infant sleep

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.

childjournalingwriting.jpg

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

sweet sleep LLL.jpg

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.



sweet sleep LLL.jpg

Normal Sleep from 6 to 12 months

sleepingbaby pixababy yc0407206360.jpg

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.

small tote reverse.jpeg

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.