Do we need help from a baby sleep professional? - A screen tool

          This morning, I had a phone consultation with a loving mother. She told me she wasn’t sure if her little one was having sleep issues or if his sleep difficulties were part of his normal development. I feel as though there are many parents who are uncertain if they need to seek the help of a baby sleep professional and may have felt overwhelmed because of using those countless on-line self screening tools for their little ones’ sleep. If this describes your situation with your baby, the sleep tool below can help you determine if baby needs help. Remember, this is a self-screening tool which indicates if your child needs further help. It is not for diagnosing purposes. 

Vancouver Polar-BEARS screening tool

Bedtime problems
- Any problems falling asleep or refusing to go to bed?
- How often/ how frequent/ how severe? When did it begin?

Excessive daytime behaviours
- Naps or falling asleep during boring activities (e.g. car rides)?
- “Hyperactivity”?
- How often/ how frequent?
- Does your childhave any difficulties waking up in the morning?
- How often/ how frequent/ how severe? When did it begin?

Awakenings during the night
- Wake up frequently during the night? Any complains /signs of discomfort?
- Any sleep walking, shouting out in sleep, nightmares/terrors, teeth grinding?
- How often/ how frequent/ how severe?

Regularity of sleep/wake cycles
- Does your child have a regular and wake time?
- Getting enough sleep over the night? How many hours?
- Differences between weekdays/ weekends/ holidays?
 - How often/ how frequent/ how severe?

Snoring and other symptoms of breathing difficulties during sleep
- Snoring or witnessed breathing gaps, mouth breathing, dry mouth or sore throat, sweating during the night, restless sleep, problems getting up/ grumpy in the morning/ headache upon waking.

- How often/ how frequent/ how severe?

Well-being scale

(for the child & caregivers)
- How does your child’s sleep problem affect your child/ your wellbeing?
   Your child’s wellbeing (low) 1 2 3 4 5 6 7 8 9 10 (high)
   Your wellbeing (low) 1 2 3 4 5 6 7 8 9 10 (high)
- Would you expect any change in your child’s/ your wellbeing if the sleep problems could be solved? 
   Change in your child’s wellbeing (low) 1 2 3 4 5 6 7 8 9 10 (high)
   Change in your wellbeing (low) 1 2 3 4 5 6 7 8 9 10 (high)
 

Seek for help : Advocate 
(for your child & yourself! Key clinical questions to help orient you)
- Is the sleep of your child restorative or not?
  IF NOT, can the non-restorative sleep be improved with Sleep Health measures [e.g. changing lifestyle]?
- Are sleep associated situations stressful (e.g. going to bed)?
  IF YES, can they be improved with focus on Seep Health measures
  [e.g. changing routines]?
- Imagine best & worst case scenarios & speak with your therapist, support worker and/or physician about these.

* This screening concept is based on the BEARS concept, a tool for screening the most common sleep problems in children and adults. BEARS does not aim to diagnose, but instead structures an exploration and facilitates self-reflection for concerned families and helps them to develop and set goals. It was developed by Owens and Dalzell in 2005 (Sleep Med. 2005 Jan;6(1):63-9) and adapted by UBC research team (Ipsiroglu et al. NOFAS-UK: Fetal Alcohol Forum, 2012).

If you think your little one has sleep issues and you want to address these, please contact Minnie via cdababysolutions@gmail.com

When you are faced with choosing a child care centre for your child: A guide for choosing a quality and safe learning environment

          My blog is not only for discussing sleep issues but also for development, education, community resources for infants and toddlers. I received a request from an amazing mom who I had recently helped with her baby’s sleep. She is thinking about putting her little one on the wait list for a child care program (I know it is a big problem in Metro Vancouver, some places have a wait list of over 12 months).  She told me she was looking for a high quality and safe setting but she doesn’t know what to look at. So I thought this may be a great opportunity to share my insight about a quality and safe learning environment.

Why environment?

The environment has a great impact on improving children’s abilities, how well they can learn, when they use particular skills and how competent they are perceived to be.

Safe environment

Did you know many children are injured or worse because of preventable accidents? It is very important to check if there are any conditions, events or situations that may cause unintentional child injury and death at a centre.

Quality environment

Along with the home environment, the child care environment where your child will spend a tremendous amount of time largely influences their outcomes. A good quality environment can provide positive learning experiences and pathways to reach their optimal outcomes. 

What do you actually need to look at?

A centre based learning environment has multiple layers, and these factors influence the quality of children’s experiences and their learning. These are possible questions you can ask or check for each layer.

Diagram from McLean, Wolery, & Bailey, 2004, p.220

Ⅰ. Interactions: Interactions with teachers and peers.
- Do the teachers speak in a warm fashion to children?

- Are children encouraged to interact with peers?

Ⅱ. Classroom Features: Classroom curriculum, practices, schedules and nature of activities, materials.

- Does the centre have structured, but flexible schedules based on the child’s needs?

- Does the centre provide safe and developmentally appropriate activities and materials?

- Do the activities and materials promote different skills that children need to develop? (e.g. language skills, big muscle skills, small muscle skills, social skills, cognitive skills, self help skills)    

Ⅲ. Classroom Staff Characteristics & Classroom Structure: Education and training, experience, beliefs and goals of the teachers, child-teacher ratio, group size, arrangement of physical space, equipment, furnishings and hours of operation.

- Is the centre licensed, unlicensed, or licensing not required?
(If specific outcomes are the goal such as tutoring, the child care does not require a license, however, licensed centers must meet and comply with the Community Care and the Assisted Living Act as well as comply with Child Care Licensing Regulations. You can view the Child Care Licensing Regulation at www.health.gov.bc.ca/ccf/)

- What are the qualifications of teachers?
(e.g. responsible adults, assistance license, early childhood educator license, infant and toddler license, special needs license - all of them must have had a criminal record check)

- How many teachers and children are in each class?
(Group care: under 36 months -12 children with 3 teachers min, over 36 months- 25 children with 3 teachers, Preschool : 20 children of the ages of 3 to 5 years old with 2 teachers max, Family child care: 7 children with 1 adult, Multi aged care: 8 children with 1 teachers in B.C.)

- Is the classroom big enough and well-arranged? Can children move around freely?

- What are the hours of operation?
(Group centres offer year-round, full-day care, typically opening between 7:00/8:00 a.m. and closing between 5:00/6:00 p.m)

- What other spaces are provided that add to the learning experience? 
(i.e. playgrounds)

- Are there any potential hazards?
(e.g. cutting boards, cleaning supplies)

- How can the teachers and classrooms accommodate children with special needs? Do the teachers have the proper abilities in order to support the child? Is there limited access to certain spaces and materials for the child?

Ⅳ. Administrative Characteristics: Philosophy, administrative structure and support of staff.

- Does the philosophy of the centre meet your child’s needs and interests?

- How is the inclusive program operated? (e.g. fully or partially)

- Do the policies meet your child’s needs and interests? If not, is it flexible to meet them?

- Is there funding support as well as specialist support for children with special needs?

 ★It is important to assess the environment as well as communicating with the teachers and administrators to let them know your priorities, beliefs, needs of your child before and after entry into the program in order to be able to set common goals for your child. There is a very useful website with a check list. http://www.health.gov.bc.ca/ : Parents’ Guide to Selecting and Monitoring Child Care in B.C.

Getting the rest you deserve!

           If you are reading this, you are probably exhausted and worried about not only your child’s sleep but also your own. I know you probably can’t remember the last time you had more than 3 consecutive hours of sleep. You probably find yourself being short with others and irritated. Even the smallest of problems can make you upset. This can affect your relationship with others, including your husband. Moreover, a lack of sleep can also cause postpartum depression. 

          I always ask parents to take time out of their hectic schedules to rest before and during sleep training. Now, I know what you are thinking… “Is that even possible? If it was possible, why did I come to you?” Though sleep training requires a lot of energy, time, and most importantly, a commitment from parents, you still must consider your own rest in order for this plan of action to succeed. It may seem obvious but parents can be more productive, patient and make better choices for their babies with more rest. So how can we make this all happen?

           My first suggestion is whenever your baby sleeps, so should you! Even though you cannot fall asleep with your baby, you can still lie down, close your eyes and empty your mind. Forget about those house chores!  It is ok to order food, postpone the laundry even though that means your husband might have to wear that same pair of underwear for an extra day! It doesn’t make you a bad mother or wife, it just means that you are addressing your needs which will also benefit your child. Remember, you can always take care of these things after you take care of yourself. 
 

          Secondly, get as help as much as you can. Once you start sleep training, having a guest is not a good idea since it can over-stimulate your baby. However, if you want to accumulate energy for sleep training, consider help from those that you trust such as your partner, family members or friends. For example, ask your partner to take charge of night time waking so you can sleep at night. Your mother can come over and help you out over the weekends. You can set up a play day with your friends who can take care of your older one. If you can afford it, hire a housekeeper. Now is the time to use whatever support you can get. 

           Lastly, sleep train your baby. Teaching your baby how to fall asleep by himself/herself, stay asleep and enjoy sleep is the greatest gift you can give your baby. You may have already realized your baby’s sleep helps the well-being of the entire family. Once your baby sleeps well, you are not going to worry about your baby’s growth and development due to a lack of sleep. Moreover, you will have your sleep and even that date night back!

           Being a well rested parent is one of the best ways to be a great parent!

Please contact us if you’d like to take the next step in sleep training your baby - cdababysolutions@gmail.com