Full Term Newborns: 14-17 hours a day
Infants (4-11 mos): 12-15 hours a day
Toddlers (1-2 yrs): 11-14 hours (includes nap)
Children (3-5 yrs): 10-13 hours (includes nap)
Children (6-13 yrs): 9-11 hours a day
Teenagers: 8-10 hours a day
The National Institute of Health and the National Heart, Lung and Blood Institute studies state, "Sleep plays a vital role in good health and well-being throughout your life...Sleep affects your heart, circulatory system, metabolism, respiratory system, and immune systems...In children and teens, sleep also helps support growth and development. Getting inadequate sleep over time can raise the risk for chronic (long term) health problems. It can also affect how well you think, react, work, learn and get along with others.
You will need to know what a typical sleep/wake pattern is in order to identify when there is an abnormal pattern.
If you are a Sprout Pediatric Therapy Services, LLC provider, you will find a printable log that can be used to assist you with this dialogue in the private content section of this website. Use it to detail the current schedule and review the questions to guide dialogue with the family and caregivers as you work to figure out where to start.
The information you should be gathering here is... what is happening in the environment that may be affecting the child's sleep. Many of these are problematic for children with sensory processing differences.
1. LIGHT (What kind of light is entering the child's room)
2. TEMPERATURE (Is there a consistent home temperature)
3. TOUCH (Who/What is touching the child)
4. SOUND (Noises outside and inside the home)
5. SMELLS (Is someone cooking something that may be alerting the child to wake? This may happen if a parent has a nighttime shift and gets in late)
It is recommended that the bedroom be dark, not lit up like a landing field. If there is light coming in from outside, then try to use window coverings that will block the light. There are nightlights now that detect movement so that when you are entering the room, it will trigger "on" and after a few minutes go back out.
Use of Red Light:
The type of red light that affects your sleep is light that emits red light wavelengths — not simply light bulbs that are tinted red. The theory is that these longer red light wavelengths stimulate the production of melatonin and offer a calming effect to the body. Melatonin is a naturally occurring hormone that helps you sleep. Your brain releases more melatonin as darkness falls and tends to release less when you’re exposed to light. Most of our little ones are having less outdoor time and way too much indoor time. The most natural suggestion would be to "GO OUTSIDE" and play!! When this does not occur, another option is to suggest "red light". Amazon has a tremendous number of off the shelf "infra-red light therapy" devices that can be purchased.
Blue Light waves are short waves that are emitted in energy efficient bulbs that we are all using, are found when we watch TV, iPads or use other electronic devices. JAMA Pediatrics contains a study from 2016 Dec 1;170(12):1202-1208. doi: 10.1001/jamapediatrics.2016.2341.Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis that supports the relationship between blue light and inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness.
Just like there is a strong link between age and sleep, there is a significant link between age and temperature.
Fluctuations in temperature that cause a child to get hot or cold during the night may cause the child to wake. Co-sleeping with a child may cause the child to get "hot" next to the adult's body and wake.
Well, some of us like touch and some of us don't care if the bed linen is 100% cotton or silk, but if you have sensory processing differences, touch can be a challenge when awake and when asleep. Things to consider when looking at the sleep environment are the child's preferences:
1. If the child has a strong need to be held and rocked to fall asleep, then it is likely that having some pressure on the body is what the child may need to stay asleep. Using a weighted blanket or compression sheets may be a suggestion.
2. If the child has issues with tags in clothes, then the texture of his bed linen may be something to consider. Look for soft 100% cotton or flannel sheets.
3. The sheets/blankets may not be the issue at all, it might be the clothes...are they too tight, are they too loose, they might have tags that are irritating, or they may be causing the child to get too hot or cold during the night? Re-assess and change the clothing first before changing the bed linen.
4. Are you touching the child? If you are co-sleeping, it can be a convenient way for you to care for the child without needing to leave the bed, but there are some issues that may present when this is done:
5. What about all the stuff in the bed? Is the baby's bed full of stuffed animals and toys that may limit movement during the night? Consider eliminating these if the child needs more space. Conversely, some children with sensory differences may be seeking something touching their bodies at night. While it is not recommended to have pillows, blankets and stuffed animals in an infant crib, once the child is in his/her own bed you may be able to create a more suitable cozy space.
I did not know until I started working on and reviewing literature for this website that there were different "colors of noise". I had always heard of "white noise" and honestly want to rip my ears out when I am listening to it. The point I am trying to make about this is that if you have tried "white noise" or "pink noise" (which is what is really in those sound machines you get) and it did not work or made sleep worse, then you are not hitting the child's sweet spot. Try something else.... perhaps classical music or no noise at all. To be honest, if your little one is hearing sensitive (as I am) then noise will be irritating and cause more disorganization. So, if you are just wanting to hide other sounds in the environment (like adults talking, siblings playing, the telephone ringing) another option would be sound proofing.
I found some information from the following website: soundproofcow.com
YOUTUBE has a tremendous number of noise making videos that support sleep. My favorite is Classical Focus that I call upon my Alexa app to play. Hint** the volume should be fairly low. Just loud enough to hear.
Essential Oils are becoming increasingly popular for use as a wholistic alternative modality. It is important that if you are using essential oils with a child, you make sure they are not allergic to it and that they do not ingest it. The typical mechanisms that are used to absorb the benefits of the oils are through inhalation (breathing it by disbursement into the air from a diffuser), skin transfer (rubbing it on the skin with a carrier oil like coconut oil) and ingesting it (swallowing). The research article I have included supports the health benefits of essential oils as well as some of their adverse effects. If you will be using essential oils with your child, please review this and other medically based research before use.
ESSENTIAL OILS USED FOR RELAXATION AND SLEEP:
There are a variety of essential oil diffusers on the market, and while they may look different, they're all designed to spread a therapeutic aroma throughout the room. Dispersing the oils in the form of breathable mist. When buying essential oils look for 100% pure, therapeutic grade products such as:
Carrier oils support the disbursement of essential oil through the skin. These include:
Tents OR Cozy Corners are spaces to help to provide a sense of containment – they can be helpful for children with lots of different needs. They can be used for children to have some relaxing time, to enhance sensory experiences, or to reduce environmental stimulation. Add special lighting, the child's fascinations in pics to look at or hold and a favorite blanket.
When a standard bed will just not work, consider getting a special safety bed. Many times, these specialty beds are funded by medical insurance as long as the doctor writes a prescription, and you detail the medical/safety need with a letter of medical necessity. The bed shown here is the SAFETY SLEEPER but there are many others includin
When a standard bed will just not work, consider getting a special safety bed. Many times, these specialty beds are funded by medical insurance as long as the doctor writes a prescription, and you detail the medical/safety need with a letter of medical necessity. The bed shown here is the SAFETY SLEEPER but there are many others including the Haven Series Safety Beds and KayserBetten Hannah Safety Bed 135
Something you should consider when you transition your child from an infant bed to a "big kid" bed. The child has been sleeping in a crib with boundaries (rails) and suddenly there is nothing on all sides. Try to offer lateral boundaries by orienting the bed so that the walls provide a lateral barrier, and you can use long jumbo bolster s
Something you should consider when you transition your child from an infant bed to a "big kid" bed. The child has been sleeping in a crib with boundaries (rails) and suddenly there is nothing on all sides. Try to offer lateral boundaries by orienting the bed so that the walls provide a lateral barrier, and you can use long jumbo bolster style pillows with a toddler safety bed rail to create a barrier on the other side.
Some medicines can negatively impact sleep. Talk to your pediatrician if your child experiences sleep problems and takes any of these medicines (do not discontinue a medicine or change dosage without first discussing it with your child’s primary care physician).
SLEEP APNEA: Approximately 1% to 5% of children experience Obstructive Sleep Apnea. In children, common causes include enlarged tonsils, obesity, and certain dental conditions or birth defects.
RESTLESS LEG SYNDROME: Also known as Willis-Ekbom disease, is a movement disorder that can significantly disturb sleep. There is an overwhelming urge to move one’s legs and increases at night when the person is at rest. It can be caused by an underlying issue such as iron deficiency or late-stage kidney disease.
BRUXISM: Bruxism is repetitive teeth grinding. When it occurs at night, it can disrupt a child’s sleep and can also lead to a number of painful symptoms including headaches, tooth damage, and injury to the jaw muscles.
GENETIC CONDITIONS: Scientists from Cardiff University have studied the sleep patterns of children and adolescents with one of the most common genetic conditions—22q11.2 deletion syndrome (22q) and found that 60% of these children under age 17 suffer from sleep difficulties.
THYROID DISEASE: An overactive thyroid gland (hyperthyroidism) can cause sleep problems. The disorder overstimulates the nervous system, making it hard to fall asleep, and it may cause night sweats, leading to nighttime arousals. Feeling cold and sleepy is a hallmark of an underactive thyroid (hypothyroidism). Children with Downs Syndrome are more likely to have thyroid issues.
NEUROLOGICL DISORDERS: Autism (among others) is a neurological disorder. Many children with Autism have self-regulation issues and regulating a sleep/wake cycle is one of those regulatory functions.
ANXIETY & DEPRESSION: Common symptoms of anxiety and depression in children include trouble falling asleep, trouble staying asleep, and not feeling rested after sleep.
TRAUMA & INFECTIONS: Brain trauma such as TBI (Traumatic Brain Injury) and birth traumas that affect brain function such as CP (Cerebral Palsy) along with Infections that impact the brain such as meningitis and encephalitis have impacts on sleep/wake cycles.
PAIN: There are a million different things that can cause pain/discomfort for our little ones, and they often do not have words to tell us. Try to be mindful of teething, ear infections, abdominal discomfort, medical procedures, etc that may be contributing to sleep challenges.
SALMON: Fatty fish like salmon or tuna provide a rich source of healthy omega-3s and fatty acids. Not only does this increase serotonin production, but it also helps your body regulate sleep. Consuming salmon on a regular basis or for dinner can help you fall asleep faster and experience deep sleep.
POULTRY: Chicken, turkey, and some meats contain tryptophan, a naturally occurring substance that’s converted to melatonin once digested. Melatonin helps you stay asleep for longer and experience deep, satisfying sleep. It is no wonder that after eating Thanksgiving meals, we all want to take a nap.
CHERRIES: Cherries are a great source of melatonin making them one of the best foods that help you sleep. They also have impressive amounts of potassium, antioxidants, magnesium, and other essential nutrients that your body craves.
ALMONDS: Almonds are incredibly nutritious are a great source of melatonin. They also provide manganese, phosphorus, and riboflavin.
WALNUTS: Walnuts are full of phosphorus, melatonin, and omega-3 fatty acids. As a result, they’re amazing at keeping you asleep for longer.
LEAFY GREENS: Kale and Collard Greens contain a hefty amount of calcium. To clarify, calcium converts tryptophan to melatonin, which is commonly found in meats like turkey and chicken.
"Melatonin is a hormone that your brain produces (naturally) in response to darkness. It helps with the timing of your circadian rhythms (24-hour internal clock) and with sleep. Melatonin supplements may help with certain conditions, such as jet lag, delayed sleep-wake phase disorder, some sleep disorders in children, and anxiety before and after surgery." (US Dept of Health; National Center for Complementary and Integrative Health) This, along with the following information was found on the Website: https://nccih.nih.gov/
Short-term use of melatonin supplements appears to be safe for most people, but information on the long-term safety of supplementing with melatonin is lacking.
Also keep in mind:
SAFETY IN CHLDREN AND SIDE EFFECTS
NCCIH (nih.gov) suggests that melatonin supplements at normal doses appear to be safe for most children for short-term use, but there’s little information on the long-term effects of melatonin use in children. Because melatonin is a hormone, it’s possible that melatonin supplements could affect hormonal development, including puberty, menstrual cycles, and overproduction of the hormone prolactin, but we don’t know for sure.
Possible melatonin supplement side effects reported in children have usually been mild and have included:
**Adults who want to give their children melatonin to support sleep should discuss this with their child's pediatrician. Therapists working in early intervention do not prescribe medications but may suggest it as an option for physician dialogue.
Contrary to what you might think, there is very sparse literature on the effectiveness of use of weighted blankets to improve sleep. Occupational Therapists regard this sensory integration modality of deep pressure input as a way to support self-regulation and calming. Unfortunately, the research just does not indicate that it supports longer sleep or better sleep.
If you do decide to use a weighted blanket, then you will want the blanket to be no more than 10-12% of the child's body weight. The blanket is not meant to hold the child down like an anchor! The child should be able to move freely under the blanket. The concept is that it feels like a gentle hug, like someone is holding the child and offering pressure on the body surface. Select fabrics you think the child prefers such as soft fleece
25 lb child = 2.5 lb - 3 lb blanket
30 lb child = 3 lb to 3.5 lb blanket
35 lb child = 3.5 lb to 4 lb blanket
40 lb child = 4 lb to 4.5 lb blanket
Be aware of who you recommend a weighted blanket for.... it is suggested that you talk to the child's physician before using a weighted blanket if any of the following are present:
First off, the child will NOT sleep if they are not tired!! My point here is that if all they are doing is lounging on the sofa and watching TV or viewing another technology device, then you are setting yourself and the child up for sleep failure. Suggestion here: GO OUTSIDE!! Wear them out. Figure out a way to spend their energy and teach them something about the world at the same time. When my children were growing up, I would feed them a good breakfast and send them on their way. Outside you go! Don't come back unless you are bleeding to death or on fire! (kidding!) It takes time and training to help kids understand and appreciate the value of being outdoors, but once they have it, this is where they will want to be. That means, that when they are very young, you will need to be outdoors too.
There is not a single parent I have ever met that said, "I want my child to be a screen junkie!" On the contrary, most adults want their children to be social beings, play with toys and enjoy the outdoors. So, if you want this for your child you need to model it for them. Put away your phone and turn off the TV. I simply cannot say it more succinct than that. I have a book in my arsenal called, "The Happiest Toddler on the Block" by Harvey Karp, MD. He compares toddlers to primitive man. Literally, he suggests we have "Bam-Bam" from the Flintstones. As he puts it, "modern homes are both boring and overstimulating at the same time. Boring because they cannot replace the exciting sensations of nature (the bright colors, the feeling of the wind on their skin, the brilliant sun, the soft grass, the sounds of birds chirping, etc)." Overstimulating because we are having them watch TV (crazy cartoons, videos, computer games, noisy toys, bright clutter everywhere). We have become a society so consumed with "things" that our houses look like we have purchased an entire isle from "Toys-R-Us". If your child has sensory differences, this clutter and chaos can be a real problem. It is likely triggering the billions of synapses they possess so that they look like a bumble bee that lights for only a few seconds on a flower before they are off to something else. If this is what your day with your toddler looks like, then why not try something different.
Daycares are required to build in "outside time" for little ones and by rule, they must have so many square feet of outside yard to meet state regulations. I am throwing this out there because, I am sadly aware that may ABA centers often do not have outside environments for little ones. Nor have I been able to find any regulations concerning the physical environment for ABA centers. Keep this in mind as you look for places that are suitable for your children to be cared for. In Louisiana, if you want your toddler to take a nap at an ABA center, you must either pick up the child and take them home to nap or pay someone out of pocket at the center to watch them sleep because they are funded for a "specific number of intervention hours" and sleep is NOT considered a reimbursable event.
**If I am wrong about the above statements, please contact me as I would like to know more about how ABA centers in Louisiana support the natural occupation of outdoor gross motor activities and sleep for their clients and where the state regulations can be found concerning these indicators.
Did you know that not all movement is the same? Some movement is excitatory, and some is calming. If you want to calm a child, use slow, consistent, linear movement. Examples of this type of movement include:
Conversely, movement that is fast, inconsistent and involves rotation are excitatory and DO NOT support calming.
Bedtime routines are a consistent, repetitive set of activities that are carried out before bed every night. They help prepare your child for sleep by having them relax and wind down. A predictable routine also gives your child a sense of security and teaches them how to fall asleep on their own.
A bedtime routine for kids usually consists of set of activities done in the same order help them wind down their bodies an begin to cognitively recognize that "sleep time" is here.
Typical bedtime activities sleep include:
Be open to adapting the routine if what you are currently doing is not working!!
Here are some additional suggestions that may support you and the child with learning to get on a sleep routine:
1. Set an alarm- use an auditory cue to signal it is time to begin the routine.
2. Fill the belly- if your child is not a particularly good eater or if they just did not eat well for dinner, work in a snack.
3. Transition object - if the child needs a little something to hold or suck to support calming, then provide it. As the child gets older, they need to become more responsible for gathering the things they need to get to sleep. These may include a favorite blanket, a pacifier or sippy cup.
4. Use a visual schedule- A schedule of the order of events in the bedtime routine may be beneficial to keep everyone on task.
5. Take a warm (very warm) bath: Warming the body is a great way to help the body calm. Add Epsom salt or a couple drops of essential oils to the bath to support calming. Most importantly, don't rush the bath - especially if this is one of the child's favorite things!! Let them play in the tub and get in a good soak.
6. Use music as a transition: Most parents don't realize this, but at daycares children are trained to "get in their nap spot" when the lights are turned off and music goes on. The use of this is similar to classical conditioning whereby the onset of music (neutral stimulus) causes sleep (naturally occurring reflex). Keep in mind that we all have music preferences and not all kids will respond to the same music in the same way.
7. Yoga & Breathing Exercises: Older children may really enjoy the stretching and slow sustained movements that yoga offers. Deep breathing supports a vagus response that induces a calm, self-regulated state. See link below for polyvagal theory.
7. Be attuned to sensory needs: If the child has sensory processing differences, you may need to incorporate this into the nighttime routine. Some of these may include:
Co-sleeping is the practice of family members sleeping together. It is never recommended that you co-sleep with an infant due to the risk of rolling atop a sleeping infant and causing suffocation or due to the risk of SIDS; however, they will not be infants forever. Many cultures and societies still practice co-sleeping. Independent sleeping is a practice in the western industrialized world.
Children have a natural biological need to sleep with other humans. We are social beings. Primitive man slept in groups, many animals still pack together because there is safety in numbers and being together offers a sense of safety and protection. In India, Africa, & Japan, co-sleeping or bed sharing is the norm, and most children will sleep with their parents until about 6-9 yrs. of age. Having a child sleep alone in their own bed is a western culture phenomenon.
BENEFITS OF CO-SLEEPING:
CHALLENTES OF CO-SLEEPING:
As an early intervention provider, we need to remain culturally sensitive and honor the desires of parents. I bet each one of us has performed co-sleeping to some extent while raising children and for myself it was a matter of self-preservation!!
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