infant sleep

Sleep Training Part 2: Sleeping Through the Night

Sleep Training Part 2: Sleeping Through the Night

What is consolidated sleep? At what age do babies start sleeping through the night? This article reviews one research study looking at sleep consolidation and includes suggestions for seeking support if consolidated sleep is a struggle for your little one.

Sleep Training: Misinformation, Misunderstanding, and Missed Opportunities

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?”.

Bridge to the Next Connection

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Bridging to the next connection is an attachment-based strategy for separating from a child in a way that reduces anxiety and resistance, and respects a child’s developmental and emotional ability to separate. The concept of bridging to the next connection was developed by Dr. Gordon Neufeld, Developmental Psychologist from British Columbia who co-authored the book “Hold Onto Your Kids”, and whose Neufeld Institute runs courses on understanding the emotional and attachment needs of children. Bridging is a strategy for separation that I have used as a parent, and have recommended at my workshops and private consults. It can be a tricky concept to get the hang of, and so I am describing it below so that parents who feel their child is ready for separation at bedtime have a developmentally-sensitive and attachment-oriented way to nudge their toddlers and preschoolers towards more independent sleep.

Bridging is a strategy that can pave the way for all sorts of separation situations including the separation to school, for a sleepover at grandma’s house, time with a co-parent, and even getting yourself out the door for much needed solo time. I’ll focus here specifically on using bridging as a strategy for solitary sleep in toddlers and older children but have included two children’s books in the resource list that address a broader idea of separation. Despite its usefulness in a number of scenarios, bridging is a particularly useful strategy for parents who are working towards leaving their child’s sleep space while their child is still awake, with the expectation that the child will stay in the bedroom and fall asleep on their own.

The premise of bridging to the next connection is that by focusing on being with, rather than leaving, you help your child relax because they trust you will return. The focus is on reconnecting, not on leaving. Children are more likely to fall asleep alone when they can relax in the knowledge that you will return before they need you. They will, in effect, not be chasing your attachment literally right out of the room when you get up to leave.

Although the concept works well in practice, it is somewhat difficult to explain and does require hitting a bit of a sweet spot in the yin and yang of meeting a child’s nighttime needs. So here are some ways to approach bridging, and ideas on how to implement it with your three year old or older child.

To pull off this bit of bedtime magic effectively, be in a place of surrendering to the present: you are in your child’s room, so bring your brain and future self back upstairs and be there with your child! I know this is easier said than done, but when your thoughts are on dishes or the email you need to return, or the thirty minutes you will relish when you finally can kick up your feet and watch TV, your child will know you are not fully in the room with them…And they may not relax enough to fall asleep.

When you are in the room at bedtime and are fully present and focused on being there, do not check your phone, or check the time. Fully suspend the thought around how soon you can leave! After finishing off any bedtime routine in ways that bring joy and calm to both of you, it is now time for you to leave. But the focus is on coming back. Yes. Just when you are feeling so close to escaping from the room after a very touched-out day, focus instead on when you will return. Tell your child you are going to step out of the room for one minute, and describe to your child what you will say when you come BACK (“I’ll come in to tell you I love you”) or what you will do (I'll tuck you in again, I’ll cuddle with you till you fall asleep). Tell them to listen for you to come back and that when you do you will be so glad to get one more hug before they fall asleep.....Then leave for as short as you need to (10 seconds? A minute? Five minutes if they -and you- are good at this) without her calling out for you. Return before she worries you aren't there. Then build from there.

What will you do while you’re gone? Go pee. Wash one dish. Tidy the bathroom counter. It’s likely worthwhile staying away from email (we know how time magically disappears when that happens!). Do anything that is short, is verifiable (they hear you), and is easy to end early (a good long pee aside). Then return before they call out! Return early as a way of shoring up their trust in you, and as reinforcing your promise to return. They may not be sure you will return initially, especially if bedtime separations have been rough in the past or they have never fallen asleep on their own. But build slowly (step into the hall to blow your nose every night if that will help) and over time you can grow their trust and help them relax in the knowledge you are coming back.

How does this actually look in practice? When our son was three and our second born was still an infant, we were desperate for a bit of separation from the bedtime routine of staying in his bed until he drifted off. I would like to say we wanted that time to relax together, but truth be told we were thrilled by the idea of cleaning the kitchen together which, I’ll point out, was actually a wonderful way for us to work together and connect at the end of the day. I had just completed Gordon Neufeld’s Making Sense of Preschoolers online course and the idea of bridging to the next connection made so much sense in terms of his development (separation anxiety was high!) and his needs (he had a great deal of difficulty falling asleep without us there).

We went through the regular routine and then I, not without trepidation, said “I’m popping out of the room for a glass of water. I’ll be right back”. And then I left. It was short, and I returned before he called out.

When I returned, I stayed with him as usual until he fell asleep. The next time, I left twice, and attempted to leave for more than a minute. It worked!

Until it didn’t. The third night I was over zealous perhaps, and thinking of what I could get done after I left. Or perhaps he just needed me more that night. Regardless, I was staying out of the room too long, and he was not relaxed enough to fall asleep, even coming out of the room before I got to the end of the hallway. And so, as we continued working on this separation gradually, we ebbed and flowed with the idea that some nights would be easy peasy, and on other nights his need for our presence would be high. When these higher-need nights happened, we suspended our expectations that this was a straight trajectory. Nothing in parenting seems to be, except the straight trajectory of our child following us out of their room when we want them to stay in bed!

I gradually, and with various excuses, left the room for progressively longer time. Within the first week, I was leaving the room for about 5 to 10 minutes at a time, and returning to a kiddo who was awake but calm, in bed, and happy to see me. I recall there being a joyful “you came back!” look on his face, happy that his faith in me returning was warranted. By about the fifth visit (and occasionally the eighth or ninth), he had drifted off to sleep, confident I would return as promised.

There were nights, in the coming weeks, that he called out soon after I left. There were other nights when I forgot to return, and he would call out wondering where I was. Yet more and more frequently, he would not call out at all, I would return once or twice, and be pleasantly surprised to find a peaceful sleeper with nary a peep of protest.

On the nights that he drifted off to sleep and I remembered an hour later that I hadn’t returned, I made sure to pop up and peak in on him, and to tell him in the morning how nice it was to come in and see him sleeping so soundly, and to whisper I love you. “Did you hear me in your dreams?”, I’d ask him? He never did, but I like to think that his knowing I came to check on him reaffirmed his feelings of safety and love we wanted to give him.

We have continued to use this approach for all of our kiddos, sometimes with great success, and other times not so much. When it hasn’t been working, it usually has been for one of two reasons:

  1. We were already “out of the room” before we left, and our kids knew we were not present and focused on them.

  2. Their needs were higher on a particular night (impending illness, a rough day, overtired, wound up) and we hadn’t adjusted our night time routine to accommodate that.

When it wasn’t working, we didn’t throw the idea out the window. We did our best not to become authoritarian and threaten separation (“You HAVE to stay in that room or I am not coming back!”) —that, if you didn’t notice, is about the polar opposite of what bridging is trying to do.

To this day, when the boys ask us to stay with them to fall asleep we know that for some reason they need us more that night, and we do it (mostly) with an open heart. But more nights than not we can check on them a few times after lights out and find that like candles burning themselves out, the boys quietly fall into a relaxed sleep at some point when we are not in the room; even when they are certain they are not the least bit tired and will still be awake when we come check on them.

And that, for us, is a parenting win.

References:

Tamara Strijack, Bridging the Night: Untapped Magic (online blog article)

Neufeld Institute, Making Sense of Preschoolers (online course)

Patrice Karst (author) & Geoff Stevenson (illustrator) The Invisible String (published children’s book about separating from a parent at night and during daytime, and through death of a loved one).

Audrey Penn (author) & Ruth Harper (illustrator), The Kissing Hand (published children’s book about separating from a parent to go to school)

Deborah MacNamara (2016). Rest, Play Grow: Making Sense of Preschoolers (or Anyone Who Acts Like One). Published book based on Neufeld’s Making Sense of Preschoolers Course.

Neufeld’s Six Stages of Attachment and What They Mean for Bedtime (Part I: Stages 1 to 3)

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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:

  1. Proximity

  2. Sameness

  3. Belonging or Loyalty

  4. Significance

  5. Love

  6. Being Known

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

  1. 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.

In closing:

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.

Guest Writing on Motherhood and Sleep Deprivation

I have been less active on the blog front lately, but have certainly still been writing.

You can find my most recent writing in the following places:

  • Kathleen Lockyer’s RxOutside.com, a website and Occupational Therapy practice dedicated to using access to nature as a means for improving health and wellbeing. (March 11, 2019).

  • Rachel Marie Martin’s FindingJoy.net compilation from writers and entrepreneurs on what we would tell our 20 year old self about motherhood. (February 4, 2019).

And soon, a review in Occupational Therapy Now magazine of the book “Broccoli Boot Camp”, which focuses on evidence-based strategies for solving picky eating. This book adds valuable strategies to my approach to supporting families when mealtimes are not going quite as well as they pictured.

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Book Review: Sweet Sleep -Nighttime and Naptime Strategies for the Breastfeeding Family

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La Leche League’s 2014 book, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, is a book for families of infants which focuses on attachment-oriented research evidence and strategies for understanding and addressing sleep challenges.  The intent of the book is to provide breastfeeding-friendly infant sleep knowledge, support, and problem-solving and, as I describe below, the authors have succeeded in meeting this aim.  

Writing in a calm, articulate manner, Weissinger, West, and Pitman are appealing to educated and informed parents who are at least somewhat familiar and open to attachment-based parenting approaches to sleep.  Likely the La Leche League publication naturally draws the attention of those already inclined to providing nurturing measures, in general. Although not an academic paper, the level of education required is rather high.  The book’s strengths lie in its use of evidence and research balanced with clear descriptions and case studies that highlight the key points.

It is quite a lengthy book that takes several hours to read, something that may be a challenge for all but the most motivated sleep-deprived parents.  Despite this, the depth and quality of the information and evidence provided make this my new primary recommendation to clients who are keen to read about infant sleep. Unlike other books on infant sleep, this books looks specifically through the lens of breastfeeding. However, it is still appropriate for non-breastfeeding families if shared in a sensitive way to those not currently struggling with breastfeeding or with previous decisions/necessity of weaning.  There is enough valuable information to firmly entrench this as an infant sleep book for professionals to consistently draw from when providing eager parents with detailed information or references scientific evidence.

Reading this book now, as a weaned mother of three children who now sleep well, I was so excited about the evidence they include that supports attachment-based sleep support for families.  In particular, their section on bedsharing (detailing La Leche League’s Safe Sleep Seven principles) is both evidence-based and instinct-focused: you, as a parent, must weigh the information available to you in the context of your own infant, yourself, and your family.

The references and citations are the real strength of this book.  Subtitles and indexing make it fairly easy to navigate the kindle version. The richness of the content makes it likely that families would benefit from a print version, rather than kindle version, in order to mark particular sections and to use the index more freely. I suspect most families who are so inclined will have print versions decorated liberally with sticky notes.



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Normal Sleep from 6 to 12 months

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For those concerned about their infant's short naps and night waking, a new study led by Dr. Pennestri at McGill adds to our knowledge that:
-Interrupted sleep in infancy is normal. 
-Consolidated sleep happens gradually over time. 
-Interrupted sleep is not correlated with developmental issues (contrary to some previous studies).

Pennestri’s study coincides well with a much older study (Scher, 1991) that showed an increase likelihood of regular night waking at 9 months of age: although 40% of babes were waking up regularly at 6 months of age, this increased to 60% at the 9 month mark, dropping only slightly to 55% by 12 months of age. These studies explain what many parents have experienced at this age and explains why a significant number of my clients call me by the 10 month mark, concerned and exhausted! This bump in the road might be explained by the enormous social and emotional changes that are happening at this age.

What does this mean for you and your little one? 
1. Biologically normal night waking can be approached through perspective changes, self care, and environmental adjustments to help nudge children gradually towards longer sleep periods. 
2. Listen to your instincts about whether there may be an underlying issue (colic, reflux, environmental and food sensitivities) --these can all be sleuthed out and addressed to bring sleep more in line with your child's natural sleep needs.
3. Lean in to what is normal for babies and soak this intense, amazing, draining, and exciting time in as a season of parenting that can feel tiring, but does not need to feel terrible.
4. Call for support! Even if your baby is sleeping "normally", it can be helpful to have someone support your efforts through evidence, reflection, suggestions, and guidance. Sometimes the best intervention is through understanding.

Because there are significant (and often challenging) changes to infant sleep between 6 and 12 months, expect further articles of the research on “what is normal” for this age range soon! And even though it is hard to “rest” assured, most babes are shifting towards more regular and longer sleep periods by the one year mark. Better sleep is ahead!

Resources:

The McGill study, by Dr. Pennestri et. al., is in the December 2018 issue of Pediatrics. and is reported in McGill.ca, November 2018. Parents shouldn’t worry if their infant doesn’t sleep through the night by 6-12 months of age

Scher (1991). A longitudinal study of night waking in the first year. Child: Care, Health, and Development, 17 (295-302).


Photo Source: Pixababy yc0407206360

Photo Source: Pixababy yc0407206360

Reflections on Parenting

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.

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