"It was incredibly useful to ask Katie specific questions regarding my situation. The advice was invaluable and I plan to implement all the suggestions ASAP."
Keeping your child cool in a heatwave ...
23rd May 2019
Keeping cool during the day:
- A longer lunch nap at home in the cot will keep your baby or toddler out of the intense heat of the midday/early afternoon sun, and enable them to get a better quality of sleep.
- When there is direct sunlight into the bedroom, keep the blinds/curtains drawn. Open them again when the sun moves around the other side of your home.
- Only use a breathable blackout shade over a pram/buggy or car seat. They are very effective for blocking out light and distraction and can really aid naps on the go but a normal muslin, sheet or blanket could heat your child to a dangerous level.
- Give your baby or toddler opportunity to play in water to keep them cool.
- Find shady spots outside and don’t forget a hat.
- Park your car in the shade where possible and take shoes/socks/layers off for longer car journeys as babies, especially, get very distressed when they’re too hot in the car.
- Run a tepid bath at bedtime, rather than a cold one, as our body temperature can rise to try to counteract the cold.
- Keep your baby or toddler well hydrated during the day and before bed.
Keeping cool at night:
- Increase air flow with windows open and the door slightly ajar.
- A fan can be helpful in the room where your child sleeps but don’t position it directly towards their face.
- Hanging a damp towel (soaked in icy water) or placing a bowl of cold water and ice in front of a fan can help too, so that the water evaporates.
- Make sure your baby is in an appropriately-sized cot for their age so that they’ve got enough space around them without touching the sides when they stretch. Most babies are ready for a full-sized cot between 3-4 months.
- Don’t have blankets or soft toys in the cot around where your baby or toddler is sleeping and make sure that the sheet is fitted.
- If your toddler sleeps with a duvet, keep the cover as a sheet so that it stays familiar but remove the duvet from inside and then tuck the cover under the sides of the mattress so that it stays more securely over them.
- If your toddler wakes during the night feeling hot, flip their pillow over to the cooler side.
- Feel your baby’s chest or the back of neck rather than their hands or feet as a good indicator of their body temperature.
What to dress your child in at night:
- Adjust what your baby or toddler wears according to the temperature in the room and establish whether there’s a significant drop in temperature overnight too.
- For 18-20°C – 1 layer (sleepsuit or light pyjama top and bottoms) and 2.5 tog sleeping bag
- For 21-23°C – 1 layer (long or short-sleeved vest) and 1 tog sleeping bag
- For 24-27°C – 1 layer (short sleeved vest) or just a nappy and 0.5 tog sleeping bag
- Above this – just a short-sleeved vest or nappy with no sleeping bag
Managing the clock change on the 31st March
12th March 2019
The clocks go forward on the 31st March at 1am.
If you're keen to preserve an earlier bedtime and your evenings, or you're a working parent and your child needs to maintain their daily routine for childcare, nursery or school the following week, then it's a good idea to actively help your child return to their normal bedtime as soon as possible, otherwise they could be missing out on overnight sleep.
You could start adjusting their body clock a day or two before, or just on the day of the clocks going forward, by around 15 minutes. Over a period of 4 days, the idea is to start each day gradually earlier, or reduce the daytime sleep, so that bedtime can come forwards incrementally. If your child is on an earlier bedtime pre-7pm or you'd like to shift their sleep-to-wake cycle a little later permanently, go with the clock change and only adjust as needed.
If they generally sleep from 7pm – 7am, for example, wake them around 6.45am on the 29th or 30th, or 7.45am on the 31st, or reduce one of their daytime naps by 15 minutes. Adjust all timings for the day and then you can try an earlier bedtime of around 6.45pm on the 29th or 30th, or 7.45pm on the 31st. If your child wakes earlier anyway during this period, or you usually cope with early starts and play catch-up with naps and the day to help them through to bedtime, then just adjust all timings for the day a little earlier accordingly. The key is to shift everything in the day routine, including feeds, meals, naps and the bedtime routine.
If your child is around 6-8 months and in the transition to two naps, try dropping the third nap so you can just bring bedtime forward. Repeat on subsequent days. If your child is around 12 months or over and in the transition to just one nap, you can use the clock change as an opportunity to try dropping the morning nap, so that they go down for one long nap after lunch around 12/12.30pm (which will actually be around 11/11.30am for their body clock).
10 top tips for working parents to make sleep training more manageable and successful ...
25th January 2019
1) Keep a detailed diary for 48-72 hours tracking sleep, feeding/eating and activity to give a realistic overview of the issues and patterns of your child's sleep and behaviour - when you're exhausted, frequent night wakings are hard to keep track of.
2) Rule out any underlying digestive or health issues affecting your child's comfort levels
3) Tackle the quick wins first: optimise naps, adjust sleep environment, review sleep hygiene and the bedtime routine etc.
4) For a more intensive plan, try to clear 2-3 weeks in your diary so that you can keep consistency in your child's familiar home environment
5) Implement change at bedtime on a Friday night or when you have the longest period available with support or off work
6) Review the consistency of your child’s routine if they have different childcarers so that you can keep their body clock well regulated
7) Divide the night or share settling with a partner if you can
8) Think about whether any chores can be outsourced or friends/family can help
9) Changing habits and the way brain processes sleep and associations takes time, so be patient with progress when you’re working gently with your child
10) Get yourself ready for bed and eat dinner early ahead if your child's bedtime if you can so that you can devote the evening to helping them settle and resettle in a new way without getting frustrated
Diagnosing and managing a cow's milk allergy in the first year of life
26th November 2018
If a cow’s milk allergy is being explored as a possible cause for your baby’s symptoms, there are now some very clear, updated guidelines for presentation of suspected CMA in the first year of life, as well as how it should be managed by primary clinicians.
Allergies can cause unsettled sleep and more frequent night wakings, as well as skin, gut and respiratory symptoms, so getting to the bottom of the food that is causing problems is likely to unlock better health, wellbeing and sleep for your child.
Here’s a summary of the iMAP fact sheet published for parents:
Food allergy has become more common and happens when a child’s immune system wrongly reacts against some of the proteins in food, thinking they may be harmful. This will then result in either the onset of an immediate allergic reaction or a more delayed onset reaction.
The typical mild-to-moderate symptoms include one or usually more than one of the following:
• Irritability (colic), reflux, vomiting, refusing or disliking being fed, loose or frequent stools, constipation (especially straining to pass even a soft stool), signs of pain in the tummy, a little blood or slime in the stools
• Itching of the skin, redness of the skin, a tendency to ‘rashes’, eczema
• CMA is more likely to be the cause of these symptoms if there is a history of eczema, asthma, hay fever or food allergy in any close family members, but does not have to be present.
There are no skin or blood tests for delayed onset CMA. The only reliable test is to take all the cow’s milk protein out of your diet if you’re exclusively breast feeding or out of the diet of your baby if they're bottle fed by switching to an extensively hydrolysed formula, and then to later reintroduce it in a planned way.
The period of exclusion should be up to 4 weeks (minimum or 2), as this is the time it may take for the symptoms to improve. During the trial, the symptoms will either begin to clearly improve, suggesting the presence of CMA, or there will be no significant change, which usually excludes the diagnosis of allergy.
At the end of the trial, it’s really important to reintroduce the cow’s milk protein. This will then show you whether any clear improvement seen in symptoms during the trial was actually due to CMA and not just your baby improving naturally. If allergy is the cause, the symptoms can be expected to return within a few days of reintroducing the milk protein, but will usually settle well again as the milk-free diet is restarted. If the diagnosis is confirmed, these guidelines are here to ensure that your baby gets appropriate care and the on-going support of a dietician.
Immediate onset of CMA:
• This usually affects older children and often due to other foods, such as egg, peanut, tree nuts or sea food. But it can also occur with cow’s milk and most commonly when cow’s milk-based formulas are used as top-ups or later when weaning with solids and dairy is introduced (yoghurt, cow’s milk, cheese etc).
• Symptoms usually develop within minutes following ingestion, which may be mild, such as reddening of the skin, hives and puffiness around the mouth or eyes or less common is anaphylaxis.
Click @05 for a link to Allergy UK's resources and the guidelines maps, which you can take with you when seeking a diagnosis or making an initial appointment with your GP.
How to improve your child's sleep hygiene for a calm, positive bedtime
12th August 2018
GOOD SLEEP HYGIENE is one of those terms that sleep consultants use all the time. This blog post explains how to achieve this and how you can improve your child’s sleep without resorting to more traditional sleep training programmes.
Many sleep training techniques take time and effort to undertake, and I know many parents often feel overwhelmed and daunted by the probability of getting even less sleep in order to address night time behaviour, so beginning with some simple strategies for bedtime, as well as in the lead-up to bedtime, is a great place to begin.
Facilitating time to wind down before the bedtime routine starts, establishing a series of predictable soothing cues and positive associations with the bedroom as a peaceful, restful place, using optimal lighting away from bright, social spaces and getting the awake time right, together in sequence, will all help to promote a calmer bedtime and a better quantity and quality of night time sleep, whether your child is 6 months or 3 years old.
Choosing a set bedtime:
An ideal bedtime is between 7-8pm as this is when melatonin rises. Choose a bedtime and routine that is manageable for your family across the week and weekend, so that you can consistently begin at the same time each night and follow the same sequence of calming stages that lead to your child being settled in their cot or bed. Aim for no more than 30-45 mins from start to finish so that the cues for sleep aren't lost, keeping it focussed around the bathroom and bedroom, so that you’re not bringing your child back into a light, social space they associate with play.
Benefits of a bath:
A daily bath is a great way to begin your bedtime routine each night as it’s a wind-down activity at the end of the day when children are starting to get fussy and tired, it signals the beginning of the cues for night time sleep and the drop in core body temperature coming out of the warm water is a key sleep trigger. In hot weather, just run tepid water so that your child doesn’t overheat.
Swapping screen time for calm play:
We know that the blue light emitted from screens interferes with the production of melatonin, so turn TV and screens off after dinner to give your child’s brain time to unwind and recover. Try some calm play strategies instead before you run the bath, like a filling a ‘treasure bag’ with items to pull out and explore, jigsaw puzzles or shape sorters. If time between returning from work/collecting from childcare and bath time is squeezed, even just 5-10 mins of quality parent-led calm play can make a difference to help your child wind down after the excitement of seeing you, as well as giving their love tank a boost before bed.
Keeping the bedroom as a place of refuge and sleep:
Take away anything from in or around your child’s cot or bed that could be distracting or emits a glow, like a mobile, light show or lots of soft toys. If you have another area in the house for play, it really helps to keep most toys out of the bedroom, particularly anything that’s overstimulating, like toys that are big, bright and noisy. Declutter the floor so that everything can be tidied away out of view and out of reach as part of the bedtime routine, as well as for nap time.
If your child is exhausted and crashing out at bedtime, look at increasing daytime sleep or shifting bedtime a little earlier, even just by 10/15 mins to begin with. ‘Crashing’ asleep changes the architecture of the sleep cycle and does not allow a child to experience the gradual shifts in sleep state as they fall asleep. This can be one reason why they wake up after the end of each sleep cycle as they are unfamiliar with the changing sleep state. Conversely, if it’s taking a long time for your child to fall asleep each night, it’s likely that they are just not tired enough and you need to increase sleep pressure by reducing daytime sleep or increasing awake time before bed (particularly if bedtime is earlier than 7pm).
Optimal sleep latency:
The optimal sleep latency (the time it takes your child to fall asleep) is around 15 mins. It’s hard to accurately measure but you can get a sense of whether you child is ‘crashing’ or falling asleep gently. As children drift into sleep, they often move around, toss and turn, move their head from side to side, clear their throat or make murmuring noises. Once deeply asleep, they become very still and quiet and breathing becomes soft and steady.
Nutrition for sleep:
Avoid refined carbs, sugary or caffeinated foods close to bedtime. If your child has an early nursery tea and is hungry when you pick them up, stick to foods with protein and fibre, like egg or peanut butter on wholegrain toast, bananas, oatcakes or natural yoghurt, rather than sweet cereals or treats.
Children’s eyes are more sensitive to light than adults’ so in summertime especially, it can help to start dimming lights/closing blinds and curtains around the house and using a dimmer light in the bathroom too. Really effective blackouts are a worthy investment so that light doesn’t creep around the edges at bedtime (or from sunrise for those early risers). If your child is afraid of the dark, choose a red night light and position it away from the cot and their eye line, as this will inhibit melatonin less.
Benefits of exercise:
Try to do at least 1 activity a day that gets your child’s heart rate up and plan for lots of outside play and fresh air. Bouncing is a great activity for babies not yet on the move, set up an obstacle course in the house if it’s raining or try some baby/toddler yoga or dancing together. Toddlers, especially, have boundless energy and they need to expend it during the day!