Ask us anything #1 (Ep 6)

Episode Transcript
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(00:02):
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(00:27):
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(00:50):
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Enjoy the show.
Okay, welcome back to the sleep edit.

(01:11):
This is going to be our first, Idon't know if it's ask us anything.
Mailbag episode.
I am Dr.
Craig Canapari.
I'm Ariel Greenleaf, certifiedPediatric Sleep Consultant.
Oh
we asked you these fewquestions and my son said these
Yeah.
which I think is actually incorrect.

(01:32):
deese nutz, yeah.
But
he has a lot to learn.
it was the only one like that I got.
We solicited questionson Instagram via email.
We also have a email for the showpeople can send questions to for future
episodes, the Sleep Edit show@gmail.com.

(01:54):
Let's get into it.
Let's go through theseInstagram ones first.
They're short and
All right.
Okay.
What should the light setup be in a toddler's room?
The light set up.
You know what, I get this a lot actually.
And what I would say to parents is,pitch black is the best but a lot
of toddlers and younger kids likenightlights my kind of rule of thumb

(02:17):
is first of all, it should be darkenough in your kid's room that you can't
read while you're sitting in the room.
Read a book.
And second of all, if your childinsists on having a light, make it so
the light is not shining directly intheir eyes, you can sometimes put a lamp
behind a piece of furniture, et cetera.
The less the better.
Yeah, I think sometimes people come to meand Their problem is, oh he has to sleep

(02:41):
with the light on And obviously that'sjust not conducive to healthy sleep.
Yeah.
And there's lots ofdifferent things you can do.
I think in the last episode with Dr.
Gray, we talked a lot aboutresources for fear of the dark.
Can be very useful.
Yes, absolutely.
I think It's best to say asdark as possible until your

(03:04):
child says something about it.
And they may never say somethingabout it, but it may become a
thing around the toddler years.
But certainly an infantis not afraid of the dark.
Yeah.
So Ariel, this is a good one for you.
Can you immediately stop usingpacifier when sleep training?
So pacifiers can become a dependency.

(03:29):
And if they're a problem atnight, then it's best to just
eliminate them for all sleep.
And saying that it's scarier fora parent than it is for the child.
So the sooner you can eliminatethe pacifier, the better.
I would say it's very hardto eliminate a pacifier.
With a child over the age of 12months, probably until age three.

(03:51):
And sometimes it can really backfire.
So in those cases, I often say let'skeep it until the child has a more, has a
better understanding of, reason you couldreason with them a little bit better.
That's also the time, agethree is like the time that we
recommend for transitioning toa big kid bed or a toddler bed.

(04:14):
Similarly, I just find it's verydifficult to get rid of the pacifier
before age three, but I, so I wouldrecommend doing it as young as possible.
And no, after the newborn stage,obviously, 'cause it's, it is a
preventative measure for sids, but afterthe newborn stage, let's get rid of it.
Yeah, I was gonna say wemissed that six month window.

(04:36):
So then we had to do this elaboratepantomime with the Binky Fairy coming.
And I remember my younger son just,he's okay, you're taking my pacifier.
I'm taking my nap away from you.
And that was
Ugh,
so yes, sometimes there's retribution, butI think it's a lot harder to take it away
from like an 18 month old or a 2-year-old.
That being said, there's two concerns.

(04:57):
One are you having to replace it amillion times in the middle of the night?
Then you might need to get rid of it.
The second is, is there any concernabout the child's dentition?
And really, it's not a concern typicallyuntil your child starts losing baby teeth,
yeah, absolutely.
I also, I missed the memo on gettingrid of the pacifier, so my daughter

(05:17):
had one until about age three, andthen I was able to show her that there
was like a crack in it, and she sawthat it was dirty and that grossed
her out, and she was done with them.
She was a little fussy like thefirst night, but after that it
was like, it didn't even matter.
Well, there you have it.
Just swap your child's fear ofnot having the pacifier with
germophobia and you're all set.

(05:38):
Yeah.
the here's a good one.
How to introduce room sharing.
And I think there's a question a littlebit further on about this, but I'd say
that in general, parents overestimatethe difficulty of room sharing.
It's a relatively recent idea and inonly in really western countries that
kids are gonna have their own room.

(05:58):
And that often parents I think,worry about this more than.
think they need to.
The idea is that you room share butnot bed share with your infant for
at least the first six months of age.
So it's not like when there's a newbaby that you're necessarily moving
them right into the older siblingsroom, which is the hot button time
when parents are worried about it.
Most parents do just fine withroom sharing and the parents really

(06:22):
shouldn't feel guilty about it.
I see the question is more aboutintroducing room sharing to siblings.
Is that correct?
yeah, I it's a short
Yeah, I know, it can't possiblybe introducing it with parents.
So I would say from my perspective,when I'm in a situation where, for
instance, there's a baby and there'sa three-year-old or something and they

(06:45):
want the baby, they wanna move the babyout of the room into the siblings room.
'cause I've had this a lot, a lot oftimes people are like, I need the baby
to sleep better so I can move them intothe toddler's room or the big kid's room.
And so I always recommend doing the sleeptraining in the parent's room and then

(07:06):
moving once that's done, moving the chthe baby into the older child's room
In many cases, what we do isremove the parents from that room.
If, sometimes they're sleeping on acouch, it's just a couple of nights, and
then they go back into the room, baby'ssleeping better, and then they can make
that transition to the older child's room.
So I don't recommend sleep trainingthe baby in the older child's

(07:31):
room with the older child there.
Yeah it is.
I think it, it is possible especiallyif the older child goes to bed later.
Sometimes I've had parents sleeptrain the if they're already in
the room, have actually move theolder child who's sleep, right?
It's usually the older child who'ssleeping better into the parents' room

(07:52):
for a few nights is another way to do it.
For the middle of the nightawakenings, they tend to actually
disturb the older siblings less thanparents think they will, because,
little kids sleep so deeply.
It tends to be less of anissue than people anticipate.
And that's similar to multiples.
So if you have multiples, parents arealways freaked out that the twin or the,

(08:13):
whatever is going to wake the other.
And in almost all cases I'veexperienced that's not the case.
They sleep right through it.
Here's a good one withouta really clean answer.
Tips for jet lag when flying overseas.
Kids waking up at midnight to have dinner.
Ooh, I'll let you take thefirst stab at that one.

(08:37):
Sure.
First of all, in my experience, a lot ofthe times the kids adjust more quickly to
the new times than the parents do anyway.
For parents on relatively short trips.
if you're flying east, so all of a suddenyour child's natural bedtime is at eight,
you fly to Europe, their natural bedtime,is like midnight or one in the morning.

(08:58):
It can actually be, if you have a shorttrip, like three or four days it can be
fun to just stay in the later schedule.
European hotels and homes tend tohave these really wonderful shutters
where you can keep it very darkand just to have your kids stay up
later and stay on this home scheduleis often the easiest thing to do.
It's actually a little bit harderto fly west because all of a sudden

(09:21):
your kid wants to go to bed reallyearly and get up really early.
That's less fun for parents thanbeing like, oh, we're going out to
dinner in Paris at, at nine o'clockat night, it's oh, we're we're seeing
California at three in the morning.
I would say that generally there'sno kind of magic solution here.
If you know your kids are goingone way or the other, you can try

(09:41):
to habituate them a little bit.
Melatonin honestly is tricky.
Jet lag questions are hard becauseyou really need to know the time
zone someone's originating from andwhere they're ending up and what
their sleep schedule is to providegranular information about the timing
of melatonin or light exposures.
There are calculators for this online,and it's more, it's same for kids and

(10:01):
for adults, but I'd say most of the time,if you're going for a really short trip,
keep them on the same schedule if you can.
If you're going for a longer trip, they'reprobably gonna habituate pretty quickly.
You?
Yeah, I usually just suggest gettingthem outside and into the sunlight
if they're able to and try to.
Not force the schedulelike a normal schedule.
It depends.

(10:22):
Again, it depends on howlong they're going for.
So if they're going for a longer trip,I just encourage getting outside into
the sunlight, trying to reset the clock.
'cause sometimes I've had people who,they go visit family for a month in
the summer or something like that.
And so in those cases, sunlight is yourbest friend, in my opinion, when it comes

(10:43):
to adjusting to any time differences.
Natural light is very helpful.
And also just being a little bit carefulwith screens I think in general, light can
be tricky if you're doing longer trips,like going 12 hours or more, light can
sometimes push you the wrong direction.
But that's prob that'slike a whole discussion.
For most vacations people are traveling.

(11:04):
three to five hours where it's enoughthat they may feel it a little bit, but
it's not so far that it's a complicatedmath problem to figure out what to do.
Okay.
Okay, here's one.
How much movement during sleep is typicalin an elementary schooler and how can I
tell if my child is getting quality sleep?

(11:26):
Solid bedtime routine andappropriate bedtime are in place?
Oh, I've got this one.
This is I think this is avery interesting question.
Generally little kidsmove more than grownups.
If a child's got a solid bedtimeroutine and going to sleep without
difficulty, that's one box youwant to check because some children

(11:47):
who move a lot at night do have acondition called restless leg syndrome.
They will complain that their legs botherthem at night, but sometimes they'll
just say, my legs are, my feet are hot,or I feel like there's ants on my legs.
Sometimes they may not say anythingabout them, but the parents will
just notice they're fidgeting,they're kicking a lot, et cetera.

(12:08):
But the key is they're havingproblems falling asleep as well.
If a child is falling asleep at bedtimewithout complaint, they probably
don't have restless leg syndrome.
The other thing to think about isthere is a newly described disorder
called restless sleep disorder.
This is adjacent to restless legsyndrome, but there's no sensory
phenomenon in the evenings.

(12:29):
But parents will describe theirkids flopping around like a fish or
helicoptering around the bed, like sortof kids whose blankets are everywhere.
The key part of that diagnosisis that children are also
struggling during the day.
They may be, have difficulty gettingout of bed, which is again, not
typical of a younger child moretypical with adolescents or have having

(12:52):
irritability during the day, et cetera.
If you're concerned about that, typicallyit's a good idea to see a sleep physician.
Usually is a sleep test involved in thediagnosis and the treatment is usually
checking a blood mi iron marker calledferritin and treating that if it's low.
So yeah, if your kid flopping around alot at night they're getting what seems

(13:12):
to be an appropriate amount of sleep,but they're having problems getting up,
but they're irritable during the day.
It's probably worth talkingabout with your pediatrician.
That's interesting.
I think a lot about my clients of younger,on the younger side, so infants young
toddlers and parents are always concernedabout children moving in their sleep.

(13:35):
She must not be sleeping.
She's moving around and I.
I would say probably 90% of the timeit's just they're moving in their sleep.
And I think there's definitely, yousee the ones who are cause for concern,
but I would think that, how, whatpercentage of children suffer from

(13:56):
that particular, medical diagnosis?
Yeah, I think they restless leg.
It's not uncommon.
It's probably 3% of kids whichdoesn't sound like a lot, but
most kids don't have any problems.
Restless sleep disorder is newer, soit's more like the prevalence of kids
presenting to sleep clinic, which ofcourse is a highly selected group of

(14:17):
people that have access to a sleep clinic.
Somebody's concerned enoughto ask for a referral.
They've waited long enough for a clinicand the prevalence, there was like 10%
of kids referred to a sleep clinic.
I would say yes, most of the time yourkid seems to be sleeping and they just
move and you don't know it unless you goon a vacation and share a bed with them.
typical history of these kids whenI see them in clinic is oh yeah,

(14:39):
there's one kid in the family.
No one wants to share a bed withthem when they go on vacation.
yeah, I'm thinking more of, moderntechnology and parents, you and I both
have feelings about video monitors butparents really just freaking out because
of what they can see on their monitors.
Yeah.
It's one of those things.

(15:00):
Sometimes ignorance is bliss.
All right.
Do you wanna get into melatonin?
yeah.
Let's get the melatonin.
talk about melatonin.
About seven weeks ago, we began givingour daughter melatonin each night at
the suggestion of her pediatrician.
After years of having troublefalling asleep and being a restless
sleeper, she is now falling asleepquickly and sleeping soundly.

(15:23):
But how long do we continue this?
Our daughter doesn'twant to stop taking it.
That one's from Christina.
And you know what, Ariel, whydon't you read the next one too?
'cause I think these are related actually.
Kenzie says, what are yourthoughts on melatonin?
Our pediatrician said, if yourchild is not sleeping well, the
benefits of melatonin for a shorttime probably outweigh the risks.

(15:47):
But what does the datasay about long-term usage?
That's a great question.
And that's from Kenzie.
So I think this is Areally important topic.
the background is melatonin is ahormone that your body naturally makes.
Typically melatonin is undetectablein the blood till about an hour
before your habitual sleep time.
It starts to rise up when it'sfirst detectable in the blood.

(16:10):
We call that the dimlight melatonin onset.
And melatonin secretion continuesthroughout the night until
an hour after you wake up.
When you take melatonin over thecounter, it is way over the amount of
the physiologic amount that is beingsecreted in the blood and melatonin, if
you take it the fancy word is exogenous.

(16:32):
If you take a melatoninpreparation has two effects.
Most people who are giving theirchildren melatonin, are looking
for the hypnotic effect, whichis the sleep inducing effect.
That does not happen in every person.
But it happens in asubstantial number of them.
So some parents will try melatoninand be like, oh, it didn't work.

(16:52):
There's no reason tokeep escalating the dose.
The other is the chronobioticeffect, which is the effect
on sleep schedule adjustment.
M relief, dosing for that.
That's if someone is staying up superlate, you wanna move the schedule earlier,
we'll use a very low dose of like quarterto half a milligram at dinner time.
So talking about hypnotic dosing andmelatonin, first of all, I would applaud

(17:12):
both of these parents because they discussthis with their children's pediatrician.
Certainly I can tell you that melatonin,although it's over the counter, it's
a hormone and I can't, the only otherhormone I can think of that is taken
over the counter is, believe it ornot, vitamin D is also a hormone.
But, other hormones we think of thatpeople may be prescribed are things like

(17:33):
testosterone or progesterone or estrogen.
because of some.
Complicated issues about theway melatonin is reg regulated.
It's treated as a food supplementand the quality is not that good.
Sometimes the dose ishigh, sometimes it's low.
Short term melatonin dosed appropriatelyseems to be totally fine, like

(17:54):
safe if you're giving it withthe advice of a medical provider.
You're also working on behavioralsleep issues at the same time because
it's not magic, it's not anesthesiaif there's other stuff going on.
If your bed bedtime is mistimedit can be very helpful.
The appropriate dose for someonewho's less than 40 kilograms, which

(18:14):
is about 88 pounds, is one to threemilligrams for children over 88
pounds or 40 kilograms in the uk.
Or else, anywhere else in thecountry, in the world, would be
up to five milligrams really.
I start people on half amilligram of melatonin.
I like ones that have third party testing.
for example, say NSF tested startat half a milligram and slowly

(18:40):
titrate up by a milligram a week.
And I'd say use it for a couple ofmonths while you're also making sure your
child doesn't have a device at bedtime.
Making sure the bedtimeis age appropriate.
In situations like this, for Christinaa child having long-term difficulty
struggling asleep, one of the terms forthis is chronic insomnia of childhood
and melatonin is well studied in it.

(19:02):
It definitely can be helpful and itsounds like it may be with the other
child for a short term trial, it's lessclear what the background history is.
We actually don't know what theeffects are of long-term melatonin,
but the limited data we haveBeth Malow, who has done a lot of
research on, melatonin in autism.

(19:22):
It did trials of about a year showingthat it did not lead to premature
puberty or changes in hormoneprofiles in children with autism
taking melatonin for about a year.
That being said, I think like withany medication, we use it for the,
that we use the minimum dose we needfor the shortest period of time.
So when parents are interested incoming off of melatonin after they've

(19:44):
been using it for a while, oftenI'll just ask 'em and be like, just
see if you can cut the dose in half.
If it's more than a minimal dose,more than half a milligram or a
milligram, and see how that goes.
Try it for a little bitand then try skipping it.
And it may be a disaster in whichcase I think you could restart and
then try again in a month or two.
Recognize though, there is alsoa psychological dependence when

(20:05):
somebody said, our daughterdoesn't wanna stop taking it.
And I think it's worth with, Idon't know how old that child is,
but it's worth thinking about.
To talk about your child, belike, oh, some, we're gonna,
we're gonna use this for a while.
We're not gonna stop it without a warning.
But think about when you feelcomfortable, we might try without
it and see how it goes and enlistthe child in making a plan.
And now we're gonna get a guest onto talk about melatonin in detail.

(20:28):
Yeah I, it's what concerns me ishow readily available it is and
how quickly parents just grab itoff the shelves at Target or CVS
Without understanding it really.
And a lot of times I'll see inFacebook groups moms who say, I've

(20:51):
been giving my child melatonin andthey fall asleep right away, but
they're still waking up all night.
Why is that happening?
And again, it's likepeople don't understand.
I think you make a good pointthat you need to be looking at the
behavioral at the same time becauseI think people see that as the only
solution to whatever their problem is.

(21:14):
'cause there have beenseveral, another article about.
Overdoses in young children becausethey find the gummies and they're
taking too many but sometimes parentsjust don't know what they don't know.
And like you said, the dosages aretotally different on, you could take
four different brands and they're gonnabe totally different from each other.

(21:35):
So that's concerning to me.
And it is just a bandaid in many cases.
So that's, concerningfrom that perspective.
I would say that there's someimportant things you just said.
First of all, yeah, it'sbasically candy, right?
It's a gummy.
We used to think that it waspretty, the overdoses weren't
serious, but there was a big trial.
It's definitely one of the mostcommon reported accidental ingestions.

(21:57):
And a small subset of children weregetting hospitalized, and they even
reported a few deaths associated with it.
So it is not totally benign.
The other thing is that themelatonin dose is too high, can cause
nighttime awakenings and nightmares.
So parents are like, oh my God,my kid's falling asleep great, but
they're waking up in the middleof the night and you're like you
probably need to cut your dose back.
And sometimes it actuallyworks better at a lower dose.

(22:17):
So that's why starting at a lower doseand stepping up, it's much more helpful.
Now, there are a subsetof conditions that.
It's very helpful in, and there's a lotof evidence for one is attention deficit
hyperactivity disorder, another is autism.
So as a pediatric NP nurse practitioner,I frequently get questions on how
to help parents of children withautism, especially regarding them

(22:40):
getting them to stay in their bed,calm down and sleep through the night.
What advice, meds, or resources doyou recommend, and that's from Jen.
so we talked about melatoninand there is a lot of evidence.
I think the first key is.
I guess for the next question toyou is behavioral methods do work
as well in children with autism.

(23:01):
But they often need more time andthey need to go more gradually.
And should back up if anyone'snot, most people are familiar with
the term autism, but autism is aneurodevelopmental disorder associated
with like rigid and behavior and kindof stereotype behaviors like repetitive
behaviors and social difficulties.
It's becoming more and more commonfor reasons we don't understand.

(23:21):
And it really, from a sleep standpoint,it can be incredibly challenging.
Every child with autism has sleepproblems, but many of them do.
In my world, often kids will presentto my clinic at age one or two.
The parents are doing everything rightand their sleep is totally dysregulated.
It's all over the place.
And often I feel like those kidstend to go on, especially if

(23:45):
there's developmental or languagedelay to have an autism diagnosis.
So often parents are actually evenstruggling with the sleep issues before
they even get an autism diagnosis.
I've definitely seen that in myexperience and you can see it from
early stages and in every casethat I've been suspicious about.

(24:07):
The parent has come back later and saidthat the child has is on the spectrum.
There are some children thatonly have minimal impairments
and there are some children thatreally are struggling quite a bit.
Physical activity during theday, especially vigorous physical
activity is incredibly helpful.
So parents will say my kid'sin school during the week.

(24:28):
and they struggle with sleep.
And on the weekends we go to theplayground, the trampoline park,
and they sleep a lot better.
So I think thinking about waysto get physical, a lot more
physical activity is helpful.
I think that a lot of parents ofchildren with autism resort to
screens which is understandable, butit can be toxic to sleep at bedtime.

(24:49):
And actually a lot of autisticchildren also have sensory issues.
So a sound machine can be helpful.
Some children like tobe hugged or squeezed.
Like parents will say, my kidcomes into my room and they want,
they press against me really hard.
They want me to hug them really tightly.
In that situation, sensory measureslike a weighted blanket or my
preference is actually for a Lycrasheet, like a stretchy sheet around

(25:12):
the bed can be quite helpful.
I prefer a Lycra sheet becausethey're not hot compared to the
weighted blanket, they don't fall off.
And they're a lot cheaper.
You can get one for 20 bucks on Amazon.
I'd also just plug this bookSolving Sleep Problems in Children
with Autism Spectrum Disorders.
This came out in 2014.
I think they should update it.

(25:33):
It is literally theonly book on the market.
And Beth Melow, who's at Vanderbilt,who actually, I really want Beth
to come on our podcast soon.
She's great.
She has two daughters with autism,so she knows personally what she
speaks of as well as professionally.
The book is great forparents and for providers.
So the next question is my three-year-oldautistic son used to sleep through

(25:57):
the night until he started needingsomeone in the room with him.
Are cried out methods, okay,for toddlers age three and up,
or is it considered abusive?
We tried the chair method, but daylightsaving time disrupted our progress.
This is from Chris M.
Yeah daylight sa it's funny,a couple years ago we tried

(26:19):
to do a research project.
We never got off the ground in theautism clinic to look at sleep disruption
from daylight savings time, whichseems to be far exceed what you would
expect in terms of sleep disruption.
In this pot clinic population they arevery, they do tend to be very sensitive.
So to tackle this, I think firstof all, cry out in a 3-year-old is

(26:40):
tough and would not be my preference.
I wouldn't call it abusive, but Ialso feel in children with autism
who have a lot of difficultywith self-regulation, especially.
They could cry for aninfinite amount of time.
They could cry all night.
And it's not that I hear the desperationI'm reading between the lines here.

(27:02):
The chair method couldbe difficult as well.
I think you might have to go very slowly.
The other thing is, if he startedneeding things in the room with
them, it may be worth exploring.
is there a sensory issue orthere's some nighttime fears?
Is there some anxiety?
Certainly in the US at least before agethree, birth to three will help children

(27:22):
like Chris's son after age three.
It's often through the school district.
Some children also are receivingABA therapy for autism.
And working on some of these issuesduring the daytime can help at nighttime.
He may, this child may or may notbe verbal if he isn't maybe worth
exploring if there's some nighttimefears and trying some other strategies,
this child might well do well witha huggy puppy style intervention.

(27:44):
I would say just go very slowly,predictably with the child.
One intervention my colleague describedonce, Arielle, we've talked about
this bedtime charts can be reallyhelpful and provide real predictability
and for nonverbal kids actually.
I had one colleague just hada Velcro strip in the bedroom.
And every time the child did oneof the activities, like they had a

(28:06):
toothbrush, they had a little tinybook, they had a little tiny blanket.
The child would pull it off, theVelcro, put in a bucket, and that
was the signifier, that it wastime to transition to bedtime.
But Chris, yeah, I would sayabsolutely the daylight savings
time stuff give it time.
Hopefully it will getbetter in a week or two.
Right now when we're tapingthis, we're about a week out.

(28:27):
So by the time you listenthis, hopefully it's better.
But I encourage you to have a team andto have people help you work on this.
It is a challenging set of issues.
Okay.
The next theme is nightnursing and weaning.
"My 4-year-old baby woke up almostevery other hour at night due to
a cold and I bed shared and nursedher back to sleep each time.
Now she demands two tothree feedings a night.

(28:50):
How can I reduce her night feeds soshe can sleep for longer stretches?"
That's tricky.
The first issue right off the bat is I.
If I was looking at this, firstof all, I'd wanna know what
does daytime feeding look like?
'cause I don't wanna say, oh, youshouldn't feed your child that many
times without knowing if the childis getting enough during the day.

(29:13):
Let's say that the baby is getting enoughduring the day and they've just become,
the sickness kicked off around the fourmonth mark, which is tricky anyway.
And now the child is just dependenton a parent coming in and maybe not
even hungry, but now is dependentupon that feeding to fall back asleep.

(29:37):
Now, I would say though, if, and didthey say, have the feedings increased?
Was that included?
It sounds like it increasedreading between the
So if the feeding is increased, then.
You're probably not dealing with hunger.
It's more likely that it's a dependency.

(29:58):
So I think you have to start from scratch.
And, several of you know our otherepisodes addressed sleep training,
and I would definitely say thisis a good case for sleep training.
I would also take a look atyour daytime feedings, make sure
there's enough going on there.
Young infants often need to be nursedeight times a day, and if they're only

(30:23):
nursed five times a day or four timesa day, they may be hungry overnight.
But then I would pull back and lookat how is this child falling asleep?
Are you nursing her sleep,or are you putting them down
independently and walking away?
If you are nursing, there'ssome sort of a dependency here.
So if you are nursing to sleep,you'll wanna look at ways to back

(30:48):
off of that and help your childlearn to fall asleep independently.
That's ultimately the goal.
We have to start at thebeginning of the night and stay
consistent throughout the night.
And that's not to say don't feed yourbaby, it's just to say that you don't need
to feed your baby every hour overnight,as long as they're healthy and regularly
developing, and you don't need to attendto them, every hour during the night if

(31:13):
they're normally developing and healthy.
It is such a nuanced question, right?
Because I'd say that if you'rechanging your kid's diapers
multiple times during the night,it's probably really a full feed.
Whereas it might be alsojust nursing for comfort.
not every four month old is quite readyfor sleep training, but I think that
yes, this would fall under what a lotof people call a regression, right?
Your kid gets a cold.

(31:34):
And the interesting thing aboutwhat Xiaofan says here is it like.
The child was sick and then themom changed her behavior and
then the child responded to that.
And this is parenting, right?
It's a, it's a dance
It's interesting that you say that'cause that makes me think of our
episode that's about to drop with Dr.
Garay and talking about how, a lot ofour sleep troubles are our own faults

(32:00):
because we've changed our behavior andin doing so, we've created a new habit
or accommodation as we were talking aboutthat the child becomes dependent on.
Oh yeah, no, I think I we've allseen the kids where ev the kids
where the kid was sleeping great.
Then they went on vacation, theybed shared, and then you see them

(32:20):
two years later and they're like,yo, this is how it works now.
But yeah.
Xiaofan, eo, this isyour child is so young.
This is likely gonna get better.
I suspect the time anyway, but more, yeah,the things to do as Arielle talked about
might speed this up a little bit for you.
Here's another one.
This is actually from my pal, Dr.
Michelle Caseta, who's a alocal pediatrician where I work.

(32:45):
What are your thoughtson mom's breastfeeding?
They're three month old to insert agehere, I think it probably 24 month old,
36 month old all night from their bed.
If no one is complaining, is there anage at which breastfeeding should stop to
prevent dental caries or can it continueuntil a parent wants their bed back?
I think that's a really tough questionbecause, we have to look at different

(33:09):
cultures have different ways ofdoing things and raising children.
I particularly follow theAAP guidelines of safe sleep.
And so I personally neverrecommend bed sharing.
I know it happens.
I'm not judging anybody.
I'm just saying I would never workwith somebody that wanted to bed share.

(33:30):
I would certainly help someoneget away from bed sharing,
but to me that's just a no go.
If they're happy, then I'mprobably not hearing from them.
Yeah.
If they're happy, and I don't think we canmake that decision for people, because in
my opinion, it should never have started.
but again, if they're happywith what they're doing, then

(33:54):
we're not hearing from 'em.
Dr.
Caserta is a primarycare doctor and they are.
And I think a couple ofthings to shade this for.
So let's to take the safe sleepout and say this is like a nine
month old or a 12 month old.
I think that sometimes when thesepatients come into my clinic, it's
because the nursing parent is happyand the nursing parent's partner
again, 'cause I don't wanna be toogen heteronormative here is not happy.

(34:18):
And sometimes it can create some conflict.
I think that you just need to lookat when is it appropriate for a
child to stop feeding overnight?
And it's very difficult tostop feeding overnight if the
child is bed sharing with you.
So I would often get questions.

(34:40):
I'm not con, I don't wannastop co-sleeping, but I
wanna stop nursing all night.
And it, I don't know how, I'm sure thereare people out there that work with this,
but it's like getting back to the ideaof you're you are right in front of them.
They can smell your breastmilk and you're saying no.

(35:00):
But I would definitely say that ifa child is old enough to not need
to be eating overnight, certainlythere's a cutoff age for you.
Yeah.
And I think also too about thedental caries is an important point.
it's absolutely true.
I think that this kind of is a littlebit of a throwback to the heyday
of attachment parenting, right?
The sort of Dr.
Sears idea that you should justessentially be nursing your, have the

(35:22):
family bad, nursing your children untilthey go to college or what have you.
I feel like I'm seeing this alittle bit less than I used to.
But maybe just 'cause thosefamilies don't want to hear from me.
I think that it's.
Yeah, as pediatricians, just likeyou, Ariel we're like very sensitive
to safe sleep topics, but, differentstrokes for different folks, right?

(35:43):
My kind of take on it is everyone,is that bed sleeping well at night?
Then it's probably okay.
But if somebody is not sleepingwell it's probably worth addressing.
Yeah, I totally agree.
So here I got, I, okay,I got some more for you.
Under the heading of sleep trainingchallenges, my 2-year-old son still

(36:07):
requires a bottle and rocking to goto sleep and sometimes wakes in the
middle of the night crying for us.
How do we break the cycle?
Cycle of bottle feedingand rocking to sleep?
From Eli.
You have to just stop doing it.
Eli, we're not making fun of you.
You're reaching out, which isthe first step to fixing this.
But yeah, sometimes you just haveto stop doing things you don't like
Yeah.
And I always hear, mychild requires, and it's,

(36:31):
Who's the parent sometimes.
But I get also that you're tired, likeyou just resort to what is working,
even though it's not really working.
Ultimately, you just, you have to stopthe behavior that's causing the problem,
and that is the rocking and the bottle.
A 2-year-old does notneed a bottle overnight.
And again, we're talking about the teeth.

(36:52):
But from a nutrition standpoint,again, if your child is normally
developing and healthy, theydo not need a bottle overnight.
So this would be a case of investigatingthe various sleep training methods
to start down a path of teachingyour child to sleep independently.

(37:12):
so yeah, I think all you just, you'regonna have to stop the behavior
and figure out the best method thatfeels right for you and your family.
Eli did mention if the child isalso receiving calories during the
middle of the night I'll start,I agree that it's 2-year-old.
You should probably justthrow your bottles out.
Maybe hide them in the attic or somethingif you're not gonna have another kid.

(37:35):
But you know what?
Burn your ships, right?
Just be like, okay, we'renot doing bottles anymore.
Your child is not gonna starve to death.
If you want to go more gradually, youcould keep the bottle, but move it
earlier being like, okay, we're notdoing a bottle in the bedtime, we're
having our last bottle at dinner.
You can have a sip.
I, again, I'm like,just get rid of it, but
Yeah, I think that method works.
I usually encourage parents tomove to sippy cup, or a straw,

(37:58):
like a straw cup, which is what thedental community recommends And.
Yeah.
I always hated those though.
'cause they'd be like, all thelittle pieces would get lost in the
Yeah, just any of them.
Sippy cups are the same way.
Water bottles are the same way.
So you're right.
If you want, you can say, if it's hardto know how far into two your child is,

(38:19):
because on the earlier side, they're notgonna understand as well if your child
is two and a half, close to three, it'spossible that you can say, you can talk
to them, you can have a conversationor at least tell them what's going
on and what you're planning to do.
And then just consistency is really key.

(38:40):
consistency is key.
And it is.
I think as parents Eli, Idon't want you to think we're
coming down too hard on you.
Sometimes it just comes out, ifyou don't like something, you just
gotta fix it and your kid willprobably adapt pretty quickly.
Burn the bottles.
Outside, you don't want toinhale them like an outdoor fire
You can add the pacifiers too.
here's one will removing a middle ofthe night sleep crutch for a toddler

(39:03):
result in split nights as they adjustto falling back asleep on their own.
I'm guessing this is a pacifier.
Natalie, this is a question from Natalie.
She did not specify,
a bottle
A bottle, maybe.
a bottle.
Middle of the night.
Sleep crutch or rocking or,it could be anything really.
No.
Yeah, I think it's really,it's something that you have to

(39:26):
deal with as a parent, right?
So if you have to replace, if you haveto rock your child, as you said, if you
have to get a bottle, if you have to, findthe pacifier that they have flung out of
their crib and put it back in their mouth.
if you get rid of that, they probablywill complain for a little bit.
But you are probably gonna besleeping better within a week if you

(39:49):
Yeah, I think that's the thingthat a lot of people are afraid of.
Like they're scared, these childrenare demanding things and they're
afraid that what if they changetheir behavior the child is gonna
complain for a very long time.
And the truth of the matter is, childrenadapt quickly if we are consistent in

(40:12):
what we're doing and they're on an ageappropriate schedule, A lot of times
people are transitioning out of theMerlin sleep sack or something, or
out of the SNOO, SNOO is a lot harder.
But it's much easier than you everanticipate and I always like to say, your
choice is you can change the behaviorand have some complaining probably

(40:33):
for a week or so, or you continue downthis path and there's no end in sight.
So that's ultimately your choice, butthose are the two options that you have.
I think, yes, sometimes as parents,we are so afraid to make these
changes because the reason thesethings have evolved is because it
is the way that we are surviving.
When you like I remember doing thiswith my kids being like, I hear

(40:55):
the first stirring in the monitor,and I would be flying out of my bed
to stuff the pacifier back and toone of my son's cry holes, right?
Just because I did not I was afraidthat they would be awake for longer.
And I manufactured thisproblem for myself.
And Natalie, I encourage you, Take thatcrutch away, everything's gonna be fine.

(41:18):
Yeah.
Truly just have faith in yourselfand have faith in your child.
Children learn so quickly.
So here's another sort ofbete noire for many parents.
When I experienced my myself,early morning awakenings.
How do you deal withearly morning awakenings?

(41:39):
Four 30 to five in themorning in a 10 month old
Okay oh, early morningwakings are so challenging.
There are so many different thingsthat can cause early morning wakings.
One of them is, we talkedabout having a dark room.
Some chill are justextra sensitive to light.
And if the sun is rising early,they will open their eyes, see

(42:01):
that it's light and wanna wake up.
If this is something new, then it'sprobably related to something else.
And one of the things Dr.
Canapari and I talked about was, I don'tknow how many naps this child is on.
Is there a nap transition happening?
Do you need to drop a nap?
Is there too much daytime sleep?

(42:21):
A lot of times I, what Iusually look at is sleep totals.
How much is this childusually sleeping overnight?
How much is this child usuallysleeping during the day?
And someone just texted me today asking,it's actually a colleague just asking
for some advice about a six month oldwho is only sleeping 13 hours a day.

(42:44):
Now 13 hours is still within normal,but it's lower in the sleep needs.
So we had to look at it and really geta limit daytime sleep to two or two
and a half hours if you wanna expectat 11, 10 and a half or 11 hour night.
So looking at when is bedtime,what's happening during the

(43:05):
day is really important.
One of the biggest mistakes Ithink parents make with early wake
up is just getting your kid up.
So I think what can be helpful is, Idon't know if you've done any sleep
training, but I would recommend.
treating it like a nighttime awakeningbecause 4:30 is it's nighttime.

(43:28):
That's really early.
If someone tells me five 30to six, I'm like, your kids,
you have to live with that.
Four 30 to five.
That's.
That's too early.
Yeah.
So those are the things that I look at.
It's often a scheduling issue and sYeah, so it, I would say it's usually
a scheduling issue or the light,having the room not completely pitch

(43:52):
black can really make a difference.
The, to amplify what you said,I'd say if this child is falling
asleep independently at bedtime.
This is probably a scheduling issue.
If the child is not falling asleepindependently at bedtime, working towards
independent sleep at bedtime, AKA sleeptraining, we'll likely address this.

(44:13):
The other thing is looking at what you'redoing, it is very easy to take your 10
month old into your bed at 4:30 in themorning and that will perpetuate this.
Exactly.
so we dealt with this,with my younger son.
I didn't know you then.
he would just wake and talk and I wouldbring him downstairs 'cause he was waking

(44:33):
everybody up, lie down next to him onthe ground with a pillow and he would.
Just look at me and talk and stickhis hands in my mouth for 45 minutes.
What were you thinking?
we have just,
Oh my gosh.
I was tired, I guesswhat should I have done?
He was falling asleepindependently at bedtime.
Should I have just ignoredhim, turn off the alarm, or, I

(44:56):
think that's what we ended up
what, like how early was he waking up?
Oh, 4:30 in the
Oh, yeah.
So again, I treat that as a night waking.
It sounds like you did sleep trainingwith him because he was falling
asleep independently at night.
So I would recommendtreating it with your method.
It's hard to get them it's hard to be likea, a check and console method where you're

(45:16):
going in and outta the room at that hour.
So if you have the stomach for itit would just not go in until it's.
I think that's what we did.
I think we ended up doing extinctionbecause I'm old school but also because
we just don't wanna be messing around.
That's, the trap of thechair method, right?
If you're doing the chair method,doing it five times in the
middle of the night is pretty
Yes, absolutely.

(45:37):
Here's another one From Gabrielle,my 22 month old daughter wakes for
one to three hours in the middle ofthe night, several times per week.
How can we help her getback to sleep faster?
To three times per week
No sorry, forgive me.
One to three hours inthe middle of the night.
every night,
I, several times per

(45:59):
several times.
It's actually easier tounderstand if it's, I.
I, I feel like the first thing you haveto do, Gabrielle, is some really careful
sleep diaries because of some nightsthe, she is up for hours in the middle
of the night and some nights she's not.
I feel like she's getting some napsyou don't know about during the

(46:20):
day or she's falling asleep and thecar in the way home from daycare,
or she's napping more at daycare.
I feel like there, there is we'remissing a part of the story for
those prolonged nighttime awakenings.
It's usually not a behavioral problem.
It's usually what Brett Kuhn callstoo much time in bed syndrome.

(46:41):
And this might be a kid where you thinkabout, if it was happening every night, I
hate to say it, but you might wanna see ifgetting rid of this nap made this better.
yeah, so I would say.
I totally agree withthe sleep diary, ibel.
I believe in that for everybody that'shaving struggles, particularly overnight,
looking at daytime sleep, looking atwhat the, what is the average amount

(47:02):
of sleep your child is getting in a24 hour period, and then how do you
break that up between naps and night?
So I would say this child might behaving a really crappy night and
then the next day, like catching upon sleep and then have a good night.
And then they don't need, theymay still want a nap for three.

(47:23):
You may let the child naplonger on a, after a bad night.
And then the next day they sleep well'cause they're tired the next day.
You let the child sleep as longas they want again during the day,
but they've already caught up onthe sleep that they missed and so
then it's affecting the overnight.
I see that a lot flip-flopping.

(47:43):
Sometimes daycares or,nannies or whatever.
Caretakers don't log all the sleepthe right way or appropriately.
Yeah.
And I think that this is a situationwhere if your kid's in daycare, for
example, you have to be like, okay,I'm working on my child's sleep.
I can, you just really be,gimme some detailed stuff

(48:04):
about what, what's happening.
Here's another one.
My son refuses to sleep in his ownroom since his sister was born.
He gets out of bed multiple timesa night and doesn't sleep for more
than a couple of hours in a row.
What do we do?
This is from Hyglak,
I mean, it sounds like thechild probably slept well
previous to this because it's in

(48:25):
Let's assume
Yeah.
And I would say it's very commonbecause I, I'm assuming it's probably
a younger, maybe like 18 months, two,two and a half, something like that.
18 months don't fully understand So Ilike to do a lot of work around hyping
up the things of why is this baby gettingmore for the parents even, it doesn't

(48:48):
matter which parent giving that childone-on-one time every day, even if
it's for 20 minutes, if it's outside atthe playground for 20 minutes, if it's
reading books together for 20 minutes,but one-on-one time without the baby.
And then, you
Absolutely
back to the, you get back tothat idea of charts and say,

(49:10):
you have to be a big kid and.
And sleep in your own bed.
Explain why the baby needsto sleep in the room.
Tell them their role and have them modelwhat it means to be a bigger sibling.
And so turn it into a positiveversus and I get it, if you have
a newborn, you're exhausted.
So it's tricky, but I think that thoseare the things that I would recommend.

(49:36):
Yep.
Praising the child for evenattempts to stay in their room.
How would you use a chart?
Let's get this talk specifics here.
so I just same, similar towhat you were describing.
I would use a, I like to call itlike a behavior chart or I don't
like to say reward or whatever.
'cause you don't necessarily needto use a reward because we know.

(49:59):
That children thrive onpositive reinforcement.
So it could just be a celebrationat breakfast or something.
I like to include just very simplestuff, got ready for bed brushed
teeth, read books got into bed quietly.
And then the most importantthing is stayed in bed all night.
Now, in many cases, the first couplenights they don't get that sticker

(50:24):
or pull that piece of Velcro,whatever it might be, but explaining
to them and saying, you did great.
Look at all of this, and tonight,if you do this, you get all
your stars or whatever it is.
And so they can visually see that.
But I think also oh man, oh likea visual clock out of their room.

(50:45):
Is also extremely helpful.
And I use that in conjunctionwith one of those bedtime charts.
and I would say the bedtime chart,especially for me, that's like a three and
up kind of intervention for a younger kid.
And I guess we're making some assumptionsbecause if they're, if the child's
coming outta their room, it's probably,they're probably sleeping in a bed.

(51:06):
Yep.
you know, definitely for a youngerkid who's waking up more at
night, I think, yeah, the key ismore attention during the day.
It will get better.
So here's some napping questions.
Should we try to match our six month olddaytime naps, daycare nap schedule on
weekends or continuing following his cues?

(51:29):
there's so much that I needto know about that, I think
having a schedule is important.
So just I don't love like nappingwhenever you see them yawn or whatever.
'cause that can cause issues.
at six
Yeah.
Yeah.
So I think, trying to follow somesort of a schedule is important.
And I do, if they're therefive days a week, it's probably
helpful to follow it loosely.

(51:50):
However, I also find that childrenthat go to daycare can sometimes
be tired a little bit earlier athome from their long week away.
And so if nap time is nine 30 atdaycare and they seem tired at
nine, okay, that's totally fine.
I think there's a windowgoing each direction.

(52:11):
30 minutes.
Beyond that, if you're just like they'reon two naps at daycare and you're
doing four naps at home, I definitelywouldn't recommend that consistency.
In schedule and like numberof naps is important.
However, I will say when childrenare forced to drop naps at daycare
or drop from two naps to one nap orsomething, they may need two naps

(52:35):
at home, or they may need a nap.
There are ways to compensatefor that over the weekend.
However, for a six month old, Iwould just try to stick within that
schedule 30 minutes each direction.
Yeah, that sounds perfect.
I had a patient in New York Citywho was kicked out of his daycare
'cause he gave his nap up early.
Some daycares are more flexible thanothers about these sorts of things.

(52:56):
And again, this is an older kid like Ithink he was maybe two, two and a half.
From Michelle, do you have anyrecommendations for a 3-year-old
that is inconsistent in taking a nap?
Arielle, do you want to break the bad newsto Michelle or do you want me to do it?
you can do it.
Michelle, I think yourchild is giving up the nap.

(53:16):
It is a sad day as a parentwhen your child gives up the nap
because it's great when they nap.
It's not like a 3-year-old will justraise their hand and be like, Hey,
I don't think I'm gonna nap anymore.
They're gonna nap some days.
Some days they won't.
Some days they'll fight you on it.
And then they'll be miserable.
But until bedtime it's neverthat smooth a transition.

(53:37):
I think you offer a napat the appointed hour.
There you can have an expectation that thechild be quietly in their room for say,
30 minutes even if they're not napping.
I had one month where mykids napped at the same time.
It was bliss.
one month of bliss,
A month of bliss in my life.

(53:57):
in my life.
I would also say that if thatnap is affecting bedtime,
absolutely do not offer the nap.
And sometimes I know the quiet timeis great, and I do love quiet time.
However, if the nap is causingproblems at bedtime or overnight.
You might have to keep them moreoccupied and be with them and doing

(54:19):
pu a puzzle or something, or watchinga 30 minute cartoon or, I don't know,
a couple bluey episodes, somethinglike that, just to keep them awake.
And I would also suggest backing upbedtime a little bit earlier for a bit,
because they can, it's a big transitionto go from napping to not napping.
Compensating with an earlier bedtimefor a little while can be very helpful.

(54:45):
So, okay.
I think this next one's for me.
Okay.
Let me see.
I can read it to you.
So in your book you mentionedthat both parents need to be
able to do the bedtime routine.
What do you do if your babyshows a strong preference for one
parent, and this is from Lauren.
this is pretty common andusually it's if it's a mom who's

(55:09):
nursing, it's for that parent.
Again, I think that sometimes thisfalls into gender stereotypes 'cause
in my clinic I'd have a lot of parentscome in with a man and a woman.
And the dad is she won't go to bed for me.
And it's like this learned helplessness.
I think that it's very, and in situationslike that where the other parent might

(55:29):
feel a little bit left out or beingsidelined first of all, don't feel bad.
It's normal for children to sometimesprefer one parent or the other.
But the reason for the recommendationis that recommendation.
it can't just fall to one parent toalways be responsible for bedtime.
And if this becomes veryrigid, things fall apart.

(55:49):
If that parent wants to go out foran evening and then they get a phone
call when they're out having fun withtheir friends, the, their child won't
go to sleep and it just isn't fair.
heard, In situations like this, it's okayfor the other parent to go for a walk
if the weather's nice and be out there.
I just think it's really, the otherpart of the recommendation is don't

(56:11):
have your bedtime routine so complicatedthat you need two people to do it,
because that works with your first kid.
It doesn't work for your subsequent kids.
Yeah.
I was just gonna say, youmentioned single parents and I
was thinking of shared custody.
That's a real reason why both parentswould need to be on board and be
able to do the bedtime routinebecause it's a true challenge.

(56:35):
So I, I also just think it'simportant to have someone else, not
even necessarily the other parent ababysitter, because you can't be the
only one that can put the child's bed.
Yeah.
And it's, the fact is.
For a lot of the parents, we see bedtime'sa stressful time, but with a little bit

(56:57):
of effort, it can be a wonderful time.
And it's awesome to put yourkid to bed and read stories.
it's adorable.
I'll read this.
My 6-year-old son was born with congenitalheart disease, has never managed to
sleep alone due to various issues,including my health and his anxiety.
He has never slept through thenight, wakes with bad dreams
and does a little sleep talking.
What can we do to help him sleep better?

(57:19):
This is from Natalie and Arielle.
Can I say that I see this all the time.
So congenital heart disease.
Many.
This is true of many childrenwith issues like this.
A child with congenital heart diseasemight need multiple surgeries in infancy,
and there might actually be situationswhere they can't let the child cry.
For parents of children with complicatedmedical issues, say there were a NICU

(57:41):
baby who needed to be fed multipletimes overnight or needed oxygen, all
of a sudden you, you end up with afour or 5-year-old where their health
issues are better, but they havenever learned to sleep independently.
And I think that's what she's getting at.
I would say in a situation like this,first of all, if your child is involved
with medical specialists, just sitdown with them and be like, Hey, I'm

(58:03):
struggling a little bit with this.
Can you just let me know that all ofthese medical issues are now resolved?
And if that is the case, I think sometimesthis is a situation where working with
a consultant, a sleep physician, oreven a psychologist, if this kid is a
little bit older, like a 6-year-old,'cause there is very likely this child,
and it sounds like this mom has someunresolved anxiety for good reason.

(58:28):
If your child has had to have multiplesurgeries and hospitalizations,
it's incredibly stressful.
But it is a wonderful thing now ifyour child is doing better and this
is a great time to work on this.
So I would say that working verygradually towards independence at bedtime,
very gently praising your child formaking step towards independent sleep.

(58:50):
Et cetera.
And I'd say if there's a lot of baddreams, waking through the night, sleep,
talking, if there's snoring, a sleep test,may be worth exploring some conditions.
I see commonly like children thatwere born early in the neonatal ICU
premature infants turn into threeor four year olds with sleep apnea.
Just a medical evaluation ispart of that is a good idea.

(59:12):
Yeah, I say anytime I get anybodywith more complicated medical issues,
I always recommend getting clearanceessentially from their care team.
And.
It sounds like mom is also dealing withhealth issues and that is contributing
to the six year old's anxiety.

(59:34):
I don't know if there's a great wayto address that, but that actually
makes me think of working withpossibly a psychologist to address any
anxieties that could be causing issue.
And a lot of times actually clinics,like congenital heart disease clinics
actually will have a psychologist orsocial worker as part of the care team

(59:56):
who can help you with these issues.
But hey, I gotta pop off.
Got a dinner
take a kid to a fencing lesson.
And then I gotta go have a birthday
Is your birthday?
Today's my
birthday.
What?
Why?
Oh my goodness.
I think so.
This has been The Sleep Editthanks so much for listening.

(01:00:17):
I'm Craig.
And I'm Arielle.
Give us a shout if you havequestions for future shows at
the Sleep Edit show@gmail.com.
We'll put what we talked about inthe show notes and thanks for all the
parents who submitted their questions.
This was a lot of fun.

(01:00:37):
Thanks so much forlistening to the Sleep edit.
You can find transcripts atthe web address Sleeped show.
You can also find video of theepisodes at that address as
well as in my YouTube channel.
You can find me at Dr.
Craig canna perry.com and on allsocial media at D-R-C-A-N-A-P-A-R-I.

(01:00:59):
You can find Ariel atInstagram at Ariel Greenleaf.
That's A-R-I-E-L-L-E-G-R-E-E-N-L-E-A.
If you like the flavor of the advice here.
Please check out my book.
It's Never Too Late to Sleep.
Train the Low Stress Way to high QualitySleep for babies, kids, and parents.

(01:01:20):
It's available whereverfine books are sold.
If you found this useful, pleasesubscribe at Spotify or Apple Podcast
and share it with your friends.
It really helps as we're tryingto get the show off the ground.
Thanks.

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