Lullaby and Goodnight (part 2)

baby sleeping

baby sleeping

If your child is experiencing difficulties sleeping, she may have a sleep disorder.In Part 1 of this article, I discussed symptoms and approaches to identifying sleep disorders in your child. Once you have identified the causes of your child’s sleep problems, you may want to implement some of the following remedies and suggestions.

Suggestions to promote good sleep hygiene.

(Most of this information is also available in the book Pediatric Disorders of Regulation in Affect and Behavior: A Therapist’s Guide to Assessment and Treatment (Practical Resources for the Mental Health Professional) by Georgia A. DeGangi)

  • Provide a comfortable sleep setting. Suggestions for room and bedding decor to assist your child’s ability to relax at bedtime.
    • Is your child is too hot or too cold?
      • Check the temperature of the room,
      • type and amount of bedding and sleep clothes to decide what combination is best for your child.
      • Remember that your child’s sense of temperature may be different than your own.
      • Recall what temperature your child seems to prefer and/or seek during the day, and consider when making decisions.
    • Is your child sensitive to touch (tactile sensitivity)?
      • Certain textures can relax or arouse your child.
      • Look at bedding and pajama textures.
      • Your child may prefer his/her feet covered or uncovered with footed pajamas, socks and or even the covers themselves.
      • How tight or loose the clothing fits, and whether or not there are elastic, seams, or clothing tags can be an issue for some children.
      • Also bedding should provide the optimum level of pressure.  Consider using a weighted blanket if your child is sensory seeking.
    • Are noises and other sounds affecting your child? At night, when trying to relax and fall asleep, the noises your child hears may be over powering and impossible for him to filter out. These noises, such as water running or an animal scratching may not affect you or other household members but can be disrupting for a child with a developmental disorder such as Autism or Sensory Processing Disorder. Sometimes a fan, air filter, TV or soft music in the child’s room can help mask other noises and provide a consistent sound that is comforting and/or soothing.
    • Is your child sensitive to light?
      • Is your child afraid of the dark?
      • Some children with autism spectrum disorders may seem to prefer dark places during the day but may need some minimum amount of light at night.
      • Streetlights, the moon, or car lights shining in the room at intermittent intervals may be affecting your child’s sleep.
      • Providing a room that is consistently light or dark may be very important, depending on your child’s needs.
      • Consider installing blackout curtains over the windows.
  • Establish a regular bedtime routine Bedtime routines and rituals are very important for most children in establishing positive sleep patterns, but are extremely critical for children who suffer sleep disorders.
    • Set Time Pick a time for bed that is reasonable for your child and which you can consistently provide.
    • Provide predictability and a comforting, familiar pattern. For further understanding and structure, a visual bedtime schedule can help. A visual schedule can provide reminders and consistency for the whole family.
    • Choose calming activities A good bedtime routine will help teach a child to calm down, relax and get ready to sleep. For example, if bathing is stimulating or frightening for your child, even though you may want him/her to bathe before bed, it may be best to bathe at a completely different time of the day. Likewise, there may be sensory integration activities that have proven to be relaxing to your child during the day that you can also use as part of the bedtime routine.
    • Routine means the same everyday and should include activities that are pleasant and relaxing as well as special and individualized to fit your child’s needs and interests. A bedtime routine should realistically consist of 4 to 6 steps that do not take more time than is reasonable to accomplish on a nightly basis.
    • Example activities to consider as part of a bedtime routine or ritual include:
      • looking at the same book or story each night,
      • saying good night to favorite objects,
      • toileting,
      • bathing,
      • getting pajamas on,
      • brushing teeth,
      • having a glass of water,
      • singing a favorite song or prayer,
      • listening to calming music that the child enjoys,
      • hugging and kissing family members
      • engaging in a calming sensory integration activity.
    • Variations are inevitable. There come times when you are not able to perform the exact routine/ritual.  You can shorten each step significantly and potentially eliminate nightlong frustrations due to the change. If your child is away from home for a night or two you may see old sleeping patterns emerge. Even in a temporary new environment, routines may help. Upon returning home the bedtime routine will continue to be effective, though the excitement from the change may take a night or more to fade depending on your child and how long you have been away.
  • Teach your child to fall asleep alone
    • Children and adults naturally wake up several times each night. Each time we wake up, we check out our sleep environment and then quickly go back to sleep. These wakings are so brief that we often do not remember
      them in the morning.
    • If your child cannot fall asleep alone, then each time he/she wakes up, it is hard to fall back asleep without your help. If your child learns to fall asleep alone, then he/she will also be able to learn to fall back asleep at times of natural night waking, and wake more rested in the morning.
  • Promote healthy daytime behaviors
    • Physical Activity
      • Exercise during the day helps your child sleep better at night. Children and adults who exercise find it easier to fall asleep at night and have deeper sleep.
      • If your child does not get regular exercise at school, try to schedule this at home. Make sure the time for exercise is early in the day, as stimulating exercise close to bedtime may make it harder to fall asleep. Be sure all hard or tiring activity ends two to three hours prior to bedtime.
    • Caffeinated Foods & Beverages
      • Caffeine is a stimulant that can cause an ‘alerting effect’ and keep your child awake at night.
      • The effect of caffeine stays in the body for 3 to 5 hours and up to 12 hours.
      • If your child has caffeinated foods or beverages (e.g., chocolate, coffee, tea, and soda) in the afternoon or evening they may have difficulty sleeping.
      • Some children sleep best when these products are taken
        completely out of their diet.

Alternative approaches

Many of the experts approve the above remedies and sometimes offer the following experimental approaches in extreme cases.

  • Address Food allergies and other digestive issues like lactose intolerance
  • Use of sedatives at night only if other methods have not worked.
    • Must be prescribed by a pediatrician
    • Supplemental melatonin has been used successfully under physician guidance as a means of treating serious and chronic sleep disorders

Resources:

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About Emily Lauren

Jenny Clark, OTR/L, BCP (AOTA Board Certification in Pediatrics), is a licensed pediatric occupational therapist with over 22 years experience working as a school-based occupational therapist, independent contractor for early intervention services, private practitioner, speaker, consultant, author, and inventor. Jenny currently owns a pediatric therapy private practice, Jenny’s Kids, Inc. Jenny Clark Jenny is the author of the best-selling book on sensory processing entitled Learn to Move, Move to Learn: Sensorimotor Early Childhood Activity Themes(AAPC 2004), (Starter Kit available) More recently Ms Clark has written a sequel Learn to Move, Moving Up! Sensorimotor Elementary School Activity Themes (AAPC 2009). In addition, she has published two DVD’s Learn to Move: Dinosaurs (AAPC 2005), a companion to her first book, and Sensory Processing Disorder Kit: Simulations and Solutions for Parents, Teachers, and Therapists (AAPC 2006), which won the 2007 media in excellence video award from Autism Society of America. Jenny’s newest publication is a music CD, Sing, Move, Learn (AAPC 2010), which accompanies the songs in her first book. Ms. Clark is a contributing author for the book Autism Spectrum Disorders: A Handbook for Parents and Professionals (Greenwood Publishing Group 2007), as well as a chapter author for Autism Spectrum Disorders: Foundations, Characteristics, and Effective Strategies. (Pearson Publishing 2011 by Boutot & Myles). Jenny is the inventor of the Patent-Pending “Weigh” Cool Bracelet. Jenny has spoken both nationally and internationally on a variety of topics, including sensory integration/processing. She received her bachelor’s degree in Occupational Therapy and graduated with distinction from the University of Kansas.
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