Tag: sleep

Healthy Sleep Hygiene for Kids

By: Kelly Nesbitt, MOT, OTR/L

One of the trickiest parts of a child’s daily routine for families is sleep, going to sleep, staying asleep, and finding consistency in the bedtime routine. Below are some helpful tips to make your child’s bedtime restful and not stressful.

Author’s Notes: I use both identity-affirming language, “autistic children,” and person-first language, “children with autism,” throughout this post, as these are two schools of thought within the autism advocacy community of how to refer to someone with this diagnosis. Generally, I use the language that feels most respectful to each individual family and child. As I am not someone with autism, I don’t have the lived experience to make a judgment on which school of thought is “right.”

Also falling asleep and staying asleep is a complicated process. Both environmental modifications as well as your child’s physiological processes impact sleep. Don’t be afraid to bring up sleep to your child’s pediatrician if you are worried that even with good sleep hygiene, your child is still not sleeping well.

Steps for a Child’s Bedtime Success

First, ensure your child’s room is set up in an optimal sleeping environment. Physical set-up includes:

  1. A Quiet Room: If it can be helped, having children not share a room so that if one child wakes up in the household, it does not wake up your other children. If you have two children sleeping in the same room, you can try having music or a white noise machine playing in the background so that the children can get used to having noise present in the room.
  2. A Dark Room: Also, ensure that the room is dark (with the exception of a nightlight if a child needs it), which helps a child’s brain know it is time to sleep. Trial blackout curtains if a lot of light creeps in the windows, if your child is going to bed when the sun is setting, or if there is ambient street light coming into the room.
  3. A Cool room:  A cool room is optimal for sleep. A room between 60 and 68 degrees is cool enough for children to sleep well. (Best Temperature to Sleep: Research and Sleep Tips (healthline.com)

Consistency is Key

One of the biggest keys to having good sleep hygiene is having consistency every night. This means a consistent bedtime, routine, and expectations for sleep. Give yourself and your child about 30-45 minutes to start the whole bedtime routine and keep it consistent every night.

As a family, you can decide what activities are calming for your child that you can work into your routine for bedtime (taking a warm bubble bath, changing into PJs, and listening to quiet music for a few minutes before you tuck them in).  It will take some trial and error to find what makes your child feel calm and sleepy.

 I recommend keeping a journal or note on your phone on what time you started the bedtime routine, what activities you chose, and what time your child got to sleep. This will help you find patterns of what worked in the routine and what did not work.  

Limit screen time to 1 hour (at least) before bed

This is a big one. Screen time is often very overstimulating for kids and sends signals to a child’s brain to stay awake! In fact, a review of many studies from the American Academy of Pediatrics shows that “In >90% of these studies, more screen time was associated with delayed bedtimes and shorter total sleep time among children and adolescents.” So how do we reduce screen time around bedtime?

About an hour before bed, turn off the electronics! That means tablets, iPhones, laptops, and televisions. There are parent control apps (check them out here: How to Check Screen Time on Different Devices (guidingtech.com). These apps can turn off children’s apps or even password lock the device at a certain time. It’s also recommended that children do not have access to devices in their rooms (no televisions or tablets in their rooms). You want your child to associate their bedroom as a calm space for sleep, not for sitting and watching shows.  Replace screen time with reading time, unstructured playtime with their toys, or quiet music and drawing time. This hour before bed can be explained to older kids as “a time to quiet our bodies and minds.”  The activities you do before bed with your child (discussed more below) should be quieter, organizing, and not high-energy activities.

This change to limiting screen time will likely be a tough adjustment for kids, as it’s difficult to beat the immediate gratification and fun of visually stimulatory ipads, iphones and TV. But consistency is key, and kids are resilient, so they will accommodate over time. Make it a challenge for yourself, too- take a break from electronics with the kids at night and don’t get them back out until they are asleep!

Find Out What Activities are Calming

Play around with what activities you try an hour before bedtime. Here are some quieter activities that can promote settling kids’ bodies for bed:

Heavy Work/Proprioceptive activities: Heavy work/proprioceptive input is compression to joints that sends calming signals to the central nervous system. Any activity that has “pushing, pulling or carrying” contains proprioceptive input. The trick with heavy work input around bedtime is selecting activities that are not going to be too active. Do these activities for about 10-30 minutes or until you notice that your child is looking tired or their body is regulated.  These activities could include:

  • Doing wall push-ups
  • Pushing a toy container around to pick up toys
  • Pull a weighted blanket with their stuffed animals on it
  • Lay on bellies on hardwood or linoleum floor and pull with their arms (you can put a towel on the floor for the child to lay on to get less resistance when they pull).
  • Have the child fill a fabric bag with what bedtime stories they want to read that night and carry it to their room

Calming Bath time: Draw a warm bath for your little one with calming bubbles if your child enjoys that. There are also some cute light-up bath toys to play with along with having the overhead lights turned down (if it’s safe to do so). Always make sure that your child is supervised when in the bathtub.

Additional Sensory Supports

Here are some additional sensory supports that could be added to bedtime to help your child prepare their body for sleep:

OLFACTORY/SMELL:

  • Use gently scented lotions with soothing scents (chamomile, lavender, vanilla, for example) for an olfactory signal for your child to get ready for bed.
  • Trial essential oil diffusers (that are out of reach of children in their room) with calming scents

TACTILE/TOUCH:

  •  Trial using a weighted blanket at bedtime or during quiet time. See this blog post for more information: The Benefits of Weighted Blankets – Easterseals DuPage & Fox Valley Blog (wordpress.com). To sleep with, a child’s weighted blanket be no more than 10% of their body weight!
  • Rub your child’s back while they lay in bed with deep pressure, which is calming.
  • Cuddle with deep squeezes to their body (think of swaddling a baby to sleep)
  • Allow children to have access to their security blanket or toy (often children use these items to remind them of their parents’ love and literally take that with them as they look at that toy)

VISUAL/LOOK:

  • If you can, dim the lights in your house or turn off a few lights so the house is a little darker before bed.
  • Again, limit screen time
  • Have a soft, warm night light in the child’s room
  • Have the child’s toys “out of sight and out of mind” during bedtime. They can have their preferred stuffed animal if they are old enough, but other tempting toys should be put away.

GUSTATORY/TASTE:

  • Have warm milk prior to bed
  • Avoid a big meal or snack right before bedtime, as it’s hard to sleep when you are digesting a lot of foods.

AUDITORY/HEAR:

  • Use a quieter, softer tone of voice to help signal to your child that it’s time to settle down.
  • Play a white noise machine in the bedroom
  • For children 3 and up, there are Children’s bedtime podcasts to listen to during getting ready for bed. Select stories that are slow-paced, and the narrators have a calming voice.
  • Play soft music in the background during the bedtime routine

VESTIBULAR/MOVEMENT:

  • If your child is soothed by being rocked, you can make a blanket swing with 2 adults holding the ends of the blanket and your child climbing in. Give your child slow, rhythmic movements which are calming.
  • Read bedtime stories in a rocking chair

You can also talk with your child’s Occupational Therapist about what other activities and sensory supports can work for your child.

Cuddle and Connect

Once your little one is all settled into bed, use this opportunity to connect with your child with a special routine or routine that is important to you as a family. This can be reading a bedtime story, saying prayers together, reviewing the best parts of the day, saying what you are grateful for, or singing a bedtime song.

Feeling safe and connected with their parents is a good way to bond and send them to sleep. That being said, sometimes separating from mom and dad in order to go to bed is really scary and a normal childhood fear. Having this consistent shared time can help a child feel safe and secure prior to going to bed. You can also read some separation-themed stories to help them to ease this anxiety.  (Children’s Books about Separation Anxiety – Sleeping Should Be Easy)

A Note on Autism

I would be remiss not to mention that even with immaculate sleep hygiene, some autistic children still have difficulty falling asleep and maintaining sleep. There is a higher prevalence of insomnia in autistic children than in their neurotypical peers. There are some theories that gastrointestinal issues, possible sleep apnea, anxiety, restless leg syndrome, epilepsy, medication side effects and/or hormone imbalances can contribute to more sleep issues in children with autism (Wide Awake: Why children with autism struggle with sleep). It is recommended that parents who have concerns with their child with Autism’s sleep discuss this with their therapy team as well as the pediatrician. Their pediatrician may refer them for a sleep study to evaluate the quality of their sleep and what barriers contribute to them not sleeping well.

Wishing all a good and restful night!

References:


Routines and Why They Can Help

By: Laura Van Zandt, MS, OTR/L

Routines are very important for all children, but they can be particularly important for children with developmental delays. Routines help provide a sense of certainty and security for children by offering them a predictable pattern that allows them to know what to expect, which will result in less frustration as well as fewer tantrums or meltdowns.

Certain routines are almost universal, such as morning and bedtime routines, but others may exist for specific circumstances or stages of life, such as your family’s weekend morning or school or summer routine.

A great place to start a routine is having a set bedtime. The American Academy of Pediatrics recommends that children ages 3-5 should get 10-13 hours of sleep a day (including naps) and children ages 6-12 should get 9-12 hours of sleep each night. The benefits of getting enough sleep are numerous and include mental/physical health, attention, memory, learning, behavior, and more. The AAP also recommends no screen time 30 minutes prior to bed, no electronics in children’s bedrooms, and having a set bedtime routine.

Setting up a bedtime routine:

Ryan - web
Photo from Take Three Photography

Bedtime routines can be anything you want them to be, as long as they are familiar and predictable. For my infant son, he takes a bath every other day. After his bath (or mom and dad quiet playtime on non-bath days), he gets a nice massage and we read a couple goodnight books. When he shows us signs of being tired, we turn off the bedside lamp, swaddle, and turn on the white noise machine.

This routine is something I hope to keep as he gets older. For an older child, you can do a similar routine but you will need to add in time for personal hygiene and perhaps next day activities such as pick out your clothes, pack your backpack, etc. You can use a similar routine for naps, except they would just be shorter.

Aside from bedtime, morning routines, can also be beneficial. Some families have different weekday and weekend morning routines, but other children may need to have one routine that stays the same regardless of the day.

Mealtime can also present an important routine. An easy place to start is to try to have meals around the same time each day. I know this isn’t always possible- but getting as close to a specific time each day can be beneficial and having everyone sit together to eat.

Additionally, having chores to do in family routines helps children develop a sense of responsibility and some basic skills, like the ability to manage time. These are skills children can use for later in life that you can begin at a young age. One great example is singing the “clean up” song when it’s time to finish an activity and move onto something different.

“Clean up clean up
everybody everywhere.
Clean up clean up
everybody do your share.

Clean up clean up
everybody everywhere.
Clean up clean up
everybody do your share.”

Routines can also be great for teaching personal hygiene. Ever heard a parent sing the ABC song while their child washes their hands? This is just one great example.

Here are some tips if you are looking to introduce routines into your daily life:

  1. Only change one part of the day at a time.

2. Come up with your basic non-negotiables and then give your children some                    choices (bedtime stories together or separate?).

3. Make a poster with the routine, including photos in the right order, to allow for              self-monitoring. In a good routine, everyone understands their roles, knows what              they need to do and sees their roles as reasonable and fair.blog_visual

4. Follow the same routine every single day for at least one month, after which it will         become habit and your older kids should be able to keep themselves on schedule for         the easy routines.

Establishing routines has lots of great benefits that can help both you and your child develop scheduling abilities, and increase the likelihood that your family will have a smooth day.

For more information on Easterseals DuPage & Fox Valley, visit eastersealsdfvr.org. 

Sleep Tips for All Ages

By: Laura Van Zandt, OTR/L

As a soon to be new mom, sleep is something that is very important to me and something I will soon be getting very little of in my life! I often get questions by parents about sleep and how to better help their little ones develop good sleep habits and routines. There are many great sleep books available  to read and review for sleep suggestions. Many are targeted towards babies; however, they still contain useful information about typical sleep patterns as well as some guidelines for establishing sleep routines and how to sleep coach. In order to better prepare myself and my husband, I’ve been reviewing some of my handouts on sleep and wanted to share what I found useful.

My first step with families is to help them understand that sleep is a learned behavior. There are many reasons children have difficulties with sleeping. A child may have difficulty sleeping because:

  •  She hasn’t yet learned to put herself down to sleep
  • He might have difficulty self-calming and quieting his body and mind for sleep.
  • She might have separation anxiety
  • He is testing limits
  • She might have an overactive imagination
  • He wants to play longer and will resist going to bed
  • She is sensitive to noise, textures, or odors which makes it difficult to relax to sleep.

04_Bodhi2.jpgOlder children have increasing demands on their time from school, sports, extracurricular activities, and other social activities which can impact sleep.  A child might also snore or have noisy breathing during sleep which should be evaluated by their pediatrician with possibly a referral to an ENT to rule out sleep apnea or enlarged adenoids.

Going to sleep and getting enough sleep are skills we need to teach our children. Optimal sleep helps to ensure children are able to play and ready to participate in daily activities. It also promotes brain development and growth.

How many hours does a child need to sleep?

Newborns sleep about 8 to 9 hours in the daytime and about 8 hours at night. Most babies do not begin sleeping through the night (6 to 8 hours) without waking until at least 3 months of age; however, this varies considerably and some babies do not sleep through the night until closer to 1 year.

Infants typically sleep 9-12 hours during the night and take half hour to two hour naps, one to four times a day, fewer as they reach age one. Research shows that when infants are put to bed drowsy but not asleep, they are more likely to become self-soothers which allows them to fall asleep independently and put themselves back to sleep when they wake up. Babies need our help to establish their own sleeping and waking patterns. You can help your baby sleep by recognizing signs of sleep readiness, teaching him/her to fall asleep on their own, and providing the right environment for comfortable and safe sleep. Your baby may show signs of being ready for sleep by rubbing their eyes, yawning, becoming fussier, or looking away.

Toddlers need about 12-14 hours of sleep in a 24 hour period. When they reach about 18 months of age their nap times will typically decrease to one a day lasting one to three hours. Caregivers should try to avoid naps occurring too close to bedtime as this could delay sleep at night.

Preschoolers typically sleep 11-13 hours each night and most do not nap after 5 years of age. It is not uncommon for preschoolers to experience nighttime fears and nightmares in addition to sleepwalking and sleep terrors.

Children ages 5-12 years need 10-11 hours of sleep. Older children may show signs of insufficient sleep by falling sleeping when it is not nap time, frequently waking-up tired and crabbing, seeming irritable or difficulty to please, appearing clingy, or may have a short attention span.

Here are some general tips for all ages.

19_JOERGENRUDAbel.jpgRoutines and consistency is a critical. Parents and caregivers can significantly influence a child’s sleep through scheduling and routines. Some kids do well taking a bath and reading books/telling a story while lying in bed and preparing to sleep. Reading together can be a great way to spend some quality time together and allow the body to relax. Some kids might also need some calming heavy work input prior to bath time or getting into bed for stories. One of the first things new parents learn at the hospital is how to swaddle their newborn because snugly wrapping your baby in a blanket provides calming deep pressure tactile and proprioceptive sensory input allowing the newborn to feel secure and safe. Rocking chairs and baby swings are also some of the most valued and used pieces of baby equipment because of the repetitive movement qualities that provides calming vestibular sensory input.

Some examples of calming heavy work input and movement that might help your child include massage, yoga, pillow squishes, gentle, rhythmical, and linear swinging for at least 15 minutes before bedtime. I would recommend trying simple games that don’t have a competitive nature to them since they are more likely to increase arousal level. We want our children to learn to calm down and be quiet before bedtime.

Darkness is key. Make sure that the bedroom where your child sleeps is as dark as possible and pay special attention to blocking out the early morning sun. Sunlight is a natural wake-up signal; using room-darkening shades and curtains to block out light will help your child sleep. If you are going to use a night light in your child’s room, try to make a compromise and place one right outside your child’s bedroom or opt to turn off the night light after an hour. You can also try a touch operated, battery powered night light with a timer that goes off if your child wakes up in the middle of the night and needs to use the bathroom or hears a noise and needs to be reassured briefly.

Provide some white noise. Parents and caregivers of babies can often be heard making the familiar “shushing” noise or quietly humming to quiet and calm their little ones. These repetitive, quiet sounds mimic the calming, reassuring noises the baby heard when he was in the womb. A sound machine or small fan in your baby’s room will provide a soothing hum of background noise. This has the added benefit of drowning out other noise that might otherwise wake your child

Adjust pajamas. Don’t let your child go to sleep in daytime clothes. Observe your child’s sensory preference for touch. Typically speaking, soft textures are not just comforting but it is also a tactile sign for your body to be calm and quiet down. If you are the parent of a baby, you might want to consider swaddling or using a sleep sack as they grow. Swaddling providers a snug comfort via deep pressure and tactile input that is similar to the womb space.

Look at different blankets and mattresses. Some children, especially children who might have difficulties with sensory processing, are sensitive to the feel of different textures. Blankets of different weights and materials might also be preferred at different times of the year. Weighted blankets or lycra sheets over the mattress may also be helpful options as the provide gentle but sustained deep pressure input which can be calming to the body. Some children like to create a cocoon of several blankets, prefer a sleeping bag, or some have favorite blankets that they use. I was surprised to find many different mattress textures. Try as many mattresses as possible in the store to see which is more comfortable.

plush.pngTry for natural warmth: Try tossing a blanket in the dryer or cuddling up to a warm scented stuffed animal. Warmth typically sends calming signals to the body to help quiet the mind.

Look at scents: Certain scents can have a calming effect on the nervous system and help to encourage sleep. There are a variety of different scents that can be calming.

Look at nutrition: Proper nutrition throughout the day can also significantly impact the ability to sleep at night. This can be difficult with our picky eaters but being more aware and trying to find a balance can be helpful. The biggest factors to keep in mind include:

  1. Plenty of protein
  2. Limiting carbohydrates and sugars
  3. Limiting preservatives, additives, and dyes,
  4. Having plenty of fruits and vegetables.

Incorporate heavy work during the day: Exercise helps tire our bodies out and make us ready for night. Provide plenty of opportunities throughout the day to engage in heavy work activities (i.e. push, pull, climb, squeeze, gentle rough housing). These activities can include pushing/pulling a laundry basket to the bathroom to complete nighttime routines. Inside the laundry basket include several heavy items as well as pajamas, toothbrush, toothpaste, favorite books to read, etc. The activities can also include wall push-ups to be completed by standing 2-3 ft. from a wall, placing hands on the wall, and slowly lowering body to wall. There are a ton of ideas for heavy work input. Heavy work input involves any type of activity where the person is actively moving their body against resistance.

Limit screen time: No screen time at least one hour prior to bedtime. It has been suggested that longer screen times may be affecting sleep by reducing the time spent doing other activities – such as exercise – that may be beneficial for sleep and sleep regulation. The content on the iPad can also impact sleep. For example, exciting video games, dramatic or scary television shows, or even stimulating phone conversations can engage the brain and lead to the release of hormones such as adrenaline. This can in turn make it more difficult to fall asleep or maintain sleep. Less obvious is the impact that light has on sleep and on our sleep-wake patterns in general.

Try an earlier bedtime: Contrary to popular belief, kids tend to sleep more and longer with an earlier bedtime. Ever heard of the “witching hour”? This is typically when kids are overtired and doing everything in their power to fight off sleep. If a child gets to the point of exhaustion or over tired, it can backfire on the nervous system. Just think of the nights when you pushed past your feeling of exhaustion because you just had to get that one last thing down. How did you feel later that night when trying to fall asleep? It was probably more difficult for you.

This is because when you work past your point of exhaustion it is usually because you are stressed. Stress releases the hormones adrenaline and cortisol. Cortisol normally rises and falls throughout the day and it typically highest at around 8AM and lowest between midnight and 4AM. Stress normally causes a surge in adrenal hormones like adrenaline and cortisol that increases alertness making it more difficult to relax into sound sleep. Frequent stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state impacting continually restful sleep.

We ALL need sleep, and when there are concerns, it becomes even more important. When we are not getting enough sleep it impacts our mood, behavior, and overall self-regulation.

Visit eastersealsdfvr.org for more information about our occupational therapy services.

Additional Resources:

  • Stanford Children’s Health
  • St. Luke’s Hospital Sleep Medicine and Research Center
  • American Occupational Therapy Association
  • GetYourBabytoSleep.com