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Sleep Specialist Appointment and Our New Bedtime Routine

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How to teach your toddler to sleep independently from you.We finally had our appointment over at John’s Hopkins in Baltimore with their sleep clinic. This was just an assessment and we saw a medical doctor, as well as a behavior specialist from Kennedy Krieger. They came in right after one another in the same office which was helpful because it was less traveling. The medical piece was a bit frustrating because we were back AGAIN at “let’s do the behavior piece first and see how it goes.” It seems like we keep getting new behavioral stuff to try and being told that if stuff doesn’t work that we can resort to checking medical problems. But the behavioral specialist actually had a good plan for us so I’m happy enough that at least we have something to DO. And it’s working… sort of. We’re currently a few weeks in and we’ve managed to get G sleeping in his own bed… without us. Getting him down to sleep is faster so we’re not spending 2 hours trying to help him fall asleep. He’s not rubbing my neck raw. Lots of good things. Unfortunately, he’s still waking up 3-4x per night most nights… we’re hoping that as we’re consistent over time that this will get better. The best part is that there’s no cry-it-out and that makes it less painful for us. Cry it out made him miserable and a mess and this method seems to be making him MORE confident about sleeping on his own- not less. Good stuff!

I want to share what we were told because I really don’t like how many BOOKS there are about sleep… I’m not sure about everyone else, but when I’m exhausted I don’t have a strong desire to read a non fiction book. If only I had that kind of time and energy. I could rule the world.  At the very least, you’d think more people would just publish a video with this information. Anyhow the following information is what he told us for us… G doesn’t have any clear signs of a sleeping disorder and I can’t promise that the information is perfect. It’s just notes that I took during the appointment. I’m hoping it will help someone else save a few hours of appointment or book reading. Good luck.

So here’s the quick and easy stuff we changed:

  • No more baths before bed. The body needs to cool down as part of falling asleep. Raising body temperature immediately before bed makes it harder for them to fall asleep. We are doing baths earlier in the day or in the morning now… he suggested keeping baths for 2 hours or earlier before bed. 
  • Keep him in a cool, dark environment for one hour before bed time.
  • Giving him an earlier nap vs. a later nap. 
  • All screens off 1-2 hours before bedtime… LCD screens can keep them up.
  • Calming activities for one hour before bed. Stuff without flashing lights and running around. Ie. Legos, books, etc. He recommended doing things in the same order every time with limited time for each activity… 5-10 minutes an activity so he doesn’t get over excited doing one thing. For example, 10 minutes pretend play with puppets, 10 minutes Legos, 10 minutes reading, etc. Having a very set routine helps increase predictability which for some kids, like mine, is important. 
  • We’re potty training and we give G the iPad for toilet time as a motivation. As we’re cutting out the screen time before bed, he suggested using bubbles to play with when he sits on potty. He said it’s a great tool for potty training. It also helps them learn to take deep breaths (like to calm down when angry). He also said we can add some solution to the toilet water and bubbles will pop up when he pees (does this make anyone else want to put the soap in their toilet water to test?! I think it sounds fun! Maybe I’ll do this before our next house party to give our guests a fun surprise!).
  • He suggested cutting out nursing before bed. Instead we’re doing that earlier in the bedtime routine. I think he meant doing it at another point in the day, but that’s hard to explain to a toddler so we’re just adding other activities between nursing and bed so he’s not “nursing to sleep”- not that he’s done that in the past year or two because apparently breastmilk is his caffeine. Ha. 
  • In our case, my husband is doing all the sleep training with G because I’ve still got to deal with our baby, but we still all do the bedtime routine together. Otherwise we’d trade off nights. The doctor felt it was helpful to have one person sit with him before bed (see the next section) rather than me sitting with him, then having to get up to get K and having Brandon taking over at that point. That just seemed a bit too disruptive.
  • Respond immediately to crying/screaming if G wakes up… by going back to our spot to help him get back to sleep (see below, right now we sit in a chair outside of his room). 
  • It’s okay to let him scream and get mad… you’re present and there to be a support, without reinforcing the behavior (ie. giving in). G actually didn’t give us as much trouble here as we expected, probably because we were still there with him and he had a slow process to get used to each change.
  • Once you decide to do this, do NOT go back to old ways. Ie. letting him sleep in our bed. It’s a nice thought, but the behavior reverts to previous behavior and you’ve gotta go through the whole process below again. Not cool. I like snuggling with my son so I try to add snuggling to other parts of our day instead to make up for it. Ie. snuggling while watching a movie, or right after nap. 

Here’s the routine to remove ourselves from bed: The idea of this plan is to “fade the parents” as part of falling asleep. At this point, he uses us as a “sleep crutch” to get to sleep. He needs up to fall back asleep every time he wakes up. Which causes a lot of issues because people NORMALLY wake quite frequently- they just put themselves back to sleep easily. In his case, he needed us. At this point, he still needs us but it’s getting better. Hoping a few more weeks we’ll see even more improvement.

We were, prior to this, laying in bed with him to help him fall asleep. He’d get mad if we had a foot out or turned away from him, etc. The idea of “fading” us was to get us eventually sitting in a chair outside of the room.

Brandon started out sitting up in bed while G was falling asleep. No talking to him once goodnight was said. If G was having trouble falling asleep, Brandon could move his hand to an item that might soothe him. If G got out of bed, Brandon would not say anything but would pick him up and put him back in. He did this a few nights until G was falling asleep okay this way.

At this point, Brandon would put one leg out of the bed while G was falling asleep. A few nights of this until G was fine.

Then he put both legs out of the bed until G eventually had a few nights of being okay with this.

Next, he sat right next to the bed in the rocking chair. As G got used to this, he’d move the rocking chair inches closer to the door until eventually we were sitting outside of the door in the rocking chair each night.

This is where we are now. It’s very quick to get him to sleep most of the time, although occasionally we have a bad night where G wakes up at an odd time and wants to stay up to play for an hour. We put him back into bed without talking to him and leave to sit in the chair until he falls asleep. Sometimes we just go in our room seeing he can’t technically see if we are there. He seems to still be checking in to make sure we’re there- so every now and then he’ll peek around corner. But usually he checks, then goes back to sleep. So far so good. I’m going to have to try this with the baby eventually, but I’m a bit scared. Haha. We’ll see.

Again, hope this is helpful to someone out there on the interweb… anyone else have any tips they’d like to share?

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