The first 2 years
What follows is a description of the overtired child in approximately the first two years of life. The order of presentation of the information which follows is approximately related to age. Thus the first description usually relates to the youngest infant and the last description to the oldest.
The Behaviour of the Overtired Child
As mentioned in the previous section about overtired newborn babies, fatigue is very common. The following is a general description of some behaviour patterns which may be found in an overtired child. If your toddler gets overtired but still behaves like an angel, then read no further. If you see a description of your child below, then at least part of the cause is probably tiredness.
In the very young child, say in the first year, the signs of tiredness can be subtle. Body posture can give some hints. The baby who is well rested, has a full stomach and is ready for sleep will often have a ‘relaxed’ body posture. The head tends to be on one side, eyes closed or closing, the arms are ‘heavy’ and out straight. I sometimes describe these babies as being happy ‘drunks’ and most mothers recognise what I mean. The opposite to this is the overtired baby. The eyes are often open, the arms are flexed at the elbows, muscle tone is tight and they frequently cry. Facial expression will often contain a little frown or scowl. The hands often tremble. Some parents mistake this for shivering, but at the same time are confused as they know that the child is warm. The startle reflex is often very brisk. Sometimes even a loud noise can cause a reflex where the arms suddenly spread wide apart and then the hands come together towards the chest.
Interpreting these patterns is part of learning to ‘read’ your baby. Eventually you will read your children like a book. It always amused me to see our children express surprise at our seeing through their childhood ’storytelling’ when their body language gave them away so totally.
There are two things to look at here. First what I refer to as ‘meaningful eye contact’. This is difficult to put into words because it is an emotional event. When you look into the eyes of a healthy, well rested baby or child there is a sense of emotional connection. Some exchange of emotion occurs. Parents and teachers never seem to hesitate when this idea is mentioned to them. They know what is meant. The reverse of ‘meaningful eye contact’ is blank contact. You may lock eyes with your baby, but their expression is blank. No emotional exchange occurs. The child could be looking at a brick for all the response that you feel. As a child becomes increasingly tired, their ability to make ‘meaningful eye contact’ decreases. If you are struggling with fatigue in your baby, then as their sleep improves, as they ‘deposit more sleep into their sleep bank’, one of the markers of success will be improved eye contact.
The second eye sign is deceptive. It is misleading and traps some parents. The eyes are wide open. People generally expect tiredness to lead to blinking or even closing of the eyes. While this is usually true, in the very overtired infant, the reverse is the case. Watch carefully and if your baby becomes badly overtired, the eyes may be wide open. The expression is often ’startled awake’. Sometimes the eyes will be so widely open that you will see the white of the eye above the iris. The trap here is that when the parents are discussing the problem, someone quite logically says ‘He can’t be tired, look at how wide open his eyes are.’ Logical but wrong. Beware of the tearful baby, who only settles in your arms and in whom the eyes are ’startled open’ a lot of the time. This child is likely to be severely overtired.
It is mentioned elsewhere in this book, but I will briefly explain it here. Look up ‘confidence radius’ in the index for a more complete description.
The well rested infant gains emotional confidence, and while enjoying your company and touch will not be overly distressed by being alone for reasonable periods of time. The child who needs to be in your arms or your lap may well be overtired.
This is a generic term which applies to every age. If any of us are overtired, it is difficult to be happy. As the child becomes more tired, smiles will be harder to get, shorter lived, and less frequent. Children who are rested are almost always happier and easier to live with.
The overtired child will be annoyed at not getting his or her own way. Removing unsafe toys, turning off a tap, turning down the volume control on the TV are all met with rage and irritability. Many of you will have seen Oscar-winning rages brought about by an action such as the removal of a biscuit. If the biscuit is returned, it is thrown away. You are now in a no-win situation. Getting angry simply raises the stakes and generally worsens the situation as the overtired child has gone past the point of reacting rationally to parental anger. Achieve sleep as soon as possible. It is usually the only way forward.
This one is easy. Overtired children play clumsily, tend to fall over or off things. They are often bumping into objects both stationary and mobile. Some parents report that as the child’s sleep improves, even after falling they are more tolerant of the discomfort and cry less. They get up and play more vigorously.
The combination of eating and sleep problems is quite interesting. A small majority of the children that I see for the first visit have both feeding and sleeping problems. Of these the primary problem is usually sleep. Fix the sleep and the diet often improves. In fact, it is not uncommon for parents to report that, even though their children were regarded as good or adequate eaters, that after their sleep improved, their appetite did also.
The overtired, poor eater has the whole orchestra of common domestic feeding problems. Inadequate volumes, inadequate range of foods, intermittent food refusal, and commonly a preference for drinks and milk drinks in particular. Parents often describe their children as grazing or browsing through the day.
As mentioned above, the sleep problem is usually the primary or major of the two. Once sleep performance is improved and the child begins to achieve 10 – 12 hours sleep overnight, breakfast becomes an attractive proposition
As a side issue, resolving feeding problems in the two to five year age group is usually achievable. Here are the basic steps I use in addressing feeding problems if they continue once the child is sleeping well.
(1) Food is not the issue. This is a power game. ‘I will not do what you want because I wish to be in control.’ Children at this age are not old enough to be given responsibility for their diets. If teenagers make of mess of it, imagine what a two year old would arrange. If the issue is power, and it is, take control and be confident at setting sensible, nutritional rules.
(2) Give solid foods before liquids. Give the Weet-bix before the glass of milk.
(3) If the meal is not eaten well, do not become embroiled in a fight. Meal times are for eating, not fighting. Clear away the food, and send the child off to play. The next meal will be in four hours. By the way, there is nothing to eat or drink until the next meal. Please take heart. It takes weeks to starve, but only a few hours to become seriously hungry. The trick here is to avoid ’snacks’ between meals. Bring the child to the next meal hungry and thirsty. At the very most allow some water between meals.
(4) Be consistent. This is a power play. Once the child recognises that mum or dad are not a pushover and that your rules about eating are non negotiable, they will comply.
(5) At the end of the program, your child should be eating three meals per day where the volume of food, the range of food, and the speed of eating are consistent with the norms for your family.
The description of sleep deprived behaviour in the toddler is as true in the toddler as it is for the younger child described in the previous chapter. The remainder of this chapter will focus on what to do about resolving these problems.
Resolving Sleep Problems in the Older Child
Newborn babies are great in that they stay where you put them. By something between nine to 18 months they are mobile and by the age of two years a lot of them can climb out of cots and open doors. The mobile, door-opening, bad sleeper is hard to ignore as they come to you even if you won’t go to them.
Sleep basics are the same as for other ages. Going to sleep is usefully regarded as a learned skill. Sleep achievement is partly based upon cues of sleep. These are the things or objects in the vicinity plus routines and styles of management. Cues of sleep are learned. Almost universally in ‘poor’ sleepers, mum or dad have become the necessary objects for sleep achievement and sleep maintenance. The task then is to allow the toddler to ‘learn’ cues of sleep which are parent independent. Unfortunately, these children are hard to ignore because of their mobility. You may have a perfect program of sleep achievement, but at two am there is the patter of little feet, or a little body sliding into the bed beside you. Some children perfect this technique to the stage that you do not hear or even feel them getting into bed. You just wake up at some time to realise that there is an extra body in the bed.
How do we handle this problem?
I promise you that bribing, rationalising, arguing and pleading will not work. For the child there is no greater reward than your company. (This appears not to be true for teenagers.) They are too young to rationalise that mum and dad deserve a good nights sleep. Anger is counter-productive, as it leads to insecurity and a greater need to obtain security by receiving affectionate contact from a parent.
So what works?
The answer sounds terrible and unloving but be patient with me. It all comes together in the end.
Once the child is mobile to the extent of getting out of a cot or bed and opening a door, we only have one choice. Secure the door. This will tug at your heart considerably, as it feels terrible to be ‘locking’ your child in their room. The sequence of events from this point takes broadly one of two paths.
(a) Younger Child Less Capable of Verbal Negotiation
The child is put to bed with a request to stay in bed or else the door will be closed and secured. As you leave the room, your child follows you out. So you return him or her to the bed or cot and leave, locking the door as you go. The child cries vigorously behind the door, demanding your return. You return and give minimal reassurance at 15, 20, 25, 30 minute intervals. The reassurance is short lived and as simple as you can arrange. Thirty to sixty seconds of returning the child to the bed, a settling touch and a few words, and you go, locking the door behind you. Gradually increase the time that the child is alone until sleep is achieved. If sleep is achieved on the floor either gently return him or her to bed, or if this wakes the child, gently cover them so that they will not become cold. If the child awakens through the night, simply return them to bed at once, lock the door and do no more until sleep is achieved again. Check your child once you are sure they are asleep. Repeat this every night until the child accepts that the place for sleeping is in their own bed. As long as you are completely consistent, you should have major success within a week. The door is then left open or closed as you see fit.
(b) Older Children Able to Negotiate Verbally
With the older child of say 2.5 years or above you can discuss the problem during the day. Some children will even agree with you that yes, they are big boys and girls now, and yes they can sleep through the night alone. Of course come nightfall, all is forgotten and the sleep disturbances begin again. You have forewarned your child about the door and so you now lock it and go through the program of diminishing reassurance described above. The difference here is that the older child will negotiate. Commonly they will offer an alternative to the locked door. ‘Dad if you leave the door open I will stay in bed.’ Unfortunately, as soon as the door is open all promises are cancelled and you have company again. The key here is the response. The child is instantly returned to bed. Try to remain even tempered because you certainly have the upper hand now. Return him or her to bed and lock the door until sleep is achieved. The key message is that no variation of your plan, which you both negotiated, is allowed. This seems to work quite rapidly, and it appears to lead to independent sleep in something between four and seven nights. Any breakdown in the child’s adhering to the rules immediately leads to a return to bed and locking the door.
Words of warning
Make sure the bedroom is childproof. Some children will empty drawers, take down pictures, kick doors, ride rocking horses, and generally be imaginative in expressing their opinion about Dr Symon’s advice.
Conclusion on teaching sleep skills in a closed room
This advice is hard to give and hard to apply but there is no other choice once they are mobile. The positive side is that once applied consistently it is rapidly effective. In addition, all is forgiven once the family is sleeping well. Never has a family reported to me that they believed the experience led to emotional damage. Almost always parents report that both they and the children are happier with better sleep and that the improved quality of their relationships more than outweighs the cost of a couple of nights crying.
The final statement in this chapter hardly requires writing if you have read this far. The overtired child will have poor sleep skills.
There are three elements of sleep which I find useful to discuss.
(1) Sleep achievement. The ability to go to sleep in an appropriate place in a reasonable time with no or minimal protest. This will be preceded with a gentle, reassuring and affectionate settling program.
(2) Sleep Maintenance. The ability to awaken for a normal arousal within a block of sleep and then return to sleep quietly or with minor noises. This should occur without any parental attention at all.
(3) Ignore background noise. The ability to sleep through normal domestic noises. A baby sleeping well should sleep through doors banging, phones ringing, adults talking and children playing.
All three are connected. All three get better or worse together. The overtired child will be difficult to get to sleep, will tend to awaken through the night, and will be more easily disrupted by minor noises. The opposite of this is the child sleeping well. They achieve sleep efficiently at the start of the night, sleep silently or with very minor noises overnight, and are not disturbed by you, going in to check on them or by normal domestic noises, such as a telephone.
Patient Comment : ‘Matthew’
At seven months, our son’s nocturnal routine was to wake just before midnight. He would cry and scream until we could pick him up and then he would miraculously fall asleep in our arms, only to wake up again when placed in his cot. We had tried wrapping, rocking, a night light, a roll-over feed and nursing, but nothing seemed to consistently work.
We got to the stage that Matthew would end up in bed with my partner and me. It was something we didn’t want, but we both agreed that we had no choice. Each night was survival of the fittest, and the most frustrating and exhausting thing was that Matthew was fitter than both of us.
Dr Symon came into our nightly fiasco after we questioned the sedative approach another doctor recommended. He explained sleeping, my son’s pattern of sleep, and that it was possible to teach Matthew to sleep and to sleep 12 hours every night.
His technique was very basic, although one had to be committed and to know that we were on the way to a child that slept well. We gained the confidence that as parents we were capable of teaching Matthew how to fall asleep by himself and to go back to sleep should he wake up.
My relationship with my partner certainly benefited from Matthew sleeping consistently during the night. Each morning we wanted to see him and didn’t wake up frustrated and tired because he had kept us up during the night.
Matthew is certainly a happy, loving and eager 10 month old boy. I’m sure it is mainly due to his sleeping well.
His parents are sleeping too. Friends label us as ‘lucky’ to have a child who sleeps. We confidently know and explain that we had a ’sleep doctor’ who taught us how to teach Matthew to sleep when he needed to.