Deirdre Budd’s Blog

Archive for February 2009

For many years newborn children were put to sleep on their sides, or on their tummies. Mums were told that a baby sleeping on his/her tummy, can still lift his head and turn his face the other way. Babies were seen to push up slightly on their arms and hands to achieve this.

The biggest concern of new parents has always been the possibility of Sudden Infant Death. This is a tragedy when it occurs and no one wants this to happen to their child.   Consequently when research suggested that babies would be safer if put to sleep on their backs many parents and health professionals followed this advice.  However, putting baby to  sleep on his or her back does not offer the opportunity for baby to practice turning his or her head and improving muscle strength to the neck and shoulders. Consequently there is now much effort put into persuading mums that baby should have some “Tummy Time” on the floor while awake and while attended by a parent or parents.

Now I am regularly asked, “How much tummy time should my baby have and when?”  If baby is fed, clean and comfortable, and you are willing and able to spend some time on the floor,  giving your child a few minutes each day is fine.  Children learn to roll over and make their own tummy time too. Encourage this with simple toys.

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Periodic Limb Movement Disorder PLMD – is characterised by a partial arousal or waking, with repetitive, stereotypical limb movements during sleep. Some patients are totally unaware of these movements and others are wakened by them. The movements typically occur in the legs and ankle and are rhythmical in nature. PMLD can co-exist with RLS ( see previous post) and may occur in as many as a quarter of children who have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD).

 While there are theories about the causes of PLMD there are as yet no firm conclusions. Studies show that some of the associations of RLS apply equally to PMLD. Secondary PMLD can occur where there is iron deficiency anaemia and where there are diagnosed metabolic disorders including uremia.

Regular physical exercise does seem to help sufferers both by improving the overall sleep pattern and by releasing Beta-endorphins.

Restless Leg Syndrome RLS  has been the subject of a number of research papers recently. RLS is characterised by uncomfortable sensations in the legs, this can be “like electricity/spasm/cramps/spiders crawling on legs” . Only moving the legs relieves this. The symptoms are worse or  are exclusively felt at night. It is only recently that this has been recognised in children and adolescents. In children this may appear as bedtime resistance or difficulty falling asleep. It is a common problem for adults (5-15% of the population) and it is now thought that there may be a similar undiagnosed core of children affected by this.

A  recent study looked at children diagnosed with “growing pains” to see if they also fitted the criteria for RLS.  They found that some children diagnosed with Growing Pains met the diagnostic criteria for RLS and that a family history of RLS was also common in these children. Some children had symptoms severe enough to warrant treatment with medication.

Associated problems 

  • Iron deficiency anemia and low levels of B complex vitamins are linked to RLS  and correcting these blood levels can significantly reduce the problem. 
  • Medical disorders such as Diabetes mellitus, rheumatoid arthritis, and hypothyroidism are also linked to RLS.
  • Children with Williams Syndrome are also more commonly affected by RLS.
  • About 15% of pregnant women develop RLS in the last three months of pregnancy.
  • After these women have given birth about 1 in 7 continue to have symptoms. 
  • 60% of  affected adults have a family history of RLS

Sleep is often thought of as a quiet experience but some children can be quite noisy. Sometimes this is because they are dreaming and carrying on a kind of conversation, babbling through the dreams. This is quite harmless and there is no need to disturb the child. Some children breathe nosily when asleep. This can be because of the shape of the child’s face and bone structure, because the child has a cold or respiratory infection, is very overweight, or because the child has a structural problem in the airways. Children who snore regularly during sleep may have enlarged tonsils or adenoids and it may be necessary to remove these to ensure that the child’s level of oxygen in the bloodstream does not drop significantly during sleep.

When the child constantly snores while asleep and is not well rested after sleep, it is possible that there is a degree of sleep apnoea. This can be simply checked by monitoring the child’s oxygen level overnight. Children who have this problem are often treated successfully by removal of their tonsils where they are significantly enlarged.

Any child who consistently snores or has a noisy sleep pattern should be checked out by a physician to ensure that they are not having periods of apnoea (stopping breathing) during sleep. The brain has a sensor within which detects low oxygen levels and on sensing this, the lungs and chest muscles are “kicked ” into action to encourage a deep breath to be taken. This can result in a startled awakening. If this happens regularly during the night then the quality of sleep and the sleep cycles are disturbed resulting in a sleep deficit.

Sleep is as important to the body as exercise and correct feeding. If you think your child has a problem it is important that it is checked out.

Dream-Angus.com offers help and support in assessing and managing sleep problems. Contact us for advice and support.

Sleep is made up of different stages. When we first go to bed we experience a stage of ” light” sleep where we are dimly aware of our surroundings and gradually relaxing into sleep. If we are woken at this stage we feel that we have not slept at all. This often happens with a new baby in the house. Then we progress into the second stage of sleep, a little deeper and so on until we reach the fourth stage which is deep “Delta wave” , very long slow brainwave sleep. In delta sleep growth hormone is released and the cell divison and protein synthesis necessary for growth is produced. These stages are all non REM sleep.

REM sleep is Rapid Eye Movement sleep. The brain is flushed with blood and we dream. This is the stage when babies and children are consolidating the day’s experiences and it is thought that the brain and nerve cells are developing and growing at this stage.

As we pass from one stage of sleep to another we may change position in bed and return to sleep unaware that we have woken. This is a natural occurance and can happen up to 5 times a night. Babies and small children have to learn to do this. When they are passing from one stage of sleep to another they are very lightly asleep and may cry out and waken easily. If a child has learned to self soothe then it is possible for the child to return to sleep without seeking contact with anyone. It does take several months to learn this behaviour. Some children can acomplish this by 3-4 months others take a little longer but by 6 months there is no physical need for baby to waken for feeds so, by this stage baby should manage to sleep through the night.

We have learned that adults sleep includes periods of REM (rapid eye movement sleep) and non REM sleep. Babies are a little different.

Newborns spend more than 50% of their sleep in REM sleep.  As they develop and grow this reduces to about 33% by the age of 6-8years.  A baby’s sleep cycle is about 45 minutes and an adults about 90 minutes.

When mum looks at baby asleep she may see lots of facial expressions, grimacing, etc this is a demonstration of baby in REM sleep. The brain is flushed with blood and, some believe this is what helps baby to organise and understand experiences and encouraces the development of the growing brain.

A sleep cycle consists of both REM and non REM sleep. When an adult passes from one stage to the other they may be dimly aware of being in a lighter phase of sleep and change position.  During this “lighter” phase baby is more easily roused because he has not yet learned to progress to the next  stage without waking. Most babies wake 3-4 times a night. Some will seek attention and some will sooth themselves back to sleep.

Adults go into non REM sleep more or less immediately on starting the process.  New mum’s may be in early non REM sleep when woken by baby. If this is a regular occurrence mum may believe that she has not slept at all. This contributes to the perception that baby has turned night into day and mum has had no sleep at all. Yet, if a sleep diary is kept mum’s are often surprised that they have had a few hours sleep.  If truth be told, they do not feel as if they have.

Night waking

This is one of the most common problems parents face. Although babies of 6 months are physically capable of sleeping through the night and no longer require night feeds, a high percentage of them still wake.
All children, regardless of age, wake briefly four to six times during the night. Children who do not rouse their parents have learned to self soothe and return to sleep without any intervention. Children who have come to rely on set conditions being met before their initial sleep often require that the same situation is re created before they will resettle.
This is known as “sleep Associations”. learning to sleep involves learning to sleep with the “right/good” associations so that further intervention is not required.

Sleep is a learned behaviour and we owe it to our children to teach them the best possible associations and behaviour patterns so that they can carry them throughout their lives and reap the benefits.

If your child has problems with night waking contact us at Dream-Angus.com for information and support.