Category Archives: toddler sleep strategies

Hypermobile Kids, Sleep, And The Hidden Problem With Blankets

 

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Everyone knows that sleep is important.  Research in sleep science (yes, that is a thing) tells us that our brains are working to digest the day’s learning, the immune system is active during sleep, and our bodies are repairing and renewing tissues and organs while we slumber.  As much as we need sleep, kids need it more.  They are building the brains and bodies they will carry into their future.  Children need good quality sleep as much as they need healthy food.

Helping children to sleep well is usually a combination of creating good and consistent bedtime routines, giving them a full day of physical action and warm social interaction, and developing a healthy sleep environment.  This means providing a sleep-positive environment and removing any barriers to sleeping well.  But giving kids the chance to get a good night’s sleep can be harder when a child has hypermobility.

Some of the challenges to sleep for hypermobile kids are sensory-based, some are related to activity during the day, and some are orthopedic.  Here is a list of things that make sleep more challenging for these kids:

  • Children with limited proprioception and kinesthesia due to low tone or excessive joint mobility can have difficulty shifting down into a quiet state for sleep.  They spend their day seeking sensory input;  not moving reduces the sensory information that makes them feel calm and organized.  Being still is a bit similar to being in a sensory deprivation tank, and it’s not always calming.  To understand more about the sensory concerns of hypermobility, take a look at Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children.
  • Some hypermobile kids have joint or muscle pain that keeps them up or wakes them up in the middle of the night.  Pain also makes kids more restless sleepers.  Restless sleepers thrash around a bit under the covers, becoming trapped in multiple layers of bed linens, or they can fall asleep in awkward positions that result in pain.
  • Children that are sedentary during the day for any reason (preference for tablet or video play, fatigue, pain, etc) may not be physically tired enough at night.  They may also be staying up too late at night.  Good sleep hygiene includes enough daytime activity combined with a conscious wind-down hours before bedtime occurs.
  • Some children with generalized low tone or joint hypermobility (especially with a connective tissue disorder) have issues with the partial collapse of their airway during sleep.  They snore or gasp in their sleep, and appear exhausted even after a full night’s sleep.  This is a serious issue.  Sleep apnea should be evaluated and addressed by a professional.
  • Hypermobile kids can get arms and legs caught in their bedclothes or between crib slats and mattresses.  Any layer can be a potential problem, from the sheet to the decorative afghan that Granny sent for his birthday.
  • Limbs can slide off the mattress during deep sleep and create strain on ligaments and tendons.   You and I depend on our brain to perceive an awkward position and take corrective action by waking us slightly.  The same child who “w” sits and slides off a chair without noticing is not going to wake up when her arm is hanging off the bed during sleep, even though the tissues are stretching beyond their typical range of motion.
  • Waking up to go to the bathroom or having to clean up a nighttime accident ruins sleep.  It isn’t uncommon to have older kids wear protective garments well past 5 at night, and some children need to practice holding in their urine to expand the bladder’s ability to hold it all night long.  This is something to discuss with your child’s urologist or pediatrician, since “holding it in” can be it’s own problem.  Read Teach Kids With EDS Or Low Tone: Don’t Hold It In! to learn more about the pitfalls of too much “holding”.

Here are some simple strategies that may improve your child’s sleep:

  • Try a duvet or a flannel sheet set to minimize the number of layers of bedclothes.
  • Use a rashguard suit instead of pajamas.  I am particularly fond of the zip-front style so that less force is needed to get arms in and out while dressing.  You can peel it off more easily.  The lycra creates sensory feedback that can support body awareness while keeping them cozy.  An all-in-one suit also gives a bit of support so that limbs don’t easily overstretch.  A little bit of proprioceptive input in a breathable fabric that can also generate a bit of neutral warmth (from body heat) to keep tissues from getting too stiff.
  • Avoid footie sleepers that are too short.  Too-small footie sleepers create compressive forces on joints and could even encourage spinal torque.  Hypermobile kids will be the last ones to complain since they often don’t feel discomfort right away.  My preference is not to use these sleepers at all with hypermobile kids or kids with low tone.  See the next suggestion for another reason why I feel this way.
  • Make them take off those footie sleepers when they wake up and walk around.  As fabric twists and children stand/walk on the fabric, not the soles, it creates a safety risk underfoot.  Less sensory feedback and slippery soles!!  Get them dressed once they wake up.
  • Address sleep apnea, lack of daytime activity, and toilet training/scheduling rather than waiting for things to improve.  Not all young children achieve night time dryness on pace with other children, but ignoring the impact isn’t going to help things.
  • Carefully consider the issues before you try a weighted blanket.  Originally sold for kids on the autistic spectrum and for kids with sensory processing disorders without muscular or orthopedic issues, these blankets have become popular with other groups.  The biggest concern for hypermobile kids is that placing weight (meaning force) on an unstable joint over time without conscious awareness or adult monitoring is a safety issue.  It is possible to create ligament injury or even subluxation of a joint with weights, depending on limb position, length of time weight is applied, and the amount of force placed on a joint.  Talk the idea of a weighted blanket over with your OTR or PT before you order one of these blankets.
  • Consider aromatherapy, gentle massage, white noise machines, and other gentler sleep strategies to help your child sleep well.  consider techniques like gentle joint compression and/or deep pressure brushing, but ask your therapists how to adapt it for your child’s specific  needs  Can You Use The Wilbarger Protocol With Kids That Have Ehlers-Danlos Syndrome?.  For kids who sleep well but wake up stiff, learn how to use gentle massage and possibly heat to help them get going.  do not ignore pain at bedtime, or complaints of pain on awakening.  These are important clues that you need to address.   Ask your occupational therapist or your pediatrician for ideas to adapt your bedtime routine (OT)  or your pain plan (MD) to handle nighttime pain.
  • Try K-Taping or Hip Helpers for stability.  Kineseotape stays on for days and gives joint support and sensory input while your child sleeps.  Hip Helpers are snug lycra bike shorts that limit extreme hip abduction for the littlest kids ( when legs rotate out to the sides excessively).  They gently help your child align hip joints correctly.  As with weighted blankets, I strongly recommend consulting with your therapists to learn about how to use both of these strategies.  When used incorrectly, both can create more problems for your child.

Looking for more information about managing hypermobility in children?  Take a look at Should Your Hypermobile Child Play Sports? and Hypermobility and ADHD? Take Stability, Proprioception, Pain and Fatigue Into Account Before Labeling Behavior.

 

Looking for more personal assistance in addressing bedtime issues?  Visit my website and purchase a consultation session to ask questions, get resources, and even make a sleep plan that works!

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Negotiating With Toddlers? Why They Think That 90/10 Is A Good Deal

 

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Toddlers can make you doubt your sanity.  They really can.  How can a crushed cookie be the end of the universe as they know it?  Why do they think you can make more cookies appear on demand?  And how to explain to this person that thinks you hung the moon that you simply cannot erase crayon marks?

This post is an effort to explain how to successfully negotiate (most of the time) with children 18 months to 5 years old.  It is based on The Happiest Toddler on the Block strategies by Dr. Harvey Karp.  Once I learned his techniques, I never looked back and became a toddler whisperer.  Really.  You need to embrace his two most important ideas and then you are ready to hit the negotiating table with your toddler.

Dr. Karp’s most basic concept is that you need to understand that the toddler brain isn’t capable of much logical thinking due to immaturity.  This means that they cannot negotiate well, even when calm.  It gets better as they get older, so a 4 year-old will have flashes of rational negotiation, and an 18 month-old may never get it.  She can’t.  Her brain simply doesn’t “do” rational well at all until that frontal cortex is mature.  The other concept is true for negotiation with anyone, including your partner and your boss.  You have to see their side of the story and communicate to them that you are aware of their feelings….whether or not you agree with them!

Agreeing that they get 2 more bedtime stories but not a snack as well, agreeing that they get the giraffe cup but can’t spill half of it on the new carpet to make a pattern, agreeing that they can wear pajamas to the park but only with shoes are all successes.  Tell them that you understand that wearing Spiderman jammies is indeed cooler with Spiderman sneakers helps them negotiate the deal.  Honestly saying that you are too tired to read 6 more books using an exaggerated yawn and a sad look helps.  You need to go night-night too.  They may be able to see your perspective since they are tired as well (but may never admit it to you).

So here is where your paradigm shift happens.  You have to be OK with deals that seem unfair to you.   Adults want a 50/50 split at the very least.  But you aren’t negotiating with another adult.  Be prepared to leave your ego at the door.  If you are the kind of person that needs to be right, you are going to fail at toddler negotiation.  Toddlers negotiate from the heart and with heart.  A mature sense of fairness isn’t going to be helpful with an irrational mind.  Hint:  if you have ever had a totally irrational boss that you actually liked when things weren’t exploding all over the office, you will have had some experience with the toddler mind.

Successful initial negotiations with a toddler often yield a 90/10 split.  90% for them, and 10% for you.  If they walk away happy,  you should too.  This is why this is not only a good deal for you, it is the only way to teach fairness in negotiation: toddlers start out expecting 100%.  A 90% deal is, in their mind, having given in big-time. But if they feel OK about it and life goes on, you won.  If you can manage that, the next negotiation could be 80/20.

Many toddlers cannot manage this when tired, overwhelmed, hungry, etc.  So negotiations can start over something simple, something that doesn’t matter very much to either party, and when things are calm.  You are teaching a skill, not making a business deal.  But the results could make everyone’s life a lot calmer in the end!

Weaning the Pacifier From An Older Child

Weaning pacifiers can be difficult, no matter the age.  I wrote a popular post a while back on pacifier use and abuse, Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic , but I think that I might need to write another.  Once an older child, over 3, still uses a pacifier, it is a different game to get rid of it.  There are professionals that will tell you that if your child really needs it, she should have it.  They all agree that if it has disrupted tooth formation or contributed to ear infections, those are good reasons to let it go.  But what if her teeth and ears are great?  Should you get rid of it because her younger brother let go of his pacifier at 18 months?

Every child is different in their ability to handle daily stress and develop more mature methods of calming and organizing.  If you haven’t read The Happiest Toddler on the Block, you might want to try Dr. Karp’s terrific strategies for building self-control and handling frustration.  I highly recommend his strategies for bedtime and dealing with aggression and defiance, because those times are when kids (and parents) default to the “paci” to get a child calmed down.

If your child’s speech is delayed, then you have two good reasons to address pacifier use right away, today.  First, pacifier use is a very immature tongue/mouth pattern of movement.  Please don’t encourage the use of something that slows down/prevents them from making gains in therapy.  Second, they can’t talk and suck at the same time.  They are losing opportunities to try to use words to deal with their feelings and thoughts.  OK, I guess third would be that being unable to communicate all the complex thoughts that they have probably makes them even more edgy and whine for that pacifier.  If I had a dollar for every agitated child with a speech delay that became polite, calm, and sweet-as-pie once he could be understood just a little…….

If you haven’t introduced a “lovey”( a toy or other safe object that a child can bring to bed or cuddle with) now would be the time to try it out or try another one.  Older children can enjoy the backstory of having a princess or a superhero with them.  I have also taught Dr. Karp’s  breathing technique to promote calming to older children.  That can be very helpful to them, but they do need to see you use it and they have to practice at calmer times in order to be able to use it in the clinch.  For some parents who love yoga and meditation, this is great!  For others, they will admit that they won’t remember to breathe through someone cutting them off in traffic: they yell.  And so does their child when his TV show is shut off.

Some children will accept the idea that the pacifiers are sent to the little babies, the pacifier fairy, or some other entity.  Others cannot believe this has happened to them.

Dr. Karp’s techniques for teaching toddlers how to handle frustration and communicate their emotions make life in the daytime better, but they might just be more important for bedtime.  Kids and grown-ups are tired, and kids don’t want to leave the fun, especially if it involves a parent that they missed all day long.  Pacifiers can be how a child calms themselves down because they don’t know how to interact and manage emotion.  Totally understandable at 10 months, but if they are 3 or 4, it is time to build some emotional regulation skills.  Teaching these skills is almost impossible to do at 7 pm.  The time to work on those skills is when they are fresh as a daisy.  If this means playtime with the purpose of teaching patience stretching at 7:30 am while waiting for cereal, it is still a better idea than 7:30 pm, when they are grumpy and tired.

I am convinced that the kindest thing to do for a child, one that uses the pacifier because this child has no other effective ways to calm herself, is to teach her better skills.  Mature skills that will last for years.  The gift that keeps on giving!

Why “Go The F**K to Sleep” Resonates With Parents of Special Needs Toddlers

 

I have been asked to teach a short class on sleep and special needs kids this spring, so of course this funny little book came to mind.  Truthfully, when I heard of it, I laughed out loud.  But bedtime struggles are not fun when you are in the middle of a tantrum at 11 pm.  Wrangling with a toddler that alternately cries, whines and yells about bedtime is not a joke.  It is hell.

If you have trouble sleeping, then you might be a little more sympathetic to a toddler that fights bedtime, but probably not any more capable of getting him to sleep. You just want the fighting to end so you can get some sleep too.

I asked some other professionals to give me their opinions and experiences with special needs toddlers and sleep problems.  Their comments always mentioned the same thing:  poor self-calming.  Well, my response is that most toddlers need our help to learn this skill and they need to be calm to learn it.  It isn’t a natural ability any more than speech.  We are wired to speak, walk, and sleep, but kids need modeling, a supportive structure and emotional connections to do all three well.  They really do.

Kids with special needs, including autism, sensory differences, and developmental delays can have a harder time adopting a bedtime routine and communicating their desires.  They often benefit a lot from things like weighted blankets and aromatherapy to signal to their nervous system that they need to downshift and sleep.  White noise and achieving a calm state for sleep can do more than token economies (the kind where you get a star if you get into bed) for special needs kids because they address the biological state of sleep rather than develop a cognitive motivation.  That being said, some older kids can use tokens effectively for motivation.

The most powerful thing I know to build good sleep behaviors in special needs toddlers or kids functioning at the toddler level is patience stretching.  Dr. Karp’s amazing technique for getting kids to wait can be magic at night.  A toddler that can calmly wait for you to return to his crib is one that can let the white noise and the lavender and the weighted blanket lull him back to sleep.  The toddler that is agitated and fearful will be so upset that all the other stuff is window dressing.  Calm kids can learn to self-soothe.  Agitated kids cannot.

Think about it, and try it out.  Please post your comments once you have given it a try!

Get Your Toddler And Preschooler To Sleep Faster When You Use Happiest Toddler Techniques at Bedtime

The Happiest Toddler on the Block has a unique perspective to bedtime sleep training:  it starts right after breakfast.  One of the cornerstones of THTOTB is Patience Stretching.  In my post Stretch Your Toddler’s Patience, Starting Today! I wrote about Dr. Harvey Karp’s fabulous technique, and how parents have to use a little creativity and positivity to get things started.  At first, it’s hard to put on a smile and be agreeable at 3 pm when you have had a day of clingy, whiny toddler demands.  But it pays off quickly,  it really does.  You will no longer dread 3 pm.  Then you need to plan to use it at bedtime.  It is like bringing a show up to Broadway.  This is the big time.  You don’t just put the backdrops in a truck and tell the actors where to stand.  You make a plan.

Here is what you need to do to make the transition from daytime Patience Stretching to bedtime sleep training work:

  • Perfect your daytime performances.  Get your toddler so good at waiting when she is not exhausted, not ill and not totally overwhelmed that you would be willing to go on YouTube for a demo.  Yes, that good.  How To Get Your Toddler To Wait For Anything (Hint: They hear “Wait” as “No”)  That means that your child and you understand the how and why of this method.  It is 10 times harder when you are both tired.  Maybe 20 times harder.
  • Now get this working well in unfamiliar places and/or when she is a little off her game.  Night time is harder than any other situation.  She is aware that she will be without you for hours, and the fun of the day is definitively over.  She has to be able to handle that.  Try improving transitioning skills, because this is the biggest transition she makes each day:  totally away from you and away from interaction to fall asleep.
  • That piece leads to this one:  having a good day as defined by toddler terms is essential for a good night.  Your version of a good day is not exactly hers.  She has a good day if she has had enough physical activity, enough warm exchanges, and enough positive attention.  If it has been a day stuck in a small space without face-to-face warmth and lots of redirection that she perceives as negative then bedtime is when she will make you pay big time.    You know this is accurate, right?  Make every effort to plan in some physical fun, create situations where you both can laugh and hug, and get good at redirection by saying what you want her to do instead of “no!”   See my 2015 post Discipline and Toddlers: What Do You Say if You Don’t Want to Constantly Say “No”?for more details on how to accomplish this.
  • Now you are ready to give this a try.   Use a kind but convincing voice.  Try very hard not to start with “It’s OK, it’s OK”, as your child will cry harder to convince you that it is not OK with them.  Did you read my post on that topic yet? Your response should be brief and a little robotic: “Oh, you are awake.  It is night time, time to sleep”.  Some kids do better if you don’t look them in the eye.  It excites them too much.  It isn’t cruel to avoid eye contact when you know that doing so helps them sleep, and engaging with them will make it harder.  Think about that one for a minute.
  • Go to her at 3 am when she cries out.  Yup, you don’t cry-it-out.  She needs to know you are there for her, but remember the robotic and unengaged plan.  Check for true distress and diaper issues and tell her firmly but warmly that it is time to sleep.  Not a lot of eye contact and absolutely no bright lights.  You could hold her for a few moments if you think it won’t be interpreted as coming out of bed, because you are going to put her down and do Patience Stretching in just a few seconds.  You know… “oh….I have to go tell Daddy something and I will be right back….” and come back after 15 seconds.  You could come back for a sleepy chorus of your bedtime song and then do it again…oh…I just have to go potty… and leave for 45 seconds.  The excuses and her confidence that you return should be familiar from all that daytime stretching and the time gets longer and longer.  You lie her down and then you do return.  You have to.  She might still be awake.
  • But she might not!  She might have dozed off without wailing.  Everybody wins, no tears, no feeling abandoned or feeling like you are abandoning your child.  You are giving her the chance to settle herself.  She already believes you, because you always return it the daytime.  This just gives her the chance to try relaxing into sleep while you are gone.

Good luck!  If this works for you and your child, please comment and share your unique twist that made it a success for you.  Other parents that read this blog are eager to hear your success story!