Set Limits at Bedtime

I have mentioned several times how important it is to set limits on toddler behavior around bed time. But I haven’t fully explained why limits are so important to parenting in general and to bedtime routines in particular.

Why You Need To Set Limits: The Dark Room Story

I want you to imagine you live in a large room. The room is completely dark. No lights in the ceiling, no lamps, no pocket flashlights. Complete darkness.
You need to move about in this room, so what do you do? You walk slowly with your hands out, feeling for the walls. When you find the walls you keep a hand on them as you move to maintain your balance and to keep you from banging into anything. You need to know where the walls are in order stay oriented.

There’s one more important feature of the dark room. A guardian holds the walls in place, making sure they do not move.

The Walls of Can Do and Can’t Do

For a toddler, the world is one big dark room.

There are several sets of walls in the child’s room. Maybe we can think of them as boundaries. One is a literal set of walls, gates and safety locks that keep a child from harming herself. And another set is a metaphoric set of walls: the walls of proper behavior.

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A child has a natural desire, probably innate (created or evolved, as you prefer) to know what is and is not okay to do. She doesn’t ask for reasons and explanations, neither does she need them. The need to know why things are right and wrong develops later in childhood.

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This need has two desires: to know the “location” of the boundary between okay and not okay, and to know that the boundary is being guarded. Very early in life the child designates a “Setter of Limits”, usually one parent (although some children look to more than one person as a designated limits setter.)

The Guardian Nods

Now, back in your dark room, imagine that the guardian of the walls goes to sleep and the walls magically move or worse, disappear. What happens when you reach out to feel for the wall and it isn’t there? For certain you will become disoriented. You may feel as though you’re lost in your own room. That’s an anxiety-provoking situation!

This is what happens to a child whose designated limits setter either cannot or will not set limits and enforce them. Rather than feeling liberated and elated, the child is more likely to feel disoriented, lost and anxious. Children need to know that the boundaries of right and wrong are being guarded by you just as much as the person in the dark room needs to know that the walls will stay in the same place.

Testing the Limits

This is why children test their parent’s limits. This is why they stare fixedly at you as they slowly push the bowl of cereal to the edge of the high chair and over on to the floor.  They are looking for a particular response from you. And the response they are looking for is “No. Do not do that.” Then she smiles and laughs.

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It’s around here somewhere…

So what is the smile and the laugh all about? Are they being little devils? Are they just bad kids? No. Neither. The smile is not the smile of impishness, it’s the smile of true happiness. The child is happy that she has reached out and felt the wall. She’s happy because the walls are being guarded. She feels safe and secure and happy.

Again and Again and Again and Again

OK, wise guy, you say: if all she wants to know is that I’m guarding the walls, how come she has to knock the bowl over repeatedly? Doesn’t she get the message? Why isn’t she happy with one demonstration and leave it at that?

This is because of another endearing feature of our little ones: their pleasure response does not dampen easily. If you make a funny face that amuses her, she will laugh. Then if you stop and make the same face. She’ll laugh again. Try it: toddlers can keep this up for an hour. You’ll get bored with it long before she does. They never get tired of pleasurable stimuli. This is why they test limits repeatedly. It feels good to know you’re there and you’re in charge.

Now, what happens if the child knocks the bowl of cereal off the table and the limits setter just shrugs and ignores it? Wait, she says, You were supposed to say “No! Don’t do that!” Why did you stop guarding the wall? Even if you are totally bored with the game, you must play it or risk confusing her, or worse, making her anxious. If you truly are bored, or exasperated, you must “set limits on the limits setting”, and divert her attention to something else. Pick her up from the high chair. Distract her with some new activity. Anything but abandon your limits setting post!set limits 3

Set Limits at Bedtime

The same principle apply at bedtime. You’ve paid attention to her cues and figured out at good time to begin the bedtime routine. Everything that happens between dinner and night-night is regular and predictable. Now is the time when she may test the limits because she’s tired and she really really needs to know that you are there guarding the boundaries of her world. More so now than perhaps any other time of day.

  • When she tests the limits, give her the answer she wants to hear (“no”) calmly and matter-of-factly.
  • Try hard not to deviate from your routine. Toddlers do better with routines. People do better with routines! Start the routine at dinner, or one hour before bed, which ever is longer.
  • If you think you are going to lose your cool and you can’t take any more of her limits testing, re-direct her attention elsewhere. Trust me. This trick works!

My Baby Cries So Hard She Pukes!

Help! I don’t know how to handle my toddler at bedtime! She cries so hard she pukes!

Ah, Toddlers! Such clever creatures! How on earth did they figure out that they can delay bedtime by massively throwing up all over the crib?

I wonder sometimes if there is an International Toddler Convention at which they come up with ideas like this. Imagine what the brainstorming sessions must be like:
“Ooooh! Ooooh! I know! We could light the house on fire and that would activate the fire alarms and then we wouldn’t have to go to bed!”

“I have an idea! Let’s massively throw up all over the place and then mom has to change the sheets and we don’t have to go to bed!”

“Sheer genius. All in favor?…”

Why She Cries So Hard She Pukes

Appearances to the contrary notwithstanding, toddlers really don’t share ideas. Certainly not at international conventions (but wouldn’t it be neat if they did?) It only seems that way. The truth is more prosaic: babies and toddlers are more likely to throw up when they get upset than adults are.

So when your toddler throws a tantrum in the crib and cries so hard she pukes, it does not mean that something is terribly wrong, or that’s she’s sick, or that you’ve scarred her psychologically. She’s only doing what she tends to do.

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But when mom, having heard the retching, rushes in and makes a big scene, the toddler may say something to herself that goes something like this:

“I’m not really sure what just happened, but look at this reaction from mom! I’m gonna do this again!!!”

Secondary Gain

What starts out as a gastrointestinal accident can quickly develop into a habit. This is especially so if mom or dad makes a big show of emotion and pays a lot of concentrated attention to the puker after the event. This is what the psychologists call “secondary gain“. The toddler doesn’t get much benefit from throwing up. Very few people do. However, she gets a fair amount of benefit from the aftermath! She gets to delay bedtime and she gets attention from mom!

The Sears Way

Dr. Sears recommends that you try to identify the trigger for the tantrum and then to engage in “holding therapy”:

Hold your child in a relaxed and comforting way (even if he squirms) and reassure him with the most soothing voice you can muster. The message you’re trying to convey is that he’s lost control and you’re there to help him regain it. Later in life, when your son is past the tantrum stage, his memories of calm during the stormy behavior will prove valuable.

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Not sure what I did but I’m gonna do it again!!!

Well… First, we know what the trigger is. The child is ticked off that it’s bedtime and she has to go to sleep. Second, holding therapy is giving the child exactly what he wants: relaxed comfortable holding with a caregiver. Who doesn’t wan’t that? I’m not sure how this solves the “cries so hard she pukes” problem. To the contrary. It’s only likely increase the odds it happens again tomorrow night.

The Obleman Way

My colleague Dana Obleman has a much more practical, and in my view, effective way of dealing with the bedtime puker. Dana recommends standing your ground and insisting that bed time is bed time and no amount of tantrum-induced throwing up is going to cause you to deviate from the routine!

Although you might feel like she will continue doing this forever, creating chaos and piles of laundry, the truth is that when she sees that it doesn’t change what she’s allowed or not allowed to do, she will stop. If the problem occurs at bedtime, just matter-of-factly clean up the mess, change her pj’s and stick with the routine. She should stop within a few nights once she gets the message.

Exactly right.

The trick is to do all this “matter-of-factly” as Dana says. No emotion, no comment, no “holding therapy”. If you avoid all this there will be no secondary gain. And the behavior will go away.cries so hard she pukes 3

Limits setting

I can report from bitter experience that consistent limits setting and enforcement was one of the toughest things I had to do as a parent. And here’s something even tougher to do: understand that your children need you to set and enforce those limits! Without clear boundaries that are guarded by vigilant caregivers, children tend to be more anxious less secure in their world. Don’t set limits for the sake of the laundry, do if for the children!

Breath-holding Spells at Bedtime

One of my most memorable clients is a 15-month old girl who threw tantrums at bedtime. Recently she had begun crying so hard she began breath-holding. One night in particular, she held her breath so long she collapsed. Her mother became so scared she called 911.

The little girl was fine. She woke up moments after collapsing, but it was too late for the 911 call. EMS was already on the way. When they heard the story, the paramedics and the doctors immediately understood what had happened. They had received many cases of breath-holding spells where someone panicked and dialed 911. But there was one funny twist to this story: mom witnessed the entire episode and she swears the baby’s lips did not turn blue before she passed out. She was quite sure the baby stayed her usual (somewhat pale) color throughout.

Breath-holding Spells

Of all the “normal things” that can happen to our children, breath-holding spells have got to be the scariest.  They are triggered most often by temper tantrums, but they can also occur when the child becomes suddenly frightened, frustrated or any other form of emotional upset.

They cry so hard they actually stop breathing. And anyone who stops breathing long enough will eventually faint from loss of oxygen to the brain. The good news is that as soon as the child faints and falls down, she starts breathing again, and “wakes up” often a moment later. Sometimes the child’s body will jerk briefly, causing witnesses to believe the child is having a seizure. These are myoclonic jerks, not seizures. These fainting spells are not harmful to the child and there are no lasting effects whatsoever.

Here’s the important point: the child is not doing it on purpose! It’s actually very difficult to make oneself pass out purposefully. Certainly no toddler can do it.

Tears Before Bedtime

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She’s holding her breath

I hear a lot of stories from parents of toddlers who perform a consistent bedtime routine, at the same time every evening. But it always seems to end with the toddler dissolving into tears the moment she’s put in the crib, or when a parent leaves the room. In cases like these, the crying has become part of the routine! The toddler (and the parents) know the sequence: dinner, bath, PJs, book, bed, cry… then pick the child up, put her down, more crying, etc. Clearly, this isn’t the bedtime routine anyone wants.

This is the time to sit down and re-think the bedtime routine. Is the toddler really tired enough to go to sleep? It makes sense to keep a log of the number of hours she sleeps. At 15 months, she should be getting a total of 12-14 hours, 11-12 of which happen at night. If the toddler has had an afternoon nap, perhaps late in the afternoon, it could be that she’s not ready to sleep at the prescribed bed-time. In that case I recommend pushing the bedtime routine later in small increments, say 15 minutes at a time.

What if there has been too much time between the last nap and bedtime? Perhaps the child is overstimulated (some say “over-tired” – I say it’s the same phenomenon: tired brain). Or the child is overstimulated because her day is just too full of sensory overload? In these cases, it may be time to change things up.

Mid-course Correction

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No more sweets, please!

Very often, in the course of a consult, the parents and I can identify some factor that we can adjust, and test to see if it has effect on bedtime tears.  Reducing stimulation is easier said than done, but it is often helpful. Paying attention to the child’s diet can be important as well.

Do you give her juice? You don’t have to. In fact, you shouldn’t! Juice is not fruit, it’s sugar-water. Better to have her drink water. The same goes for sweet cereals and snacks.

Some children are sensitive to the things that are added to processed foods, such as dyes, flavorings, and other additives. Very few children I know of react badly to real food. By “real” I mean food that resembles the thing that came out of the earth or the livestock pen.

Limits setting

It’s also possible that the toddler may tantrum at bedtime (even to the point of breath-holding), because she knows this will delay bedtime. In cases like these, I recommend that parents become actors. They need to pretend that they are not fazed at all when the child passes out. This isn’t easy to do, and should be considered a last resort. But just as you want to avoid bad sleep associations, you want to avoid convincing the child that breath-holding is an effective way to get you to stay with her. Like any behavior you want to modify, limits setting and enforcement are key to raising a happy, secure child.

Back to the Twist

What about the 15-month old who didn’t turn blue when she fainted from breath-holding?

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Diet matters, folks

Because the EMTs took her to the emergency department, she had blood drawn. One test showed that the girl was severely anemic. Anemia is known to be associated with breath-holding spells. She was so anemic that she didn’t have enough red blood cells to turn blue when she passed out!

The anemia in this girl’s case was due to her diet. This girl drank about 40 ounces of whole milk per day. She ate very little or no food. Why should she? She was full of milk! In about 40% of infants, drinking cow’s milk causes them to lose small amounts of blood through their gut. Since this girl drank only cow’s milk, she became profoundly anemic as a result.

This girl’s anemia, and her breath-holding spells, were cured by taking her off milk and giving her an iron supplement.

So this breath-holding story had a happy ending. Virtually all of such stories do. The behavior goes away in a few months. If you have any questions or concerns about breath-holding, or if you are having a difficult time managing these episodes, consult your pediatrician.

 

 

Overstimulation: It’s Keeping Your Toddler Awake

To explain what overstimulation is, and what it has to do with sleep, I have to tell a joke:

This economist, Dr. Schwartz, sits down in his local diner, as he does every weekday morning. Millie, who has worked at the diner as long as anyone can remember (and has a pencil permanently embedded behind her left ear) approaches with a pot of hot coffee.

“So, Dr. Schwartz,” Millie asks “How’s your wife?”

Schwartz is an economist, so he answers as only an economist would:

“How’s my wife?” He shrugs, “Compared to what?”

What Do You Mean By “Overstimulation”?

The joke reminds me that “overstimulation” assumes that we know what a normal amount of stimulation is! Over-stimulated compared to what?

One expert defines “overstimulation” as more experiences, sensations, noise and activity than [the child] can cope with. This means there are two sides to the overstimulation problem. There’s the stimulus, and there’s the child. Depending on the child’s temperament, she may handle lots of stimulation without a problem, or she may easily melt down.

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The “Filter Function” and the “Tilt Switch”

Your child’s temperament might depend in part on her ability to filter out sensory information. Newborns have a neat way of dealing with this. As I’ve explained elsewhere:

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Overstimulated?

The reason you are able to read this is that you are able to filter out most of the sensory inputs that are coming your way. You don’t pay attention to the lights in the room or to extraneous sounds coming from outside. You probably are also filtering out the scents around you and the taste in your mouth.

Now imagine that you are forced to pay attention to all these sensations equally. If you were, you’d be incapacitated. You’d be forced to stop everything and go lie in bed. This is what the world is like for a newborn. Fortunately, newborns are lying down already. This is why most babies prefer low-sensory environments. They do well in places where there isn’t too much light, noise, and temperature fluctuation. They tend to prefer dim lighting, near silence, and contact with warm human bodies. We can tell that babies prefer these conditions and do well in them because they eat and sleep better than in noisy, light, cold, and hot environments.

Switch Failure

Because babies are unable to filter out sensory stimulation, they’ve developed a way to protect themselves from overstimulation. I call it the “tilt” function. In the era of desktop-based and hand-held gaming, fewer and fewer people remember old-school arcade pinball machines, complete with silver-ball plunger, electronic bumpers, and flashing lights. Classic pinball machines all came equipped with a “tilt” switch, which prevented you from cheating by jiggling the machine to make the ball go where you wanted. If you jiggled the machine, a “tilt” light came on, the machine went to sleep, and you lost the ball…

Parents often find out just how overstimulated their baby is when she becomes incredibly fussy later— after the sensory overload— when she has difficulty going to sleep or even feeding”.

Loss of the Tilt Switch

By toddler-hood, most children acquire pretty good sensory filters, but they lose the tilt switch. This means they can no longer “shut it down” when too much stimulation comes their way.

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Over the top

How much is too much stimulation depends not only on the child’s filter, but also on the child’s sensitivity to any stimulation.

It’s interesting to note that some adult conditions, such as chronic fatigue syndrome and fibromyalgia, might really be disorders of filter function. Patients suffering from these disorders list sensory overload and physical activity among the most common triggers of their symptoms.

Obvious Sources of Overstimulation

Parents can usually tell when a day is going to be stimulating for a toddler. There’s a special occasion like a birthday party; or you take a long day trip to a zoo; or you have a particularly crazy day where you’ve raced from one activity to another. Fireworks displays are other obvious sources of overstimulation: they’re bright and loud! It might also seem obvious that the child can be overstimulated by being frightened by something she sees in a video or on TV.

Not-So-Obvious Sources of Overstimulation

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umm… bedtime

Some children, especially sensitive types, may be overstimulated when they meet new people, or do an activity that they do not usually do. You may not discover that the child has been overstimulated until bedtime, when she may be unusually cranky or fussy.

Book-reading time may be a source of unexpected overstimulation. You probably already avoid scary or overly exciting stories before bedtime. But did you know that funny books can be overstimulated? Just try falling asleep when you’ve got a case of the giggles.

TV and Screens

For some families, video-watching is part of the bedtime routine. Even if the toddler is watching calm, soothing stories, she may be getting too much stimulation from the screen. This is because the blue light emitted from most screens inhibits her brain from sending out melatonin, the signal for the rest of her brain to shut down and go to sleep. The same goes for hand-held devices like cell phones. Children love to play games on their parents phones. But the hours before bedtime would not ideal, especially if your child is particularly sensitive to the blue light effect.

How to Prevent and Manage Overstimulation

Some sources of overstimulation cannot be avoided: there’s that birthday party for Grandma that everyone has to go to, etc. If you know ahead of time that a day is going to be busy or hectic, or if the child is sensitive to meeting new people or new activities, I recommend breaking the day up into chunks. Between each chunk, try to give the child some down-time.  This is a period, an hour or so, of quiet and relative absence of activity. If the sound and sights and other sensations cannot be avoided, try to sit with the child and do a quiet activity. This can help “turn down the volume” on the stimulation she is receiving.

When she is older, she may learn to self-select what activities she does, avoiding the overstimulating ones. She may buy clothes that don’t irritate her. She may avoid large crowds, or jobs that involve constant contact with other people. In other words, she’ll find a way to get through life happy and well-adjusted. But during childhood, she’s largely at the mercy of her caregivers. If you aren’t sensitive to her sensitivities, you may be exposing her to more stimulation than she can cope with.

Pay attention! Follow her cues.

 

 

Snoring: Why Your Toddler Does It

I can hear my kid snoring from down the hall!

She snores like an old man!

There are two kinds of snoring: the kind you don’t have to worry about and the other kind. How can you tell which is which?

Two Kinds of Snoring

There are two kinds of answers: the short answer and the long answer. The short answer is “see your pediatrician if you have any questions or concerns about your child’s snoring”. The longer answer is… well, read on!
Snoring is more than just loud breathing. When you sleep, the muscles in your upper airway (nose, mouth and upper throat) relax and become narrower. As you inhale, the upper airway wants to get even more narrow. This is because the air pressure goes down (you wouldn’t be able to inhale air into your lungs if the pressure didn’t go down in your airway – so this is a good thing).

Sometimes the airway becomes so narrow that the walls of the mouth and throat slap together audibly. This is the sound of snoring. If someone’s upper airway is narrower than normal, or floppier than normal, the more likely the “slapping together” is going to happen, giving rise to snoring.

Big Tonsils, Big Adenoids

One thing that can make an upper airway narrower than normal is big tonsils and adenoids.snoring

Before going on, we should talk a little about adenoids, because many people have heard of them but don’t really know what they are. As you can tell from the picture, one reason you may not know what adenoids are is that you can’t see them in most people’s mouths. They’re located high up at the place where the nose meets the throat.

Adenoids are part of your immune system. In people with allergies, adenoids can get large. They can get so large that they can partially or totally block off the nasal passages. People in this situation need to breathe through their mouths all the time. If they need to breathe through their mouths only during sleep, the person is more likely to snore. When adenoids are so large that they cause serious breathing problems, and trials of medical therapy do not work, patients and their doctors often choose to have them removed.

Snoring because of tonsils is easier to understand because you can see really big tonsils can get in the way of air flow. People with allergies can have big tonsils, as can people who have lots of throat infections. It used to be that frequent bouts of tonsillitis were the main reason tonsils were removed. This is no longer the case. Today, the most common reason for tonsillectomy is obstructive sleep apnea (OSA).

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What is OSA?

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Uh-oh. Obstruction

The problem of OSA is defined by its name. The upper airway becomes obstructed during sleep, leading to pauses in breathing. Apnea literally means “cessation of breathing”.

It may be obvious why pauses in breathing can be a problem, but the consequences may not be well known. While snoring, people with OSA, including children, send signals to their brains that they are not inhaling enough oxygen. The signal causes the person in deeper sleep to arouse enough to shift, move, and sometimes fully awaken. Normal rhythm of sleep is disrupted. These people do not get enough restful sleep.

In children, this chronic lack of restful sleep can lead to behavior problems. In fact, many children who carry the diagnosis of ADHD are in fact suffering from chronic sleep deprivation due to OSA. I have seen a few children who had been diagnosed with ADHD cured by tonsillectomy/adenoidectomy.

For reasons that are not well understood, some children who wet the bed frequently do so because their breathing is disrupted during sleep. Again, many cases of bedwetting have been cured by treatment for OSA and other causes of “sleep disordered breathing“.

Young drivers with sleep disordered breathing tend to be less alert and are known to get into more frequent accidents.

Big Kids

Sadly, OSA is becoming more common in childhood because of the rapid rise of obesity. The thicker one’s neck is, the narrower the upper airway. Sometimes the only way to reverse airway obstruction is weight loss. And of course, the best, healthiest way to do this is healthy diet and exercise (see how diet, exercise and sleep all tie together?)

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Not my fault I snore. I was bred this way

Does everybody who snores have OSA?

No. Sometimes it’s just plain “simple snoring”. This is loud breathing during sleep that does not lead to all the negative consequences I’ve detailed here. I lay out all this detail because it may not be immediately obvious that behavior problems or bedwetting may be related to sleep disordered breathing. The only way to tell sometimes would be to perform an overnight sleep study.

Non-surgical Therapies

Not everybody with OSA has to have surgery. For allergy sufferers who snore, even toddlers, the treatment may involve removing allergic triggers from the child’s environment, or simple over-the-counter allergy medications. Consult your child’s pediatrician about this if you suspect allergies.

Take Care of It Early

OSA can be annoying and lead to behavior consequences and bedwetting. But these symptoms tend only to occur in childhood. The reason to pay close attention to snoring in childhood is because over time, OSA can cause cardiovascular problems such as high blood pressure and heart disease. The sooner OSA is reversed, the easier it is to reverse these complications.

So if you have any question at all as two whether your child’s snoring is the normal, boring kind, or the kind that deserves attention, I recommend seeking medical attention. The impact on your child’s lifetime health and wellbeing may be substantial.

 

Bedtime Ritual: How to Set Limits

For Boy#1, I ran the bedtime ritual.

“Bedtime” began at dinner. We’d eat, where the challenge was to keep a reasonable amount of food on the table. Then we’d have a bath, where the challenge was to keep more water in the tub than on the bathroom floor. Then we’d change into pajamas which was surprisingly free of challenges.

The real challenge happened at book-reading time.

I loved book reading time. I mean I really loved it. I loved how we sat together on the floor. I loved inventing voices to read the various characters. I loved how he sometimes crawled away to play with a toy but was clearly listening carefully (when he got older he would correct me if I made a mistake). But there was only one problem with book reading:

He wanted me to read every book on his shelf.

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Sometimes I’d nod off during book-reading

This was a problem. I was usually exhausted as well by bedtime and I especially ran out of energy at book-reading. After the third book I would sometimes nod off in mid-sentence. Also his bedtime was 7PM: extended book-reading time sometimes pushed us closer to 7:30.

I began to realize that perhaps Boy#1 was doing this on purpose! He wanted me to read more books so as to delay going to sleep. He must of known that I loved reading to him. I was a pushover when he would ask for another. But things were getting out of hand. We were risking messing up a good thing: a consistent, regular schedule.

Something had to be done.

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The Importance of the Bedtime Ritual

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…and so to bed

As I never get tired of saying, consistency is everything. Children thrive on consistency. I also never get tired of stressing the importance of healthy sleep, diet and exercise. But even when I say this, what also I mean is consistent sleep, diet and exercise. I find that when a child’s day is regular and predictable, they sleep better than when the schedule is erratic or unpredictable.

Perhaps I am projecting here: I’m a creature of habit. I ate the same sandwich for lunch for eight years. Fortunately, other experts agree with me. And the principle certainly has held up in practice. I find that clients who find the way to introduce more consistency, regularity, and predictability into a child’s day are rewarded for their efforts with better sleep.

Pick Your Battles, But Set Limits

Another important principle of parenting is limits setting. I believe firmly that children do better in life with limits that are clearly defined, and just as importantly, enforced. But, as any parent knows, you can set limits on practically everything. For example, in my own bedtime ritual, there was the challenge of dinner time. I could have tried to set a limit on how much food ended up on the floor, but this would have been a practical impossibility for my toddler. I could have tried to set a limit on the splashing in the tub (and as he grew in size and splashiness, I did). Instead, what I did was pick my battles. You have to pick battles or you risk disciplining your child during every waking hour.

There are some obvious places where limits setting is essential. These are things that have to do with safety. You obviously need to set limits on running toward the street, or bolting away from you in a crowded place. After this point you need to prioritize your values: what matters most to you? Those are the things that you should consider setting limits on. But do yourself and your child a favor: pick your battles. You’ll give your kid a break and it will be less stressful for you as well.bedtime ritual 1

How I Set Limits on the Bedtime Ritual

So rather than end up face down snoring in the pages of “Barnyard Dance!” every night, I decided to take action.

I began book-reading with a declaration: “Three books!” I would announce. Then I’d let Boy#1 pick which books we’d read. I’d do the best job I could on those three books, making sure did the most dramatic readings, and of course, the character voices.

I confess to surprise at how well this worked. Boy#1 knew what to expect. There would be three books only. It was predictable. He got to pick the books, so he had some “ownership” in the process. And when it was done he’d get into bed without a fuss.

 

Bottle or Binky in Bed: Bad Idea!

Have you done this? This is for you parents who said they’d never do it. Your toddler sleeps with a bottle or binky in her mouth. You said you’d never do it, but there it is! How did it happen?

The Slippery Slope

It’s a real thing, folks. When you step out on to the edge of the slippery slope you end up at the bottom before you know what happened. bottle or binky 2

I’ve been there. Trust me, I know what it’s like to suffer from toddler-induced sleep deprivation. You will do anything (within reason) to get the little one to settle.

Perhaps you’ve even said this to yourself: “I’ll give her the bottle or binky just this once. I don’t want it to become a habit. I just need to get to sleep!”

A week, maybe a month later, you remember what you said to yourself and the feeling of guilt creeps in. Because the binky is still in the toddler’s mouth, or the bottle is still in the crib. I’ve been there as well.

The Problems Bottle or Binky Cause

Things seem ok for now. She’s sleeping after all, isn’t she?

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Is that juice in that bottle?

Yes. For now she is. But what if the binky falls out and she goes looking for it? If she doesn’t find it and wakes up fully, she’ll be pissed! This is because the object in her mouth has become a sleep association. That is to say, something that she associates with going to sleep. If that thing is no longer present when she arrives at a shallow sleep phase in a couple hours, she may go looking for it and fully rouse herself.

What about her new teeth? Could they grow in crookedly because of the rubber object in her mouth 8 hours straight? Yes, it could happen. She might also increase her risk for ear infections.

Then there’s the speech thing.

Don’t Talk With Your Mouth Full!

I have met dozens of mothers who worry that their toddlers aren’t speaking when they should. One look at the toddler can tell the story. If her mouth is full of binky, or if she has a bottle hanging from her lips at all times, she probably is going to have a tough time speaking! I’ve consulted on toddlers who do manage to learn to speak around their binkies, but I must say this is rare. Suffice to say these kids aren’t easy to understand. A friend who is a speech pathologist has managed more than one case by simply popping the binky out of her patient’s mouth!

More Teeth Problems

Another typical “slippery slope” story is the problem of “milk bottle cavities“. I’ve seen my fair share of kids who’s mouths look like this:

bottle or binky
Sorry for the disturbing photo, folks

It turns out that bacteria love sugar. When you bathe baby teeth in sugar for several hours at a time, bacteria that cause cavities have a feast! I know that these parents never wanted their toddler’s two top teeth to rot! I know they only wanted the little one to get to sleep and this was the “only way” to get it done. Well, of course it wasn’t the only way, but once you step out onto that slippery slope, you end up at the bottom before you know what hit you.

The sugar in breast milk or formula is fine for your baby; you’d have to admit it’s good for her! But it is meant to be sucked down and swallowed. Milk was never meant to pool in a human’s mouth for any length of time. The effect on teeth tells the story.

Need a SLEEP COACH?

What goes for milk goes triple for juice. Juice is not fruit. Juice is flavored sugar dissolved in water. There is no good dietary reasons for your baby to consume sugar. How much more so is there no reason for sugar-water to swirl around in her mouth. It does nothing but provide a tasty meal for those bacteria!

Bottle or Binky Before Bed?

As I’ve said before, I’m a big fan of the binky. It can be the breastfeeding mom’s best friend for the first six months of the baby’s life. Prior to 4-6 months, your baby needs some external source of soothing. Beyond this point, the baby is able to do it herself, so she doesn’t need soothing aids. This is when the binky becomes something much less than a friend. It becomes a habit that you desperately wish you had broken earlier. The longer you wait, the tougher it gets. A “window of opportunity” begins to close at around 9 months. By one year of life it takes a strong parent indeed to pry the window open again!

bottle or binky 4
Now see? She’s addicted to it!

As for the bottle, it has no place in the crib, ever.

If you absolutely must give a bottle to a toddler in a crib, it should be a bottle of water (sugar-free) and you should do this only on one particular situation (discussed in “The Three Temptations“). After the child has had her sip, she doesn’t need it any more and you can take it away.

Spiked Shoes

I once heard an ethicist say he wished he could climb down the slippery slope with spiked shoes. Sorry. You can’t do that. No one can. The best way to fix the problem of a toddler who won’t sleep without a bottle or binky is never to give either in order to make them sleep. For a binky, you have some leeway until 6 months. With the bottle, it should be easier:

Just. Say. No.

Climbing Back Up the Slope

But if you do find yourself at the bottom of that slippery slope, not all hope is lost. If your toddler really needs something with her in bed, you can replace the bottle or binky with another transitional (or comfort) object. Whatever it is, it should be something she can put in her mouth that will be safe for her. A blanket or stuffed animal can be a good substitute.

Another trick that works well for some parents is a “goodbye” ritual, timed to coincide with a big event like a birthday. My sister prepared a goodbye ceremony for her daughter’s binky when the girl turned 3. They went and threw away all the binkies in the dumpster, and then and bought a nice present for the little girl. My niece was very enthusiastic about the entire thing.

Of course, it’s ideal to be able to avoid transitional objects and goodbye rituals in the first place!

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Why Your Toddler Won’t Nap… And How to Fix It

Q: My toddler won’t nap! What can I do?

She is 2 years and four months old. Until about two weeks ago she took a nap every afternoon after lunch for two hours. Now at nap time she complains that she wants to do something else. Anything else but nap. By 6 o’clock she’s so cranky that she throws tantrums and she never throws tantrums! Help!

True story… This is a very common situation. I get a lot of questions like this. In order to answer them, I need a lot more information!

A: So, your toddler won’t nap!

First, I need a lot of background. I ask about the child’s sleep history and her developmental history. Was she full-term or premature? Did she feed and grow normally during the first two years (I ask specific questions about milestones). Then I ask a sleep history. What is her current daily routine like? I’m particularly interested in nighttime sleep: how many hours does she get? Does she sleep continuously or does she wake up? If so, how many times? I also ask about diet and exercise (Really! These things matter!)

With this toddler, it turns out she was getting enough sleep – but the way her sleep was distributed was a little screwy.

Her parents had a terrific bedtime routine: everything from dinner time to bedtime was completely regular and predictable. The girl went down without a fuss at 7PM sharp (in her toddler bed!). She would wake up at 7AM, have a bottle in her bed, and a short time later would fall asleep again until 9AM, when she’d be up for the day. For several months, she’d take a brief nap in the afternoon. Now she wasn’t napping at all, and the tantrums were beginning.

The Routine

toddler won't nap
I’M NOT CRANKY!!!

Her parents didn’t count the 7 AM bottle as an awakening and a nap, they counted it as part of her nighttime sleep. This little girl was getting 14 hours of sleep per day, which is on the high end for a toddler of her age. But she was getting all this sleep basically in one shot.

When most children drop down from two naps to one, it’s the morning nap that goes. They tend to keep the afternoon nap. This child kept her morning nap but lost the afternoon nap. As a result, by bedtime she would have stayed up 9 straight hours, which was a lot for her. She would become overstimulated and cranky. This actually made it more difficult for her to go to sleep at night!

Her fix

toddler won't nap
I LOVE daycare!

I explained to these parents that their daughter was getting great sleep at night: 12 hours! By the afternoon, she was not getting sleepy, because she had already taken a two-hour nap in the morning!  I thought that when she woke up in the morning, she should be up! But instead, she was conditioned to have her bottle and fall back to sleep. I pointed out that what she was doing was holding on to her morning nap beyond the point where she really needed it. She probably still needed the nap, only later in the day.

The fix was remarkably simple. Frankly, I was surprised how easy it was. I recommended that at 7AM, mom should start a new morning routine. She’d invite the girl to get up, have her bottle in the kitchen, eat a healthy breakfast and start her day. This activity alone was enough to stimulate the girl enough to convince herself she was awake and ready to play. By 1 o’clock in the afternoon, she began to get sleepy and went down for a nap. She’d get up at 3, and then would go down for the night at 7PM.  No crankiness, no tantrums.

Need a SLEEP COACH?

Overstimulation

There are many other reasons why a toddler’s nap schedule can get screwed up. Some toddlers have the kind of temperament that makes them sensitive to stimulation. In order to nap, they need low light and quiet. If there is too much sound, light, or activity, they will want to pay attention and stay awake.

Many toddlers nap badly at daycare. Even though most daycares do a terrific job of lowering the lights, playing soft music, and limiting noise and activity, sometimes it doesn’t work. The sensitive toddler won’t nap because she’ll be stimulated by whatever sound and activity is going on at nap time.

On the other hand, some parents tell me that daycare sleep is great but the toddler won’t nap at home! With further questioning, I usually find that the toddler is being overstimulated at home more so than at daycare!

toddler won't nap
Yeah.. no

In both these situations, if your toddler won’t nap and the reason is overstimulation, the fix is to try to reduce the amount of activity, sound, and light as much as humanly possible.

The Cheetos Sweetos Nap

Diet matters. Sorry, folks, it just does.

Here’s another true story: I did a consult for a family that had three children. One in first grade, a pre-schooler (age 3), and a baby just turned one. The reason for the consult was that the 3-year old wasn’t napping.

The mom had all three children with her when we sat down to talk. I spotted the sleep problem immediately before we even started getting to know one another. There was an open bag of Cheetos Sweetos being passed around and all of them were eating them… even the baby! Everyone had a sippy cup of juice.

Sure, they’re tasty. But Cheetos Sweetos is not food. It is the enemy of sleep. These poor kids were so amped up on sugar that it’s a wonder any of them slept at all. They got plenty of activity – this was obvious from watching them, but their diet was awful.

The Three Legs

I never get tired of reminding people that all of health and wellness stands on three legs: diet, exercise and sleep. All three of these are closely related to one another. Good habits in one domain reinforce the other domains. For example, kids who eat well tend to get better exercise, and they sleep better. Kids who sleep well tend to have more energy for exercise… and so on.

But you can also see how poor habits in any one domain can throw off the others. In the case of the Cheetos Sweetos family, poor diet was probably the most important key to understanding why the toddler won’t nap. So the take home messages are identical to the three legs of health:

  • Eat Real Food: If it doesn’t look like it did when it came out of the ground or from the animal, it’s not real.
  • Get Plenty of Vigorous Exercise: Humans are meant to move. Make sure the kids get at least an hour of real physical activity every day.
  • Get Plenty of Sleep: Keep consistent, predictable schedules, as much as possible. Avoid overstimulation. Listen to sleep cues, but provide structure!

 

 

 

 

 

How to Get Your Toddler to Sleep in Her Own Bed

Half the battle is over: You moved the baby from a crib to her own bed.

Well… let’s say that one-quarter of the battle is over. Now you have to figure out a way to get her to sleep in her own bed. Maybe you’re one of the lucky few whose sweet little angel sleeps all night in her brand new bed. Not likely, though. Here’s how to close the deal:

How to Get Your Toddler to Sleep in Her Own Bed

Step One: Lay the Groundwork

If possible, let the toddler know her “big girl/big boy” bed is coming. This may not be possible if you had to buy the bed in a hurry on the day she climbs out of the crib for the first time. But if you do get the chance, let the little one know that a terrific present is coming. If she can stand it, you might even go shopping for the bed with her. Be as positive about the event as possible. If you are genuinely enthusiastic about the toddler bed, she’ll pick up on your enthusiasm.

Some parents score by buying the bed and setting it up in the toddler’s room before she makes the transition. You might even have her try to take a nap in it. This is a similar technique that works in toilet training: you introduce the potty long before the child actually sits on it to poop! In a similar way, the toddler bed becomes an “acquaintance” before it becomes a “friend”.

What if There’s No Time to Lay the Groundwork?

What if one day you hear “the thud” followed by the cry of the frightened toddler who didn’t realize it was that far to the floor when she climbed over the rail? No time to introduce the bed (although there may be time to shop)? In this case, you may need to rush the process of introducing the her own bed… like down to less than a day. Your toddler might not like the idea of such a dramatic change. I understand.

Need a SLEEP CONSULTANT?

But changes happen in her life, often suddenly and she always adjusts. This time will be no different.

Step Two: Be Consistent

One thing doesn’t have to change, and that’s your bedtime routine. For me, the “bedtime routine” begins at dinner. After that time, every single thing that happens is regular and predictable. Dinner should be at the same time. Bath at the same time. Book reading at the same time. Everything. Consistency is the key to troubleshooting any sleep issue and this one is no different.

own bed
They’re not sleeping, but they’re happy!

As long as you are staying consistent, it is best to use the same mattress she slept on in the crib, with the same sheets and bedding. Most toddler beds are designed to accommodate a standard crib-size mattress. Perhaps you had already splurged and purchased a crib that converts to a toddler bed. Even better! The point here is that the surface the toddler lays on will feel exactly the same as the crib. This is important to her keeping good sleep associations. You might even consider placing the toddler bed in the same place where the crib stood.

Step Three: Set Limits

If you have a perfectly normal bedtime routine and your little one drifts off to a blissful sleep, then you’re done. But more likely than not, your toddler is going to want to get out and find you at night. Most likely this will happen sooner rather than later.

If you have not done so already, this is the time to baby-proof your house. Gates should be placed on stairs. Cords and outlets should be safely secured and out of reach. Every item of furniture that could be pulled down, including chests of drawers, should be secured.

If you haven’t gotten into the habit of setting limits with your child, this would be a terrific night to get started. The first limit ought to involve your bed. Just because the little one has her own bed, doesn’t mean she can sleep in any bed, least of all yours. Now, some parents are fine with this and I cannot judge them. However, if any or all occupants of the bed are not okay with this arrangement, then it’s not okay, period! Also ask yourself if you still want the little one in your bed in four months. Or what if there’s a new baby coming? What if the new baby has already arrived? Clearly, a limit should be set.

own bed
Now THAT’S what I’m talkin’ about!

The limit goes something like this: “You’ve got your own bed. [Partner] and I have our own bed. Everybody sleeps in their own bed!” Simple and matter-of-fact. No reasoning and explanation is required. If you do not know already, you should know that your toddler does not care about reasons! All she wants to know is: What are the limits and are you (mom) going to enforce them?

Step Four: Enforce Them

Here’s the toughest part. Once a limit is set, it’s got to be enforced. Among the worst things you can teach a child is that the limits you set are phony and you aren’t really serious about them. Children who grow up without enforced limits are more anxious and less happy. They may not show it, but they need limits! Kids test limits not because they are unhappy or imp-ish, but because they need to know that the limits are there and are being enforced by the “Limits Setter(s)”.

Every time she gets out of bed and comes to yours, you should bring her back to her own bed. The tough part of this act is doing it calmly and without emotion. I cannot stress this enough. Remember: no explanation or reason is going to help. It’s just wasted breath. Your toddler is never going to say to you “Gee, Mom! I never thought of it that way! Thank you for explaining it to me”.

Step Five: She’s Got Her Own Bed, Now She’s Got to…

When you return her to own bed, the routine should be the same. Brief, matter-of-fact, and to the point. This is much easier said than done. Your toddler’s main job in life is to find the chinks in your armor and plunge through them. Maybe she’ll ask for water, or a bottle (don’t get me started on this one!) It will be tough, but you are tougher. Stay firm, stay calm, and stay consistent.

The Easier-Said-Than-Done List

  • Be Consistent: Keep the entire bedtime routine exactly the same as it was when she slept in a crib.
  • Set Limits: Everybody sleeps in their own bed. Children thrive on limits. Without them they are lost.
  • Enforce the Limits: No limit is any good if you don’t enforce it. Remain calm. Take deep breaths. And enforce the limits you set. You’ll be glad you did. So will your toddler.

Best Toddler Beds

Half the battle is over: You’ve moved the baby from a crib to her own toddler beds.

own bed
A bed of her own

Well… let’s say that one-quarter of the battle is over. Now you have to figure out a way to keep her in the toddler bed. Maybe you’re one of the lucky few whose sweet little angel sleeps all night in her brand new bed. Not likely, though. Here’s how to close the deal:

Toddler Beds

If possible, let the toddler know her “big girl/big boy” bed is coming. This may not be possible if you had to buy the bed in a hurry on the day she climbs out of the crib for the first time. But if you do get the chance, let the little one know that a terrific present is coming. If she can stand it, you might even go shopping for the bed with her. Be as positive about the event as possible. If you are genuinely enthusiastic about the toddler bed, she’ll pick up on your enthusiasm.

Some parents have had success by buying the bed and setting it up in the toddler’s room before she makes the transition. You might even have her try to take a nap in it. This is a similar technique that can be successful in toilet training: the potty is introduced long before the child actually sits on it to poop! In a similar way, the toddler bed can become an “acquaintance” before it becomes a “friend”.

What if There’s No Time to Lay the Groundwork?

own bed
See? She LOVES it!

What if one day you hear “the thud” followed by the cry of the frightened toddler who didn’t realize it was that far to the floor when she climbed over the rail? No time to introduce the bed (although there may be time to shop)? In this case, you may need to rush the process of introducing the her own bed… like down to less than a day. Your toddler might not like the idea of such a dramatic change. That’s understandable.

But changes happen in her life, often suddenly and she always adjusts. This time will be no different.

Be Consistent

One thing doesn’t have to change, and that’s your bedtime routine. For me, the “bedtime routine” begins at dinner. After that time, every single thing that happens is regular and predictable. Dinner should be at the same time. Bath at the same time. Book reading at the same time. Everything. Consistency is the key to troubleshooting any sleep issue and this one is no different.

own bed
They’re not sleeping, but they’re happy!

As long as you are staying consistent, it is best to use the same mattress she slept on in the crib, with the same sheets and bedding. Most toddler beds are designed to accommodate a standard crib-size mattress. Perhaps you had already splurged and purchased a crib that converts to a toddler bed. Even better! The point here is that the surface the toddler lays on will feel exactly the same as the crib. This is important to her keeping good sleep associations. You might even consider placing the toddler bed in the same place where the crib stood.

Set Limits

If you have a perfectly normal bedtime routine and your little one drifts off to a blissful sleep, then you’re done. But more likely than not, your toddler is going to want to get out and find you at night. Most likely this will happen sooner rather than later.

If you have not done so already, this is the time to baby-proof your house. Gates should be placed on stairs. Cords and outlets should be safely secured and out of reach. Every item of furniture that could be pulled down, including chests of drawers, should be secured.

If you haven’t gotten into the habit of setting limits with your child, this would be a terrific night to get started. The first limit ought to involve your bed. Just because the little one has her own bed, doesn’t mean she can sleep in any bed, least of all yours. Now, some parents are fine with this and I cannot judge them. However, if any or all occupants of the bed are not okay with this arrangement, then it’s not okay, period! Also ask yourself if you still want the little one in your bed in four months. Or what if there’s a new baby coming? What if the new baby has already arrived? Clearly, a limit should be set.

own bed
Now THAT’S what I’m talkin’ about!

The limit goes something like this: “You’ve got your own bed. [Partner] and I have our own bed. Everybody sleeps in their own bed!” Simple and matter-of-fact. No reasoning and explanation is required. If you do not know already, you should know that your toddler does not care about reasons! All she wants to know is: What are the limits and are you (mom) going to enforce them?

Enforce Them

Here’s the toughest part. Once a limit is set, it’s got to be enforced. Among the worst things you can teach a child is that the limits you set are phony and you aren’t really serious about them. Children who grow up without enforced limits are more anxious and less happy. They may not show it, but they need limits! Kids test limits not because they are unhappy or imp-ish, but because they need to know that the limits are there and are being enforced by the “Limits Setter(s)”.

Every time she gets out of bed and comes to yours, you should bring her back to her own bed. The tough part of this act is doing it calmly and without emotion. I cannot stress this enough. Remember: no explanation or reason is going to help. It’s just wasted breath. Your toddler is never going to say to you “Gee, Mom! I never thought of it that way! Thank you for explaining it to me”.

She’s Got Her Own Bed, Now She’s Got to…

When you return her to own bed, the routine should be the same. Brief, matter-of-fact, and to the point. This is much easier said than done. Your toddler’s main job in life is to find the chinks in your armor and plunge through them. Maybe she’ll ask for water, or a bottle (don’t get me started on this one!) It will be tough, but you are tougher. Stay firm, stay calm, and stay consistent.

The Easier-Said-Than-Done List

  • Be Consistent: Keep the entire bedtime routine exactly the same as it was when she slept in a crib.
  • Set Limits: Everybody sleeps in their own bed. Children thrive on limits. Without them they are lost.
  • Enforce the Limits: No limit is any good that is not enforced. Remain calm. Take deep breaths. And enforce the limits you set. You’ll be glad you did. So will your toddler.