So you’ve hit what seems like the 4-month sleep regression. Your beautiful baby was sleeping so wonderfully and is now waking up all night and catnapping in the day. Suddenly you find yourself not knowing what to do next! Cue…Google at 2am!
Sleep associations are a massive part of the way your baby goes to sleep and in fact learns to go to sleep. Sleep associations can both help and hinder sleep.
WHAT IS A SLEEP ASSOCIATION?
A sleep association is something that a child associates with falling asleep. A sleep association is something that your child requires to get to sleep and something that they cannot sleep without.
Anything can be a sleep association if your baby needs it to fall asleep, such as:
· Bottle Feeding
· Driving or Walking in the Pram - Motion
· Comfort Toy/Lovey
· Baby Carrier
THE DIFFERENCE BETWEEN A POSITIVE AND NEGATIVE BABY SLEEP ASSOCIATION Sleep associations only become negative when they get in the way of great sleep. An easier way to know if a sleep association exists is if your baby can’t “stay” asleep after going to sleep in a certain way.
For example: If your baby is rocked to sleep and wakes up 20 minutes later needing you to rock them back to sleep – rocking is a sleep association.
OR – If your baby is dependent on a dummy and wakes up every 2 hours needing that dummy to be replaced by you each and every time – that’s a negative sleep association.
On the other hand, if your baby uses a dummy to fall asleep but can sleep through the night, that’s grand. The dummy in this example is a positive sleep association. You are using the dummy as a sleep prop but it is not getting in the way of a good night’s sleep – both for you and for bub.
WHAT ABOUT NEWBORNS? Newborns are so fragile and they need you to comfort them, feed on demand and get them to sleep! Newborns do not have the developmental capacity to self-settle and most will require some form of help to get to sleep. So don’t think you are going to form “bad” habits in the first two to three months! Enjoy those beautiful cuddles!
Just because you nurse, rock or hold your newborn to sleep does not mean that you will be doing this for the next year of their life! Ultimately we don’t want to be doing this at 4 months so between 3 and 4 months is the perfect time to start getting your baby to gradually learn some self-settling skills.
YOU THINK YOU’VE GOT IT COVERED AND THEN….SLEEP ISSUES MAY START The 4 month regression….we have all heard it! This is when the sleep associations that you had been using during those newborn months suddenly stop working. Why? Because your baby’s sleep starts to consolidate, sleep cycles become more adult like and your baby’s awareness increases. You may start to experience frequent wakeups and catnaps. Your baby will wake up at the end of a sleep cycle looking for the prop or aid that got them to sleep in the first place. Teaching self-settling is the answer here.
And do you know what? You may be fine with frequent wakeups and catnaps and that’s cool. You just do what works until it doesn’t work anymore…
When you are frantic for long naps and longer stretches of sleep, you will need to take a look at your baby’s sleep associations to see what can be reduced or removed (negative associations) to help your baby consolidate their sleep.
EARLY SLEEP PROBLEMS CAN HAVE EFFECTS MUCH LATER ON LIFE
There are several long-range studies regarding childhood sleep habits and the effects of adolescence and adulthood. For example, one study in Montreal among 987 parents demonstrated that early sleep problems in 5 – 17 months continued for older children between 29-40 months. This study showed that certain habits such as mother present at sleep onset or giving food/drink after child awakens due to sleep difficulties led to disturbed sleep such as bad dreams, taking longer to fall asleep, and disrupted sleep.
PREVENTION IS ULTIMATELY BETTER THAN CURE
In case you don’t know much about me – I am a mum of two boys and I’ve had experience with many baby and toddler sleep challenges. My eldest son is the reason that I am a sleep consultant. This allows me to confidently say that I’ve been in your shoes and you will get through this!
The best way that I can describe the way I parent is that I am proactive rather than reactive. I don’t allow my kids to come into my bed and I don’t stay with them to fall asleep. But that doesn’t mean that I love them any less – I want them to have good sleep so that they can thrive and tackle each day feeling energised.
Dr. Elsie Taveras of Harvard Medical School found that long-term sleep related problems started as early as infancy and was quoted in a Times interview saying, "Parents and paediatricians should keep in mind that children have to develop the capacity to regulate their own sleep early in life and self-soothe themselves during the night."
If you’re reading this and have yet to have the issues start in the first place, go ahead and feel free to know that you’re doing a great job and to keep doing what you’re doing!
If you are starting to encounter issues, my warning is this: If your baby has any negative sleep associations it is a good idea to try and change these now. Yes it will be hard but ultimately it is going to save you months and months of broken, un-restorative sleep.
If you are not sure how change this or need some support in doing so then I can work with you to do this. Don’t think that you have to go it alone.
Simard V, Nielsen TA, Tremblay RE, Boivin M, Montplaisir JY., ‘Longitudinal study of preschool sleep disturbance: the predictive role of maladaptive parental behaviors, early sleep problems, and child/mother psychological factors.’ Arch Pediatr Adolesc Med. 2008 Apr;162(4):360-7. doi: 10.1001/archpedi.162.4.360. Accessed from https://www.ncbi.nlm.nih.gov/pubmed/18391145?fbclid=IwAR2Pr9fQs0d_i3CnIhZB0d8U5nseRptYVS7w7mRvhH2MOVoP6ae8ddcAYsA on 20th July 2019
Sharples, T., 2008, ‘How Not to Get Baby to Sleep.’ Time Magazine. Accessed from http://content.time.com/time/health/article/0,8599,1728755,00.html on 20th July 2019
WHAT CAUSES NIGHTMARES?
One important thing to know about nightmares is that they can happen for no reason. Better Health Victoria reveals that "The cause of nightmares isn't known, but it is thought to be the ordinary stresses and strains of growing up. Children who have experienced a traumatic event, for example, tend to have frequent nightmares for the next six months or so."
Professor Harriet Hiscock further explains that "During nightmares...children will usually wake up completely from their bad dream and be scared. They welcome a hug and can remember what happened in the morning."
Children who have an overactive imagination are more prone to nightmares as are children who are sick with a fever. Nightmares can also happen because a child is not getting enough sleep or going to bed too late at night.
AT WHAT AGE DO NIGHTMARES BEGIN?
Your child can start having scary dreams at two years of age. Nightmares will reach a peak between the ages of 3 and 6 years.
Often if a child is under five years, they will not be able to tell the difference between a nightmare and reality. That’s why most of the kids within that range wake up terrified after a nightmare and remain scared for a while before going back to sleep.
NIGHTMARES VS NIGHT TERRORS
Sometimes nightmares get confused with night terrors. Night terrors (also known as sleep terrors) are "dramatic events that present a partial arousal state from deep sleep," and are characterised by, "facial expressions of fear, shouting, screaming, gasps, moans, uncontrollable shouting and agitation." 
After a nightmare, the person wakes up may remember details but a person who has experienced a night terror remains asleep and does not remember anything in the morning, although they may be able to recall aspects of the sleep terror immediately following the episode. Night terrors generally occur in the first third to first half of the night, and rarely during naps. Sleep terrors and sleepwalking are part of a group of parasomnias (undesirable movements and behaviours that occur during sleep) and are linked.
So if your child is experiencing a night terror, they may seem wide awake but they are actually not. Their eyes may be open but they will not realise that you are in the same room. It is best not to try and calm your child if they are experiencing a night terror as you could make the situation worse. Your child will calm down themselves and go back to sleep once the night terror is over.
Though the cause of night terrors is still unknown, it seems to be hereditary. This is because children who experience such sleep-distractions come from families with a history of night terrors, sleep talking, or sleepwalking.
Night terrors affect almost 40 percent of children and a much smaller percentage of adults. However frightening, night terrors aren't usually a cause for concern. Most children outgrow night terrors by their teenage years.
HOW CAN YOU HELP YOUR CHILD DEAL WITH NIGHTMARES?
If your young one tends to experience nightmares more often, there are several things you can do to minimise or brush off the bad dreams. Such things include:
1. Keeping on top of your child’s sleep and ensuring that they get enough sleep in every 24 hour period.
Your child’s sleep needs to be quality sleep –Is their sleep environment encouraging restful sleep? Are they getting enough sleep? Maybe their bedtime needs to be earlier?
2. Establishing a consistent bedtime routine.
Do you have a good bedtime routine that starts two hours before bedtime and lets their brain and body wind down from what went on in the day? Are the books you are reading before bed conducive to restful sleep? i.e. No dragons or monsters or vampires in the stories? TV should be off by 4pm as it is just so stimulating and often as parents we are often not even aware of what our children are watching or what the episodes contain.
3. Discussing the nightmare with your child if there is a reoccurring theme.
If your child is experiencing nightmares with common themes or the same nightmare over and over it would be a good idea to have a chat as it might be something that is in fact bothering your child. Things like starting a new school, the introduction of a younger sibling or even moving house can be enough stress for a young child to start having nightmares. Talk to your child about dreams and explain that everyone has dreams and lots of people have nightmares.
4. Reassuring your child - Don't ignore them!
Give your child a comfort toy so that during the night if they wake up they can give that toy a cuddle and use it as a form of support. Use a night light that is pink, red or yellow as blue or white light actually prohibits the production of melatonin (our sleep hormone). You can also keep their bedroom door open. Get your child to draw our their fears on a piece of paper an hour before bedtime and then put it next to your bed so that you can “keep the fears away” and “keep them safe”. We would never use tactics such as “monster spray” as this showing your child that there is something to be scared of. We want them to know that there is nothing to be afraid of in the first place.
5. Not letting your child sleep with you!
When you're exhausted and at the end of your tether it is really tempting to bring your child into bed with you so you can get some much needed rest. This often backfires with nightmares and it suggests to you child that sleeping in their own bed is causing the nightmare. They may then become scared of sleeping in their own bed and want to sleep with you every night.
 Sleep Terrors in Childhood
Mason, Thornton B.A. et al.
The Journal of Pediatrics, Volume 147, Issue 3, 388 - 392
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Lauryn Stanlake - Infant and Child Sleep Consultant