Infant Sleep Training, Regressions & Routines
EPISODE: 49 | DATE: July 1, 2021
“It’s easy to assume you’ve either got to either Wait it Out or Cry it Out. But there is so much you can do in between. It shouldn’t be in an all or nothing situation.”
Thank you for being here, Helen! You are a sleep coach and pediatric nurse and you have 4 children. What was your experience with them and their sleep as infants and toddlers?
- It varied. Having 4 children, they are completely different!
- I was a pediatric nurse when I had my first child, Daisy. I didn’t have much training to do with sleep, so I just did what my health visitor advised me to do: sha told me to read the book by Richard Ferber and to that method.
- Before that, Daisy was a bad sleeper and she was very clingy.
- It took about 3 days to do the Ferber method. It worked in the sense that she didn’t cry out for me anymore which I thought was a huge success.
- But then when she hit any developmental milestones or was sick, we had to retrain her.
- In the meantime I had done a lot more reading and I was thinking about becoming a health visitor.
- During that time, I realized that there were a lot of other techniques I could have used to help my daughter sleep.
- I still have a lot of guilt around that.
- So with my other 3 children, I was a lot more responsive.
What is a health visitor?
- In the UK we have health visitors, and they are public health nurses.
- My speciality was development and early intervention. I helped families with weaning, breastfeeding, sleep, things like that.
- I also did signposting, which means that I would identify any issues and refer out to speech and language experts, dieticians and physios, etc.
- I did this with the NHS (National Health Service) for 21 years!
And now you have your own sleeping and feeding company called Essential Parenting?
- Yes. Essentially what I do now is like being a private health visitor.
- I trained with a holistic sleep coach named Lindsey Hookway and became a certified sleep coach. So I started my company focusing on sleep.
What are the main differences between a sleep training method say around controlled crying versus what you call a more responsive approach?
- So first off, there is no judgement. Everyone will choose their own way.
- People do things for lots of reasons. For me it was a lack of understanding and a lack of knowledge of the alternatives.
- I think there is a lot of information out there about sleep training and it’s more geared toward methods like crying it out.
- Because of that, t’s easy to assume you’ve either got to wait it out (WIO) or cry it out (CIO).
- In reality, there is so much in between, and it doesn’t need to be in an all or nothing situation.
- The main idea behind sleep training and CIO is that you need to teach your children to sleep in a way that fits in with you and your lifestyle.
- In this way, you look at sleep as a behavior that can be managed and tweaked. That’s the emphasis around sleep training. It’s seen as a behavior that you can alter.
- My approach is more gentle, responsive and respectful. It’s more baby led, but it’s not wishy washy and permissive.
- I’m not telling parents that they need to breastfeed or co-sleep or baby wear or anything like that.
- With my approach, all I’m trying to do is to look at what is biologically normal for a baby of that age and to optimize things from there.
- It’s about figuring out the best way of managing sleep in order to be mindful of the needs of the parents while also being respectful of what is biologically normal for the baby.
Let’s talk about some of the most common misconceptions about infant sleep. What is biologically possible for babies and sleep?
- For me, the main myth would is that babies should be taught to self soothe. That’s the one I find is the most common.
- Self soothing is a term coined by Dr. Thomas Anders in the 70s, and he meant it to mean babies who were in a place or relaxation and could drift off happily.
- It wasn’t meant to mean putting a baby down who maybe doesn’t want to go down and then being able to take themselves from a place of high anxiety and high stress to a place of relaxation.
- That’s self regulation and that’s something that we as adults do when we’re in a place of high stress: we’ll do meditation or have a glass of wine or talk it out or stop it off in a boxing room.
- But children don’t do that. Even teens don’t do that – they can’t self regulate.
- So the idea behind a baby being able to self regulate is a complete myth.
- Children learn to soothe by being soothed.
- They learn to be independent by first being dependent.
- And when you respond to your baby in a timely and respectful and responsive way, you are saying to them that distress doesn’t last, that problems can be solved and that you’re there as their safe place no matter what they are going through.
- And that’s what builds securely attached independent curious children as they get older.
What are some of the biological expectations we can expect of a child from 0-12 months?
- To say that you need to stop feeding your baby to sleep, that’s a big one and it’s not true in that age range. People get really hung up that they need to not nurse to sleep because it’s a sleep crutch, etc.
- But actually biologically, that’s difficult because when you’re feeding them you and your baby will be producing a raft of hormones – oxytocin, leptin, neurotrophic factor, etc. – all these amazing chemicals – and they’re all there to make you feel happy and sleepy and content and drift off.
- So to try and not do that is completely going against any kind of what you’re hard wired to do.
- The other idea is that by a certain age or weight that babies should be able to sleep through the night. That’s absolutely not the case.
- Babies wake up for a million and 1 reasons, not just food.
- If it was just food then maybe you could put some limits and say if you’re 20 pounds maybe you don’t need food in the night, and if you’re having 3 meals a day you don’t need that milk in the night.
- But actually feeding is so much more than nutrition. It’s relational. And babies wake for lots of different reasons.
I’m sure it’s different for every baby, but at what age can we expect a baby to sleep through the night, either an 8 hour stretch or even 10-12 hours?
- Unfortunately there isn’t one right answer.
- Because the thing is you and I wake up every 90-120 minutes all through the night. We wake up constantly. We’ll shift. Thump our pillow. Turn over and go back to sleep. And we won’t remember.
- And if you’ve got a baby who is a more high need baby or who signals a lot, then they will wake up after their sleep cycle – which is about 45 minutes for babies – and they will need to know that you’re there.
- And they will need that every single time they go to sleep sometimes.
- And until they’ve learned the idea of object permanence, they won’t stop. That’s a massive thing that doesn’t come until way later down the line – when you realize that things are still there when you can’t see them.
- All this brain development – this has all got to mature before you can expect a baby to not need an adult present in the night.
- So unfortunately it all depends on temperament. It’s so multifaceted – so you can’t really put a time schedule on it.
What advice would you have to somebody who has a baby signaling in the night? How can we optimize that situation to work for both parent and baby?
- I think that’s hard. I would like you to realize that this is just a season and it’s a bloody hard season and it won’t last forever.
- But there are some practical tips:
- One would be a floor bed. So if you can co sleep in whatever way that looks, maybe you can put a floor bed in the baby’s nursery. The baby can go there in the beginning of the night and you can lay with them.
- When they are asleep, you can sneak away and have an evening with your partner, and when the baby wakes up in the night, you can go in and spend the rest of the night on the floor with them.
- My 4 year old has a bed on our floor. She goes to bed in her room every night and at some point she’ll come in and get on her floor board. So she has that connection and doesn’t wake us up.
- The other thing which I think is really really key if you have a child who is seeking you out is to spend time before your bedtime routine boosting them up, filling them up, getting that love tank full to overflowing.
- Because bedtime is a time of separation and children very quickly recognize this.
- And when you can spend that quality time – if you can really focus on what their love language is – that is helpful.
- There is a fabulous book called The 5 Love Languages. They’ve written one for children now too!
- We all need to be shown love in all these 5 ways, but we all have one or two more dominant ones.
- Knowing your child or children’s dominant love language is key. It can have a massive impact on night time wakings and needing that connection in the night.
What are some of the best ways to set up a good sleep environment for children to give them a better sense of connection and a better shot of sleeping through the night?
- One of the main reasons we go to sleep is based on our circadian rhythm. That is our body clock.
- So anything we can do to strengthen that will ultimately help when it comes to bedtime.
- We can do that by first, in the morning – before noon – getting out in the fresh air in the bright sunlight. Sunlight and temperature and those kinds of cues switch your body clock on and signal the start of the day.
- Essentially it’s a very clear message to your main body clock.
- The second thing also has to do with light but later on in the evening: when you start to think about winding down and getting ready for bed, that’s when you want the light dim because that’s when the melatonin starts to increase.
- We know that melatonin is the sleep hormone so we want to give it the best chance.
- Melatonin is inhibited when there is blue light about. So think of night lights,monitors, tvs or games – anything that emits a blue light.
- Get rid of it 2 hours before you want your kids to be going to bed.
- Melatonin starts to produce 2 hours before you go to sleep. So the optimum amount of time to cease blue light to dim the lights is 2 hours.
- That said, we’re talking optimally. I don’t personally do that. My kids watch tv before they go to bed.
- Just pick a few of these tips to implement – doing it all isn’t necessarily realistic for all families.
- The other thing would be to make sure that your kid’s bedroom is nice!
- It shouldn’t be a place of punishment or play.
- But we want it to be a safe sleep place: safe, secure, comfortable and only having positive sleep associations attached to it.
- Don’t have loads of toys around. I know that’s hard because we don’t often have homes that are big enough to hold toys in a separate room but if you can try to make it as dull as possible, that is ideal.
- Also make the bed comfortable. Baby’s mattresses are really firm so once they get older – once you get past that 12 months when the SIDS threat is reduced – make it comfy with pillows, duvets and things like that.
- Also use a comforter – like a transitional object. Something that smells of you that they are attached to that can be a substitute for you when you’re not there.
- I think when it comes to bedtime, I always like to factor in before we start the winding down, the lights going low, some silly time.
- Some big body movement time as well.
- Because as the day goes on and as we get more tired, cortisol builds up in our body. And a couple of ways to get rid of it is one, having a big cry, which nobody wants before bedtime.
- But the other thing is moving our bodies.
- So jumping around the garden or sofa, doing head, shoulders, knees, and toes, dancing and whatnot is really good. It gets the wiggles out.
- So if you’ve got a child who is hyperactive before bed, make sure you’ve spent some good quality time getting the wiggles out and being energetic and then start the wind down time and the bedtime routine.
How long should the wind down be?
- It depends on the age of your child.
- When you’re talking about beginning to end bedtime routine for a very small child, you’re probably only talking 20-30 minutes.
- But as they get older, I’d probably want a good 10 minutes of quiet tidying up and talking in a quiet voice with lights dim. No tv. Lavender diffusing. All these sleep cues that make your little ones know that they are getting ready for bed.
- And then the bedtime routine should be about half an hour.
- That needs to be a time for being calm, connecting and containment because during that time – especially as they get older – that will be the time where they start telling you about their worries and the things that have happened during the day.
- So you need to factor in enough time that they feel like they’ve had some connection, that they’ve been contained and that they’ve had a chance to calm down.
Does that include a bath?
- It’s all so individual.
- I would just pick 3-4 elements: bath, massage, lullaby, story, feed, snack – whatever those things are.
- But I would do them predictably, so the same things in the same order at the same time.
- Because then there is that safe predictability that builds on those sleepy cues and children love routine, they love knowing what’s coming next.
- They don’t like schedules. But they love the predictability of routines.
What are your thoughts on swaddling and sound machines?
- I think swaddling can be really useful if you’ve got a baby that has a really active moro reflex – that’s that startle reflex.
- And then you think about in the 4th trimester how babies need to be very tightly held.
- So swaddling does help to elicit that womb-like experience.
- But it’s a short term tool.
- I think you’ll often find that babies who are swaddled for a long period of time actually struggle a bit later on because that moro reflex needs to be integrated into the body.
- So it needs to be worked through, processed, developed, matured – until it disappears.
- And if you’ve had no or limited time to process and integrate this reflex, you’re just putting it off.
- So you’ll have to do it at some point and make that transition later down the line.
- That said, while babies do like to be held tight, if you think about the womb, yes they are held tight but they’ll use their hands to soothe themselves: they’ll suck on their fingers, they’ll touch their face. They use their hands as a soothing mechanism.
- So when you’re swaddling them tight, yes you can keep them safe but you’re also removing another really useful soothing technique that they’ve been developing over the last 9 months.
What’s the deal with putting your baby down drowsy but awake?
- I’ve been looking after families for 22 years and there are very few children that will go down drowsy but awake.
- They are a certain type of child that are the self soothers and babies who will be quite happy laying there and will snuggle themselves in and suck on their fingers and feel a blanket and drift off.
- But for the vast majority of us, that doesn’t happen.
- We all have rituals that we go through at night, whether that be putting on hand cream washing our face, having tea, etc..
- We do these things because they make us feel good. They set the scene, the mood for going to sleep.
- And all the things that we do to help children go to sleep are perfectly natural because most of them need it! Most of them need to be rocked.
- You pick up a baby and you start swaying. It’s hardwired.
- That’s how we look after babies. That’s what we do.
- For generations, babies have needed close contact, rocking to sleep, feeding to sleep, time to suck (sucking is a massive thing for babies for soothing).
- And we used to do that.
- Now we’re saying to moms, don’t do all those things because that is causing a negative sleep association.
- Instead, use this pacifier,use this cradle that rocks, use this white noise machine.
- And we are providing families with stuff that they can buy that takes over what we would do naturally.
- So this idea that children will go down drowsy but awake – some do! But the vast majority do not. And that’s perfectly normal.
- I know we want a quick fix for our children’s sleep, but the fact is that children take time for brain development, and to develop nurture and attachment. It all takes time. But that’s hard for us modern people!
You spoke about pink noise on your website. Is that the same as white noise?
- No. Pink noise is more of a natural noise.
- It’s still irritating droning noise but it’s more like leaves rustling, natural noise.
- And the research says that it really helps to initiate that deep slow wave sleep.
- Which is why we say to parents don’t use it before 6 months.
- Because pre 6 months is when children are at the highest risk of SIDS, so we want them to be in a light sleep. That’s protective.
- The level of any noise machine should be about the same as a running shower.
- Noise machines can be useful to drown out other noises that may otherwise wake up your baby (cars outside, sudden noises from other people in the house, etc.)
Let’s talk about sleep regressions. What are some of the most common ones and how can we navigate our way through those?
- I don’t actually hold any weight on them.
- From my background as a pediatric nurse, to say they’ve regressed is to say that they’ve lost a skill. And sleep isn’t a skill. It’s a homeostatic bodily function.
- If a child were to lose the ability to walk or talk, that would be a massive red flag and regression.
- So I don’t think it’s accurate to call them sleep regressions.
- For the sake of this conversation, though, I suppose the main ones are the 4, 8 and 12 month “regressions.”
- The 4 month one gets the most attention.
- The reason for most “regressions” is that it’s always around a big developmental change.
- So when your baby is going through separation anxiety or they’re just about to nail walking or crawling or sitting or talking.
- It’s almost as if sleep goes on the back burner for that period of time until they have perfected that new skill.
- And that 4 month one – that’s the time when your circadian rhythm – theinternal body clock – matures. It happens between 4 and 6 months.
- So it’s at that point that the body clock is more mature and you’ll find that babies will need less sleep around about that time.
- And that’s what’s happening – you’ll have had a 3 ½ month who slept so many hours and then a 4 month old – same baby – but gradually over time that circadian rhythm has matured and they don’t need quite as much sleep anymore.
- But you’re still trying to make them sleep the same amount you did a couple of weeks back.
- This again is why it’s so important to take a step back and ask: what’s going on?
- Are they actually tired? I know they went down at 10am every day a few weeks ago but it’s not reasonable to think that’s always going to be the case.
- I think there is a lot to say about just riding these things out.
- Because the more we worry about them and preempt them, the more stressed we get about it.
- And it’s not anything you can control because it’s just this massive developmental change.
- If it is separation anxiety then you work on that. If it’s that they are learning to sit up, then you work on that during the day.
- Often it’s these kinds of physical and emotional things that are maturing.
- But working on them during the day will help speed up the so-called regression.
Can you give us some tips on safe bedsharing?
- Bedsharing is a personal decision and it can be done safely.
- If you can’t safely do it I would advise you not to do it. But if you can do it safely I support you in that.
- In my previous job as a pediatric nurse, I was a children’s intensive care nurse.
- So unfortunately I was on the opposite end of looking after children and those who had had life changing illnesses and accidents.
- And I had to look after a few babies who had had near death experiences from a SID type of situation.
- So it’s imperative that we teach parents how to practice bedsharing safely.
- Because in those circumstances it was families who had gotten so tired and they had sat in the chair and they’d just fallen asleep and the baby had slipped in between the sofa.
- So you do need to give parents the ability to make an informed decision.
- There are a couple of really good websites and they will say this more succinctly, like The lullaby Trust.
- But basically, here are the safe tips for bed sharing:
- It’s a full term, healthy baby.
- If you don’t smoke or drink alcohol.
- If you’re not so tired that you wouldn’t wake up (so that could be because you’re absolutely exhausted or take meds).
- If you’re breastfeeding. Because the evidence show that breastfeeding mothers naturally go into a sort of c-shape hold that formula mamas don’t.
- A firm flat surface.
- And no loose covers or gaps or ties.
- Some of the research says that if you follow that advice, your baby is as safe as if you’d put them in a crib on their own.
- You don’t have to have a floor bed as long as the mattress is firm and flat.
- There is some other research that says the vast majority – 80-90% of parents – end up bed sharing.
- But only a small amount will plan to.
- Parents will unintentionally fall asleep on the sofa or just nod off or just can’t be bothered to get up and put their baby back down.
- The difference between an unplanned co-sleeping is miles apart from a planned one because if you’ve planned it, your baby will be safe.
- If you’re pregnant now – plan to bed share. At least familiarize yourself and put as much in place as you can to ensure that in the middle of the night the baby is as safe as can be.
- Because it’s the time when we’re not intentional in our actions that is the most dangerous time.
Is there any point when you work with a client whose baby is waking up frequently at night when you might suggest that something might be wrong that needs to be addressed? Like a medical issue?
- Well, night waking is normal.
- But that said, you would want to approach things observationally in a gentle way.
- You’d look at naps and connections and weaning and allergies.
- And any underlying psychological issues. Is this baby mouth breathing? Is there an iron deficiency? Restless legs?
- There are lots of things that could be causing night wakings. T
- That’s what’s great about my medical background because I can use it to help with my assessment when I work with families.
- If there is something that doesn’t seem right, get it checked.
Is there an ideal bedtime?
- No. Because with children, there is an average amount of time that you could expect a 2-3 year old to sleep overnight (probably around 9-10 hours) but that will be dictated to if they have naps.
- A 2-3 year year old should be getting about 11-14 hours, maybe a bit less.
- So if they have a good nap, that takes some of that off.
- If you’re putting your baby to bed at 7 and they only need 9 hours overnight then you’ll get that early wake up.
- If you don’t mind that, that’s great.
- But if you want the other way then you’re going to forgo that evening time.
- Because children will sleep as much as they need.
- This goes back to the thing that sleep isn’t a behavior that we can teach.
- It isn’t something that we can make someone do.
- They will do it when they need to and they will stop when they’ve had enough.
Helen Davies is a Registered Children’s Nurse, Health Visitor and certified Holistic Sleep Coach. Her full professional qualifications are listed below, but what sets Helen apart is that she has 4 kids of her own and 22 years of experience working with families. Her company, Essential Parenting, empowers families to help their children sleep and eat with simple, holistic, evidence-based and gentle techniques.
RNDipHe (child) – Registered Children’s Nurse
BSc Hons (SPHVA) – Registered Health Visitor
Certified holistic sleep coach (level 6)
Multi agency level 2 and 3 child protection
Associate of IHV – institute of health visiting
V100 – non medical prescriber
Trained in Solihull approach
Trained in the Henry core training course (health, exercise, nutrition)
Completed the Unicef Baby friendly breastfeeding course
Completed safer sleep awareness course
Member of the International Association of Child Sleep Consultants
Member of British Sleep Society
Resources in this episode
Dr. Thomas Anders – Self Soothing
Holistic Sleep Coach, Lindsey Hookway
Book: The Baby Whisperer by Tammy Hoag
Tips for Safe Bed Sharing/Co-Sleeping: The Lullaby Trust