baby-crying-cribIn today’s Western society, more often than not parents believe their child should be sleeping in ways that are just not biologically normal.  They expect babies to sleep through the night by 12 weeks, to no longer need to be rocked to sleep or nursed to sleep, and so on.  And of course we all know that there are people out to make money who promote these untruths so they can sell you something, so it’s no surprise these myths abound.

But somewhere in our push to help parents understand what is normal, we may have overlooked that not all sleep behaviours are normal.  Yes, far more are normal than are considered as such by society, but we also have to leave room for the abnormal, for these parents should not be told that everything is fine and just to “wait it out” when there may be a problem worth looking into.  Indeed, your child’s sleep behaviour may be the one cue that is supposed to push you to find out what exactly is wrong.

First, before we continue, I want any parent who believes their child’s sleep is abnormal to check out this series of posts on what is normal because only by understanding what is normal can we start to look at what might deviate from that.  Often parents just need to be made aware of the fact that what they have been told is abnormal really isn’t.  For example, if your six month old wakes a few times a night to nurse, that is normal.  Or if your one-year-old still needs to nurse to sleep at night, that’s normal.  And of course there are the usual regressions of sleep that come during periods of teething, growing pains, and separation anxiety.  Parents need to know about these and understand that they are normal and will pass.  [If, however, you know your child’s behaviour is “normal” but is very problematic for the family, please do not “sleep train” but rather check out these gentle resources to help you and your child… peacefully.]

So… what if you’ve read all on normal sleep and you’re still wondering about your infant’s sleep?  Let’s be honest, you’re probably dealing with one of two options:

1.  Your child wakes and cries all the time.  Like every hour or less.

2.  Your child takes a very long time to fall asleep.

What do you do?  Well, both problems have some overlapping possibilities so we’ll discuss the possibilities and which problems might stem from them, with a lot tying into the two issues.  [I do want to mention though that if you have a baby who has a health condition or was underweight or is premature,   you can expect greater wakings and feeding sessions as your baby attempts to “catch-up”.  This is a case where what may be abnormal for some is actually normal for you.  If you have a child with any medical condition, who spent time in the NICU, or was otherwise small or early, check with your caregiver about what to expect for the first few months after going home.]

Food allergies.  One of the most common problems that affects both the ability to fall asleep and stay asleep include allergies or intolerances.  For those of you breastfeeding, this means what you eat as well.  In particular, cow’s milk allergies have been linked to an infant’s ability to fall asleep and stay asleep[1][2], but celiac disease may also been implicated with sleep problems in infancy due to the excessive gas and cramping that accompany it, even in infancy[3].  In fact, given that gas is a common side effect of food allergies or even intolerances, cases often diagnosed as ‘colic’ may indeed be food issues.  Notably, one thing parents might notice right away is that their child has green poo.  While this can be indicative of other problems as well, it is a possible side effect of a food allergy.  What’s the fix?  The most common allergens or intolerances are cow’s milk, wheat, gluten, and soy.  Breastfeeding moms are recommended to try an elimination diet and give it a couple weeks to see if there are improvements (for information on elimination diets, see here and here).  Formula moms may want to try a switch to a hypoallergenic formula to see if that works.  Just remember: It can take time for the body to rid itself of all allergens so don’t expect too much too quickly.

Breastfeeding problems.  Particularly in the first six months there are many feeding issues that may result in excessive crying, interrupted sleep, or failure to fall sleep easily[4].  Some of the feeding problems include low milk supply, “bad” latch, and undiagnosed tongue ties, amongst others.  These problems often manifest in lots of crying and bad sleep due to failure to feed to satiation[5].  And like any sane person, a baby who is hungry will wake and cry as regularly as needed in order to stay alive and attempt to thrive.  Typically parents in this situation will see slower weight gain (or even loss of weight) along with the crying and waking.  What’s the fix?  These parents need to find a good lactation consultant.  Not a pediatrician and not a family doctor, but a lactation consultant who can diagnose these feeding problems and find a personalized solution to whatever the issue happens to be that you are facing.  And remember that the earlier you find someone, the better the chance at finding a solution without supplementing if this is something that is important to you.

Reflux.  I shared a guest post from one mom’s experience with reflux here and it’s worth a read if you believe reflux is just a bit of extra spit up.  It’s not.  Reflux can occur both in the way we normally think, including regular vomiting and regurgitation, but can also be silent which can make it much harder for parents to diagnose.  Infants diagnosed with reflux, or GERD, are known to suffer regular sleep interruptions[6].  On top of this, reflux can co-occur with both tongue-tie[7], lip-tie (and resulting bad latch)[7], and cow’s milk allergy[8], making the likelihood of sleep disruptions far greater than for other infants.  What’s the fix?  Co-occurring problems should be looked for and addressed via elimination diets and/or visits with a lactation consultant as sometimes these fixes can reduce or eliminate the need for reflux medication[7].  Parents should also look for a doctor who specializes in reflux or GERD.  There are medications but not all infants are able to take them and not all should.  A doctor who has specialized in this will be able to provide you with the necessary information you need to determine the best course of action for your baby.

Highly sensitive children.  I’m not talking about high-needs children here, but rather the very highly sensitive children.  They are often dismissed in the medical community which is a shame because they do require extra care and consideration.  Often parents will notice other co-occurring issues, such as crying from bright lights, too much noise, or too many people (and more), but sleep is an area that can be very difficult for them[9].  It may be because the slightest noise wakes them or there’s too much noise if you live in a city… the possibilities are many.  What’s the fix?  This can be harder because it will depend very greatly on your particular child.  I have met highly sensitive children who needed to bedshare to sleep at all well and ones where touch was too much of a stimulus and they had to sleep independently in a quiet room with a noise machine to sleep at all.  I would recommend finding support groups or reading books on sensitive children (like this one) to help you figure out ideas that may help you with your child.  [Of course, you also may have to accept a longer period of sleep interruptions as your child may not adapt to sleeping through for quite a while and in this case, it may be normal for your child.]

Another medical condition.  Is it possible that your child’s sleep problems actually reflect an undiagnosed  medical issue.  For example, although much of the research is with older children, there is a link between sleep problems and later diagnoses of Autism or Autism Spectrum Disorders[10][11].  Babies can also have sleep apnea and will need to get checked for that as it can negatively affect sleep (obviously).  What’s the fix?  If you are certain that none of the issues above are a problem and your child is still demonstrating excessive crying, wakings, or insomnia-like behaviour, you should consider finding a doctor who can help you look for other causes.  If the doctor immediately suggests sleep training, get another opinion.  Immediately.  As suggested over 20 years of research, early sleep training not only doesn’t work at a population level, but can have unintended, negative consequences for mom and baby[4].

***

Although I have focused on infant sleep herein, many of these will be applicable to toddler sleep problems as well.  However, in toddler sleep, we need to also consider some of the more psychological issues that are more prominent in that age group after the onset of separation anxiety as well as the more varied reasons for night wakings (e.g., toilet learning, nightmares which I discuss in this article directed specifically at toddler sleep).  Hopefully this piece does offer some help for those parents of infants who feel they have been suffering, have been (rightfully) resisting sleep training, but feel that being told that it will pass is simply not cutting it.  Remember: Sleep training may shut down the crying response, but it will not fix the underlying issue .  If we really want to help our children, we need to be willing to search for the cause of excessive crying and waking.  You may not find it immediately but you owe it to your child and yourself to figure it out.

For more information on sleep and what can influence sleep, I strongly recommend the following books:

    



[1] Kahn A, Rebuffat E, Blum D, Casimir G, Duchateau J, et al. Difficulty initiating and maintaining sleep associated with cow’s milk allergy in infants.  Sleep 1987; 10: 116-21.

[2] Kahn A, Mozin MJ, Casimir G, Montauk L, Blum D.  Insomnia and cow’s milk allergy in infants.  Pediatrics 1985; 76: 880-4.

[3] Tanpowpong P, Broder-Fingert S, Katz AJ, Carargo Jr CA.  Age-related patterns in clinical presentations and gluten-related issues among children and adolescents with celiac disease.  Clinical and Translational Gastroenterology 2012; 3: e9.

[4] Douglas PS, Hill PS.  Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review.  J Dev Behav Pediatr 2013; 34: 497-507.

[5] Edmunds J, Miles SC, Fulbrook P.  Tongue-tie and breastfeeding: a review of the literature.  Breastfeeding Review: Professional Publication of the Nursing Mothers’ Associations of Australia 2011; 19: 19-26.

[6] Machado R, Woodley FW, Skaggs B, Di Lorenzo C, Splaingard M, Mousa H.  Gastroesophageal reflux causing sleep interruptions in infants.  Journal of Pediatric Gastroenterology and Nutrition 2013; 56: 431-5.

[7] Kotlow L.  Infant reflux and aerophasia associated with the maxillary lip-tie and ankyloglossia (tongue-tie).  Clinical Lactation 2011; 2: 25-9.

[8] Czinn SJ, Blanchard S.  Gastroesophageal reflux disease in neonates and infants.  Pediatric Drugs 2013; 15: 19-27.

[9] Crawford C.  The Highly Intuitive Child: A Guide to Understanding and Parenting Unusually Sensitive and Empathic Children.  Alameda, CA:  Hunter House, Inc. Publishers, 2009.

[10] Richdale AL, Schreck KA.  Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies.  Sleep Medicine Reviews 2009; 13: 403-11.

[11] Schwichtenberg AJ, Young GS, Hutman T, Iosif AM, Sigman M, et al.  Behavior and sleep problems in children with a family history of autism.  Autism Research 2013; 6: 169-76.