15 05, 2019

Baby Sleep and Teething

May 15th, 2019|Categories: Baby Sleep|

We’re frequently told that teething and poor baby sleep go hand-in-hand. But is that always the case?

Teething and Baby Sleep 

When I had my first baby, and she wouldn’t sleep, teething was the frequent go-to reason.

Not napping at 4 months? Teething

Not sleeping well at 6 months? Teething

Waking up screaming at 4am at 13 months? Teething.

And of course, I did what every other parent does in these situations.  I tried all the homeopathic and medical solutions out there.

From cold facecloths to camellia capsules; we did it all.

I even remember getting my husband to go to someone’s house at night to get an “authentic” amber teething necklace.

(Please note: I do not advocate using these. When placed around the neck, they are an extreme choking hazard, even the “quick release” ones. You can read more on why they are not recommended here,  here, and here, )

But not surprisingly, none of these seemed to work.

I wish I had known then what I know now.

Which is what, you ask?

Teething Isn’t Always to Blame for Poor Baby Sleep

I have been a pediatric sleep consultant for many years and have helped hundreds of families. I’ve seen kids pop teeth out in the beginning, middle and end of sleep coaching and it not impact their sleep at all.

Now, I understand that this isn’t going to be everyone’s experience. But the truth is; teething isn’t always to blame for baby sleep problems. In fact, most of the time it isn’t to blame at all.

If you find this suggestion unbelievable, I would like to offer this;

Teething not being the cause of all baby sleep problems is great news!

The idea that teething may not cause as many baby sleep issues as we think, means that we aren’t at the mercy of the teething gods for 2-3 YEARS while all 20 teeth pop out.


So what could be real issue?

Sleep deprivation.

Sleep Debts

Now, I know it’s not as sexy to talk about.  In fact, it’s something that is rarely talked about.

At all.

It’s not discussed in mommy groups or on Facebook.

And I have rarely had my clients tell me that their pediatrician even asked about how much sleep their child is or isn’t getting.

But if your child is having issues sleeping, it is more likely that they are overtired and sleep deprived.

 This is also referred to as having a sleep debt.

Your Child’s Sleep Bank

So, what is a sleep debt, exactly?

We can think about it like this; say you’re financially in the clear and you have $500 in the bank. That’s a surplus. That is like a child who is well rested.

Now, imagine that child misses a nap or goes to bed too late. They will start to lose the sleep that’s in their sleep bank.

The part many parents don’t realize is; it doesn’t take a lot for children to get overtired.

That one missed nap or late bedtime can start the spiral. If it happens a few times in a row or throughout a week, the child quickly becomes sleep deprived.

When these overtired children fall asleep, their brain spends more time in a shallow sleep state, rather than a deep one.

And this shallow state allows for more wakings due to any disruption; wet diaper, cold room, dog barking or teething pressure.

Chicken and Egg: What Comes First?

Now, you may be saying to yourself; “but my child is overtired because they are waking due to teething.”

This may be true, but from my experience, it doesn’t happen as everyone tells us it does.

What is much more common is this…

Usually a sleep debt started to form before the teething occurred, however we didn’t notice it. The child slowly starting to lose more sleep in the weeks prior from whatever reason, and that in turn, left them more prone to shallow sleep.

Then, once any teething pressure started to emerge, because they were already having lighter sleep, they started to wake up more frequently. 

This made transitioning from sleep cycle to sleep cycle difficult, resulting in extra wakings.

Why does this happen?

It’s because when children are overtired, their bodies go into overdrive and extra stimulating hormones (cortisol and adrenaline) are released to try and fight the fatigue. This then suppresses deep sleep states from occurring.

If you want to imagine what it feels like, think of their lighter, more shallow sleep state as being similar to us when we watch a show on TV at night and begin to drift off.

Any sudden noise or disturbance will wake us up because we are only in the lighter stages of the sleep process. Usually, it feels uncomfortable to be jolted awake and not fully refreshed. 

Similarly, when an overtired child tries to transition through to another sleep cycle and is woken up fully, they usually cry because they feel uncomfortable and still tired. 

How To Help Reduce a Sleep Debt

Perhaps after reading the above, you start to suspect that your little one’s wakings are indeed primarily due to being overtired.

If that is the case, then the best way to help them feel better, is to work on putting more sleep into their sleep bank.

We do this by:

  • creating a relaxing wind down routine before each sleep period. This helps to cue the brain to release sleep hormones and set the stage for sleep.
  • Next, we ensure that the child is having age-appropriate length of naps each day.
  • And finally, we keep their wake windows age appropriate.  You can find a reference chart here.

I’m Sure Teething Is Causing My Baby’s Sleep Problems!

To help determine if teething is the issue, check what applies to your child;

  • The sleep issues are very recent; only in the last week
  • My child is not suffering from any illness, allergy or intolerance
  • My child has been on a solid nap routine for many weeks before the wakings started
  • Naps were over an hour on a consistent basis
  • My child could both fall asleep and transition through sleep cycles, independently
  • My child was recently sleeping through the night and just waking for 1-3 night feeds (age-dependent).

If you answered “yes” to all of these questions, then teething may actually be the cause of your baby sleep issues. (Woohoo?)

But, if you answered “no” to several statements, your child is likely waking due to another reason.

How To Help A Teething Baby Sleep Solidly

What can we do if our little ones are waking up due to teething? Here are a few suggestions;

  • Keep a regular nap routine 
  • Ensure consistent nap times each day. Sleep begets sleep.
  • If naps were shorter that day, move bedtime up earlier to help make up for the lost sleep.
  • If your parenting philosophy embraces the use of medications or homeopathic remedies, then with your healthcare practitioner’s advice, you may proceed as you feel is necessary. (Please note; if you are using medication and your little one is still waking well within the dose being in their bodies, then the wakings are not related to teething discomfort.)
  • If wakings occur, always give them a few minutes to see if they can return to sleep unassisted. Many children take about 20 minutes on average. However if this doesn’t feel comfortable for you, try 10.
  • Offer some reassurance and soothing after giving them time to return to sleep.

Baby Sleep After Teething; Back on Track

It generally takes less than a week for a previously well-rested baby to get back on track after a few bumpy nights.
However, if they were already overtired, then it may take closer to a week to fully recover.
We want to remember their sleep bank levels and if it has a large deficit, then it will take more time to replenish that lost sleep.
The best way to reestablish healthy sleep routines is to still follow the basics of healthy sleep;
  • Soothing wind down routine before all sleep periods
  • Placing baby down relaxed, fed, clean, but awake
  • Consistent nap times
  • Adjusting bedtime to quality of naps each day

Baby And Sleep And Teething; Oh My!

Whether your baby’s sleep is being disrupted by teething pressure, or a previous sleep debt, the good news is that no matter what; there is hope.

Either way, by focusing on your child’s overall sleep routine, nap quality and bedtimes will help both issues and get everyone back track as quickly as possible.

Want more tips to get back on track after a sleep debt or teething disruption?
A Mini-Consult is a great way for us to talk through the issue and get your family sleeping well again. You can book one here



19 03, 2019

Baby & Toddler Sleep On Vacation; 8 Tips for Success

March 19th, 2019|Categories: Travel Tips|

How to Vacation with Your Baby or Toddler, Without Messing Up Their Sleep

Winter is almost over which means that summer vacation season will be here before you know it!

If you’re thinking about booking a trip away (or getting ready to take one final winter one), you’ve probably also been wondering how to take a successful family vacation without messing up your young child’s sleep pattern.

This is a common question I get this time of year, so here are some tips to consider when you plan your vacation with babies and toddlers joining you.

Vacation With A Baby and Toddler Go Better With Sleep

This seems like an obvious statement, right? But, many times in their haste to pack #allthethings, arrange accommodations and map out routes, parents miss this important detail.

If your baby or toddler is caught up on their sleep before you even leave, it makes travelling, and the vacation in general, much smoother. 

This means in the two to three weeks leading up to the trip, be strict about your baby or toddler’s sleep routine.

Need some help getting your child on a good sleep routine before you head out?

Grab your free Baby Sleep Basics Guide here.

Get your free Toddler and Preschooler Sleep Solutions Guide here.

Keep bedtime on the early side, especially if they have a sleep debt, and have very regularly scheduled naps that don’t widely fluctuate in starting time, each day.

Maintaining a healthy sleep schedule in the weeks leading up to the trip will not only make the travel day easier, but help your little one adjust to the inevitable routine changes while on the trip.

Travel Mode

By air or by land? That is the question.

Vacation travel with a baby or toddler presents different sleep challenges, depending on the mode of transportation.

Which is going to be easier for you and your child and what do you need to plan on doing for travel option?

How will you factor their sleep needs into the travel day?

Obviously, the distance to your vacation will play a big part in this decision. Just make sure you’re prepared for the demands of each travel option.

Travel By Air

If you’re planning to get to your vacation spot via air, then getting a baby to sleep on the way there usually helps the rest of the day go smoother.

For those little ones that will easily nap on the go, try to pick a flight that departs in the morning. This way, by the time you board, your baby will have accrued enough wake time, to nap during the flight.

The morning nap is also the easiest nap for a child to achieve on the go, so consider this when booking. And at this age, we use whatever works the best to achieve the nap. Whether that be in a car seat, holding in your arms or a sling. A well-rested baby is the priority.

Extra Tip: If your little one is breastfeeding, nursing them during take off and landing can help their ears quickly adjust to the pressure changes.

For toddlers and preschoolers on one nap, you have more options as there are larger chunks in the day without rest periods. However, usually, we have more time in the morning before the mid-day nap.

Keep in mind that there is a higher chance that your toddler may not sleep on the plane. Therefore, bring a lot of back up activities to keep them occupied if you will be flying over their regular nap time.

If you have options with flight times, also consider other factors;  travel time to the airport, the wait time before the flight, the flight time itself and then the time to get to your vacation accommodation.

Will there be enough time for your child to get some good rest between all the commotion?

No matter what time you are departing, there will always be pros and cons. Do the best you can with the options available. It will be ok!

Travel By Car

But what about car travel? Let’s look at babies under 12 months first.

How do we manage our baby sleep schedule while traveling to our vacation destination in a vehicle?

If you choose to travel by car and your baby tends to take short naps on the go, I would recommend leaving after they’ve had their morning nap. This should help you get off on your travels with a good start to the day.

If the car ride is only a couple of hours, baby should be able to nap well, when they need to in keeping with their usual routine. Driving gives you a lot more control compared to flying. You can stop when you need to, and you don’t have to worry about the noise and distractions from busy airports and flights.

For toddlers, they may still easily fall asleep in the car around their regular nap time. However, it is likely the nap will be shorter than usual. If this happens, don’t panic. Move bedtime up earlier that day if you can.

Depending on your car or van, sometimes parents can use portable blackout blinds on the side windows to block the mid-day sun. It won’t be perfect (after all, as the driver you still need to see!), but it may help cut down a little on the light.

Extra Tip: If your child sleeps with white noise at home, bringing a portable sound machine or downloading white noise tracks on your phone, can be a great soothing aid for naps on the go.

Whether by plane or car, with a little extra planning, your baby or toddler will still be able to get some sleep.

Vacation and Baby Sleep and Time Zones, Oh My!

One of the most asked questions I get when clients are looking at traveling with their kids is; “how do I adjust their sleep schedule to the new time zone?”

My tip for the travel day and day after arrival is to just survive.

Don’t book any outings, or schedule any events. Everyone will be tired, and if there is a large time change, the whole family will need some time to reset their internal clocks.

Although a vacation is great, the reality is that a baby or toddler will need time to adjust to a new sleep schedule.

Use this day to unpack, explore the new accommodations and allow your child to nap as needed.

Depending on how far you’ve had to travel and how long the journey took you, it might be easier to simply stay on your regular time zone and schedule for the first day, if not the entire vacation. Sometimes, an hour or two isn’t worth fighting over.

If staying on your old time zone and schedule isn’t an option, adapt to the new local time as quickly as possible. I recommend getting out in the morning sun as this resets the internal circadian rhythms.

If you know that there will be a significant change in time zones, you can start to adjust your child’s schedule 15 minutes at a time, 1-2 weeks in advance. However this isn’t strictly necessary.

Usually you can get away with just jumping into the new local time. I would say that this is the best, and easiest, option. The sunlight and darkness will help your child to adjust naturally and prolonging the adjustment is no fun for anyone.

Location, Location, Location

The next most asked question?

“Where should my baby or toddler sleep while on vacation?”

Luckily, there are a variety of options for sleeping arrangements when you travel. My vote will be to always have little ones in their own separate space. In this instances, renting houses, condos, or cabins are great options for a ton of space and large families.

If staying in a hotel room, one option is to select suites that have separate kids spaces. Often these are billed as Kids’ Theme Rooms and provide a somewhat, if not completely separate, sleeping area.

Another option for larger families is to book adjoining rooms. Each parent can sleep in one room and depending on the age of the children, the youngest can be still be in a Pack and Play beside mom if nursing.

But what about those families that aren’t large, and/or don’t want to spend the extra money for separate sleeping areas?  Never fear, there are a variety of choices as well.

Rooms that come with a king-sized bed and pull out couches are good options for a variety of situations; especially toddlers and preschoolers who are too big for Pack N Plays.

If you are renting the average two queen bed hotel room, it can still be configured for families with little ones needing a separate space.

Pack and Plays can often be situated next to the entrance closet or bathroom and sometimes, if it’s big enough-in the bathroom itself!

If your toddler or preschooler is too big for Pack and Plays, and you decide to use the other queen bed, you do have to take safety into account.

Make sure that you build up the sides to prevent them from accidentally falling in the middle of a nap or night sleep. This can be accomplished with sticking foam pool noodles, extra pillows or a rolled up top sheet, under the fitted sheet.

If a parent will also be sharing the bed, sometimes you can also do this with a pillow in the middle of the bed to prevent little feet from kicking you in the back at night. 😉

So, as you see, regardless of your vacation space, your baby or toddler has a variety of sleep options!

Baby and Toddler Vacation Packing List

There are plenty of things you can bring on the vacation to help your child find the travelling, new place and slightly different routines, a little easier. 

For anyone past the exclusively breastfeeding/bottle feeding stage, I absolutely recommend a variety of snacks. Seriously, for the love of all things holy, don’t forget the snacks.

Other items to pack…

  • Car seat
  • Favourite baby carrier
  • Pacifier
  • Favourite stuffie
  • A few small toys that have never been played with
  • Pack and play
  • Unwashed sheets or pjs that have the scent of home on them
  • Noise machine
  • One or two favourite story books
  • Travel black out blinds

Extra Tip: When bringing new toys, I find it even better if you can wrap the small toys in wrapping paper like they’re presents. It adds an extra layer of fun and distraction that will make the stress of travel and change easier to cope with.

Tips For the Travel Day

When traveling with a young child, first and foremost, travel as light as you can. If you’re flying with your children, make the most of the curbside check in! And if they’re old enough, you can get them to help by carrying their own bag.

Individual snack bags and electronics (used sparingly) can be absolute life savers when traveling with young children too. 

For toddlers, make sure that you set boundaries and expectations ahead of time. However, keep in mind, they are little humans who will get tired and bored easily. 

While I am usually not a proponent of rewards and bribes, when travelling, sometimes we need to pull out all the stops. If it helps, reinforce good decent behaviour with praise, and then snacks and electronics.

But before you set off, accept that the travel day will be a challenge and keep your expectations low. Just know that you WILL survive!

Once Arrive at Your Vacation Destination

Once you arrive, set up the room like home as best you can. Bring all things (within reason) from home to recreate your baby or toddler’s sleep environment on vacation.

Bonus points if you can bring black out blinds and the same sheets from the crib without washing them! This will help to maintain smells of home, which can be a powerful trigger.

If you have changed time zones, the family will need a day to adjust, but after that, get onto the local time and enjoy the trip!

To the best of your ability, keep the same routine you had at home. Children on 1, 2 or 3 nap routines at home, still have those same sleep requirements on vacations.

Not only will this keep your child well-rested and prevent crankiness and overtired night wakings, but it will also make returning back home much easier.

How Do We Get Baby’s Sleep Back on Track After Vacation?

So now the trip is done, you’ve survived the travel and have a lifetime of memories-well done!

But perhaps your baby or toddler’s sleep got a bit off track though while on vacation. Don’t worry-it happens and it can be fixed!

For a start, adopt back to your local time after a day. Get back into a regular routine as soon as possible and let the natural sunlight help you with that.

Second; know what to expect.

It can take about a full week for your child to fully adjust, especially if there was a large time zone change. But they’ll be back to a normal routine before you know it.

Third, move bedtime up a bit earlier if some sleep debt accumulated. (Hint, it usually does.) You may need to do for 3-7 days.

Yes, Your Baby or Toddler Can Vacation and Sleep!

Remember, just because you have a child, doesn’t mean that you have to give up your yearly winter get-away or summer vacation! 

Just know what to expect and be prepared.

The travel days will be the hardest, but it’s all worth it for the fun and memories you’ll make together.


Back from your trip and need some help getting back on track? Book a mini-consultation that will help you devise a plan of action that you can use immediately!


8 03, 2019

Sleep Training Myths

March 8th, 2019|Categories: Uncategorized|

Sleep Training Myths

In my job as a child sleep consultant, I have come across every sleep training myth in the book. Unfortunately, as new parents, nobody teaches us about our child’s biological sleep needs and as such, myths, rumors and inaccuracies abound.

Sleep, which is the FOUNDATION for life, is never discussed once parents have a baby. Instead, we are left on our own to try and figure out how to establish healthy sleep habits.

In fact, in a recent, quick poll I did on the Baby Sleep 101 Facebook page the other day, out of the close to 100 parents that responded, only one of them were given any instructions about their baby’s sleep needs before being discharged from the hospital with their newborn! And that parent, had a midwife for her delivery.

So we can’t be faulted for believing some of the following myths.  I used to believe many of these when my own daughter wouldn’t sleep.

But, having the wrong information creates issues for parents and children as they lead you to believe things that are inaccurate. This ultimately ends with children developing unhealthy sleep habits and parents becoming frustrated.

So, let’s correct some of the most common sleep and sleep training myths once and for all.

1. Late Bedtimes Results In Better Night Sleep or Later Wake Ups

This is by far one of the most common sleep training myths that I hear. Most of the time it has come from a well-meaning older relative who has no understanding of the science of sleep.

Again, we can’t fault anyone for this. There have been incredible discoveries about how we sleep in the last 50 years. #Funfact; REM sleep was only discovered in the 1950s and it wasn’t until the late ’60s that scientists started classifying the different stages of NREM sleep.

This means these discoveries were only being made by scientists during the previous generation’s time. And even with the quick dissemination of information in the internet age, most people don’t know how sleep works or is categorized. 

So this brings me back to disputing the first myth; keeping children up later does not make them sleep better at night or wake later in the morning.

It actually causes the opposite to happen!

Children can only comfortably stay awake for a certain amount of time, depending on their age. By keeping a child up later, they will become over tired. This then triggers a biochemical response to release stimulating hormones to try and fight the fatigue.

Once these hormones are in their body, it causes them to sleep less and wake up earlier compared to a well rested child who has a bedtime that is in keeping with their wake times and sleep requirements.  

2. Skipping Naps Means Better Sleep At Night

Similar to the first myth, skipping naps does not make your child sleep better at night. Instead, it builds up the sleep debt during the day.

This increases the release of cortisol and adrenaline; two hormones associated with daytime and stress, and makes them more prone to night wakings.

Just like keeping your child up later, this will cause them to be overtired. Overtired children do not sleep deeply or restoratively. Their sleep will be shallow, hence the increase in night wakings. Therefore, children have sleep requirements that need to be met through naps in order to be healthy.

3. Sleep Training Can Cause Damage

The myths that sleep training breaks the bonds of attachment, causes ADHD, insecurities and creates toxic stress are not true. There is no peer-reviewed, research that indicates, reports or even hints at any harm from sleep training.
See: here, here, and here.

What research does show is that NOT having healthy sleep habits has been associated or linked to a whole host of problems such as (but not limited to): 

 negative impacts on the ability to regulate mood and emotion,

may be an early indicator for anxiety disorders in adulthood,

increased cortisol levels ,

lowered neurobehavioral function, 

and impact to school performance,

There is even more research when it comes to adults and how sleep loss impacts them; diabetes, heart disease, memory, Alzheimer’s disease, cognitive function-all have links to poor sleep quality or quantity.

4. Sleep Training Fixes All Problems

Nope, sorry. Sleep training is not the be-all, end-all to every sleep issue.
This is why some people will say; “I tried sleep training and my child is still taking short naps, waking up crying and waking multiple times a night.”

Very often parents misunderstand what the true purpose of sleep training is. Using a method of sleep training should only be used to wean sleep associations.

It can’t and won’t fix other issues such as night wakings which are due hunger.
Many babies will still need a few feeds a night up to 6-8 months (always check with your healthcare and breastfeeding professionals). This isn’t anything wrong or in need of correction in these situations. And sleep training certainly will not “fix” hunger.

Sleep training also won’t help solve sleep problems that are due to a lack of sleep hygiene, poor quantity or quality of sleep, short naps or overtiredness.

In these cases, creating healthy sleep habits, timing sleep correctly with circadian rhythms, and reducing the child’s sleep debt, is the cure. 

5. Sleep Training Means Night Weaning

Let’s put a stop to this one-right here, right now.
You absolutely can sleep train and continue to feed at night. The two are not mutually exclusive.

However, there is a difference between feeding a need and feeding a habit. 
If you feel some of the night wakings are habit (and your healthcare provider has no concerns), you don’t have to wait until your child no longer needs feeds during the night to begin sleep training once your baby is ready.

6. Formula, Solids or Thickening Feeds, Improves Nights

Adding formula, solids or thickening a bottle will not help your baby sleep through the night sooner. Instead, doing this can be harmful to your baby’s health, can be a choking hazard and/or create gut issues.

It also does not address the specific sleep issue that may be causing the problem with how a child is falling asleep or with their routine. 

Instead, follow a well-timed daytime nap routine, follow good sleep hygine and employ an age appropriate bedtime. This will create a healthy and restful sleep routine for your child overall.

7. CIO is a method

CIO stands for Cry-It-Out. This is not an actual sleep training method, but rather a general term that is used to group together a variety of methods and techniques. CIO can mean many things to different people and unfortunately that can cause a lot of confusion when the term is used.

What it commonly gets mistaken for is either Extinction, Graduated Extinction, Timed Intervals or a combination of all three.

8. It’s Normal For Children to Snore

Snoring in an otherwise healthy child, is not normal. It can indicate a variety of problems that need to be addressed such as:

    • An airway issue
    • Low resting tongue posture
    • High or narrow palate
    • Allergies
    • Tethered oral tissues
    • Enlarged adenoids or tonsils

If your baby or child is snoring, it should not be ignored. This is an indicator of an underlying issue. Please bring the issue to your child’s doctor.

9. Children Who Resist Sleep Are “Low Sleep Needs”

The vast majority of children require a significant amount of sleep that average around the same amount of hours per age.

When parents say to me that they believe their child has lower-than-average sleep needs, very often the exact opposite is true.

Depending on their age, most babies and children need an average of 11-12 hours of sleep each night, plus several hours of naps during the day.

But when children are overtired, they resist sleep more, cry longer and harder and can really fight the soothing process due to an increased cortisol levels.

Although it may feel like it, these cues are not indications your child doesn’t want to sleep, but rather they are overtired and have caught their “second wind.”

10. This Too Shall Pass

This is a common phrase that many well-meaning relatives, friends and internet groups say. But the truth is that many children don’t outgrow their sleep issues by themselves.

Especially sleep debts and sleep associations;  they don’t fix themselves. They just get transferred from one issue to another and the problems escalate and snowball.

While sleep is a biological need, falling asleep independently is a learnt skill and healthy sleep hygiene is fostered by parents.

Another factor to consider is how long some issues take to change. In the meantime both you and your child are not getting the proper amounts of rest needed to be at optimal health.

Even if children could work out their sleep issues over time, they cannot recoup the sleep that they have lost. Your child looks to you to set the tone and routine so that sleep needs are being met.

The Truth About Sleep Training Myths

In the age of the internet, sleep myths abound. Although many are well-meaning, they are often not based on the science of sleep or healthy sleep hygiene.
And as we’ve seen, frequently the exact opposite is actually the truth. Carefully consider the information and the source when being told sleep advice so that your child is getting the best rest possible.

Sleep is complex but vital to your child’s development. Helping them to achieve healthy and restful sleep will benefit them in all areas of their life.


14 02, 2019

Sleep Training and Sickness; What To Do When Baby Becomes Ill

February 14th, 2019|Categories: Uncategorized|

Sleep training and sickness; how do we manage both?

It’s that time of year! I’m sick, my kids were sick, and my clients’ kids are getting sick. It’s by far my least favorite time of year.

Being ill yourself is one thing, but there is nothing worse than having a sick child. All you want to do is take it away and make them comfortable.

If only it were that easy!

One of the most common questions I get from my clients this time of year is “What do I do when I’ve started to sleep train and my child becomes sick?”.

Attempting to do anything with an ill child is not easy, let alone something like sleep training which can be a huge undertaking at the best of times!

A Common Sleep Training Scenario

Here’s a situation I see happen frequently;

For argument’s sake, let’s say you started to sleep train your 7 month old. After a week into shaping the routine, getting naps on track and having more consolidated night sleep, they became sick.

They suddenly struggled to sleep at night because of their high temperature, runny nose and cough. As a parent, all you wanted to do was help them to feel better and ease their discomfort. 

But after being up all night with them trying to get them to sleep, you of course, became exhausted too.

You decided that because you both needed to get some rest, you would nurse them every time they woke the next night.

This way, they would be soothed and you would both quickly get back to sleep.

It was a win-win situation.

Or so you thought.

After 4-5 days, you may have noticed that your child was starting to get better. The flu like symptoms were going away, they were more comfortable and able to sleep much easier.

But just to be on the safe side, you continued to offer extra feeds for a few more nights and held them until they were asleep in your arms.

By the end of the week, your child was 100% back to being their normal, healthy self again.

Deciding to get back on track to sleeping through the night, you decided that the next night would be back to the regular routine.

But when you went to place them into their crib at night, they cried and protested at being put down awake, rather than being nursed to sleep.

What happened?

Your child had formed a sleep association with feeding back to sleep while they were sick. 

Sleep Training and Illness

When your child becomes sick, you need to take care of them first and foremost. Their health and well being comes above all else.

But when tending to them and helping them sleep, sometimes we can inadvertently do a little too much in certain situations.

In the example above, the baby was probably fine to start being placed down awake by the fourth or fifth night. They were already enough into the sleep training process at that point (naps were starting to lengthen as was night sleep. This would indicate that the child was beginning to transition through sleep cycles on their own), that they had developed some independent sleep skills.

But by continuing to feed ‘just in case’ baby needed to be soothed, a sleep association around feeding to sleep, developed.

Now please note, this is neither right or wrong.

It’s just how the brain and sleep work.

Whatever state or environment is present when a child enters the first stages of sleep (stage one in the diagram below), is what they come to expect in order to re-enter another cycle later on.

What To Do When Your Child Becomes Sick

If you find yourself in a similar situation, I strongly encourage you to do what feels right for you, your family and your ill child.

I would also encourage you to give assistance according to the intensity of their illness.

Some tips to consider:

  • If the child has a slight cold, some parents feel comfortable still maintaining a regular routine. This doesn’t necessarily mean formal sleep training where we are actively weaning sleep associations, but it does mean keeping the timing of naps and bedtime on track.
  • If the child’s cold is more severe, we may want to use a humidifier in their room (or steam up a bathroom and sit with them in there for a few minutes), help clear their nose, and move bedtime up slightly earlier. Sleep training is paused, but sometimes the routine is maintained.
  • However, if your baby has a bad flu or stomach bug, sometimes we need to pull out alllllll the stops. This might mean that you sleep in their room on the floor to quickly help them in the night as needed. Or, you may want to offer extra milk feeds, holding them for naps and offering more naps through out the day.

Should You Do Formal Sleep Training?

No one likes being ill so it’s important to make sure your child is as comfortable as possible when they are unwell. Unless it is a very minor cold, most of the time I recommend that parents pause sleep training.

As mentioned previously, you may still be able to keep a some-what consistent nap routine, as well as semi regular nap and bedtimes as well.

After all, sleep is one of nature’s best medicines. 

But for doing the actual weaning of sleep associations (which is what sleep training is *only* to be used for ), then most of the time we need to pause.
I know the concern is that we may undo all of the progress that has already happened, but you don’t need to worry about this.

First,  when it comes to actually helping them fall asleep, we want to only do as much as needed. And this will vary according to the severity of the illness.

Second, if they were already partly on track with sleep skills, then these skills don’t dissappear. You can get back on track when they are feeling better.

When To Get Back On Track

If your child becomes accustomed to a certain situation when they are unwell, they can form sleep associations or learned habits. And sometimes we need to take an active approach to changing the habits.

If this is the case, when you feel that your child is ready, you need to be confident in allowing them to sleep alone, as they normally would.  

In general, I like to wait until the child has been feeling 100% better for several days before resuming formal sleep training.

In the days leading up to this however, you can always start to get back to a more scheduled day if you weren’t before.

Maintaining a well-timed sleep schedule can greatly assist with the sleep training later because we start to eliminate the sleep debt before starting sleep training.

To Summarize

Do whatever you need to do to help your child feel comfortable while they’re ill.

When it comes to sleep; try to soothe them as much as is necessary, without doing more than is needed. This way you lessen the chance of  habits forming during the time that they are sick.

Should bad sleep habits form after you had already started sleep training, remember that your child still has sleep skills. They have not vanished all together, they simply need to be refreshed. Children are very capable of learning and relearning, it just takes time and persistence.

Worst-case scenario; for severe cold and flus; don’t worry about creating bad sleep habits because you can always re-teach and undo any associations, once they are back to full health.

Need further sleep tips? Download your free sleep guide.

Newborns: Newborn Sleep Survival Pack

Babies: Baby Sleep Basics 

Toddlers and Preschoolers: Toddler + Preschoolers Sleep Solutions

6 02, 2019

Tongue Ties+Lip Ties; A Hidden Cause of Poor Sleep?

February 6th, 2019|Categories: Baby Sleep|

Tongue ties and lip ties; are they causing sleep problems for your baby?

A mom emails me to say that she’s considering sleep training.  Her baby is around four months old and she’s wondering if he’s hit the four month sleep regression. We book our consultation and the time comes for us to chat.

After we exchange pleasantries, I get down to business. I have already seen her intake form, and a detailed multi-day sleep log. I ask questions and find out that this baby was never a good sleeper.

This is pretty common with my clients. But in these situations,  mom will tell me that when her baby was a newborn, baby was colicky and/or had reflux .

This is often the first red flag I see.

When I ask if baby was put on medication for the reflux, the usual answer is “yes, but I’m not sure if it worked.”

Second red flag.

I will then ask about breastfeeding and find out that there is a history of pain, bleeding, cracked nipples, over or under supply or supplementing with formula because she felt (or was told) that she wasn’t producing enough.

Third red flag.

As I go through my now standard questions that help me get to the bottom of where the sleep issues are stemming from, (I firmly believe every child can sleep well, but there is always *something* that is preventing it from happening) I will come across issue after issue that usually leads me to asking;

“Was your child ever evaluated for a tongue or lip tie?”


And then either I hear;

“what’s that?” or,

“yes, but the ___ (insert doctor, doula, midwife, lactation consultant, nurse) said there wasn’t one.”

I will then spend some time explaining why I think their child may have some sort of oral restriction.

They are often in disbelief or frustrated that something so simple may have been missed by the multiple health professionals they’ve seen.

And although they came to me believing there was a sleep issue, in situations where oral restrictions are present, it’s a feeding issue that is the root cause. 

We will further examine the relationship between feeding, sleeping and ties in a bit. But first, let’s look at the basics of tongue, lip and buccal ties. 

The Name Game

The first thing we need to know are some of the terms commonly used.

Frenum: This is the general term given to any fold, band of tissue or mucus membrane, in the body that attaches or anchors to a semi-mobile organ in the body.

Frenulum: A small frenum. The terms “frenum” and “frenulum” are often interchanged.

Lip Ties: This is when the lip (labial) frenulum is restricted or tight. Referred to as; upper labial tie (ULT), maxillary (upper) or mandibular (lower) or a combination of the terms.

Tongue Ties: Also known as ankyloglossia,  or lingual ties.

Cheek Ties: These are often called buccal ties.

Tethered Oral Tissues (TOTs): A term referring to any ties located in the mouth.

Tongue, Lip and Buccal Ties-What Are They?

An oral tie, is a condition that refers to restricted movement of either the lip, tongue or cheeks due to a short, thick or tight frenulum. While we all have frenulums, they are only considered “tied” when movement or function is prevented or impaired.

Tongue Ties

Medically known as Ankyloglossia, a tongue tie is identified when the tongue’s movement and function  is restricted due to a tight, short or thick lingual frenulum. A list of symptoms also needs to be present in order to make the diagnosis.

When the lingual frenulum is normal, it doesn’t hinder the full movements of the tongue; side to side, up, down and out. This means that there are no issues with children sucking, eating, swallowing and speaking.

But when there are tongue ties present, they can negatively effect a baby’s ability to latch, suck, feed and swallow. (Older children may also have difficulties with eating, chewing, nasal breathing, speech and dental alignment).

Classification of Tongue Ties

While the term “tongue and lip tie” is beginning to become more common, there are still many components that are misunderstood. One such example is identification.

Dr. Larry Kotlow, a pediatric dentist and one of the leading experts in TOTs, has devised a classification system based on the location of where a tie attaches, that many (but not all) TOTs experts use. However, this is not a classification of severity, but location only.

Classes 1 and 2 are anterior tongue ties. Classes 3 and 4 are posterior tongue ties. And in case you were wondering what’s the difference is, read on…

Anterior tongue ties – This type of tongue tie is very much visible and most commonly detected.

  • It is either at the tip of the tongue (Class 1) (sometimes resulting in a heart-shaped tongue tip) or, just behind the tip of the tongue (Class 2).
  • Class 1 ties are usually the only ones that some medical professionals consider a “real” tie, leading to many parents’ concerns being dismissed. However, some leading experts feel that every anterior tie also has a posterior component to it as well.

Posterior tongue ties – This type of restriction is under the tongue and not as easily identified.

  • Here the membrane is less visible (Class 3), or hidden completely (Class 4).
  • It is under the tongue and in the case with Class 4s, needs to be gently pushed down at the base and sides to be seen.
  • Unless a health professional has specific training in tie identification, posterior tongue ties are most often missed. 

How about Lip Ties?

We get a diagnosis of a lip tie when the labial frenulum  attaches under the top lip to somewhere on the gums near the front teeth, causing restriction and tightness, along with an array of symptoms to both mother and child.

While many children have prominent labial frenulums, not all are considered restricted. This is why it takes an expert to assess how tight the restriction is, location of attachment in combination of symptoms noted by parents.

Similar to tongue ties – some professionals use a lip tie classification system. Again, this does not define the severity of the lip tie, but rather where the frenulum attaches to the lip.

  • Class 1 – This type of lip tie is very rare and has little to no visible attachment.
  • Class 2 – The attachment occurs somewhere on the gum line but above the edge of the gum line.
  • Class 3 – The tie attaches to the edge of the gum line in line with a structure called the anterior papilla
  • Class 4 – This type of tongue tie wraps right around to the hard palate.

Many parents will be confused as to whether or not their child has an actual lip tie, and not just a normal upper labial frenulum. For further readying, this is a wonderful article from Dr. Bobby Ghaheri, an ENT and another leading expert on ties, that talks in depth about the difference; The Difference Between a Lip Tie and a Normal Labial Frenulum.

Buccal Ties

Buccal or cheek ties are the least known of all the restrictions. This is when a small piece of tissue is attached from the inner cheeks to the gums.

They can be located anywhere from way in the back beside where the molars will eventually erupt, to closer to the front of the mouth. To identify these, a practitioner may have to gently hook their finger into the side of the mouth and lift up and outwards.

They don’t seem to cause as much trouble, however, they are the least known of all TOTs, and therefore, the least studied.

The Mighty Tongue

How many of us think about our tongue?

Not many, I would guess.

It may seem rather unimportant, but it is anything but. The tongue is comprised of eight muscles that connect to various parts including the hyoid bone and the skull, but it is the only muscle that isn’t connected to bone at both ends. (Want to know more about the muscles in the tongue, check out this video!)

Although we think of our tongue as primarily used for tasting food, it is also important for speech, sound formation and aids in chewing.

Lesser known, but also extremely important is that the tongue helps to shape our airway by always resting against the palate (roof of the mouth) keeping it wide and flat.

Proper resting oral posture should always be; lips closed and tongue fully against the roof of the mouth. But when a tongue is restricted, it may prevent this from happening leading to a high and narrow palate and potentially constricting the airway.

Tongue Tie and Lip Tie Symptoms

Since breastfeeding (and bottle feeding as well) requires the middle of the tongue to lift up to form a seal and suction, many tied babies are not able to feed efficiently due to the restriction of the tongue. This can be happening even if the child is gaining weight.

(This can be for several reasons. In the newborn stage, often mom’s supply is being maintained by hormones, so the baby doesn’t have to work very hard to receive milk, but issues can develop closer to four months of age when supply begins to be regulated by baby.
Older babies may start to increase the amount of feeds during the day and night in an effort to meet their needs.)

To a similar extent, the lips also play an important role in proper feeding. When one of these two components aren’t functioning properly, we can see a whole host of problems begin to emerge. 

Here is a list of common symptoms tied babies may experience.

Tongue Ties and Sleep; What’s the Connection?

Many of the children that come to me who aren’t sleeping well, particularly around the fourth month, exhibit symptoms of having oral restrictions.  It has become a chicken-and-egg scenario that looks like this;

  • Baby can’t nurse or drink properly due to poor seal/suction on bottle or breast.
  • Baby falls asleep feeding, but only sleeps enough to take the “edge” off, not to fully satisfy their sleep needs
  • Baby wakes crying and mom feeds but baby can’t control flow from breast or bottle and pulls off, cough, chokes or gags
  • Baby tries to compensate by using lips, cheeks or gums to extract milk
  • Mom is experiencing painful nursing sessions, but has been told this is normal.
  • Baby tires easily from working hard to drain breast or bottle, falls asleep before feed is complete
  • Since they aren’t taking in the proper amount of calories at each feed, very short naps (usually under 30 minutes) and multiple night wakings result.
  • Baby also may inhale a lot of air when feeding, leading to discomfort
  • This causes excess air being ingested that results in reflux-like symptoms, the need to burp frequently and/or a gas that hinders the child from sleeping well due to discomfort.
  • Baby is continually tired from the lack of restorative sleep
  • To counter the building sleep deprivation, the brain increases the amount of cortisol and adrenaline that is released, further leading to shallow and unrestorative sleep
  • A combination of severe sleep deprivation, insufficient calorie intake, discomfort from excess gas, lead to the inability to sleep deeply or fully.
  • This causes short naps, multiple night wakings (more than what is considered “average” for the age) and early morning starts.
  • Parents are dismissed and may be told this is all normal and “just how babies are”, leading to extreme sleep deprivation on the part of the parent.
  • Parents may fall victim to risky behaviours, in an effort to cope with a wakeful baby and their exhaustion.

How Sleep Problems Escalate

As parents become desperate to help their babies sleep, they begin to try all sorts of props, gadgets and methods. Unfortunately, this then develops the child’s dependency on sleep associations.

Overtime, these sleep associations become habits that are deeply entrenched in the child’s sleep routine and it becomes a murky issue for parents to try and make sense of.

Further challenges erupt when the pediatrician has given the all-clear to night wean, either because the child’s weight gain is high or the baby has reached the six to eight month mark. Parents try, and it results in a very stressful night for all involve.

Can a Tied Baby Be Sleep Trained?

I help children sleep better by having a holistic approach rooted in sleep hygiene and sleep science. This means that my focus is always on when and how naps and bedtime are starting and lasting.

Timing and quality of sleep is a crucial component for a strong sleep foundation.

The actual sleep training method (ie Timed Intervals, Chair Method, Extinction, Pick Up, Put Down, No/less-Cry), is the LAST consideration.
If a parent chooses to sleep train, it is only appropriate for four months and older, and only to wean sleep associations.

Sleep training does not fix wakings due to sleep deprivation or hunger.

My focus is always primary based on making sure our little ones are not sleep deprived. So if you’re asking if a tied baby regardless of age, can learn to sleep better; absolutely yes. 

But if you’re asking if a tied baby can learn to sleep completely through the night, without any feeds, then I will say “usually not”.  And almost definitely not if they are under six months of age.

Of course each child is different and the severity of restriction needs to be taken into account. But as a general rule, I usually ask families of suspected tied babies to add more night feeds, not less. 

If a baby is waking out of hunger, then trying to wean those feeds is unfair and unrealistic. (However, I am not a consultant that pushes night weaning even in untied babies. I know that sleep training and night feeds are not mutually exclusive.)

So if you suspect your baby may have an oral restriction; fear not. We can we get them on a more healthy sleep routine, reduce (but likely not eliminate) the amount of times they are waking at night, and help them to nap longer.

How To Help a Tied Baby Sleep Better

Ok, so the next question is, how?

We do this by following the basics of healthy sleep hygiene. That is, create good sleep habits.

Good day, sunshine: Start with having regular morning wake up times, which after four months of age, tends to average somewhere between 6-7:30am. 

Sleep Ritual: Create a soothing wind down routine that is relaxing and comforting. This helps the child to associate the routine with sleep.

Location, location, location: Have your child nap in a location that is comfortably cool and very dark. Doing so kick starts the natural melatonin production and encourages the wonderful deep sleep that the body and brain craves.

Encourage restorative naps: This means that on average, your baby’s naps are lasting longer than an hour. If your child is on three nap-a-day routine, the first two tend to be the long naps, and the third nap is shorter; about one sleep cycle.

Don’t worry about trying to lengthen this third nap-just let it be short. Want to know how many of hours of daytime sleep your child should be averaging? See below…

Timing is important: We also want to have naps that are well-timed with the child’s sleep circadian rhythms (if older than four months old) so that the sleep that they do take is as refreshing as possible.

Keep wake periods age-appropriate: If we keep babies up too long in between naps on a regular basis, it will further add to their sleep debt levels. This will cause extra crying and resistance during the wind down. 

Early bedtime: Finally, to help manage the sleep debt, we must make sure to adjust bedtime to the quality and quantity of daytime sleep. That means, if naps have been short and unrestorative, bedtime must be earlier than usual to accommodate for the missing sleep. Sometimes this may only be twenty minutes and sometimes it’s two hours. It really depends on the child’s age and nap quality.

What To Do If You Suspect Your Baby Has a Tongue or Lip Tie

If you are nursing, an International Board Certified Lactation Consultant (IBCLC), who has taken additional studies in tethered oral ties, should be seen to assess latch, position, form and structure as they can often offer mothers ways to help baby feed more efficiently (even with bottles!).

In some parts of Canada and the US, Speech-Language Pathologists or Oral-Myofunctional Therapists may also be certified to do oral assessments. Alternatively, there are a number of pediatric dentists becoming tie savvy and performing exams.

Regardless of the practitioner, a comprehensive exam of the baby’s mouth including upper and lower lips, cheeks, tongue mobility, lift and reach should be checked.

Sometimes I hear of practitioners only checking if a baby can stick their tongue out. However, proper oral resting posture, nursing and later, speech, all require the mid part of the tongue to freely lift up, not out. 

Feeding should be assessed, as should body structure to evaluate for any tension or tightness. Finally, all of mom and baby’s symptoms should also be documented.

After the evaluation, the IBCLC, SLP or OMT will refer you to a release provider. In addition, usually some sort of bodywork is prescribed to help baby with any tension they may be experiencing from trying to compensate with the restriction. This may be cranial sacral therapy, osteopathy, or pediatric chiropractic care.

I have seen many posts in social media groups asking for other members (who are not certified practitioners) to identify tongue ties based on a picture. However, to have an accurate diagnosis, an examiner should do a full investigation on function, not just form. Just because you see a frenulum in your child’s mouth, does not mean they have a tie.

While social media can help point us in the right direction,  a well-trained professional must still fully assess your baby’s mouth, including upper and lower lips, under the tongue and cheeks.

Many practitioners will also use one of more assessment tools/forms/checklists that have been established to help diagnose a restriction. Some common ones are;

Carole Dobrich’s: Frenotomy Decision Tool for Breastfeeding Dyads

Carmen Fernando’s Tongue Tie Assement Protocol (TAPs), 

Alison Hazelbaker; Hazelbaker Assement Tool For Lingual Frenulum Function (HATLFF)

Lingual Frenulum Protocol by Martinelli and Marchesan 

Where Can I Find More Information?

Knowledge is power. The more you know, the better.

 Here are some further resources for you….

Dr. Bobby Ghaheri: Website, Facebook Page 

Dr. Larry Kotlow: Website, Facebook Page 

Dr. Soroush Zaghi: Website

Tongue-Tied: How a Tiny String Under the Tongue Impacts Nursing, Speech, Feeding and More

Tongue Tie: From Confusion to Clarity 

Tongue Tie Babies Facebook group has links to local chapters and providers. American based, but has links to other countries.

Canadian Tongue Tie Facebook group also has resources and information on providers, categorized by province.


You and Your Family Can Sleep Again!

The world of tethered oral tissues can seem overwhelming at first. I know, I’ve been there first hand with my own children, and with countless other parents who have sought out my help.

It can be confusing to try and sort things out. You may have just come to terms with thinking your child has some challenges with sleep, but now may realize that it may be rooted in a different issue altogether.

However, the good news is, you are not alone! Whether tongue, lip or buccal ties, there are more people becoming aware of their impact.

There are many parents going through what you are.  And while, it can be tricky to find them, thanks to the wonders of the internet, there are many professionals that can help you on this journey. 

If you suspect a TOTs issue, seek out a practitioner near you and have your little one examined. That way, you and your family can get the sleep you all deserve and need. 

Need more help with getting your child’s sleep on track, even if they have tongue ties or other oral restrictions? You don’t have to suffer with sleep deprivation. Here are some free resources for you…

Newborn sleep? Download your free newborn guide here.

Baby sleep? Download your free baby guide here.

Toddler and Preschooler sleep? Download your free toddler and preschooler guide here.