Singapore

A family came over from Singapore for my help with their little boy, Joshua sleep. Unfortunately he contracted tonsillitis so we were unable to do the sleep training. Joshua is now 15 months old, He currently has 2 day naps and night sleep, takes 20 minutes to 2 hours to get to sleep, attends daycare, wakes 3-4 times at night and breast feeds. His food intake in the day is poor. Developmentally he is age appropriate and he is crawling, walking with help and pulls to stand.

I called in to see them to chat through what they need to do when they return to Singapore. I observed that he couldn’t settle and calm without the breast in his mouth which will lead to emotional problems if he cannot do this soon. They are hoping to start the sleep training very soon. These are typical questions parents ask me. I thought it would be useful to share this case study with you.

Sleep training

Q … How do we differentiate between distressed and normal crying? He always sounds distressed to us when he cries.

A … I’ve sent you some audio samples of stressed and non-stressed crying from my gmail account to help you.

Escalation of behaviour

Q … What should we do if he intentionally harms himself while crying or complaining when being trained e.g. sometimes he can give himself bruises with big contusions by banging his head on things and I’m guessing that he may bang his head on the side of the cot when we train him?

A …  Yes, this is a possibility and this is what is known as escalation of behaviour. This can include, head banging, breath holding, biting, hitting, tantrums, retching and vomiting. All these things I have seen. The important thing is that he cant actually hurt himself. I promise. If he bangs his head he cant get a brain injury, not possible. It is so important that you must downplay all of this otherwise you will reward and imprint his behaviour and keep on doing it. So the best thing if any of this happens is IGNORE the behaviour, eyes closed, poker face etc. If he vomits clean him up, change his clothes and put him back in the cot with the minimum of fuss. Do not react or he will keep on doing this behaviour.

Sleep training

Q … When doing the initial 7 – 10 days of sleep training. a. While we are sitting with our arm resting through the cot, should we immediately pick him up if he is (i) distressed crying or (ii) cries for more than 3 mins?

A … (i) Only on day 1 and only if there is an escalation. If there are pauses no don’t pick him out of the cot. By day 2 try not do cuddles, they will work against you. No to Q ii) it’s about how distressed the cry is not how long it goes for.

When to do cuddles

Q … When doing the initial 7 – 10 days of sleep training. b. I recall that you mentioned after the 3 min mark if he is still crying and unsettled, we should cuddle him for about 30 seconds, before setting him back in the cot. What happens if he continues crying beyond that time? Should we hold him until he stops crying or should we put him back in the cot even if he continues crying?

A … No you put him back in after 30 seconds even if he is still crying.

Share the load

Q … Should either mummy or daddy do the full 7 – 10 days of training or can we alternate between the two of us?

A … I think it’s a good idea to alternate.

When to help him

Q … Assuming that he is trained to sleep well beyond the initial 7-10 days: Should we only pick him up if he cries for more than 3 mins?

A … Only if he’s unwell or something is clearly wrong.

Move to his own room

Q … Our initial thought is to train him to sleep in a separate cot in our bedroom until we move house in 3 or 4 months’ time – then place the cot in a separate bedroom after we move house Is there any downside to keeping the cot in our bedroom for a few months more?

A … No. However they do sleep train easier in a separate bedroom. It would make it easier for all of you.

Is it fixed forever?

Q … After we move house (and put him in a separate bedroom) will we have to sleep train him from scratch using the same technique again?

A … No, you shouldn’t need to.

Throwing food

Q … Food / feeding question: We try to provide him with a variety of food (different carbs, protein, veggies/fruit) but he refuses to eat most types of food and throws them off the table. We’ve been doing this for the past month and half and he still throws almost all his food off the table. Any suggestions on how we can get him to eat a broader range of food?

A … Eat with him every meal, sit at the table with him and show him how to eat by you eating his food. Eat food off his high chair tray. Praise any compliance e.g. “Well done Joshua for eating your food, good job!” Also sleep training will improve his appetite.

Not eating properly

Q … The few solids (meat/fish/oats) he will eat, he will hold / chew in his mouth for several minutes until he has stuffed too much food in his mouth and then he will spit all of it out. Is there any way to encourage him to swallow the food?

A … Modelling behaviour, showing him what to do, eat with him the same food. When parents eat with their children they can eat up to 25% more food.

Cruskits

Q … The only food he never spits out are Cruskits, although once we give him a tiny bit of a Cruskit he will push away all other food and demand to only eat Cruskits. Do you have any suggestions about what we should do in this situation?

A … Yes keep on with the Cruskits, this works with the most challenging of children! Thickly spread other foods onto the Cruskit e.g. ricotta, cream cheese, avocado, hummus, peanut butter etc.

I hope you found that helpful and it helped you with your toddlers sleep and eating 🙂

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