Most sleep problems are behavioural in origin i.e. they are caused by learned behaviours baby cannot recreate e.g dummies falling out, patting, rocking and feeding to sleep.
So when do you decide sleep training/learning isn’t working and call it a day?
Babies with behavioural sleep problems are able to achieve a good sleep pattern, self settling within 2-4 weeks. Toddlers can be a different story entirely. Even taking a couple of months to get there.
Once you’ve got to week 2 and things are not improving it’s time to reassess. To keep on doing the same thing, that is not working is counter productive. As a baby whisperer, registered nurse and midwife I’m able to see when things are OK or not. It’s important to know medical conditions can cause sleep disorders.
I’ve come across a few of these babies and children and they stand out.
Organic/medical causes of sleep disturbances in babies and toddlers
- Reflux – GORD (gastro-oesophageal reflux disease)
- Tonsils and adenoids – enlarged resulting in sleep apnoea, these babies will snore.
- Food allergies, particularly cows milk protein allergy and digestive disorders. These cause gut pain and I’ve had a few toddlers with severe food allergy. Some undiagnosed until 18 months, reflux and sleep disorders.
- Sleep apnoea. Always investigate snoring in babies and children. It isn’t normal.
- Fungal/candida and urinary tract infections
- Iron deficiency anaemia
- Medication and inhalers – Use of ventolin and other steroidal inhalers used close to bedtime can hype some children and prevent them going to sleep. Check the side effects of prescribed, over the counter medication or homeopathic treatments your child is taking.
- Ear infections
- Neuromuscular disorders e.g. cerebral palsy
It’s important to look at family history of atopic disease.
Is there asthma, eczema or hay fever in the family? It’s important to check for food allergies. Asthma is the biggest predictor and not to give mums any more mothers guilt, particularly on the maternal side, it is an issue. Look at the medical history of grandparents, siblings and close family for patterns of these things.
Another biggie is SNORING. Babies and children should not snore. Any snoring needs investigating. Sleep apnoea, tonsils, adenoids and sinus issues are common and very treatable. We just need to identify it and do something about it. Snoring and sleep apnoea reach a peak at 2 years. Tonsils and adenoids naturally enlarge at this age.
You may see the following in young children with sleep apnoea
- During sleep, they tilt their head and neck back to stretch open the airway. This sign has the highest correlation with a positive sleep study.
- They may snore, although up to a third do not. Some parents just describe heavy breathing.
- Parents may note occasional pauses in the breathing, gasps and choking noises. Children are more sensitive to apnoea than adults. Even 1 – 3 seconds of apnoea is significant.
- They tend to be restless and can pivot around the bed. Parents who co-sleep often note kicking. Waking one or more times at night is common.
- They may be sweaty at night.
- Bedwetting is sometimes seen.
- Some are skinny because they are burning up calories at night, working hard to breathe.
- They prefer a mushy diet such as yoghurt, cheese and pasta. It is easier to swallow soft food if the tonsils are bulky.
- Bulky food like meat tends to make them gag or spit.
- They may have a crossbite and high arched palate
- Some have a dry mouth and lips whilst others dribble a lot and have dark circles under eyes
If obstructive sleep apnoea (OSA) is untreated, it will have an impact on the developing brain. While adults with sleep apnoea become tired and forgetful, children become hyperactive, although they can also be tired and cranky especially at the beginning and end of the day. Toddler behaviour problems may be mistaken for ADHD. I see heaps of these kids.
If there are positive findings for sleep apnoea, refer the child for a sleep study with a paediatric sleep physician or review by an ENT Surgeon.
Here are a list of good ENT surgeons and sleep specialists I commonly recommend to parents.
Australian ENT and Info
- Dr Ian Jacobson – Royal Randwick tel 9398 3039
- Dr Gillian Dunlop tel 9487 7877
Australian Sleep Physicians and Info
- Dr Arthur Teng – Sydney Childrens Hospital Sleep Clinic and he has rooms at 66 High Street, Randwick tel 9310 0606
- Dr Chetan Pandit – Chatswood tel 9411 8888 – http://www.kidsallergy.com.au/about/dr-chetan-pandit
Common treatments for obstructive sleep apnoea are:
- Corticosteroid nasal sprays
- Removal of tonsils and or adenoids
- Orthodontic treatment
- CPAP airway devices
- Mouth and jaw splints
Left untreated, OSA is associated with risk of cardiovascular, neurodevelopmental and ongoing respiratory health problems.
So hopefully I’ve given you things to think about if sleep training on your toddler isn’t working. It’s maybe time to reassess and get another opinion. Is there something else medical going on?
It’s important to speak to your doctor about these types of issues.
With my medical training, I’ve worked with many parents to resolve medical and behavioural sleep issues. Read one of my many case studies here: Complex medical cases and sleep training
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Some more helpful reading below