Knowing Gordon Neufeld’s Stages of Attachment has allowed me to anticipate my children’s needs better over the years, and has helped me understand their behaviour better too, something that can be very powerful and reassuring amidst the uncertainty and challenges of parenting! Applying these stages to sleep, this article explores what each stage looks like, and what parents can do to support each stage.
How we interpret the science of infant sleep can have an impact on how we are able to trust our instincts. Our hearts and our minds can align if we ask ourselves the right question: “How can I support my baby’s sleep development?”.
When nighttime sleep has been a challenge for breastfeeding mamas, many will turn their attention to the question of whether night weaning from breastfeeding will lead to a better night’s sleep.
After all, it makes intuitive sense that, as Jay Gordon suggestions, if the diner is closed, there’s no point waking up for a midnight snack.
In this article, we will take a look at what we know about night weaning and explore what may work to support night weaning in an evolutionary and nurturing way.
In addition to exploring strategies for night weaning, I’ll indulge in a bit of storytelling, too, as I share my night weaning experiences with my three children. Most of the suggestions below assume that you are considering night weaning a baby over 12 months of age, and that your toddler is bed sharing with you, or are continuing to room share with you: the effort of continued night feeds for a child down the hall makes it likely that toddlers who are sleeping in their own room are already weaned. Also, night weaning before 12 months has special considerations that include development and growth that I won’t cover in this article.
The challenge for some parents (though not all) that emerges in the toddler years is that as parent longing for some personal space goes up, so does toddler restlessness, acrobatics, long lazy latches, and nighttime nibbling. Nipples get sore, heads get kicked by flailing toddler arms, and toddlers go through periods of increased feeding for comfort, emotional connection, nourishment, and more —nothing close to the straight trajectory towards natural weaning that we pictured when we first imagined natural child-led weaning. It can feel like a return to the early days of feeding, except kiddo is three times as big, and waaaay more active. Parents who are nursing a toddler through the night probably recognize some similarities with nighttime at the 7 to 10 month mark too —a typically challenging period of time for infant sleep.
As decisions are made about if and how to night wean, it can be helpful to keep two questions in mind: what are you reasons? And what are your goals?
I want to emphasize that when we, as parents, have decided we are “done” and want to end the nursing relationship, it is ok! Sometimes this is out of frustration, fatigue, being “touched out”, or wanting some flexibility through the night (to work, to rest, to be alone). As decisions are made about if and how to night wean, it can be helpful to keep two questions in mind: what are you reasons, and what are your goals. The answers to these questions will help guide your actions, and will also help you evaluate things, and change course (subtly or significantly) if what you are doing doesn’t align with your goals. Your goals, of course, may change too!
Often, breastfeeding parents feel that night weaning will reduce night waking. That connection is quite murky —I could find no evidence to support this idea in the literature, though certainly there are some children for whom this is true, anecdotally. I would suggest that in terms of sleeping through the night, it be approached more as a developmental skill, and one that may or may not be impacted by night nursing. However, despite this, moms may still feel a strong pull towards night weaning for their own physical comfort, and their desire for some bed boundaries and personal space. These are important things to honour!
There may be sweet spots that, developmentally, can make it better “timing” —these generally happen between Plooij and van de Rijt’s popular “Wonder Weeks” in addition to other frameworks of developmental jumps. However, timing isn’t everything —your needs are factors here too.
Before we delve into how to night wean, let’s take a peak at what we know about night breastfeeding.
Research doesn’t tell us much about weaning. And research tells us even less about night weaning. What do we know? We know that:
up to 1/3 of a child’s nutrition at 12 to 24 months of age can come from night feeding (WHO, 2015);
breastfeeding beyond the first and second year of a child’s life is recommended if it aligns with what a family feels is appropriate (CDC, 2014); and
night weaning can be among “the most logistically and emotionally challenging” aspects of weaning (Cuniff & Spatz, 2017, p.93)
Night feeding and bedsharing are highly correlated
What does that mean for moms who are ready to night-wean? It can be gradual. It can be your decision. And it can be difficult. But, as with many parenting situations, being difficult doesn’t necessarily mean it is not the right decision. Weigh the benefit and draw backs, be flexible, and be gentle with yourself. This, like so many other aspects of parenting, requires flexibility and an open mind.
Weigh the benefits and draw backs, be flexible, and be gentle with yourself.
Here, then, are some insights for those who have decided to nudge things towards night weaning.
One of the more popular suggestions for night weaning parents is Dr. Jay Gordon’s nighttime weaning process (Gordon, 2002). For kiddos above the age of twelve months (and more than likely 18 months and older) who are ready, his process can work well. However, in practical experience, these steps can be difficult, and distressing especially at a younger age —there are gentler, more developmentally-guided approaches. Likely, if his approach (some of which are incorporated in the suggestions below) is not working, it is not good timing: pause, re-evaluate, and try again. It is ok to stop, and wait for a better time. Other strategies that can feel more respectful, flexible, and gentle, are included below and are drawn, in part, from Elizabeth Pantley’s book, “No Cry Sleep Solutions".
I don’t remember many of the details of weaning my first born. I know there were portions of the process that were not easy. And there were a few re-starts, and pauses, and “try agains”. My toddler would rather have nursed, but I don’t recall the transition being an exceptionally difficult one, and the glorious indulgence of a bed I could stretch out in was pure bliss—a welcome focus on my needs after the intensity of the first year and a half of parenting, was nothing short of amazing.
With our second, I was glad to be done with night nursing by about age 2, motivated by my own worthwhile need to have my body be my own at night. It is not a decision that I regret, though I do know there are 101 different choices, options, strategies, and nuances that can make night weaning look different for every child, and every family.
We chose what we felt was best for us, with a great deal of flexibility, and our eye on the big picture: night weaning would happen eventually whether we promoted it or not. A bit of nudging in that direction was just fine. And assertive communication from our toddler was worth evaluating and re-evaluating: was our expectation of him reasonable? Was it best to wait a bit longer? Does this feel right?
We did play some musical beds during this period: sometimes my spouse was the one cuddling our weaning toddler at night, and we did not balk at changing the plan from night to night (or part way through the night!) if what we were doing was not working well for any one of us.
Night weaning generally falls into the “can do, but don’t have to” category of parenting decisions. Weaning will happen over time, even if you do nothing in particular to nudge it along.
By toddlerhood, parents are adapting to the assertive and big emotions from toddlers who don’t (can’t) always have their needs or desires met in precisely the way they would like them to be met: no matter how much they want to, they cannot run across the road, smash a glass on the floor, or hit their sibling. Night weaning, however, generally falls into the “can do, but don’t have to” category. Weaning will happen over time, even if don’t do anything in particular to nudge it along. If the timing is right for you, it’s a matter of balancing needs, and moving flexibly and sensitively towards your goal.
Keeping an open and flexible mind allowed me to use our toddler’s room for night weaning. The time spent with him at bedtime and through the night helped me figure out what parts of night weaning were workable, and what parts needed tweaking. There were many missteps (the bruise on my forehead from a sippy cup thrown in frustration by my toddler being one of them). My “in the moment” goals around night weaning shifted depending on how tired I was. What felt most important to me was to honour the ebb and flow: to know that I was not “giving in” if I chose to breastfeed him, and to know that weaning would happen eventually. Night weaning when mama is ready, but baby isn’t quite on board, is an exercise in respecting everyone’s needs, and finding solutions that work best under the circumstances.
With our third, I needed to be on medication that, based on multiple sources, required weaning. It was, quite frankly, an awful process for both of us, as neither of us was ready: I had had my intentions to night nurse for longer than I had the other two, and the sorrow and frustration we both felt with early weaning was heavy. If you are experiencing a similar situation, Dr. Jack Newman’s International Breastfeeding Clinic is a highly recommended resource for working out the necessity of, and the details of, weaning due to medical/medication needs, particularly with the closure of Sick Kids’ Mother Risk organization. If night weaning is not your personal goal, but appears to be medically necessary, gathering all the support you can to make a workable plan. This may include strategic, professionally-supported timing of medication, as well as validation of your feelings through this process, and practical strategies for paving the way.
Nurturing strategies can be applied to make the process of weaning smoother.
If night weaning is necessary, know that sometimes there are factors beyond your control, and that you have many other nurturing strategies at your disposal for maintaining a strong bond with your baby, even if circumstances (medical or otherwise) lead you to night wean before one or both of you are ready. Know as well that if night weaning is right for you, these nurturing strategies can be applied to make the process of weaning smoother, and respects the emotional well-being of both you and your baby.
If night weaning is chosen for your own well being, know that that is an important reason in and of itself. Night weaning before a child is ready can be challenging, and pulling in all the supports and strategies you can is important, too.
The following are some strategies to consider when night weaning your toddler.
Strategies for Parents Who Feel “Done” with the Nighttime Feedings:
Reflect first. Is this feeling like a permanent shift in your feelings around nighttime nursing? Or is this feeling a blig in the road? Are you doing this for you (great! If it’s not working change it. Your priorities and preferences matter!) or is there pressure from others? I use a nighttime weaning readiness checklist with clients to explore this further.
Eliminate barriers! Reflux, excema, tummy issues, and respiratory difficulties (apnea, environmental allergies, stuffy noses) can lead to frequent night nursing to relieve discomfort. Addressing these issues, and resolving them as best we can, paves the way for meeting night-time weaning goals. Occasionally something as straightforward as a diet change or fresher air in the bedroom can improve sleep, and make night-time weaning easier.
Change it up: the bedtime order of breastfeeding and cuddles may not have a huge impact on overnight feeding, but it can help some parents feel that they are moving in the right direction. Toddlers may wake up sooner when they first shift away from nursing to sleep (we don’t really know —and some toddlers coast right through to the usual next wake up). Regardless, with the right routines in place, and an approach towards flexibility and gradual separation of nursing and falling asleep, your toddler may surprise you with their readiness.
Close up shop: in the early days of breastfeeding, nursing shirts and button pajamas make it so much easier to breastfeed. If you are looking to wean, a change of clothes may be helpful. By switching to pull over shirts you’ve created a mild inconvenience; not enough to dissuade a child who continues to need the breast at night (physically or emotionally), but enough that a child that could take it or leave it might decide it’s not worthwhile. Button-up pajamas on backwards never appealed much to me, but by the time I was ready for nighttime weaning, the buttons on my pajamas were so loose that I may have seemed to have a flashing (no pun intended) neon sign that said “no need to knock: the door is already open”.
Different space, different parent: Shifting primary parent at night to your partner, and potentially to a different room (a twin mattress floor bed in a toddler-proof room, for example) can allow for some musical beds. For a toddler who is ready, the different caregiver and different environment can make the shift through night weaning easier. A favourite sippy cup of water might help too, and expressed breastmilk in a bottle may help bridge the change.
Shorten the meal: Keeping the nursing time to shorter and shorter intervals can still give toddlers the comfort they seek from the breast, while reducing how long they are on, and giving them the opportunity to adjust to coming off the breast before falling asleep. Your toddler will let you know loud and clear if they are ready for this! Adjust the interval if it’s not working as well as you hoped.
Shorten the hours: Choosing a window of time when the diner is closed can work well for some kiddos. Some parents have “closed” one breast, and have found that the lower flow of the other breast has led rather smoothly to less interest in nursing.
Use language to bolster your plan! Sometimes as parents we forget that our words, and tone of voice matter. In addition to reading picture books about night weaning, and explaining what to expect (in clear, simple words), having a short phrase to say at night as you unlatch or as you turn down a request for nursing, can have a profound effect. Not only is your voice one of the nurturing nighttime tools you have, but the combination of your simple, and soft words, with your actions can help move the process of night weaning forward.
If it’s not working, it’s ok to pause, and re-evaluate. Sometimes timing is everything. I know how challenging it is to set your mind on something, and then have half a dozen other factors completely knock over your carefully laid plans: two year molars, a move to a new room at daycare, family vacation, and illness, can all make your dream of a night without nursing seem impossibly difficult to achieve. Pause, re-evaluate, and try again. No parent should feel they need to continue night nursing when they feel “done”, but it is ok if it is a jerky walk to the finish line: be gentle with yourself through the ups and down, and look at the trajectory over time.
As with all stages of childhood and motherhood, weaning is a natural and expected part of the mother/child relationship. As babies become older there is a shift more towards balancing the needs and intentions of both mama and babe. It is ok to move towards night weaning when you are ready. And like so many other aspects of mothering, it is a dance: with some back and forth, a shift in who is “leading”, and the occasional toe might get stepped on! You are both on the dance floor together, but sometimes mama gets to pick the next song.
Picture Books on Weaning/Night-Weaning
Havener, K. (2013). Nursies When the Sun Shines: A little book on night weaning.
Susan, M. & Low, H. (illustrator) (2018). A Time to Wean.
Saleem, J. (2014). Milkies in the Morning: A gentle night weaning storybook.
Parent Books on Night-Weaning
Wessinger, D. et al. (2014). Sweet Sleep: Nighttime and nap time strategies for breastfeeding families.
Bonyata, K, Flora, B., & Yount, P. Night Weaning, www.kellymom.com.
Sears, W. & Sears, M. Night Weaning: 12 Alternatives to the All Night Toddler Nurser. www.askdrsears.com.
Peer Reviewed Articles
Cunniff, A., & Spatz, D. (2017). Mothersʼ Weaning Practices when Infants Breastfeed for More Than One Year. MCN, The American Journal of Maternal/Child Nursing, 42(2), 88–94. doi:10.1097/nmc.0000000000000310 Accessed online June 13, 2019.
World Health Organization (2015).
My favourite Canadian developmental psychologist, Gordon Neufeld, outlined six stages of attachment to explain the development of attachment in children. I have found these stages helpful as a mom in knowing what emotional and attachment needs my boys could be expected to have, and how that can shape my parenting. Knowing the stages has allowed me to anticipate their needs better over the years, and has helped me understand their behaviour better too, something that any parent of a toddler will tell you is a bit of a miracle!
The stages that Gordon Neufeld describes are:
Belonging or Loyalty
As I watched my first two boys move from stage to stage, almost exactly as Neufeld described, I was awestruck with the idea that something as seemingly “soft” as attachment could be so predictable. I was also well aware that the attachment I was seeing emerge from them would form the basis of every healthy relationship they have in their lives. My third kiddo, somewhat obscured by the busy-ness of life with three boys, has benefited greatly from my understanding of the natural progression of attachment, while at the same time I have paid far less attention to the details. Despite my lack of attention, the stages of attachment have marched on anyway. I can say, though, that anticipating each stage, and reveling in this natural emergence of attachment, is really rewarding.
Here, I outline the first three of Neufeld’s six stages of attachment and describe what each stage may look like, and how parents can respond to the needs of their child at each stage.
In general, the six stages of attachment correspond to age in years. Developmental and neurological challenges, trauma, illness, and separation can all have an impact on the timing of these stages —and when this is the case, understanding these stages can be helpful for establishing attachment on a child’s own timeline. It is useful to appreciate that the stages of attachment are worth working through gradually, at a child’s pace, and with the intent to ensure the needs at each stage are fully met. It is also helpful to appreciate that we can be grown adults and still have needs that correspond to earlier stages of attachment, particularly if we have had negative relationships early on in our lives, or have experienced trauma and adverse childhood events. Babies don’t entirely abandon earlier needs (e.g. the need to be close), However, Neufeld feels that the better a child’s attachment needs are met, the more easily they will be able to move to the next stage of attachment. It is never too late.
It is also helpful to understand that attachment is “in the present moment”. Attachment can be temporarily ‘broken’ if we are distracted, angry, or disconnected, or if our children are frustrated, overwhelmed, or angry. And attachment that has fallen apart earlier in the day can be re-established through connection, empathy, and attention. By focusing on re-establishing our connection with our children “in the moment”, we can re-establish the bonds of attachment. In practical terms, this means bedtime can be wonderful one evening and then feel like it is falling apart at the seams on another: look at ways to reconnect at your child’s level, if things feel disconnected. It also means that bedtime can be a wonderful time of day to repair attachment: focus on slowing down, listening, paying attention, and reconnecting during the bedtime routine to finish the day with strong, secure attachment.
STAGES OF ATTACHMENT
Proximity (1 year old)
What it is:
The need to be close, to touch you, to be touched by you, to be nearby, to see you, to hear you, to smell you.
What it looks like:
Babies will curl into you, reach out to you, cry when separated from you, be soothed by skin on skin contact with you, and have an easier time regulating with touch, breastfeeding, being held, or being carried.
How parents can meet this need:
Expecting babies to need to be close to you can help set reasonable expectations in the first year and beyond. Ways to meet this need for proximity include babywearing, roomsharing, holding, rocking, breastfeeding, bedsharing, and orienting yourself to hold baby for bottle feeding in ways that mirror breastfeeding (skin on skin, frequent cradling, considering having one primary ‘feeding person’ for bottle feeds) can all meet this need. Hugs, and squeezes, horseplay and cuddling are all very physical ways to meet this need. Using your soothing voice, your eye contact, or even remaining visible are all ways that help babies relax through your proximity.
As babies become more mobile, they will begin to move away from you but will circle back to you for proximity in order to get reassurance, particularly when unsure in a new situation. As they get older, this ‘circling back to you become visual: they will turn to check that you are still there.
By ensuring the need for proximity is met, we are reassuring our babies that we love them and are taking care of them.
2. Sameness (age 2)
What it is:
Two year olds tend to want to be like the people they love.
What it looks like:
Your child will mimic or imitate the behaviours, actions, and words of you and other very key caregivers (usually one or two key adults). Two year olds love to imitate household activities, facial expressions, gestures, and mannerisms. Children will often show an intense need for sameness of one caregiver over another at certain points in time. This may be difficult for the other parent or caregiver who can feel rejected and not understand why: the intensity of attachment is so great that it is often directed really strongly to one parent. This changes over time, and requires patience and understanding that it is typical.
What parents can do to support this stage:
Take pleasure in this imitation. Be playful with it. Model calm self-regulation, and share in these imitated activities as much as you are comfortable with. Enjoy this shared behaviour, and know that this imitation indicates a strong attachment to you. Encourage your two year old to help you around the house: wiping windows, folding cloths, using utensils, putting toys away. Imitation is a powerful indicator of attachment, but it is also nature’s way of setting the stage for behaviours that we come to expect our children to have. Know that if you are a loving parent who is not the object of this imitation, your presence, consistency, and love will lead to this happening: it is worth the wait!
At bedtime, create some ‘sameness’ with same physical belongings like pillow cases or even two stuffies that are the same (one for you and one for your two year old!) if you sleep apart. Same pajamas can also be a fun way to build on this stage.
The same routine, and reveling in that routine, can be a powerful way of providing security and predictability for your two year old. The same book, the same chair, and the same tuck in routine each night lets your child know what to expect.
3. Belonging/Loyalty (age 3)
What it is:
A strong sense of acceptance as a family unit to you and one or two other key caregivers.
A sense of you ‘belonging’ to your child. This can feel like ‘ownership’ or possessiveness, but is based on a strong sense of unconditional belonging.
What it looks like:
This stage can be clear to see when our children start using the phrase “my _____”. “My mommy”, “my cup”, “my toy”, and “my baby” are frequent at this age. Often, this age coincides with the birth of a baby which can make children feel even more possessive of parents and cherished things. Eventually, this sense of belonging extends to the new baby too, though this takes patience and time to get there!
How can parents support this stage:
At bedtime, belonging and a sense of loyalty can be supported through continued bedtime rituals that strengthen your child’s sense of safety and unconditional love.
Urie Bronfenbrenner, father of attachment, has said that every child should have at least one adult who is crazy about them. Enstilling a sense of unconditional belonging supports this stage of attachment.
Leaning into the need for your presence and for feeling the need to belong allows a child to relax in the reassurance that you and they are a family unit. It may also help them feel, over time, less concerned about how a new sibling can threaten this feeling of belonging.
This is a great age to consider shifting children to their own bed or own bedroom. Pulling the space together for them and focusing on phrases like “your room” and “your bed” can be helpful. Follow through by respecting that space and protecting their space from siblings in order to maintain this space as something that belongs to them.
Consider these stages ‘signposts’ of attachment development, rather than as set-in-stone measures of attachment. Use them to guide your parenting, to anticipate your child’s needs, and to take pleasure in the ever changing emotional landscape of childhood! It can be quite a ride.
Next month I will add stages 3 to 6. If you don’t want to wait, you can view my 5-8 minute videos describing each stage of attachment via my facebook page. Stage #3 is a stand alone stage pinned at the top of my facebook page, but the rest of the videos are all in a folder together (securely attached!).
If you want to understand more about how to use the Stages of Attachment to strengthen your child’s sleep routine, or want to explore other shifts in parenting and the environment that can support infant sleep development, I welcome you to connect with me via email or phone.
If you want to read or learn more about Gordon Neufeld’s approach to attachment and child development, I recommend his book, Hold Onto Your Kids (co-authored by Gabor Mate). I also highly recommend the online courses offered through the Neufeld Institute, most especially Making Sense of Preschoolers.
After sleep, and perhaps after discipline, potty training is next in line as one of the likely questions you’ve had (or will have!) about raising your wee ones. Aside from it being a rite of passage for our kiddos, moving beyond diapers is also a big leap for us as parents. When our children stop using diapers and start regularly using the toilet:
We cut down on purchases and on garbage (extra garbage tags, anyone?);
We spend less time dressing and undressing, wiping, and washing the kids.
We have more freedom on outings, even if initially we are simply trading diapers for a portable potty seat.
And we can relish in a significant milestone that shows us our little ones, regardless of how many other ways they need our support, are developing and growing up.
Getting to that point of diaper free, however, is not like stepping through a single doorway. Just like with infant sleep, it is a developmental skill that is complex and cannot be rushed without consequences. Below are strategies for approaching toilet learning with kiddos. And, as with all things parenting, we can begin setting the path right from birth.
“R.E.S.P.E.C.T.”. Awareness of and respect for one’s own body (and all its bodily functions!) starts with how others treat us. Telling your little one what you are doing as you do a diaper change is a simple and yet helpful way of reminding us (and teaching our children) that we respect them.
Pay attention to patterns. Whether you approach peeing and pooing from the perspective of Elimination Communication, or whether you have a toddler with longer periods of time between wet diapers, or an approaching enrolment date for kindergarten, being aware of body language, timing, and triggers (how many pee-infused baths have your kiddos had?!) is helpful.
Each in their own time. Although there are general trends on when children are able to use the toilet regularly for peeing, the age at which children are ready varies so widely that these age ranges are usually not helpful. With the exception of identifying medical, neurodevelopmental, and emotional barriers to toilet learning, the age when most kids are toilet trained may not be helpful in appreciating when your child is ready. Paying attention to signs of readiness, instead of age, can be helpful for taking the pressure off and for respecting your own child’s development.
Model the outcome you want. Kids who see how the toilet is used are more likely to imitate its use, even at the age of one. Consider pointing out why you are using the toilet, and perhaps even invite your toddler to flush! But be prepared that modeling your behaviour might transfer over to putting other things in the toilet —a plumber once told me that in one troubled toilet he found an entire mini collection of playskool people. Pens are surprisingly effective at causing all sorts of back ups (this from personal experience —oh what chaos one little pen can cause). And no one wants their toothbrush to make its way into the bowl. Take it in stride. And keep a plunger nearby!
Offer it and they will pee. Eventually. Having available a potty or an accessible toilet seat (including this one that is built right into the adult seat) along with an appropriate step stool can encourage children to spontaneously try toileting. Getting a potty long before your child is ready results in it being as natural a part of the bathroom as the toilet itself. For kids who don’t like dramatic change, this may be helpful.
Pomp and Circumstance. For kiddos who love to have their milestones celebrated in style, novelty toilets with their favourite characters on it may help. But more importantly, the positive and genuinely pleased approach you take towards their learning may make a longer term impact (and transfers over into all sorts of achievements and milestones without the need to surround yourself with Paw Patrol paraphernalia). Being interested and excited—without been too interested and excited—may take some trial and error. Knowing your child’s temperament, and what works for them in terms of your reaction to other achievements, can help guide you.
Go with the Flow. Whether your child goes diaper-free or bottomless for three intense days in the winter, or for two months in the summer, there will likely be wet clothes and pee on the floor at some point. Cleaning it up without chastising, and (if you can muster it without it seeming like you are punishing them) recruiting their help in a calm way is important for avoiding shame and embarrassment about a tricky developmental skill that will inevitably have its ups and downs.
Know when to hold’em… know when to walk away. If things are not going so smoothly, it is often a sign that they are not ready. Put the goal of potty training aside for a while, and return to it when there are other cues. If, however, you feel like there is more going on, pursue it with your doctor. Urinary tract infections can sometimes be symptom free and yet will cause all sorts of upsets to the progression of potty training.
Natural Opportunities and Oops’s: At one point in the gradual transition to full toileting with my first born, I found myself at a park ten minutes from home when he had to go pee —and we had not brought a diaper with us. This was the first time in the toilet-learning process that he’d been away from home for toileting and he wasn’t so gung ho about the idea of peeing in the public washroom. I offered a choice: he could either pee in the public toilet or we go home right away for him to pee there and remain at home. Although not initially happy with this choice (it was a beautiful day at the park, but boy oh boy the toilet at home was familiar) he weighed his options and chose to give the public toilet a try. It worked! We got to stay another hour, and he overcame the milestone of using a washroom other than our own. The next week, however, at the same park, we ended up with a surprise wet pair of pants. Sometimes natural opportunities (or genuine forced choices) help us make progress. But it’s not always linear.
Dry Nights. If dry diapers at night seem like a distant dream, and you feel like it ought to have happened already, consider constipation. If children are backed up (even if they are pooping every day), it can cause night wetting. If you feel this may be a factor, an x-ray can confirm it, and strategies can be put in place to get things flowing better. Once the bowels are emptying easily and fully, there is less pressure on the bladder and ureter, and more ‘room’ for developmentally-appropriate night dryness. Resolving constipation will also set the stage for smooth transition to toileting for bowel movements too.
When Hurdles Get In the Way
There are a number of situations that delay toileting or that prevent independent toileting. Mobility issues, neurodevelopmental and social-emotional challenges, frequent UTIs, and cognitive delays can impact a child’s ability to progress towards independent toileting. Whether these hurdles are resolved over time (e.g. cognitive development or resolving UTIs) or whether these hurdles remain, respecting a child’s developmental, emotional, and physical abilities is crucial. By appreciating what the challenge is, we as parents may work towards remaining calm about the goal, the timeline, and the barriers.
This patience and acceptance includes when the child is ready and willing emotionally and yet is unable to achieve this milestone, and vice versa —when the child appears physically able but is not emotionally ready.
Signs Your Child May Be Ready for More Progress to Toileting:
Their diaper remains dry for a greater length of time;
They pause activity and take a pee posture (or expresses to you verbally that they are peeing in their diaper) that lets you know they are peeing willfully;
They show an interest in the toilet, especially if it involves imitating you. (However, imitating can happen long before a child is ready physically.) Encourage this imitation, even if it doesn’t ‘yield results’. Toilet habits are a nice thing to develop, if led by your child, even before toilet use is consistent.
Should I Use Rewards to Encourage Toileting?
I generally take an “Alfie Kohn” approach to rewards (see his book Unconditional Parenting for his perspective on rewards and punishment): rewards usually coerce compliance rather than support the development of a skill. Although a well-timed encouraging gesture can tip “almost ready kids” solidly into the “totally potty-trained” category, rewards tend to assume that all the pieces are in place for success, and that all the child needs is a sticker or toy or chocolate to achieve the milestone. This is not usually the case. Kids are built to want to develop new skills. If they are resistant to developing a new skill then perhaps (a) they are not ready yet and a reward will frustrate, rather than motivate, or (b) they are relying a lot on this skill being your priority rather than a priority that comes from within. Occasionally, a reward to sweeten the deal can be helpful in cases where there is a lot of fear —the extra motivation to overcome that fear might help. But in my view, we ought to use rewards sparingly.
All in Good Time
Generally, as with most developmental skills, if we as parents provide the environment (nurturing, supportive, with opportunities for development, and access to the right tools -e.g. a potty!) children will develop new skills when they are developmentally ready, including toileting. If the timing is right, this happens smoothly, albeit gradually and with set backs along the way. And although there may be pressure to speed things up and rush the process, we can remind ourselves that, just as with learning to walk, most kids will get where they need to go when they are ready.
Alfie Kohn, Unconditional Parenting
Built-In Potty Seat, amazon.ca
I recently took some time to reflect on what my priorities are in supporting parents with infants and young children. I wanted to hone in on what message I am really trying to share with families, regardless of whether we connect about infant sleep, development, or parenting. Whether family life is going along tickity-boo, or whether things feel like they are falling apart at the seams, these thoughts are ones I turn to to help me have perspective, and to have trust in the process.
This work is important to me. And I’m honoured to get to come along with you on your parenting journey as your OT when you reach out to me for support.
Holiday Gift Giving : Re-thinking, Re-prioritizing, and Re-gifting
When we think of Christmas time we think of an abundance of joy, toys, wrapping paper scattered happily everywhere, and excited squeals of delight.
The reality may be quite different: overcharged credit cards, disappointed gift receivers who didn't get the latest toy, an overwhelming and cluttered play space, and toys that go untouched after the initial excitement is over.
It may be worthwhile, before preparations for the holidays go into full swing, to reflect on your priorities and your vision of what gift giving could be like in your family. It is an especially good time to give this some thought if you are expecting a birth in the coming months, or if your children are very young. Setting your family's intentions around gifts and toys early is easier, and can set the stage for many years to come.
If the idea of abundance and meaningful toys without the clutter is appealing, enjoy the links below this article about how to make the shift to more meaningful and minimalist gift giving in your home. And if you would like exploring this idea more, send me an email ....I’d be pleased to organize a workshop to explore ideas around gift-giving in the new year (when you have lots of time to think about things for next year!). Simplicity is a central value of mine and one that can shift our thinking from how to buy the ‘right’ toy to:
How to choose developmentally appropriate toys that last;
How to enjoy the abundance of gift-giving while moving towards minimalism;
The love language of gift giving and why it can be a wonderful thing and a challenge;
Gift giving traditions based on simplicity.
Resources for Giving in Meaningful Ways:
Infant Mental Health: A primary goal of attachment-based parenting
Early in my career as an occupational therapist, I had the privilege of participating in York University's inaugural Infant Mental Health certificate program. The focus was on understanding the environmental and biological basis for infant mental health.
Since that time I have studied the science of attachment theory and ecology, and learned the impact of our parenting approaches on infant mental health. What has struck me most across all of this learning was appreciating the impact that our environment can have on the developmental well-being of infants and young children. Our children’s environments are largely created but us in the early years, and we have a significant influence on how nurturing their environments are.
Nurturing, stable, safe, and loving environments can have a positive influence on children, including those with a history of trauma. Although we cannot change the past, what we do today to shift towards more nurturing environments can support infant mental health.
The passion I have for connected parenting in the early years and beyond is reflected heavily in my approach to supporting infant sleep. Sleep deprivation can make even the most patient parent short-tempered and less compassionate. Sleep-deficient infants are more easily upset, more 'wired', and often more difficult to get to sleep. And yet, at the heart of it, infants need proximity to a loving adult who has the capacity to parent in a nurturing way. It is helpful to listen to our instincts about how to support their biological and emotional needs, and to seek support (from family, from friends, from skilled mental health care professionals) to do that.
My approach to infant sleep is to inform, to guide decisions, and to change the environment and expectations in order to progress towards sleep practices that support everyone's sleep needs. For families who have additional challenges, including mental health issues, and trauma history, I connect families with local health care professionals who can continue to support families in ways that respect the family's needs and goals.
Understanding the huge impact that we, as parents, have on our children’s well being is not intended to add a burden. Rather, it can help make decisions easier: we can choose to meet the need. We can choose to connect. We can choose to be present with our children. And we can choose to take care of ourselves and to get support when we feel overwhelmed.
Attachment based parenting improves infant mental health.
Our environment impacts our health.
Decisions are easier when we know why attachment is important.
Self-care is critical: fill your own cup so you can fill theirs too.
I am not a mental health professional. But there are talented and compassionate people in our community who are. If you are concerned about mental health and about your capacity to support a nurturing relationship with your child, reach out and seek support.
In Niagara, local supports for infant and family mental health include:
Pathstone Mental Health Services, pathstonementalhealth.ca
Emily Pollak, Social Worker, individual and family counselling, St. Catharines, emilypollak.ca
Niagara Infant Mental Health website (Early Childhood Community Development Centre), http://www.eccdc.org/infant-mental-health/
Within and beyond Niagara, supports include:
911 for medical emergencies
411 for information about local mental health services in some jurisdictions
Your family physician
Local initiatives to support infant and child mental health
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.
Sadler (1994). Sleep: what is normal at six months?. Prof Care Mother Child. 4 (6): 166-7.