Getting quality sleep is crucial for toddlers and children. It directly impacts their resiliency, attention span, cognitive abilities and relationships. In this webinar, we have invited child sleep expert Gemma to discuss early childhood sleeping issues and share solutions with you.
- How sleep issues feed into educational challenges, mental illness and cause other medical issues
- The core sleeping issues faced by different age ranges
- Strategies for parents to address different sleep problems
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Transcript of webinar: How to deal with kids' sleeping problems?
Bizibuz: Okay. I don't want to keep the people that have joined waiting and we've got a lot of materials to cover, so why don't we kick things off? Welcome to the webinar on child sleep issues. Thank you for joining us today. I'm a Hong Kong parent of two children, so I'm interested in today's session myself. Unfortunately, children’s sleeping habits can cause a lot of frustration for bubs right through to primary aged kids and have repercussions on mood, attention span and educational engagement. And then of course, there's the impact on the rest of the household. Let’s face it, when we’ve not had enough sleep, we all become total two year olds. We're now kicking off the new school year, so we wanted to ensure everyone's kids get off to the brightest start possible, whether at playgroups or primary. And we hope you find this webinar of great help. I'm also the founder of Bizibuz, which is an after school platform for parents. We use technology to help parents make more optimal activity selections, and then we automate the management of those activities. We also love working with child experts to bring parents practical advice on how to ensure their children blossom to the fullest extent. If you are interested in joining our community, please follow the links now listed on the chat area.
I'd like to welcome Gemma Fiske, who is a certified infant and adult sleep consultant based in Hong Kong. Gemma speaks from both professional and personal experience, given her eldest daughter suffered sleep issues as a baby and she has helped hundreds of families enjoy a much better night's rest. She works as a freelancer and also has a dedicated role helping parents that come to her through Joint Dynamics, which is a clinic that addresses a broad range of wellness issues from joint problems to nutrition, psychology and sleep. Just one more housekeeping item before we start. If you're interested to ask Gemma questions, please go to the icon that looks like a triangle, square and circle in the lower right hand side of your screen. We’ve disabled the chat function so you won't be able to use normal messaging. But you can definitely go to this area and you can type Gemma questions and at the end of the webinar we’ll be opening up the session to take these questions. With that, Gemma, let's start by having you walk us through your own background and experience and the sort of sleeping issues you've encountered in the children of Hong Kong.
Gemma: I'm just going to open up my presentation so you can see. You’ve got to tell me if you can see my screen. It's coming through now. Brilliant. Thank you for inviting me on. And so, as Cristy explained, my name is Gemma. I'm an infant and an adult sleep coach. I'm based in Hong Kong. I also specialise in insomnia and cognitive behavioural therapy for insomnia in adults. I've been lucky to work with a lot of families in Hong Kong with babies from newborn to six years so I'm able to offer these sleep services, and beyond that and into adulthood too. So a little bit of what we're going to talk about today. We're going to discuss the importance of sleep and why we sleep, to function day to day, how much sleep our children need, and the impact of not meeting their sleep needs, identifying sleep disorders, and which ones you can prevent because there are a few that can actually be prevented, then sleep hygiene and sleep associations. Then we've got a bit of a slide on should you sleep train and I'd love to hear some views on that if anyone's open to sharing. And then like Cristy said, we'll have a Q&A at the end.
So I'm a mother as well, and I have Lila, who is now four, and Ivy, who is one. And my four year old was the drive to start this business. I used to breastfeed Lila to sleep, and which meant that she would never complete more than a sleep cycle of 45 minutes before calling me back in to feed her back to sleep again. So you can imagine after a few nights of this, I was extremely broken, like a lot of mothers, and actually didn't really feel like I was offering my best self to my child.
Just because I was so sleep deprived, I looked into studying sleep. And actually going down the route of sleep training really changed my life and my view of being a mother. As a result, Ivy sleeps wonderfully. But I did things very differently from the second I brought her back from hospital. So I have a business. I'm the owner of Sleeping Beauty and the Sleep Coach, Hong Kong. But I also work with Joint Dynamics, specifically the evolved team who focus on women's health. And there's a really lovely crossover between us. I believe in sleep science. That's the way I've studied, but being a mother, I have more of an emotional side and I don't believe in any harsh sleep techniques such as crying it out for sleep training.
So why do we sleep? Sleep is vital for cognitive and emotional health. If we sleep better, we have better emotional control. For toddlers and young children, they struggle with emotional control when told no they can't have something. I'm sure everyone's experienced that at some point. And that's actually even harder for them to understand and regulate if they've not had enough sleep. You might find as an adult, if you haven't slept very well, that you feel a lot more emotional the next day, perhaps more tearful than you would usually. Or you fly off the handle at something more than you wouldn't normally if you'd slept well. So better sleep, better emotional control.
And we also need good sleep for growth hormones. Our babies do the most growth they'll ever do in their whole lives when they're between zero and four months in those newborn stages. Sleep is so important for their growth, and particularly at that point. And that's why newborns sleep so much. But they also continue a lot of growth until the age of two and after two. Of course, they continue to grow. They do get bigger. They do develop. But it just slows down a little bit. And as a result, sleep also isn't quite as needed to the same amount as an under two. It is still needed for cell division and replenishment, which plays a role in improved immunity. If you've slept for 6 hours or less, during the day after your chances of catching a cold are 300% more likely than if you had had a full night’s sleep. That’s huge. And for young kids, they're always catching things at school, sore throats and colds. So bad sleep is going to mean that there's even more germs going around.
If they've slept well and their brains have had that detox and that emotional cleanse, it means that children can become more sponge like and can absorb more information. Before going to school, when they're very little, they're learning very basic things like walking, talking and crawling. If their brains are more sponge-like then they can absorb all that information. And then a good sleep afterwards is like hitting the save button in our REM sleep, which we're going to talk about in a bit. It's when we do all of our memory consolidating and it's key for learning. That REM sleep mostly comes at the end of our sleep in the early hours of the morning. This is why having a nice long sleep is so important when it comes to our children’s learning and memory.
It's said that sleep is like a brain detox. It cleanses the build-up of unwanted chemicals. We can't always control what ends up in our bodies and our children's bodies. We can check the back of bottles and labels, and try our very hardest, but there are chemicals in our food, shampoo and sunscreen. So eventually these chemicals, unfortunately, do find our way into our body. A good sleep is a physical detox of these chemicals to prevent any build-up.
Then finally, restoration occurs to give our brains and body a good rest, which I'm sure everyone is aware. A study showed that children getting less than 10 hours of sleep per night at two and a half years old were three times more likely to have low receptive language skills. And that's regardless of daytime sleep. I think that is particularly important because to us, 10 hours does still seem like a lot of time. But to even a two and a half year old, it's just not enough. And this is regardless of what they're doing during the day in terms of sleep.
Bizibuz: Can I just ask about that comment, ‘regardless of daytime sleep’. Is that because a nap is worth less than sleeping at night for even young kids?
Gemma: Good question. It is and it’s because they get a lot more deep restorative sleep at night and that's when we're going to do a lot more memory consolidating. It's going to help more with learning and development.
Bizibuz: It's interesting, my kids went to Montessori kindergarten and we were encouraged to cut back their naps during the day and try to get them to bed much earlier, to lengthen their nightly sleeps. Have you heard that sort of thing?
Gemma: That's interesting. But I do say that we should keep a nap until at least three, three and a half because they do need that that nap still. But it's correct in a sense, because night time sleep does always take priority.
So this slide shows us a sleep cycle. I don't know how many of you have seen it, but this is what sleep cycles look like for children above four months and also for adults. They just vary in length. When we first fall asleep, we enter into stage one, which is the lightest sleep. That's sort of when you're nodding off, you can see your child's eyes just starting to close and they're slowly slipping into stage one sleep. They can be very easily awakened at this point. If you let your child perhaps fall asleep in your arms and after 5 minutes or sooner, you try to transfer them into the bed and they wake up, it's because they're still in a very light phase of sleep.
They then move through to stage two, stage three, stage four, and it gets gradually deeper and deeper. So stage four is the deepest phase of sleep, and this is when our bodies do the most growth and physical repair. The last phase in this sleep cycle is when REM sleep happens and REM stands for Rapid Eye Movement. It's when we do our dreaming and breathing becomes more rapid. You might even see the eyelids flicker during this point, and it's a really essential part of the sleep cycle.
If a child is below four months, they still have sleep cycles, but they don't look like this. They're a bit more irregular. They come in what we call sleep bursts and they vary in length. But once the child hits four months, then it turns into a sleep cycle like this, which is where the four month sleep regression comes from. I'm sure a lot of you have heard of that. A lot of people dread it and it's a very difficult time. But basically your child is is progressing and they just need to learn to connect those sleep cycles in order to sleep. When the child then becomes closer to three, the sleep cycle will be around 60 minutes in length, and then at five years it will go to 90 minutes in length and it will remain that length all the way through to adulthood.
If you have a baby and they sleep for 30 minutes or less, then it's likely that they are struggling to transition from deep sleep into REM sleep. It's very frustrating but common for these little catnaps to finish at 30 minutes and that can be caused from over-tiredness. If the child has gone to bed and they are overtired or there's been a little bit too much awake time between naps or waking up in the first nap, then we're going to see a short 30 minute catnap as opposed to a nice long 45 minute sleep cycle or longer.
This is a table of sleep needs going from 0 to 6 years and I'll be giving some information for children above six years. If any of these ages are relevant to your child, take a note and write them down. I've worked with this graph for four years and I have to say it's applicable to almost every child I've worked with, and a lot of parents are quite surprised at how much sleep the child needs. Once they are achieving these amounts, they quickly realize that it is the best amount at that age. And you can see how needs slowly decrease as they get older. As we spoke about before in terms of growth and development, that would be why. You can see that at the top here. This is how much night time sleep they should be getting and in the yellow is how much daytime sleep they should be getting. The pink along the bottom is any naps or quiet time they should be getting.
The most important bit is actually the dark blue, the wakeful window. These are particularly important for children aged three or below because that's when they're still taking their naps. If a wakeful window is extended, it basically means your child has been awake for too long and longer than their bodies can actually cope with. When they are extremely tired, their bodies become stressed. It releases the cortisol hormone into the bloodstream which then makes their brains think that they're unsafe. This means that the next nap is either really, really hard or it means that there's going to be disrupted sleep or early rising. If you're experiencing any of those things, I strongly recommend having a look at the wakeful windows and making sure that they're always kept within that time. If you have a child that's above six years up to 13 years, your child needs to be getting between 9 and 10 hours and 45 minutes of sleep at night. If they're between 13 to 17, they need to be getting between 8 and 10 hours of sleep each night.
Bizibuz: Can I ask, what are the things parents should avoid during quiet time? Very specific do's and don'ts.
Gemma: Yes a great question. A quiet time should definitely still be taken for as long as you can manage it, even in adulthood. If you can give your brain a time out as opposed to being stimulated and engaged from the second you wake up, it's very beneficial. I would recommend putting your child in their bedroom to take it, or a quiet area of the house where the lights can be down low and it's quiet, cool and comfortable. Activities could be a jigsaw, reading or even an audio book is lovely. Anything that's going to keep them quiet and nothing too engaging. I think it's quite tempting to pass the iPad or put them in front of the telly. Sometimes that is the only option when we've got very active children and I don't blame anyone for having to resort to that, but if they've got a screen in front of them, it's keeping their nervous system on high alert. Although it's giving them a physical rest, it's not actually resting their brains at all. And if you really can't get your child to sit still and the iPad really is the last resort, then consider a programme that's perhaps a little bit more relaxed. I don't know if anyone's heard of Guess How Much I love you. You can get that on YouTube. It's really sweet. That could even encourage them to sleep whilst they're watching. And keep quiet time for as long as you can.
Okay. Sleep disorders. So first up, you might have heard of most of these – sleepwalking, confusional arousal, night terrors, sleep talking and nightmare disorder. A confusional arousal is basically when a child is stuck between being sleep and being awake, and it usually happens in the first part of the night, anytime between bedtime and midnight. Usually you'll hear your child cry out and you'll possibly assume it's a night terror because it's a real screech. And when you go in to see them and check they're okay, they'll either still have their eyes closed or their eyes will be open, but glazed almost like they're looking through you. That is because they're stuck between the state of being asleep and being awake. They're so common and they're caused from overtiredness, and a lot of people just assume they're night terrors. Confusional arousals are not damaging and are not going to cause trauma. Your child won't even remember them the next day. But it's just a bit of an alert for us as parents to think, okay, we might need to shorten wakeful time tomorrow or try to get to bed a little bit earlier, or try and get a nap in.
The key as to whether your child's experiencing night terrors or confusional arousal is what time of night they're waking up. If it’s before midnight, that's when it's more likely to be a confusional arousal than a night terror. If it's after midnight, then that's more likely to be a night terror. And the reason is we do most of our dreaming in the second half of the night. A nightmare is essentially a bad dream, and a nightmare will be remembered the next day. If your child wants to talk about it, then that's great but we can’t prevent nightmares. They're really normal as long as they're not happening every single night then it’s just processing of something that's happened recently. Perhaps there's been something that happened at school or something that's upset them. Their brains are basically going to relive that and digest what's happening as a safety mechanism so that we don't then repeat the same thing again. However, confusional arousal we can prevent.
Circadian rhythm disorder. Our circadian rhythms are our internal body clocks, and they help us to establish the difference between day and night. This is particularly important if you have a really young baby. Make sure they are exposed to light only during the day and complete darkness at night, and their independent circadian rhythm will be developing at around eight weeks. So from that point, that's when you can really start putting a bit more of a structure and a routine in place for the baby. Jetlag also is a part of a circadian rhythm disorder. It's only a minor and temporary one.
Then there is delayed sleep phase disorder or advanced sleep phase disorder. This is basically taking an early bird and a night owl to the complete extremes. A person with advanced sleep phase disorder will wake up at 4:00 in the morning ready to start their day, and a person with delayed sleep phase disorder could still be wide awake at midnight and not actually feel slightly sleepy until 2 a.m. If the adult or the parent experiences advanced or sleep phase disorder, it's quite likely the child will as well.
Rhythmic Movement Disorder (RMD). This is head banging, body rocking, head rolling, body rolling. Babies often shake their heads as a form of movement to get to sleep, which is why they end up with that little bald patch on the back of their heads. You might have noticed they're very cute and it's normal. The only time that I would suggest to get it investigated is if your child is five years or older and they're still doing it, but below that age, it’s really common. A lot of my clients have children that need some form of movement that they just do themselves to send them off to sleep.
Obstructive sleep apnea (OSA). This is when the tonsils or adenoids are too big. The symptoms include sweating, snoring, restlessness and sitting up a lot. There's a few different types of sleep apnea. Obstructive one is the one that is most common in children. If they've got it, the snoring will be really quite loud and it will also be worse when they're lying on their backs. Sometimes it sorts itself out. Sometimes as the child gets bigger and their heads and their necks form, then the tonsils and adenoids aren't too big anymore. But if they're past four or five and it's still an issue, or if you're noticing excessive sleepiness the next day, then I definitely recommend going to see an EMT specialist. It's very frustrating for the child who's just desperate to sleep and constantly being woken up during the night gasping for breath.
Bizibuz: Gemma, you said RMD and OSA may occur at a certain stage and be totally normal and then a child can overcome them on their own. How should a parent gauge if these are issues that won’t resolve themselves and they should go and seek expert help?
Gemma: If your child's having repeated nightmares at any age, that is consecutive nightmares or that are happening more than a couple of times a week, then that's when I recommend reaching out. And if your child hits adolescence and they're still sleepwalking or sleep talking, then again, I would suggest looking for some additional help. If you think they're suffering from advanced or delayed sleep phase disorder, and it's not just waking at 5:00 or 6:00 in the morning, then I would seek help. Then for RMD and OSA, if they occur at any point after 5 years of age, you could seek help because it can cause excessive sleepiness during the day. If it seems minor and it just sounds like snoring very loudly, then I would wait until around four because that's usually when it sorts itself out. If it hasn't, then go and get another opinion.
Sleep hygiene. A lot of this also applies to adults so please take note. Ideally, we want room temperature to be between 18 and 22 degrees. Kids should be dressed in long sleeved pyjamas with a sleep sack of 1 to 2 tog. The general rule when it comes to the temperature of the room is a cool environment, warm body. We're very lucky to have air conditioning here, and it helps them to be snug. If you are unsure if your baby is too hot or too cold, never go by the hands or the feet. You always want to check the back of the neck and if that feels sweaty or not. For sleep safety, you want to be placing your baby on his back and with feet at the end of the cot. No blankets or toys should be present in the cot to prevent SIDS.
You want to keep your child in a cot until they're at least two and a half years old. That's because the child doesn't have the cognitive ability to understand the concept of staying in bed until they're at least two and a half or three years old. If you make that transition a little bit too early, you might end up with a child that just gets out of bed repeatedly. And of course, when they get out of bed, they're going to come and find mommy and daddy which means you'll get a visitor many times during the night. So keep them in a cot for as long as you possibly can and keep the room cave dark. Look at getting blackout blinds, even black paper stuck to the windows with tape and invest in a Gro Blind for travelling. I've used mine so much although maybe not in the last few years because there's been lack of travel. But when we were traveling, I brought it with me everywhere.
Sleep associations and co-sleeping. A sleep association is when a child learns to associate falling asleep with a comfort item, a parent or an activity. This could be being rocked, being cuddled, being fed to sleep, patted to sleep, bounced to sleep, sung to sleep. All the things the child needs in order to fall asleep or fall back to sleep. We have negative and positive associations. A negative sleep association is being rocked to sleep or fed to sleep because that's something that an adult needs to be present for. But a positive sleep association could be the pacifier or dummy if your child can replace it themselves, or an association with the white noise machine or a soft toy because that's something you can give to them at the beginning of the night and if they wake up during the night, they can just reach for it themselves.
A lot of parents come to me and say I co-sleep. Is that okay? And my answer is, if it's okay with you, then I think that's fine from a safety perspective. We should be aware that it's not recommended for really young babies, but co-sleeping isn't necessarily negative unless it prevents the family from sleeping or it's having a negative impact on the parental relationship.
Sleep training. A controversial topic. Some people are dead against it, some people I don't think really fully understand what it is and some people swear by it. There are so many different techniques and methods. It's not the number one go to unless a child has a sleep association, then you might want to look at a gentle sleep training technique to bring them away from needing that in order to fall asleep. However, if you just want to maximize their sleep so they could be getting better naps, then there's lots of other things we can look at, from environment to nutrition to routine and to activities that are happening throughout the day. This is why we need to look at things holistically. If you want a sleep training technique, all you need to do is type it in the internet and many hundreds of articles and books on sleep pop up. I would recommend that you choose the one that is most suited to your child, their temperament, their personality, their age, and also one that's going to suit your family. If you choose to go down the route of a harsher technique, and you can't see that through, then the child will sense that you're not comfortable and it will just it could just frighten them more. If you then cave after perhaps doing it for an hour, you've then trained your child to cry in order for you to come in to check on them. So choosing the right technique is really important and that's a key part of my role as well. Understanding the family, understanding the child, and then helping them to choose the right method. I mention here absolutely no judgment to anybody who has ever tried cry it out, because I've been sleep deprived before, and if someone said to me, this is 100% going to work, I would have done it too. But it's just not advised because there's research that's shown that a child that's left a cry for long periods of time on a frequent basis could develop attachment issues. If you've tried it once or twice, I'm sure there is no damage done but basically your child stops crying for you because they think they've been abandoned. A study that's been done shows that their stress levels, even though they've stopped crying, are still very high. Hence, it's just nice to choose a more gentle technique that involves staying with the child so that they feel happy, they feel safe and comfortable and can just drift off peacefully and without any stress.
Bizibuz: Gemma, in the interest of time, I’m just letting you know we have got a few questions.
Gemma: Thanks Cristy. Just one final comment. A note on routine and consistency. Your bedtime routine should last between 45 minutes to one hour and during that time, the most perfect order is bath, feed, book, bed. The bath at the beginning of the routine helps to relax their muscles. When they come out of the bath, it helps their body temperatures to drop and we need this in order to initiate sleep. Then putting the book between feed and bed breaks any form of feed to sleep association. If these steps could all be done in their sleep space, in dim light lighting, in quiet voices without other parents wandering in and out, then that's perfect. It's nice and relaxing for the child. No TV or iPad should be used within 90 minutes of bedtime because the blue light that's projected off the screen can mimic daylight too well. And we don't want the child to think that it's time to be awake because it's time to go to sleep.
Bizibuz: Let's jump into the questions. We've got one from Han Han. My 14 month old is always rolling or sitting upright during his sleep. Most of the time he can continue sleeping on his own. Is it normal? Rolling over, sitting upright.
Gemma: So that that could be a symptom of obstructive sleep apnea if he's feeling the need to sit up because when they're lying on their backs, that's when it's harder for them to breathe during the night. I would be asking if there's any obstructive sleep apnea in the family and also looking at his weight. Feel free to reach out independently if you want to discuss that in a little bit more depth. I can refer you to an EMT specialist if you want the name of a good one.
Bizibuz: Another question. How can I break the feed to sleep habit for breastfeeding. A 14 month old is always awake at 5 a.m. and crying for milk. I think it's a true hunger need. I tried to feed more milk before his sleep, but he refuses to drink.
Gemma: So when a child gets to 8kg, that's when you can feel confident that a night food is no longer required which is usually between seven and nine months. If it's genuine hunger, I would be looking at the diet during the day. How much is he getting during the day, making sure he's not underweight or anything? And if he could be thirsty due to air conditioning. Sometimes children that sleep with their mouth slightly open, it can mean that their throats get very dry. It could then make us think as parents, once you've given them milk and they're guzzling it, that they're hungry, but actually it could be due to thirst.
Gemma: Yes, I've just done this myself because we went to England. When it comes to jetlag, there's no magic cure. Typically, for each hour of timezone change there is a day of adjustment. So for the UK, it's a seven hour time difference and typically it would take seven days to get over it. The best way is to think that our circadian rhythms are like clocks governed by light, darkness and mealtimes. Once you're on that flight, don't stress about what time it is. Just survive the flight. You've got a 24 month old and that's going to be hard enough as it is. But once you get to the other end, change your clock to a local time and shift from the routine that you would have always done and move to local time.
They might be hungry during the night, especially at 24 months of age. If they are hungry and they're demanding food, it's okay to give them something to snack on but just make sure that it's something very bland, absolutely no sugar or anything like that. Things like crackers or something like that. And when you're feeding them, keep the lights down low so that their bodies think that it's sleep time, it's not time to be awake.
Bizibuz: Final question. Is there any particular reason why some babies, toddlers are good or bad sleepers? Is it genetic or is it because there was something wrong the parents did when the child was a newborn? I think you’re personally experienced about this because it sounds like your two daughters have quite a different sleep behaviour.
Gemma: Yes. And their personalities are completely different as well. I don't believe it's anything that a parent has done. I've met children that sleep through the night at two weeks old. I've met children that have never slept through the night at six years old. There are just some children that are a bit more sensitive. I can say this about Lila for sure. My four year old, she's quite a shy, quiet, reserved character. Whereas Ivy was a lot more independent and she can just roll over and go to sleep. I don't think it's anything that anybody does. It's just the way the child's temperament is. That's why I said choosing the right technique is just so important to suit the child.
Bizibuz: Gemma, thank you so much for all your insights on child sleep issues. We hope parents found this webinar helpful and the advice really helps to achieve more restful nights. Please remember to sign up if you'd like to receive more parenting tips or webinar invitations. Thank you so much Gemma.