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By: Rebekah Thomson, Pediatric Sleep Coach
For those of you who are planning to travel over the holidays, here are suggestions to make your family adventure as smooth as possible, sleep-wise. Prepare a sleep-friendly environment. Whether you’re staying in a hotel, rental house, or with family, try to create a sleep-friendly environment for your little ones. Bring along unwashed crib sheets (the familiar scent will be soothing), favorite loveys and blankets, white noise machine, and night light. If you’re not sure the window shades will be dark enough, pack black trash bags and masking tape or thumbtacks for makeshift blackout shades. The Phil & Teds “Traveller” cot is a great alternative to traditional pack n plays; it is small and light enough to fit inside your suitcase, has no uncomfortable crossbars, and has the added advantage of an optional top in case you’ve got a climber on your hands. Respect your child’s need to sleep – even on vacation. Yes, your child may miss a few naps due to travel and bedtime may be a little later due to older cousins. But try to not abandon your child’s schedule altogether, particularly if you are away for more than a few days. If normal crib naps are not possible, plan to drive during nap times, squeeze in catnaps to take the edge off, and opt out of a late dinner if your little one is showing signs of fatigue. You’ll be glad you made the sacrifice – over-tired children usually don’t make the best travel companions anyhow. Maintain the rituals. Try to maintain your family’s pre-sleep routine, or at least an abridged version of it. The familiar books, songs, and other positive sleep associations will be especially comforting to them as they adjust to their new environment. Talk to your children. Even one year olds often understand a lot more than we think. Let your little ones know that you are doing things differently than usual because you are traveling. “Today we are going to take our naps in the car because we have a long drive to grandma’s house. You can rest in your car seat, and we will wake you up as soon as we get there!” Avoid using the same crutch you just broke. Sure, some sleep regressions may happen during travel. However, if you have recently worked hard to stop nursing your baby to sleep, try rocking her or patting her down instead. It’s less confusing and less intermittent reinforcement, which means ultimately it will be easier to undo. Nip bad habits in the bud. Let your little ones know that once you are back home, it’s back to business as usual. So if you had a co-sleeping nurse-athon in order to keep her quiet at your in-law’s house, the “open bar” officially closes when she kisses grandma goodbye. It’s much easier (i.e. less crying) to tackle new sleep issues before they are fully engrained. Wishing everyone a wonderful holiday season! Rebekah www.countingsheepmv.com
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 By: Rebekah Thomson, Pediatric Sleep Coach
Happy New Year! This is the third part of a series dedicated to laying a good foundation for sleep with babies under six months of age. If you missed the last part, click here. Infant Sleep Tip #3: Look for natural day/night cycle to emerge – usually 6am-6pm or 7am-7pm Most babies fall into a 6am-6pm or 7am-7pm (or thereabouts) schedule. During the day, we want to focus on full feedings every few hours, outside time, floor time to practice new skills, and napping at appropriate intervals. When you notice your little ones starting to fall apart around 6pm or 7pm, she’s probably ready to call it a day. Many parents mistake this fussiness as a need for one more nap. But after a 12-hr day, her central nervous system is taxed, and it is time to get her into a less stimulating, more sleep friendly environment. Bring her to the bedroom, give her one last feeding, change her diaper, dim the lights, turn on some white noise (especially if the rest of the house is still up and at ‘em), sing her a song, swaddle her up (if she’s into that), and put her to bed. Infant Sleep Tip #4: Manage day and night feedings so that caregivers can get some rest too. Even though she’s ready to hit the sack around 6 or 7pm, a later evening feeding works well for babies and parents. Rouse her for full, boring feeding 2-3 hours later (around 9-10pm), then put her straight back to bed. Then YOU go to bed too! Babies can naturally take one long stretch per 24-hour period. At first the long stretch may just be 4 hours, but it will lengthen over the upcoming months to 5, 6, 7 hours and will eventually become her night sleep. We want to encourage the long stretch to be at night after that last 9-10pm-ish feeding. If she takes it during the day in the form of an epic nap, she will legitimately be up all night making up for calories didn’t receive during the day. (Yes, that means wake a sleeping baby from a nap so that she doesn’t sleep through a daytime feeding.) And if she does her long stretch from 6-10pm, then you haven’t benefitted from it. So encourage her little body to take its long stretch after that last evening feed. Note: If mom really needs some more sleep, see if another caregiver can do the next feeding (probably around 1-3am) so that mom can get a solid stretch herself. If breastfeeding, this can be a bottle of expressed breast milk. As the saying goes, “if mama isn’t happy, ain’t nobody happy.” Knowing how intense as the first few months can be, we need to do what we can to support ourselves. An uninterrupted 6+ hour stretch of sleep can do wonders for a mom coping with baby blues, postpartum depression, or simply trying to regroup after a challenging postpartum time.Most babies fall into a 6am-6pm or 7am-7pm (or thereabouts) schedule. During the day, we want to focus on full feedings every few hours, outside time, floor time to practice new skills, and napping at appropriate intervals. When you notice your little ones starting to fall apart around 6pm or 7pm, she’s probably ready to call it a day. Contact Rebekah Thomson for your Sleep Needs! Rebekah Thomson Counting Sheep Pediatric Sleep Coaching rebekahjthomson@gmail.com (917) 455-3054  By: Rebekah Thomson, Pediatric Sleep Coach
This is the second part of a series dedicated to laying a good foundation for sleep with babies under six months of age. If you missed the first part, click here. Infant Sleep Tip #2: Create a flexible feeding and sleeping routine A flexible routine does not mean a minute-by-minute schedule, but rather a sensible framework so that full feedings and sleeping are prioritized. Almost every sleep book on the market agrees that in general, an “eat – active time – sleep” cycle (in that order) is beneficial. In other words, feed your baby “up.” When she wakes, give her a full feeding (and burping). Then encourage her to stay awake for a short period. This is the time to engage with your baby, give her some tummy time, take her outside, etc. How long this active time should last is dictated by her age (wakeful windows get increasingly longer) and your baby’s cues. When she starts to show her sleepy cues – yawning, rubbing her eyes, zoning out, mild fussiness, etc. – you’ll know it’s time for her to rest. This cycle can be continued throughout the day, at least until the afternoon when her central nervous system is more taxed. The beauty of this routine is that it makes parenting easier. Infants don’t differentiate their cries right away, so it can be hard figuring out why she’s not happy. However, if you know she has had a full feeding, she’s been appropriately stimulated, and now she’s fussy, she’s probably ready to sleep. On the other hand, if she’s had a partial feeding because she fell asleep during the feeding, it’s hard to read her cues. Is she hungry again? Did she not rest enough? Is something else wrong? The “eat – active time – sleep” cycle brings other advantages too. It helps to disassociate falling asleep and eating (though it’s fine for infants to fall asleep at the breast/bottle sometimes). And for babies dealing with reflux, having upright time after feedings is crucial. Contact Rebekah Thomson for your Sleep Needs! Rebekah Thomson Counting Sheep Pediatric Sleep Coaching rebekahjthomson@gmail.com (917) 455-3054  By: Rebekah Thomson, Pediatric Sleep Coach
I know I’m not the only one noticing how much shorter our days are getting already. Daylight savings 2014 will end on November 2nd. Clocks are moved back one hour from 2 a.m. DST to 1 a.m. For parents of early risers, the upcoming change can be nerve-racking. “He’s already waking up at 5:30 a.m. Does this mean he’s going to start waking up at 4:30 a.m. now?!” Fortunately the answer is no. You are going to gradually shift his schedule to the new time, just like when you are traveling. So what will it look like? You have a few options. One is to allow your child to wake up at his natural time on the morning of the 3rd. According to the clock, it will be an hour earlier than usual. If he usually wakes up at 6:30 a.m., he will likely awaken at 5:30 a.m. That’s fine. It will be short-lived! Try to keep things low key for 30 minutes until you are ready to start the day. Base the day’s routines (meals, naps, etc.) around the new clock time. If your son’s bedtime was 7:30 p.m., the clock will now read 6:30 p.m. Aim for good naps that day so he can make it to at least 7 p.m. (new time). You can gently push his bedtime back to 7:30 p.m. over the next few nights. Alternatively, if going “cold turkey” doesn’t appeal, you can also approach the time change incrementally, starting next week. Push naps, meals and bedtime back 15 minutes later each of the days leading up to the end of daylight savings. If his usual bedtime is 7:30 p.m., he can go to bed at 7:45 p.m. on October 29th, 8 p.m. on the 30th, 8:15 p.m. on the 31st, and 8:30 p.m., on the 1st. By the time daylight savings ends, he will already be adjusted – or at least well on his way. Regardless of which approach you choose, stay consistent and don’t let him really start his day before 6 a.m. (new time). He’ll be adjusted within a week. If your child had too late of a bedtime before the time change, this is your chance to move it earlier without too much fuss. The ideal bedtime for most children is between 7 and 8 pm. So if your son’s bedtime was too late, don’t move it later; just put him to bed at the new time of 7 or 8pm. Note: If your little guy seems plagued by early rising, it’s time to get to the bottom of it. Follow this link to read my earlier post about the common causes of early rising and how to address them: http://www.capecodmommies.com/1/post/2012/05/the-early-bird-does-not-catch-the-worm.html *Includes information from Kim West’s Good Night Sleep Tight. Contact Rebekah Thomson for your Sleep Needs! Rebekah Thomson Counting Sheep Pediatric Sleep Coaching rebekahjthomson@gmail.com (917) 455-3054  By: Rebekah Thomson, Pediatric Sleep Coach
Most of my sleep advice is directed toward children six months and up. By that age, babies are decreasingly reliant on nighttime feedings (though some may still need a few) and more responsive to behavior modification. That said there are some basic, developmentally appropriate ways in which we can begin to lay a solid sleep foundation with babies under six months. And in the case of parents returning to work, coping with postpartum depression or blues, or simply burnt out from sleep deprivation, some early interventions may be necessary. Over the next few posts, I will focus on how we can gently introduce positive sleep habits for our very young babies. Hopefully new and expectant parents will find these suggestions helpful. On a personal note, my third baby is due in a few weeks so I’ll be using these techniques right along with you! First, a word about sleep advice from well-intentioned family and friends… Like parenting in general, how we approach sleep is very personal. Parents must decide for themselves what they feel comfortable with, what meshes with their values and philosophy, and what works for their child’s unique temperament and feeding needs. Lots of friends and family like to opine about sleep, but it is essential that parents listen to their gut and understand that just because an approach worked for one family, does not necessarily mean it’s a good (or healthy) fit for theirs. There are significant individual differences between all children (and adults!), particularly in babies under six months. This is why one size does NOT fit all and what worked for a friend and her baby, may not work for you. For example, some infants may be able to consume large amounts of breast milk or formula, enabling the baby to go 3.5 hours without another feeding. Another baby with a smaller capacity may truly need to eat every 2 hours. Both are healthy and normal for this variable age group, but clearly the babies have very different feeding needs. Alternatively, one baby’s mother might have an abundant milk supply, while the other’s mother’s supply might be perfectly adequate, though not sufficient to stretch out feedings. Attempting to do so would actually put their otherwise healthy baby at great risk. For this reason, any recommendation from a book, friend, or family member for scheduled feedings should be taken with a big grain of salt. Infant sleep Your infant will probably sleep much of the time, but she won’t sleep deeply. Infant sleep is not well organized neurologically, which means it’s a very light slumber. Hold her, rock her swing her, do what feels right and comfortable for the first few weeks/months. When you are ready, start weaving sleep friendly routines and patterns into her life. This is a gradual process so don’t expect huge, dramatic changes in her sleep patterns immediately. But you are laying the groundwork for improvement in the coming weeks and months. Infant Sleep Tip #1: Establish a healthy feeding pattern as soon as baby is born With young babies, everything revolves around feeding, including sleep. Making sure their feeding needs are being met is essential to their health and growth, as well as any sleep success. Most infants need approximately 6-7 full feedings between 6am–10pm, plus more at night depending on their growth and individual needs. “Full” is the operative word here. If breastfeeding, this usually means emptying both sides. The goal is to avoid snacking throughout the day, though shorter cluster feedings in the late afternoon are perfectly fine. If there is any concern or doubt about whether the baby is getting sufficient calories during each feeding – or if breast or bottle-feeding become challenging – consult your pediatrician and/or lactation consultant promptly. Note: Babies usually have growth spurts around 3 and 6 weeks, and 3 and 6 months. It is essential that they receive additional calories at these times and if breastfeeding, that they go to the breast more to up their mother’s milk production so that she can meet their need. More infant sleep tips will be coming in my next posts. In the meantime, wishing everyone a good night’s sleep. Rebekah Contact Rebekah Thomson for your Sleep Needs! Rebekah Thomson Counting Sheep Pediatric Sleep Coaching rebekah@countingsheepmv.com (917) 455-3054  By: Rebekah Thomson, Pediatric Sleep Coach
Happy August everyone. I apologize for contributing so infrequently recently. My mother passed away from metastatic breast cancer in June, and as the primary caregiver for my children and her, it has been an epic roller coaster. But as our children constantly remind us, life marches along – and alas, so do sleep challenges! I’ve had a lot of questions recently about nightmare and night terrors. Knowing how to differentiate between them is essential to figuring out how to tackle them. Nightmares are common, particularly in children between 2-3 years old when their imaginations are developing but the lines between reality and fantasy are blurred. · Occur during REM sleep · Child will seek comfort from parent and recognize you · Child can recall nightmare, or parts of it · It may take time for them to get the frightening thoughts of their mind and fall back asleep · Can occur during times of stress or when a child is reliving a traumatic experience, but also normally occur in well-adjusted, happy children every once in a while What you can do: · Avoid playing scary or stressful games · Avoid exposing your child to potentially frightening shows, videos, books, and stories (children are far more sensitive than we often think) · Make sure room decorations are sleep-friendly and calming · During episode, respond quickly and sensitively, calmly reassuring them of their safety · Make sure your child is getting enough sleep (11 uninterrupted hours at night, plus a nap, is typical for most young children) as sleep deprivation can increase nightmares · Avoid high-dose vitamins prior to bedtime and check with your pediatrician to make sure medications are not interfering with your child’s sleep · Don’t lead the witness! If your child learns that night awakenings elicit overly sympathetic reactions from you (“Oh no! Did you have that scary nightmare again?! Oh my poor baby…!”), you may be inadvertently feeding a much larger behavioral pattern. Night Terrors look (and are) very different from nightmares. · Occur during NON-REM sleep, usually within 2 hours of falling asleep · Child may scream, appear anxious and/or have a racing heartbeat · Child may be inconsolable · Child often does not recognize you and may seem frightened by you and/or push you away · Episode usually lasts 5-15 minutes · Child usually doesn’t remember it (though parents sure do!) What causes night terrors? · Occur more often in boys · Child more likely to experience them if either parent had a parasomnia disorder such as sleep walking, sleep talking, or night terrors themselves · Commonly triggered by sleep deprivation or a disturbance in the child’s sleep pattern (jetlag, sickness, obstructive sleep apnea, stress) What you can do: · Ensure your child is physically safe during the episode but avoid interfering, which can make things worse · Consistently put your child to bed earlier at night · Keep your child on a regular sleep schedule · Do not discuss the terror with (or in front of) your child · If the night terrors are persistent, keep a log to help identify any patterns (occurring at the same time each night or during weeks when bedtime was late) · If you find the night terrors are happening at the same time, rouse your child 15 minutes beforehand so that she mumbles or rolls over, every night for 7-10 days. As upsetting as nightmares and night terrors can be for parents, it’s important to know that they are normal experiences and not necessarily signs of major stress or unhappiness. The calmer and more reassuring you can be in the heat of the moment, the less disruptive the episodes will be for everyone. Wishing you all a good night’s sleep, Rebekah Contact Rebekah Thomson for your Sleep Needs! Rebekah Thomson Counting Sheep Pediatric Sleep Coaching rebekah@countingsheepmv.com (917) 455-3054 By: Rebekah Thomson, Pediatric Sleep Coach Many times after working with a family to solve their child’s sleep challenges, parents ask me for sleep tips for themselves. My training does not include adult sleep issues, but below are some excellent suggestions from Kim West that often solve the problem. In addition to the following tips, I also highly recommend www.lowbluelights.com, who make night glasses and other products that block out blue light, thereby tricking the brain into secreting melatonin while lights are still on. In my household, we use the glasses, night-lights, iphone covers, and lightbulbs. Here is to a great night's sleep for your entire family! 
Tips for Sleeping Well Every Night by Kim West Did you know that getting 7-8 hours of sleep at night can help you live longer, be thinner, think clearer and look younger? Despite these incredible benefits more then half of U.S. adults get less then 7-8 hours of sleep at night!
If you are one of the 75% of adults who report having a sleep problem, consider some of these helpful sleep tips to start to get the sleep you need and your body craves. * Go to bed and wake up at around the same time every night (and while you have young children you might want to set your bedtime earlier than usual). Even on weekends, try not to modify it by more than an hour. Routines "condition" us for sleep, psychologically and physiologically, and the conditioned response then makes it easier to fall asleep and stay asleep. This tip is essential for children's night sleep and naps too! * Give yourself one hour before lights out to wind down, letting your body and mind become more relaxed and ready for sleep. Listen to quiet music, take a bath, or read a book. Some people find that light stretches, meditation, creative visualization, or progressive relaxation helps. The average person (adult or child) takes 15-20 minutes to put her/himself to sleep. * If you need to catch up, rather than tinker too much with your nightly sleep schedule, take naps. But either take a short twenty- to thirty-minute nap or take a longer ninety- to hundred-minute nap so you don't wake up during a non-REM sleep cycle and feel groggy. Before I learned that, I used to set the alarm for one hour and wake up feeling lethargic and lousy, like I needed a major infusion of caffeine. * Make sure your bed and your bedroom are sleep friendly. Your room should be quiet, dark, and secure, and your mattress, pillows, and sheets should be comfortable. Sort out any temperature-control issues with your partner or spouse! *Avoid any "screen" time for one hour before bed. That means turn off the TV, computer and cell phone and don't bring them in to the bedroom. The light from the screen tells the body not to secrete melatonin, the drowsy making hormone, making it more difficult to go to sleep. * Exercise at least twenty to thirty minutes three times a week, but try to do it in the morning or during the day, not in the evening. If possible, leave at least three to four hours between strenuous exercise and sleep, and you certainly don't want to work out right before you go to bed. The same goes for rough housing with your child before bed, try to keep things quiet and mellow at least an hour before bed. * Try to get some natural light in the afternoon. Go for a walk or sit in a sunny room, and try to get out of the house or at least briefly escape your artificially lit office cubicle. This tip will help your child too! * Eat dinner at least three hours before going to bed. This of course does not apply to babies. * Reduce your caffeine consumption (two cups maximum), and don't have any caffeine for at least six to eight hours before bedtime because it stays in your bloodstream. Caffeine doesn't just mean coffee--it means tea, many sodas, chocolate, and some over-the-counter cold and headache remedies. We become more sensitive to caffeine as we approach our forties. * Nicotine is a stimulant, so if you haven't stopped smoking, poor sleep is yet another incentive. * Watch your alcohol consumption. Alcohol may help you fall asleep, but more than three to five glasses, even less for some individuals, fragment our sleep. We wake up more often at night and earlier in the morning. *See your doctor if you or your child has asthma, allergies, reflux, anxiety, depression and significant stress to make sure it is not interfering with your sleep. Sleep is as important as a good diet! Sleep deprivation can cause depression, heart disease and weight gain...not to mention it makes you age faster. There really is such a thing as "beauty sleep.” Make it a priority to get 7-8 hours as an adult, and remember that children need between 10-11 hours of sleep at night for the first 10 years of their lives!  By: Rebekah Thomson, Pediatric Sleep Coach Sleep is a vital need, essential to a child’s health and growth. Quality sleep promotes alertness, memory and performance. Children who get enough sleep are more likely to function better and are less prone to behavioral problems and moodiness. That is why it is important for parents to start early and help their children develop good sleep habits. Below are some general guidelines for how many hours of sleep the average child requires at various ages. Remember, every child is different – some need more or less sleep than others – but variations are minimal. As you can see below, children need about 11 hours of sleep for the majority of their first ten years. Ideally, parents will come to learn their child’s sleepy cues (more on these in a later post) and put them to bed when their child’s body is ready. Otherwise, parents can count 11 hours backwards from the child/household’s wakeup time and aim to have their child asleep by then (i.e. not just starting the bedtime routine). For example, if everyone in the house is up by 6:30am to get to school and work, the child should be asleep around 7:30pm.
Based on Richard Ferber’s Solve Your Child’s Sleep Problems Nap suggestions correlate to the average baby’s windows of wakefulness, which means ‘the length of time you can expect your baby to stay awake between sleep times without becoming overtired.” Average windows of wakefulness by age:
The above times are averages for children who are sleeping well at night. How your child naps is dependent upon how your child sleeps at night. Make sure that your child is getting enough sleep, and be aware of your child’s window of wakefulness. Try to ensure that you are starting the naptime or bedtime routine at least 30 minutes before the window of wakefulness expires to mitigate naptime resistance (and meltdowns).
Based on Kim West’s Good Night Sleep Tight Here’s to a good night’s sleep! Rebekah Contact Rebekah Thomson for your Sleep Needs! Rebekah Thomson Counting Sheep Pediatric Sleep Coaching rebekah@countingsheepmv.com (917) 455-3054 By Brooke Nalle In order to avoid a super early wake up Sunday morning on the new time, spend today shifting everything later by 15-30 minutes. Make sure you shift everything later - feedings, naps, routines, and bedtime. If 30 minutes is too hard for your baby, start with 10 or 15 minutes. Start tomorrow and on Sunday try to get your routines and schedules even closer to the new time - you should be eating and sleeping on the new time with no problem in just a few days. For example, your napper goes down at 9:15 instead of 9, 1pm, instead of 12:45, and 4pm, instead of 3:45, and bedtime is at 7:45 instead of 7:30. Feedings work the same way.  In the early morning, do your best to delay your response to your sleeper in a way that you feel comfortable doing. You can push a little more gently here and try to push the times at other moments of the day - naps and feedings. You can also try to catch your sleeper as soon as she stirs to see if you can get her back down quickly.  Do you already have a super early riser? Don't despair, you will probably have more success guiding him back to sleep at 3:45/4am (new time) so that he can start his day later. Also make sure that your sleeper has good falling asleep skills that he can put into practice in the pre-dawn hours. Finally your sleeper might wake early but don't rush to feed him. Try to do one mini activity before you sit down to nurse or offer a bottle (making a cup of coffee is a perfect example).  By Brooke Nalle You did it. You survived summer vacation. You went to Grandmas and back. You have packed up the pack and play, put away the suitcases, and are settling in for fall. Smooth sailing from now on, right? Not always, because of course, there are some challenges that come with this new season. First colds, dark mornings, early wake ups, and of course the dreaded … time change. Here are a few pieces of advice that I share with my clients this time of year and that will hopefully get you back on track or keep you going in the right direction. 1. If your child has a cold, you continue to gently follow your sleep routines and expectations. Just know that congestion makes it tough to feed, take a pacifier, or suck a thumb, so you might need to supplement how much you help to get them to go to sleep. If your child has a fever, do not embark on a sleep training plan! As soon as they are better, plot out a path to improve sleep, to get back to where you were, and take a few steps to get there in a day or two. 2. If your baby or toddler is waking up too early (it feels especially early this time of year), then make sure she is fully putting herself to sleep at bedtime as independently as possible. That way she can apply these same ‘going to sleep skills’ when she stirs in the early morning hours. You can adjust the afternoon nap to prevent her from going down too tired as well. 3. And last but not least … the time change. You can either work proactively or reactively to adjust your child to the new time. To prepare in advance, shift your child’s naps, bedtime, and feeding schedules 15/20 minutes towards the new time. You need to shift all 3 for it to work. You should also allow 3 to 4 days to get there. If the time changed, and you want to move your child onto the new time as quickly as possible, then shift naps, feedings, and bedtime as close to the new time as possible. I don’t suggest doing the full hour, but break it in ½ or 1/3rd based on your child’s temperament and what you think he can handle. Finally Halloween can be very exciting and sometimes scary for your child. Try to plan your Halloween events from their point of view. Look for celebrations that are geared towards the age of your child – perhaps a Halloween parade, or even dog parade rather than a trip to a Haunted House or Scary Jack O’Lantern ride. Brooke Nalle Pediatric Sleep Consultant Sleepy On Hudson www.sleepyonhudson.com 917.885.2594 brooke@sleepyonhudson.com |
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