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09th Sep, 2020
Sandra popped in to see me the other day for a routine script. She had come hot from grabbing 3 year old Polly from day care and was still in her suit. Sandra who is attractive, capable whose little girl who is so gorgeous people stop her in the street to look at her, is a mess. Polly has probably slept through the night less than seven times since she was born. On a good night she’s up once and settles back to sleep within half an hour. On a bad night- and there are lots of these- she can be up three times and take an hour or more to settle each time.
Sandra’s starting to crack it. She has well controlled multiple sclerosis, and the sleep deprivation is threatening to set it ablaze again. She’s too tired to bond with her husband and she’s too tired to enjoy being a mum.
Sandra’s plight is scarily common- maybe it’s just a bad week this week but I’ve had chats to 4 families about this issue this week so far. And make no mistake, it’s torture. Sleep deprivation is banned under the Geneva Convention and yet plenty of our nation's most divine cherubs are inflicting the kind of night time torment on their adoring parents that would be frowned upon in Guantanamo Bay. And these parents keep their dirty little secrets hidden because having a night stalker in the next room is shameful.
For the 30% of Aussie kids who are running a sleep deficit, their own health is at risk. There’s evidence their developing brains can be affected, their immune systems can take a beating and older night owls can be ratty during the day saddling them with a diagnosis of ADHD and medication they don’t need. 75% of children with chronic headaches are sleep deprived.
But solving the problem is fraught. Advice from friends and family can be laced with judgment and professionals can be useless – or worse. If you make the critical error of walking into a pharmacy to ask for some over the counter medical assistance, brace for the scorn. We doctors are to blame of course. A 2004 article in the prestigious journal Pediatrics described the phenomenon of “social medication.” This practice is apparently used by loser parents to give them “control over children’s behavior that they perceived as fractious and irritating.” Like them keeping you up all night.
There is a legitimate concern about sedatives in children. The link between babies taking sedatives and SIDS started to be recognized in the 1990s. Promethazine (the main ingredient in Phenergan) was one of the problem drugs cited, especially when used in combination with other sedative drugs in children under the age of two. Not big numbers mind you, but we all agree, that any baby dying from an over the counter medicine is pretty horrendous. Hence the warnings on the packs and promethazine containing medicines being placed behind the counters of pharmacies. And hence the victim blaming and shaming of desperate sleep deprived parents who are looking for a solution to their nightmare.
So if you’re trying to survive a night owl, what should you do?
If your nocturnal cherub is under six months of age they do get a hall pass to call you out for a feed in the midnight hours. After that, if perennial lack of sleep is getting you down, here's what you should do:
1. Head to the GP and get your little one checked for a medical problem. Sleep apnoea and iron deficiency can both cause chronically disrupted sleep. Iron deficiency is picked up with a simple blood test and sleep apnoea is found on a sleep study. This is likely in kids with huge tonsils and who snore.
2. Once that is done divide your plan of attack into short term and long term strategies. Short term, your sleep deprivation means you can't see straight enough to do long term planning. So you just need to do whatever it takes to get some sleep in the bank and clear your head. Beg a sleepover for the little one at a sympathetic friend or family member. Let your little night owl sleep in your bed (safely) if it gives you a few more hours. Take nana naps when you can get them. And if your baby is two or over, you can use medication short term to get a couple of hours of indispensable shut eye.
3. Once you're in the headspace to think clearly, you can go to making some long term plans.
If you live in a house without in laws, flat mates or irate neighbours, and your baby doesn’t vomit on demand when upset, you can opt for 'controlled comforting' AKA 'controlled crying'. You know the procedure- where you leave your baby to cry for short periods of time gradually increasing the amount of time between visits. Or the fainter of heart can opt for ‘camping out’ where you do the same thing but sit beside your child, gradually moving the chair further and further from the cot till you’re out the door.
And this raises the issue of the elephant in the bedroom- your relationship with your partner. Sleepless kids drive wedges between parents whose approaches to the problem vary. If each of you feels unsupported by the other in how to manage your night owl, both of your resolve crumbles and you’re both assuaged with self-doubt, anger and hurt. You guys have to be on the same team here- not stuck at opposite corners of the ring throwing opportunistic pot shots at each other. There are only two of you in the world who love this child as much as you do. One might have to give 100% support to the other for a period of 2 weeks. If it doesn’t work, both change tack to the other’s method- but as a UNITED team
Your sense of purpose, your resolve and ability to plan will be better if you’re supported and you’re not stuck in Guantanamo. And your little night owl won’t have quite the impact on your physical and emotional wellbeing if you have the backing of your team mate and sanity thanks to precious sleep on your side.