Q&A with a Certified Pediatric Sleep Consultant

Katie Pitts, Certified Pediatric Sleep Consultant from Sleep Wise Consulting stopped by the Nourisher Facebook page on December 12th to answer baby, toddler and child sleep questions from our Nourisher mommas. 

Read what questions they had to ask her, and how she recommended they approach sleep issues. Katie will be back on January 16th at 8 p.m. EST for a follow-up Q&A.

Starting Off in a Crib

Sheryl: Soon-to-be a first time mom and we have just set up our nursery. I will be sleeping on a bed in the nursery for the first few weeks and I'm planning on putting our son right in the crib from the first night. I know most families go with a bassinet, so I just want to double-check that it is safe to be in a crib right away! Planning on using a sleep sack as well.

Katie: Congrats! Yes - a crib is a safe way to go! You will want to make sure there is nothing else in the crib besides a fitted sheet and your precious little baby.

Getting a Dependent Toddler to Sleep on Her Own

Amanda: I have a 2.5 yr old. We have a night time routine and she generally goes to sleep okay. However she gets up in the morning between 2 and 4 several nights a week and refuses to go back to sleep. We usually end up with her in our bed or getting up for the day. Is there a way to get her to go back to sleep on her own? We went as far as to get a toddler sleep clock/light that tells them when to get up and that didn’t work.

Katie: What is your schedule? Does she take a nap?

Amanda: Well that’s her other problem. She refuses to take a nap on her own now. She used to be good about it. I have to sit in her room and get her to lay in her crib till she falls asleep. But if she sleeps it’s a good 1.5 - 2 hr nap. She wakes around 7, naps around 2, and goes to bed around 7-8.

Katie: Okay - so it sounds like your little girl is relying on you for a sleep prop! A sleep prop is anything external a toddler uses to fall asleep or stay asleep. She is doing great at bedtime (yay!) but requiring that prop for naps and middle of the night. So the goal -- you want to get yourself out of that room :) This is easier said than done - unfortunately she is now used to in there! I would recommend a very clear reward and consequence system to encourage her to sleep in her own bed. If she is up in the middle of the night, she gets one warning to go back into bed and then, if she does not follow, an immediate consequence takes place. (The consequence really varies depending on you and your parenting style/philosophy). If you need help coming up with a system and developing a plan for her, one of my consultants would be happy to speak with you about it! 

Weaning a 6 Month Old from a Sleep Prop

Kristin: I have 6 month baby who refuses to sleep at night. We are up throughout the night and all she wants to do is be held. She will feed for two minutes, fall asleep, but when I go to put her down she screams uncontrollably. I spend a lot of time just holding her. She is definitely getting enough food during the day. HELP - this working momma needs sleep!

Katie: It sounds like you are one tired momma! I have been there. I always said there was a reason sleep deprivation was used as a torture technique! The good news - there is a solution! The key here is to get your daughter to be prop free. A sleep prop is anything external a baby uses to fall asleep and stay asleep. This could be nursing, rocking, bouncing, bottle feeding, etc. When they require a prop to fall asleep, they require this same prop to put themselves back to sleep many (MANY!) times throughout the night. In order to get your daughter sleeping in longer chunks during the night, you will want to put her down in her bed relaxed but awake (after a calming bedtime routine of 20-30 minutes). Next - create a very clear plan on how you will respond to her if she has trouble falling asleep. Consistency here is absolutely crucial! 

Helping a 3 Year Old with Separation Anxiety

Carly: Our toddler will be 3 in March and has always been a wonderful sleeper, would go to bed easy and wouldn’t wake at night. This last week has been awful for him and has stared screaming and crying after we do our whole bedtime routine. I hate letting him cry to sleep, but have no idea what else to do. He also has been waking at night the last few nights. I have noticed that he’s been much more aware that bedtime means no more playtime, and he’s been extremely clingy to me more so than he normally is. Any suggestions would be so helpful! Thank you!!

Katie: What time is bedtime? Does he take a nap? If so, how long?

Carly: We usually have him in his bath by 6:15/6:30 and he’s in bed by 7/7:15. We always put him down for a nap during the day, some days he will nap for an hour to 1 1/2 hrs and other days he won’t fall asleep at all, but will look at books in his room. On the days he doesn’t nap, we will start bedtime routine a little earlier.

Katie: Do you notice any trends with days he doesn't nap and going to bedtime a little easier?

Carly: Actually on the days he doesn’t nap, he is so cranky by dinner time and has a lot more tantrums and since this has just been the last week that he’s been doing this at bedtime I haven’t noticed a difference between nap and no nap days.

Katie: Because it seems that he is going through a separation anxiety, I would try to focus on positive reinforcement as much as possible! This could be a reward chart, positive checks in his room if he's laying quietly, etc. On no nap days, have him in bed by 6 to help with any late afternoon melt downs!

Transitioning Away from a Swaddle

Shelby: I have two questions - how do I break my 4 month old of the swaddle and how do I get him to start putting himself to sleep when he's tired instead of rocking or nursing him to sleep (he doesn't nap but sleep okay at night- not great but ok.)

Katie: It sounds like your little guy is relying on a few sleep props to fall asleep. A sleep prop is anything external a baby uses to fall asleep and stay asleep. This can be rocking, nursing, bottle, bouncing, etc. When your baby requires a prop, he will need this prop replaced in the middle of the night in order to fall back asleep. At this age, it's likely the swaddle has become a prop as well. My recommendation would be to take away all props at the same time and place your baby in the crib awake so he can develop his own self-soothing strategies. You will want to have a plan that you feel comfortable with (it does not have to be cry it out!) and stick with it 100%. A calming routine before you put him down in the crib can be very helpful as well. (Please note - I'm not saying that you cannot nurse your baby at bedtime or in the middle of the night - rather use nursing for nourishment and then allow your baby to put himself to sleep). Here is a guide with some great tips to help you get started: http://sleepwiseconsulting.com/free-download/

Shelby: Thanks so much. I did cry it out with my older two, but I can't remember when i started it. My third was under 4 1/2 pounds at birth (full term) so I've been worried about cry it out with him.

Katie: If you work on teaching him healthy sleep habits, it doesn't mean you have to take away night feeds. Some babies need night feeds longer than others! You can still have a baby who is prop free, sleeps well but still needs some calories at night. Just remember - nurse for nutrition, rather than his ONLY way to put himself to sleep :)

Cutting Out Dairy to Help with Sleeping

Lauren: Our 17 month old is a pretty great sleeper, but every few weeks she'll go through a week where she cries out at night. Sometimes after two or three times she fully wakes up and takes at least an hour to go back to sleep. Is she having nightmares?

Katie: What is your schedule?

Lauren: She normally wakes up around 7:30/8 am and takes at least one hour and a half to two hour nap during the day. Then is mostly asleep by 8pm. She will sometimes with lunch but mostly drinks water. We do have a nighttime routine after a bath she gets 5 oz of cows milk. Then she goes down to sleep after that.

Katie: I would limit the cow's milk to morning and afternoon snack. There is some evidence out there that cow's milk in the bedtime routine can cause nightmares so that potentially could be what you are seeing!

Choosing the Right Swaddle

Lauren: I'm 38.5 weeks pregnant and have received many different kinds of swaddles as baby gifts. Obviously we don't know what will work for our child yet, but do you have any swaddle products you recommend or swear by?

Katie: Saying that baby products can be overwhelming is an understatement! I personally like the Halo Sleep Sack with the velcro for a swaddle but swaddling with a blanket works just as well. I've seen great things with the Love to Dream. Try a few things out and see what your little one likes and what he/she doesn't!

Dropping Nap Time for a 3 Year Old

Holt: My 2.5 year old has been a rockstar sleeper from day one. We have a consistent bedtime routine, and he goes down at a reason time every night (7 - 7:30 p.m.) He has really been fighting bedtime recently. Any thoughts about what we can do here?

Katie: Does he take a nap? If so, what time and for how long?

Holt: He typically naps for about 1.5-2.5 hours a day. Generally goes down around 12:30 p.m.

Katie: I find that many toddlers are ready to drop their nap around 2.5 to 3 years of age. This almost never shows by nap time fights - rather the struggle comes at bedtime! I would either move bedtime back to 8:00 or think about dropping nap and move bedtime to 7:00 (put him in bed at 6:00 for at least a week to help adjust to over-tiredness).

Getting Past Sleep Regression

Shannon: We are currently in 4 month sleep regression. How do we get past this? Does this also affect naps? He will not nap in his crib longer than 30 but will sleep in his pack and play in the living room for hours!! Help!!

Katie: Try nursing him first in the routine and then follow with PJs, book, and lay him into bed.

Establishing Self-Soothing for an Infant

Sarah: I have a 3 week old who wont sleep much of anywhere except my arms/chest. She currently sleeps in the bed with us, which I know is not safe. Any suggestions? We would like her to sleep in the co sleeper next to our bed. We do swaddle, but that doesn’t help much.

Katie: This can be a tough age and I share your concerns about safety - but also know the frustration when your baby won't sleep anywhere else! I would start by looking at your awake times and avoid over-tiredness. During the day, make sure your little one is not awake longer than 45 minutes. However you get her to nap - that is fine! Then, at bedtime (somewhere between 8 and 10 pm), do a small calming routine (book, wipe down, feed) and put her in bed within 45 minutes of waking from her last nap. If she fusses, leave her for a minute or so to see what she does. If she cries, pick her up until she is calm and put her back down. Continue this process until she falls asleep. It's never too early to teach self-soothing skills in a very gentle way! This guide should give you a few more tips to help: http://sleepwiseconsulting.com/free-download/ This is one of my favorite ages to work with because you can see amazing results with absolutely no crying!

Shortening a Bedtime Routine

Sa: My 3.5 year old has regressed into a very long drawn out bedtime routine. We start at around 7 and it often takes until 8-8:30 until he's asleep! He's even being held on his chair for a few mins before getting in bed. We have another baby on the way within a week or 2 and I'm worried what will happen once the baby arrives and I can't be doing the bedtime song and dance anymore. Any suggestions? Thank you!

Katie: This is a popular age for our toddlers to do some famous stall tactics. Is he still taking a nap?

Sa: Yes, naps every day anywhere between 12:30-3:15 for 2 hours

Katie: So unfortunately, at this stage of the game, it sounds like you are at the spot to either have a later bedtime or cut the nap! Your toddler likely isn't tired enough at bedtime. Most kids this age no longer need a nap and can easily go to bed around 7:00. If parents really want the nap, they typically need an 8:30 bedtime! With a baby on the way (congrats!!), this can be your call to whatever will work for your family!

Shifting Bedtime for a 4 Month Old

Jeffrey: My wife and I have a 4 month old who is doing great sleeping from 10pm-8am but would like to start having some alone time at night. How do you recommend we start to transition her to an earlier bedtime?

Katie: Great question. What time is your baby's last nap?

Jeffrey: She normally takes an hour long nap from 7-8 each evening.

Katie: So you will want to do a gentle shift with her circadian rhythm. I would recommend moving bedtime earlier by 10-15 minutes every 3-5 days. You will want to make sure she is up from her last nap at least 1.5 hours before bedtime so you might have to wake her. When she wakes in the morning, expose her to bright sunlight (or bright lights in the bathroom) as soon as you can to let her body adjust to an 8-8 schedule. If her wake up time is around 8 am, you will want to have an end goal of bedtime at 8:00 pm. Give this a try!

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