Welcome to another installment of our Ask An Expert series on the Tuck Sleep Blog. We’ll be taking the most frequently asked questions from our readers and getting them answered from experts/specialists. For this question, we’re working with Macall Gordon, an infant sleep researcher and certified pediatric sleep consultant from right down the road from our HQ in Seattle. If you have a question you’d like us to answer, please reach out to us at [email protected] and we’ll get on it!
The books make it sound so easy, don’t they? A few nights of 10-15 minutes of crying and your child will be sleeping through the night…. Not. You’ve tried crying-it-out, you’ve tried patting/shushing, you’ve tried feeding on demand – earlier bedtime, later bedtime, bath, no bath – standing on your head and pleading. Nothing has worked. Your child isn’t sleeping well anytime, anywhere. Naps are hard, bedtime is hard, and nighttime….don’t even ask.
As a coach, I frequently see frustrated, exhausted parents who have been trying so hard. The saddest part is that they think it’s all their fault; that somehow, they are doing something wrong. Parents, take a breath. There are some good reasons why sleep training/coaching doesn’t work, and many of them have nothing to do with what you are or aren’t doing. See if any of the questions below apply to your situation.
Does your child snore or mouth breathe (not associated with a cold), have a sweaty head when they sleep (not associated with a warm room), or are really restless when they sleep?
These symptoms can point to conditions that contribute to sleep apnea or obstructed breathing. Tonsils and adenoids can grow at disproportionate rates and cause breathing during sleep to be difficult. A check-in with the pediatrician or a pediatric ear, nose, and throat doctor might be in order.
Has your child ever been diagnosed with anemia or low iron?
Low iron in children can directly affect sleep architecture (even when iron levels are back up). Low iron stores can also cause Restless Legs Syndrome, “itchy” or “tickly” feelings in their legs and an inability to get comfortable enough to sleep. Iron supplements may be prescribed.
For children under a year, does it ever seem like they’re in pain at any time during sleep?
If your gut tells you that your child seems in pain when laid down flat, or they wake up screaming, or they sleep best when they are slightly on an incline (like in a seat), your child may have symptoms of silent reflux. Silent reflux does not involve “spitting up” and can cause pain as stomach acids bubble up. This kind of pain directly interferes with the ability to go to sleep or stay asleep. While it’s true that reflux rarely hits a child later in infancy, or those who never had reflux as a newborn, there are cases where reflux has not fully resolved, or teething/growth spurts cause symptoms to return.
Is your baby alert, perceptive, sensitive, persistent?
Temperament is a major factor in sleep troubles. Sensitive babies who hear and notice everything are going to have a harder time disconnecting from the exciting world of awake time. These babies need a very consistent, very regular routine of naps with adequate wind-down time. Alert infants and children require a slightly different approach to sleep and may need more help than their mellower peers.
Is your baby younger than 6 months?
If your baby is younger than six months and you’re not seeing success with sleep training, it may be that your baby is too young. Infants under 6-months (and especially those in the throes of the 4-month regression) have limited capacity to manage distress or sleep and awake states. It’s okay to take a break, do what you can to get sleep, and try after 6-months.
Is your child going through a developmental leap?
During the first few years, children go through a fair number of developmental shifts that can throw everything out of whack. Generally, every time your child gains a new motor or cognitive skill, sleep will suffer: crawling (8-9 months), pulling to stand (10 months), walking (12-months) and then 15- and 18-months, and 2-years. You may find that even though your baby was sleeping well, these periods can get rocky…or rockier.
How is your child napping?
Make sure you know how much naptime your child needs for their age. An overtired baby/child will have more trouble going to sleep and staying asleep. Sometimes, just getting naps at the right time will help both daytime and nighttime sleep. If your child is really nap-deprived, try to get naps in any way that works for a while and work on bedtime go-to-sleep skills. Once your child is sleeping light a champ at night, you can work on going back to crib sleep.
Also, know how long your child can stay awake for their age. Before 6-months, it may only be 60-90 minutes. Even at a year, children can only manage about 3-4 hours before they need a nap. If you are watching for sleepy signals, but not watching the clock, you may be missing those optimal windows for naptime and bedtime.
Things parents CAN do:
- Don’t jump ship too soon: In their desperation, and lack of confidence, parents may try too many things too quickly, resulting in frustration and confusion. Pick something to work on and stick with it for at least 4-5 days.
- Work on bedtime skills: The best, easiest time to get the biggest bang for your sleep-training buck is at bedtime. Work on encouraging your baby/child to go to sleep without being rocked, nursed, held all the way to sleep. There are several approaches that work, so pick one that you can live with and stick with it.
Macall Gordon, M.A., is an infant sleep researcher and certified sleep coach specializing in gradual approaches to sleep. She has a Masters degree in Applied Psychology from Antioch University, and a B.S. in Human Biology from Stanford University. You can find more about her practice here. Have a question you’d like her to answer? Send it to [email protected]!