Outline

1. Preventing Sleep Problems and Developing Healthy Sleep Habits in Young ChildrenMaya Garbuz, MSSW, CISWCertified Child Sleep Consultantmadisonsleepconsultant.commaya@madisonsleepconsultant.com

2. Outline • Sleep physiology • Causes and effects of sleep disruptions • Prevention of sleep disruptions • Intervention techniques • Cultural Competence • Community resources

3. Sleep Cycles

4. Circadian Rhythms • More information: • Secrets of Sleep Science: From Dreams to Disorders; Craig Heller. Stanford University Lectures

5. Melatonin • Hormone that regulates sleep • Melatonin production depends on light • Melatonin manufacturing is not regulated by FDA: • Side effects don’t have to be listed • Dosage may not be accurate • Not enough studies to test safety of melatonin use on children • More information: • National Sleep Foundation: sleepfoundation.org

6. Light’s Impact on Sleep • Research: • Exposing eyes to lots of light during the day increases melatonin production at night • Exposing eyes to light in the evening decreases melatonin production at night • Blue Light is the biggest melatonin suppressant • More information: • Lowbluelights.com • Richard Hansler, Ph.D. Pregnant? New Baby? Need Sleep!

7. Statistics • 1 in 4 adults struggle with sleep in some way • 20-30% of young children experience some kind of sleep disorder at some point in their childhood • Up to 80% in children with special needs and chronic illnesses • 80% of children with Autism (20% being severe sleep issues) • About 50% of all children with sleep issues having this being an “every night” occurrence • More information: • American Academy of Sleep Medicine: aasmnet.org

8. The Bizarre Phenomena of Sleep Suppose you have a new baby and your obstetrician is telling you of the neonatal exam: he says you have a beautiful, healthy baby, but there are a few things you should be aware of as new parents: frequently, your baby will go unconscious and be unresponsive to normal stimulation; the frequency of these attacks will gradually decrease to one a day by the time she goes to school, but they will last throughout life. Periodically, when unconscious, she will be paralyzed, except for spastic muscle twitches; her eyes will dart back and forth and her heart and breathing rate will get irregular. As she gets older, she will have hallucinations during these episodes; she will hear voices and see things that are not there. Some of these things will be very strange, and may be even terrifying, causing her to sit up and utter screams of fright; but not a problem, because this condition is also characterized by total amnesia: she won’t remember any of these terrifying experiences. Loss of consciousness, paralysis, spastic muscle contractions, cardiac and respiratory arrhythmia, hallucinations, terror, amnesia, my word! You are upset, anxious, but the doctor tells you: nothing to worry about it; this is completely normal. It is sleep! (From Secrets of Sleep Science: From Dreams to Disorders, Craig Heller; Stanford University Lectures )

9. Causes of Sleep Disruptions

10. Obstructive Sleep Apnea • Night Symptoms: • Snoring • Gasping and pausing for breath • Restlessness • Sweating • Bedwetting (leaking diaper) • Day Symptoms • Sleepiness • Difficulty awakening in the morning • Irritability • Long naps • Falling asleep in the car

11. Environmental Issues 7 Ingredients of healthy sleep environment: • Dark • Quiet • Comfortable • Low-stimuli • Cool • Consistent • Safe • More information: • National Sleep Foundation: sleepfoundation.org/bedroom/

12. Other Causes of Sleep Disruptions • Other Medical Issues • Behavioral/Temperament Issues • Trauma • Sensory Processing Disorder • Hunger • Separation Anxiety • Overstimulation • Nutrition Issues • Unbalanced Internal clock • Many changes happening • Travel Effects • Developmental Milestones • Lack of Consistent Schedule & Bedtime Ritual

13. Effects of Sleep Disruptions • Physical: • Lack of energy, fatigue • Compromised immune system • Weight gain • Slow and impaired reaction • Emotional: • Bad mood • Impaired social interactions

14. Effects of Sleep Disruptions • Behavioral: • Hitting • Moving all the time or not at all • Cognitive: • Difficulty learning new concepts • Short attention span • Impaired abstract thinking • Lack of desire to play, especially with new and challenging toys • Delays in all areas of development

15. Symptoms of Sleep Deprivation in Children • Moodiness and irritability, aggression • Temper tantrums • Grogginess when they wake up in the morning • Child falling asleep in the car • Having to wake child up almost every morning • Child has trouble thinking during the day • On some nights, child “crashes” much earlier than their usual bedtime

16. PREVENTIONS OF SLEEP DISRUPTIONS Stop singing Rock A Bye Baby to put me to sleep… A song about a baby in a cradle that comes crashing down does not exactly make me want to close my eyes

17. What Do We Need to Prevent Sleep Disruptions: • Consistency!!! • Bedtime routine • Sleep environment • Good-for-sleep foods • Level of activity during the day • Light exposure during the day • Boost melatonin production at night • Watching sleep cues

18. Sleep Cues: “I am ready for bed” • If being fed – sucking slower or weaker • Yawning • Turning away from faces • Decreased activity • Glazed look • Babbling less

19. Sleep Cues:“I am close to losing it” • Being disinterested in surroundings • Laying head down for a second • Rubbing eyes • Slower movement • Nuzzling into your neck • Seeking contact • Red circles around eyes

20. Sleep Cues:“No way I am sleeping now!” • Fussing • Crying • Can’t nurse • Arching • Flailing

21. Average Sleep Hours

22. INTERVENTION TECHNIQUES

23. # 1: Change Parents’ Expectations • What is “sleeping through the night?” (American Academy of Pediatrics vs. public awareness) • When is my child should be sleeping through the night? • Differences between child and adult sleep • More information: • Parentingscience.com (Gwen Dewar, Ph.D.)

24. Differences Between Child and Adult Sleep

25. #2: Teach Child to Self-Soothe • Cry-It-Out is not the only option: • Extinction(Weissbluth) • Gradual Extinction or Controlled Crying (Ferber) • Extinction with parental presence (West) • No-cry (Pantley) • Research shows that consistency, not the method delivers results • More info: Timothy Morgenthaler, etc. Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. An American Academy of Sleep Medicine Report

26. # 3: Introduce Consistent Routines • Sense of Control: • Knowing when something happens creates a sense of control and safety • Reduce bed time struggles (blame the clock) • Physical Cues • “My body feels sleepy”

27. # 4: Improve Bed Time Routine • What is a good bed time routine? • Older children can be a part of developing their own routine • Sleep Aids • Picture schedules • Timers • Pass system • Loveys (Build-A-Bear)

28. Children’s Books About Sleep • Goodnight, Moon by Margaret W. Brown • Goodnight, iPad by Ann Droyd • The Quiet Book by Deborah Underwood* • Dr. Seuss’ Sleep Book • The Going To Bed Book by Sandra Boynton • Just Go To Bed by Mercer Mayer • Time for Bed by Mem Fox • The Boy Who Wouldn’t Go to Bed by Helen Cooper • I Love to Sleep In My Own Bed by Shelley Admont • I Don’t Want to Go to Sleep by Chris Francis*

29. # 5 Improve Nutrition • Sleep-inducing foods • Problem foods • Iron deficiency • More information: National Sleep Foundation: Sleepfoundation.org/bedroom/taste.php

30. # 6: Don’t Neglect Naps • Research: important for development in various areas (cognitive, physical, emotional) & longer attention span • Support night sleep • Age

31. Naps and Learning • There is evidence that we are more likely to retain what we’ve learned if we go to sleep shortly after our studies (G. Dewar) • Naps are as effective as night sleep for learning

32. How to Promote Naps at Daycare • Quiet and dark room • Lullabies or white noise? • Pre-nap slow-down activity • Comfortable (shoes off, warm) • Low-stimuli setting (toys cleaned up) • Loveys

33. Cultural Competence • Cultural differences affect where, when, and how children sleep • No difference in the total amount of sleep within 24-hour period between white and ethnic minority children • Differences in timing and distribution of sleep

34. Cultural competence – Cont. • When talking about sleep have to take culture into consideration • African-American infants have higher incidence of SIDS and are more likely to be placed in prone for sleep – prevention! • More info: • Oskar G Jenni, Bonnie B. O’Connor. Children’s Sleep: An Interplay Between Culture and Biology. Pediatrics. Vol. 115 • Julie Boergers, Daphne Koinis-Mitchell. Sleep and Culture in Children with Medical Conditions. Journal of Pediatric Psychology. Vol. 35(9)

35. SIDS Awareness • Factors that may contribute to SIDS: • Prematurity • Smoking during and after pregnancy • Bed-sharing* • Sleeping alone in the room • Having “fluff” in the crib • Prone to sleep • Trying to sleep-train too early

36. Co-sleeping vs. Bed-sharing

37. Community Resources • Medical • Sleep Clinics • Chiropractors • Behavioral: • Sleep Consultants • Psychologists • Occupational Therapists

38. On-line Resources • American Academy of Pediatrics • Aap.org • National Sleep Foundation • Sleepfoundation.org • American Sleep Association • Sleepassociation.org • Gwen Dewar, Parenting Science • Parentingscience.com

39. Books on Sleep and Sleep Training Methods • Good Night, Sleep Tight by Kim West (all ages) • The No-Cry Sleep Solution by Elizabeth Pantley (best for infants) • Solve Your Child’s Sleep Problems by Richard Ferber (great info on sleep) • Sleeping With Your Baby: A Parent’s Guide to Co-sleeping by James McKenna (information on safe bed sharing and co-sleeping) • Sleep Better! A Guide to Improving Sleep for Children with Special Needs by Mark Durand

40. Questions? No, seriously… Tell me more. You are so interesting…