Introduction

If you have already watched the Simple Sleep Solutions 0-3 months, there is going to be some overlap between these two modules but there is also some new information here, too. If you’ve already watched the first one, you’ll know that these are your foundations for good sleep, so it’s important you watch at least one of the Simple Sleep Solutions before you dive in to the other modules. This module is our starting point for everything else on in the sleep programme.

Some of what we cover in this module is also known as “sleep hygiene”, which is nothing to do with how clean your bedsheets are! Sleep hygiene is a collection evidence-based actions that we can take to improve sleep. This module goes a bit deeper than just sleep hygiene, though.

Two things that I’d like you to bear in mind as you go through this module is that:

  • Babies sleep when they are tired. Remember: sleep is a biological function, and our bodies know how to sleep. Where babies are concerned, this may just not happen when and how we want it to! I’ve included a chart with averages below – I’ll explain this in more detail in the Sleep Science module, but it’s worth bearing in mind, that unless there is an underlying medical problem most babies get enough sleep.
  • Babies sleep when they are calm and comfortable. Working out what calms your baby often results in them falling asleep much easier, and eliminating discomfort will help your baby sleep better.

Medical issues

Before you move on, it is really important to deal with any underlying medical issues that might affect sleep. Some of the conditions that are known to disrupt sleep include:

  • Reflux*
  • Allergic rhinitis, asthma
  • Recurrent ear infections
  • Food allergies and intolerances*
  • Skin conditions like eczema and psoriasis
  • Constipation or diarrhoea
  • Anaemia and other nutritional deficits
  • Poor weight gain*
  • Tongue tie*

The conditions that have an * next to them are ones that I am trained to evaluate, either as an IBCLC, or through additional training I’ve undertaken. You can book a free 15 minute call with me here, if you want to explore any of these further.

RED FLAGS:

The following are signs that your baby may be struggling with sleep apnoea, or has an obstructed airway:

  • Snoring
  • Mouth breathing (you may notice a wet patch of drool on the cot sheet, next to their mouth)
  • Stopping breathing (this may look like a pause in breathing, followed by a gasp)
  • Waking up tired and groggy

Your baby may snore or mouth breathe occasionally when they have a cold, but if you find that your baby exhibits any of these signs then it may be helpful to check on your baby over the course of several nights and at different times and observe their breathing while they sleep. If you see these behaviours for 4 out of 7 nights of the week, this is usually enough to identify sleep disordered breathing in 85-90% of children. If you notice any of these behaviours, you can video it and see your GP and/or get a referral to ENT (Ear, Nose and Throat doctor).

Sleep hygiene

When we talk about strengthening your baby’s circadian rhythm, it’s about making sure we don’t interfere with the body’s natural ability to be awake during the day, and asleep during the night. (I will explain this in more detail in the Sleep Science module.) 

So during the day you want to do lots of activities that are going to strengthen your baby’s circadian rhythm to really reinforce that it’s daytime.

It’s a really good idea to start the day early, at the same time every morning. You might want to open the blinds, or turn the lights on if it’s still dark, get up and about talk in a normal voice. It’s making a clear, distinct start to the day, rather than dozing in bed for an hour or two. I know this is really hard if you’re a night owl, or if you’ve had a rough night – you want to try to catch up on your sleep! Remember though, this is something that is going to help your baby sleep better at night time, so it’ll be worth it in the long run. 

Try to spend as much time outdoors as possible, but at the very least, get out for a walk early in the morning. Depending on the age of your baby, you could go for a walk for their first nap, or go for a walk after it. Before 10 am is ideal. If you’re indoors a lot, try playing with your baby near a window with lots of natural light.

Try to do all naps in daylight, without closing the blinds. This might be tricky if your baby has got used to a darkened room for naps. It’s worth bearing in mind that the production of melatonin (that night time sleepy hormone) may happen if a child is in a dimly lit room for an hour or more – so long naps in a darkened room are more likely to upset the balance of melatonin production, and impact night waking. This is less likely to be the case if your baby cat naps. Naps happen because of sleep pressure (how tired your baby is), not because of melatonin production – we only want melatonin to be made at bedtime.

It’s good to have a bit of structure to your day, with naps and meals at roughly the same time every day. If your baby is still getting milk feeds (either exclusively or as a substantial part of their calorie intake), you’ll want to feed responsively for these – I’m not suggesting that you schedule milk feeds at all. If your baby is under the age of one, you’ll definitely not want to eliminate night feeds, unless your baby drops them spontaneously. Often the easiest way to introduce some structure into your day is follow your baby’s lead. From around 3 months there is often a much clearer pattern around wake times, nap times and bedtime. Of course, this changes regularly as naps are dropped over that first year! And then you have to readjust those timings again!

Melatonin is produced in response to dim light so around 2 hours before bedtime it’s a really good idea to dim the lights and avoid the use of screens, so phones, TV’s, hand held devices.

At night time, you’re going to want to make sure that your baby’s bedroom is really dark, whether they are still in your room or in their own room, it should be dark!  A useful light test is to go into the room when it’s dark, let your eyes get used to it, and then check for any light sources – chinks of light around windows and doors, night lights etc. You may need to use blackout blinds, or think about turning off hall lights. Ideally, you shouldn’t be able to see anything in the room, no shadows or shapes – it should be pitch black. Some babies (and adults) are really sensitive to the amount of light they are exposed to at night time, so eliminating all light can improve sleep. 

Obviously, you will still need to tend to your baby at night time, so sometimes a night light is helpful. If you are going to use a night light in your bedroom, it should be very dim. It should have a red tone to it, not blue, yellow, green or white. If possible, try not to leave it on all night. 

Sleep hygiene – a few other ideas

Temperature regulation at night is important. You can try putting a pair of socks on your baby at night time. Sometimes this helps to regulate their body temperature overnight and prevents a wake up or two. In a similar vein, think about your room temperature – you actually need it to be fairly cool overnight for sleep – between 16 and 20 degrees Celsius. Sometimes using natural fibres for bedding can increase temperature regulation at night time too.

Think about smells in the room. Some babies are very sensitive to smells and this can actually activate their nervous system – think about using scent-free laundry detergent, or doing an extra rinse on cot sheets and baby clothes. Be careful of any additional scents in the room, such as air fresheners, or even essential oils. Although some are calming, sometimes babies with a very sensitive nose will still react to even natural, calming scents.

Food and milk

As I’ve already mentioned, I recommend feeding on cue whether you’re breastfeeding or bottlefeeding. Try not to schedule feeds, or try to get your baby to take bigger volumes. 

Around four months, babies often start to get really distractible when feeding. This behaviour can last for several months and often results in babies reverse cycling – where they feed a lot less during the day, and then make up for it at night time.  It can be helpful to get more feeds in during the day, as this often takes the pressure off at night time. It can either help to remove some of the distractions, or to add in a bit of motion, as this seems to help babies focus on feeding. You could try:

  • Feeding your baby in a quiet room, turning the tv off, giving your older child some screen time while you feed in a different room, playing some music while you feed, avoid talking to your child or others,
  • Standing and rocking a bit while you feed (either with baby in arms or in a sling), or sitting on a gym ball and bouncing slightly.

The other thing that happens around four months is that babies start to wake up a lot more during the night and this has traditionally being seen as a sign that they are ready to start solids. For nearly the last 20 years, the advice has been to start solids around 6 months. There really is no rush, even though here in the UK there is a really strong cultural pressure to start babies on solids. I think this is partly because we have this notion that the quicker and earlier that babies do something, the better it is. However, there really is no benefit to starting solids before six months. There is also this myth that if babies are started on solids they will sleep better. This really isn’t true, one study that compared babies that started solids at around 4 months, compared to 6 months, and found that solids helped babies sleep for a grand total of 7 minutes more! So hardly a difference in real life. There really are a lot of benefits to waiting till six months and if you do wait till six months, it is much easier and more straight forward to start your baby on solids.

When you do start solids, it’s important to think about the kind of nutrients that your baby gets. Traditionally, we have started babies on pureed vegetables and fruit. These are great first foods, as studies have shown that babies that accept these flavours early are more likely to eat them as they get older (even when they become fussy toddlers). However, the two main nutrients that babies need from around six months are iron and zinc (found in meat, nut butters, beans, eggs, and whole grains), so it’s good to add these in to babies’ diets as soon as possible. Highly processed foods like baby rice and pre-prepared baby foods are best avoided as they are devoid of nutrients and high in sugar, as well as being more expensive than preparing home made food.  First Steps Nutrition Trust has an excellent guide on first foods here:  Eating_well_the_first_year_June_20_for_web.pdf (squarespace.com) 

Contrary to popular opinion, having a big feed just before bedtime doesn’t usually contribute to improved sleep.  So whether it is a big bottle of milk or porridge just before bed, this probably won’t improve sleep, but instead might just result in a bit of tummy discomfort.  Leaving a gap of around 3 hours between the last meal of solids and bedtime will allow for digestion.  

It can be helpful to think about mealtimes as a family event rather than just about nutrition. Eating a healthy, balanced diet with lots of fruit and vegetables, complex carbohydrates and healthy sources of protein will teach children good eating habits for life. If we as parents model this behaviour, then our children are more likely to copy us. Plus, it benefits our health and our sleep too! It is unlikely that children will suffer major nutritional deficits if they are eating a wide range of healthy foods, as they are likely to get enough micronutrients from their diet. The two exceptions would be vitamin D and iron. All children (and adults too!) should take a daily supplement of vitamin D. Formula has vitamin D added to it, so as long as your child is getting 500 mls formula a day, they don’t need an additional supplement. Some breastfeeding mums prefer to take a high dose of vitamin D themselves rather than to supplement the baby directly. Iron-deficiency anaemia is a common issue that can affect sleep. Hence the importance of introducing good sources of iron early on in the weaning process!

SOME FOODS THAT HELP PROMOTE SLEEP (Great for dinner or supper!)

BANANAS – high in magnesium, potassium and tryptophan – eg mashed banana on wholegrain toast, banana smoothie

KIWI – high in seratonin, folate and vitamins C and E 

ALMONDS – high in calcium and tryptophan – eg almond butter on wholegrain toast, or slivered, ground almonds added to yoghurt or blended in a smoothie (no whole nuts obviously!)

DAIRY – yoghurt and milk contain tryptophan, a precursor to melatonin – a cup of warm milk, or yoghurt for dessert with fruit, or blended in a smoothie 

TURKEY – contains tryptophan – maybe substitute it for mince in a bolognaise sauce, or grill some turkey strips for dinner (great for babies to chew on!)

CHERRIES – contain melatonin – blended in yoghurt or a smoothie 

COMPLEX CARBOHYDRATES eg rice, sweet potato, quinoa, wholegrain pasta – can all be used at dinner. Children usually love meals that have a lot of carbs!

FOODS TO AVOID – sugar, processed foods that are high in fat, chocolate, caffeine.

Adapted from Holistic Sleep Coaching (Hookway, 2019) 

Daytime is for living, night time is for sleeping

It’s great if you can expose your child to a wide range of sensory experiences during the day. If we can expose our babies to lots and lots of really interesting experiences during the day they usually sleep better. I know it’s been very hard over the last year with lockdown and we’ve been really limited as to where we can take our babies, but even just getting out early in the morning, going for a walk and taking them with us to as many of the places that we need to go, really helps to tire your baby out. You don’t have to take them to specific baby classes, you just need to get out of the house with them. Most people find that their babies are much more settled and content when they’re out of the house. 

How does this work with naps? Well, we’ll look at awake windows in more detail in the Sleep Science and the Sleep Shaping modules, but for now I want you to think about your baby’s sleepy signs, and roughly how long they can stay awake (each child is different so take the Awake Windows on my chart with a pinch of salt). If you are planning on leaving the house, you can plan one or two (or all!) naps to be when you’re out of the house. Perhaps you can make a cup of coffee in a travel mug, take the long way to your local supermarket and let your baby nap in the car, while you enjoy a mug of coffee in peace and quiet, before you lift them out and do your shopping. Or perhaps you want to go for a walk in the park. You can start it before your child is tired, and then let them fall asleep in the sling or the pram. It’s really about working your daily activities around your baby and facilitating sleep in the easiest way possible.

You’ve probably signed up for this course because you want to change sleep, and if that is you, then that’s fine.  However, if you find that feeding to sleep, or going for a walk with your baby works for you, then you don’t need to worry that you’re causing bad habits. I really do believe that the path of least resistance is the easiest one, and you should really only change how sleep happens if it’s no longer working for you. 

When babies are tired, most of them will fall asleep within 15-20 minutes, provided they have a comfortably full tummy (not overfull), they’ve had exposure to lots of sensory experiences and they are calm. Any activities that we do to help them sleep don’t put them to sleep, they just calm them enough for sleep to happen. For example, feeding, rocking, shushing etc. They just help calm a baby down for sleep to happen. If your baby isn’t tired or calm, then it’ll just take a really long time for them to fall asleep.

If you’ve been stuck in the house for a few hours and your baby is getting grumpy, don’t assume straight away that they are tired. They may well be bored! I have seen an awful lot of parents fall into this this trap. In fact, this was me with my first baby! You spend some time with your baby, then you start to get a bit frustrated because you need to get something done, so you leave your child to play on their own. They start to fuss and whinge after a few minutes, so you think they are tired. You take them to bed, where they fuss and resist sleep, before finally falling asleep 45 minutes later. You’re frustrated and fed up at this stage, and either rush around trying to get your housework done, or you relax with a cuppa, some Netflix and and some serious parenting guilt, because you know you have so much to do. Sound familiar? 

So what might be helpful is to assume that your baby isn’t tired in the first instance. Just assume that they are a bit bored. Often our attention wavers because we’re tired or get distracted, and then that makes them grumpy. They can get a bit bored and just need a bit of interaction with you. This is where you can get out and about, you can go for a walk and or perhaps read them a book, sing some songs together, see if you can entertain them first, before trying them with a nap. Usually if they ARE tired, entertaining them won’t help, they’ll just get a bit fussier, but then you can try some calming activities and they’ll fall asleep fairly quickly, and this has taken the pressure off you.

Connection: the final piece of the puzzle

Along with the fact that babies need to be calm, is the fact that babies really need to feel connected to us. Babies have a really strong attachment to us as parents, and we help to regulate their emotional state. So when we’re thinking of doing a bedtime routine with them, when we’re doing those little things that are going to help to calm them down before sleep, it’s really important that we’re calm as well. So taking a couple of big, deep breaths, maybe just doing a minute or two of mindfulness, just forgetting everything else that we need to do. If we concentrate on our babies at this stage and really focus on them, connecting with them while we’re doing those calming activities like rocking or feeding, it’s going to help our babies fall asleep a lot easier.

The whole purpose of a bedtime routine is just to provide a few minutes of connection and calm with babies. So you can have a think about what works for a routine for your baby, either for naps or for bedtime. What you really want is for this time to be quality time, that helps to bring them to that point where they’re really, really settled and ready for sleep. I have a list of activities in your workbook, that you might like to think about.

NAP AND BEDTIME ROUTINES

Remember, the purpose of a routine is to provide a small pause in your day to calm your child and provide a sense of connection. If you are out and about, you don’t need to do a routine. If you are at home, you can think about introducing a few simple activities that help sleep happen easily. For nap time you might want a short sequence, lasting 5-10 minutes. For example: nappy change, lullaby, cuddle, feed to sleep. For bedtime you might want to add in a few more activities such as a massage or reading a few bedtime stories (both of which are proven to help sleep happen!). Bathing doesn’t always calm a baby! Sometimes it’s just a little bit too invigorating for babies, in which case you want to move the bath to earlier in the day.