'If she doesn't immediately get milk she goes hysterical'

'If she doesn't immediately get milk she goes hysterical'

Laois psychologist and Operation Transformation expert Dr Eddie Murphy has advice for Leinster Express readers.

Reader's Letter: Mary writes; “Dr Eddie I have a 19 month old beautiful granddaughter called Amy.

She has a good diet, eats very well very few sweets or biscuits and no fizzy drinks. She has her evening dinner with Mam & Dad and her four year old sister around 6pm.

They all play for a while, then they watch Night Garden, a baby programme, and she has 5ozs milk around 7pm, then very happy and off to bed, sleeps immediately.

She cries three or four times every night at different times.

It could start at 12, if mother or father doesn’t give her milk immediately she goes hysterical, her hair gets all wet, her clothes all wet, her body all wet and she is in a distressed and upsetting state. It takes ages to calm her down.

If they put water in the milk or If they don’t give the milk when the crying starts, the above happens and works herself into a state.

Mam & Dad are afraid to let her cry too long, as some months ago a GP sent her to Crumlin hospital at 11pm one night, with Febrile convulsions which lasted 45 minutes.

This was due to a viral infection. She was kept overnight  and they gave them medication if it happened again, so far it hasn't.

Bless them, they are both so tired with getting little sleep. Another gastro paediatrician was recommended to them, by their GP, He examined her and could find nothing wrong whatsoever.

Her last crying at night is probably around 5am to 5.30am and she is up then for the day.

During the day she's a very happy playful child, not talking yet but understands what we are saying.

She has her own bedroom. She sleeps once in creche in the morning time for about one hour and no more, the same Saturday and Sunday when she is home.

So Dr Eddie, if you have any advice for us I would be so grateful.

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Dr Eddie Responds:

Thanks for such a comprehensive report of your granddaughter. It shows great concern and support to all involved. A number of things struck me.

Parental Anxiety: Given the experience of the febrile convulsion it’s only natural that both parents are sensitive to Amy wakening.

Its hardwired in a way for parents to respond to their children and this significant event will ensure that any wakening is associated with potentially some checking to ensure no convulsions are taking place.

In addition having gone to two specialists they both have indicated that this was a febrile convulsion linked to viral infection and not to anything else.

Normal Sleeping for Infants: The bottom line is that most children don’t sleep through the night.

Our normal sleep wake cycle involves Deep sleep (Non-REM sleep) which restores the body and is vital to remain healthy. It repairs tissues and muscles, boosts your immune system and stimulates growth and development.

There is also Light sleep (REM sleep).

The young child will go from being awake to a Deep Non-REM sleep within 20 minutes. He/she will remain in a deep Non-REM sleep for approximately 60 to 90 minutes, followed by a brief Light Non-REM sleep for about 10 minutes.

He/She will then return to a Deep Non-REM sleep for another hour or so.

The child may then awake briefly and return to a Light Non-REM sleep for 30/40 minutes before returning to a brief Deep Non-REM sleep.

After this the child will go from REM sleep to Light Non-REM sleep with some brief awakenings for approximately the next 5 hours.

In the early morning he/she will return to a Deep Non-REM sleep followed by a brief awakening to a brief REM sleep to brief Light Non-REM sleep until they are finally awake for the day.

The key message is that its normal for a 19 month old to awaken 3 to 4 times at night. It’s what happens next that either reinforces or extinguishes the behaviours.

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Basic Behaviourism

Our actions can increase or decrease the likelihood of the behaviour. Children have a brilliant ability to maximise the time with their parents.

The behaviour awakening I do not think is associated with hunger (but is part of the normal sleep wake cycle) and that the stress is associated with seeking comfort from mum or dad or both.

This in turn makes it more likely for Amy to repeat the behaviour = awaken/cry/parental response/ bottle.

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self-soothing

Mary we all regardless of age need a sleep script, just like we have a script or routine, for going to the cinema, getting a taxi, eating in a restaurant.

Amy has an excellent script of how to go asleep, starting with relax time, going to bed and sleep.

Too often I have seen kids who are kept up to the point they fall asleep on a couch and then lifted to bed. They wake up not knowing how they got to bed!.

Amy’s next challenge is to learn the script of how to self-sooth herself when she wakes up as part of the normal sleep wake cycle.

There will always be disruptors to sleep; Teething, separation anxiety, changes in routine, night terrors, illness, etc.

The challenge is to support the child to return to their pre-existing routines as soon as possible.

I believe with some work on developing Amy’s self-soothing strategies things will improve straight away.