Continuing with the sleep topic we will be exploring two additional aspects of sleep in this blog installment. We will continue this topic again in a later blog exploring bedtime routines and sleep disorders. This blog looks at aspects of:
• Sleep Associations
Sleep Associations – what are they and what do they do?
Sometimes coined as a bad phrase, sleep associations are not actually negative things! We all have sleep associations, even adults, you just might not realise you have them anymore as they have become the subtle little things you do or need in order for you to sleep. A common adult sleep association is your partner. You might have heard people say “I just don’t sleep well without my partner in bed with me!” or “I need the fan on all year round or I just don’t sleep!” These are sleep associations. Routines, objects or behaviours that we need to replicate each time we go to sleep to have sleeping success. Children are EXACTLY the same!
A sleep association in children is often a comfort toy, dummy, bottle/breastfeeding, rocking to sleep, sleeping with a parent etc. These are all associations for sleep that cue a child it is bedtime. The most commonly used sleep associations in the U.S. and Australia are bottle/breastfeeding, comfort toys and dummies. In countries like Japan, The Phillipines and South America the strongest sleep associations for children is their parents as co-sleeping/bedsharing is socially accepted as common practice.
There is no right or wrong with sleep associations, as what works for one family or one child may not be what is best for another. Understanding the needs of your individual child and taking into consideration your culture and/or family desires or beliefs is key to finding what sleep associations work best for your family.
Newborn sleep associations
A human is never sleepier and requires more sleep than when we are newborn. As such, sleep often (but not always) comes easily to a newborn with minimal intervention from a parent or attachment item. When they are used, the most common sleep associations for newborns is a dummy and rocking to sleep. Newborns are born with a very strong biological urge to suckle, therefore the use of a dummy can be useful in soothing them for sleep. The action known as “non-nutritive sucking” releases hormones in babies’ bodies that reduces stress, promotes sleepiness and can even help decrease pain. Bottle and breastfeeding can also become a very strong sleep association for a newborn as they may often fall asleep whilst feeding and therefore make the positive association to sleep.
Newborns can also develop other associations that promote sleep such as a comforting bedtime routine, swaddling, consistent lullaby or white noise. These associations can often continue into infancy and toddlerhood where they can remain as positive sleep promoting tools.
Infant and Toddler Sleep Associations
As your child grows and develops their attachment to individual sleep associations also grows and strengthens. Newborns are flexible with associations and can more readily gain a new one or not require an old one. However, around 4 months old your child will begin to become “attached” to their sleep associations requiring them with every sleep initiation. At this age their brains are beginning to mature sleep cycles and these cycles begin to mimic an adults more regularly. This is also known as the “4 month sleep regression” which will be discussed later. As this change to sleep patterns occurs, babies wake more often overnight (and naps are often disrupted also) and as their attachment develops to their sleep associations, they will seek that association again in order to go back to sleep. So for example, if your child falls asleep with a dummy, they will wake between sleep cycles and likely seek the dummy to be put back in their mouths in order to drift back off.
Introducing a comfort toy from around 7 months of age (as per SIDS recommendations) can be a wonderful sleep association to help children and toddlers be comforted throughout their sleep. A comfort toy is an object (often a blanket, soft plush toy or other soft object) that your child attaches to through positive reinforcement of soothing, feeding and joy whilst using them. Children attach easily to these objects as they can carry them with them in times of need for comfort or when anxious or experiencing upset. These objects then become a strong positive tool for settling babies and toddlers in their sleep.
It is around this time and as your child moves into toddlerhood that some sleep associations can become impractical or harder to maintain and a shift needs to be made to better suit the family and child. For example, if you have been rocking your child to sleep and they are now getting too heavy to do so, you may like to change to patting them in their cot/bed. Or you may have been feeding to sleep and this is no longer working for you and your family so you would like develop a different sleep association for your child to move away from feeding.
Remember that there is no right or wrong with sleep associations, only what works for your child and your family. If what you are doing is working for you than keep going! If you need or want to make a change than that is okay too.
Creating a new sleep association with older babies and toddlers takes time and patience. Once you have chosen what your new association will be, introduce it with patience and consistency as developing new attachments and associations at this age can be harder than with newborns.
Below are some examples of ways you may like to introduce a new association -
• Comfort toy - You may like to introduce it whenever they are sad, having a cuddle with you, when they are having a feed, let them play with it during the day and have it with them every time they go to bed. Over time start decreasing the old association you are replacing whilst continuing to utilise the new comfort toy. Or if you are simply adding a comfort toy but not replacing an association you can just continue using it throughout the day and for sleep.
• From rocking to patting – If you have chosen to move away from physically rocking to patting you may like to start with an in arms cuddle, then lay them down and gently rock their body while you pat them to emulate the same movement as before. Then over time as your child becomes comfortable you can begin to decrease the rocking of their body to just patting from the start.
• From Feeding to sleep – If you would like to stop feeding to sleep you can approach it with gradual decreasing of offering of breast or bottle until you feel they would be ready to simply not have it anymore. Alternatively, you may like to introduce a new sleep association that you are comfortable with to replace this. This may be a dummy, comfort toy, rocking/patting. Which ever you choose remember to do so slowly and with patience and this will help your child build positive connections to the new association.
There is a lot of talk around sleep regressions. Some people say they should be called “progressions” as what is generally occurring is a leap in their development that changes a child’s sleeping patterns. There is a lack of sound research on what a sleep regression is, but what is known currently, is mostly anecdotal. However, there is a lot to be said from anecdotal information and when it comes from many MANY families corroborating the same story with a wide variety of children… it can be said that they do, in fact, occur. So below is a breakdown of what the current belief and limited research says on regressions, what may be occurring at the time which would cause it to occur, and what we can do to support our children through them.
The (dreaded) 4 month sleep regression – The, by far, most talked about and dreaded sleep regression. Newborns are notoriously (although not always) very sleepy and relatively easy sleepers. They will sleep anywhere, at anytime (mostly all day and party all night) and have two easily identified sleep stages (active – where they look like they are waking up, grunting, even crying; and Deep – where they do not move a muscle). Then your child turns 4 months, they are no longer a newborn and their sleep cycles begin to mimic those of an adults. Their sleep switches slowly (over a few weeks) from active/deep to a full cycle with REM, light and deep sleep patterns. This change can cause frequent wakings, short naps, unsettled sleep and a need for more hands-on settling techniques.
How to support your child: provide them with opportunities to practice their new sleeping skills (new sleep cycles) with practicing sleeping in their cot/bassinet, hands-on settling techniques will help them to learn how to link their new sleep cycles and sleep for longer stretches, incorporate a positive sleep association that works for you and your family to support your child to become comfortable with their new sleeping pattern.
8 month sleep regression – This regression is often anywhere from 8 to 10 months and it coincides with the child’s development of a concept called ‘object permanence”. This is the child’s newfound ability to understand that when an object or person is no longer in view they still exist. What an amazing leap in development, as previously children under this age do not understand this. However, this results in children learning that when their caregivers walk away or leave the room they still exist and they may protest your absence. This causes children to wake more at night seeking their parents, showing resistance and separation anxiety at bedtime and challenges with settling.
How to support your child: Providing your child with opportunities to experience separation from you in positive ways throughout the day can support them to build their knowledge and understanding that you will always return and that separating from you does not need to be something to fear. This can be done by practicing leaving the room, separating for short periods of time with a trusted caregiver (Grandparent, early education service etc.)
12 month sleep regression – This regression occurs anywhere from 12 months to 15 months and coincides with a child learning to walk. Walking is one of the biggest milestones that a typically developing child will master, how much fun is it to learn how to walk! This can then translate into your child wanting to practice this skill whenever they wake in the night. They want to get up and walk out of the cot, and why wouldn’t you… exploring is so much more fun now.
How can you support your child: Providing ample time and opportunities to build this skill throughout the day. This not only wears them out but also helps keep the urge to practice this skill lowered during the night. Children of this age are also more receptive to boundaries and when used with calm and consistent approaches children respond well to having bedtime structure and routines. Helping them to understand that bedtime means sleep-time will help them to move through this regression with minimal struggles.
The 18 month sleep regression – Children of this age group start to have a challenging time with bedtime as they have begun the wonderful developmental leap of understanding that their words and actions impact/influence others! They have learnt that they have choices, they can express those choices and they will do so out of impulse and an unconscious drive to find their independence in the world. You may find that your child is waking more frequently at night and protesting having to go back to sleep, they may resist bedtime and even try and skip their nap during the day. This is all part of them discovering and craving control over their world.
How can you support your child: As one of the main reasons for this regression is around independence and autonomy, the best way to support your child through this stage is by giving them what they crave. Providing them with choices in their bed time routines (e.g. do you want to walk to your bed for the story tonight or shall I carry you?, “would you like the blue pajamas or the green ones” etc.) Providing options allows the child to feel autonomous but also ensures that you can maintain your boundaries around bed time, routines and expectations.
The 24 month sleep regression – This sleep regression is less common but can be considered the most challenging as it often coincides with transitioning to a big bed. Around this age children have really begun to understand that their views, opinions and thoughts are separate to others and that they have choices and can control things around them with their voice and actions. Whilst this a great milestone for their cognitive development, it spells doom for sleep. This is because they now realise they can choose to sleep, they can affect the sleep routine with their actions and with their innate drive for autonomy and independence… they want to push the boundaries to see what they can do.
How can you support your child: The best way to support your child during this regression is to keep going with your routines as usual, if you begin to bend and deviate from the normal routine they will see that they really do have choices around sleep and will continue to push the boundaries as far as they can. If your child has transitioned to a big bed and they keep getting out of bed you may like to gently return them to their bed each time, reminding them it is bedtime and they must stay in their bed to fall asleep. The novelty wears off over time and they begin to feel more comfortable to remain in bed when they feel the security of the consistent boundary.
Written by Kelly West
Partnerships, Inclusion and Research Coordinator