Tackling Anxiety and Sleep Issues in Children: A Psychologist’s Perspective

Episode Transcript
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(00:02):
Welcome to the Sleep Edit, apodcast devoted to helping tired
kids and parents sleep better.
We focus on actionable evidence-basedsleep advice, so everyone in your
home can sleep through the night.
Now, a quick disclaimer, this podcastis for general informational purposes
only and does not constitute thepractice of medicine, nursing, or
other professional healthcare services,including the giving of medical advice.

(00:27):
No doctor patient relationship is formed.
The use of this information andthe materials linked to this
podcast and any associated videocontent are at the user's own risk.
The content on the show is not intendedto be a substitute for professional
medical advice, diagnosis, or treatment.
Users should not disregard or delayobtaining medical help for any medical

(00:51):
condition they have or that theirchildren may have, they should seek
the assistance of their healthcareprofessionals for any such conditions.
Nothing stated here reflectsthe views of our employers or
the employers of our guests.
Enjoy the show.
Welcome back to the Sleep Edit,and this is our first guest ever.

(01:13):
I am pleased to welcome Dr.
Danielle Garay to.
Podcast.
She's a pediatric psychologist whohas dedicated her career to improving
the lives of children and families.
Originally from the great state ofCalifornia, she arrived to Yale in 2021
after competing a pediatric psychologyfellowship at the Children's Hospital
in Los Angeles with a PhD in clinicalpsychology from Palo Alto University.

(01:38):
Dr.
Garay has a strong backgroundin child psychology.
Having worked with children inmultiple medical specialty clinics, Dr.
GRE's passion for sleep medicinestems from her belief in the
transformative power for both of sleep,for both parents and children with
a focus on improving sleep quality.
She has helped countless families overcomesleep related challenges and achieve

(01:59):
better overall health and wellbeing.
And I just wanna say having.
Dr.
Garay joined our clinic here at Yalehas been personally transformative
because many of the patients that Ididn't know what to do with, now she
is fixing, which is pretty great.
And I'd also say this is this isgoing to air well after the Super
Bowl, but she is a 49ers fan.

(02:19):
So just to put that outthere in the universe,
It is true.
So I'm either celebrating whereverI am or in deep mourning that
Taylor Swift took me down.
But that's okay.
look, if you're gonnaget beaten by the best,
That's right.
That's right.
Yep.
Can't even be mad about it.
Thank you so much for having me.
I'm very excited to be here andtalk about talk shop, about sleep

(02:39):
and anxiety, all the good stuff.
Yeah.
We're it's funny like thinking aboutthe, this topic because we started
thinking about, first about separationanxiety because it's pretty it's been
common on what we've seen in clinic,and I think it's an underlying.
Sort of theme in a lot of the morechallenging patients we've seen
lately in sleep clinic, but I thinkthere's, Danielle, why don't you start

(03:03):
and just talk a little bit about therole of a psychologist in the care
of children with sleep difficulties.
Yes.
So coming into the sleep clinic I findthat there are a variety of things
that people come in for that psychologycan be particularly helpful for.
I would say the main camps are kindof kids who don't sleep or can't

(03:24):
sleep, that have insomnia and needsupport to be able to do that.
Kids who should be wearing theirCPAP machines, if they have breathing
difficulties, they don't wanna wear 'em.
So helping them to get used to that.
And then we have the anxiety sleeptraining camp where there are kids who,
for whatever reason, are not sleepingwell and there is not a clear medical
diagnosis that's like underlying that.

(03:45):
And they need some behavioralsupport to be able to get on track.
And more often than not, that workis typically with the parents.
'cause the parents arethe captains of the ship.
And so it, it requires them toset the stage for their kids
to be able to be successful.
And so the psychologist really helps tomake a plan and be able to set the parents

(04:06):
or the family up for success in order tohelp equip their children to build the
skills to sleep more independently orjust have more restful sleep at night.
In sleep training, we're teachingparents to change their behavior to
shape the behavior of their children.
And that's actually a lot of the workthat you do as well because I think

(04:26):
that one of the frustrations thatparents have is if children are having
challenging behaviors, they are seldomthe ones that want to change them.
The parents are, you have the illusionof control when your children are small.
But really once they getbigger, they have agency.
And all you can do is to try to nudgethem towards the behaviors you like.

(04:50):
Yes.
I, there's oftentimes parents comeand they'll like, bring their kids
to me and say please fix their sleep.
And they like push their chairtowards me and I'm like, why don't
you pull up alongside, this isgonna be definitely, you're gonna
be a part of this conversation too.
there's something that's so reassuringas a parent to, to watch your child
sleep and sleep well and it causes suchanxiety for parents when their children

(05:14):
aren't sleeping well Kids can feel that.
And so then that can feed into thisfrenzy where then no one is sleeping
well and everybody feels upset.
And and so it is such a powerfulintervention to be able to
help people with their sleep.
I
A as intimidating as that sounds, I thinkit's actually very empowering for parents.
The idea that you can change yourown behavior and that will help move

(05:36):
things towards the outcomes you desire.
I would say that in my worldthat, and of course, I.
I deal with a lot of kids with sleepissues, but as a pediatrician, sleep
problems and feeding problems are,I'd say the two domains that are
cause the most anxiety for parents.
it can be so disheartening when these,you feel that your child is not doing

(06:00):
well in these really basic domains.
I think that's, you know what'sso difficult about that is it,
they're both are so important.
To the health and wellbeing,physical health, mental health of
the child and the entire family.
But I feel that parents justdon't get enough direction

(06:21):
with either of those things.
We might get a handout
So some will say my pediatrician said tonurse to sleep, or my pediatrician said
to co-sleep, or my pediatrician said, shutthe door and don't go in no matter what.
There's no, digging behindis there a medical problem or
what else is going on here?
And similarly, I feel that feedingis something that I see all the time.

(06:45):
Parents do not know how to feed theirbabies and children and it's not
their fault, but they feel like itis it's something that should just
naturally come to them that we can,obviously everyone should be able to
teach their baby how to sleep or eat,but it's way more complicated and
they're just, it's just frustrating.
'cause I wish there was more educationfor parents, all parents around this.

(07:10):
Only very recently that we don't.
Children are not raised withgrandparents in the house, right?
Like in the last couple of generations.
And that as an adult, you feel likeyou're making it up as you go along.
It's because you are youdon't have multiple family
caregivers helping you out.
So we have a, we have an outline togo through and I just want to make
sure we cover all these topics.

(07:31):
And the first is a term that I think getsa lot of, it's thrown around a lot in the
sleep space in a rather imprecise way.
So Daniel l I was wondering ifyou could comment a little bit on
temperament and in, in your work.
Is that a meaningful termor what does it mean?
Is it helpful concept whenyou're approaching a child

(07:52):
with sleep difficulties?
Yes.
So temperament is in its most simple form.
It's just like the genetic or biologicalpredisposition that you have that
Defines how you act in the world orhow you react to certain situations.
And so it can be helpful in that it canhelp you feel less guilty if you have a

(08:14):
child who just, t typically is more, hasmore of a negative affect, like a little
bit more fussy, a little bit more anxious.
It just helps you to conceptualize thatas opposed to a baby who acts a little bit
more happy or a little bit more carefree.
But it can also be dangerous becausethen you start to just categorize the
child as that and then start respondingto them and socializing them that way.
So I, I think that it is helpful in thatit may help inform, if you know that your

(08:39):
child tends to react a little bit moresensitively, think to things, or if your
child tends to let things roll off ofthem, it may help you to formulate what
interventions may be most helpful to them.
But outside of that, I don'tfind it to be super helpful.
'cause I think it just ends upcreating stereotypes and unhelpful.
Socialization practices for kids.

(09:01):
Yeah I agree.
I'm always concerned aboutthe narrative of this is, oh.
My child is difficult.
My child is high needs, my baby is highneeds and then many times we just find
the baby's hungry or tired, and oncethey start eating better or sleeping
better, they're no longer high needs.

(09:22):
yeah, a Arielle, I thinkthat is it's so true.
Parents come in and they justhave this idea that their child
is, their child's a poor sleeper.
And it's this sort of reflexivenegativity that nothing.
I've tried everything,nothing's gonna work.
And I'd say to a parent who's reallystruggling, you owe it to yourself to.
Things can always get better.
They may not be perfect, but just imaginea world where things can get 10% better.

(09:46):
And that's the start, right?
'cause honestly you fix the sleep problemand then something else weird, they're
gonna do something else weird in a week.
That's just life.
So on our next topic I have Danielleleknow we were talking a lot about,
a little bit about this today.
I had a colleague reach out to me thissummer and actually it was last summer
and it was a really rainy summer.
There were a lot of thunderstorms.
This little girl, I think she was fouror five, and they had a thunderstorm

(10:10):
that was scary to the child.
And after this.
Little girl was absolutelyobsessed with thunderstorms.
She was, anytime there was arainstorm, she would have to
sleep in her parents' room.
She was obsessively asking them to checkthe forecast, which they were doing
because they thought that was helpful.

(10:31):
And it really was adversely affectingthe life of the whole family.
'cause they they couldn't makeplans around, where the child
might experience a thunderstorm.
It was affecting everyone'ssleep in the home.
And this was a kid that hadn'treally been particularly tightly
wrapped or anxious before Then.
How, when you hear a story likethis, what do you, like, how common

(10:53):
is it to hear a story like this?
It's quite common because I, nighttimefears, which is what we would call this
kind of thing, where it's, it soundslike the fear was mostly at night.
Is that right?
With the storms?
Yeah,
sure.
So nighttime fears are very common.
And it, probably the most commonone would be the dark monsters
in your room or under your bed.

(11:14):
And then also these things like stormsor the noises that are going on in the
house, kids as their imagination startsto come online in really beautiful ways.
It also starts to fill in theblanks at night when there is
really no visual stimulation.
And so then they're just like left tobe hearing or imagining and thinking.
And so it's just a very fruitful placefor kids to develop fears and anxieties.

(11:37):
And for a lot of kids, this is just mild.
And it's something that they might justneed a little bit of reassurance or
an extra snuggle before bed, and thenthey're able to successfully go to sleep.
And then other kids need a lot of supportand may need some intervention, either
from a parent or a professional to beable to really navigate the fear and
learn some skills to be able to either.

(11:57):
Mentally learn some strategies todistract themselves, to be able to
fall asleep or perhaps learn some factsabout things that are going to dispel
whatever it is that they're worried about.
And yes, it's a very commonthing to be afraid at night.
But it's not something thatnecessarily is so uncommon or
something that parents can't do.

(12:18):
Some very simple thingsto help their kids with.
So I actually have a question.
So my, I have a nine, nine and a half yearold and a very active imagination, but
she must have seen something about ghosts.
And all of a sudden shebelieves ghosts are real.
And I guess, and this is terrible.
I had white noise going one night.

(12:39):
I don't normally haveit, so I don't know why.
It was on one night it was on, shewas calling for me for an hour,
she told me and started crying.
And I felt horrible because I didn't hearher and she was too afraid to get up.
I'm across the house.
So anyway, the ghost thing was a thingfor a little bit, maybe a week or two.
And I, I don't know thatI handled it properly.

(13:02):
I just kept tellingher, ghosts aren't real.
That's just for stories and make-believe.
And, as a parent what do you say, what doyou do if your child has seen something
scary and they believe that I, thatyou're, that the parent is wrong and
they know better and there are ghosts.
Yeah.
Yeah.
So this would be an example of whereI actually think temperament wouldn't

(13:26):
be the right word, but like thinkingabout the type of child that you have.
But I would say that some kidsbenefit from the talking through it.
I so a lot of parents want to justassuage their kids' anxiety by trying
to ignore it or say things like you'resaying, like it's not real, it's not
something that you need to worry about.
And for some kids that is enough,like just them hearing their parents

(13:48):
say, this is not a real concern.
I'm not worried about it.
You shouldn't be worried about it.
That can be enough for them.
Other kids are more of like truthseekers or fact seekers, and so
then they want to know more howdo you know they're not real?
What, and they wanna ask questions.
And I think parents may wannago the other direction let's
just not even think about it.
But that it, if you think about the thingsthat we as adults worry about, sometimes

(14:09):
more information helps to settle usbecause it's like we're adding data and
it's removing some of the question marks.
So if your child is asking questionsabout the thing that they're afraid of.
Sit down and talk with them and be willingto enter the conversation with them
because you modeling, I'm not too afraidfor your scary feelings models to them.
I can sit with my scary feelingsand ask questions about it.

(14:32):
So even just modeling, likehow to approach something
that's scary, can be helpful.
However, then on the other side, thereare kids who might ruminate on it and they
just wanna talk it over and over and over.
And so one thing that's has been.
Shown in the evidence to bevery helpful is something that's
called scheduled worry time.
So it's where you literally say, allright, like 10 minutes before bed,

(14:53):
let's go crazy with our worries.
Tell me all of your scariest thoughts.
Tell me all your worries, andreally just let them get it all out.
And then at the end of that 10 minutesor however long you've taken for the
worry time, then you say, alright,whew, shake it off, shake off your
worries, and now we're gonna go to sleep.
We're gonna put that outof our mind until tomorrow.
And if you have, if you start to have anythoughts or worries while you're going

(15:16):
to sleep, just say, alright, I'm gonnaput that tomorrow for my worry time.
So it just gives them permissionto be able to feel afraid.
'cause fear is a very normal thing,but it gives them permission to have
it in a more contained safe space.
I'm pretty sure they telladults to do that too.
I feel like I
Yes,
a therapist tell me that one time.
Yeah.
It really does work.

(15:36):
It, or it's, yeah itworks for a lot of people.
I like, it's such a, it's sucha well-defined bucket to put
your concerns into, right?
As opposed to just having them, itspill over into every aspect of your day
exactly.
But it still is because one of thehallmarks of anxiety is avoidance.
It's like trying to shove it outtayour mind, shove it outta your

(15:58):
mind, shove it outta your mind.
But the more that it starts tocreep in, the more afraid you get of
letting it come into your brain andthe more you wanna shut the door.
But when you invite it in a way thatyou're saying, okay, you can come into
my space and let's work together here.
I'm not gonna just let you control me.
It helps them to develop theskills to deal with it, as opposed
to just avoiding it and alwaysdistracting yourself from it.

(16:22):
Yeah, no, and I think specifically forFear of the Dark, which is something
that is common in our patient population.
Things like flashlight, treasurehunts can be really helpful.
And I know Danielle, you put some,I can link to some books in the show
notes too that are really helpfulspecifically to the fear of the dark.
It's so common.
And I'm familiar with Uncle Lightfoot.
I don't know these other ones, but it'sjust a nice, it's a nice, resource for

(16:44):
families These are things that oftenparents can address on their own.
Absolutely.
Yeah.
The other two books that Ithink are really great one is
Orion in the Dark and Orion.
Have you heard of
Yes.
And my clients love, love, love that book.
It's so good.
It's just this boy who hates the dark,and then the dark takes on like a
physical form and comes and takes himon this adventure and makes him love the

(17:06):
dark and become friends with the dark.
And so it's just a nice personificationof the dark in a kind of a cute way.
And then the other book is TheRabbit, the Dark and the Biscuit Tin.
And that one is The Rabbit Hatesthe Dark so much, and so traps
the dark into this biscuit tin anddoesn't let it ever become night.
But then the carrots start to wiltbecause it's always sunny and there's

(17:26):
never any dark, and his friendsaren't coming out because, like
the fox is the nocturnal animals.
And so the dark is talking to himfrom the tin you've gotta let me out.
I promise I'm not so bad.
There's good things about the dark too.
And so then he finallylets him out and it's fine.
So it's, they're both just cute or allthree of those books are just good at
again, not avoiding the conversationabout the dark, but rather just

(17:47):
like putting a different spin on it.
So let's talk a little bitabout nighttime tantrums, right?
And I can say this.
My older son's not gonna listen tothis, but I think I read my book that he
had a black belt in tantrums, like thecraziest knockdown, drag out tantrums

(18:07):
about two hours of tantrum a dayfrom between ages, like two and four.
It was terrible.
Usually not at night in his case, butI think a lot of families struggle if
they're trying to implement a behavioralplan at bedtime sleep training or
something like that, and they have atoddler or a preschooler who just loses
it and gets hysterical either aroundbedtime or with nighttime awakenings.

(18:34):
How should parents be thinking aboutthese episodes and what should they do
either, either in the moment or kind ofupstream of the moment to deal with this?
Do you wanna go first?
Arielle?
For me, parents will come to me and say,my baby or my toddler or my preschooler
is tantruming at bedtime, or, tantrumingat bedtime or then waking in the middle

(18:58):
of the night and having a tantrum.
And to me, I don't seeeither of those as tantrums.
I see them as a symptom of lackof sleep or lack of routine
or, lack of consistency.
So it, to me, a tantrum and atoddler, toddlers have tantrums.

(19:20):
It's just, it's the way it works.
Toddlers are supposedto have tantrums, right?
That's how they process their growth.
But when people come to me andthey're paying money to talk
to me, it's because things havegotten, beyond just normal tantrum.
And so the, it's almostlike a buzzword to me.

(19:41):
So when people are like, oh, my,my kid tantrums at bedtime, and
then all through the night, it'ssomething else is going on there.
It's not simply a toddler tantrum.
There.
There's some, in most caseswhen I'm handling it, it's
because they're overtired.
I know Craig, you struggled withthat term, but what I experience

(20:02):
is usually the bedtime is too late.
And many times it's in conjunctionwith, I say that bedtime's too late.
They say, I try to put him to bedearlier, but he's running circles
around the house and then the tantrumensues when they try to enforce bedtime.
To me, in my experience, that isnot a tantrum, that is a incredibly

(20:26):
overtired, overtired child.
Like in most cases, if we can startto create a good bedtime routine give
them ways to quiet their body and mind.
'cause some children reallyneed time to quiet their mind.
Maybe some, meditate, but me bedtimemeditations or if they need to get

(20:48):
their sillies out, as my dad used tosay when I was a kid moving their body.
So bedtime yoga, sometimesfamily yoga together.
Or just simply, literally goingfor a walk an hour or an hour
and a half before bedtime.
Just getting some energyout really helps with that.
But in, again, in my experience,the child is probably overtired

(21:10):
and it's not a tantrum.
They're just, it's a symptom of themneeding more sleep or structure.
I would say my experiencehas been the same for sure.
And I think also the wordtantrum has a component to it.
I think that already creates like arise of frustration in the parent,

(21:33):
almost like it's a choice thatthe child is making to tantrum.
And and so I, I think if parents canreframe in the moment that like take a
deep breath and say, my child does nothave the skills or the current physical
capacity to handle this moment and Ineed to help them have the skills to
get to sleep, that can help them to feelless like I'm, it's me against my child.

(21:57):
And more like I'm gonna come alongsidemy child to help them build the
skills that they need for thismoment to be able to go to sleep.
And hopefully as they learn theseskills and as we do this enough times
consistently, it will be less of atantrum before they go to bed and they're
gonna be able to, it's just gonna getbetter and better as time goes on.
Yeah, I think if they can controlit at bedtime, it makes it

(22:19):
much easier with consistency.
With the overnight tantrums.
I just think that tantrum has such anegative connotation, and it's not like
a child is choosing to have a tantrum,and I feel like sometimes parents see
it as the child choosing to have thattantrum and cause chaos at bedtime.

(22:40):
And it's really just not the case.
one of my favorite things to do withparents is to show them like like an
M-R-I-F-M-R-I picture of a child's brain.
And you can see that like theamygdala in the brain is like the
place where all of the emotions are.
Your fear, your joy, youranger, your, all of that.
And that is nice and meaty,even as like an infant.

(23:01):
It's coming online.
It's strong.
And then the frontal lobe isjust like a gray area that's
smooth, not at all developed.
And it's that's thesecretary of the brain.
That's the problem solver.
And so the brain develops in this wayto keep us safe where we, 'cause we
need to feel fear, we need to feel theseemotions to be able to keep us safe.
And so that comes online much sooner.

(23:21):
But the problem solving partthat's not fully online until
you're like in your twenties.
So it's when you think about it likethat and you think my child is so good
at having emotions, but so far behind in,in like solving problems, it just helps
you to see your child less as the enemy.
'cause I know that theycan just grow horns, right?
Right around that six o'clock hour.

(23:42):
It's like how is my child a human?
I don't know.
I, I have a question about that.
Just because, I think that peopleexpect more out of their toddlers
than toddlers are able to give thembecause they do become tiny humans.
They really aren't developed enough too.
Manipulate or tantruming isn'tdone on purpose to upset you, but

(24:06):
I think about self-regulation.
I think that's something that's discusseda lot in the sleep consulting industry.
People talk about self-regulation, so I'mcurious from both of your perspectives,
when can you start to expect a child tobegin to regulate their emotions begin

(24:28):
to understand rules and boundaries.
For instance, think of, people who cometo me and they've moved their 15 month old
out of the crib and into a bed and theydon't understand why the child is getting
out of their bed or out of their room.
I am a pulmonologist, so I'mgonna let Danielle take this one.
I'm gonna give a classic psychologistresponse, which is, it depends.

(24:50):
So I would s
Tell me about your mother.
Take a seat on my couch.
No I would say that I do think thatit depends, and it also, it's not as
simple as there's a switch that is, I'ma good problem solver, I'm a bad problem
solver, or I can regulate my emotions.
I cannot, 'cause I'm sure right now itwould take you less than half a second to
think of adults in your life that have noidea how to regulate their own emotions.

(25:12):
So it, it has less to do with ageand more to do with the opportunities
and the yeah, the opportunitiesto build skills and the templates
that have been provided for them.
My 2-year-old nephew istremendous at taking deep breaths.
His parents started doing thatwith him from such a young age.
I have a 10 month old, so I watchedthem do it before before I was there,

(25:34):
and it was like he was like ninemonths old and he'd be crying and
they'd be like, take a deep breath.
I was like.
Are you crazy?
He can't do that.
But lo and behold, he's two yearsold and now he can take deep breaths.
So they started so much earlier thanhe was able to do it, but they weren't
expecting him to be able to do it.
Rather, they were just showing him whatthey like, what would be helpful so

(25:55):
that then once he started to be able todevelop the skill of breathing through
his nose, then they could say, breathethrough your nose, out through your mouth.
And so it's, and it's just getting, moresophisticated and better as it goes on.
That being said, he's still in a crib.
they're not ready to put him into bed.
That's a problem.
That's something that's problem solving.
That's a little bit up the road.
So I would say thatit's a graduated thing.

(26:16):
And it also, it depends on how yourchild is the kind, like where they are at
cognitively, where they're at emotionally.
Like boys tend to develop alittle bit later than girls.
So there's just, there'sall of those little things.
So I would say to get out of this, just"it depends" vagueness I would say that
you can start building those skills reallyearly and modeling those skills to them.
And when you start to get frustrated inthe kitchen, when something's not working

(26:39):
or whatever, say, Ooh, I'm frustrated,I'm gonna take a deep breath or whatever.
Kids from a very young age canwatch their parents do things and
start to model that themselves.
But then also, like probably themore like cognitive reasoning and
through thinking about regulating youremotions and being able to talk about
it, that's probably closer to like.

(26:59):
Seven, like seven to eightto nine around that time.
And then being able to develop a littlebit more like theory of mind, thinking
about how it's making other people feel.
When you act like that's morelike around like 10 to 12.
So it's, there's like differentstages to emotional development.
So I think it's not as simpleas providing just one age.
But I think you can startinstilling skills in kids really

(27:22):
early without expecting mastery.
And I love that too, that the idea thatyou model these behaviors yourself, right?
Because the journey of becoming an adultis learning self-regulation, right?
Managing your own feelings.
'cause the feelings don't goaway as you get older, right?
You just get you if you're lucky andand you've been parented appropriately.

(27:44):
You learn to manage these things yourself.
And I love that anecdote, just teaching.
'cause the parents, the baby'sscreaming and the parents are just like,
Yeah.
just trying to like, likereally let it go a little bit.
That's, it's really valuable.
And which is not to say parents,I know you've yelled at your kids.
It's okay.
I've done it too.

(28:04):
Maybe Danielle hasn't yetbecause Griffin's small.
I'm sorry.
I would
No, that's
say your son's name, I've got,because your son is small, your son
is small and he looks really cute.
He's not quite at the agewhere he is gonna really start
Oh no.
He's very advanced.
We think he's a genius 'causehe is already throwing tantrums
or whatever we wanna say.
He's still building.
He's like learning.

(28:25):
We're learning.
He needs his skills building.
He was arching his back during dinnertonight to let me know he was not
interested in what I was serving.
And I was like, wow.
So early.
You're such, you're so advanced.
man I remember those days andyou feel like you're a genius.
'cause like your two year old's helike, oh my God, he likes everything.
He eats avocado.
He is eating salad and it's twoand a half and it's like chicken

(28:46):
Yeah, wait till they're stillnine and a half eating like
mac and cheese all the time.
Oh yeah.
Got.
The let, lemme tell you is my sidebarparenting struggle is that at no point in
my parenting career if I had two childrenwho like eating pizza at the same time.
And when my son, my older son wasyoung, he went through a stage where

(29:08):
he wouldn't have cheese in his pizza.
So I , an Italian man, had a go tothe pizzeria like a jerk, and order
a pizza with no cheese only for him.
And then he started eating pizza normally.
And then the younger onestarted picking the cheese off.
And now when we have a weekly pizzanight with our friends and they're always
like, oh, pizza, we don't like pizza.

(29:30):
And I'm like, come on,
Get in touch with your Italian blood.
This is who you are.
Just Eat the pizza.
Everybody likes it.
Anyway, let's go on our next topic,which is, it's funny I'm just editing
a episode we did on, I cry it out,everybody's favorite sleep training
technique a couple weeks ago.

(29:51):
So let's talk about extinction sleeptraining in older kids, which is,
I think, honestly, personally, it'ssomething I try to avoid if I, if we
can though often sometimes you haveto have a little bit of this, right?
Ariel, I know this was on your mind.
I think well, and we've talkedabout this with infants too.
I think every parent's desireis that they are going to soothe

(30:14):
their child with their presence.
And I, that being said, I wouldsay age, I probably three and up.
I cannot stand the term cried out.
I start with more parental presence.
With an older child, with a toddlerbecause they have started to

(30:38):
develop, they could have startedto develop some fears of the dark.
I've talked about the lobsters we had.
I had a client whose kid wasafraid of lobsters even though
there would not be lobsters in hisroom in the middle of the night.
But, kids get these weird things,and I think I've said this before,
sometimes they don't know how to evenname what it is that they're afraid of.

(30:59):
They're not quite there yet.
They just have a feeling ofanxiety or, they, they're
scared and they don't know why.
So they'll just, grab something,lobsters, cats, whatever it is.
So my first course of actionis to like, just really change
up the routine of the evening.
Start to settle things downan hour before, and then I.

(31:21):
Again it depends, and I know we talkedabout temperament, but some kids are
going to need to run around for alittle bit and go outside and, burn off
some steam and then come in and playsome games and then change things up.
And then mom and dad go in there andthey lay out the rules and here's
how it's gonna be and I'm gonnasit with you for a little bit and

(31:43):
then I'm gonna go whatever it is.
And for some children just shakingup the routine a little bit and
stepping back and thinking about whatdoes my child really need and how
can I address that in a better way?
That can, and sometimes it's great.
You go the child, the parent will sitwith the child and they say, I'm gonna
sit here with you until you go to sleep.

(32:04):
And the child is calmed by that andwithin 20 minutes they're asleep.
Sometimes children willtake advantage of this.
And having a parent there just eithercreates a power struggle where the child
is getting out of bed and the parentkeeps putting them back into the bed
and then they're, it becomes a game.

(32:24):
I try to encourage parentsto ignore that behavior.
It's hard as a parent not to want to pickthem back up and put them into their bed.
I've had, I remember one time I hadsomebody and their son got outta bed
and was like crawling all over themand then playing with toys, even
though I told them to remove the toys.

(32:44):
Eventually it did work, but it tookway longer than it should have.
It took two weeks for him to realize,okay, they're not gonna be very fun
right now if they sit in my room andI'm tired, so I'm going to sleep.
in some cases, children need a littlemore space and sitting there is
just way too stimulating for them.
So in those cases, you mighthave to let them fuss or scream

(33:10):
a little bit, yell at you.
I think the most important piece aboutthat is reassuring them that you're
still there, but this is bedtime.
So it's creating thatboundary but reassuring them.
And in the beginning, forsome kids that can last.
It can be a long night for a few nights.
But if you're consistent with it,like you said, kids learn quickly

(33:36):
if you're consistent with them.
And so parents are like, thefirst night, oh my gosh, I cannot
believe we were up all night.
He fell asleep for this amount oftime, but then woke up and it was
the same thing all over again.
It's okay, but he fell asleep.
At some point, so let'skeep going down this road.
But I would say, crying is notmy, and it sounds terrible.

(33:56):
It's oh, with babies,sure, cry it out is great.
It's just different somehow witholder children and where they are
developmentally in my experience.
So I would love to hearwhat you think about that.
Yeah, I agree.
I think that that as.

(34:18):
Kids are older and also more verbaland can express things like it, you're
just dealing with a different ballgame than just like this graduated
approach of putting them in their bedand then going and checking on them
after eight minutes or, whatever it is.
It does require a differentlevel of approaching the issue.
But I, what I like to tell parentsis this will be uncomfortable.

(34:39):
I think sometimes parents want tochange their child's sleep with.
No discomfort.
And it's it's currently not comfortable.
That's why you're here and whyyou're wanting some help and support.
But we need to create a zone of changethat is it's big enough that it gives
the child space to be able to developthe skill and be able to do it.
But it's also not so big that it, itfeels like it's cavernous and they're

(35:01):
not gonna be able to it's like toomuch to expect for them at that point.
And so you wanna think about itlike this scaffolding of I'm gonna
help to support you and we'regonna get through this together.
And it's exactly what you said.
It's like validating.
I know that this is really hard,but then building their confidence.
But I am, I know that you can do this.
And so it's pairing thosetwo things together.

(35:21):
I like to really with older kids,help parents develop a plan that is
going to give them the right levelof support, but also give them enough
space that they can develop the skill.
'cause likely the problem is thatthey are needing their parent too much
in the night and we wanna help teachthe child you, it's okay to need your
parents, but it's okay to need them.
A little bit less and a little bit less.

(35:43):
And a little bit less.
I feel like I've seen the kids andthese are often the kind of the mid
to late toddlers, early preschoolers.
Where the parents are justtrying to go zero to 60, right?
The child has never slept independentlyand all of a sudden the parents like

(36:04):
one, usually I think they can goabout three years with terrible sleep,
but they're having, I'd say, there'sa new sibling coming or something
like that, and they, all of a suddenthey're like, that's it, you are
now sleeping in your room tonight.
And they're like closing the door.
And it's a disaster, right?
Because the child is hysterical.

(36:24):
They've never really had, hadtoo much of an expectation to
do any of this on their own.
And now they have to sink or swimand usually those kids, frankly,
are a little bit more on the anxiousside anyway, if the parents are
still struggling at that point.
And I've even, and I, Arielle I thinkyou alluded to this in outline, we've
had parents who like lock their kids intheir room and there are context where

(36:47):
it's appropriate, I care for childrenwith neuro developmental issues like with
autism, who wander the house, get out ofthe house, turn on the stove, et cetera.
There's a real safety issue there.
But for neurotypical children whoare younger I think that the safety
issues are really not front of mind.

(37:07):
And if a parent told me they, theyhad done that and they're just trying
to survive, I would not be calling upchild services, but I feel like if you
need to keep your child in your roomyou probably should be on the other
side of that door talking to them.
Like what?
I feel, Daniellele, I think you mayhave seen this or anything like that.
If a parent was asking youabout should I close, should

(37:28):
I lock my child in their room?
What should they, like a desperateparent, what would you tell
Yeah.
I would say generally speaking,it's not my favorite intervention
because it's not really teachingthem a skill, and especially
since we're talking about anxiety.
If a child feels trapped in theirroom, like they cannot get out,
that will only worsen their anxiety.
And even if you're saying like, you'regonna be fine in there, whatever the,

(37:51):
I don't think any of us would like thefeeling of getting locked in So if we
think about how much we wouldn't likethat, kids wouldn't really like that.
Now, if you have child locks on adoor and you have an 18 month old or
a 2-year-old, and they don't know thatthey're trapped, that's not a bad thing.
It's not, then they aren't experiencingthe feeling of being trapped in as
long as they're, there are obviouslyall the safety precautions about you

(38:12):
being able to get in the room or, fire,safety, all of that stuff, obviously.
But there's a difference between if youhave a young child who you doesn't know
that they're being trapped compared toa child who you're saying, I'm locking
the door so that you can't get out.
That's a very differentkind of experience.
So it's not I just find it tobe I don't wanna say lazy, but
ineffectual way of fixing theproblem because it's not building

(38:34):
any skill, it's just containing them.
And then as soon as the door isnot locked, then they will come
out and it hasn't really gottenrid of the underlying issue.
And I think this is a good segueactually, 'cause I love the idea of.
change may be uncomfortable,especially in an an older child.
You've gotta, you've gottacreate a situation in which

(38:56):
they can succeed, right?
And you're you're you're slowly movingthe window of what you're expecting,
but you're allowing some discomfortfor the child, but you're also allowing
them an opportunity to succeed.
And I think nowhere is this more clearthan with some of the children we see
with pretty severe separation anxiety.
I'm just trying to come upwith a vignette for this.

(39:17):
Imagine or 5-year-old who refusesto sleep without their mom present,
she follows her mom from room toroom when her mom's in the house.
If both parents are there, is notinterested in the other parent and
really struggles with issues likedrop off at preschool et cetera,

(39:37):
and can be very clingy at night.
Would you say that's a fair kindof depiction of what separation
anxiety might look like?
What are some of theother hallmarks of this?
And I think since we're talkingabout sleep stuff that, that, that
manifest at night,
separation anxiety is, it's the.
The anxiety of being separatedfrom, I, I don't know how much

(40:00):
explanation there is needed in that.
it really
so cleverly
straight to the point.
But it's typically betweenchildren and their parents.
But it can also be, adultscan have separation anxiety.
Like it's not somethingthat's only in childhood.
It's most commonly found bya landslide in childhood.
But it is when you feel so uncomfortablethat it is causing you significant

(40:22):
distress in your functioning tobe away from typically we'll just
say your caregiver or your parent.
And so th this would.
I think you hit all of the main pointsanytime that the parent tries to leave.
not being able to sleep independently,sometimes not even being able to
sit in their own chair, constantlyhaving to have physical contact.
And so it, it can really look alot of different ways based on

(40:44):
kids, but it's when there is a deepdistress when they are not in very
close proximity to their parent.
I, I saw one child who had separationanxiety about even their parent going
out to the mailbox to get the mail.
Like even it's the, it could be a fearthat something bad is gonna happen
to the caregiver or something bad isgonna happen to the child, and they

(41:05):
just feel a lot safer when they are,when they can see 'em, keep eyes on 'em
and feel like they're close to them.
So there really are varyingdegrees of intensity and how
impactful it is on functioning.
I'm gonna recommend the show notes EliLebowitz book about dealing with child
anxiety and OCD and the idea that childrenwho are anxious, sometimes they're, they

(41:26):
appear fearful or anxious, but sometimesthey can be very angry and aggressive.
And this insight really struck me forwhen my kid was tantrumming a lot.
I think he was just being anxiousand he, he's he's a anxious dude.
And just to remember that if yourchild is absolutely losing it when
you leave the room or you wanna leavethem at night they might be angry,

(41:48):
they might be aggressive to you orto a sibling or something like that.
It still can be a manifestationeven if they don't seem frankly
fearful.
there.
There's something about.
Tender sensitive anxiety that elicitsmore compassion than a kid who's like
thrashing around and really angry.
But it's, it often is coming from the sameplace, and some kids feel more comfortable

(42:11):
to cry and feel and let out that morelike sensitive, sad side of their fear.
And some kids feel more comfortable totake up space in the room or like to
feel like they are, angry and upset.
And it almost can for some kids,give them this sense of control
over their fear, but really itis their fear still driving them.
But it, but when it manifests sodifferently, it can be hard for

(42:33):
parents to tell what's going on, butit often is stemming out of anxiety
what's the
for separation anxiety.
It can, it, it starts as early as I.
Infancy.
So like I, I think like the firsttime is it can be like around four
to six months, and then it happensagain, like around eight to 10
months is the next little peak.
And then again, I think around two tothree years it starts to, to peak again.

(42:55):
But then if we're talking aboutlike the separation anxiety where
the, yeah the childhood separationanxiety it is like around like
the five, six, 7-year-old range.
And that's often coincidingwith when they're starting in
school, things are changing.
But I will say that I, to just validateparents' experiences right now for any
parents that are listening, there is stilla lot that we don't know about how the

(43:20):
pandemic impacted anxiety in kids, andespecially separation anxiety in kids.
And so if you're looking for yourself tobe reflected in, scientific studies or
in books, it may not be out yet becausewe're still doing research on finding
out how this cohort of children wasreally affected by something completely
out of your parental control, completelyout of their childhood control.

(43:41):
But I just recently spoke with a familywho was saying that their child for the
first two years of life barely saw anybodyoutside of them and their grandparents
because there, there were some medicalissues that really put them at risk to
being able to socialize with other people.
And so their anxiety looksuniquely different than other
children from other generations.
And I think that's also something tothat, I wanna make sure to validate

(44:04):
that parents are experiencing a part,particularly rough go of anxiety
right now because of some of thethings that have gone on in the world.
I still feel like we're seeing pandemicstuff shake out in children's mental
health Academically, socially, from amental health standpoint, we're still
feeling those repercussions shake out.
And I, I'm a, I'm an optimist.

(44:25):
I'm, I believe in the resiliencyof children, but I do think there's
sometimes some unique challengesthat have come out of this.
I really want to talk about accommodationsbecause I feel like this is such an
incredibly valuable concept for parentsto understand in dealing with separation
anxiety, dealing with fears, et cetera.
And what parents need to thinkabout when managing these things.

(44:47):
Would you mind explaining whataccommodations are significant
accommodations are a term that is usedtypically to talk about anxiety and
with parents who have anxious children,or actually any children at all.
Every parent makesaccommodations for their kids.
So let's start there.
Every parent makesaccommodations for their kids.

(45:09):
Your child might preferthat their sandwich is cut
diagonally versus vertically.
Your child may prefer to eat off ofthe green plate versus the pink plate.
Your child may prefer to sit on the rightside of the car versus the left side.
So there's lots of accommodations that wedo all day to keep our kids on their feet.
And, it's, and you do lots of thosethings to avoid power struggles.

(45:31):
Accommodations in and ofthemselves are not a bad thing.
We need them to be able to make our worldspin and our children smile sometimes.
Now there are unhelpful or unsustainableaccommodations, and that is when
the accommodation must occur forthe child to be able to function.
And it is . Parents do this toalleviate short-term distress.

(45:54):
But then it creates long-termpotentiation of the problem.
So if you think about if your childprefers their sandwich cut a certain way
and you accidentally did it a differentway or a parent that didn't know, cut
it a different way and we were out ofbread, this is the only sandwich you
have, and they absolutely cannot functionif their bread is not cut that way or
they cannot go to bed if mom is puttingthem down and, but they prefer dad

(46:17):
or they like, it's that kind of thingwhere the accommodation is something
that cannot be done all of the timebecause sometimes mom needs to go to
work and dad has to do it, or, sometimesthe green sweatshirt is in the wash
and so it has to be the red one today.
It's like when those accommodationsare happening frequently enough
and are at an intensity where itcompletely stalls the functioning

(46:38):
of the home and they have to happen.
So those are unhelpful accommodationsor unsustainable accommodations.
And so children who are anxious if parentslook at their lives what I'll do often
when working with families is I'll sayI want you to take this week and just
take stock of all of the accommodationsthat you find that you're making.
And parents will come back to melike, oh my goodness, I'm, I have so

(46:58):
many accommodations that I'm doing.
I didn't even realize like how many thingsI'm, I like how many different ways I'm
bending over backwards and going throughhoops to make my child's day kind of flow.
And so it's, it doesn't mean that youshouldn't have any accommodations for
your child, but we wanna think about howto reduce them and how to find the ones
that are in this unsustainable patternto be able to help your child learn.

(47:20):
Like I can survive.
Eating off the pink plate, I willcontinue to breathe if I wear the red
sweatshirt, like it's that kind of thing.
But then generalizing it to bigger thingsI'm going to be okay to walk into school
today without my mom, and I'm gonna beokay if my dad goes out to the mailbox.
So taking a look at all of theaccommodations and being able to

(47:43):
to make some wise decisions aboutwhat is sustainable and what is not.
the reason that this concept is souseful is because finding the right
accommodations that parents need toaddress is the first step for parents
to successfully manage these issues.
And it's again, like I'm not an expertand I know you are, but just reading a

(48:05):
bunch about this is, it's like parentspick accommodations that actually,
that you don't like doing, right?
Like that, that are difficultfor you, that happen regularly.
And then it's really a parental behavior.
It's not the child's behavior, right?
you can you can tell your child you wereleaving the room after five minutes.
that's making a change.
The change can't be, and yourchild has to stay in the room.

(48:28):
you are expected just to changeyour own behavior as a parent.
their behavior because they're so used tomaking accommodations and they know that
not making certain accommodations aregoing to be, it's gonna be uncomfortable,
and they just want to know that it's okay.
Then they wanna know,okay, how do I do it?

(48:51):
Then they need the support to enforceit and stay consistent with it.
So I think that's, I thinkthat's, it's very common with the
people that I work with becauseit's like they know what to do.
It's just hard.
It's really hard.
Y So hard.
So hard.

(49:12):
Yeah.
And I I think.
Really, it's said all the time, butparents are the experts on their own kids.
we're sleep experts, respiratorymedicine experts, like we're, we
all have our little, niches thatwe fit into, but their child that
no one knows more than the parent.
And so being able to empower themto say, no, you're the expert.
I'm gonna give you some skills here,but you have the permission and also

(49:34):
you have the, yeah the skills andthe power to be able to do this.
And I'm gonna partner along with you,but really you're the star of the
show to help, to set some parametershere, but the parameters as you
said, Craig, like true boundaries.
Should require the otherperson to do nothing.
It's it's you setting theboundary for yourself.
So if your child is hitting you, obviouslyyou don't want your child to hit you, but

(49:56):
you say, I'm not going to let you hit me.
I'm gonna keep myself safe andI'm not gonna let you hit me.
Or if they're hitting a sibling, I'mnot going to let you hit your sister.
But it's then removing yourself from thatsituation or removing the other child
from the situation or whatever it is.
But it's, it is generally speakingit can be very freeing to know I
can't fully control your behavior,but I can control my reaction to

(50:16):
it and how I'm going to receive it.
And then helping the childbuild the skills to then have a
different situation next time.
Yeah, and I think you, you make a goodpoint, is that a lot of times sometimes
when these patients are making it to you.
These are complex behaviorsthat have evolved over years.
And they're not it's not like sleeptraining is six month old, which, you

(50:38):
do it, you can get it done in you cando get it done in a couple of nights.
Really this takes a mindful approachand it takes a little bit of time for
people to really unpack these things.
And I think in a, I'll put, I'm gonnaput in the show notes Eli's Parent
book, which I think is for most people,but we have some sleep consultants and
some physicians that listen as well.
He has a book for providers and init I, I stole, he has this protocol

(51:02):
for a child that's not slept intheir own bed for years and how
they get them in their own bed.
And all it is basically, firstof all, step one, make sure
the child has their own bed.
'cause some of these families they've justpiled a bunch of, books or something on
the kid's bed, and have the child pretendto go to sleep just for a short period
of time, and then go in their parents'room every night and slowly build up the

(51:25):
child's tolerance for being by themselves.
And it's just so important to,e especially in this situation,
there's an expectation the childhas a little bit of discomfort,
but not a lot of discomfort, right?
That we should put tasks in frontof them where they can succeed
I
can build that
for older kids is beingable to see that they.

(51:49):
They were successful.
And I do a lot of like behavior charts,just simple bedtime routine charts.
I brushed my teeth, I readmy books, I got into bed.
It doesn't have to be overly complicated,but they start to see, oh, look did it.
And they even two and a half yearolds, they can get so excited by the

(52:09):
fact that they're completing thingsand the parent is praising them in the
morning and in the beginning if thereis an expectation, slept all night in
their own bed or something like that.
And they didn't get the stickerfor that particular thing.
You can still celebrate everythingthat they did and say tonight you
can get that sticker if X, Y, z.

(52:30):
If you sleep in your bed and you don'teven have to, even if you wake up early,
but you're quiet, if it's an early wakingchild and they've been waking the parents
at four 30 in the morning, but then theystay quiet until, hatch light goes off or
something like that, until six, you cancelebrate that win and celebrate all the
wins, even if they're little, and thenslowly but surely, they want to please

(52:52):
you and also feel success themselves.
Daniellele WI hink this is aninteresting point because I do
think in all, like kids, threeand up, like reward structures,
incentives are, can be very effective.
And the flip side is, and a lotof this literature about dealing
with like anxiety, it's more aboutparental behavior change and dealing

(53:12):
with accommodations like parentsjust changing their own behaviors.
What, in what context do you think morewe want to re reward or incentivize
certain behaviors from a childversus another situations we're just
gonna change the parent behaviors.
Do you do those twothings at the same time?
Do you do one in one context,one in another context?

(53:35):
Yeah, when there's like a lot of loopor there's a lot of different, like
if you do this, you get one sticker.
If you do this, you get two stickers.
If it gets too complicated, thenit gets too convoluted for the
parent to remember and it doesn'tfeel as rewarding for the kid.
It could, it should basically be likevery clear if this happens, you get this.
If this happens, you don't get this.

(53:55):
And one thing that I will say aboutreward charts, you never take something
away that a kid earned If they got it onMonday, but they didn't do it on Tuesday,
you never take away Monday sticker.
If they got it, they earned it.
So yeah.
But in terms of when to have likerewards slash incentives versus
like parental change, everythingrequires parental change.
There's no plan or no interventionthat doesn't require parental change.

(54:18):
'cause the parents are thecaptains of the ship or the.
they're the pilots of the plane, and sothey will always be involved and it will
always be parental if the child, I wouldsay that I usually just, I don't have a
fast and like a hard and fast rule aboutwhen to use reward charts versus not.

(54:39):
I think some kids just really likethat visual and they really benefit
from having a way to mark progress.
Whereas other kids you'll know prettyfast if you try to do it and they
don't really care, then you know that'snot really gonna be that effective.
So I, yeah I don't know thatI have a hard and fast rule.
Do you, Arielle?
No, absolutely not.
And I, it depends like some kidsreally, just like you said, they just.

(55:03):
They wanna see the, theywanna see their progress.
They wanna see their wins, and they alsowanna feel celebrated by their parents.
Wow, even though you didn't do this,look at all the things you did.
And again, it doesn'thave to be complicated.
Brush teeth, read books,got into PJs, whatever.
Other kids, they don'tgive two craps about it.

(55:26):
They really don't care.
one of the biggest things I talk aboutwith parents is what motivates your child?
What does your child getreally excited about?
And how can we incorporate that intowhatever plan we're going to make?
But I agree that there is noplan without parental change.
Like parents have to change their behaviorand their methods and their boundaries in

(55:50):
order to see a change in their children.
my kind of gut, I guess is, oh, some ofthe kids that I see, these are really
just learned behaviors around bedtime.
Like curtain calls.
Kids go in their room, they comeout, they come in during the night
'cause they're used to doing it.
It's not really that fraught or emotional,it's just what they're used to doing.
And a situation like that, a simple rewardsystem like the bedtime pass or something,

(56:13):
can work really well if it's a childthat's interested in that sort of stuff.
Whereas if you have a child that is reallythey're so anxious they're just explosive.
They re it it's hard.
There's no way the child wouldsucceed with that structure because
there, it's just too fraught.
I think you really need to take moreof a, more of an approach of really.

(56:38):
Parental behavior management andremoving some of these accommodated
behaviors but in a stepwise fashion.
Because the child really, becausethey're so anxious, they're unable
to make those steps themselves.
And you kind you do geta feel for it, right?
You do this for a while and you'relike, the parents have a feel

(56:58):
for what, some parents have beenlike, how about a reward system?
Would they like stickers?
And the parents will say no,they don't care about that.
And then you gotta thinkabout something else.
But also I feel if I, am I hearing anarrative where the, where there's so much
emotion wrapped up in it and the childreally just isn't functioning well, right?
Like they they're not able to do basicstuff that kids need to do, be in a

(57:19):
room by themselves for five minutes.
When they're coming from a place offear, rewards aren't gonna be helpful.
in listening to this podcast there,I'm sure there are just constant wealth
of information of things to try andtips and tricks and things like that.
And if you've tried some things asa parent and you feel like you're
constantly coming up against a wall orlike you feel like, as Arielle said,

(57:40):
if you feel like I, I need to havethe steps to take, like I want to take
them, but I don't know exactly what todo and I need some guidance on that.
Seeking out a psychologist or a goodsleep consultant on those things, like
there is no shame in asking for help.
And also the idea that you shouldjust know how to do it Is bunk, like

(58:00):
the, this sleep is a behavior and itis, and something that you can get
better at and that you can learn.
And teaching your child to sleepbetter is a whole different beast.
And I would say that if.
Any parent that is like struggling withtheir child's sleep should feel like
they can seek out extra help It mayjust be that one session is enough for
you to feel like, okay, I've got it.
Let me go try these things.

(58:21):
And it may be something whereit's a little bit more ongoing,
where you need more supportdepending on how your child is.
From the perspective of anxiety, Iwould say that if you notice that your
child is experiencing real distresswhen they're trying to go to sleep and
they're not able to go to sleep or theirworries are really bothering them and
it's not something that they can dismiss.
And it's something that's becoming moreruminative for them if it's starting

(58:43):
to bleed into daytime and start toimpact their daytime functioning.
If you're noticing that it's, takingaway from their sleep so then they're
overtired during the day and that'shaving impacts on different things, those
are signs that that maybe bringing in aprofessional could be helpful to be able
to check out some of those things and givethe child and the parents some skills.
And.
And the degree to which they mayneed help will vary on the child.

(59:06):
But I would say that thekey word is distress.
If you notice that your child isexperiencing distress, and that could
be, as we talked about, that couldbe like that sensitive tearfulness.
Or it could also be like anger andfr and irritability and frustration.
If you're seeing those kinds of things inyour kids then I would say seeking some
help would be a, more than warranted.

(59:28):
I had say also too for parents, ifyou're at your wit's end and like you
are also not functioning well as aresult that's a good time to reach out.
And, it's great to startwith your pediatrician.
Make sure you're notmissing a medical disorder.
Often your pediatrician will know that.
Providers in the community who can bemost available and most helpful for you.
I will put a link in theshow notes to, I know Dr.

(59:49):
Garay has talked about someresources in Psychology Today.
Can help you find atherapist for your child.
I'll put some stuff about the books.
Dr.
Garay, is there any place thatpeople can find you online or
that you want to plug today?
I really don't, you can come ondown to Yale and come see me through
the sleep clinic if you would like.

(01:00:11):
We, we have an email box too,the sleep edit show@gmail.com.
If people have questions, I thinkwe're gonna do a question show
once we accumulate enough of them.
hey take it easy guys.
Have a good night.
Thanks so much forlistening to the Sleep edit.

(01:00:31):
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.
You can find Ariel atInstagram at Ariel Greenleaf.

(01:00:55):
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.
It's available whereverfine books are sold.

(01:01:16):
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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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Tackling Anxiety and Sleep Issues in Children: A Psychologist’s Perspective