribute to many areas of healthy development.

As adults many of us suffer from insomnia due to stress and many of us have developed bad habits with regards to sleep, such as watching the news or reading emails right before going to sleep, or when we wake up in the middle of the night. These are not habits we want to pass on to our children. We want to set them up for success in their sleep routines so that they can experience success during their waking hours.

 While your needs will definitely take a back seat to your newly adopted child or children.  Your sleep needs are equally important to consider, as sleep deprivation will affect, among other things, your ability to learn new things, your mental capacity, and your emotional state.  Which are all necessary functions as a new parent, especially your ability to manage your emotions and remain calm.  Even when when you are being pushed to the edge of your capacity, regardless if it is by an oppositional toddler, or a colicky newborn.

SLEEP - THE PARENTING ENIGMA SLEEP THE PARENTING ENIGMA In this book you will learn about: 

Why routines matter to children at all stages of their development.

How to cultivate healthy sleep habits in your children from an early age that they will benefit from into adulthood. The effects of sleep on brain development. The benefits of reading to your child before bed.How screen-time is sabotaging your child's sleep, and strategies you can try to minimize the adverse effects.

SLEEP THE PARENTING ENIGMA Bedtime Routines

To learn more about why a regular bedtime is important, please listen to the following 4 minute podcast on National Public Radio: 

Why a regular bedtime is important for children(https://www.npr.org/2013/12/16/251462015/why-a-regular-bedtime-is-important-for-children)A bedtime routine can consist of many relaxing activities that you and your child decide on together; however, as you heard in the podcast it is important to remain consistent in the routines. Although routines are meant to set limits, they should not be inflexible. The key is to allow your child to have flexibility within the limits- for example, if one of the routines for your toddler is playing in his/her room before bath time, let them decide on what they want to play. Routines are also important for a number of other reasons:(1,2)Children feel safe when the home environment is predictable. Routines ensure you have time to spend together as a family, which contributes to the relationship that you have with your child. Routines help the entire family as children's behaviours improve when they know what is expected of them. If a child gets to do whatever they like whenever they like they may be resistant to for example brushing their teeth at bedtime when you ask them to. By establishing a routine the events leading up to getting into bed are less disruptive. Having a routine fosters independence, responsibility and time management. If you and your child complete the same activities every evening, as they get older they will do the activity of their own without you asking. Maintaining a routine is important for brain development. The American Academy of Paediatrics has identified five educational “Rs” that foster the relationship that children have with their parent(s), particularly within the first 1,000 days of life. “Developing routines, particularly around meals, sleep, and family fun” have been identified as one of the ‘Rs’. The others include: read together every day with your child; rhyme, play and cuddle with your child every day; reward your child with praise for successes to build self-esteem and promote positive behaviour and develop a strong and nurturing relationship with your child as the foundation for their healthy development.(3)  

SLEEP THE PARENTING ENIGMA Establishing a Routine and Getting Your Child to Sleep

Although there are some key features to an effective routine, it is important to find a rhythm that works around meeting your family’s individual needs: (4)

A routine should be well planned, with the aim of everyone knowing their roles, and seeing these roles as reasonable;Routines should be a part of everyday family life;In a good routine, things are predictable and happen in the same order each time. 

The Cleveland Clinic has developed some suggestions you may want to consider around your child’s bedtime routine. These are also habits that your child can carry forward into their adolescent years and adulthood.[5] 

Maintain a consistent sleep schedule- regardless if it is a school day, your child should be waking up and going to bed at relatively the same time every day. If they wake up at the same time regularly, this allows adequate sleep pressure to build up during the rest of the day which helps them fall asleep more quickly. Don’t go to bed hungry- provide your child with a light snack before bed, but avoid heavier meals 1-2 hours before bed. Plan up to one hour of quiet time before bed - this part of the bedtime routine should be calm and enjoyable and may include activities such as bath time, a foot rub, and story time. The last 10-15 minutes should occur in the child’s bedroom. It is also important to consistently allow your child to fall asleep in their bed, as this helps them learn to fall asleep by themselves. Create a comfortable sleep environment -The child’s bedroom should be quiet, comfortable and dark. If your child is attached to a blanket or a stuffed animal then it is fine to make these objects a part of the routine. The bedroom should be associated with positive feelings; therefore, it is not recommended that the child’s bedroom be used for time-outs. 

If your child has difficulty falling asleep you may want to consider using white noise. For babies white noise can create a familiar womb like sound, which is soothing and helps them tune out other sounds. For some children creating a calming environment using white noise becomes a familiar cue that is it sleep time.(6)

If you have a child whose mind is always racing, you may encourage your child to try guided meditation. Meditation helps children focus on one thing and wind-down at the end of the day. There are a number of podcasts, and guided meditation sessions available online. If you are interested in using guided meditation to help your child fall asleep, consider signing up for HeadSpace (https://www.headspace.com/ ), where there are a number of options for sleep, life balance, waking up, etc. 

SLEEP THE PARENTING ENIGMA Are Children Getting Enough Sleep? 

Even with a consistent bedtime routine, the question still remains if children are getting enough sleep. 

A study conducted in 2018 by Gruber and colleagues at McGill University examined the sleep patterns of 144 children ages 6 to 11 during the academic year. The children were divided into three categories based on age; 6-7, 8-9, and 10-11. Each participants’ sleep patterns were assessed for seven nights using a wristwatch device that measures movement to evaluate sleep. The results showed that only 17% of children ages 6-7 got the recommended amount of sleep, and this figure dropped to just 2.5% for those ages 10-11. The team also found that those in the 8-11 age categories showed increasingly unhealthy sleep patterns that are usually found in teenagers, such as later bedtimes, inconsistent sleep schedules, and sleep deprivation. [6],[7]

These findings are staggering, especially when compared to research conducted roughly a decade ago. In a cross section survey of 3,235 Canadian youth, findings revealed that 70% of youth did not obtain the recommended hours of sleep per night. [8] Therefore, children are not just getting less hours of sleep than a decade ago, but this is occurring at a younger age.

The charts and content below were developed by the Canadian Pediatric Society.  They illustrate the general guidelines for average hours of sleep over a 24 hour period, including nighttime sleep and naps. [9]

Infants (4 to 12 months old)

12-16 hours

Toddlers (1 to 2 years old)

11-14 hours

Children (3 to 5 years old)

10-13 hours

Children (6-12 years)

9-12 hours

Teenagers (13-18 years old)

8-10 hours

SLEEP THE PARENTING ENIGMA

Infants 

At this age babies sleep an average of 14 hours a day, but anything less or more can be normal for your baby. By 4 months, most babies need three naps a day; one in the morning, afternoon and early evening. Between 6 and 12 months, your baby will probably go from 3 naps a day to 2 longer naps, one in the morning and one in the afternoon. Every baby’s napping needs are different. Some nap for as little as 20 minutes at a time, while others sleep for 3 or more hours.

Toddlers

Most toddlers sleep between 11 and 14 hours in a 24-hour period. Similar to the later infancy stage, there will be a gradual decline in daytime naps, and some children will discontinue their morning nap; leaving an afternoon.[10]

Children (3-5)

Preschoolers typically sleep about 10 to 13 hours a day. As your child approaches 3 years old, she/he will probably drop to one nap a day. Some children give up daytime naps altogether during this period. You can use that time—often after lunch—for quiet time with your child to read and relax.

At this age, it’s common for children to have some sleep problems and to resist going to bed. They may also wake up during the night from nighttime fears or nightmares.

Children (6-11)

At this age child will begin going to bed later, and consistent sleep onset begins. As children are going to bed later, their total sleep time is reduced.[11]

Teenagers 

Sleep patterns will change during adolescence. The brain produces melatonin at a different time of the day. This makes your child feel tired and ready for bed later in the evening. Encourage your child to get enough sleep each night. On average, teenagers need 8-10 hours.[12]

SLEEP THE PARENTING ENIGMA The Effects of Sleep on Physical and Mental Well being 

Sleep deprivation in children, adolescents and adults has a negative impact on health (metabolism, immune function), cognitive function, emotional regulation, and accident risk.  This section will explain the benefits of sleep, and the harmful effects of sleep deprivation in further detail. 

Sleep and Physical Health 

Body Weight- sleep modulates levels of hormones that are involved in regulating metabolism and controlling appetite. Variable sleep patterns or reduced sleep cause hormonal imbalances which cause an individual to feel hungrier and eat more throughout the day. This has been linked to an increased risk of weight gain or obesity in children and adolescents. Additionally, insufficient sleep can cause fatigue during the day, which discourages children and adolescents from exercising, which leads to fewer calories burned. 

Immune Response- sleep increases the defence of the immune system by increasing the production of proteins called cytokines. Cytokines are necessary to counter infections and   inflammation. In addition, infection-fighting antibodies are reduced when individuals do not get enough sleep. [13]

Risk of Injury - In young children sleep deprivation increases the risk of injury such as accidental falls; and is also associated with a higher rate of injuries that require medical attention. For adolescents, sleep deprivation is the number one cause of mortality due to unintentional injuries, most notably automobile accidents. 

SLEEP THE PARENTING ENIGMA

Sleep and Mental Health 

Learning and Memory - sleep plays an integral role in memory processes, especially in retaining new information. Irregular sleep will therefore do the opposite, where learning and memory function are negatively impacted. 

Academic Performance - Sleep disorders, sleep deprivation and daytime sleepiness is linked to school absenteeism. When a child gets the average sleep necessary for their age, they are more likely to perform better in activities and tasks that require reasoning. Shorter sleep duration almost triples the risk of a child performing poorly on neurodevelopment tests that examine school readiness into primary school. 

Executive Functioning -  executive functioning refers to the cognitive processes that organize and regulate information and behavioural responses.These processes include inhibitory control, planning, flexibility, problem solving and reasoning. The executive regulatory system plays an important function in a child’s academic achievement. Poor executive functioning is associated with behavioural problems. A lack of sleep has been shown to reduce planning, problem solving, attention and vigilance, and as a result impair one’s ability to regulate their behaviour

Parenting and Family Stress- when your child is not sleeping well, or getting enough sleep it affects the entire family. Your sleep will also be disturbed, which impairs your ability to deal with stress, and regulate your emotions. Parents may also be more likely to allow their children to sleep with them. For some children this will become a habit, and they will not learn how to fall asleep independently. You may recall that it is not recommended that you share a bed with your baby as this increases the risk of Sudden Infant Death Syndrome. 

SLEEP THE PARENTING ENIGMA The Causes of Sleep Deprivation in Children  

Disturbed sleep and shorten sleep duration are often linked with external cues and stimuli, and also how society and caregivers prioritize sleep.

Sleep needs to be treated as a high priority similar to a healthy diet, physical activity, and mental wellbeing.  Children and adolescents live in a 24/7 society- stores are open later, energy drinks are encouraged to stay awake, sporting events occur in the evening; not to mention that both parents and children have busy schedules. Children are often enrolled in multiple curricular activities and parents’ work later hours, which delays family activities such as eating dinner – all of which delay the onset of sleep. As a society we perceive time spent sleeping as time lost doing something more productive; but based on the physical and mental impacts of sleep, parents should not be neglecting sleep as an important component of a healthy lifestyle.[14] 

Additionally, external stimuli such as modern technology that emits excessive light exposure, the physical environment, and consumption of caffeine substances also affect the quality and duration of sleep.

The Effects of Screen Time on Sleep

A 2017 survey conducted in Australia showed that 43% of children use a screen before bed, and 26% reported sleep problems.[15] Screen time affects sleep in two ways 1) delays the onset of sleep, and hampers the quality of sleep. Children need 4-6 sleep cycles each night. A normal sleep cycle includes both non-rapid eye movement, and rapid eye movement, and one cycle takes approximately 90-110 minutes to complete. [16]

When digital devices are present in the room, children’s sleep cycles are disrupted with the noises emitted from notifications. The other ways in which screen time affects sleep are as follows: 

Premature waking: If digital devices are readily available, despite feeling tired, some children will choose to wake up early to get a dose of screen time before they start their day. 

Sleep Delays: Electronic devices such as smartphones and tablets emit a blue light. Blue light suppresses the production of melatonin, the hormone that makes us tired and regulates our sleep/wake cycle. If a child is on the device right before going to bed, their melatonin production will be delayed. Additionally, the content of a television shows, exciting video game and/or stimulating phone conversation can lead to an adrenaline high, which makes it more difficult to fall asleep.[17]  

SLEEP THE PARENTING ENIGMA Night waking: Watching something that is frightening of violent can keep your child awake at night or result in interrupt waking. This is more common among younger children under the age of 10, because developmentally they are still susceptible to intense fear from disturbing images.


Parents should restrict digital devices 90 minutes before the child goes to bed, and keep the bedrooms a tech free zone to allow children to get their 4-6 cycles of uninterrupted sleep. It is also important to lead by example, and begin to wind-down and put your digital devices away when you are going through your child’s bedtime routine. If you are able to, it is suggested that you have a ‘landing-zone’ in your home. This is where all the digital devices go to charge at night. This is an easy way for you to do a count to ensure that no phones/tablets have been smuggled into the bedroom.   

SLEEP THE PARENTING ENIGMA Behavioural Sleep Interventions (Sleep Training)

Sleep training can be daunting for parents. There are a number of methods available, and depending on the method you choose, the beginning days can pull at your heartstrings. 

Clinical studies have shown that frequent night waking’s and bedtime problems are prevalent among 20-30% of infants and children. As you read about in the last section, sleep that is interrupted or insufficient can lead to effects on cognitive development, mood regulation, as well as health issues, Bedtime problems also have the secondary effects on parent(s) including stress, anxiety, depression and reduced coping ability. Thus, the purpose of sleep training is to teach infants how to fall asleep, and stay asleep throughout the night.

From a developmental standpoint, there is not a clear consensus on when to start sleep training. However, it is not recommended to begin sleep training before approximately three months of age. Babies younger than three months are too unstable to sleep training, and do not have the self-regulation to calm themselves down. Additionally, in the first few months of life a baby has not established their sleep-wake cycle. Babies younger than four to six months need to be fed every few hours; therefore, sleep is fractured and confusing, as feeding can occur anytime of the day. When a baby drops their middle-of-the-night feed is when they begin establishing internal sleep rhythms; and you can begin sleep training if you feel that you and your child are ready.

Behavioural Sleep Techniques

There are approximately six different behavioural sleep techniques; however, there maybe others that have been modified by sleep therapists to meet their clients’ specific needs.

Check and Console (also known as graduated extinction, progressive waiting and interval method

The Check and Console method involves the parent(s) continuing to check on their your baby at preset intervals but never feeding or rocking them to sleep, because the aim is to get the baby to fall asleep on their own. The parent(s) leave and check on their baby, increasing the time interval between visits until the baby falls asleep. If you baby wakes up, you start the process all over again.
Chair method (parental presence)

The parent(s) sit in a chair next to the crib. When the baby falls asleep, the parent(s) leaves the room. If the child wakes up, then the parent(s) returns to the chair until they fall back asleep. Every night the parent(s) move the chair further away from the crib, until the parent(s) is out of the room. The cons with this method are that it can be confusing for the child, if you are in the room watching them cry, but not responding. You presence in the room may also cause too much stimulation for the child.

SLEEP THE PARENTING ENIGMA Pick up, put down and shush-pat

In this technique the parent(s) stand over the crib and gently pat the baby or shush them in an effort to reassure them. This technique works well for babies that are under seven months of age, but after that age picking your baby up and putting them down could be too stimulating. 

Bedtime-routine fading

With a fading technique, the parent(s) continue to use the method they were originally using the help their baby fall asleep, but decrease the amount of time you spend doing it, until it is phased out all together. 

Bedtime Hour Fading 

This technique involves putting your baby to bed at the time they naturally fall asleep; however, this will likely be later than desired and making that their “bedtime” for a couple of nights. The parent(s) create a calm and consistent routine, and then continue moving the bedtime 15 minutes earlier; until your baby is going to sleep at the time that you desire. 

Extinction or Cry it Out 

The idea behind extinction (or full extinction to differentiate it from graduated extinction) is that you want to extinguish the behaviour (crying) by not responding to it. This involves putting the child to bed and ignoring him/her until a set wake time in the morning. 

The cry-out method is controversial and debated among experts. However, from the perspective of trauma, especially among adopted children, we do not recommend the use of this method. You may recall early in the Education Program there was a detailed section on the effects of chronic/toxic stress; and how early life experiences and environment can leave affects on brain architecture and long-term health. Letting a baby ‘cry it out,’ can lead to strong, frequent and prolonged activation of the stress response system.Toxic stress increases the levels of hormones that flood the child’s brain as a self-soothing mechanism; and in severe circumstances leads to disassociation with the caregiver.  You want to avoid disassociation, and instead build a secure attachment relationship that is built on trust, predictability and responsiveness.  This could mean that sleep training takes more time, patience, and variation of techniques, but at the end of the day it should be a process that works well for you and your child. 

SLEEP THE PARENTING ENIGMA Story Time 

For many children story time is their favourite part of going to bed. It is also an excellent way to encourage sleep, and has positive impacts on brain development.

When a parent interacts with a child verbally, which includes reading to them, there are developmental gains in improved logic, reduced stress, and mastery of language. When you exaggerate the sounds of words you are stimulating neuron connections in the auditory cortex, the part of the brain that is responsible for language. The more often your baby or toddler hears the sounds the faster they are able to notice patterns, sequence the words and process them. As they grow, the development of  neuron connections enables them to hear the difference between words, add to their vocabulary, and sound out words they are unfamiliar with.[18] 

To build and strengthen neuron connections, help develop imaginations skills, and boost their creativity, it is  encouraged that you do voices for the characters, allowing your child to ask questions to make sense of the whole story, and talking about the pictures.[19] 

Reading a story to your child is another way to foster secure attachment. The hour before bed may be the only time you get to connect with your child at the end of the day. You have put this time aside in your routine, so try to create an environment without distractions- leave your phone in the other room and spend some relaxing time as a family.

SLEEP THE PARENTING ENIGMA