anxiety in children

May 18, 2022

Sleep and SEND- a guide for parents

As any parent knows having a child who has difficulties with their sleep is exhausting! But as a parent of a child with SEND your child is more likely to be struggling with their sleep, in fact research shows about 80% of children with autism have problems sleeping.

Why your child is struggling with their sleep

Children with autism often have difficulties winding down and going to sleep. They may repeatedly get out of bed and refuse to go to sleep unless you are close by.
They may also have problems staying asleep and be awake for many hours during the night, perhaps coming into your room or going to other parts of your home.
They often find it hard to relax and can have high levels of anxiety, meaning emotional upsets at bedtime and taking a long time to go to sleep.
Social cueing difficulties can mean your child finds it hard to make connections in terms of pre bedtime activities and understanding that it’s bedtime. They may have developed a series of nightly rituals and routines that potentially delay bedtime.
They can have a poor concept of time and not realise it’s bedtime or recognise tired signs.
Research shows many children with autism have irregular secretion of the sleep hormone melatonin, impacting their ability to go to sleep.
Your child may have sensory difficulties such as sensitivities to smells, sounds, touch and light that could prevent them both falling asleep and staying asleep.
They may have medical conditions affecting their sleep such as sleep apnoea, epilepsy, restless leg syndrome, allergies and gastrointestinal problems such as reflux.

What can you do to help your child sleep?

As most child sleep problems are multifaceted it will help you get a good understanding of your child’s sleeping pattern by filling in a sleep diary for a week or two. This information could also be invaluable when discussing your child’s sleep with health professionals.
A visit to your GP may be needed to explore underlying medical concerns, as well as a possible referral to a dietician.
Review your child’s sugar and food to ensure they are having sleep inducing foods rather than high sugar snacks in the evening.
To help your child understand sleep and the steps of their bedtime routine, visual aids showing their bedtime routine in picture form can really help. You may like to make a booklet or laminate cards and create a Velcro wall chart that you go through with them on the lead up to bedtime each evening.
You may also wish to create a social story for your child that you read to them each evening that describes their bedtime routine and makes them the centre of the story. Social stories were created by Carol Gray in 1991 and are meaningful short descriptions of activities and specific actions to help children understand and know what to expect.

Children love routine. You may wish to revisit your child’s bedtime routine:

Time your child’s bedtime routine so you have a consistent start time each evening and even more importantly, a consistent wake time in the morning.
Aim to avoid all screens an hour before bed. Light from screens can suppress the sleep hormone melatonin.
Start their bedtime routine with about 10 to 15 minutes of quiet fine motor such as colouring-in, fuzzy felts, sticking or puzzles. Or your child may just like a relaxing story at this time.
To help your child unwind, from this point on it’s best not to chat too much. Instead use simple sentences or their visual aid booklet to guide and instruct them.
Then go for a short relaxing bath in warm water.
Go straight into the room they sleep in to get dressed for bed. To stop your child becoming distracted or loosing focus with the routine it’s best to keep everything around the bedroom and bathroom area.
Once they are tucked up in bed, read then a bedtime story, at this time of night its best to be to too lively or stimulating.
Some children find a massage and or soothing music will help them to go sleep. Do whatever you feel is right for your child’s sensory needs.

Check their bedroom environment.

Your child may have their own specific sensory differences that you need to consider. Is their bedroom dark, cool and quiet? Do they find it more relaxing to have gentle sleep sounds playing and a small amber night light? Are there smells that they find upsetting, can you minimise smells from the kitchen and would scented oils help them relax.

If you would like help with your child’s sleep please call us to discuss how we can help you.

January 15, 2022

Sleep and anxiety- how to help your child sleep

It has been a worrying time for us all and it will be no surprise that your children, just like you may have been impacted by fears and worries that have stopped them sleeping. Parents have reported that their child finds it hard to go to sleep, wakes in the night seeking reassurance and that many are experiencing vivid and scary nightmares.

The figures speak for themselves; at Millpond we have seen a 30 % increase in the number of sleep inquiries for young peoples sleep. This trend has also been seen in adult sleep patterns. A recent survey, by The Sleep Council of more than 2,700 people’s sleep during COVID-19, found around half of the respondents (43%) were finding it harder to fall asleep, with unease around the current situation affecting sleep for three quarters of people (75%). Women being twice as likely as men to report feelings of stress.

Your young person will be very aware of the changes in both their and their family’s lives. They may hear or read the news, over- hear adult conversations and pick up on the general stress in the community about the impact of COVID 19. They may worry about the future and what this all means for them and their loved ones.

Often these fears only surface at bedtime, when the day is over and there are no distractions to divert their thoughts.

So how can you help your young person manage their sleep at this time…..well the good news is there are things you can do to help.

Anxiety/Worries and Sleep

Anxiety is a natural response to a stressful event. It was essential for survival when we lived in the wild. Our fight or flight mechanism helped us to run away from animals who wanted to eat us. But we now live in a modern world and have very little need for this response. The only problem is our bodies find it hard to differentiate between a real or a perceived danger; being worried or anxious at bedtime can trigger this stress response in our bodies, triggering our sympathetic nervous system.

Unsurprisingly if your body thinks you’re about to be chased by a tiger the last thing you will be able to do is sleep!

What causes worries or anxiety at bedtime?

There are numerous causes of anxiety in children that can impact negatively on their sleep. These include long term unresolved sleep issues, over thinking or over worrying, nightmares, fear of the dark and monsters, starting nursery or school, family breakdowns and bereavements.

Older school aged children who struggle to sleep are often perfectionists and academic high achievers. They find themselves in a vicious cycle where they worry about how lack of sleep will affect their work, which stops them falling asleep and in turn leads to negative thoughts or even fears about sleep itself.

Children with autism and ADHD have more bedtime anxieties than their peers. Bedtime can be particularly challenging for children with ADHD who have difficulties quietening their racing mind from the stresses or worries about their day.

A typical bedtime

Children with anxiety at bedtime usually struggle to fall asleep and can lie awake for hours. They often reappear numerous times in the evening with excuses such as being hungry, thirsty, too hot, to cold or needling the toilet. You take them back to bed, but in no time at all they are back with more excuses. This process happens night after night leading to cross and stressed parents and an even more anxious child; you all dread bedtime!

You eventually find yourself getting into your child’s bed just to get them to sleep and then in the night they wake and seek you out again to help them get back to sleep. The perfect recipe for a tired and stressed family!

Have a stress free bedtime that helps your child sleep well

Start the bedtime routine

About an hour before your child goes to sleep have quiet time. Tidy away the toys and turn off all screens. Research has shown light from computers, IPads etc. can interfere with the production of the sleep hormone melatonin.

“Talking time”

This is the time to set aside 10 to 15 minutes of one-to-one time with your child. Ensure you put your phone away and make sure you have nothing else you need to do at this point so you can give your child your undivided attention. At Millpond we often call this “Talking Time”.
This will give your child the space to discuss any worries or fears they may have and just as importantly means they are less likely to need to bring them up just before you say goodnight.
If your child doesn’t have anything specific they wish to discuss, as an alternative you could help set a positive tone by discussing 3 positive things about that day. If possible try and find new things each evening. Your child may like to write them in a note pad that you keep just for bedtime.

Get your routine right so your child settles to sleep calmly and happily.

Initially focus the bedtime routine around the time your child naturally falls asleep; even if this seems late.
For example if your child usually falls asleep at 10.00 pm start your routine at 9.15 pm. This way you are allowing 30 minutes for the routine and 15 minutes for them to fall asleep.
Carry out the same series of steps every night – make this routine your bedtime ritual. Having a regular routine means your child’s body will start to prepare for sleep as soon as you start this process.
If your child is falling asleep well in 15 minutes, after a few nights, start your bedtime routine 15 minutes earlier. Repeat this pattern, slowly advancing the start time of your routine until you reach the time that works best for your child.

Have a warm relaxing bath.

Have a warm, relaxing bath lasting no longer than 10 minutes. Keeping the bath to a maximum of 10 minutes means bath time doesn’t become a stimulating play time. The added bonus is coming out of the warm water allows the body to cool quickly triggering the sleep hormone melatonin.
Then go straight into your child’s bedroom; going back into the living area at this time will lose the focus and magic of the routine.

Dim the lights.

Pre-dim the lights in their bedroom, as this will also help with melatonin production. If your child is scared of the dark and requests you leave a light on it’s best to have one the emits a warm amber or orange glow. Turn it on at bedtime and leave it on all night. The warm low level light will not interfere with their sleep and will offer then the reassurance they need.

Dress for bed.

Have their night clothes ready for their return from the bathroom so they can quickly get dressed and climb into bed.

It’s time for a story.

Even if your child can read to themselves, read a quiet almost boring story and have a cuddle and kiss goodnight then tuck them in with their favourite soft toy so they are warm and cosy.
Now that they’re drowsy, leave the bedroom so that they learn to fall asleep independently.

I want you to stay.

Your child may only be able to fall asleep happily if you stay with them. If this is the case you can help build your child’s confidence in falling asleep independently by implementing a slow gradual retreat programme at bedtime.
If you are currently sitting by the side of your child’s bed as they go to sleep, start by sitting just a little further away. Reassure them you will wait for them to be fully asleep before you leave their bedroom. After 3 to 4 nights, move just a little further away from their bedside; you may only move a foot at a time. Keep repeating this process very slowly moving in small incremental steps until you are out of their room and then along the landing as they go to sleep. This process should take about two weeks to achieve.

Mandy Gurney is the founder of Millpond Children’s Sleep Clinic and has been advising on baby, toddler and school aged child sleep issues for nearly 30 years. She is a qualified nurse, midwife and health visitor.

July 20, 2020

Children’s sleep severely affected by impact of coronavirus

Children’s sleep severely affected by impact of coronavirus, say experts

The coronavirus crisis is having a significant impact on children’s sleep, with anxiety and lack of routine causing serious disruption, experts and charities have warned.

The Millpond sleep clinic, in London, says there has been a 30% rise in sleep inquiries from parents about children aged five to 13 compared with the same period in 2018-19. A common issue is that children are going to bed later and sleeping in more.

“At the moment we are very busy,” the clinic’s founder Mandy Gurney said. “We have definitely seen a spike in six- to eight-year-old children with anxiety impacting their sleep. And for younger ones who are not seeing other babies in parenting groups – I think it will be hard when they start to go out more”.

She added: “Parents are also finding it hard to keep older children’s or teenagers sleep’ on track, as the temptation to lie in is very strong when there is no school to get up for.”

A survey of 2,700 people in April gave the early warning sign about the long-term negative impact coronavirus is having on children’s sleep.

It supports a newly published paper from the Journal of Child Psychology and Psychiatry that suggests the potential for sleep problems to emerge or worsen during and following the pandemic is high.

The survey found that 70% of children under 16 are going to bed later – but are also waking later (57%). It found children were becoming more heavily reliant on technology with nearly three quarters (74%) of parents reporting that their children are using electronic devices more during the coronavirus lockdown.

For full article…..

Feature from The Guardian.com lifestyle 17th July 2020 Sarah Marsh

June 17, 2017

Guest blog from Dr Sione Marshall on helping your child cope with loss

Helping your child cope with loss

As much as we’d like to protect our children from difficult times, the loss of a pet or grandparent, divorce or separation often feature in their lives, exposing them to the effects of grief.

At these times parents often struggle in knowing how to manage the impact of these events on their children’s lives. Children’s expression of grief varies greatly depending on factors such as their age and understanding of a situation. For example, a toddler with limited understanding of death and little experience of separation may show signs of disturbed sleep. Other responses to loss in young children may lead to a change in eating habits, crying, regression to earlier behaviors such as bed wetting, tantrums, fighting and angry outbursts.

Whilst an older child of ten or eleven might also suffer from sleep disturbance, the impact of loss may lead to problems at school or withdrawal from friends and family. As children grow older the effects of loss may lead to worries about physical health, fear of dying, risk taking behaviors, or avoidance of difficult feelings.

You can help your child to cope with loss in a number of ways:

Be honest and tell the truth.

Although it often feels easier to avoid talking about difficult issues, hiding information that children ask for can lead to confusion. Using the language that your child understands and the correct words for death instead of phrases such as “going to sleep” or “losing” someone will also avoid confusion. Accept your child’s responses and let them know that they are normal responses to sad events.

Create opportunities that encourage your child to talk and ask questions.

Check out any misunderstandings and areas of confusion. Children will often seem to dip in and out of grief, one minute seeming very sad and the next forging on with the ordinary tasks of daily life as though nothing has happened. This process provides the function of a safety valve, allowing your child to take a break from difficult emotions and so set their own pace in experiencing loss. As a parent this often feels difficult to manage. Offer opportunities for a cuddle and a chat when your child is experiencing strong emotions. Your child’s understanding of a loss or separation will shift and change over time so have more than one conversation about their experience.

Closure

Children like adults need to experience closure to a loss so involve your child in any routines such as hospital visits or rituals such as funerals, in whichever way is most comfortable for them.

As well as talking about their experience of loss help your child to express emotions privately through a dairy or art. Encourage them to collect keepsakes and maintain memories of someone special they may have lost.

Feelings

Loss or separation are often a very sad experiences. Your child may also feel abandoned by the pet or person they have lost which can lead to feelings of anger that are often directed at you as a parent. Give your child the opportunity to express these emotions and let them see your sadness too. Modeling appropriate responses helps children feel safe in expressing their thoughts and feelings. You yourself may experience particularly strong and dramatic emotions at these times that may alarm your child, so seek to share these privately with another adult.

Children will often feel that something sad that happens in their lives is in some way their fault. Reassure your child that they are not to blame.
Older children will often find certain aspects of school difficult when coping with difficult times. Talk to their teachers and other relevant adults who may also be able to provide support and the opportunity to talk with your child.

When to get help

Whilst we know that most children seem to adjust emotionally and return to healthy functioning both at home and school within about twelve months of their loss or separation some find it very difficult in adjusting and are most at risk during this first year. Other children may have apparently moved on in their lives only to be confronted with their loss two or more years later at a time when they have more understanding or a different view of a difficult situation. If you feel that your child is struggling with their grief our team is here to help.

Some useful references

For children:

Muddles, Puddles and Sunshine By Diana Crossley

Always and Forever By Alan Durant

The Copper Tree By Hilary Robinson

For teenagers:

Urban Dreams Edited by Elias Thompson

Dr Sione Marshall CPsychol., AFBPsS.

Chartered Clinical Psychologist

*Grief and child sleep problems *Child Sleep Problems *Sleep Training *My child won’t sleep