What is Normal? Six Month Sleep


 Photo credit: Studio 7042, Pexel.

Photo credit: Studio 7042, Pexel.


When it comes to understanding the normal development of independent sleep, knowing the facts can make a profound difference in our perspective on the “problem”. Understanding normal sleep patterns in childhood can be incredibly reassuring. And, frequently, this involves realizing there is no problem at all!

Knowing what is typical can help us figure out if the expectations we have (or our family has, or strangers have!) match with what is developmentally reasonable. To know that frequent night waking doesn’t indicate that we have “done something wrong” to cause our babies to have frequent night waking, but rather that it is biologically normal, can take away a lot of pressure! Putting energy into coping with the phase rather than fighting our child’s nature can be a refreshing shift from trying to fit our babies into the expectations,. This way we can model our expectations on our babies’ abilities.

In my September 12, 2018 facebook interview with Built to Birth’s Melanie Farrell, we spent an hour online chatting about what is normal, how to shift perspectives on the problem, and how to manage the challenges that come with supporting infants and young children to gradually develop the holy grail of parenting: independent sleep. One of the papers I mentioned was Sadler’s 1994 paper called (most encouragingly!) Sleep: what is normal at six months?

Here is a bit more of the detail of that paper, and why it is relevant to parents of young babies.

  • Of 640 parents who completed a survey about the sleep of their infant, only 16% reported that their 6 month old “slept through the night”.

  • 16% of the infants were reported to not have a regular sleeping pattern at 6 months of age (meaning a sleep pattern maturing from within the child, rather than a lack of ‘routine’ from the parents). This suggests that the internal regulation required for a regular sleeping pattern takes several months or more to develop. This fits with our understanding of infant development and neuro-maturation.

  • 61% were sleeping in their own room by 6 months, but many ultimately shared a bed with the parents upon waking: a whopping 43% were always, almost always, or routinely (34%) brought into mom and dad’s room upon waking.

The author suggests that knowing that these sleep patterns (frequent waking, proximity to parents during sleep) are normal can be reassuring.

What may help in re-framing the perspective of night waking in your 6 month old:

  • It is normal for babies (even at the ripe age of 6 months) to wake often and prefer proximity to mom.

  • “Sleeping through the night” is typically defined as 5 consecutive hours, not the 8-hours-a-night we come to expect as adults.

  • The pressure to have young babies “sleeping through the night” does not coincide with biologically normal sleep.

  • Trusting your instincts regarding sleep problems can be helpful, especially if baby is not sleeping as well as they ought to be because of colic, reflux, food allergies, sleep apnea, or poor air quality.

  • A return to more frequent night waking at 9 months, after a period of relatively good sleep, is normal. This tends to improve after 12 months of age.

  • The route to independent sleep is not a linear one.

  • Sometimes the best strategy is to anticipate the wave, hang on tight, recruit help, and ride it out. When mother nature is the one dictating the rules, changing course may be futile! Nature has a way, and we’d do well to consider that although our environment has changed a great deal, the nature of sleep has not.

So, what is a parent to do if they are struggling with their young child’s sleep but think it might be developmentally normal? Get support! Support can go a long way in reassuring you, in tweaking some strategies for sleep, and in emphasizing (giving you permission!) to focus on your own self-care. Parents who have sought my help and needed, primarily, reassurance, are among the most rewarding consults I’ve done because it puts the power back in parents’ hearts that what they are doing feels right, is supported by evidence, and, in the end, works to create healthy, and even joyful, bedtimes and a happy and confident independent sleeper. It may not take much to bring this power back to parent decision-making, but it can make a world of difference to how you feel about your child’s sleep.

References:

Sadler (1994). Sleep: what is normal at six months?. Prof Care Mother Child. 4 (6): 166-7.

Breath of Fresh Air -Reasons and Resources for Getting Outdoors

 Seneca, New York (image in the public domain)

Seneca, New York (image in the public domain)

 

As an OT interested in environmental health, I am excited to see how much more attention is being paid by health professionals to the importance of being outdoors in natural environments. 

Time in nature is more than just something that 'feels good'.  More time outdoors means less time indoors, where air quality is frequently much poorer.  More time outdoors also addresses many physiological needs that improve physical and mental health, energy level, hormone balance, growth, and more.  At its most basic, more time outdoors fills our evolutionary need and gives our bodies and minds the type of environment we are physiologically designed to thrive in.

I recommend more time outdoors surrounded by trees, or with sand between your toes, or soft grass to lie on for cloud gazing for families as a balm for virtually any of the challenges young families face.  And I'm not alone.  More Occupational Therapists are promoting outdoor time as an effective and evidence-based approach to a variety of challenges.  

Kathleen Lockyer, an Occupational Therapist from California, has been 'prescribing' outdoor time for over 20 years.  In April 2018, Kathleen co-led a keynote address  at Guelph Outdoor School in Ontario, Canada on the importance of accessing the outdoors.  Her website has helpful resources as does her former blog The website RxOutside.com  focuses on her Nature-Led (c) approach to supporting children.

Angela Hanscom is a paediatric Occupational Therapist whose TimberNook.com approach to taking OT outdoors for addressing such diverse issues as ADHD and autism, focuses on nature-based child-led activities.  Based in New Hampshire, Angela's approach is now modelled through mentoring, training, and certification, with programs for children running in Calgary, Alberta, and Peterborough, Ontario

OTs aren't the only ones developing unique nature-based programs for children.  Growth in interest in Forest Schools in Canada, and in child-led outdoor programs like Erin Fleming's Little Seeds playgroup and Learning in the Woods alternative education in Hamilton, Ontario are providing ample opportunity for families who want to increase their child's time in nature.  The motivation to access these programs comes in part from the aesthetics and romance of the outdoors and in part through a desire to address health and behavioural issues beyond prescriptive and medically-based approaches.  Regardless of whether the reasons are romantic or a response to specific challenges, time outdoors is time well-spent.

Just as filling our plates with nature-based foods leaves less room for processed foods, filling our days with nature-based activities results in less time indoors.  Considering the well-established evidence regarding poor air quality and its impact on child health, the more time we can spend time in healthy outdoor environments the better.  Indoor Generations' compelling video on the hazards of indoor air quality on children is rather dark in its mood but reflects the current evidence on not only the proportion of time many children are spending indoors compared to previous generations, but also the reasons why indoor air quality tends to be so poor.  

With several weeks of summer weather, and a beautiful shift to fall stretched out before us, there is ample time to rejig our days to focus more on access to the outdoors.  With some attention to our routines, a motivation to shift how our time is spent, and a desire to access an effective and free 'treatment' for many of the things that ail us, summer is a terrific time to lay the ground-work for a nature-influenced childhood for our kids.  The winter, while posing some practical and psychological hurdles, is also a wondrous time to access nature --with a bit of planning, the proper clothing, and a summer of rejigging priorities, our children can benefit from outdoor access year-round.

If you are looking for strategies to incorporate more outdoor time (including camping with kids!), and feel like making these kinds of changes is daunting, I consult to families who have questions or concerns about infant development, infant sleep, and parenting.  Nature time supports all three of these areas, and I would be more than happy to support you.  

 

Resources:  

Forest School Canada http://childnature.ca/forest-school-canada/

Indoor air and child health: https://www.velux.com/indoorgeneration

Kathleen Lockyer: https://www.kathleenlockyer.com/  https://www.rxoutside.com

Learning in the Woods learninginthewoods.ca

Little Seeds https://www.facebook.com/groups/1459957610922767/

Timbernook OT program timbernook.com and timbernook.com/canada
 

 Short Hills Provincial Park, Ontario, Canada (photo in public domain)

Short Hills Provincial Park, Ontario, Canada (photo in public domain)

Breathing in Anger: How to Cope with a Child's Rage

angry adult.jpg

Angry outbursts from our children, hurtful words from them, or a hurtfully hard megablock thrown deliberately at you...These can all trigger our own anger, hurt, and tempers.  

How do we handle such fiery hot emotions from our children while staying calm ourselves? 

How do we help our little ones regulate these intense feelings? 

What are we supposed to do to discipline them?

I will venture to say that developing our own self-regulation is the essence of helping our children do the same, and it is much more than child discipline: it is our own self-discipline!

When tempers from our children flair, we may be tempted to try to take the reigns, control the situation more tightly, force them to comply with our expectation, and threaten with punishment.  And we may soon discover that this fans the flames, leading to a child who feels unregulated, behaves in even more challenging ways (or complies out of fear, rather than connection) and may lead to us reaching a boiling point too.

Here are some ideas for managing ourselves in the heat of the moment.  Start here.  Start with you.  When you feel calm, and open, and able to cope, then you can more effectively help your child to feel calm, and open, and able to cope too.

 

  • Breath in, breath out.  Whether it is to slow down your heart rate, buy time to think of an action plan, or to model calmness that you hope will rub off, taking a deep breath in, and out can be a first step.  You do not need to know what to do next.  You simply breath.  And breath again.

 

When Your Child is Angry.jpg
  • Make your breath count.  Pema Chodron, an American Buddhist monk, teaches the meditation of Tonglen: to send and receive; to breath in the anger and the hurt of another, and to breath out calmness, love, and joy.  Regardless of your religious beliefs, you may find this resonates with you as a way of making your breath meaningful not just in practical ways but in ways of the heart too.  If approaching your breath this way helps  you feel more open to accepting your child's anger, lovely!  If not, the simple act of a deep breath in and out still works to calm an excited nervous system.

 

  •  Know there is a reason behind it.  Challenging behaviour is a sign of a need.  We may not always understand our children's anger, but if we know that a need is at the base of it, then we can respond in a way that looks to meet that need.  Often, with negative behaviour, we look to an emotional need: fear, embarrassment, hurt, shame, insecurity.  And often this is the key.  At other times anger and challenging behaviour may reflect physical pain, illness, or physical discomfort.

 

  • Provide your presence, not your advice. Gordon Neufeld, developmental psychologist in British Columbia, discusses ways of being present for a young child (or adult too!) who is challenged with big emotions.  When your child is lashing out in anger, stay close but not too close, talk quietly and calmly but not too much. Do not correct, until you connect.  Dr. Bruce Perry, an American psychiatrist specializing in childhood trauma, describes this as three steps: regulate, relate, then reason.  Understanding that none of us can process information very well when we are angry is helpful to remember when being present for our angry child.
Regulate Relate and Reason.jpg

 

  • Give another outlet -a physical one- for your child to release this anger.  Ripping paper, kicking a garbage can. And yes, even emptying the garbage can onto the floor.  If you can find a way to stay calm with it, then let it happen (though I've certainly swooped in to rescue a cherished bowl or other breakable object!).  I know it seems counter-intuitive perhaps to let children destroy things, but I have found that the wider the girth I give my kids to release their anger, and the less upset I am with it, the more I see the limit of what they will do --at one point I told my angry preschooler, who was holding a book in a way that suggested he was about to rip it, that it was ok; that if he felt that angry he could rip the book. And he didn't. He almost melted into the permission as if he wanted to know just how far it would be before my unconditional love stopped. And he realized it doesn't.  It is not always easy to stay that calm --but when it happens it feels like reaching the sweet spot of parenting: remaining calm in the tempest.

 

  • Use simple language to calm the situation.   We cannot process language very well when we are angry.  And yet, calm, rhythmic, repetitive, and simple language can help us calm down, and can help give us tools for coping.  I think this is why 'mantras' are so helpful for those who meditate.  At young ages especially, talk in simple sentences (e.g. it is ok to be mad, it is not ok to hurt me, repeated).

 

  • Use simple language to "correct" the behaviour or to reason with your child.  When both you and your child are calm, then address the behaviour.  For young children this will be more direct and simple, and can include words that acknowledge their anger, their behaviour, and gives an alternative.  For older children, reasoning around why some things are not ok to do, and looking at ways they can cope with angry feelings next time can be helpful.  Physical closeness can be an important part of this.  By continuing to use simple language, we can avoid 'giving a lecture' or bringing up past behaviours.  We can focus on empathy, reflection, and problem solving instead.

 

  • Go for the long haul.    Sometimes the hard work we do parenting through challenging situations doesn't bear fruit for a long time.  Our children may make the same mistakes over and over, or take a very long time to develop enough self-regulation to stop pushing their sibling, throwing things, or biting when angry.  Think of this in the long term.  However, you may also find that the work you do in regulating your emotions gives you wonderful payoffs right away:  when I stay calm through the tempests of my middle child (which is not always!), I am often met with a spontaneous "I love you" when things are calmer.  I take this "I love you" to also mean "thanks for staying with me through that.  Thank you for not getting mad".  

 

It is a very challenging thing to regulate our own emotions when trying to help our children develop self-regulation skills.  It can trigger a lot of hurt and anger in us that makes it difficult to meet the needs of our children.  Hugs to anyone who has had to dig deep to stay calm with their angry child.  It is no easy thing.  As Laura Markham, Clinical Psychologist, has said, our own self-regulation is the foundation of effective parenting.

 

Cry-It-Out and Martyrdom: The Third Choice Mamas Ought to Know About to Get More Sleep

Cry-It-Out and Martyrdom: The Third Choice Mamas Ought to Know About to Get More Sleep

There is an impression that the two options for helping your infant sleep are to “Cry it Out” or to sacrifice it all. There is a third option: Meet the biological, developmental, and emotional needs of your infant while also meeting your own needs. It may look different than you planned, but you can find a way to do this that feels right to your vision as a family, that feels good in your heart, and that aligns with the evidence on infant sleep.

The Seven-Year Sleep Switch: Reflections on School-Age Sleep

I don't usually focus on school-age issues with sleep --almost all of my focus is on birth to three-- but we have a school-age child in our family, and because we take an attachment- and nurturing approach to sleep, our approach includes his needs, too!

Here's the interesting thing, though: I have heard and read a lot on the developmental shifts that happen in, generally, seven year increments.  Waldorf philosophy considers age six or seven a transformational age during which children will have a leap in their thinking and emotional development (give or take a year).  Developmental psychologist, Jean Piaget, also describes a shift around this age as a leap that affects all areas of development.  And this transformation is one that is picking up speed in our 8 year old. 

So much is changing within him right now.  His humour has taken a leap.  His maturity and ability to empathize is evolving.  His concept of himself, his strengths, and his challenges, is changing.  His physical strength and competency is increasing in leaps and bounds.  He has a tolerance for doing things he doesn't want to simply because it needs to be done.  He is growing his natural tendency to care for his brothers simply because they need him.  His leadership abilities are emerging.  And also, not least, his sleep needs are changing.

We have, up until now, generally gone to bed as a family (with the adults frequently 'rolling ninja-like out of bed and quietly exiting the room' so that we can watch something on TV or clean up from dinner!).  But lately, wow!: the entire day will be going so smoothly, and then as they each get tucked in a switch goes off and our eldest begins behaving in ways that are the bain of the 'night time parent'.  In short, he is mean, disruptive, and disagreeable.  His behaviour becomes what every parent who feels she has coasted through the day on top of her game, dreads: thoughts of "what?  Not now.  Not at bedtime!  We're nearly there!" creep up and parental patience is thin.  And it seemed to be happening nearly every single night for several days.

After getting over the initial let down that the day is ending like a lion, my mind tends to go to ruling out medical and health issues, because it hasn't been a 'one off' single event.  But the wonderful and complicated thing about humans is that we are much more than our physical selves.  We are inquisitive, emotional, curious, energetic, intuitive, and social.  When problems happen, it could be health-related, but it could be any of these other emotional intangible things, or a combination of them, that cause the challenge, and resolving it requires an open mind.

When mayhem became the theme at night, and it was clear that he was having a great day up until then, my husband's attention turned to looking at whether we needed to re-jig our eldest's bedtime.  As I type this, it seems so obvious now: he's been going to bed when his brothers do, despite never having needed as much sleep as they do, and up until now, a long Narnia-chapter or two has kept him in bed as his brothers drop into slumber.  But something was not cutting it anymore.

It was time for a change in perspective.  So, we did a bedtime overhaul and changed our approach, and his bedtime, to fit with his own needs for sleep.  It's been quite a dramatic improvement.

Here's what sort of thinking helped (and, as it turns out, they apply to any age, really!):

  • Resistance is Futile: If we are feeling resistant to 'meeting the need' because we feel he is too old to need help at bedtime, we shift back into the mode that we were in when he was little: meet the need, and be flexible.   We remind ourselves that we don't always know why our kids behave a certain way, but that we can always be open to doing something different that works better for everyone.
  • "By the Book": We appreciate that his temperament was not laid out in the text book of child sleep.  He may feel anxious, or be bringing worries to bed that make bedtime challenging.
  • The 'make a sandwich' concept: Being able to do something independently does not mean always doing it independently.  I know how to make a sandwich all by myself but it sure is nice to have help sometimes.
  • "The Long Game": We keep our eye on the long term goal: that sleep, and bedtime, even for an eight year old, ought to be enjoyable, relaxing, and safe so that he continues to have a healthy relationship with sleep (and so that we can enjoy it too, even if it is different than we expected).
  • Things evolve: We don't consider this a step back but simply an evolution, and a basic human condition of not being or feeling the same every day, every year, and at every age. 
  • No bad habits: We do not believe that meeting the need will create a bad habit. Sleep routines will evolve, and if they evolve in a direction that we don't like, and that doesn't work (or no longer works) for us, we can change them.  If none of the usual 'strategies' are working, consider that it may be an unmet need. 
  • Collaborate!  Ask our child what may work to solve the problem (but not ask at bedtime, when his ideas couldn't be explored or discussed fully and with patience).  Kids are learning to know themselves, and understand their own needs.  Being asked to contribute to a solution that they are a part of is powerful --and can be surprising!
  • Practical magic: We divided bedtime -young kids first with one parent, our eldest downstairs doing table top activities (drawing, writing, math: things he enjoys and seems to gravitate to in the evenings).

The last suggestion (a split bedtime) is perhaps the most tangible suggestion on this list, but it is not the most important.  It is what we came up with to try, and it worked like a charm.  If it didn't work, we'd know that all the other ways we were 'thinking' on the problem were going to help in coming up with a workable solution.  

The split bedtime also took some enticement for the younger two --they wondered why our eldest was downstairs, and what he was doing.  So we upped the interest in bedtime routine, introducing a new tuck in routine that focused on each of them individually, and we switched from Narnia to graphic novels about ninjas.  So far so good.  

We also remind ourselves that this is never an end point.  Our son will continue to shift and change, mature, and grow.  And his needs will change, too.  By focusing on problem solving and meeting the need, we know that we will be more prepared for the next challenge.  And so will he.