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?”

Silence.

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.

Research:

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. 

16 10, 2018

The 8 Month Sleep Regression; What Causes it and How to Solve It

October 16th, 2018|Categories: Baby Sleep|

You Say Regression, I Say Progression

Raise your hand if you’ve ever heard of a sleep regression. Likely, it was the 4 month sleep regression. But what about other regressions? In particular the 8 month sleep regression? (Sometimes called the 8-10 month regression. But don’t worry, it doesn’t last that long, rather it can happen sometimes during those months. Whew!)  It’s not talked about as much, but can still impact your child’s sleep.

What is a Sleep Regression?

Sometimes the term ‘sleep regression’ is overused and we say it to explain any challenge with sleep that occurs. (I myself have been guilty of that in the past. I distinctly remember posting on a sleep forum to try and find out if there was such a thing as a 13 month sleep regression. Note: there isn’t!) 

But in the truest sense, a sleep regression describes a previously completely independent sleeper in the weeks before that suddenly has gone off the tracks. However, if there were sleep associations, medical issues, poor sleep hygiene, and/or the challenges that were present in the few weeks leading up to the sleep disruption, it’s likely not a sleep regression.

The good news is; regression or not, changes can be made and solutions can be found to help you overcome this challenging period of development. 

What is the 8 month sleep regression?

If you had previously heard of the four month sleep regression, then it’s important to know that what happens at eight months is quite different. At four months,  your child underwent a biological and cognitive sleep shift. This was a development in the way that your child fell and returned to sleep. Sleep cycles developed and your child began to enter and exit these cycles all night long.

The development they undergo at eight months is slightly different.

This time, your child’s biological sleep patterns are not changing. However all the physical milestones that your baby may be experiencing at this time can start to impact their sleep. 

Additionally, this is a common period for children to experience nap transitions as well and a sleep debt can build up. There’s a lot going on for children development wise at this time in their lives. It’s like the perfect storm of sleep disruptions.

What Causes the 8 Month Sleep Regression?

As mentioned, there are a few reasons why this blip in your child’s sleep may happen. Let’s look a bit more closely at the reasons;

  • Cognitive developments: Your baby is developing a sense of object permanence. She is starting to understand that even though you are gone from sight, you have not actually disappeared. This means they may cry for you once you’ve put her down in the crib.

 

  • Language development: The brain is working overtime to practice moving the jaw, tongue and lips to form new sounds to communicate. 

 

  • Physical developments:  Developing more strength and motor skills. Children are starting to learn to crawl, sit up and pull up. They may decide to practice these skills during nap time or at night.

 

  • Nap transitions: Baby is ready for slightly more awake time, a more regular schedule and might be ready to drop from three to two naps.

 

  • Overtiredness: If a child has the wrong routine, too late bedtimes or all the new developmental changes are tiring them out, this can cause a regression in sleep as a sleep debt builds.

 

Can You Sleep Train During the 8 Month Sleep Regression?

The short answer is ‘yes’. But understanding that sleep training is the last component to put into place, is important.

The long answer is, if you’ve read my articles or follow me on Facebook, you know that sleep training plays a very minor role in creating an overall healthy sleep routine for your child. The priority should always be a well-timed daytime routine and an age appropriate bedtime.

Want tips for a great routine and a solid night’s sleep? Download your FREE copy of Baby Sleep Basics here. 

Many sleep issues can be completely solved with just doing the foundation work of having a wind down routine, well-timed naps and an age appropriate bedtime. In fact I would go so far as to say that many sleep regressions can be avoided altogether with this, somewhat, simple advice.

Sleep is essential for everyone, including your child. Helping baby to get more sleep that they need to be healthy, so don’t let a developmental spurt stop you. 

How Do You Handle a Regression While Baby is at Daycare?

Handling a sleep regression when baby is at day care can be tricky, but there are things you can do. First and foremost, make sure the day care has a good understanding of healthy sleep habits, and the sleep needs of your child. Communicate with them what you’re experiencing and make sure they are understanding of the situation.

Tweak your baby’s routine as needed and ensure that the day care is supportive of this. And always remember to be patient. Many day cares have policies they have to follow. If it seems like they’re being difficult, they’re probably just following a procedure.

Tips to Handle the 8 Month Sleep Regression

Sleep Needs

Know how much sleep they should be getting in a 24 hour period. See this chart.  This is an important place to start. If your child is clocking significantly less than recommended, they may not be experiencing the 8 month sleep regression at all, but rather just be overtired.

Sleep Accumulation

Log their sleep for 5-7 days to see what they’re actually getting. Divide the total amount of hours by the number of days and it will give you an average to compare to the recommended amount.

Identify Problem Areas

Is your child having disrupted night sleep? Or are naps the biggest challenge to your child’s sleep needs? Once you see where the main issues lie, you can tweak your baby’s daytime routine. 

If your child’s naps are too short,compensate with an earlier bedtime. But if night time is the bigger area of concern, you may need to tweak the routine to reflect their biological circadian rhythms and natural sleep windows.

And finally, if a nap transition is needed; follow this article for tips and move to two naps.

Give Practice Time

If your baby is enjoying practicing her new skills instead of sleeping, offer her some practice time during the day. While you don’t have to sit, prop, or pull her up, offering her the ability to naturally practice these skills during the day can help.

Sleep Train, If Needed

Once an age appropriate routine is in place, if you want to wean any habits your child has become dependent on, you can. Pick a method that you feel the most comfortable with and be consistent with it. There are a variety of methods outlined in this series. 

Be Patient

Sometimes, with new skills, comes blips in sleep. If your child’s routine is on track, bedtime is age appropriate and she’s an independent sleeper, all we can do is just wait for the cognitive or physical milestone to develop allow the novelty to wear off. In these cases, as long as we don’t start any habits we don’t want to maintain long term, this phase lasts one or two weeks.

Have more questions?

There are many ways to get answers. Make sure to like and follow the Baby Sleep 101 Facebook page to get notifications when there is a free Q & A session.
Download your copy of Baby Sleep Basics or book a one-on-one private consult to get detailed and specific help for your unique situation.

24 06, 2017

Does My Baby Still Need to Feed at Night?

June 24th, 2017|Categories: Baby Sleep|Tags: , |

Baby still need to feed at night? Here’s how to tell!

You know the drill: you have spent an hour trying to get your baby to bed for the night. You haul your exhausted body to bed, only to be woken up a few hours later to the sound of crying.

Climbing out of your warm covers, you scoop up your baby and try to feed her. She takes a few sucks and then is back asleep. Laying her back down, you try to return to sleep but you can’t-you know she will be back up in an hour to repeat the process.

And so you start to wonder;

“does my baby really need allllll of these feeds, or am I being used as a human pacifier” ?

Whether I’m teaching workshops, doing my free Q & A sessions or working with private clients, it’s a common question.
Usually it’s followed up with; ” I’m totally fine with feeding-if she truly needs it-but how do I know? She never refuses a feed and it seems to be the only way I can get her back down”.

It’s rare for a baby to not feed at least a little when offered a breast or bottle. Even older babies, who may be waking every 1-2 hours often still eat when offered. But this doesn’t always mean that they are hungry. Confusing, right?

So let’s clarify something.

A baby waking at night feeding for true feeds, and, waking at night and wanting to eat because the baby is used to falling to sleep while feeding, are two separate things.

You can have a baby that wakes to feed at night to satisfy true hunger and still knows how to fall asleep independently. The two are not mutually exclusive because sleep training does not mean forced, premature night weaning.

However, if your baby is only feeding as a means of getting back to sleep and isn’t taking full feeds, this is usually referred to as a sleep association, prop or crutch.

Confused yet?
But wait, there’s more.

It’s common for children to combine these during the night; sometimes waking because of a sleep association and other times needing to be fed.

How does a tired mom decide which category her child falls into?

To answer this question, we need to examine a few factors.

Factors To Consider

Before we start, we need to consider your baby’s;

  • age
  • growth, weight percentile (both current and past)
  • general health, and any medical concerns
  • daytime sleep routine and amounts
  • bedtime
  • whether the child is falling asleep feeding or not
  • feeding routine and
  • intake amounts; day vs. night

When I work with my private clients, I also get their opinion on where they feel they are in their breastfeeding journey (if applicable), as well as their feelings/instincts on whether the feeds are needed out of hunger or wanted as a means of getting back to sleep. (To read more about sleep associations click here.)

Get your FREE copy of “Help Your Child Sleep Through the Night, 5 Tips Every Parent Needs To Know”

It is also important to factor in any medical professional’s opinion that you value such as the child’s doctor and/or an International Board Certified Lactation Consultant (IBCLC).

While we want to get a complete picture, I do find that most of the time, mama knows best. Sometimes there have been one-too-many opinions and my moms are feeling a bit overwhelmed and are just looking for some guidance. I know you’re tired, but don’t discount your own gut instinct.

How Many Night Feeds Per Age

Let’s start by looking at some common feeding patterns. Please note: this is just an average. Every child is unique and you need to consider all the factors mentioned above.
Case in point; I’ve seen 4 month olds go 11-12 hours at night without a feed, and other 4 month olds that needed 3 feeds throughout the night. But here are some average night feeding amounts.

0-3 Months: Feeds every 2-3 hours

4-5 Months: Bedtime feed, plus 1-3 more feeds through the night

6-8 Months: Bedtime feed, plus 1 feed

9-11+ Months: Bedtime feed, 0 night feeds

If your baby is feeding more frequently than listed above, she may have developed a sleep association with the breast or bottle. Use the following checklist to help you narrow it down more.

Night feeds may be needed if:

  • Your baby is younger than 8 months
  • Your baby can fall asleep independently
  • Eating solids are not a part of your baby’s regular daytime routine
  • Your baby takes a full feed at night
  • Your baby is going 1.5-2.5 hours between milk feeds during the day, and takes a significant feed at each one
  • Your baby goes back to sleep easily and quickly after a night feed
  • Crying escalates and continues for a long time if you try to wait to feed your baby at night
  • Your baby is regularly waking up at similar times for a night feed (eg: 12:30AM and 4:30AM)

When Are Feeds Not Needed?

A feed may not be needed if:

  • Your baby is 8 months or older
  • Your baby frequently falls asleep at the breast or bottle
  • There are a wide variety of solids being consumed, 3 times a day
  • Your baby only nurses or drinks to get themselves back to sleep
  • Your baby is going 3-4 hours during the day between milk feeds
  • Your baby stays awake for 20+ minutes after a night feed, and is happy
  • Your baby returns to sleep (after fussing/babbling for a while) if they wake at night and you don’t feed them
  • You describe your baby as a “snacker” during the day but takes long feeds at night
  • There is no consistency in night wakings; sometimes she sleeps until 3am, other times she feeds at 11pm.

Still Not Sure?

“Ugh! I’ve read everything and I’m still not sure-does my baby need to feed at night, or not?”

If after reading the above categories, you still are undecided on what your child needs, I recommend that you continue to offer night feeds but begin to document your child’s night wakings.

For 7- 10 days, record/log their daytime feeds and amounts, as well as night time wakings and intakes each time you offer the bottle or breast.

Once finished, review the information you have collected. What do you see?

Do you notice which feeds are larger than others?

Are there any similar patterns from night to night?

Babies four months and older may fall into a pattern of a feed at bedtime, and then two more after that during the night. Using that information you may find that the bigger/longer feeds may be the “true” ones and the shorter feeds may be the ones that are the sleep associations.

If you find there are several more feeds than that (and there are no health concerns or weight gain issues), you can talk to your IBCLC or doctor about weaning some of the extra night feeds.

Want to discuss the results of your night feed logs? Join the Baby Sleep 101 Facebook page to participate in the weekly Q & A session, or book a private mini-consultation from the A La Carte section to spend more time in a one-on-one discussion.

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6 04, 2017

11 Month Nap Regression; Tips for Getting Back on Track

April 6th, 2017|Categories: Baby Sleep|Tags: , , , |

11 Month Nap Regression

Finally, it seemed like your baby was settling into a good routine and then BOOM, the 11 month nap regression strikes.

As babies grow and begin to sleep more consistently, many parents feel that they are “out of the woods” in terms of dealing with sleep issues. So you can imagine how frustrated they feel when their little sleeper begins to “regress” and starts skipping their nap or having night wakings.

Overall, I think the term “sleep regression” is widely overused, but I do find there are a few certain key places where it’s appropriate and around 11 months is one of those times.

But first; let’s define what we’re specifically talking about when we use the term sleep regression.

What is a Sleep Regression?

I discussed sleep regression in my post 4 Month Sleep Regression: What It Is and How To Fix It, but here’s a quick refresher:

In order for a child to truly be going through a sleep regression, in my opinion as a sleep consultant, they would have to have been a solid sleeper for at least two months prior.

Anything less than at least two months of a solid sleep routine; long, restorative naps and sleeping 11-12 hours through the night with perhaps a night feed, is not as likely to be a regression.

But let’s say your baby has been a rock-star sleeper from months 8 through 10. Then as she approaches 11 months, you start to notice that she’s fighting naps. IF nothing else has changed-no alterations in her routine, no illness or vacations in the past few weeks, then this could be the 11 month nap regression.

What Causes the 11 Month Nap Regression?

Sleep issues start to creep up around this time due to the fact that your baby is growing stronger, developing and becoming mobile. Many physical milestones occur around 11 months and they can wreak havoc on your baby’s sleep, specifically their naps.

Whereas before your baby used to just lie around looking at the ceiling, she is now crawling, cruising, pulling up, standing or walking independently.

And as she practices these new skills, they are going to tire her out, similar to us adults when we start a new exercise routine. Using new muscle groups intently and frequently now is tough work!

The tricky part is, that because of her age, she will still appear awake and social. Eleven month old babies can tolerate longer wake periods than a younger baby can and they can engage with their environment for longer as well. But now we also factor in a baby who has discovered that she do all these exciting feats, which makes it harder to detect that she’s tired.

Get your free sleep guide here;  Help Your Child Sleep Through the Night; 5 Tips Every Parent Needs to Know.

Unfortunately for us parents, if we miss a baby’s just-ready-for-sleep window (which can be hard to detect) and they enter into an overtired state, they can get even more active due to a surge of fatigue-fighting hormones. . Add in all the entertaining and exciting new skills she can do, and she will likely keep herself awake too long if we don’t step in

When we do go to put them down for a nap, they are too wound up to sleep and continue to practice their new skills in the crib.

Talk about being misleading!

What we see on the surface isn’t a reflection of what is going on beneath.

Many parents mistake this behaviour as an indication that their child needs fewer or shorter nap times, but reducing rest periods, when the children is exhausted, is a one-way ticket to disasterville.

When children don’t stick to a consistent napping schedule they quickly begin accumulating a sleep debt; waking up at night and early in the morning. Now we have morphed from a developmental blip to a sleep-debt bomb.

Solving the 11 Month Nap Regression

Ok, so here’s how you get back on track. Let’s diffuse this bomb.

Step One: Start the morning nap earlier

You may be in the mindset that your child is moving towards needing later or even fewer naps, but that’s going to result in more problems. What we can do instead, especially if your child is starting to wake up earlier than 6AM, is to begin the morning nap a little earlier.

For example, if the child woke up at 6AM, and their morning nap is usually around 9AM, then putting them down for a nap around 8:30AM can assist with them settling down quickly and easily.

Step Two: Cap the morning nap

Keep this nap to about an hour in length. Keeping your child’s morning nap shorter, “protects” the afternoon nap by ensuring that your child is ready to sleep for a second nap. It also helps the second nap to not start too late, which if it does, can interfere with their night time sleep.

Step Three: Give your child time to settle down

How exciting it must be to realize you can move yourself, without needing to rely on someone else. From your baby’s perspective, it is much more interesting than napping. This explains why many children will skip their nap and instead practice their new skills during nap time.
If this happens, don’t panic and don’t end nap time prematurely. If they are happy and safe, sit down and enjoy a cup of (decaf) tea. There isn’t anything you can do at this point, so it’s better to give both of you some downtime and it allows them the opportunity to fall asleep.

I know it may not seem like it after a few days of skipped naps, but they will get back on track.

How long? Wellllll, the 11 month nap regression can last several weeks, but if you follow these tips, you may reduce it down to only a few days.

Step Four: Have an age appropriate bedtime

At this age, we’re looking at a wake period of about 3.75-4 hours after a solid second nap. It is also ideal to have it before 7:30pm. If you feel your little one is extremely tired, then you may even put them down closer to 3.5-3.75 hours for a few days and then move it out to 4 hours. If there wasn’t a second nap to base off of, then you’re looking at a stupidly  super early bedtime.

Since this regression can last a few weeks, stick with the above advice during this period to help keep on track of any sleep debt issues that may emerge.

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30 01, 2017

Sleeping Through the Night; Two Mistakes Most Parents Make and How to Avoid Them

January 30th, 2017|Categories: Baby Sleep, Toddler Sleep|

Sleeping Through the Night

Whenever I teach workshops or talk to parent groups, I will hear “I just have a quick question-why isn’t my child sleeping through the night?”.

Although the question may be quick, the answer isn’t. It’s difficult to give a short summary in a sentence or two.

There are a plethora of reasons for night wakings, and in order to be able to offer advice, I need to know specifics about that child; age, personality, sleep temperament, napping routine, bedtime, plus more.

What’s Your Definition?

“Sleeping through the night” means something different to every parent. And it can look different at various ages.

We have different expectations for a four month old versus a four year old. The first one will likely still need to wake up to feed during the night, whereas the latter won’t.

If the four month old wakes up to eat twice a night but goes right back to sleep and overall sleeps 11-12 hours each night, I would consider that sleeping through the night. If the four year old did the same thing, I would not.

Keep in mind that children and adults alike, do not technically sleep straight through the night, without waking. We all wake up throughout our sleep cycles, however most of the time it is not a full, conscious, “gee, I’m awake and it’s 3am” type of waking.

We shift our position, get comfortable and go back to sleep. This will occur in children as well. This a normal and healthy sleep pattern. The trouble happens when a baby or child fully wakes up and signals, cries or calls for a parent multiple times a night.

A Tale of Two Culprits

But putting those details aside, and assuming a child is healthy, and I can summarize the two main mistakes that parents inadvertently make that can cause and encourage night wakings.

First, I want to preface the information with the caveat that you should always check with your child’s doctor if you believe there may be a medical reason for the sleep issues.

This can include (but is not limited to) severe reflux, poor weight gain due to breastfeeding difficulties, insufficient transfer of milk, tongue or lip ties, snoring, mouth breathing, food or environmental allergies, restless leg syndrome or obstructed sleep apnea.

If no medical issues are present, then one of the following two issues may be at play;

  • Sleep debt accumulation: the child is chronically sleep deprived and exhausted
  • Sleep Associations: the child is unable to fall asleep independently

What is a Sleep Debt?

Sleep debt is the cumulative effect of not getting enough sleep, and leaves your baby, toddler or preschooler feeling mentally worn-out, physically exhausted, and can dramatically impact their mood, thought, and behaviours.

In most cases sleep debt occurs when a child habitually does not get the required amount of sleep each day and night, leading to chronic sleep deprivation.

This occurs most often when children are;

  • being kept awake for too long during the day,
  • naps that may not be occurring at the right biological times,
  • or bedtimes that are too late.

A sleep debt can be thought of like a financial debt; the more money you take out, the greater the debt becomes. If you don’t replenish the money, the debt remains.

Similarly, the longer the child goes without the proper amount of rest, the more overtired they are and the bigger the sleep debt becomes.

In both examples, if the debt is large, making a small one-time deposit doesn’t clear up the debt.

How Do I Know if My Child Has Sleep Debt?

When children are overtired, they can get revved up as their body releases more stimulating hormones such as cortisol and adrenaline in an effort to counter the exhaustion.

It is common for parents to tell me that their toddler will have a ton of energy in the evening, or as they try to rock their baby to sleep, the child is crying in their arms, pushing away and arching their bodies. The harder the parent works, the harder the child resists the attempts to soothe her.

Being overtired also manifests itself as;

  • seemingly scared of or,
  • hating their crib/bed,
  • excess crying,
  • taking extended periods to go to sleep.
  • Appears to not be tired and acts hyper, almost manic
  • Clingy behavior
  • Unable to settle

Getting Out of Debt

Luckily, these issues can be resolved by adjusting the child’s routine so that they are getting more sleep. One of the easiest ways to do this is by moving bedtime earlier in the evening.

For children under the age of 5, regular bedtimes earlier than 7:30PM work best. If you suspect your child has a sleep debt, then moving bedtime up by 20 – 30 minutes may help them feel more rested.

Some children even need a bedtime closer to 45 minutes to an hour earlier. If you’re not sure, this wake time infographic below can help you determine the right bedtime for your child.

 

Can you guess what the number one follow up question is, when I suggest an earlier bedtime? Parents wonder if it means their child will now wake up earlier in the morning.

To that I say a resounding “no”.

The reason is that when a child is overtired, doing an earlier bedtime allows their brain to acquire more cycles of sleep, which is like putting money into their sleep bank and reducing the sleep debt.

Why Your Child Needs an Early Bed Time

During a child’s sleep, their brain cycles through REM and Non-REM (NREM) types of sleep.

REM sleep is light, active, helps to consolidate memories and results in dreaming.

NREM is a deep sleep that helps the body to repair itself, release growth hormones and helps to clear the sleep debt.

The structure of night time sleep is such that there are more cycles of the deep NREM sleep in the first part of the night than there are later on.

When a child is overtired, an early bedtime helps to take advantage of this.

When we put a child to bed too late, the potential maximum cycles of Non-Rem sleep that they could be receiving, is cut off.

Part of this is due to the fact that a child’s morning wake up time is biologically set. A young child that goes to bed at 7pm has a better night and more cycles of NREM than a child that goes to bed at 9pm.

They will both likely still wake up at the same time in the morning. And if they don’t, for many children, if they do sleep in (past 7/7:30am), it can be a red flag that their body is extremely overtired and the quality of their sleep is already compromised.

Naps Are Necessary For Sleeping Through the Night

How many of you have been given the advice to skip your child’s nap because it will help them sleep better at night?Did you know that doing so will almost guarantee the opposite to happen?

Ensuring your child is taking long, regular naps is a crucial component for a healthy, debt-free and sleeping though the night, routine.

This is much easier said than done, I know. Helping a child to nap better can be a challenge because it takes much longer for a child’s brain to consolidate naps than it does for night time sleep. Whereas night sleep starts to get on track within a week of dedicated work and problem solving, naps take closer to 2-3 weeks.

 

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The good news is that it absolutely can be done! By maintaining a regular napping routine that matches a child’s natural sleep rhythm, we can help a child get the maximum amount of sleep cycles they need for a healthy nap.

The timing of when a nap happens is just as important as how long the child naps. This important fact is often overlooked when sleep problems are discussed.

To begin with, consider how long your child can stay awake in between naps. It will slightly increase the older your child gets, but only slightly.

For more tips on napping, see here and here.

The Skill of Falling Asleep Independently

The second area that commonly causes sleep problems in children over four months of age are sleep associations. Around four months of age your baby’s circadian rhythms will begin to mature, allowing your baby to develop the ability to fall asleep on their own. However, sometimes as parents we don’t realize that this transition is taking place. Out of love, we continue to “help” until our child becomes so dependent on our methods, that it feels like they “need” it to get to sleep.

These can include:

  • Physical stimulation, such as rocking, holding, or bouncing
  • External props, such as feeding, soothers, or bottles

When we begin to remove the extra help, this can produce tears of frustration in our little ones. If you’re a parent overwhelmed with sleep deprivation yourself, it can be difficult to recognize this. But keeping the context of the crying in mind can be helpful. If you’ve taken your child’s daytime routine into proper consideration, have fed and changed your child, then the crying that is happening is a result of being frustrated.

Consistency is Key

Once you’ve determined which external factors are at play you can start to remove them. This is the act of sleep training.

Sleep training is ONLY helpful in these situations. It does not fix a child that is waking and crying at night because of a poor daytime routine-that will continue to happen long after a sleep association has been weaned if the sleep debt is not first addressed.

Now, I know that the term most people are familiar with is Crying-It-Out (CIO) (AKA Extinction), but that isn’t your only option. You can choose to wean sleep associations slowly or quickly, depending on your preferences.

The key here is consistency: every day, every nap, every bedtime, and every night waking (minus the one or two that are for true nutritional purposes). For more information see my sleep training series here.

Ensuring that you remove bedtime “associations” not only helps establish a healthy bedtime pattern, but children who fall asleep without a sleep association experience better night sleep cycle transitions. This, combined with an age-appropriate daytime routine, in turns leads to children sleeping through the night.

Compare the dotted line with the solid line in the image below and you will see how a child that can move through sleep cycles easily has a deeper and more restorative sleep.

 

 

 

Removing all the sleep associations in the world won’t help if you don’t address an underlying sleep deficit and keep your child on a healthy sleep routine. It’s also important to introduce these changes during times when you are distraction-free and can focus on the task at hand, so avoid attempting to implement any changes during vacations, travel, when you are hosting visitors or doing home renovations.

If you find yourself slipping back into old habits then break the changes up into small, manageable steps. The easiest first step is to make sure that your child is napping at appropriate intervals, and that bedtime is consistent and meets their needs. This is the foundation for any sleep training that you may want to implement later on.

If you have a child that isn’t sleeping through the night, you may be too tired to make any changes yourself. Are you feeling overwhelmed and want someone to make a plan for you and guide you through the process? Book your consultation today and save yourself time and frustration or join me during one of my free Q and A sessions every Wednesday night from 8-9pm CST on the Baby Sleep 101 Facebook page.