Friday, May 8, 2015

How to help a child that struggles with sleeping

We've been on the sleep road a long time now....since about the time our oldest (6.5 years old now...) turned 18 months old.  Do you know how crazy it is to have a toddler that can stay awake until midnight??!!  And not a fun crazy.  She also stopped napping at that point, so onset of sleeplessness caused major problems in her happiness factor.  And ours!!!

For her, she had an amazing ability to "keep herself awake."  The tireder she got, the more she would wind herself up and look for ways to stimulate herself (singing, climbing her furniture, playing, crying, dancing, etc.) so that her body would not slow down and transition into sleep.  We would find our 18 month old on the top of her book shelf (standing up, touching the ceiling), asleep on top of her high dresser, and once she actually moved her toybox/bookshelf combo across the room, tipped it against the wall and was asleep under it--our frantic babysitter called us, freaking out that our 2 year old had moved the furniture and worried about her safety.  She would tear up her room, kick her door, jump on her bed, sing at the top of her lungs, crawl into her name it....all to avoid sleeping.  

Around the time she turned 6, we finally got a good, healthy, peaceful handle on the sleep issues on a consistent basis.  I've had so many people (who knew about our crazy sleep journey) ask questions as they struggle at one time or another with sleeplessness in their own kiddos, so I decided it was time to write my thoughts down.  We talked with her pediatrician about our sleep problems and did not feel that she took us very seriously--her recommendations were a warm bath and a routine.  By that point we were so far past those two things that it felt like she was giving us a band-aid to put on an amputated arm.  At this point I began to do my own research.....lots of reading about sleep/child development stages/sensory issues, lots of trial and error, and talking to our homeopath and her wonderful teachers at school.  

To begin with, we definitely encounter sleep issues in Quinn to varying intensities in phases.  She will have a couple of months where she is able to transition into sleep on her own and easily.  Then she will have weeks or even months with intense difficulty sleeping and will require more intense interventions from us (her parents) to sleep.  Quinn definitely has some sensory issues and seems to lack a filter with which to block out sensations from her environment that don't involve her.  She takes EVERYTHING into her little person....This might look like she is absolutely not able to mind her own business--she is tuned in to everyone and everything else in the room.....the sounds, the smells, the emotions, etc.  She gets very saturated in sensations and becomes over-stimulated and almost buzzes herself with all this absorbed energy.  It's during these seasons--when her filter is not blocking out anything--that she has most trouble sleeping.  Often we have observed that it seems to be connected to growth spurts for her--she is very affected by growth periods and they seem to influence her sleep most of all.  She is also very sensitive to changes in her routine or world--the beginning of a school year, a trip, a parent being gone, etc.  These temporary situations seem to "rock her world" and cause sleep problems, as well.

Knowing the above information about situations that make sleeping hard for her makes the whole "sleep thing" easier for me to work with as a parent--knowing that it isn't going to be horrible forever, and if we can get through this rough patch there will be smoother water ahead.....

So I would encourage parents with children that suffer with sleep issues to do some investigative and observational work to see if you can figure out what causes your child's sleep issues--are they connected to anything?  It might even help to keep a journal for a couple months regarding what is going on in your child's life and then how bedtime/sleeptime goes each night.  

And now....drumroll.....Here are some of the interventions that have been helpful to Quinn and transitioning her to sleep.  At times we may use one of the other times a couple in combination, and some weeks we pull out the whole shebang.  All of this takes time, so don't expect an instant result.  Trying anything new with children takes several exposures before things typically work the way you intended.  So don't get your hopes up or down (as to the successfulness) without giving things a week or two to level out.  Also, as a parent you are going to get to know your child's sleep best--so after a while you will be able to easily discern which interventions work best with what conditions.  Until you get to this point, try adding just one new intervention at a time, giving a couple of weeks between.....start slowly, but stick with it and be consistent.  Inconsistency may very well make things worse, so once you start something, keep with it unless you really feel it is having harmful results.  Also, don't let your child use these interventions turn bedtime into a giant production or more ways to procrastinate bedtime.  You will need to be firm about what is acceptable at bedtime.  Plan out (with your spouse) what interventions and what order they will be used ahead of bedtime and share this with your child, so that as you are beginning the bedtime wind-down, they don't start asking for everything under the sun.  It might help to have a little "meeting" before the bedtime routine even starts, with parents and child.  "What two things do you think would most help you sleep tonight?"  You might need to have a picture chart of some options for your child to choose from.  Obviously if you have a very young child, this won't be possible and you will make these decisions, but for an older child the goal is for them to transition into taking control over their own sleep situation, and giving them tools they can use on their own.  

1) No tv/media/tablet, and no excess sugar or caffiene for dinner and after
We don't let Quinn have any media most of the time, because there is black and white research out there that screens negatively affect sleep.  Most parents like to kinda ignore this because it's inconvenient....but it's proven.  So one of the first recommendations I'd make is to wean off screens, especially from noon on.  Don't tell your kids you are taking away screen time because they aren't sleeping well--this adds stress and negativity to the situation.  If they ask, just tell them "not today, we're going to do something else today!"  In the place of screens, try teaching your kids to listen to audiobooks or podcasts like  or reading books, playing, going outside, etc.  The no excess sugar is something you have to pay attention to--there is tons of sugar in most yogurts, so we had to cut those out.  Keep your eye on what your kiddos eat and drink in the evenings.  Remember juice is super high in sugar.  

2) Set up a conducive sleep environment.  
We had to put a piece of foamboard under the blinds in Quinn's window to block out the light.  We also discovered she likes sleeping in a small space, so we set her adjustable toddler bed to the smallest size and she sleeps curled up in her little nest.  We don't allow her to make changes to her sleep environment once bedtime is underway--we say no to requests to sleeping on the floor, turning on her lamp, etc.  We keep the environment exactly the same every night, unless we've previously discussed it in a little "meeting" and we're all on board with this being a good decision.

3)Bedtime Routine
Our bedtime routine changes slightly between seasons--ie: in summer and on school nights, but we try as well as we can to keep to the same bedtime routine.  
For us it is generally a bath--we've found she needs to bathe by herself and not with her little brother, as this amped her up and was not calming.  After bath a parent gets in her bed with her to read.  We read by lamplight to start calming down the situation.  Usually we read 20-30 minutes.  During this time we also offer some calming cuddles and talk about anything she wants to talk about.  Sometimes she has things she needs to discuss, and getting them off her chest helps her ease into sleep better.  Having a time to just be together and talk if we need to has worked really well for this means that bedtime cannot be rushed....and on nights when it is, we see a negative impact on her sleep.  We typically start for bed around 7pm with the goal of lights out at 8 or even before.  And while we like to let bedtime unfold calmly and slowly, also resist the temptation to let your child "derail" bedtime and start a series of stalling events.  Quinn is a mastermind of this and would love to add in all sorts of shenanigans: "I need to go hug my brother.  I want to show you something downstairs.  I need something to eat.,....."  We gently say no to anything not on our regular "sleep schedule" and offer that she is welcome to do whatever things she is thinking of in the morning.  "You can show me your drawing in the morning."  "You are already in bed.  You're welcome to hug your brother BEFORE bed tomorrow night.  I"ll remind you."  Because we have two (sometimes three...depends on the foster baby situation) kiddos, one parent works with Quinn and the other parent with the other kiddo/s.  We switch off so that both parents become adept at putting Quinn to bed and so that we can both bringing our unique observations and way of relating to her into the equation.  I'd really recommend considering that only one parent does bedtime with a struggling sleeper at night--two parent involvement tends to turn things into more of a production and may amp up your child.  Switch frequently and communicate so both parents are able to put the child to bed.

4) Massage
We've had great success with deep massage.  We've done joint compression with her with great success.  Here's a video (do them with your child laying down in bed, by keep things soothing.)

After that, we use lavender lotion to give her deep massage on her limbs and back.  We like the kind from Avalon Organics.  Sometimes she will ask for scratching on her back and we'll do that as well.   Often times whichever parent is reading to her will also do some massage while they are reading.  Typically we do the joint compression before we read aloud to her.

5) Essential Oils
I sometimes use a few drops of vetiver oil (grounding properties) in her bath water.  We've had even more success rubbing lavender oil onto her feet and then putting socks over them.  I don't dilute it for her feet, just rub a couple drops on, give some massage, and then cover her feet with socks.  She usually takes the socks off in the night, and that's fine.  Don't put straight lavender oil onto a child's body unless it's their feet, though, as it is strong and can burn or sting eyes and skin.  We actually think the oil on the feet is one of our best interventions, probably in combination to the feet massage. You can also put the Avalon Organics Lavender lotion on their feet.

6) Audiobooks
We started out using soothing music with Quinn at bedtime.  I'd strongly recommend the CD "Cool Bananas," It has music set to a soothing beat that begins more quickly and slows as the cd continues to help lead the child into a calm state.  It seemed to work well for us and my kids loved it.  Now, however, Quinn listens to audiobooks at bedtime.  For her, we found that if we could get her to stay in her bed and remain somewhat still, she could fall asleep.  Audiobooks were the ticket for this.  She will lay mostly still so that she can listen to the story, and this transitions her into sleep.  Obviously it took some time for her to learn to listen and build up her listening comprehenion for audiobooks.  I'd encourage you to begin using these a the car as you drive, during snack times, and especially at bedtime.  I have a couple lists of recommended books on my blog.  You can also check out your library,, and I'd really recommend a podcast called Sparkle Stories.  You can stream the stories for free.  They also have a subscription service where you can buy audiobooks or individual stories.  One series is called Sparkle Sleepytime and it is written to help children sleep.  ALL of their stories are beautifully crafted, written by people who have a very solid knowledge of child development and highly entertaining.  I cannot strongly enough recommend them!!  Here's a link to their Sleepytime Series.  We turn on her audiobook as we leave her room and say goodnight.  This also seems to help curb her freakouts of us leaving her room--she's excited to start listening to her story, so she says goodnight to us easily.  At this point we go to the library at least once, maybe twice a week to supply her audiobook habit!  She is excited about it and gets to choose the books she listens to (with Mama okaying that they are appropriate and on her level) so she's highly motivated to listen to her audiobooks.  If you are new to audiobooks and are a little unsure, I'd recommend starting with the SparkleStories audio.  ALL of their stuff is appropriate for ages 3 and up and there is nothing inappropriate, scary, or morally offensive.  Just beautiful stories that you will fall in love with, too!

We even take audiobooks with us to bedtime away from home.  We have a discman and headphones she uses at hotels, etc.  All her grandparents are awesome and keep a cd player in her bedroom because they know she falls asleep listening to her stories.  I also keep a couple of sparkle stories saved on my phone to use in an emergency.  :)

7) Heatpacks
I made several hotpacks.  Basically I sewed flannel squares or rectangles into little pockets, added some hulled barley (or rice) and some dried lavender flowers (all bought at the whole foods section of our local grocery store).  We heat them in the microwave before bed and put them on her--usually one behind her neck and the largest one across her torso.  The weight of the packs helps with her proprioception system--to calm things down and ground her body--and the heat and scent is soothing.  HERE is an article that discusses this in greater detail.  They actually recommend weighted blankets for the same purpose--but the weight of a rice pack achieves the same goal.  We do make a rule that we only heat up hotpacks once a night, so she has learned she needs to get right into bed and may down if she wants them to still be hot.  Often if we are using heatpacks in conjunction with massage, joint compression, etc., we get everything completed (all the other interventions) to the point of being ready to leave her room and the other parent runs downstairs and heats her packs and brings it in, so she receives them just as we leave her room--to have the longest amount of "warm time."  However, as noted, even when they are no longer warm, the weight of them is still beneficial.  Here's a link on making them, and you can also buy them places.  Often health food stores and probably etsy.  If you know me personally I'd happily make you one if you purchase the supplies.  They aren't hard to do!  In the summer, we sometimes skip the heating part and she just uses the packs for the weight upon her torso--as it is relaxing to her nervous system.

8) Weighted or tight blankets and tight pj's
We haven't invested in "official" weighted blankets.  However we do have several crocheted afghans that are fairly heavy--much heavier than a standard throw or quilt or blanket.  We use these with Quinn when we want a weighted blanket intervention.  We also put her in the tightest pj's we have--usually leggings that are tight and a tight top, for the same purpose as the weighted blanket.  Q tends to be a hot sleeper, so sometimes we get a good deal of resistance about anything that adds more heat (except hot packs--she loves those!) so a blanket isn't always an option. but tight pj's can help.

9) Melotonin
Finally, when we really need extra assistance, we use a few drops of liquid melatonin.  Initially I would recommend buying THIS ONE so you get the little dropper, which makes it easier to distribute and to transport.  Then I would buy THIS once your glass bottle runs out, and use it to refill the glass bottle, as it's way cheaper per dose, but the large bottle isn't real user friendly.  Or you can buy the same item, different brand from Amazon, or if you are local they have it in the natural supplements (in the sleeping aids) at HEB--that's where we buy ours.  We have never used as high of a dosage as recommended on the back.  When Quinn was very young, we could literally give her two drops and it would work.  Now we give her a dropper full.  I recommend starting with very little and increasing as needed.  You will have to read and research for yourself if you feel comfortable giving melatonin to your child, but we feel very good about it, have the recommendation of our homeopath and my husband talked about it with his pharmocology professer (an expert in the field) when he was in school and we feel it is very safe.  When she was 18 months and stopped sleeping we needed to use the melatonin every night.  However, as we've built up more of an arsenal of other tools, we find we don't have to use the melatonin very much and the other interventions often do the trick.  We do sometimes give her the melatonin right off the bat if we know she NEEDS to get right to sleep to do well the next day--if we have an unusually early morning or she is having a really bad night, etc.  Again, it goes back to knowing your kid.  We give the melatonin during bathtime, as it takes a bit of time to kick in.  It dosn't make the child at all groggy and you can't see any effects of it working until they are in the dark--which stimulates the melatonin process (way too much science that my husband could explain and I totally can not...).  We also use it for Quinn when we are sleeping somewhere other than our own beds--camping trips, vacations, etc.  She really struggles with new environments, so melatonin is helpful for this.  Now that she is almost 7, we rarely give her the melatonin initially.  She occasionally gets up out of bed an hour or so after we've kissed her goodnight and shared in her bedtime routine, and at that point we give her permission to go take some melatonin.  We're beginning to put some of the responsibility for sleeping onto her

10. Dry Brushing
We came across drybrushing as a tactile defensiveness reducer from Quinn's OT, but we found a great bedtime help from it, too.  Drybrushing involves using a surgical brush--the one they use at the hospital to scrub newborn baby's heads when they get their first baths!  You basically stroke (using a pretty strong amount of pressure) down the limbs and down the feet (if the child isn't tickled by this).  The goal at bedtime is relaxation.  For Quinn, if we brush downward on her legs (we do her arms first--the top of her arm about 20 time and then the bottom of that same arm, then switch to other side) and then legs (top of leg, bottom of leg, then switch sides) and even her back.  Don't brush tummies, as it can interfere with digestion.  Quinn loves this and it is really calming to her.  I often do this instead of massage (I give her the choice) while I read to her (I brush with one hand and hold the book with the other or let her hold the book) and she loves it and gets rag-doll limp and relaxed.  For some kids, drybrushing excites their nervous systems, so you need to try it and see what response you get from your child.  You can also buy "official dry brushes" used for health purposes from the internet, like HERE on Amazon....I don't think it matters that much what brush you use.  You can get the surgical/sensory brush from Amazon HERE.    For skin purposes, you brush toward your heart (to move the lymph fluids), but for relaxation purposes you want to go with the direction of the hair follicles (which would be from top to bottom of limbs).

I hope that these interventions can help other struggling sleepers....and their parents, too, as it is such a yucky road to travel down when your child cannot sleep and you want to help but don't know how.   Don't get discouraged....there are so many seasons to childhood and this one will likely not last forever...and if it does, as a family you can gather more tools to work together at this!

One more thing, a great resource--
The Sensory Side of Sleeping