Sleep in Children Starting School

Sleep is crucial for a smooth start to school: Here’s what you need to know.

For most parents who have a child ready to begin their first year of school, excitement runs high as brand-new school uniforms are washed, and book orders are collected. But for almost 40% of Australian families(1), the excitement is tinged with concern – because their pre-schooler isn’t sleeping well and the thought of sending a cranky, tired child to school can feel, quite frankly, a little scary.

 It's often a surprise when parents find out that sleep difficulties can be treated throughout childhood. Many believe if they didn’t solve sleep difficulties when their child was a baby or toddler, that it’s somehow too late. This couldn’t be further from the truth.

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Sleep difficulties can be treated right across the lifespan – it’s never too late.

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It’s important that childhood sleep difficulties are treated. Sleep is just as crucial for wellbeing as nutrition and exercise. Most parents are quick to seek support if their child has problems eating food, or moving their body, but sleep difficulties are often overlooked or seen as less important. 

 Children with sleep difficulties are more likely to struggle with their mental health, experience poorer quality of life, and their parents are more likely to report feeling depressed, anxious and stressed.(1) It’s hard to have a productive and enjoyable day following a broken night - most adults know this very well!

Common sleep difficulties in children aged 3-5 years include:

• Protracted and difficult bedtimes including excessive bedtime demands and reluctance to fall asleep

• Needing a lot of support from a parent to fall asleep

• Frequent night waking

• A late bedtime and long sleep in, that aren’t conducive with school start times.

• Very early wake ups

If you’re impacted by one of these sleep difficulties, here are our top tips from the sleep clinic.

If they fight bedtime and make excessive demands.

If it’s taking more than 20 minutes for your preschooler to fall asleep after you say goodnight, then you might need to move their bedtime slightly later if they’re not tired enough, or put steps in place to help bedtime run smoothly. If your child makes a lot of demands to avoid falling asleep, e.g. “I need another cuddle/drink/story/pillow” and so on, then build these requests in to a bedtime routine chart. Ensure the chart includes everything they usually ask for so they can check each of these off the list before you say goodnight. If you’ve followed the chart, addressed each of their usual requests, then it’s time for sleep. Be clear that once the bedtime routine chart is complete, no further requests will be honoured. With practice your child will realise that once you say goodnight there are no more curtain calls, and they should start to settle down quicker for sleep.

Needing a lot of support to fall asleep.

If your child relies on support to fall asleep – like patting, humming, or a parent nearby in their room, then they’re likely to call out for you overnight if they wake and find you are no longer there. Work on gradually reducing your presence when they fall asleep until they can happily settle themselves for sleep. 

Sometimes settling habits are very ingrained at this age and changing how you settle your child to sleep may be really difficult. This is where professional help may be necessary. If you’re struggling, it can help to work out a plan for how you will make these changes. It’s important all caregivers are onboard with the plan to ensure bedtime is predictable and consistent. If your child has separation anxiety then seek professional support to help you navigate this change. 

Frequent night waking.

If your child doesn’t need help to fall asleep but still wakes often or for long periods overnight, then it may be a timing issue. If they’re still having a day nap, it’s a good sign the nap needs to go. It might also help to move bedtime a little later, and don’t let your child sleep in too long after a tricky night – it’s best if they get up on time. This helps ensure their sleep drive is a little stronger the next night and this should help reduce night time wake ups.

If bedtime is late and they also wake late in the morning.

If they fall asleep at 9pm and wake up at 8am, for example, it’s going to make it difficult to get out the door and arrive at school on time. If you wake your child before they’re finished sleeping they will feel grumpy and tired when they’re trying to settle in to the school day. 

A few weeks before school starts, begin to shuffle bed time and wake up time earlier, by 15 minutes every few days until bedtime and wake up time happen at an appropriate time. For example, with the case above, you could start with an 8.45pm bedtime and 7.45am wake up. Stick with this for 3-4 days or until your child adjusts, then try an 830pm bedtime and 730am wake up. Continue making 15-minute adjustments until wake up time matches the time you’ll need them to get up and ready for school.

Very early wake ups.

If your child wakes prior to 6am on an ongoing basis and they no longer have day naps, try pushing bedtime slightly later. It might take a week for them to start sleeping in longer. It’s also important to ensure their bedroom remains dark and quiet until it’s time to wake up. For some pre-schoolers, the moment they see light creeping in they spring awake ready to start the day, long before they’ve achieved a full night of sleep!

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Sending your child off to school feeling well rested and ready for the day will help them get the most out of every school day.

Always speak to your GP if you are concerned about your own, or your child’s, health. 

 - Dr Fallon Cook.

(1) Quach, J., Hiscock, H. & Wake, M. (2012). Sleep Problems and mental health in primary school new entrants: Cross-sectional community-based study. Journal of Paediatrics and Child Health, 48(12),1076-1081.

Baby Sam: from multiple night wakes to sleeping all night.

Case study: Baby Sam, 5 months old.

Meeting Sam

When I first met Sam, a happy 5 month old baby boy, his parents, June and Ben, were feeling quite anxious about his broken sleep. They were exhausted and nothing they had tried had helped. I saw them via Telehealth in our Virtual Sleep Clinic.

The problem

June and Ben’s primary concerns were:

• Sam was crying a lot at nap time

• When Sam would finally fall asleep he would only nap for 30 minutes unless he was being held

• Sam could only fall asleep if he was feeding and often needed to be held for a long time before he could be transferred to his cot

• He had to be constantly resettled overnight

• Everyone was exhausted

June and Ben knew that feeding him to sleep and then gently putting him down in his cot, was causing him to wake up multiple times overnight wanting to be held back to sleep again.

They’d already worked very persistently at supporting him to settle in his cot, but he seemed exceptionally resistant to this. He would cry for a long time before eventually, June and Ben would give in and feed him to sleep.

The sleep diary assessment

First we looked at Sam’s sleep diary. Sam was averaging around 11.5 hours of sleep per 24 hours. On some nights he would wake 2 times to feed, which is normal and expected for his age, however, other nights Sam would wake up to 6 times and requiring intense support for up to an hour in order to resume sleeping.

This is Sam’s sleep diary before his first appointment with us. Note the frequent wake ups early on in the night and several instances when it took longer than 1 hour to resettle Sam at night.

Assessment of mood, temperament, tiredness

Factors including mood and temperament can have a huge influence on sleep and can also give us clues about what types of strategies are likely to be the best fit.

June and Ben described Sam is a very happy, relaxed and easy-going baby. They described how Sam only ever cried at nap time and bed time. Sam enjoyed being alert and active while awake, and enjoyed smiling and interacting with his parents.

He was cranky at nap time and bed time because he wasn’t ready for sleep. Age-based sleep schedules were not a good fit for Sam at all. When other babies his age were tired and cranky and ready for sleep, Sam was wide awake and looking to play.

Sam is what we refer to as a ‘low sleep needs baby.’ These are babies who seem to need less sleep than other babies their age - they cope perfectly well on less sleep than is typical for their age, and even when opportunities to sleep more/longer are offered, they tend not to.

Why are ‘sleep needs’ so important?

We all have a unique amount of sleep that we need in order to function well. Some adults do well with only 6-7 hours of sleep, whilst others need closer to 9-10 hours. You know when you’re meeting your sleep needs because you feel well rested and able to cope well during the day.

Babies are similar, they also have varying sleep needs. Some 5 month old babies need a lot of sleep (14-15 hours) and some don’t appear to need all that much (11-12 hours).

We always look at the baby in front of us. If they’re happy, well rested, and enjoying play time, then they’re probably getting enough sleep - even if they don’t meet aged-based norms for total sleep duration.

One of the most common factors that can make settling difficult, is when a baby’s unique sleep needs aren’t being accounted for - often parents are following a generic age-based schedule that isn’t suitable for their child’s unique needs.

It’s unusual for parents to not be offering enough opportunity for their baby to sleep. Usually we find parents are aiming for more day sleep than their baby actually needs and this can make settling extremely difficult.

The solution

We created a sleep plan tailored specifically to Sam’s sleep needs. This included:

• Giving Sam just 3 short (30-40 minute) naps each day, spaced out across the day. This immediately took pressure off June and Ben - they could let Sam play for longer between naps and only had to settle him when he was tired and clearly ready for sleep. June and Ben no longer had to spend time trying to resettle Sam if he woke after only a 30-40 minute nap. Sam was happier with more play time, and June and Ben reclaimed more than an hour from their day since they no longer had to spend so long trying to settle/resettle Sam.

• Steps to work on cot settling. With Sam’s revised sleep schedule he was much more tired at bedtime and more receptive to falling asleep in his cot. June and Ben chose an approach that allowed them to stay present with Sam while he fell asleep in his cot, and that allowed them to offer extremely frequent reassurance while Sam made the adjustment to cot settling.

The result

June and Ben spent 3 days working on the new schedule before they started work on cot settling. This allowed more sleep pressure (or sleep drive) to build up in the evenings. Once sleep pressure was high enough at bedtime, Sam was ready to start settling in his cot.

June and Ben were nervous about starting the steps for cot settling because they’d had a really hard time during previous attempts. But it went so much better than expected!

• It took Sam around 30 minutes to fall asleep on the first attempt at cot settling.

• Every settle thereafter was easier, typically taking only a few minutes for Sam to drift off to sleep and with very little or no crying.

• On the 2nd night Sam slept from 8pm-7am!

Let’s have a look at how Sam’s sleep diary changed:

Notice the difference between the number of night wakings before treatment (in red) and after treatment (in green). Sam also managed to increase his total daily sleep by an hour.

Follow up care

June, Ben and little Sam attended a review appointment, two weeks after their initial appointment. June and Ben were thrilled with Sam’s progress. Everyone was better rested and happier. The plan was easier to implement than expected and progress was faster than June and Ben thought would be possible.

During the review appointment I helped June and Ben plan for the future - so they were armed with a detailed plan for how to tackle common difficulties that can derail good sleep - like illness, teething, and separation anxiety. This plan also included detail on how and when to drop naps as Sam gets older.

“Sam’s sleep has changed so much because of your guidance - we would never have figured all this out without your advice on settling, sleep pressure and understanding why he cries at bedtime. Thank you so much for your help and guidance.”

— June & Ben

Key points to remember

• Babies with low sleep pressure are extremely hard to settle - if you’ve tried multiple approaches and found that nothing has worked for your baby, then it’s likely they have a sleep pressure difficulty that is impacting their progress.

• If you are struggling with your baby, toddler, or pre-schoolers sleep, get help sooner rather than later. Sleep is important for the wellbeing of you and your child and sleep can often be improved quite quickly.

• Book in for an initial appointment in one of our clinics. We will take a close look at your child’s unique sleep needs, temperament and settling, and develop a sleep plan tailored specifically to their needs.

Think you have a tricky case? We specialise in particularly tricky sleep cases, which is why we are trusted by GP’s, paediatrician’s and health nurses.

Dr Fallon Cook, PhD.

Paediatric Sleep Practitioner

Our affiliations

As featured in

Names have been changed to protect privacy and permission to publish this case study was granted by this family prior to publication. Images do not show the family mentioned in this case study.

Webinar: Toddler Sleep & Settling. On behalf of the Raising Children Network.

Dr Fallon Cook presented the 2023 Toddler Sleep and Settling webinar for the Raising Children Network.

Toddler sleep difficulties are particularly hard on parents so we’re delighted to give you access to the full recording.

This webinar will help you identify the cause of your toddlers sleep difficulties and implement strategies to solve common difficulties such as bedtime resistance, settling issues, and frequent night waking.

Enjoy!

Webinar: Baby Sleep & Settling 0-6 months. On behalf of the Raising Children Network.

I was delighted when the Raising Children Network asked me to prepare a webinar about sleep and settling in babies aged 0-6 months.

Right from the first meeting, I knew this was a fabulous opportunity to give parents practical, useful strategies they could immediately start to use.

It’s packed with all the information families ask us for in our clinics.

The webinar went live in March and is now available to watch at no charge. Scroll down to read more about this webinar and to watch it.

The webinar covers:

• Typical sleep in the first 6 months

• How to identify medical causes for baby sleep problems

• Setting foundations for healthy sleep development

• Practical steps to help your baby adjust to settling in their cot or bassinet.

It’s essential viewing for new parents (or soon to be parents)!

Of the many webinars delivered by the Raising Children Network, this was one of the most well attended (ever). It also received a huge amount of positive feedback from parents. I’m really proud of it and hope you enjoy it too.

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Click now to watch

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Links mentioned in the webinar

• The Sleep Nook

  • Bassinet/cot settling steps

  • Medical causes for sleep problems

• Raising Children Network

  • Newborns: sleep safety

  • Soothing a crying baby: in pictures

  • Sleep & settling help for babies

  • Newborn sleep: routines

  • Babies: sleep

  • Newborns: sleep

• Red Nose - Safe Sleeping

• Period of Purple Crying

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Need more help?

We see families everyday in our sleep clinics, Australia wide. Or join Sombelle, our online baby sleep program, and get started right now.

Winning the Toddler Sleep Wars: Maggie Dent interviews Dr Fallon Cook

It’s 3am and you hear the sound of small feet approaching…

You expected some sleepless nights when your baby was little, but now that baby has strong legs that can stand up and walk. And negotiation skills that would rival any ASIO officer. Things just got real.

Ever heard of Sleep Onset Insomnia?

This occurs when a toddler or preschooler takes a really long time to fall asleep. They may feel frightened to fall asleep on their own, or they might not feel ready to sleep. Bedtime delay tactics are common - another song, another book, another sip of water - sound familiar? If it always takes longer than 25 minutes for your toddler or preschooler to fall asleep, then they may meet criteria for Sleep Onset Insomnia.

How about Sleep Maintenance Insomnia?

This is when a child wakes in the middle of the night for 1-4 hours, unable to resume sleeping.

Sometimes Sleep Onset Insomnia and Sleep Maintenance Insomnia occur at the same time and cause all sorts of difficulties for parents and children.

Sleep disorders can seriously impact child wellbeing and parent mental and physical health.

These aren’t occasional toddler sleep difficulties that self-resolve, they’re extraordinarily challenging sleep disorders and they usually require treatment from a specialist. They can stop your toddler or preschooler from growing properly, and they can damage your health and wellbeing.

The good news is that they can be treated. You can reclaim your sleep.

Listen to Dr Fallon on Maggie Dent’s Parental As Anything to learn about:

• why these problems occur

• practical steps you can try at home

• when it’s time to get expert help

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Listen on Apple Podcasts

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Listen on Spotify

Help your baby fall asleep in their cot (0-5 months)

“My baby only sleeps on me.”

We hear this a lot from parents of babies aged 0-5 months. It’s a big change for your baby, going from being curled up warm for 9 months, to lying on their back in a bassinet or cot.

It’s absolutely normal for your baby to fall asleep on you at least some of the time during the first few months. It becomes a problem if a baby will never fall asleep anywhere else. It can even become dangerous for babies and parents.

• Sleeping on a chair or sofa with your baby in your arms, is extremely risky.

• Parent mental health can plummet. Postnatal depression and anxiety are common in parents of babies who struggle to settle in their bassinet/cot.

• Parent physical health also takes a hit - back, neck and shoulder pain are common in parents who hold their babies constantly.

Some babies need a lot of help learning they are safe and secure in their bassinet or cot. As their parent, you can guide and support your baby to make the transition to their bassinet or cot.

Steps for supporting your baby to fall asleep in their cot

1. When you notice tired signs, swaddle your baby or put them in their sleeping bag. Give them their dummy, if they take one.

2. Take your baby in to a dark, quiet room. You might choose to use white noise if your baby is sensitive to the sounds of older siblings, traffic, or pets.

3. Put your baby down on their back in their bassinet or cot.

4. Pat their chest in a slow heart-beat rhythm - “bah-boom…bah-boom…” Do this for two minutes.

5. If after two minutes of patting your baby is upset, then pick them up and cuddle them for a minute. Then place your baby back down and pat again for another two minutes.

6. If after two minutes of patting they seem to be calming down, then persist with patting until they sleep.

7. Repeat this process for 10 minutes at the start of each nap and at bedtime.

8. If your baby is not asleep after ten minutes, pick them up and settle them to sleep with rocking, feeding, or other methods you know will work. This doesn’t mean you have failed! You supported your baby through 10 minutes of practice and it all helps.

Steps for making a gradual transition to cot settling

If the above steps feel too difficult then it’s ok to take a more gradual approach. Try out our gradual steps with your baby.

Step 1. Introduce sleep associations that can transfer to the cot. You cannot feed or hold your baby while they're in their cot, but you can pat and hum. For this step, you're going to continue feeding or holding your baby to sleep, but you will introduce patting and humming. Later on, when you're ready to try cot settling, your baby should adjust more easily because they can hear and feel the same sensations they usually feel when they fall asleep. Introduce:

• Heart-beat rhythm patting. When you feed or hold your baby to sleep, pat them in a slow heart beat rhythm - "bah-boom...bah-boom..."

• Humming. Hum the same line of a song over and over again.

Stay on step 1 for 1-2 weeks - until you feel it has become a habit for your baby to fall asleep with patting and humming.

Step 2. Start settling your baby in their cot:

• Follow your usual bedtime routine, but place your baby in their cot awake.

• Pat and hum as you did during step 1.

• Persist for 10 minutes, then pick your baby up for a 2 minute cuddle, before placing them back down in their cot and persisting with patting and humming for another ten minutes.

• Repeat this process until your baby sleeps, if you are comfortable to do so.

• Follow this same process every time you settle your baby, so it starts to feel familiar and reassuring for your baby.

• Move to the next step when you feel your baby has adjusted to always falling asleep in their cot.

Step 3. Start to phase out patting, and then start to phase out humming:

• Pat your baby 10 times and then remove your hand from your baby for 10 seconds, and repeat this until they sleep. Gradually increase the amount of time you remove your hand, and decrease the number of pats. You can still hum your baby to sleep while you gradually reduce the patting.

• When your baby no longer requires any patting in order to fall asleep, phase out humming. The easiest way to do this is to wander out of the room briefly while still humming. Gradually hum more softly and leave for longer periods, until they are falling asleep without needing you to hum at all.

How does it work?

When you repeat the same process every time your baby falls asleep, it starts to become more familiar and less distressing for your baby. Soon enough your baby will feel ok about falling asleep in their bassinet or cot, and you can work on reducing the amount of patting you do for each settle.

Remember to be predictable so your baby can learn the process – changing what you do will make it take longer for your baby to adjust to falling asleep in their bassinet or cot. A lot of parents will try one approach for a few minutes or a few days, then switch to another approach if it hasn’t worked. This makes it difficult for a baby to predict what will happen next and they can find this unsettling. When you are calm and predictable, and persist for ten minutes each time, you are giving your baby the opportunity to learn the process and what to expect.

Need support?

Our Sombelle paediatric sleep clinic programs are designed to give tired parents immediate advice and support, tailored to the unique needs of their baby. Video lessons, practical steps, and your questions answered by Dr Fallon and Dr Laura each week. Members also have fast-tracked access to sleep clinic appointments.

-Dr Fallon Cook

Sleep Practitioner

LISTEN NOW - 'Babytalk' podcast - baby sleep and wearable technology

I recently spoke to Penny Johnston, host of ABC podcast ‘Babytalk,’ about new wearable technology that can collect data from your baby while they sleep.

• How much monitoring is too much?

• Do parents need to invest in this technology?

• Will it help you and your baby to sleep better?

Click below to listen.

International travel with your baby

Off on an adventure?

Excellent. I’ve flown a LOT with my three small people and we made amazing memories. I learnt a few tricks along the way that made travel easier.

You might be anxious about how your baby or toddler will travel. The truth is, babies and toddlers usually manage long haul flights and changing time zones, better than we expect.

Tips for helping your baby or toddler sleep well during international travel.

Book a baby bassinet on your flight

You will need to check with your chosen airline, but generally if your baby is under two years of age, weighs less than 11kgs and can fit within the bassinet dimensions, then this little beauty is going to make flying so much easier. You’ll have your hands free and your baby has a dedicated sleep space.

Use the footwell to create a bed

If your baby won’t fit in a bassinet then book a separate seat just for your baby - if finances allow. You will feel more comfortable with more room to move, and you can use the footwell to your advantage. You might have heard about inflatable pillows that fill the footwell of the seat to create a flat sleep surface for your little one. These are brilliant but not all airlines will allow them. You can improvise though! Place luggage in the footwell of your little one’s seat, so they can stretch out flat with their head on their seat and their legs on top of your bags. Most small children struggle to fall asleep sitting upright and by creating a bit more room they will lay down and get much better sleep during your flight. Of course, ALWAYS follow the instructions and advice of your cabin crew. We are also aware that following the safe sleep guidelines is almost impossible on an aircraft. Just do your best - keep a close eye on your baby when they are asleep, remove loose items from their sleep space, and always sleep your baby on their back.

Comfort items

Pack a blanket that smells like home and a favourite soft toy. Pack these in your carry on luggage so your child can snuggle down for a good sleep on the plane. If your baby has a dummy then pack several spares – you may not find the same brand overseas and you know they’re going to get it wedged under their seat before the plane leaves the runway!

Feed on take off and landing

Babies can struggle to equalise the pressure in their ears and they can find this uncomfortable and distressing. Feeding during take off and landing helps to equalise the pressure in their ears.

Time it right

If your plane will land at your destination in the evening or at night time, then try to keep your little one awake for the last 5-6 hours of the flight. This ensures that when you arrive at your accommodation they are ready to settle down for a big long sleep, and they’re already starting to adapt to the new time zone. If your plane lands in the morning or at midday, then encourage your baby or toddler to sleep as much as possible during the last 5-6 hours of the flight – this might mean keeping them awake during the first part of your flight so they will sleep closer to landing time. Then when you hop off the plane they should be ready for a day of exploring and will (hopefully) be ready to settle down for their night time sleep in the evening.

Daylight is your friend

Once you land be sure to give your child lots of bright daylight and exercise during the day, and keep it dark and boring overnight. This helps their circadian rhythm fall in to sync with the new time zone. If your child is very wakeful overnight, then keep it dark, boring and uninteresting. If they are wide awake with no signs of settling, then choose a quiet activity such as reading a story under dim lighting instead of watching a loud exciting tv show. At first you will have a few tricky nights, but try not to worry – your child will adapt.

Limit naps

It’s really tempting to let your baby or toddler have hours and hours of day time naps when you arrive. The problem with this is that it will take much longer for their circadian rhythm to adjust to the new timezone. As a rule, offer one more nap than they usually have on the first day you arrive and only let them nap for as long as they typically would at home. If your baby usually has 2 x 1 hour day naps, then let them have 3 x 1 hour day naps (if needed). If your 3 year old doesn’t nap anymore, it’s ok to let them have a 1 hour day nap on the first day, just so they are a little easier to be around. If you can stick to these rules on the first day, often they are exhausted by the time the first night rolls around, they sleep heavily, then wake up in the morning ready to go – job done, they’ve adjusted!

Set your wake up time

Your wake up time and bedtime act like signs posts for your circadian rhythm and it’s no different for little people. During your trip, set a wake up time for the family and stick to it. Even if you have a dreadful night, still get up when that alarm clock sounds. If you keep letting yourself (or your children) sleep in, then your body clock won’t adjust. Children should have a set bedtime too. If they quickly start to sleep well overnight they’ll be more settled and ready for adventure during the day – everyone wins!

Luggage

This one has nothing to do with sleep and everything to do with making your trip manageable for you. Buy a really comfortable back pack. Forget about looking stylish - handbags, shoulder bags, purses – they’re all really annoying when you’re managing suitcases, travel prams and tired kids. You can still have your wheely suitcase, but for your day pack use a backpack that has spots for drink bottles, snacks, and a hidden compartment for passports/boarding passes that you can access without taking your backpack off. You want your hands and arms free to grab your toddler before they dive in to the Trevi fountain. Trust me.

Adjust your expectations

Travel isn’t the same with kids. There will be lots of things you’d like to do that just don’t fit around your children. You’ll spend more time marvelling at your toddlers new leaf collection than you will at the paintings in the Louvre. It’s ok. You’re still making beautiful memories and the Louvre will still be there when your kids grow up.

Bon voyage!

-Dr Fallon Cook

Sleep Practitioner

Fallon with her toddler in Boston, 2019.

Sleeping well at child care

Starting child care, kindergarten, or going to a grandparents house for regular care, is a big step for your little one, and for you. Parents often worry about how, when and where their child will sleep.

Here are our steps for managing this transition with minimal disruption to your child’s sleep.

• Talk to your child’s carer about difficulties you’ve encountered with your child’s sleep. Explain what their sleep used to be like, how it currently is, and what you’re trying to achieve going forward. If you are treating sleep difficulties and have a detailed sleep plan, then send a copy to your child’s carers. If they understand your child’s sleep journey, they are more likely to be supportive. If they’re not supportive, and you are one of our clients, get in touch with your sleep practitioner and we can prepare a letter explaining your child’s sleep requirements.

• Keep a similar nap schedule at home and at childcare. If your child is prone to difficult nights after they have too much day sleep, explain this to the carer. Be clear about when and how much sleep your child needs. If your baby needs to be awake by 3pm, tell them.

• Prepare your child for the transition. Attend orientation prior to starting. Ask the carers about the daily routine they follow. If they have lunch before the midday nap, then you can start to do this at home too. Your child may be more relaxed and settled if the routine at child care feels familiar.

• Talk to your child about what to expect. If your child is toddler age or older, it can help to set up a pretend child care centre with some dolls. Play a game where the dolls arrive at childcare, say good bye to their parents, play for a while, take a nap, have a snack, then go home with their parents at the end of the day. Play can help small children understand what to expect.

• Pack a comfort item. Even if your child doesn’t have a special toy or comforter, having something familiar from home can be reassuring. For older children it can also be an icebreaker to help them ease in to the room - they can show their special item to other children and it might make drop off easier. For a baby, the comfort item might be their sleep suit and/or dummy. For a toddler or preschooler, a photo of family or a pet can help.

• Nail the drop off. Your child will take their cue from you - if you are a jittery bunch of nerves then they will be worried too. If you are calm, cheerful and relaxed, they’re more likely to feel confident. You’ve probably heard that keeping drop off quick is best right? Run in and out and they’ll settle quickly? For some kids yes, but for others, no. If your child is confident and outgoing, then a quick drop off will probably suit them well. But if your child is shy and takes a while to warm up, then arrive a little early so you have time to help them settle in. Don’t force them to start playing. Sometimes it’s best to sit down and start flicking through a book. They’ll probably start out in your lap but within a few minutes they will start to stray away from you as they warm up to the room, the children, the noises around them.

• Don’t disappear. Even if your child becomes upset, you should always tell them you are leaving and will be back later. If you wait until they’re distracted and then bolt out the door, they will start to cling to you at drop off to make sure you don’t do a runner - and they might start to cling to you at bedtime too, or even develop separation anxiety. Keep it short and simple “I’m going now darling but I’ll be back later” - and then leave.

• Trust your gut. If there is anything I have learnt as a mother of three kids who all attended childcare, it’s that honest conversations with carers helps to forge the deep, meaningful connections that you want your family to have with your childcare service. Be polite, honest, and if you’re concerned about anything, then speak up.

- Dr Fallon Cook

Sleep Practitioner

How to reduce crying at bedtime

Babies get upset at bedtime. This can be due to many factors, but most commonly:

• They’d rather be awake than asleep. Active, busy babies are often grumpy about nap time – they don’t like to miss out on anything and will often resist naps.

• They are being put down before they are ready. If this happens often, they can start to dread bedtime because they know they’ll be awake in their cot for a while, waiting to become tired enough to fall asleep.

• They don’t know how to self settle. If you’re trying to teach your baby how to fall asleep in their cot, and they are not used to falling asleep there, they’re going to be grumpy about it.

First, rule out:

• Pain and discomfort. An uncomfortable baby will be upset at bedtime when there is little to distract them from their discomfort. If your baby has mucous or blood in their poo, or if their poo is frothy or runny, their tummy may be feeling sore or irritated. Follow this up with your GP or paediatrician.

• Eczema. Dry, rough skin, even if very mild, can interrupt sleep, causing settling difficulties and frequent night waking. If your child has eczema, make sure it is well controlled with steroid ointment, speak to your GP, and read this Royal Children’s Hospital information sheet.

• Hunger. If your baby fed recently then that’s great, but if it’s been a while since their last feed then offer a quick feed before you press on with settling them.

Then check you’ve got the environment just right:

• Darkness. Most babies struggle to wind down for sleep if there is too much visual stimulation. They may hyper-focus on an object or the light coming in around the blinds and become more and more upset. These babies tend to settle much more easily when the room is very dark and uninteresting. Invest in block out blinds or throw a blanket or sheet over the curtain rail, remove mobiles from above the cot, and get down on your baby’s level – what can they see that may be distracting them? Dark, boring bedrooms are best for sleep.

• Wind down routine. A consistent calming routine that follows the same order in the lead up to bedtime and nap time, prepares your baby for sleep.

• Mask loud noises. Use white noise or a similar boring and consistent noise if your baby is bothered by traffic sounds, other siblings, neighbours, etc.

If you’ve checked off the above factors, you’re ready to think about the psychology behind your baby’s crying.

I want you to imagine you are standing in front of a vending machine. There’s a button on the front, but you can’t see what’s inside the machine. You press the button to see what happens, and a square of chocolate comes out. What would you do next? You would probably press the button again to see what happens.

Now imagine that the next time you press the button an entire block of chocolate comes out. And then the next time you press the button it’s a toy car.

It’s human nature to continue pressing the button to see what will come out next – especially if it’s something different every time, and especially if your favourite treat (chocolate!) sometimes appears.

But what happens if every single time the button is pressed, just one square of chocolate comes out, every single time? Psychological researchers will tell you that the predictability and monotony of the single cube of chocolate, becomes boring pretty quickly and humans usually stop pressing the button.

How does this relate to crying at bedtime?

As your baby grows they start to understand the world around them. If every time they cry at bedtime (akin to pushing the button) you do the same predictable, reassuring things, they will stop pushing the button (crying) sooner.

Why? Because they know what to expect from you and it starts to become old. They don’t feel so motivated to get worked up, when the same reassuring (yet rather boring) thing happens.

This doesn’t mean you have to leave them alone for long stretches of time, or listen to them crying without responding, it just means that when you reassure them you will help them calm down faster by sticking to the same type of reassurance, over and over again.

Now imagine if when your baby cries, you do something different every time – maybe you start with a pat, but then they cry more so you sing AND pat, then if the crying continues you walk away for 5 minutes because you’re frustrated, then when you return you pick them up and feed them. This type of response will increase your baby’s crying because they don’t understand what will happen next, and they may randomly receive something nice, like a feed. Just like the vending machine example above, when a response is unpredictable, we are inclined to keep pressing the button to see what will happen next.

If you stick to one way of settling and remain consistent, your baby will start to calm down. Every time you apply the same approach at bedtime it should get a little easier and they should start to fall asleep quicker.

Understanding the psychology behind your baby’s crying can make it easier to persist with just one approach to settling. And when you persist with one consistent settling strategy, you’ll de-escalate, or reduce your baby’s crying at bedtime.

TASK: Have a think about how you respond to your baby at bedtime when they become upset. Pick one approach you will use to settle your baby, and stick with it.

Need more help?

The Sombelle self-guided online baby sleep clinic gives parents access to the best resources from our sleep clinic. With video lessons, downloadable resources and effective, easy to implement strategies, it’s everything you need to master your baby’s sleep.

All strategies suggested in Sombelle are designed to protect and nurture infant mental health, and can be modified to tailor fit your baby’s unique sleep needs. Sombelle was developed by Dr Fallon Cook and Dr Laura Conway. You’re in great hands.

When to seek help for sleep problems

Sleep shouldn’t be a battle.

Baby sleep problems are very common – around 75% of parents report that they have difficulties with their baby’s sleep during the first year. For some these sleep difficulties quickly pass, but for others they persist into toddlerhood and sometimes right across childhood too. Given the importance of sleep for healthy child development and parent mental health, it’s important to seek help if sleep difficulties are severe and/or persistent.

When is it time to find help?

It can be hard to know if it’s time to find more intense support for your baby’s sleep. You might be waiting to see if things get better over the coming months. As a general rule, without intervention, settling difficulties tend to persist. Many parents spend months fixated on sleep, jumping from one approach to the next, hoping they’ll stumble on the right approach for their baby. Finding the right help early on can prevent months of fatigue and exhaustion.

It’s time to find extra support if:

• Your baby wakes up a lot. While frequent night waking is normal during the first few months, as a general rule from 6 months of age, three or more wake ups per night is probably too many.

• Your baby is difficult to settle, or cannot settle without a lot of help from you. Falling asleep is a skill that takes time and persistence to master. Lots of babies need help learning how to fall asleep in their cot, for example.

• Your baby often wakes up at night after only 30-90 minutes of sleep.

• You are exhausted. Your own lack of sleep is impacting your physical and emotional wellbeing. You don’t feel like yourself.

• You’ve tried generic sleep advice and maybe even tried a downloadable program or app, but none of it worked. Your baby has unique sleep needs that don’t fit within advice aimed at the ‘typical’ baby.

• Parenting your baby is hard work, and you’re struggling to enjoy your baby. Sleep deprivation can feel a lot like depression. Nothing takes the joy out of life quicker than disrupted sleep.

If one or more of the above sounds familiar, then it’s time to get help from someone who is highly trained in paediatric sleep.

Should I speak to my GP or health nurse?

Yes, this is a great place to start. But if you’ve tried this already and the advice you received didn’t help, then you’ll benefit from seeing someone who’s core practice is sleep.

Tricky cases and those with diagnosed sleep disorders, aren’t often helped by generic baby sleep advice. We see this s lot - parents who have tried numerous programs without success, come to us and we quickly identify a factor that has been overlooked. If nothing else has worked then it’s time to have someone do a deep dive in to your baby’s sleep - to work out what their unique sleep needs are, so so a plan can be tailored to their specific needs.

Why doesn’t generic sleep advice work for my baby?

Some babies have a more active temperament. They don’t want to miss a thing and would rather be awake and busy at all hours of the day or night. These babies are much much harder to settle for sleep, cry a lot, wake easily and rely heavily on their parents to help them feel calm and secure. Parenting these babies can be really hard, especially if you don’t have enough practical support from your partner or family.

Some babies have a lower need for sleep than average, or have difficulty building up enough sleep pressure to sleep long stretches, or may have some circadian rhythm disruption that is making sleep a nightmare. Until these issues are addressed, sleep doesn’t improve.

Looking after yourself is important

Months of disrupted sleep can make you feel awful, increase your risk of having an accident, and can impact your ability to enjoy your baby. Sleep is a pillar of good health. When your baby sleeps well they are better able to play and engage with the world around them. Better sleep is associated with a range of positive health outcomes for babies - and also for parents.

-Dr Fallon Cook

Sleep Practitioner

Medical causes of baby sleep problems

Is there a medical cause for your baby’s sleep problems?

There are several key indicators that a medical problem might be causing your baby’s sleep problems.

A baby who is uncomfortable or in pain will need a lot of help from you to fall asleep and will wake up a lot during the night.  

1.     Vomiting

Small spit ups are normal, but if your baby vomits large amounts after most feeds then your baby may have reflux or an intolerance.

2.     Dry, rough skin (eczema)

It might not even look that bad to us, but dry, rough skin can be itchy and uncomfortable, and research shows it can interrupt sleep.

3.     Poor weight gain

If your baby isn’t gaining weight as expected, then your baby may not be getting enough milk from each feed. They may wake up overnight because they feel hungry.

4.     Strange poo

Slimy, stringy, frothy, or mucousy poos, or poo that contains blood, indicates your baby has an irritated and potentially painful gut. This might be due to an allergy or intolerance and should be investigated by your doctor.

5.     Snoring coughing and gasping

Babies can have sleep apnoea, causing them to snore and periodically stop breathing during their sleep, only to gasp and cough awake again.

If your baby has any of these symptoms please speak to your doctor.

When medical causes of sleep difficulties are resolved, treatments for behavioural sleep problems can begin. Behavioural sleep problems include having difficulty falling asleep and staying asleep during the night.

For example, if your baby has recovered from reflux and has been held upright to fall asleep for many months, they may have a lot of trouble learning to fall asleep when they are lying flat.

A baby whose feeding problems have resolved may continue to wake up a lot at night out of habit, even though they no longer require feeding at night to meet their nutritional requirements.

There are many gentle ways to improve behavioural sleep problems that respect your baby’s unique needs and protect the powerful bond between you and your baby. This is our specialty – crafting gentle but effective strategies to improve baby sleep.

Need help? Book an appointment.

- Dr Fallon Cook

Paediatric Sleep Practitioner

Case study: James' amazing progress

Our first chat

When James’* mum and dad contacted us they were exhausted and desperate for help. On the phone they described that James was 13 months old and had never slept well. He would wake up and cry for hours at night. James’ mum explained that he had twice ‘failed’ a 5 night residential program (known to some parents as ‘sleep school’). They tried really hard to follow the advice they received but it just didn’t seem to make much difference.

James’ mum felt unsupported and frustrated by conflicting advice from friends, family and health professionals. She felt depressed, had barely seen her old friends and expressed her concerns that she might just be a ‘crap mum.’

James’ dad felt really frustrated with James, felt at the end of his tether, and wasn’t coping well with spending hours at night trying to rock, pat, or feed James back to sleep. He was worried about James’ mum and had never seen her so flat.

We asked James’ parents to fill in a sleep diary for a week so we could see exactly when and for how long James was sleeping. James was quite often awake for two hours, twice each night (a total of four hours awake at night).

His day sleeps were irregular, starting and stopping at different times each day depending on how he had slept the night before, and often occurring too close to bedtime. He also had a lower than average sleep need, averaging between 8 and 11 hours per 24 hours. We could see in his sleep diary that he wasn’t building up enough sleep pressure before bedtime, meaning that his drive to sleep wasn’t very high. This was causing him to wake up for long stretches during the night.

The appointment

Before we met with James’ parents we confirmed that James was a healthy weight, ruled out any obvious medical causes for his interrupted sleep and checked that James was up to date with his routine health checks. James’ mum was found to have very high symptoms of depression and she had already organised a mental health care plan with her GP and was booked in to see a psychologist.

James was tired and grizzled a lot during the appointment. His parents tried to calm him but he was not easily soothed. When his mother briefly left the room he became very upset. 

We spent an hour with the family, discussing what they had tried, how James had reacted and what their goals were moving forward. James’ mum said they had mostly tried strategies like settling him and then leaving him for several minutes to put himself to sleep. She said this never worked because when they left he cried so hard he would become more worked up and even harder to settle again.

Problem identified

It turned out that James had Sleep Onset Association Disorder, which made teaching him to self settle extremely hard. The issue with James’ sleep pressure had also never been identified or treated. This is why other approaches had been unsuccessful. When these difficulties co-occur, a careful plan is needed to correct both issues - without treating both difficulties, James’ sleep was not going to improve.

The plan

We worked up a plan to make James’ days and night more consistent with set times for day naps to help regulate his circadian rhythm. There were a few things in James’ sleep environment that may have been bothering him so we moved some furniture and put some objects away. We also developed some strategies to increase James’ sense of security. James was frightened of his parents leaving him so his settling plan needed to respect this and provide regular reassurance. At the same time we also wanted to encourage James to resettle himself during the night with less help from his parents. We spent time going through the settling routine with James’ parents so they knew exactly what to do. After detailed discussion and demonstration, we left to prepare a comprehensive, gentle sleep plan that was tailored to James’ unique needs.

How did it go?

James made amazing progress during the week after his appointment. During the first few nights he still woke up twice a night but only for around 30 minutes each time. His parents used the settling strategies we taught them to calm and reassure him. They decided to stop giving him a bottle during the night and he didn’t seem too bothered.

By the fourth night James slept from 8pm-7am. His parents could hardly believe it. Everyone was sleeping better and James was ‘like a different baby.’ His parents said he was calm and rested, enjoyed playing with his toys and wasn’t as clingy as before. They were able to enjoy their days so much more.

 James’ parents emailed most days to chat about how he was going and to ask questions if they felt unsure. They stopped tracking his sleep in the diary after a week because every night was pretty much the same – he was consistently sleeping for 11 hours without a peep!

James’ parents now

“What a game changer. We didn’t think he would ever sleep. We figured if sleep school didn’t work then nothing would. The difference with this was that we had so much support and new what to do to help James feel safe and secure at bedtime. It actually ended up being easier to fix than we thought.”

How is James?

“He’s a much happier baby. He isn’t so tired anymore so will play with his toys without crying and clinging to us all the time. The whole house is calmer and everyone is happier.”

If James’ story resonates with you then make a time to talk to one of our Sleep Practitioners. We’re highly qualified to work with complex and difficult cases - other sleep professionals often refer their tricky cases to us.

-Dr Fallon Cook

Sleep Practitioner

*name changed to protect privacy, images are not of the baby described in this article.

10 tips for settling your newborn baby

The first weeks are a confusing blur for most parents. Here are our expert tips for helping your newborn baby settle easily to sleep.

1. Darkness. Babies aren’t afraid of the dark. Keep the room as dark as possible to limit visual distractions. Many babies find high contrast patterns (black and white) very stimulating so remove anything like this from around the cot.

2. Boredom. The place your baby sleeps should be the most boring place in the house. Keep toys, mobiles, moving lights etc out of the cot and bedroom.

3. Security. Make your baby feel safe and secure by wrapping firmly in a swaddle. If they can roll over then use a well-fitted sleeping bag instead.

4. Consistent sounds. Steady, repetitive sounds can help your baby calm down for sleep. White noise, rain, and cicada sounds can be slowly phased out later on.

5. Rhythmic sensations. Gentle patting in a slow, steady and predictable pattern is very soothing for babies.

6. Ignore grizzles. Some babies find it soothing to make grizzling, whining noises before they fall asleep. Before rushing in, listen – if they are crying then go to them. If they are grumbling or grizzling it’s ok to wait and see if they resettle.

7. Get the timing right. Babies aged 0-3 months are really hard to settle when overtired. When you see signs of tiredness start your settling routine straight away. Young babies will stare in to the distance and their movements will become jerky. If they are crying then they may already be overtired so don’t wait until they’re crying to put them to bed.

8. In to their cot awake You have heard this before and it’s true – babies that are placed in their cot when awake and who drift off to sleep without help from a parent, sleep much better and for longer.

9. Persistence. It takes a lot of practice for a baby to learn how to fall asleep in their cot. Practice for a few minutes each time you put them down for a nap, and if it doesn’t work out, then try again next time. Gentle persistence will help your baby adjust.

10. Get personalised help if you’re struggling. The first 9 tips work for most babies but if you’re still struggling after trying these then please reach out. Personalised expert help is the fastest, easiest way to make lasting improvements to your baby’s sleep.

- Dr Fallon Cook

Paediatric Sleep Practitioner

Dressing your baby for sleep

Ever wondered if your baby wakes up because they’re too hot or too cold? Babies find it harder to regulate their temperature than adults, and will wake up if they aren’t comfortable.

Follow these tips to dress your baby for sleep.

1. Feel the back of your baby’s neck when they are asleep. Sweaty and clammy shows they are too hot, and cool to the touch suggests they are cold. Warm and not sweaty is just right. It’s normal for their hands and feet to feel cool.

2. Choose clothes and bedding made from natural fibres. Think cotton, wool, bamboo. These are more breathable and won’t get so sweaty.

3. Little babies (who can’t roll) can be swaddled. Use breathable material, and make sure the swaddle isn’t too tight on their hips - leave room for their little legs to wriggle!

4. Baby sleeping bags that fit well are excellent for baby sleep. They keep baby warm and can’t be kicked off. Make sure the sleeping bag isn’t loose around your baby’s neck. If they wriggle down it may come up around their face and obstruct their breathing.

5. Choose the right TOG ratings for baby sleeping bags. The TOG rating tells you how warm the sleeping bag is. Choose lower ratings for warmer days and nights, and higher ratings for colder times.

6. Avoid loose, bulky blankets. Never use hot water bottles, electric blankets, or weighted blankets, in your baby’s cot. Do not put a hat on your baby’s head when they are sleeping.

As a general rule, babies tend to sleep best in a cooler room with warm clothing. They like the snug feeling that thicker layers provide.

If you want to find out more about creating a safe place for your baby to sleep, take a look at the Raising Children Network.

- Dr Fallon Cook and Dr Laura Conway

Infant Sleep Practitioners

Prenatal health may impact baby sleep

Several studies, tracking thousands of pregnant women, have uncovered an association between health and wellbeing during pregnancy, and infant sleep.

Our very own research took a closer look at this association, because we were keen to find out what it is about women’s health in pregnancy that relates to infant sleep difficulties. We found several key factors that predict increased occurrence of persistent and severe infant sleep difficulties during the first year, including poor mental health and poor physical health.

Exactly how this happens is still being explored. When we looked at findings from other studies, results suggest that prenatal stress may change the way a baby’s brain develops. These changes in neural development may make it harder for their brains to sustain long periods of sleep.

What does this mean for parents?

• Your physical and mental health is important, valuable and must be protected.

• Some babies will need help learning how to sleep for longer settled periods overnight.

• If you struggled with your own wellbeing during pregnancy, and your baby has sleep difficulties, it’s not too late to turn this around.

  • Speak to your GP about any concerns you have for your physical health and ask for a referral to a psychologist to address stress or other concerns you have about your mental health.

  • Start tracking your baby’s sleep pattern in one of our sleep diaries and find time to talk to one of our Sleep Practitioners about how you can improve your baby’s sleep.

It’s never too late to work on sleep difficulties. We help children aged 0-5 years achieve better, more restful sleep. And often when sleep improves, so does parent wellbeing.

-Dr Fallon Cook

Sleep Practitioner