Craig Canapari MD (01:10)
Okay, well, welcome back to the sleep edit a podcast where we deconstruct sleep problems that parents and children face. I am Dr. Craig Canapari.

Arielle Greenleaf (01:20)
and I'm Arielle Greenleaf.

Craig Canapari MD (01:23)
We have a mailbag episode with questionnaires from our audience. So we have a bunch of good questions today, which we've grouped via theme. So we're just gonna get into it. And the first section is on infant sleep issues. So Arielle , I'm gonna give this one to you. Let me read the question. My baby is almost five months old. Since about one week old, she has been unable to sleep on any surface.

crib, stroller, or carrier, and will only sleep in very specific positions, either side-lying on a nursing pillow or seated upright while being carried. These positions don't translate to a crib. I tried drowsy but awake since three months with no success. I tried sleep training once, but even after two hours of crying, she woke very shortly after falling asleep multiple times. I worry this may be physiological rather than developmental. Could this indicate an underlying issue or is it still within the range of normal development?

Arielle Greenleaf (02:20)
I don't know. It could be totally normal and the child just needs behavioral and schedule adjustment, or it could be physiological. To me, I personally would just, I would discuss with a doctor first of all, because I have plenty of infants, young infants.

who come through the newborn stage who have never slept in a crib or a bassinet. Actually, lately I've had a couple people whose children have always slept on them, like contact sleep for naps and for overnight. And it might feel uncomfortable and it might feel like they can't do it without you.

with the right environment, the right method, and the right schedule in place, babies can learn absolutely to sleep on a flat surface. Now that being said, if there is something physiological going on, then nothing we try behaviorally is going to work.

Craig Canapari MD (03:20)
can't think of any biological reason why a child can't lie flat. You know, certainly if somebody had a spinal tap and they have a spinal leakage, they wouldn't be able to tolerate lying flat. If they had a heart failure and they were 65 years old, they might not be able to tolerate lying flat. I certainly would discuss this with your pediatrician. I have to put my safe sleep hat on here as well as saying that, you know, whether your child is fussy or not, it's very important.

in the first year, but especially in the first six months, your child be in a safe sleeping environment, which means a flat sleeping surface, room sharing, but not bed sharing with no soft pillows or blankets near there because there is a real suffocation risk. So I would definitely sit down with your pediatrician and brainstorm ways to address this. Again, I'm not gonna kind of handicap the risk of suffocation or SIDS. It is probably less after six months of age, but just for the listeners out there.

I would say that the first priority always has to be a safe sleeping environment and everything else is secondary. ⁓

Arielle Greenleaf (04:21)
Absolutely,

and there are ways to, I mean, discusses crying. I don't know what method she tried. Perhaps this child needs a more hands-on approach, or if it was a hands-on approach, this child may need some more space to work it out and figure it out on their own. Figuring out the right method helps alleviate the amount of crying that occurs. But again,

scheduling is also critical there. So I agree with you 100 % that we need to focus on getting the child into a safe sleep environment and barring anything medical, it can be done.

Craig Canapari MD (05:00)
Sure, I would agree. Here, do you want to read the next one?

Arielle Greenleaf (05:04)
Okay, all right Craig, this one's for you. Julie, yes, Julie says, I just read your book this week, yay, and really enjoyed it.

Craig Canapari MD (05:09)
For me?

Arielle Greenleaf (05:17)
I have a three month old and currently am using the SNOO Smart Sleeper. What are your thoughts on how best to wean her and also why should I make sure to separate eating and bedtime? Is it the idea that it will become a must to do? If that's why, I wouldn't mind that being part of our routine and dealing with it later.

Craig Canapari MD (05:37)
Okay, so there's two questions here. With the SNOO, which is for people unfamiliar, it's a smart bassinet that has some evidence that it soothes children, it soothes infants who are fussy at night. In my experience, some people really like it and some people, both kids and babies, and some don't. It does have a weaning mode built into it. I'm not sure what age the manufacturer.

recommends that you start the weaning mode, but I think you're kind of getting there. There's also a size constraint in the SNOO too. So I don't think that three months of age, starting the weaning protocol in the SNOO seems reasonable to me. Now, as for the second question, separating eating and bedtime, the idea for why this is important is it's a sleep onset association. So if your child falls asleep, feeding.

and then wakes up in the middle of the night and needs to be fed, is it because they're hungry? Which could be true for a three month old who's breastfed a couple times per night. Or is it just a habit that is keeping your child from independent sleep? I would say generally if you are happy with how your child is sleeping right now, you don't have to make a change here.

But I would put on your roadmap as your child moves between, sometime between four and six months, if you find your child is sleeping well and then starts waking up more frequently or feeding more frequently than you're used to, you may need to break those things out to break that sleep onset association. It's a little tricky here because if you're trying to wean the snoo and wean the feeding at night, those are two moving pieces and I'm a big fan of making one change at a time. I don't know what you say, Arielle .

Arielle Greenleaf (07:20)
Yeah, would, especially because the SNOO is such a, there's so much going on there, I would definitely work on that first. And then, I always say it's not a problem unless it's a problem. So if you don't mind feeding to sleep and your baby eats and sleeps a good stretch and you're not waking up every couple of hours, although some people are okay with that. So even if you are waking up, if it's okay, it's okay. If you find, like you said, if you find that

The baby is waking more frequently for feeding and not taking a full feeding when they wake and just suckling multiple times a night. That might be when you want to look at, you know, the actual action of feeding to sleep. Now feeding can still be part of your bedtime routine. It doesn't need to be removed entirely. The goal instead would be to feed your baby and then have other things in front of it. So feed your baby, read a book.

Feed your baby, sing a song. Something so that they're not associating feeding with literally falling asleep.

Craig Canapari MD (08:23)
Arielle , I've got one for you. Are you ready?

Arielle Greenleaf (08:25)
Ready.

Craig Canapari MD (08:27)
Kira writes, I have a four month old who will no longer sleep in their bassinet. Sleep is now terrible and I believe he is too young for any cry it out method. How would I manage this and will it naturally get better with time?

Arielle Greenleaf (08:40)
I've had a lot of families

lately that are really, they don't really want a lot of things. They don't want crying. They really want to be present with their child.

I will say that it's important that the parent feel confident that they can stay the course and stay consistent with that method if that's what they want to do. Because in many cases the child continues to cry. It's just that you're present with them. And it can be really challenging in the middle of the night when you're trying to stick with a method where you're trying to be present and you're trying to stay consistent.

but it's been two hours and your child still hasn't stopped crying. So I think thinking about what can you be consistent with? What is your child's temperament? And also, again, I know I always go back to this, but thinking about the schedule is so important. Try to avoid the average wake windows out there. See if you can average out their sleep.

over a seven day period. Add up all their daytime sleep each day, then divide by seven, add up all their nighttime sleep each day, divide by seven, add them together. There's your average 24 hour sleep need and what your child is able to give you on average. So that gives you an idea of if your child needs 13 hours of sleep in a 24 hour period or if your child needs 16 hours.

When we talk about wake windows, those wake windows would be wildly different. So making sure your baby is on the right schedule will help them a lot when it comes to crying.

Craig Canapari MD (10:23)
Yeah, it sounds good. I mean, I think it's a tough situation, right? I'm not sure where this kid is sleeping now. ⁓ So, but yeah. Hey, do ⁓ you wanna ask me a question?

Arielle Greenleaf (10:29)
Mm-mm.

Hey, can I ask you a question?

Craig Canapari MD (10:38)
Sure, ask me a question.

Arielle Greenleaf (10:40)
All right. All right. This is from Hannah. Is there any harm in never doing a schedule and just watching for sleep cues?

Craig Canapari MD (10:48)
Well, the only cost will be your sanity. Hannah, I'm being a little bit flip here, but I think there's nothing wrong with watching your baby sleep cues, especially in the first couple months of life, because young infants do not have the sort of sleep rhythms like down yet. So you really have to carefully watch, but I can tell you, I am a.

Arielle Greenleaf (10:51)
You

Craig Canapari MD (11:15)
So I'm a so-called sleep expert and it was sometimes very difficult to tell with my kids what the cues were and especially as your child gets older and I'm I'm gonna go out and limit and guess this might be your first kid because when you have more than one kid you will find that having a schedule and a routine is is very valuable not just for your child but also for yourself because there is this phenomenon of decision fatigue

Like ⁓ when you have to make decisions all the time, it's exhausting and it's very helpful to know being like, well, it is seven o'clock. I am going to start my kid's bedtime routine now. You don't have to think about it because you know when it happens and what the routine is. Otherwise, you're really always going to be at the mercy of what you think is going on and it's very easy to second guess yourself. So I would say,

I think as a parent, it's reasonable to expect that your child conforms somewhat to the rhythms of your household. And that's the schedule, right? Like, as your family expands and if you have other people in your family, it's helpful for everybody.

Arielle Greenleaf (12:25)
To get consistency, have to give consistency. And I always say as adults, we generally are on a schedule. Our bodies get hungry around a certain time, same times throughout the day. Our bodies get tired around the same time. We wake up around the same time. If we want that for our children, we have to create that environment for

Craig Canapari MD (12:48)
Yeah, it's an important point. are actually wired to a 24 hour cycle. Our bodies naturally conform to it once you're out of the first couple months of life. I would not think of a schedule as a hardship. I think it's a gift for your kids, honestly, as well as for yourself. Yeah.

Now we're getting into a new topic area, which are night wakings and frequent wakings. So Arielle , Michaela has a question.

My one year old sleeps through one night, then wakes three to four nights the next same schedule both days. What gives?

Arielle Greenleaf (13:26)
I'd like to know what's happening at the onset of sleep, first of all. I'd like to know what is happening when the child wakes up. How is the parent attending to the wake up? Are they being fed? Are they taking them out of the crib and giving them playtime? Are they using some sort of a method?

And I will say just because the child has the same schedule doesn't mean that they necessarily slept the same amount. So I would want to know if there was something off there with, you know, I'd want to sort of see the data about.

How much sleep is the child getting? Because you could say nap time's always at 12, same schedule, but they only slept an hour and 20 minutes this day, and they slept two hours the next day. Are they getting too much daytime sleep? That's causing night waking. There's a lot of questions that go into that. I would say, I think it all always comes back to what is happening at sleep onset.

If you're doing something at bedtime that you don't want to repeat when they wake overnight, then you need to change that using whatever method you feel most comfortable with. then again, looking at sleep totals and shifts from day to day, is the sleep off balance? Because you may have the same schedule, but is your child sleeping the exact same amount each day?

Craig Canapari MD (14:52)
Yeah, is there a nap, like are some of these days the child is in daycare and taking a long nap and a shorter nap at home? Is the child falling asleep some days on the way home? I mean, I'd say the other thing is, does the child fall asleep independently? If that's the case, the problem is either sneaky sleep during the day or perhaps like a medical problem, like nothing.

Arielle Greenleaf (14:58)
Exactly. ⁓

Craig Canapari MD (15:16)
catastrophic, but you know, it could be eczema, could be asthma, something like that. Or are you, how are you responding during the night? Like what are you doing that might be perpetuating that? So I think you need to think about a little bit further and what are you doing at bedtime? What are you doing in the middle of the night when the child wakes up? And is there sneaky sleep during the day? That be the things I'd look at.

Arielle Greenleaf (15:36)
One other thing that I would consider too is I don't know how far into one this child is. Well, I guess they said that the schedule is the same because I was going to say sometimes maybe this child is still in two naps and perhaps it's time for this child to transition to one. Sometimes things being a little off-kilter can be related to that as well.

You want me to ask you one? All right. Okay, BD asks or says, my baby is two. No matter how I change around his schedule, he still wakes up four to five hours after he goes to sleep. And then two to three hours after that again. I have tried with naps, no naps, putting him to sleep earlier and later, same results.

Craig Canapari MD (15:56)
Okay. Sure.

Yeah, I think the theme here is, first of all, is the child falling asleep independently or not at bedtime? The tempo of this sounds like a sleep onset association, right? Like a child falls asleep with mom or dad present, has an extended sleep period for the beginning of the night because that's when most of the slow wave sleep happens, then wakes up every two to three hours from REM sleep happens. So I think the first thing is, the child falling asleep independently?

Again, in situations when nighttime awakenings don't fit a set pattern, worth talking to pediatrician, worth looking for medical causes. Sometimes if a child has a consistent schedule, falling asleep independently, waking up at night, then we consider something like an overnight sleep test to make sure we're not missing something like sleep apnea. And the other thing you mentioned is adjusting the schedule. If you look...

check sleep diaries and you're looking at the amount of time that the child is sleeping in a 24 hour period. And you might either want to think about trying without the nap for consistently for a week. I think if you skip it for one day, it's too soon to say or shortening that sleep opportunity at night. So those are things that you could try.

Arielle Greenleaf (17:32)
or shortening the sleep opportunity during the day if you want to keep the nap. Because capping the nap is another way to address that nighttime stuff. But if it's so consistent that it's exactly like four to five hours and then every two to three hours or whatever, it sounds habitual. So it's probably a sleep onset situation.

Craig Canapari MD (17:50)
Yeah, I agree.

So I've got a question for you from Megan, who's in a bit of a pickle. Megan writes, my eight month old nurses to soothe gagged on every pacifier is barely interested in solids. Is crying out the only option? How long do I let him cry when he doesn't have self soothing tools?

Arielle Greenleaf (18:16)
I feel like those are completely different questions.

Craig Canapari MD (18:20)
I would agree. ⁓ I think there's also an upstream problem here as well.

Arielle Greenleaf (18:20)
you

Well, yeah, I mean, I'm not even sure where to start with. Yeah, please do, because I feel like those are two, you know, there's this, I get that they intersect, but I also feel like they're separate.

Craig Canapari MD (18:32)
Can I jump in?

Yeah.

I feel like there's a feeding problem here that needs to be addressed. If the child is not interested in solids, I mean, the first question is, is your child growing well? If that is the case, then you know, it's less urgent, but still maybe worth talking to your pediatrician about feeding therapy. Because often, I don't think it's as simple as saying, oh, if this child eats solids, the baby is going to start sleeping great. But I do think there are some concerns about feeding that need to be addressed both from the standpoint of the child.

and mom too. Mom, Megan, you need to feel confident that your child is feeding well, right? This is sort of an ambient concern that needs to be addressed. And then I do think that the self soothing is also a problem. But really, I'd say that before you worry about sleep training, check with your pediatrician, look at your child's growth curve.

see if there might be an underlying feeding issue or reflux or something that's going on here. I would look at that and then worry about the sleep training piece of this later. I would kind of leave it at that because I think that like, I think for me as a pediatrician, I'm like, if you're worried about your child's feeding, address that first and then worry about the sleep training. It shouldn't take long to get in to see your pediatrician and talk about this.

Arielle Greenleaf (20:06)
Yeah, and you know the question here, she also says, you know, is crying it out at night the only option to reduce those nighttime feeds and get him sleeping? I want to answer that question first and the answer is no. I mean you don't have to cry it out. Again, there are other methods. The goal would be to look at very closely how much is your child's

nursing during the day is your child, you may want to work with a lactation consultant and do a weighted feed and make sure they're getting enough during the day. And if they are getting enough during the day, there are ways to more gently.

you know, reduce the time you're feeding them overnight so that you're shifting those calories back into the daytime. So instead of nursing for eight minutes the first night, you might go in and reduce to six minutes. You might do six minutes for a couple nights, then drop to four minutes and two minutes and then try soothing without nursing. Those are just some options and some ways that I work with parents.

especially if a baby is eating multiple times overnight, I definitely am not saying let's just leave the baby and not feed them at all. Like we need to be realistic and understand that we have to gently shift these calories back into the daytime. But if you know there are ways to do it without leaving them to just cry it out.

Craig Canapari MD (21:27)
Okay, well, since I jumped in there, here I got one for you. Simona writes, my six month old wakes every one to two hours and is up at 5.30 in the morning. We are considering moving her to her own room on a floor bed and possibly sleep training. Should we first stop night feeds? She falls asleep independently at bedtime but needs a bottle or holding to resettle overnight. What is the right order? Night weaning, room transition or sleep training? This is a good one.

Arielle Greenleaf (21:56)
First of all, wouldn't put a six-month-old on a floor bed.

Craig Canapari MD (22:00)
Yeah, that's

a hard agree for me. I don't think there's any reason not to use a crib.

Arielle Greenleaf (22:04)
Hmm.

Absolutely not and for your own sanity I feel as though, well first of all there's so much risk there. I would say getting your baby into a, depending on their size, bassinet or a mini crib or a crib if you have a space issue. But I definitely would not recommend the floor bed. I would say getting them into their own room is priority number one.

Parents can be really distracting and on top of that parents, ⁓ babies can be distracting. They're very noisy. They move around a lot and I find that a lot of parents will jump up and attend to their child so quickly and their child could just be shifting between sleep cycles and you know they're inadvertently just running over to address that. I would be moving to the crib.

then I would start working on the feeding issue because again, kind of like what we were just talking about, we need to know how much is this baby getting during the day? Is this baby getting enough calories during the day? Are they genuinely hungry every two hours because they're reverse cycling and only eating twice during the day? Things like that need to be looked at closely. And then once that's determined and if the doctor says everything's fine, they're on the growth curve,

babies eating enough during the day, then you would work on sleep training through those specific night wakings. Again, like I said previously, you don't have to necessarily let your child cry it out there. You can definitely try reducing the feeding time or the size of the bottle as you go. See if that works and then move on to soothing cribside without the bottle.

there are options there, but my advice would be get the baby out of the room, fix the feeding problem, and then sleep training.

Craig Canapari MD (23:58)
Sounds good. Ideally, the next one, it's kind of the same question. ⁓

Arielle Greenleaf (24:04)
Okay,

all right, so are on early morning waking?

Craig Canapari MD (24:07)
Let's into early morning awakenings. Man, these are painful. man, okay. I had an early morning waker myself. My son Theodore. Yeah, we were doing the other four or five in the morning, so I feel the pain here. yeah. Yeah, no, we have a couple. He has some company here. So, here's a question from Tyler. My two and a half year old was solid.

Arielle Greenleaf (24:21)
my gosh, four in the morning? God.

⁓ gosh.

Craig Canapari MD (24:32)
sleeping from 7.30 to 6.30 in the morning, but for a month now, he's up at four to five in the morning throwing tantrums, wants food, wants to play, refuses to stay in his room even with us there. I think, yeah, sorry, go ahead.

Arielle Greenleaf (24:45)
I wanna know if this... I

wanna know if this kid is napping.

Craig Canapari MD (24:50)
Yeah, this kid is napping. It is

time to stop napping. Absolutely. No more naps for your son or is it a boy? Yeah, it's a son. No more naps for your son Tyler if he's napping. If he's not, yeah, that's when it gets a little trickier.

Arielle Greenleaf (24:54)
Yeah.

Okay.

Well, I wouldn't say drop the nap immediately. What I would say is right now you're expecting 11 hours of sleep from him overnight. And if there's daytime sleep happening as well, then there's a discrepancy between what he's able to give you and what he needs versus what you're expecting. So sometimes it's a matter of like, let's cap the nap at an hour and push bedtime a little later to get to a later, you know,

later wake up in the morning. Sometimes you can shift that way. You don't have to necessarily jump to dropping a nap. But you might have to. I also, again, would like to know, I mean, what did he say about... He wants, okay, tantrum wants food, wants to play, anything except sleep or staying in his bedroom even if mom and dad offers to join him. Well, then that, you know...

That's kind of a key thing there. like, sounds like he's allowed to get out of the room regardless. So the parent is saying, even if we want to stay in the room with him, he won't stay in the room, but you have got to find a way to contain him because right, you know, if he has free reign, then he is the one in charge. And so there have to be some boundaries there. You could consider a toddler clock that,

gives them a visual cue of when it's okay to call out and get up and out of bed, but that would probably have to be in conjunction with looking at that schedule and then, you know, reinforcing boundaries there because it sounds like there's a little bit of a lack of a boundary there.

Craig Canapari MD (26:29)
Yeah, I also don't know where Tyler is geographically located. Certainly I wouldn't expect the sun to be up at four or five in the morning, but if this is a new change in behavior, you're not nap. We're thinking if there's anything environmentally going on, is the neighbor leaving in the morning at five in the morning, four in the morning for work, et cetera. Here, let's take another one of a child who is younger having similar issues.

Arielle Greenleaf (26:40)
Thanks

Craig Canapari MD (26:54)
This is Arman writes, my seventh month old is sleep trained, goes down at 7pm, dream feeds at 9.30pm, but consistently wakes at four to five in the morning. Why?

Arielle Greenleaf (27:07)
Well, again, this could be that bedtime is too early. you know, if they're waking, say, first of all, I personally don't believe in dream feeding. If your baby is hungry, feed them when they wake up. But if you're going in and feeding them when they're asleep, it becomes a habit. Usually they usually just start to wait. If you tried to get rid of that, that baby would probably wake up at nine thirty every night. So I would personally recommend getting rid of a dream feed.

Craig Canapari MD (27:32)
Can I add one thing too? It's increasing the likelihood of that child's diaper being wet and more likely to wake up in the morning too. Liquid in is liquid out. So I would agree with that.

Arielle Greenleaf (27:33)
Yeah.

Right.

Yeah. I don't think that's necessarily disrupting the sleep cycle to make them wake at that time. But if you think about it, if they're going to bed at seven and they're waking up at say five, then they're getting 10 hours of sleep. So it may be again, shifting sleep needs and pushing schedules forward, adjusting nap times, things like that. I know I talk about this like nonstop and it's

really annoying, but it really makes a big difference to take a look at that sleep picture and look at those sleep logs and understand, ⁓ you're right, maybe he is only sleeping 10 hours overnight, so we need to readjust our schedules in our head. It becomes eight to six instead of seven to five.

Craig Canapari MD (28:26)
Yeah, these are always tricky, right? The problem is if you've slept for 10 hours, you're just not that sleepy. If something wakes you up, it's just how it works. mean, yeah, as a parent, if something wakes you up at five in the morning, you're pretty sleepy. But you haven't slept for 10 hours, right? Or eight hours. Like if you went to bed at 8 p.m. and something woke you up at four five in the morning, you're probably up for the day.

Arielle Greenleaf (28:30)
Mmm.

Craig Canapari MD (28:53)
So maybe some schedule adjustments. here. ⁓

Arielle Greenleaf (28:56)
So this

is just as an aside and I don't want to like self promote but I do have a free 24 hour sleep guide that just walks people through how to calculate it

Craig Canapari MD (29:06)
let's put it in the show notes. That sounds great. It's a great resource.

Arielle Greenleaf (29:08)
Okay.

I've got a bedtime resistance question for you. Kay says, we have a toddler 30 months old on the dot who practically puts herself down for naps, will lay down and often falls asleep within minutes, but bedtime, 8 p.m., fights going to bed by yelling, kicking the sides of her crib, et cetera.

Craig Canapari MD (29:15)
Love it.

Arielle Greenleaf (29:32)
She has a younger sister, one year old, who goes an hour before her. There is no TV or screens after 5 p.m. and we do have a stable bedtime routine. Any suggestions of what we can do to help her wind down to go to sleep smoother?

Craig Canapari MD (29:48)
Yeah, I think that it is quite possible that the nap is too long and would be, you you're certainly getting within the same zip code of age three and there's no magic time that I can say, oh yeah, it's 36 months, you're just from your kid, you have a nap. But what this sounds to me is...

I mean, it's tricky, right? Because the child is sleepy at nap time, falls asleep very easily, but struggles to fall asleep at bedtime. So I mean, it's great that the screens are not in play in the evening, that's wonderful. And this child may need that nap if she's falling asleep so easily, but the cost of that might be a later bed.

And I might look at the time that the child is actually falling asleep. Start your bedtime routine 15 minutes earlier than then. So if the child is put into bed at 8 p.m., cries, fights, screams until 9 p.m., start your bedtime routine at 8.45. That should reduce the conflict. And then start inching that bedtime earlier until you encounter resistance.

Because the alternative is getting rid of the nap. But if this kid falls, goes to basically puts herself to sleep for a nap, I think that's going to be tough.

Arielle Greenleaf (31:17)
disagree. I mean I don't disagree entirely but I I would say I would look at this a little I would want to see a little bit more of it because what I often see is that child fights bedtime fights fights fights sometimes it's two hours they're falling asleep at 10 p.m. but they're waking up at their normal time they're waking up at 6 a.m. or 7 a.m.

Craig Canapari MD (31:19)
Thanks.

Arielle Greenleaf (31:40)
And that's still not a lot of sleep, 10 p.m. to 6 a.m., 10 p.m. to 7 a.m., most 30-month-olds need more sleep than that. So what happens is they're tired at nap time. And so they get their nap, and then bedtime's a mess again. So what I try to do is...

cap the nap first. know, if there's, if there is saying, you know, she falls asleep so easily, she's sleeping for three hours, then I say, okay, we need to significantly back up that nap time. A lot of times what I find is, okay, sleeping for two and a half hours and then fighting bedtime for two hours or like fighting bedtime for an hour and a half. So it's like, we need to shave an hour and a half off that nap.

Two and a half hours puts us at an hour. Let's try capping the nap at an hour and putting bedtime at normal time and see if that helps rectify that. And redistribute their sleep back to the nighttime and redistributing it from so much during the day and putting it back into nighttime.

Craig Canapari MD (32:44)
yeah, I look, I I think we're kind of saying the same thing, right? Like, essentially, your kid is going to sleep a set amount of times in 24 hours. And it sounds like, you know, the cost of a long nap during the day is a pleasant bedtime. And some kids may ⁓

just if it benefited from getting rid of the nap, other naps, other times you might need to cap it, it's really you wanna look at your kid's schedule. if it's consistent, let's say your child is not consistently, if your child sleeps for three hours in the afternoon, is fighting for two hours and falling asleep at 10 o'clock at night, well if you want him to fall asleep two hours earlier, you have to shorten that nap by two hours. Like it's a math problem. ⁓

Arielle Greenleaf (33:22)
Yeah.

Craig Canapari MD (33:25)
I'll ask you this one. Jason writes, my five year old son is waking almost every night saying he had a bad dream, not scared, and goes back to sleep with music and one of us sitting with him. We sit with him when he first goes to bed until he falls asleep. Does our sitting with him cause him to need reassurance after waking up and not being able to get back to sleep on his own?

Arielle Greenleaf (33:27)
you

Simple answer is yes. So you need an exit plan. You need to come up with a new way of putting him to sleep. So he needs to be able to know that he can fall asleep without you there. And that doesn't mean removing yourself entirely. Can you remind me of the age of this child? age five. Yeah. So know, like, huggy puppy might be good here, or...

Craig Canapari MD (34:05)
age five. So yeah, I

Arielle Greenleaf (34:11)
⁓ You know a bedtime countdown where you're like I will come in and we will read stories and we can cuddle back up the start time of the bedtime routine so that you have time to do this and he's falling asleep at a reasonable hour and then With that middle of the night thing you kind of just have to repeat that we're up Maybe it's I'll sit with you for five minutes, but I'm leaving after that and you're going to be okay But I think you know something like hubby puppy could be really helpful here

Craig Canapari MD (34:38)
Yeah. Yeah.

We'll put in the show notes. There's the bedtime game bedtime pass, huggy puppy, there's any number of interventions with age five. But I would I would also highlight the observation that your child says he had a bad dream, but he doesn't seem scared. That is a very good and important point. That if your child really had a bad name, they're really scared. It's appropriate to comment them to comfort them. If they're like, yeah, I had a bad dream. Can you come sit here?

It's like, it has a different sort of valence to it. And I wouldn't, I would look at those techniques, we'll put the links in the show notes, and then just decide what seems like the best fit for you and your child and any other adult in the house and just implement it. I don't think it's gonna be that hard.

This from Betty, which I just dropped here. It's more of a daycare question than a bedtime resistance question.

Let me read the question. Let me ask you a question before we get into it. Before we offer the answer. This isn't jeopardy. My baby only naps 30 minutes of daycare, lights on and noisy, then crashes in the commute home, pushing bedtime to 8.30 or 9pm. Any advice for daycare parents?

Arielle Greenleaf (35:34)
No.

Okay.

I mean, I have a lot of advice for daycare parents, but this situation, again, I think it's just really difficult because I don't know what time of day this is. I don't know the age of the baby. don't know. Are they sleeping 30 minutes for one nap? Are they on three naps and they're only getting 30 minutes? I don't know. I don't know a lot, but what I will say is if the commute is shorter and baby's falling asleep,

then I would make sure you get your baby up as soon as you get home, feed them, go through their bedtime routine, and then get them down. You don't have to have this big, long, elaborate bedtime routine, but at least get them fed, get them bathed, get them calmed down and put them to bed versus getting home and letting them sleep in the car seat for two hours or something.

Craig Canapari MD (36:36)
No.

Yeah. And I think the flip side is, is a bedtime of 8.30 or nine is not the end of the world. Right? Like, like if this was like 11 o'clock at night, I'd be like, okay, you need to do something. I think the fact, the fact is it's hard to find perfect childcare. Childcare is very expensive. It's stressful for families. Everybody's doing their best. And, you know, I think sometimes you're like, it's just not going to be perfect. And I'm like, I'd say,

If the kid sleeps for 30 or 40 minutes at the end of the day, then it's up to 8:30 or 9 That's kind of okay for me. The biggest daycare challenge I find is when kids are ready to give up the nap and they nap at daycare and their bedtime's a disaster. And then the weekends they don't nap and everything is perfect. So that's something for Betty to look forward to in a couple of years.

I think you have to extend yourself a little bit of grace that like you just can't, you got to work. Things aren't going to be perfect like at home and that's okay. know, children really are resilient and you know, if you're otherwise happy with the daycare and you feel like they're doing a really good job, I think you kind of, you'd be swimming upstream to try to change the routine of the daycare. I just be like, you know what, I think you're doing okay.

Arielle Greenleaf (37:52)
Yeah, there's only so much you can control and it's not worth stressing over the things that you can't control. But like again, if the commute is not that long and baby sleeps for 30 minutes, then just make sure you're getting them up. If you're not liking the 8.30 to nine o'clock bedtime, make sure you're getting them up when they come home, feeding them all that jazz and putting them to bed versus allowing them to sleep in the car seat or something like that. But I always say, you do the best you can. It sounds like baby is actually going to sleep, so that's a good thing.

And then I always say on the weekends just do your best to get your baby the sleep that they need. So if this child is only getting 30 minutes, hopefully they're taking, you know, two or three naps during the day on the weekend and getting to bed a little bit earlier, but we can only control so much.

Craig Canapari MD (38:35)
Absolutely. And here, okay, you wanted to, you want to ask me this next one? Sure.

Arielle Greenleaf (38:39)
I'll ask it. Yeah,

we're on to co-sleeping and room sharing. So, Anna says, our almost nine month old baby is currently co-sleeping with my husband and I, but really it's me, lol. He starts in his crib, we lay him down completely asleep, but is always in our bed by 1130 p.m. Is it naive to think that his sleep will get better and more independent by just continuing the status quo?

He's in daycare and seems like he's sick every other week, so we haven't felt the time has been right to sleep train. He soothes back to sleep so much easier when he's just in bed with us. Are we doomed?

Craig Canapari MD (39:18)
I Eventually the sun will explode and, you know, it's, it's gonna be hundreds of millions of years from now. a couple of things. mean,

The AAP recommends room sharing, but not bed sharing to at least six months of age and not bed sharing until a year of age. So I have to say that. But I feel your pain. It's really tough when your kids, you know, your kids picking up everything in daycare, right? Like, so I think to address this, I think that there are seasons in life where sometimes it may be easier than harder to deal with certain problems. And

As someone who's also a respiratory doctor, this has been a really challenging respiratory season. Our census in the hospital is really high and that usually means the community level of illness is very high. If you are waiting for your child to be sick less frequently, that is likely going to happen as we head into the spring and the summertime. So the burden of illness is going to get less, right? It feels like the winter lasts forever.

in a month or two, if you are in the ⁓ Northern Hemisphere, that will get better. Now, so I would say that it would be very reasonable to think about sleep training, maybe come April, there are gonna be fewer respiratory viral illnesses. So I think that, you know, it's just tough. They really are sick a lot in their first year of daycare

Arielle Greenleaf (40:38)
I just want to add to that though because you said the question was is it naive to think that his sleep will get better and more independent by just continuing with the status quo and I will have to say that yes that is it's not naive it's just it's just very unlikely because that's the only thing he knows and so if you want his behavior to change you have to change your own behavior

Craig Canapari MD (40:55)
So I'm like.

Arielle Greenleaf (41:06)
And so he's not just gonna magically say, like, I wanna go in my own bed. And when he does, and he can say that, he's gonna be a lot older. So you just have to think about, you know, how long you can hold on.

Craig Canapari MD (41:15)
No, I mean, he

will, but it's going to be shortly before he goes to college. So, no, I don't know, maybe age 10, I don't know. But yeah, if you want to make it, if you are unhappy with the current situation, you need to make a change. But I do give you permission to postpone sleep training until we're out of the winter.

So our next section on sleep props and association, Arielle , I love this question. Lauren writes, is it okay for a five year old child to have a quiet, calm toy like a snow globe to play with while falling asleep? Our kiddo complains falling asleep is just so boring.

Arielle Greenleaf (42:00)
Hey!

Craig Canapari MD (42:01)
Letting

her choose from one toy from an assortment of simple, calm snowglobe-like toys seems to be helping, but could we be creating an unwanted future sleep issue?

Arielle Greenleaf (42:14)
I mean, I don't think necessarily. As long as she's not waking up and saying that she needs it all throughout the night, I don't think there's an issue there. Unless you find that she's suddenly playing with it till midnight, that's a different story. But I don't think there's anything wrong with that. It may be that she just needs more time to wind down before falling asleep. But the other thing you might want to consider is that

She might not be tired enough. So I don't know what timing it is, but you may also consider, weather's about to get nicer, going outside for a walk before, you know, after dinner or something, getting some physical activity, fresh air. If it's, if she's saying it's so boring, then it sounds like she's not quite wound down enough or like her body hasn't relaxed enough to fall asleep easily, so.

Craig Canapari MD (43:06)
I'm

just feeling this child's energy though. I mean, it is boring. Yeah, I think that, know, Lynelle Schneeberg, who we should have in the podcast sometime, is a child psychologist, works at CCMC. And she talks about a bedtime box, know, calming quiet toys. Yeah, just have it by the bedtime. And this is totally fine. Okay.

Arielle Greenleaf (43:09)
Yeah, I think it's lovely.

yeah, yeah, I love the bedtime box. Yeah.

Sick child.

Sick children makes me sad. I know, you deal with sick children every day. You're a saint. Karen says, may I please have your tips on getting toddler to nap and sleep through the night when they have a slight cold?

Craig Canapari MD (43:34)
Yeah, right in my alley.

every day.

Arielle Greenleaf (43:49)
She recently turned three years old. When toddler is very sick, I'd try Benadryl, but my toddler refuses to nap and sleep through the night with the slightest congestion, and I don't want to give her Benadryl when she just has the sniffles. We use nasal spray.

Craig Canapari MD (44:03)
Sure. Great question. I think that it is hard to sleep when you're congested. My first thought is if your child snores routinely, sick and not sick, it's definitely worth talking with your pediatrician, maybe seeing an ear, nose and throat doctor to see because a subset of children who struggle with nasal congestion and sleeping, they could have a condition called obstructive sleep apnea where their tonsils and adenoids are blocking the airway. This is not an emergency, but if this is a

This is a routine problem it's worth looking into. Benadryl, the only thing Benadryl does is sedate your child because the congestion, the runny nose of respiratory illness is not usually driven by allergy. So an antihistamine like Benadryl is not going to reduce the volume of secretions particularly. So I think ocean nasal spray, suctioning the nose, the nose frida or nose irrigation, if she will tolerate it.

which is a big if for a three year old would be helpful. But I definitely talk to your pediatrician if this is like three year olds, especially if they're in childcare getting colds all the time. But if colds are causing a big problem, that issue might be a mechanical problem with a big tonsil, big tonsils which are in the back of the throat or big adenoids which are in the nose. I'd ask the pediatrician maybe an ear nose and throat doctors.

Arielle Greenleaf (45:17)
Yeah, and in seeing the ENT, I would just throw in there to have them look at the eustachian tubes because sometimes children's ears, they're not affected necessarily, but they're full and they don't drain as easily. And I've found many children struggle with that because even if there is fluid in the ears, it can cause pain. it's worth, if you're gonna go to the ENT, get it all looked at.

Craig Canapari MD (45:42)
Perfect. Yeah, I love it. Dr. Canapari is always for tonsils and anodes coming out. Let's, looks like Sonia asks us a bunch of questions. Let's do a rapid fire, okay? Just scroll down to general or multiple topics. Okay. At what age can parents co-sleep with their children for naps? One year and up. You wanna take one?

Arielle Greenleaf (45:51)
Where is Sonia? yeah.

Sure. When to transition out of the crib to a bed? Should the first bed be a floor bed? Transition out of the crib to a bed if it, one, becomes unsafe and your child is climbing out of the crib and there's a risk of falling. Two, until they go to college, leave them there. Just kidding. But after age three is really, developmentally, it's much easier to go through that process with them.

Craig Canapari MD (46:18)
Yeah.

Arielle Greenleaf (46:26)
much more excited about it. You have to remember that removing them from their crib is also removing safety from around them. They're used to being contained and then suddenly they're not. And that can be really jarring for some children. So, you know, not rushing it unless it's a safety issue. And well, the other part of that would be, should the first bed be a floor bed? No, I actually, I mean, if you choose to have a floor bed, sure, but

A regular bed is perfectly fine, there's no reason for...

Craig Canapari MD (47:00)
Yeah, I learned about this.

Arielle Greenleaf (47:02)
think it's preference.

Craig Canapari MD (47:03)
It's a Montessori thing and the idea is it encourages independence. Yeah, I you could do a floor bed, you could do a mattress on the floor, you could do a toddler bed, you could just get a regular bed that your child could get in and out of. I don't think it really matters that much from a developmental standpoint. Here, okay, here's one. What are the pros and cons to not sleep train a child and just follow their natural development? And I would say that many parents don't need to sleep train their children.

Arielle Greenleaf (47:05)
It is.

Craig Canapari MD (47:32)
Right? I don't usually listen to this podcast or go to my website or Google how to sleep turn your child in the middle of the night. So I think that. You know, you should consider sleep training if your if your child is struggling and you're struggling now in that situation, if you're struggling, what are the pros of doing of doing sleep training?

which would be the cons of not sleep training, guess, would be that having continued sleep disruption for your child and yourself. What's the downside of sleep training? I think if it's done appropriately, it's very safe and developmentally appropriate, but again, it may not fit with the parent's values. And for little kids, it does seem like sleep issues do tend to improve with time, but the tempo of that can be slow. So if you're not, if you're not,

worried about your child's sleep and everyone in your home is sleeping well, you don't have to sleep training, right? Like it's kind of up to you. If you're really struggling with your child's sleep or your partner is or somebody in your house is, it is not a terrible idea to do it.

Arielle Greenleaf (48:30)
Absolutely, if it's not a problem, it's not a problem.

Craig Canapari MD (48:33)
Arielle you take this next one.

Arielle Greenleaf (48:35)
Okay, what are your thoughts on using a SNOO versus a traditional bassinet? I prefer a traditional bassinet because Well for a number of reasons the SNOO is quite expensive first of all second of all it

It has a lot of, it incorporates a lot of things that your child could become dependent on as they're going through their newborn stage and they enter, you know, infancy. Am I able to wean babies out of it? Yes, I do it regularly. Is it harder for some? Yes, it can be extremely hard because they're so dependent on the noise or the movement or even.

Being swaddled, in my opinion, for far too long, they're literally like swaddled in and in the bassinet. They have a real hard time getting out of that swaddle, and they're four or five months. So we're not supposed to be swaddling our four and five limpetls. So if you're able to use a traditional bassinet, that's my recommendation. Craig, do you have thoughts?

Craig Canapari MD (49:35)
You know, honestly, I'm not gonna lie. This wasn't a thing when my kids were little. I would have been curious as much because I'm a sleep professional to try it. I remember talking to Harvey Karp, who wrote the, The Happiest Baby On the Block, which is a book that was actually very helpful to us when my, ⁓ you know, first son wouldn't stop screaming. ⁓ So, and they did, from the beginning, build a weaning method into it. ⁓

Arielle Greenleaf (50:00)
Yeah.

Craig Canapari MD (50:02)
You know, I think the key is, and this is as much for the parents as the kids, the actual window you're going to use this should be just a couple of months. And after that, then I'd work on, I work on weaning it, starting around three months of age, referencing the question earlier. I've talked to parents who really loved it and it was a lifesaver for them. And I've talked to parents that didn't find it helpful at all. Fortunately, you don't have to buy it. You can either buy it used or you can lease it. So I think that that makes it a lot more of a

a better value proposition.

Arielle Greenleaf (50:32)
I guess for

me it's it's more yeah, I think it's preference. I don't think there's there's no wrong answer there I would just recommend if you use one working toward you know slowing down the motion or turning down the noises pulling arms out of swaddles as you near four months, you know really

not waiting and keeping it all really extra jiggly and extra noisy until your child is four or five months. But if it's saving your sanity, I'm all for that. I mean, if it's giving you longer stretches of sleep, if it's saving your sanity, do it.

Craig Canapari MD (51:08)
Beautiful.

Sonia also slipped another question in here. Sonia is very canny. My kid, two year old, is one of the 20 % that won't stay in his own bed or crib even after he's learned to fall asleep by himself. Are we screwed?

Arielle Greenleaf (51:15)
Okay.

Craig Canapari MD (51:25)
Parents are getting real here. Are we doomed? Are we screwed?

Arielle Greenleaf (51:31)
I mean, okay, so I guess my question is I don't understand, first of all, where this 20 % comes from. Second of all, I've had some really bad cases of kids escaping their room, not wanting to stay in their bed, not wanting to stay in their room, like really bad. Like one girl was like trashing her room. The pediatrician told them to like pad the room, put up.

she they put up the they put up a baby gate and she was like scaling the baby gate it was really crazy. She did so she did the double gate but then the parents were scared because she was climbing the double gate. anyway it was a lot of work and it required a lot of consistency and those parents really trusted me and they partnered with me. But you know what ultimately worked Craig was consistency with Huggy Puppy.

Craig Canapari MD (52:01)
God, God did double gates. The guy did double gates.

Arielle Greenleaf (52:25)
And it wasn't like perfect, you know, it wasn't like, here have this puppy and you know, everything's magic. It took a good 10 days of just reminding her and telling her she's safe and going in and reassuring. And, and we ultimately got her like sleeping through the night, staying in her bed and staying in her crib. And she was young. She was only 26 months.

So yeah, and you know, they had to move her to a bed at 18 months because she was, she fell out of her crib and had to go to the emergency room. So it was a safety issue. She's very tenacious. it's exhausting to embark on sleep training. I'm just going to say that, especially with a really tenacious.

toddler who is like so strong-willed. These people are going to rule the world one day. But consistency is so important. Yeah, well, yeah, right now, yeah, they are essentially ruling the house. Right.

Craig Canapari MD (53:13)
I mean, they are ruling the world. They're going to get governed by a two-year-old. Well, anyway,

not to get political, but...

Arielle Greenleaf (53:22)
Jesus. ⁓

Craig Canapari MD (53:25)
What is

that gag in the office is like, Michael, Michael Scott's like a baby, a baby should run the world. Be like actually baby be a terrible president. I mean, like, anyway. so yeah, I think that I think certainly, there's a lot of things here and safety comes first, right, you know, but there are many ways to contain. And I would argue it's a safety issue to contain a two year old that a two year old needs to be safe and not wandering the house at night.

Arielle Greenleaf (53:31)
Yeah

Hmm.

Craig Canapari MD (53:50)
Do not rely on your ability to wake up if you are exhausted to keep your toddler from falling down the stairs or climbing on the kitchen counter or something like that. I think they have to be safe. So you have to come up with some sort of containment strategy. ⁓ Well, listen, this last question here, do you want to ask me this one? This one is kind of a cool one.

Arielle Greenleaf (54:06)
Yeah, agreed.

Sure, this is anonymous. I work at, this is cool, I work at the daycare at Patagonia's HQ, the clothing company, and licensing is in the process of trying to revoke outdoor naps for infants aged six months to two years in beautiful Southern California.

Any beautiful nuggets of Yoda-ism that you can shed on the benefits of an outdoor nap, no need to worry about Cali licensing. For us to campaign the beauty of children taking a nap, al fresco.

Craig Canapari MD (54:44)
I was gonna say terrible news that is, as being Yoda, because I can't do a good Frank Oz impression, but it is very, I could find nothing about napping specifically outdoors. There is some interesting research in teenagers about,

camping and sleep and they're being outside rapidly entrained teenagers whose schedules were shifted very late to being on a more normal schedule quickly. So there clearly are benefits to natural light exposure and sleep. There was a systematic review showing the physical activity in outdoor play was associated with more with the best sleep outcomes in toddlers and preschoolers and then in Japanese toddlers playing outdoors in the morning was associated with

improved sleep at nap time and at night. So and finally, the high quality outdoor environments at childcare venues was associated with better nighttime sleep. So I think it's hard to say that directly napping outside will improve sleep, but it is very clear that spending time even in your age group at a daycare can be associated with better sleep outcomes. So I wish you the best of luck.

And ⁓ I wish I could be in sunny California and take a nap outside year round. It sounds amazing. Why do I live in the Northeast? It's terrible.

Arielle Greenleaf (56:02)
We have snow coming tomorrow. I don't even know. I know. I'm

sorry. It's just never ending.

Craig Canapari MD (56:11)
Okay, so ⁓ we will, we'll put it in the show notes, the stuff we talked about a link to Arielle 's 24 hour sleep stuff, which is super useful. And I know what's our email address again.

Arielle Greenleaf (56:24)
The Sleep Edit Show at gmail.com.

Craig Canapari MD (56:28)
Yeah, and our website is sleepedit.show. So shoot us an email if you have questions and thank you so much for listening.

Arielle Greenleaf (56:36)
Thank you.

Okay.