The stay-and-support method to help your child sleep through the night

LUCY WOLFE

Gill Books

Contents

Cover

Title Page

Introduction

Chapter 1 Why Your Child Won’t Sleep

Typical dependencies

Biological timekeeping

Understanding ‘getting tired’

Common sleep issues

Routines

Chapter 2 Getting Started

When to start

Get out and about

Where do you want your child to sleep?

Keeping a sleep log

Chapter 3 Creating Positive Supports for Sleep

Room acclimatisation

Cot exercises

The security item

The dummy

Connected play and one-to-one time

The sleep environment

Bedtime routine

Chapter 4 Gentle Sleep-Shaping Approach: Birth to six months

Safe sleep to reduce the risk of SIDS

A flexible feeding and sleeping rhythm

Learning to read your baby’s sleep language

Soothing strategies

Where will baby sleep?

A sleep-friendly environment

Establishing a bedtime routine

The percentage of wakefulness approach

Some gentle natural solutions

Reflux and intolerances

Chapter 5 Stay-and-Support Sleep Learning Approach: Six months to two and a half years

Who should start?

How to begin

The stay-and-support approach

Chapter 6 The Older Child: Two and a half to six years

How much sleep?

Has your child stopped napping?

Quiet time

What is the right bedtime?

Elements to consider

Sleep strategies

The anxious child

The bedtime routine

Chapter 7 Feeding and Sleeping Suggestions: Birth to six months

Up to two months

Two to four months

Four to six months

Chapter 8 Feeding and Sleeping Suggestions: Six months to six years

Six to eight months

Eight to twelve months

Twelve to eighteen months

Eighteen months to two and a half years

Two and a half to six years

Chapter 9 Developing the Daytime Routine

Being informed

Wake times

Daytime sleep issues

Bedtimes

Daytime feeding and sleeping suggestions

Starting the new routine

Chapter 10 The Overnight Plan

Nighttime feeds

Weakening the feeding cycle

Does your child still need a night feed?

Chapter 11 Stages to Sleep

Stage 1: Nights 1-4

Stage 2: Nights 5-7

Stage 3: Nights 8-10

Stage 4: Nights 11-13

Stage 5: Nights 14-16

Stage 6: Nights 17 and onwards

Typical outcomes

Changing the approach – interval visits

Early rising

Road blocks

Chapter 12 Landing the Nap

Naps in a daycare setting

Naps with a childminder

Achieving the nap

Nap troubleshooting

Chapter 13 Sleep Management

How do I manage travelling?

What should I do when the clocks change?

What about sleep regression and growth spurts?

What about nightmares and night terrors?

How do I make room-sharing work?

What happens when I return to work?

What about separation anxiety?

What about teething?

Are developmental milestones and sleep disturbances related?

When to move from two naps to one?

How to transition to the big bed?

When good sleep turns bad!

Acknowledgements

Copyright

About the Author

About Gill Books

Introduction

It’s good to meet you; it will be my pleasure to help you work through your child’s sleep issues in a positive and gentle way. My name is Lucy Wolfe and I am a sleep consultant and mum of four children. When my eldest son was born I knew very little about anything child-related – what was there to know and how hard could it really be? Jesse was what some might call a textbook baby; he fed and slept well initially, but as time went on his sleep deteriorated and by 10 months of age he was waking multiple times and drinking his own body weight in milk. I found myself frustrated, confused, challenged and, of course, extremely tired. I couldn’t understand how this had happened – he had slept for eight to ten hours from six weeks of age! I desperately needed things to change – for his sake, as well as my own.

I often joke that my career path was changed when I received this call from the land of sleep deprivation. My interest in sleep – the science and the strategies – was spiked by my own sleepless child. After working through my challenges and then, when I had three more children, realising that they were all so different and that there are gentle and emotionally considerate ways to help promote better sleep, I decided that I would extend my education and retrain in order to help others.

I work with families and children from birth to six years of age to establish positive sleep associations in the early days and to address frustrating sleep problems from six months onwards – without leaving a child alone to cry. To date I have helped over four thousand families directly and many more indirectly. Now it’s your turn.

I want to help empower you to address your child’s sleep issues, without compromising your own parental beliefs, with complete respect for your child’s emotional well-being and individuality. My approach is distinctly different from many others. First, I absolutely do not advocate unattended cry-intensive methods, controlled crying or crying it out, and I never want parents to leave their child upset in an effort to improve sleep. I suggest that positive sleep practices can be achieved and maintained, safely and appropriately, with a parent-led and fully attended, emotionally attached approach – and I will show you how. It is imperative that your young child feels loved, safe and secure at all times and that lack of sleep does not hold them back developmentally, emotionally or physically. Sleep serves a vital function, and sleep deprivation in early childhood causes an increased risk of health issues, impaired mood and behaviour, low concentration levels, reduced motivation and poorer academic performance.

I have a holistic approach that takes account of all the influences on sleep and merges them together in order to minimise stress and allow the child to be open to learning a new skill, while their natural body clock is in sync. I will always encourage you to attend and support your child, to be instinctive and not to second-guess yourself. My emphasis is on having all the positive sleep components accurately aligned, so that better sleep practices for your family have room to emerge and so that it feels right for you. My work is not about unrealistic expectations about sleeping through the night before your child is biologically ready or crying alone or about trying to drop nighttime feeds when they are still needed; it’s rather about setting the scene for improved sleep practices in your family unit so that everyone can function at their optimum level.

No family sets out to experience a debilitating sleep issue and not all sleep-related issues require fixing. However, all sleep can be enhanced and improved on and a solid framework can be laid; and you don’t need to cry it out to make this happen. The issues you experience can emerge at any age and stage. There will always be contributory factors, which I will help you identify. All children can be encouraged to sleep better. If you can develop a greater understanding of sleep itself and of your child’s temperament, and see the connections between the elements that contribute to the majority of child sleep issues, you will be able to help.

A feeling of failure can engulf the sleepless parent – a sense that they have done something wrong, that they should be able to sort out the problems without assistance. But all children are different, and what suits one particular child may not suit another. We change as parents, too – I know that as I had more children my own philosophies adjusted. This may be as a result of the changing family dynamic and each child’s temperament. We need to make decisions that suit everyone. I happily shared the bed with my youngest child, Harry, as it worked for us – but it may not be what you want and it definitely would not have suited my daughters Ellen and Eden. This book will highlight the reasons why you may be struggling, help you to become informed and aware, and help you to establish positive sleep associations and create the correct sleep environment for your child. It will also help you to develop an age-relevant balance between feeding and sleeping – and along the way it will illustrate common practices that help support and consolidate sleep and provide solutions for the issues with a consistent and clear approach.

Of course, we won’t just focus on problems. I will also help the new and expectant family work towards gently shaping their child’s sleep from the early days, while at the same time allowing the parent–child relationship to blossom. This can be achieved without being a slave to adult-oriented routines. When we understand how baby sleep actually works, we don’t need to be too concerned about what some may call ‘bad habits’.

I encourage you to think of your baby and child’s sleep in two parts: before six months and after six months. In the early days, your child’s sleep is not organised biologically and your baby may have a high need of parental input. I would never endorse a sleep learning exercise in the early days, but I can show you how to meet the baby’s needs in the early months and in turn work towards constructive sleep practices for your family so that you never have to troubleshoot. I call this gentle sleep shaping and if you are in the early stages of parenthood or haven’t had your baby yet, you might want to skip straight to Chapter 4 to get an idea of my strategies in the early months. Remember to move to the appropriate chapter as your newborn grows, though, so that you continue to create the correct balance for your child’s sleep as they transition through the stages. We know that the more informed parents are, the fewer problems they will have with their child’s sleep.

If your child is aged between six months and two and a half years of age and you are struggling, we can introduce a sleep learning exercise with my personalised stay-and-support approach, pulling all the influencing factors together to reverse a negative sleeping cycle, while remaining emotionally engaged and allowing your child to achieve their optimum sleep ability. I deal with this age group in Chapter 5, to help you understand sleep in a simple, practical way and then learn to implement my proven, effective approach. It takes time to establish great sleep patterns, so you will need to be patient and confident as you proceed through the stages.

I am also well aware that sleep problems are not just reserved for babies and toddlers. Many sleep issues continue into or emerge in the older age range and come with their own set of challenges – being able to protest, bargain, stall and, of course, run away from you, refusing to stay in bed, insisting that you stay and also sharing their or your bed with you overnight. So I have included a special chapter on how to package up the process and approach for your older child, too, without resorting to reward charts or incentives. In Chapter 6, I attempt to establish children’s best practice sleep habits organically and with their co-operation. The key is to provide your child with a sense of ownership and get them invested in their own ‘sleep happiness’. You provide choices and a sense of autonomy, but you remain in control, diminishing any anxieties about being alone at bedtime or through the night and consolidating their nighttime sleep, so that they get the rest they need and take great sleep habits into adolescence and adulthood. Older child sleep issues are sometimes brushed under the carpet, with fatigued parents resigning themselves to this being just the way it is; the child is ‘just a bad sleeper’. Let’s not rest on that premise; let’s be proactive and believe. Everyone can learn to sleep better and with confidence, they just need to be programmed correctly. Don’t rely on the assumption that your child will grow out of it. It can happen, but it might not.

So let’s get started!

Lucy Wolfe

Chapter 1

Why Your Child Won’t Sleep

First of all, it’s important to emphasise that not all sleep challenges require intervention or ‘fixing’. Infant sleep is highly complex and not at all organised and so what feels like a problem may well be just what your child’s sleep looks like at this early stage. I get lots of messages from worried parents that their two-week-old baby wants to be held and won’t stay asleep. This can be hard for the parents, but it is a very natural presentation from someone so young, who has been carried in the womb until so recently and whose whole system is immature. However, as time evolves and your child gets older and more robust, most sleep challenges will benefit from adjustments and intervention. Achieving better sleep for your child and family unit does not need to be about unrealistic expectations, sessions of unattended hysterical crying or trying to drop nighttime feed practices before a child is developmentally ready. It is about laying a solid framework for positive sleep practices, without compromising your child’s well-being – in fact, we will be enhancing it.

Common sleep issues from six months onwards may be represented by a resistance to sleep (taking up to three hours to go to sleep at bedtime); going to sleep with ease, then waking on multiple occasions, sometimes 8–10 times in a two- or three-hour period; or perhaps staying awake for three hours during the night, waking at four a.m., fighting daytime sleep and taking short and varied naps during the day. You may experience some or even all of the above at various stages. If you are, please know that this is the beginning of the end of the frustration and stress.

From around six months of age, the character of your child’s sleep has locked into place neurologically and the originally disorganised nature of infant sleep starts to become more organised. At this stage it more or less looks like adult sleep, except the young child needs more sleep than an adult and they dream more, too. Essentially, your child will start to have to cycle through their natural sleep phases and this is where issues can start to arise. It is not unusual for a ‘dream’ or ‘textbook’ baby to start getting more restless. Equally, you may find that issues that began at birth become even worse at around six months. This often coincides with what is referred to as the ‘six months regression’ and I suggest from this age onwards is the time to really actively start work on sleep issues. I want you to become informed and to gain a greater understanding of why your baby doesn’t sleep. Your younger baby will benefit from my gentle sleep-shaping recommendations outlined in Chapter 4, while acknowledging that before six months we don’t consider that there are any sleep problems, just an immature sleep state that may need to be actively addressed at a later stage – and it is never too late!

Typical dependencies

There are two major contributory factors to most sleep issues in babies aged six months and over. The first might be described as a parental dependency in the context of your child’s sleep. This means that if you are involved in getting your child asleep or partially asleep, your child is not yet independently able to go to sleep themselves. This in turn may mean that they are less likely to be able to cycle through their natural nighttime and daytime sleep phases. In the early months I encourage you to support your baby’s needs as outlined in Chapter 4 and I also suggest that you enable your child’s sleep ability with the ‘percentage of wakefulness’ approach. There is a small window of opportunity for introducing this approach, and if you have not been successful to date, the way your child achieves their sleep now can start to be part of a sleep problem. It can seem contradictory because your child needed support from you to get to this point, but now your support can almost go into reverse and represent one of the reasons behind continued sleep issues.

Common levels of dependency for achieving and maintaining sleep include a need for one or more of the following:

• bottles

• nursing

• parental presence

• buggy

• car

• rocker chair

• dummy

• parents’ bed

• holding

• hand-holding

• rubbing

• couch

By the age of six months your child’s sleep has started to become organised, so if your child is helped to sleep, their brain can find it difficult to maintain sleep duration without further parental intervention. When a child of six months and older who has been helped to sleep starts to cycle through sleep, the brain will periodically have a ‘partial arousal’. This is a bit like a ‘check-in’ system, where the brain checks to see if everything’s okay – ‘Is everything the same as it was when I first went to sleep?’ If it is, your child will more than likely roll over into their next phase of sleep, unless they are hungry and require a feed.

Unfortunately, if there is a level of dependency at this age and stage, when the brain checks in and things are not the same – the bottle/dummy/nipple/parent is no longer present – or the child has been transferred to the cot or bed already asleep or very sleepy, this partial arousal becomes a complete arousal and your child will call, cry and look for you to help them into their next phase of sleep. This dependency leaves you more exposed to unnecessary nighttime activity than you will be with a child who has been able to perfect the skill set. It is not unusual for some children to have been great at sleeping only for things to start to unravel when your initial sleep support stops working.

It is not uncommon for a six-month-old to initially fall into a relatively deep sleep, and you may not hear from them for the first two to four hours after bedtime. But then they awaken. This sometimes coincides with parents going to bed, and they may believe that they have caused this disturbance, but it is generally the end of the first sleep cycle. After this first awakening, your child will generally go into a light, dreamy sleep. You may find that your child wakes more frequently – every hour, every two hours, every 50 minutes, every 20 minutes – and unfortunately each time the child needs your assistance to go on to the next sleep cycle.

By the time we get to 5 a.m. young children want to do one of two things: to get up and start the day; or to go into another deep section of sleep for another hour or two until morning time proper.

When I meet with parents for the first time, at this point they are nodding and laughing, telling me I am describing their night (and possibly yours) so accurately that I must know what I’m talking about! You may find that your nights are different from this, or that they vary from night to night, or there is frequent waking directly after bedtime (this links with the second part of sleep issues, which I will outline later).

What I’m describing is essentially the biology of your child’s sleep – we can’t change that. But we can address the associations your child has with going to sleep and going back to sleep.

Often a dependency is not apparent to parents. It may take the form of a feed that happens too close to sleep time but doesn’t put your child to sleep, or it may involve an innocuous re-tuck of the blanket or kiss on the forehead; or perhaps you are still at an initial stage of my ‘percentage of wakefulness’ approach (described in more detail in Chapter 4). Either way, if your night sounds a little bit like what I have described above and your baby is six months or older, you can rest assured that you are close to the beginning of the end of your current sleep issues.

I call this a partial dependency. It’s very often triggered by a feed that happens too close to sleep time – it doesn’t put the baby to sleep, but it does help their brain get into a sleepy state. Although many sleep professionals promote bath, bottle and bed, I am keen to change the order and create a greater distance between feeds and sleep to prevent this dynamic interfering with your child’s sleep ability. If the feed is much less than 45 minutes before sleep time, I consider it to be part of the problem. I recommend a feed at least 45 minutes before sleep time and entirely separate from the bedtime routine.

Biological timekeeping

The second part of many sleep struggles, and one that is more significant for some families, is all about the internal body clock – your child’s circadian rhythm. This rhythm will not be completely set until after the age of around four years, but it is of enormous significance from birth. Your child needs lots of sleep, including daytime sleep, and they also have what I would describe as an ideal time or optimum time to be awake and an optimum time to be asleep. Young children who are not in sync with these times may find it more difficult to either go to sleep or stay asleep or, for some, a bit of both.

Timing for sleep is everything and although in the early days I endorse flexibility, at this age I would perhaps become more prescriptive. Often families that I work with have timing issues and nothing else. This makes the sleep issues no less challenging, but they can often be the reason why parents feel they have ‘tried everything’ and nothing has worked. If timing for sleep is not addressed correctly, then all the sleep learning techniques – shush, pat; pick up, put down; cry it out – that you may have read about will have limited results. Having a routine is simply not always enough – not all routines are equal – and I would encourage you to look at my age-relevant suggestions outlined in Chapter 9: I know they are effective.

What does your child do when they start to get tired? Perhaps they get cranky, whiney, fussy, moany? These obvious signals usually indicate an overtired child: intense eye rubbing; wide yawns; stretching limbs; clenching fists; arching the back; becoming agitated, a little bit impatient, unreasonable and non-compliant; wanting to get up with you, then wanting to get down again; not really knowing what they want. Or perhaps you don’t observe any of these symptoms; perhaps they get a bit hyper, or even a little bit entertaining. Maybe they request familiar items for sleep – their dummy, their lovey, your breast. If you see any of these signs, either in isolation or in combination, your child is highly likely to be overtired. Perhaps you even wait for these signs, because you know that achieving sleep will be easier.

Going to sleep when you are overtired often means that the brain is in a heightened state of neurological arousal. This means that your child sleeps lightly and everything wakes them – a flush of the toilet, creaking stairs, for example. You may be experiencing frequent nighttime arousals directly after bedtime, or maybe long wakeful periods overnight, perhaps some early rising and/or short and varied nap durations. All of this can be a sign that your child’s naps or bedtime, or both, are happening when they are already overtired. Sometimes it can be as little as 10 minutes too late!

Understanding ‘getting tired’

We have now established what the signs of being overtired are. Now let’s clarify what getting tired looks like.

The signs are not particularly noticeable – I would be looking for a quick eye rub, a brief yawn, maybe a moment of quiet – zoning out, staring into space – momentary decreased activity. Do you see this? Parents often see these signs but they disregard or misinterpret them, generally waiting until the signs are more obvious – which is the point at which your child is overtired.

These signs indicate sleep readiness – your child’s body is getting ready for sleep. The hormones, the chemicals in the brain, the body temperature dropping all play a part. The good news is that, given the skill set – we will work on this – and the opportunity that we will start to create, your child could start to go to sleep with ease and stay asleep for as long as their body needs.

What if you don’t see the signs?

It’s not unusual for parents to be puzzled and report that they don’t see these signs, and that is okay. It doesn’t necessarily mean that you are missing the sleep cues. Sleep-deprived children are great at disguising the early signs, leaving you only with the late cues. You may have twins or older children who act as a stimulant, ensuring that you are fooled into always attempting sleep when your child is overtired. Some easy-going babies are also very good at disguising how they feel. Parents often comment during the sleep learning process that now they really see the signs – how could they have missed them before? But perhaps they didn’t miss them; they just weren’t clear. As your child gets better at sleeping, they start to want you to know when the right time is and the early sleep cues emerge and become obvious.

Whether or not you can see these signs, I am going to help you plan an age-appropriate feeding and sleeping structure for your child, with or without sleep cues, that will start to match their biological clock and rhythm. This can help you start to work on improving their sleep, whether or not they give you clues.

Common sleep issues

Symptom	Cause(s)
Wakes frequently overnight	Overtired from nap deprivation Parent-dependent at bedtime Bedtime too late Parent-dependent overnight
Takes ages to get to sleep at bedtime and may or may not wake thereafter	Nap deprivation Bedtime too late Bottle/nurse/television too close to sleep time Nap imbalance
Goes to sleep very easily but wakes frequently	May go to sleep easily due to inadequate day sleep Bottle/nurse may be too close to sleep time Parent-dependent at bedtime Parent-dependent overnight Nap imbalance during the day Naps attempted at the wrong time Bedtime starts too late
Will only go back to sleep with a bottle	Bottle-dependent at bedtime Historic bottle dependency at bedtime Bottle-dependent overnight Negative feeding cycle Naps attempted at the wrong time Bedtime starts too late
Will only go back to sleep in your bed – may still wake frequently	Your child may go to sleep at bedtime in your arms/bed and is transferred to the cot already asleep and wants out as they awaken Naps attempted at the wrong time Bedtime starts too late
Will only go back to sleep with a bottle and coming into bed	Bottle is probably used close to bedtime and may be in arms or on parents’ bed when they first go to sleep Child has expectation of bed-sharing/conditioned hunger from habitual night feeds Naps attempted at the wrong time Bedtime starts too late
Wakes at 4–5 a.m. to start the day	Bedtime may be too late Nap deprivation Nap imbalance Uses a sleep prop – bottle, parents’ presence at bedtime Parent-dependent overnight
Naps infrequently	Irregular daytime schedule Oversleeps in morning Misses sleep window Day sleep not prioritised Unable to sleep without a dependency at bedtime
Takes 20–30 minute short naps	Overtired from broken nighttime sleep Oversleeps in morning Naps attempted when already overtired Parent-dependent at bedtime, nap time or both
Naps well but still wakes at night Wakes within first hour of bedtime	Nap timing may not be in sync Naps may not be balanced May require a prop at bedtime Bedtime may be too late

Routines

Many parents do not want to be routine-based with their children, and I am aware of all the arguments for and against. I do encourage a feeding and sleep structure from early on, though, and if you have been very flexible to date and are now having sleep issues with your child, adding regularity to your days will have an immediate positive effect on their sleeping pattern.

Of course, many parents are already routine-oriented and still sleep is elusive. I must point out that all routines are not equal and you may well have a routine that doesn’t suit your child.

Also, if your child has difficulty maintaining sleep or they are always close to being overtired, they are in a weaker position than a well-rested child and the timings need to be adjusted and refined further, which I will help you to do.

In the following pages I will help you:

• establish the best time to start working on your sleep

• make appropriate decisions

• establish positive supports for better sleep

• outline my effective stay-and-support sleep learning approach.

Additionally, I will help you:

• learn how to create your child’s age-relevant daytime feeding and sleeping routine

• plan your approach for overnight

• address your daytime sleep issues.

The result?

Better sleep for the entire family.