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Sleep and Your Autistic Child

About two-thirds of autistic children have problems with sleeping. If your toddler or child is autistic, you might experience difficulty in establishing a regular bedtime. This can be due to their naturally irregular or random sleep/wake patterns. They might want to sleep all day and then be ready to party at night when everyone else wants to go to bed. 

Some reasons why autistic children have sleep difficulties

Differences in melatonin production, which affect a child’s circadian rhythm. 

Heightened senses and/or sensory overload.

Social cueing problems, which make it difficult for them to make the connection between bedtime routine and bedtime.

Anxiety.

Associated neurological problems like epilepsy.

Food allergies/sensitivities/issues which are common in children with ASD – cause digestive problems and discomfort.

Sometimes autistic children have other health issues which can cause them discomfort and/or pain.

How does this affect their sleep?

Autistic children can have difficulty settling off to sleep and delayed sleep onset. This is common in lots of children but especially for those with autism.

Because of the difference in melatonin production, some autistic children sleep in short bursts rather than for a sustained period. This can mean lots of night wakings, and sometimes very early waking as well. 

Melatonin

Melatonin [“the hormone of darkness”] is the hormone that puts us to sleep and keeps us asleep.

Sometimes for people with autism, its production can be low or irregular.

If your child has sleep problems, you may have been prescribed melatonin by your paediatrician. 

It should only be given as a short-term measure, along with support and guidance about helping your child get into a good bedtime routine. It can be helpful for some children, especially if it is used to help kick-start a sleep plan. Then once a new sleep behaviour is established, the Melatonin can be withdrawn.

Prescribed melatonin is usually given about half to one hour before bedtime, and it can help a child to fall asleep. Unlike natural melatonin which continues to be produced during the night, synthetic melatonin wears off quite quickly. This can of course cause them to wake in the night. 

However, you can take advantage of the prescribed melatonin at bedtime to help you teach your child how to fall asleep in their own bed. Help them to do this without having you sitting or lying with them. This alone can help them to resettle more easily, without you if and when they wake up later.

How you can help

There are lots of things you can do to improve your child’s sleep.

I’m going to divide this into 3 categories to make it clear why each intervention is helpful.

Biological

Make sure they have an appropriate wake window so they are tired enough to sleep. 

Avoid being over-tired i.e keep their cortisol levels low.

Encourage daylight exposure – this helps to release sleep hormones at bedtime.

Stop screen time 1 hour before bed.

Have lots of exercise during the day.

Lights low 1 hour before bed.

Low red night light in the bedroom they need it – kept on all night.

Blackout blinds during summer months.

Encourage foods which contain tryptophan [milk – chicken – turkey – nuts – oats – tuna – nuts & seeds.] Tryptophan is an amino acid that helps melatonin production.

Avoid sweets/cola/fizzy drinks & food with artificial colouring and other chemical additives.

Behavioural

Have a familiar recognisable bedtime routine.

Use a social story [TM]* to help prepare for changes to the way that they sleep or let them know what they are meant to do.

Encourage them to fall asleep alone, so that they don’t wake later feeling upset that you’ve gone. It’s fine to do this in gradual steps – altering the social story as you go.

Give them rewards for good sleeping. Make sure that you are specific in your praise. For example, “You got into bed when I asked you to!” “You slept in your bed all night!”

Environmental

A tidy room – put toys away before bedtime.

A dark room or a dim red night light to encourage melatonin production.

Have the walls and furnishings in soft, muted colours.

Thick carpets to muffle sounds.

White noise/noise cancelling headphones

Try sensory lighting – lava lamp/bubble lamp/fibre optic lamp [red tones.]

Avoid strong food smells etc.

Have your child fall asleep in the same conditions that they then subsequently wake up to.

Some people use a weighted blanket, as they are good for sensory processing issues and can provide a sense of calm. It should be said that many sleep experts and occupational therapists don’t believe in their effectiveness. Weighted blankets should never be used for very young children. 

Why sleep matters

It is so important to address and try to resolve any sleep issues rather than just accepting them as part of your child’s differences. 

You want them to be as well equipped as possible to enjoy their life, their education and their friendships. 

We know that poor sleep in younger autistic children can lead to an increase in such things as social difficulties, struggles with learning and challenging behaviours.

Sleep is very important for you too! It’s hard work being a parent, particularly if you have a child who is autistic. If you’re going to give them your best, you need a good night’s sleep.

As a mum of an autistic son myself, and speaking from the heart,  I wish you lots of love and luck in helping your child with their sleeping.

Further help

If you are struggling with your autistic child’s sleeping, I’m here to help you. 

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. 

You will be in very safe, experienced hands and I treat every parent and child with kindness. 

As a qualified health professional, I can help families with medical and developmental issues.

See my reviews on Trustpilot

www.andreagrace.co.uk

*I make sleep stories a lot in my work with children with special needs and they are very effective as well as being fun for the child.

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How to safely drop your older baby’s night feeds

Most babies can sleep pretty much through the night by 6 months. One of the main reasons why many don’t is because they develop a milk/sleep association. This usually happens if they are fed to sleep at the start of the night. It can also happen simply when they are used to the ritual of a feed when they wake up during the night. 

Feed and sleep association

Feeding and sleeping are very closely connected for babies – especially in the early weeks. You can feed them to sleep without having them develop feeding as a sleep association until they are around 3 months. After that, they become more conscious and begin to form habits and associations.

When your baby was younger, if they had a full tummy, it meant that they would sleep for longer. So feeding them to sleep when they are little was and is the right and natural thing to do.

When they are older, having a tummy that is very full of milk is less important. They need to be generally well nourished & hydrated during the day. They also need to be well-fed and satisfied when they go to sleep of course – but not stuffed full!

The main things that determine the quality of their sleep now are:

  • The way that they fall asleep
  • Whether they are expecting any nighttime events to happen.

It’s okay to feed your baby during the night for as long as you want to, especially when you are breastfeeding, and you should never feel under pressure to stop if it is something that both you and your baby enjoy.

When you are ready to drop the night feeds

  • Wait until they are around 7kg. At this weight, it is okay for their bodies to rest for up to 12 hours at night.
  • If you haven’t already done it, introduce a familiar series of steps leading up to bedtime. Start your bedtime routine just before know your baby is tired and ready to sleep. 
  • Keep the bedroom light on for that bedtime feed, and don’t let your baby doze off. You may have to limit the duration if you’re breastfeeding or reduce the feed if they are on the bottle. Don’t worry – your older baby’s quality of sleep no longer depends upon how full their tummy is. 
  • Introduce a picture book or song after the feed and before they into the cot. This will help to discourage a milk/sleep association. When babies develop this association, they may feed when they wake up during the night when they are not hungry. They feed because it is their learned way of falling asleep. 
  • Turn the light off now and place your baby into the cot whilst they are clearly awake. 
  • Depending on their temperament and your parenting style, either stay with them, comforting them in the cot or pop in and out frequently but briefly to reassure them. 
  • Be patient and give them time. If your baby has been used to feeding to sleep, they may struggle at first with self-settling. There is no rush – it might take an hour or so but if you let them, they will eventually fall asleep without you feeding them. Try to remain calm and reassuring if your baby is upset. Remember that they are getting used to a change and although it won’t be easy for the first night or two, it will be worth it in the long run.
  • If your baby wakes in the night, go and check them but not give a feed. Comfort them in the cot as you did earlier if they are upset. Provided that they are well hydrated in the daytime and are not unwell, they shouldn’t need a drink. It’s fine, however, to offer some water if you feel they need it.
  • Although you can drop the night feeds all at once in healthy babies over the age of six months; if you’re nervous about doing this, it is OK to do it slowly. You can gradually dilute night formula feeds and/or to cut the duration of night breastfeeds. You need, for the sake of consistency to feed your baby a decreasing amount of milk at each waking. Feeding at some wakings and not at others will only confuse them.
  • Try not to confuse them by withholding or restricting night feeds and then giving a big, sleepy feed at dawn. They can’t tell the time yet, and as far as they are concerned, this is a night feed.

Just to say, that this is a guide. Each baby is different of course, and if you’re unsure, you should discuss your baby’s need for night feeds with your health visitor, doctor or other health care provider.

Golden rules

In one of the boxes above, I’ve said that feeding a baby sometimes when they wake and sometimes not can cause confusion. This isn’t the case when they are younger but as they grow up their thinking develops. They can struggle to figure out why sometimes they get the feed response to their waking and other times they don’t. With this in mind, it’s best to drop them all at once if you can. Alternatively, feed them every time they ask for it but give smaller amounts.

Here’s a guide if you want to feed them at each waking but gradually reduce the amount before stopping: 

I know that the issue of night feeding, especially night breastfeeding is a sensitive one for many people. I would always encourage parents to follow their instincts and values.

Also, if you’re breastfeeding, don’t think that if you do decide to drop the night breastfeeds, you have to stop breastfeeding altogether. By 6 months your milk supply is well enough established for your body to make milk for the daytime, when it is most needed!

Further help

If you’re struggling with your baby’s night waking and night feeds, I am here to help you.

My books

My bestselling books give you the tools to help your baby and yourself get a good night’s sleep. They are full of expert, practical advice and case studies. Each book teaches you to create your baby or child’s personal sleep plan and is written in a clear and accessible style.

They are available in all formats from Amazon and other booksellers.

My Courses

My courses are a mix of video, graphics and easy-to-read text. They are a great way to access my expert help – from your phone, tablet or laptop. The courses have no expiry date and are updated frequently. The Gentle Sleep Course is very comprehensive, easy to dip in and out of and is very empowering.

The Early Waking Course is concise and accessible – it takes around an hour to complete and it may be the best hour you’ve ever spent!

Both of the courses contain helpful schedules for day and night time sleep.

My 1:1 Consultations

If you choose to book a one-to-one consultation with me, you will receive my expert advice along with an individual sleep plan for your child. You will be in very safe, experienced hands and I treat every parent and child with kindness. As a qualified health professional, I can help families with medical and developmental issues. My success rate is outstanding, with over 15,000 face-to-face sleep consultations with families from all over the world.

See my reviews on Trustpilot