It is prudent to discuss any of your concerns about sleep issues with your child’s pediatrician before you start any sleep training program with your child. Is your baby gaining weight regularly? Are there any other medical problems that might be causing your baby’s sleep problems? Are there any developmental conditions affecting sleep? Is there any reason why you shouldn’t go ahead with sleep training? Is there any sleep training method that is not advisable for your baby?
Your pediatrician knows your baby, and watched him grow and develop week by week, and will therefore be able to assess whether your child is ready to begin formal sleep training. I actually require the families I work with to obtain approval to begin the Smooth Baby Sleep program from their pediatrician when their baby is around 12 weeks of age. This ensures that your baby is developmentally ready to begin the process of sleep training, and that no medical issues will impede the process.
Please do not start sleep training if your child is sick or running a fever. There are certain illnesses and conditions that can interfere with your child’s sleep quality, like: nasal congestion, teething, ear infections, colic, GERD, yeast or urinary tract infections, sleep apnea, night terrors, milk allergies, etc. For a detailed list of conditions that affect sleep and what steps can be taken to minimize their impact, please review chapter eight which discusses special considerations.
Before you start any sleep training program with your child, you should always rule out medical problems that might be causing your her sleep problems. Therefore, it is wise to discuss sleep issues with your child’s pediatrician.
These are some medical problems that might interfere with your child’s sleep quality:
- Nasal Congestion – Newborn infants must breathe through the nose. Nasal congestion in an infant’s first few months of life can interfere with nursing, and in rare cases can cause serious breathing problems. Nasal congestion in older children and adolescents is usually just an annoyance, but it can cause other difficulties. Nasal congestion can interfere with the ears, hearing, and speech development. Significant congestion may interfere with sleep.
- Teething – The discomfort that teething causes can start well in advance of any teeth actually appearing. Some babies are affected as early as four months of age. The main symptoms of teething are: fussiness, excessive drooling, runny nose, rash on the chin or near the mouth (caused by the excessive saliva), biting and chewing on anything that gets near the mouth, red cheeks, rejecting breast or bottle, more need to suck, swollen gums that may appear a purplish color, soft stools and/or diaper rash.
- Ear Infections – An ear infection is usually caused by bacteria, but a virus can also be the culprit. It happens when fluid builds up in the area behind your baby’s eardrum and then becomes infected. Pacifier use may increase the risk of middle ear infections in babies and young children. Ear infections cause mild to severe pain, which may disrupt your child’s sleep. The easiest ways to tell if your baby has an ear infection are: a change in his mood (more fussy, crying…), a fever, pulling/grabbing her ears, diarrhea, reduced appetite, a yellowish/whitish fluid draining from her ear, or a foul odor emanating from the ear.
- Colic – Colicky infants appear to have a shorter duration of total sleep. Sleep problems may sometimes persist after the child has outgrown colic because the strategies that parents developed to decrease the crying spells (i.e., frequent holding, car rides) interfere with the adoption of normal sleep patterns. An infant older than four months who continues to wake during the night is considered a trained night crier. These infants calm quickly when picked up. Some people believe that this pattern develops because parents provide secondary gain for continued awakening.
- Acid Reflux – gastroesophageal reflux disease (GER) can be painful and can cause colic and vomiting. It is also risk factor for pulmonary disease. GER causes resistance to feeding, blood in the vomit or stool, iron deficiency anemia, irritability (due to an inflamed esophagus), or failure to thrive. If your baby refuses feedings, takes very long to feed, arches her back while feeding or trying to sleep, makes ‘weird’ noises while sleeping, and/or spits ups or vomits often; you should consult with your pediatrician.
- Yeast and urinary tract infections – Urinary Tract Infections (UTI)’s most common, and often unique sign is an unexplained fever. In some cases, a baby may also have other symptoms: crying/complaining when urination, odd-smelling urine, cloudy or bloody urine, unexplained and persistent irritability, vomiting, and/ or refusal to eat.
- Milk Allergy – the main symptoms among infants are: vomiting, diarrhea, abdominal cramps, abdominal bloating, skin rashes and/or respiratory symptoms (cough and runny nose). Cow’s milk allergy may cause more awakenings, shorter sleep cycles, and dramatic reductions in total sleep time.
- Sleep Apnea – a condition in which an infant awakens periodically because he stops breathing. Obstructive sleep apnea prevents kids from getting enough sleep, and deprives them of oxygen, which can cause a variety of more serious cognitive, health, and developmental problems. And if infants don’t awaken when they experience breathing difficulties, they are at higher risk for sudden infant death syndrome (SIDS).
- Night Terrors – Pavor nocturnus (night terrors) occur approximately 90 minutes into sleep. The child suddenly sits bolt upright and screams, and is inconsolable for up to 30 minutes before relaxing and falling back to sleep. Tachycardia, tachypnea and other signs of full-fledged autonomic arousal are apparent. Night terrors usually occur in children 3 to 8 years of age. They need to be distinguished from nightmares. They are more likely to occur during times of stress or fatigue. As frightening as they are, parents and children usually only need to be reassured that they are generally self-limiting.