Dr Fallon (00:00)
Hello and welcome to the 50th episode of Brand New Little People, the podcast where we talk about all things early parenting with a particular focus on sleep and settling during those first few years. I'm your host, Dr. Fallon Cook, and I'm here with Dr. Laura Conway. We made it to 50, Laura.
Dr Laura (00:18)
Yeah 50! my goodness I can't believe it! 50 episodes well congratulations Fallon!
Dr Fallon (00:25)
Congratulations to you. I remember thinking initially, wow, imagine what we've got, you know, like 20 episodes in a little library. It'll be so wonderful. Yeah. It's amazing that we've got 50 and we'll just keep going from here. Yeah. And I think so much has changed, not just since starting the, the podcast, but also starting Sombelle as well. And even just starting Infant Sleep Australia. I so often think back to, when I used to work in research and how.
Dr Laura (00:35)
Yeah.
Yeah, absolutely.
Dr Fallon (00:55)
challenging life was trying to juggle, you know, research is a really hectic environment. But since we started Infant Sleep Australia and the podcast and Sombelle it's really meant that we've each had more time to really enjoy the work that we do and having a little bit more kind of control, I suppose, over how we spend our time and what we do with our time is an amazing thing. I just, I love it. And I'm so grateful to the parents who support us and.
Dr Laura (01:19)
Yeah.
Dr Fallon (01:23)
allow us to do this really fun and incredible work.
Dr Laura (01:28)
Yeah, absolutely. And working in research, it takes such a long time for our findings to make their way into practice and into public, in the public domain. So it's so wonderful, isn't it, to actually be able to take our research findings and bring them directly to the families and to get that immediate feedback from families as well when they've been able to apply it. So it's just been revolutionary to our
Dr Fallon (01:37)
Hmm.
Mmm.
Dr Laura (01:56)
personal lives and our professional lives. So we're so delighted that we have the Sombelle community and we have our little army of families who have come along for the ride with us. And yeah, here's to another 50 episodes.
Dr Fallon (02:00)
Yeah.
Hehehehe
Yeah, absolutely. Well, last week I mentioned at the end of the episode that we had a really big surprise announcement for our Sombelle members and I'm so excited to announce that today. We have released something we think will be really, really helpful for parents and it's included in your Sombelle membership already. There's no additional fee and it's part of us really trying to enhance the Sombelle program so that they're always the absolute best that they can be.
So what you'll now find in your unique sleep needs chapter is a lesson that gives you example daily rhythm charts. So we've created these charts where when you work out how much sleep your baby tends to need per 24 hours, so say it's 13 hours, you can go into that lesson and download the chart for a baby with a 13 hour sleep need or a toddler with a 13 hour sleep need.
And we've done this for babies and toddlers who have a sleep need anywhere between 10 hours and all the way up to 14 hours. They're the most common ones. And I think this is going to be fantastic for families because essentially when you download that sheet, you can look into the left column and it's going to list the number of naps that your child is doing. And then it will suggest a daily rhythm based on their sleep need and the number of naps they're currently having. And of course, it's just a suggestion, but I think it's really helpful for parents because it gives you a starting point.
You might look at the daily rhythm and go, well, that's great, but my child likes to go to bed at 8 p instead of 7 p So you'll just shuffle everything along that hour. But I'm really excited about it because I hear from parent feedback that a little more guidance around the daily rhythm and getting a really good daily rhythm in place is something you've all really been wanting. So fingers crossed we get great feedback. Laura, I'll be really keen to hear what parents think about those sheets. So do let us know.
Dr Laura (03:39)
Mm -hmm.
Yes.
Yeah, definitely let us know. We put so much work in behind the scenes so that we can ensure that we're value adding to the program and giving parents as much support and education as we can. And when we were hearing from families that their baby was like baby G or baby F in our example schedules, but with a slightly different sleep need. And so they were trying to add a bit of sleep here and a bit of sleep there.
We just thought, hmm, okay, we can probably do something a bit more to that. So yeah.
Dr Fallon (04:33)
Yeah, that's it. Yeah. And we didn't want to do, you know, we know there are tons of rigid age -based schedules out there and we know that for so many families, they either don't work or they even make things worse. So that's why we were always really hesitant about putting together any kind of chart. We didn't want parents to feel like, here's another rigid chart to follow. It's not like that at all. And that's why we've created different charts, depending on the baby or the toddler, their sleep need and how many naps they're having.
Dr Laura (04:46)
Mm -hmm.
Mmm.
Dr Fallon (05:02)
So that you just, we know that you're all really tired when you're trying to work through sleep problems. It just means you can glance at it and go, okay, could, could that work for my baby? Will I adjust it a little bit? And you'll have the skills and tools you need to be able to adjust it, to fit it to your child. So yeah, really keen to hear how families find that. And as always, if you've got feedback or there's something you think, gosh, I wish there was a lesson on this particular thing. Please tell us because yeah, we're so invested in keeping Sombelle.
Dr Laura (05:02)
Mmm.
Yes.
Mm -hmm.
Dr Fallon (05:31)
Yeah, the absolute best it can be. So yeah, that's really, really exciting. And Laura, for our 50th episode, we were having a chat, what do we make this episode about? And I thought we need to celebrate. So I think we need to celebrate one of our amazing families who we've worked with and who have just done an incredible job of turning sleep around for the whole family and really improving their baby's sleep health.
Dr Laura (05:34)
Yeah.
Yeah.
Dr Fallon (05:59)
And I know that, you know, as a mom, I love hearing stories about how other parents have tackled difficulties with their child and what they've tried. It's great. It's like, I used to love reading birth stories, hearing what happened for other people. It just, it helps you think about your own situation, I think, and things that you could try. So you've brought along a really great case study to talk about today, Laura. We've got, we've changed names to protect privacy, of course, but let's just say we've got parents, Hazel and Jack.
Dr Laura (06:09)
Yes!
Yeah.
Mm -hmm.
Dr Fallon (06:28)
and their little baby Lucy. And Laura, they came to see you in clinic a little while ago now. Tell me more about this little family.
Dr Laura (06:31)
Mm -hmm.
Yes.
Yeah, so they came into my clinic in Melbourne and they had a little Hazel with them. Sorry, they had little Lucy with them and they were describing about what's happening in their home life. It's just the three of them at home. They have a dog, they have a cat and they have grandparents close by on both sides.
Dr Fallon (06:48)
You
Dr Laura (07:06)
The issues that they were coming to see me about was there was Lucy had been having problems with her sleep for quite some time and Hazel had been managing it really quite well. But she knew that she was going to be returning to work quite soon. Jack also was working full time. He had finished his parental leave and he had shift work and was going to be having
Dr Fallon (07:25)
Mmm.
Dr Laura (07:34)
quite a lot of time away overnight whilst he was on call and doing night shifts. So he also knew that he wasn't going to be able to support Hazel with Lucy overnight. So they had come to this like a critical point where they'd been managing Lucy's sleep for the last six and a half months, but now there are about to be some big changes in what was happening at home.
Dr Fallon (07:40)
Okay.
Yeah.
Dr Laura (08:02)
Hazel returning to work, needing to use daycare plus grandparents to look after Lucy during the day whilst Hazel went back to work and Jack also being less available to support Hazel in looking after Lucy overnight. So they turned up at the clinic, sat down on the sofa and just went, we want to change something and we don't know how, help.
Dr Fallon (08:08)
Hmm.
Yeah right.
Hehehehe
Yes. Yeah. So Lucy's six and a half months when they come to the clinic. And I don't, I know a lot of the families who come and see me, they can feel really nervous at first. It can feel like a really big step to get help. Some parents even say things like, I feel like I've really failed at this. Like it worked for a bit, but now I just feel like I don't know what on earth I'm doing. How were Hazel and Jack? Were they kind of confident? Were they feeling a bit nervous?
Dr Laura (08:42)
Yeah.
Mm -hmm.
they were feeling really nervous about what it would mean to try to improve Lucy's sleep. So Hazel in particular had fallen down some, rabbit holes on social media where there's the, you know, the camp of you mustn't do anything. your baby must respond to your baby as many times as necessary overnight. And, it's really wrong to try.
Dr Fallon (09:15)
Mmm.
Dr Laura (09:27)
to change how your baby goes to sleep. But then she had also read other information where, yes, you absolutely must do it, but there's this one way of doing it and essentially cry it out, put your baby in their cot, they'll soon learn. So Hazel was like a deer in headlights. I'm sure she wouldn't mind me saying that because she was just so nervous. She was like, I can't carry on like this with the...
Dr Fallon (09:31)
Yeah.
Yes, okay.
Yeah.
Yep.
Dr Laura (09:56)
frequent overnight waits and settling difficulties when I'm returning to work and other people will be looking after Lucy, but it doesn't sit right with me to do something really harsh.
Dr Fallon (10:02)
Yes.
Dr Laura (10:06)
So Jack had heard from one of his work colleagues who had come to see me that I would take the time to explore a range of different options of how to improve Lucy's sleep with them and wouldn't be forcing them to choose just one particular way that didn't resonate with their parenting values. So we sat there and we became a bit of a team whilst little Lucy was playing on the floor in front of us.
Dr Fallon (10:33)
excellent. It's so good when you feel like you're really working in partnership with a family. And I know that families love that as well to feel really heard. so tell me about Lucy's sleep diary then, cause that's often the first thing we will look at is what, what does the sleep diary look like? Is there a sleep pressure problem or is the daily rhythm looking pretty good? How was it?
Dr Laura (10:53)
The first thing I noticed with Lucy's sleep diary is that she had a sleep need that was down the lower end of the average range for her age. So she was having just under 12 hours per 24 hours. I could see that she was having about three naps every day, one in the morning, one at lunchtime and one in the afternoon that could really vary. Sometimes it started at three, sometimes it didn't start until 5 .30.
Dr Fallon (11:06)
Okay.
Dr Laura (11:22)
And each of the naps were generally quite short, about an hour maximum, but often less than that. And I could also see that the time that Lucy went to sleep at night varied quite a lot. So it might've been as early as 6 .45 or as late as 8 .30 or even nine sometimes. The other thing that I...
Dr Fallon (11:22)
Okay.
Okay.
Dr Laura (11:50)
look at when I see a sleep diary is how many times a baby is waking overnight. And Lucy was waking a lot overnight. So yeah, sometimes she was waking like four times would have been a good night, but eight plus times a night wasn't unusual. And yeah, really hard. And the worst thing about those wakes for Hazel and Jack is that sometimes, particularly for wakes that were in the second half of the night,
Dr Fallon (11:55)
Hmm.
Okay.
Yeltsin.
Dr Laura (12:20)
Lucy could be up for 30 to 60 minutes and actually quite happy for some of those times, just really wanting to play and babble and touch mum's face or dad's face and just not able to go back to sleep. So they were exhausted.
Dr Fallon (12:38)
Okay. Yeah, okay. So even though they're happy to kind of, you know, feed her back to sleep and give her support, she wasn't really wanting to get back to sleep anyway, which often does mean that there is a bit of a timing issue and a sleep pressure problem. And I know that in our initial appointments, we often want to really gather a lot of information on the baby and their temperament. And if there's any other medical factors going on, what sort of information did you glean there?
Dr Laura (12:49)
That's right.
Mmm.
Yeah. So they let me know that Lucy was intolerant to soy and dairy. So Hazel was on a restricted diet for breastfeeding. And Lucy also was diagnosed with reflux when she was only about a month old and she was on medication for that. And there was then therefore a history of pain for Lucy.
Dr Fallon (13:33)
Hmm.
Dr Laura (13:34)
and Hazel and Jack needing to soothe Lucy during those periods of that really intense reflux pain. And because of that, both Hazel and Jack were very sensitive to Lucy's crying because it was associated, they associated it with the pain that she had had when the reflux wasn't under control.
Dr Fallon (13:42)
Okay.
Okay.
That's a really tough position to be in. Yeah, so what were Hazel and Jack's goals? What would they really want to achieve with meeting with you?
Dr Laura (14:03)
Yeah.
So they described Lucy as a really happy child in the appointment. She was, she'd actually just started to crawl. So she was crawling around on the mat in front of us, which is early. She was only six and a half months old, but really bright, cheery, happy little thing. Came crawling up to me, no sense of fear at all. They described that she would play independently during the day as well. They'd be able to.
Dr Fallon (14:16)
Wow, that's early.
Dr Laura (14:36)
to the toilet. That's often a question I ask. Can you go to the toilet and just leave your baby just briefly without getting upset? And absolutely they could. So for that reason, they were a little bit confused about what they had read with regards to the naps, because one of the things that they wanted, they thought that they wanted was for Lucy to have longer naps during the day. So she was having three cat naps each day.
Dr Fallon (14:40)
Mmm.
Dr Laura (15:04)
sometimes one nap might be an hour, but often they were less than that. And she was starting to resist some of her naps. And they were a bit confused because they said, look, she's generally really happy, but people are telling us she should be napping more and she should be napping for longer. But she actually is only having short naps and starting to resist them. So they wanted some help to unpick what was going on there. The other thing that they really wanted help with was how to settle Lucy to sleep.
Dr Fallon (15:22)
Hmm.
Okay.
Dr Laura (15:34)
So up until the last month, they had been feeding Lucy to sleep and it had been working relatively well for them. Lucy was still waking a lot overnight, but Hazel was able to give her breastfeeds and she would go back to sleep relatively quickly. But over the last month, they found that even with the breastfeeding, Hazel wasn't able to go back to, Lucy wasn't able to go back to sleep easily. And Hazel.
Dr Fallon (15:49)
Mmm.
Dr Laura (16:03)
was having to rock her, so giving her a breastfeed and then rocking her to sleep in her arms. And when she had those nights where she was awake eight plus times a night, that is an awful lot of physical work for the parents to be doing. So they really wanted a lot of help with that.
Dr Fallon (16:06)
Okay.
Yes.
that's absolutely exhausting. It's, you know, I hear that, that very similar story to that in the clinic all the time. It gets to a point where the parent fatigue is so overwhelming that parents often feel even a little bit panicked, like how on earth am I going to survive this if it keeps going? So, you know, often during these initial appointments, we go through kind of a typical day and we get a sense of things in terms of sleep pressure.
Dr Laura (16:24)
Mmm.
Mm -hmm.
Dr Fallon (16:49)
Did you find that you needed to make some adjustments to the daily rhythm before they could start to work on the settling?
Dr Laura (16:55)
Yeah, definitely. The real flags that we needed to adjust the daily rhythm was the descriptions about how long it was taking Lucy to go to sleep for those naps. And particularly that some days she was skipping her third nap altogether. And other times, I always ask about how long it takes a baby to go to sleep or a toddler to go to sleep for each of the naps as the day goes on.
Dr Fallon (16:57)
Mmm.
Mmm.
Dr Laura (17:22)
and at the start of the night and then each of the wakes overnight. Because that information is really important, isn't it, Fallon? Because it's telling us what's happening with sleep pressure.
Dr Fallon (17:22)
Yes.
Yes. Yeah, absolutely. Yeah. With if they're getting all the support that, you know, they're requesting and still aren't getting to sleep quickly, it's a really good sign that there's something a bit off with the daily rhythm and they're just actually not quite ready for sleep. So in terms of the timing side of things, what tweaks did you make? It sounds like you might have moved them onto two naps.
Dr Laura (17:32)
Yeah.
Yeah.
Yeah.
Yes. So Lucy had that roughly 12 hour sleep need. So I said, okay, let's move her onto two naps. Let's think about what that daily rhythm might be, the daily amount of nap. So we gave her about two hours as her total amount of daily sleep. And that left her with 10 hours sleep overnight. Because she was feeding so many times overnight, it wasn't going to be appropriate to.
immediately drop to only one feed or no feeds. So we also included a bit of time for a couple of feeds overnight. So we ended up saying two hours total day sleep across two naps and about 11 hours overnight to include time for some feeds.
Dr Fallon (18:37)
Yeah, good. Excellent. And this is a family who were really nervous about changing how they settle Lucy for sleep. What decisions were made around settling and how did that conversation go? Because I know a lot of parents are very, very nervous, very tense. And sometimes they, their immediate reaction is just no, I just can't change anything. I'm not ready for it. And others are like, right, let's just get this done. What sort of feeling did you get from Hazel and Jack?
Dr Laura (18:53)
Yeah.
Yes!
Yes. So what I tend to do in clinic is I get a really good sense of the child's personality, whether they're fearful at all, whether they're quite clingy and needing lots and lots of cuddles, or whether they're a little bit more independent. And that's certainly the impression that I got from Lucy and I could see her there in front of me. She was really happy and quite an independent little baby for her age. Now, because Hazel had been a little bit,
Dr Fallon (19:12)
Mmm.
Mmm.
Dr Laura (19:35)
nervous about what kind of approach I might suggest, we talked through the range of approaches. So we talked about going really, really gradually where we would minimize any kind of crying because of their sensitivity to crying due to Lucy having reflux that was really terrible for them in the first few months. So we did talk about going with the slowest approach and
When Hazel heard that that would take four to six weeks before we had major improvements in Lucy's sleep, not that it wouldn't be four to six weeks before there was any improvements, but until there would be the major improvements that they wanted to see, Hazel and Jack said, okay, well, that just rules out for us because we can't go with such a slow approach given all these changes that are happening in our life at the moment.
Dr Fallon (20:13)
Mmm.
Mmm.
Yes, fair enough.
Dr Laura (20:32)
So then we looked at, okay, well, is there a medium approach and which, you know, quick tapered approach or a quick fade approach. I was trying to remember their fallon of the names of the different approaches in the different age group programs that we have. And again, when we talked it through Hazel was like, you know what, she's so, Lucy is just so motivated.
Dr Fallon (20:48)
Hehehehehe
Mm.
Dr Laura (21:01)
to engage with me. If I try to just pat her all the way to sleep, she's going to be giggling, laughing, trying to climb up my arm, desperate to make eye contact and to engage. And then, so they then made the decision that that wouldn't work for them either. So then we talked about using the supported accelerated approach, which,
Dr Fallon (21:02)
Mmm.
Yes.
Hmm.
Dr Laura (21:29)
We could make some adjustments too, so that Hazel could have a chair right beside the cot, do some humming or shushing during short intervals that she, so she was staying present with her baby, wasn't leaving the room and was giving her some verbal input. But then was just giving Lucy a little bit of space for those short intervals. And Hazel and Jack felt that that was just perfect for them.
Dr Fallon (21:39)
Mmm.
Yeah. Yeah.
Yeah, I find a lot of families absolutely love that approach because they don't want to just walk away and knowing that the child's going to be a bit confused about why they're in the car and what's going on. I love the approach because they can just sit right there and stay with them and give them lots of reassurance, but in a way that still results in making progress. Cause I think that's the sort of the keys and it's sometimes it, when we're,
Dr Laura (22:01)
Mm.
Mmm.
Dr Fallon (22:23)
really just constant hands -on support. Some of these bright little babies, they'll just try to interact and start a little game. And it just constantly gets derailed. But with that supported accelerated approach, they're present, but you are, and you're giving some interaction, but you're not engaging in other interactions. So I think it's a clever approach that, yeah, a lot of families find that it's a really, really good fit for their busy little babies.
Dr Laura (22:28)
Yes.
Yes.
Yeah.
Dr Fallon (22:50)
So maybe tell us how did they go? You know, what were the, what were the results after they implemented the plan?
Dr Laura (22:55)
Yep. So they had a follow -up appointment about three weeks later. And they just looked like different people on the, obviously I saw them face to face, but with the reviews we often do over zoom and the smiles on Hazel and Jack's face were beautiful. They said things had really turned around. They had gone from, parenting a baby who was up.
Dr Fallon (23:05)
Mmmmm
Lovely.
Dr Laura (23:25)
you know, minimum four times overnight, but much more likely eight times overnight to now having a baby that was only having one feed overnight had adjusted really well to the two nap schedule. Hazel felt that her days had freed up so much more because she wasn't spending an hour trying to get Lucy to go to sleep for that last nap of the day. So she was like, it just, the day's feel.
Dr Fallon (23:30)
Hmm.
Right.
God.
Mmm.
Dr Laura (23:55)
so much better. Yeah.
Dr Fallon (23:57)
that is absolutely amazing. And I get so many families saying to me when I worked on the new daily rhythm that was catering to my child's sleep needs, after a week of just doing that, before we even changed anything about how we settled them, it all started to come together because they're only being put down for sleep when they're truly, truly ready for it. So a lot of families say that was just game changing. And then it made the settling so much easier than these parents thought it would be.
Dr Laura (24:17)
Yes.
Dr Fallon (24:25)
Was that the case for Hazel and Jack? Did they struggle with the supported accelerated approach or did it all go fairly smoothly?
Dr Laura (24:25)
Yeah.
No, it all went fairly smoothly. The thing that they struggled with was that in those first few days, when they were trying to move towards a two nap schedule, is that because Lucy's overnight sleeps were so fragmented, she often was getting tired within an hour of waking in the morning. She was also, when she woke up in the morning, she didn't
Dr Fallon (24:50)
Mmm.
Yes.
Dr Laura (25:00)
want to have a feed because she'd been feeding all night. She wasn't interested in breakfast. And just very, very tired. And yet was still then taking a little while to fall asleep when Hazel went to put her down for that first nap. So when they moved to the two -nap schedule, the thing that the parents reported was a little bit tricky on those first few days was just trying to move that first nap a bit later.
Dr Fallon (25:05)
Yep.
Hmm.
Dr Laura (25:28)
and managing Lucy when she was a little bit cranky because on the first few days when you're not working on the settling, the nights are still a bit fragmented. They persevered and they had the confidence to do it because they knew that they were going to be coming in with the skills for the self -settling.
Dr Fallon (25:28)
Mmm.
Mmm.
Dr Laura (25:53)
very soon. So they could see the rationale behind why we were helping Lucy stay awake a little bit longer for that first nap. And sure enough, when they then started to do the settling, Lucy was then sleeping much better overnight, very, very quickly actually. And then was waking up hungry, so had a lovely big feed, and then had breakfast half an hour later. And those two activities,
Dr Fallon (25:53)
Yeah.
Mm.
huh. Yep.
Dr Laura (26:23)
kept her nice and distracted and could then, you know, also gave Hazel something to do with Lucy. And then with a play, maybe a walk, she was then ready to go down for that first nap. And the schedule then each day got easier and easier.
Dr Fallon (26:25)
Mmm.
Yep.
Mmm.
Amazing. And what I'm curious to know is you mentioned earlier that Hazel didn't mind feeding to sleep. It just wasn't sort of working very well anymore. Once Lucy had sort of developed that skill to be able to just fall off asleep without having to feed to sleep. Did Hazel then decide she would still do some feeds to sleep sometimes or was she happy to just not offer feeding to sleep at all anymore? Cause I know some families, you know, it's a personal decision about what they decide to do going forward.
Dr Laura (26:55)
Mm -hmm.
Yeah. So Hazel came into the initial appointment saying her ideal would be two feeds overnight. That's what she would like to do. She said, that's fine. We can work that in. At that point, Hazel said that Lucy wasn't having lots of solids during the day. And so she was a bit wary about dropping the feeds back too much because Lucy wasn't feeding.
Dr Fallon (27:16)
Mmm.
Dr Laura (27:37)
in terms of solids a great deal during the day. But she then she did understand that one of the reasons Lucy wasn't having a lot of solids during the day is that she was having eight breastfeeds a night sometimes. So she's very happy to drop down to two feeds. And our starting point was actually three when we started with the Supported Accelerated. So we'd have, we offered Lucy three feeds a night.
Dr Fallon (27:40)
Mmm.
Yes. Yep.
Dr Laura (28:06)
and that just really gave Lucy enough time to adjust. So she started having more solids during the day. and to Hazel's surprise, Lucy dropped to one feed herself just three days in. So the, so the first two nights she was having two or three feeds overnight. And then by the third night, she did a great big, long five hour stretch. Then.
Dr Fallon (28:15)
Mmm.
Yes, amazing.
Amazing.
Dr Laura (28:34)
Hazel gave her a feed and then she slept through until morning.
Dr Fallon (28:39)
Fantastic. Laura, I'm so glad you've shared this case study because I think it is such a beautiful example of how parents can go into this feeling really worried that they might be pressured into something or it might move too fast. But it's such a great example of how you can look at the baby in front of you and what they're needing and what they're wanting and craft something that actually really honors that baby as an individual, you know, rather than, and that family as an individual family with their own,
Dr Laura (29:05)
Yeah.
Dr Fallon (29:09)
needs and wants. And I love that there's that gradual reduction in night feeds and I just, I think it's a really great demonstration of how a really carefully thought out sleep plan that's thinking about all the moving parts can just work beautifully for a family. And yeah, well done to Hazel and Jack. I think you should feel so proud of yourselves. And I'd imagine that returning to work and.
Dr Laura (29:26)
Yes.
Yeah.
Dr Fallon (29:36)
you know, having other carers for Lucy as well is just going to feel that much more manageable over the next few months. So well done.
Dr Laura (29:43)
Yeah, they did a great job. The only things that we needed to change when I saw them for their review was that they were, because Lucy had dropped down to one feed overnight so quickly, we then just needed to adjust bedtime and wake up so that we didn't, because if you remember, I was saying we gave her an extra hour overnight to cater for those feeds. So when I saw them at the review, one of the remaining difficulties was
Dr Fallon (30:05)
right yep.
Dr Laura (30:12)
getting up early for the day, you know, 5am Lucy was like, hello, springing awake, sleep pressures worn off. And so the way we worked with that was, well that's because she's not having two feeds overnight, she's just having the one. So we just looked at adjusting bedtime and wake up. And then Hazel knew that when she was ready to drop that final overnight feed and there was no pressure to do it, but when she was ready to do it, then she could adjust bedtime and wake up again.
Dr Fallon (30:14)
Hmm. so she's springing awake, ready to go. Yep.
Dr Laura (30:41)
so that it was in line with just the sleep. Didn't need to include the time for the feed as well. So yeah, they did a great job. Lovely, lovely family to work with. And now Hazel is back at work and a lot of my families do send me updates so that I know how things are going. And I know that Lucy's continuing to sleep well. She has actually now dropped her final overnight feed. So Hazel and Jack are...
Dr Fallon (30:48)
lovely.
Mmm.
are amazing.
Dr Laura (31:09)
having really nice time for themselves in the evening and Lucy's having really good restorative sleep overnight.
Dr Fallon (31:18)
brilliant. These are the ones that just keep us going in the clinic. It's so, so lovely to hear these stories. And I hope our listeners enjoyed hearing a case study. If it's something you really enjoy listening to, let us know, because we could incorporate more case studies into our podcast episodes. Because I think it does help to think about another family's experience. And it might have given you some ideas for things that you might think about changing with your own child's sleep.
Dr Laura (31:23)
Yeah, they are.
Hmm.
Dr Fallon (31:46)
Yeah, great. Look, we've had a few questions coming this week, Laura, that I think we could probably get through pretty quickly, actually. There's a few there, but I think the answers might be reasonably quick ones. Do you want to start maybe with our first one, which is Imogen?
Dr Laura (31:53)
Yeah.
Yeah. So Imogen wrote in to say that they've had a great run of sleep since they saw you Fallon and they're with their eight month old. Yeah. So their eight month old settles easily and mostly sleeps through the night. That's wonderful. Imogen says he has a 12 hour sleep need and is in a good daily rhythm. She wonders if sleep needs tend to increase when babies go to daycare and are in a highly stimulating environment.
Dr Fallon (32:07)
excellent.
great.
Dr Laura (32:30)
Imogen also wants to know about the difference between the baby and toddler programme so she's prepared for the future.
Dr Fallon (32:31)
Mmm.
It's a great question Imogen and families do ask this quite a bit. You know, we never quite know what direction a baby's sleep needs will move in. Mostly they tend to gradually decline and starting daycare won't mean that they necessarily sleep more. But some babies buck that trend and they will start to sleep a little bit more and we never quite know which ones will do it. We really don't know. We know that when they're at daycare often there's a lot more physical fatigue because they're very busy.
Dr Laura (33:01)
Mm -hmm.
Dr Fallon (33:07)
Sometimes they're happy just to have a little bit more rest in the middle of the day rather than more sleep. But I would say just monitor and see how your child goes. At first, really try and keep bedtime and wake up time very similar each day. And if you find after a week or two, they're not really coping so well, maybe try adding in a little bit more day sleep, maybe even just on the daycare days and see if that helps.
Dr Laura (33:31)
Mm -hmm.
Dr Fallon (33:31)
But definitely if night started to fall apart a little bit, it would tell us that they don't actually need that little bit of extra sleep. So yeah, every baby's a little bit different on that front. And then in terms of the differences between the baby program, Sombelle program and their toddler Sombelle program, there's a little bit of a bleed over between the two. So if you've got the four to 12 month program, look, it's probably going to serve you pretty well until there may be sort of 14 ish months or so.
Dr Laura (33:39)
Hmm.
Yeah.
Dr Fallon (34:00)
And likewise, if you had an 11 month old, you could purchase the toddlers program and it will be perfectly fine to get you started. but the toddlers program, there's more of a focus on all those, weird and wonderful behaviors we see in toddlers. When we start to see tantrums and bedtime refusal and, yeah, they might be moving to a bed or a floor bed or be doing all sorts of shenanigans in their cot. so it's a bit more of a focus around how do we troubleshoot those sorts of, difficulties that we don't see.
you know, during the babyhood kind of months. Yeah, so it's there for you when you need it, of course. Laura, we had Mariana who emailed in. She has a 10 month old who averages 12 hours of sleep each day. She says he used to be able to settle himself for naps after months of practice and attending sleep school. But after a nasty cold two months ago, things went backwards and he now insists on being fed to sleep.
Dr Laura (34:36)
Yeah.
Mm -hmm.
Mm -hmm.
Hmm.
Dr Fallon (35:00)
He wakes three to four times overnight and the first wake up might be 45 minutes or three hours after bedtime. So there's a bit of variability there. Mariana says she's going back to work in a month's time. I'm imagining that's why she's joined Sombell. It's a very common story. And she says when she's back at work, she'll be away from him for 12 hours per day, four days per week. Her son has never been able to settle for sleep for anybody else and refuses to take milk anyway, aside from a breastfeed.
Dr Laura (35:03)
Hmm.
Yeah.
Yes.
Dr Fallon (35:30)
So Mariana, I imagine is feeling a bit nervous. She says, could he sleep needs have decreased even more? Would he do better in his own room? And she's keen to know, do I fix the daily rhythm first and then wean the night feeds and then change rooms to do a new settling method? Or should she just be changing everything all at once?
Dr Laura (35:33)
Yes.
Okay, so Mariana, definitely log his sleep again, since you're questioning whether his sleep needs have changed. There is a chance they may have changed since the last time you logged his sleep and in that first year sleep needs can change quite rapidly. So really good idea to check. He might be having needing less than 12 hours now. And that might have something to do with why he's now waking more frequently overnight.
when previously I'm assuming he didn't. The other reason why he may be waking quite a lot overnight is because he's feeding to sleep. And we know that for some babies that means that when they come up into light sleep at various points overnight, they're going, I fell asleep when mum was feeding me and now I'm in my cot, what's going on? And then they're unable to go back to sleep until they're fed back to sleep again.
Dr Fallon (36:19)
Mmm.
Dr Laura (36:48)
So, since you are going to be going back to work really soon and you are going to be going away for, you'll be away for 12 hours at a time, really worthwhile helping your son develop those or redevelop those self -settling skills that he used to have. First step is always the timing. So always, because you're asking about what to do. The fact that it's about a month away that you're going back to work, you might just want to bite the bullet, Marianna.
I'd be logging his sleep, thinking about a daily rhythm where he's probably having two naps a day and then a bedtime and wake up that doesn't overextend the amount of sleep that he really needs. Some parents do find that moving children to their own room is a...
Dr Fallon (37:32)
Hmm.
Dr Laura (37:41)
is a good idea, but it's not really essential. So I wouldn't be saying that's your hill to die on if you want to keep him in your room for the time being, that's fine. And then in terms of weaning the night feeds and settling methods, if you were to, you probably listened with interest to what Hazel and Jack's experience was, they were feeding to sleep and then feeding frequently overnight. And so they were able to use a settling method that tackled both of those things at the same time. So potentially Mariana,
Dr Fallon (37:48)
Hmm.
Dr Laura (38:10)
using the supported accelerated approach after a few days of working on the timing first, it's going to be a really good way for you to help settle your baby in the cot, give him the feeds overnight that you would like to give him, and then all other times use the settling approach, the supported accelerated approach to resettle him when he wakes up. Yeah, did you have anything else to add, Fallon?
Dr Fallon (38:14)
Hmm.
Mmm.
Yeah, I would just say on whether or not to move him to his own room. I find so often breastfed babies, they adjust better to falling asleep in their cot and not feeding to sleep when the breastfeeding parent is out of sight and out of mind. So for some parents, they have a much easier time working on cot settling. If you're the non breastfeeding parent does most of the settling initially in that other room with the breastfeeding parent well out of sight.
Dr Laura (38:48)
Mmm.
Hmm.
Dr Fallon (39:02)
They can often make really good progress. So the breastfeeding parent is still going to go in there and do some feeds, but when they finish the feed, the other parent takes over with the settling. And that can mean a much, much smoother, smoother experience throughout the whole thing. So that would be something to think about. And I also remembered, and I looked this up while you were talking, Laura, episode 37 is called navigating settling changes, when, how, and in what order.
Dr Laura (39:09)
Mm.
Dr Fallon (39:27)
That would be a really good one to go back and listen to. It sort of talks about why we might work on the timing and then, you know, the settling and then feeding. Yeah. So good luck, Marianne. I hope that gives you, you know, good, good bit of information to kind of get, get your thinking in order and to, to make a start on things. And if things aren't going well, you can always book in for a coaching call if you want to have a chat through what to do. Hmm.
Dr Laura (39:50)
Yeah. So we had another question from Belle and John. They have a six and a half month old who wakes on average four times a night and is mainly fed to sleep. it's the theme of today, isn't it? Yeah. They were hoping to use the slow fade approach, but after Belle injured her collarbone, sorry to hear that Belle. I hope you get better soon. So after that injury, they realized that this wouldn't work.
Dr Fallon (40:03)
Yeah, it must be.
Hmm.
Dr Laura (40:18)
So they've switched to the supported accelerated approach. The trouble they've had is that on the first try using that approach, they were at 75 minutes in with no signs of their daughter settling to sleep. They'd like to know if we have any tips and is there a cutoff point when parents should stop trying to use an approach because it isn't going to work? that's a curly one Fallon, over to you.
Dr Fallon (40:32)
Mmm.
Yeah, it is, it is such a good, good question. When I mean, 75 minutes is a really long time. And I think if you've gotten to 75 minutes and you don't feel like you're making progress, I would stop because what it tells us is that sleep pressure is almost certainly not high enough. so I would say keep your sleep diary, work out how much sleep they're averaging. What, what is their sleep need?
Dr Laura (40:47)
Yeah.
Dr Fallon (41:10)
work on a daily rhythm that fits that sleep need for, you know, it could be three or four days or some parents will do it for a full week and then start your settling approach. We see a lot of parents who say, I think the daily rhythm is fine. Like it's, you know, it's good enough. I'm just going to change how I settle them. Not realizing that the magic happens when we work on the timing first, then there's just no way. I mean, occasionally we hear of it taking 75 minutes. It's an hour 15.
Dr Laura (41:32)
Mm -hmm.
Dr Fallon (41:39)
It's pretty rare though. It would generally take that long if sleep pressure isn't quite high enough yet. Or I mean, I don't know how Bell and John are applying that approach if there's a lot of inconsistency. So if you were saying something different every time you attended to them or you were doing different types of patting or responding, you know, in different ways that can sometimes keep the crying going as well. So check in on that. So yeah, if you try and approach,
Dr Laura (41:45)
Hmm.
Mm -hmm.
Mmm.
Dr Fallon (42:06)
and you're really consistent and it's taking a really long time, it might be that you stop and reassess their sleep needs, work on the timing for a few days and then try again. And that's generally what I would say to families. Would you add anything to that, Laura?
Dr Laura (42:21)
Now, I agree, 75 minutes is a very long time to be settling your six and a half month old to sleep. Look, sometimes when we're working with families who have a two and a half, three, three and a half year old, where there's more bedtime stalling behaviors and there's a history of...
Dr Fallon (42:25)
Mmm.
Mmm.
Dr Laura (42:45)
bedtime battles, we can sometimes in those older children see some delayed sleep onset like that when you very first start to use a settling approach. But at six and a half months, that is a long time. I really feel for you, Belle and John, that must have been really hard. So yeah, take a break, take a breath.
Dr Fallon (42:50)
Mmm.
Mmm.
Ahem.
Dr Laura (43:10)
get that sleep, get that timing right. If she's actually only got a 12 hour sleep need and you're working on a 13 hour sleep need and you start settling her an hour before she's actually ready to go to sleep, then yeah, you're gonna have those really delayed sleep onset times and that's no fun for anyone. Once you have got the timing correct and you're sure that the bedtime is the right time, then rule of thumb.
Dr Fallon (43:27)
Hmm.
Dr Laura (43:38)
use a settling approach for around about half an hour and then do your reset every half hour where you take your baby out of the room with you. You could calm them down, calm yourself down, go if you were feeling heightened. And then when everyone's calm, go back in and off you go again and you start again. And you can do those resets every half hour. It's very rare to need to do a reset more than twice. Normally it would, many families don't have to do a reset at all.
Dr Fallon (43:44)
Hmm.
Yeah.
Hmm.
Dr Laura (44:07)
more commonly you might have to do one on the first night, two at a push, but more than that's quite unusual when the sleep pressure is high enough.
Dr Fallon (44:07)
Hmm.
Yeah. And I think it's important to remember all of the approaches in Sombelle and all the ones we use in the clinic too. We always suggest you do a mini reset every 10 to 15 minutes because it is horrible. If your child's really upset and cranky as anything about the changes you're making, it's horrible. They can get really stressed out. You can get really stressed out as well. So make sure you are taking those breaks. Use those breaks. It's important for you and for your baby as well.
Dr Laura (44:35)
Mmm.
Dr Fallon (44:42)
And if it's just too distressing, if your child's too worked up, then I mean, obviously in this case, Belle and John don't have the option of using a slow approach because of the injury. But for other families who can, you might just go, you know what, our child just needs a bit more support with this. And that's perfectly fine to choose one of the very, you know, hands -on approaches instead. So yeah, let us know how you go, Belle and John.
Dr Laura (44:50)
Mm -hmm.
Hmm.
Dr Fallon (45:06)
And don't be nervous to try again. I think it sounds like it could be a timing issue there. And once that's resolved, you might have a very different experience when you go to work on hot settling again. And it's another case too, where if you're needing some support, reach out for a coaching call. It might be that there's a few variables there we can sort through with you. Good. Laura, we had Holly email in. So Holly has a 15 month old who attends childcare four days per week.
Dr Laura (45:06)
Mm -hmm.
Hmm. Hmm.
Yeah.
Mm.
Mm -hmm.
Dr Fallon (45:33)
and she's been waking very early in the morning. Holly says she loved last week's episode about night waking and has realized her daughter needs to drop to just one nap in order to start sleeping in more and getting through to a reasonable hour in the morning. So that's great. So they moved to one nap for six days, but then when at childcare, they gave her two naps. that's disappointing isn't it when you've worked really hard.
Dr Laura (45:56)
yes.
Dr Fallon (45:59)
So Holly describes her daughter has around about an 11 and a half hour sleep need. She has two hours of day sleep and goes to bed at 8 .30 PM. And Holly has three questions. So I thought we could go through these one at a time. And I reckon you'll have a very fast answer for this first one, Laura. Holly wants to know is dropping down to one nap the solution? Confirm. Yep. At 15 months of age. Definitely Holly, you are on the right track for sure.
Dr Laura (46:16)
Yeah.
Yes, we definitely keep at one nap. Confirm, yes. Yes.
Dr Fallon (46:29)
Holly also asks, should we move to one two hour nap? So the amount of day sleep is the same as what she was getting on two naps, but it's just happening in one block. She wants to know, would this increase the nighttime sleep pressure because it's a longer stretch of awake time before bed.
Dr Laura (46:46)
Yeah, yep. So many times parents do just take the two naps and they add them together. And so your child has the same amount of daytime sleep, but like you've rightly said there, Holly, there's just that much longer stretch before the start of the night. So even though it's the same amount of sleep, it's happening earlier on in the day, there's a nice long stretch of awake time to build that sleep pressure before bedtime.
Dr Fallon (46:54)
Mmm.
Hmm.
Hmm.
Dr Laura (47:13)
and, so ordinarily then, the sleep onset is, kind of reasonable at the start of the night. If you try for about a week and it's just not working, it's still taking a long time for your baby or your toddler to go to sleep at the start of the night, then you can try to reduce it to an hour and a half. the nap, I mean, and then add the extra half hour to the overnight sleep. so it's a little bit of,
Dr Fallon (47:22)
Mmm.
Mm.
Dr Laura (47:43)
trial and error when you move to one nap to determine what's going to work best for your toddler.
Dr Fallon (47:48)
Mm. Yeah, absolutely. And Holly also asks, once she drops down to one nap, how do we deal with sometimes necessary car rides or pram rides late in the afternoon? Because she does fall asleep easily in those situations. I feel like we had an episode on this one at some point too, but I can't remember what number it is.
Dr Laura (47:57)
Hmm.
Yes. And it's where we talked about power naps, I think. And how often what happens when you do move a child from actually, it's not even just from two naps down to one nap, it can be from three naps down to two naps, four naps down to three naps. Is that just in those first few days as your baby or toddler gets used to having that nice long stretch of awake time before bed, they can find it a bit challenging to stay awake in the car or the pram, because it's nice and cosy in there.
Dr Fallon (48:13)
yep.
Dr Laura (48:36)
And they're not used to having this nice long stretch of time awake yet. So they'll just drift off. As they get used to being awake for longer periods of time, their need to do that, their propensity to fall asleep when you don't want them to will start to fall away. If in those first few days when you are switching to the one nap, Holly and she is falling asleep, just try to wake her.
Dr Fallon (48:36)
Hmm.
Dr Laura (49:05)
after 15 or 20 minutes so that you can try and keep bedtime the same. If she has longer than that, then you will need to move bedtime later because then we're heading into the having had a whole sleep cycle territory and then that impacts sleep onset at the start of the night. Did you have anything else to add, Fallon?
Dr Fallon (49:25)
Mmm.
to say that I'm a big fan of just having a few toys that are new that your child's never seen that you can just hand them in the car or the pram to kind of keep their attention or for a lot of families it's just here's the iPad that can work really well it's such a novelty iPads can do all sorts of things and play all sorts of content that might just help them stay awake for that 15 minutes.
Dr Laura (49:43)
Yeah.
Dr Fallon (49:53)
If you do have a toddler who's really sensitive, because we know some, if they have the tiniest nap in the car, it can be five minutes, they are up till 10 p that night. So if that is your situation, work hard on having some distractions there in those first couple of weeks. Yeah. And lastly, we have, we've got Cassie. She wrote in to say, thank you for offering coaching calls. She says she was on the fence about booking one, but she's so glad she did.
Dr Laura (49:53)
Yes.
Yeah. Yes.
Yeah. Yeah.
Dr Fallon (50:20)
She saw you Laura a few weeks back because she was struggling with getting her catnapping five month old baby to do just three naps a day. Cassie says, even though she knew she had to increase her awake time, she just had mom guilt. we've been there. Don't worry, Cassie. We've all had that. And she says, Laura gave me so much confidence in executing my sleep plan. And within a week, she happily did her three naps a day. Sometimes even extending one. Laura, well done. You're very good.
Dr Laura (50:21)
Yeah.
Dr Fallon (50:49)
That's fantastic. Well done Cassie. Yes, love an update. Cassie says her nights have since gotten so much better as well. She's generally only waking once or twice. She says her daughter is now five and a half months old. I have lost the place where I was reading. there we are. She says we've got a pretty good daily rhythm. Generally her daughter will have around three hours awake before bedtime.
Dr Laura (50:52)
yeah great thanks for the update Cassie that's brilliant.
Yeah.
Dr Fallon (51:17)
The third nap is the shortest at about 30 minutes, but sometimes she wakes up at the 20 minute mark or sometimes her brother wakes her, you know, if she's in the car or something and she just won't resettle. So she has a really short nap and she says on these days she wakes all night and will not go back to sleep unless I hold her. She says I generally put her to bed slightly earlier on the days when that happens. And Cassie would like to know what's going on and what should I do when this happens? Is it that she's,
Dr Laura (51:26)
Mmm.
Dr Fallon (51:46)
Got too much sleep pressure, not enough sleep pressure. What are your thoughts on this Laura?
Dr Laura (51:50)
My thoughts are to hold steady on bedtime. I think that what you're seeing there is that because she's had that short nap, you've described how you have mum guilt, Cassie, I'm imagining that you're thinking, she hasn't had enough sleep. So I'll put her to bed a bit earlier and then that will alleviate any guilt you're feeling, which you don't need to feel, by the way, Cassie. And then what's happening is that actually,
Dr Fallon (51:54)
Mmm.
Hmm.
Dr Laura (52:19)
her sleep pressure is not quite high enough, and then she's quite wakeful and waking overnight. The other thing to look at is five and a half months. If she is starting to have a shorter third nap, it may, it's beginning to be a sign that she's not far off dropping down to two naps, which she might do, you know, often happens somewhere between six and seven months. And so we see those signs that sometimes they skip the third nap. gosh, I
Dr Fallon (52:36)
Mmm.
Mmm.
Dr Laura (52:48)
Fallon, I keep doing this with my thumb and getting the thumbs up. So they sometimes will only have their wake up after a short nap or they sometimes skip it. Or they start to then take a little bit longer to go to sleep at the start of the night or wake up a lot overnight. So what you're describing there, Cassie, is that she's sometimes waking up a bit early from that third nap and she's having those overnight wakes. You're thinking, that's because she woke up early.
Dr Fallon (52:49)
Your thumbs up emoji.
Hmm.
Dr Laura (53:18)
And it's the waking up early, which means that she's now waking up a lot overnight, but actually it's probably a sign that her sleep needs are just changing. And she's soon going to drop to two naps.
Dr Fallon (53:18)
Hmm.
Mmm.
Yeah.
Absolutely. Yeah, I agree with that. I think it's worth bearing in mind a lot of parents in this situation go, it must be that over tiredness thing I've heard so much about. But it's actually not. Whenever we go to change a baby's daily rhythm. So even if you know, Cassie, your baby just has that off day where the naps cut short by a brother waking her up. Sometimes when we just have a slightly different daily rhythm to normal, it just throws out the nights for no real rhyme or reason. Like often in the clinic will suggest a new daily rhythm and we say to parents,
Dr Laura (53:55)
Mm.
Dr Fallon (53:59)
expect sleep to be atrocious the first few nights because we've gone and changed something and often it's almost like we throw all the cards up in the air. It's all just a jumble and we just have to give it time to settle down so it could even just be something as simple as that. So yeah do let us know how you go Cassie. Well thank you so much to all of our beautiful listeners and our Sombell families. We appreciate you so much and thank you for sticking with us through to our 50th episode.
Dr Laura (54:07)
Yes.
Hehehehe
Dr Fallon (54:27)
And he's just starting a whole other 50. We'll be at a hundred before we even know it. But no, it really is just such a joy doing this. I absolutely love it. If you're really struggling with your baby or your toddler or your preschooler's sleep and when we help families up until their children turn six years of age, we have some clinic appointments actually available this month, which is really unusual. It's normally a couple of months wait time. So if you want to work directly with us rather than the Sombelle program, that's perfectly fine. We can see you in clinic.
So yeah, if you're looking for one of those, go to infantsleep .com .au. That's where we take our bookings for appointments either via Tele Health or in our clinic in Melbourne. If you think you'd like to get started sooner than that, of course you've got the Sombelle program with our new and enhanced resources, which is so exciting. And I think a few of those parents who emailed in questions, Laura, are probably gonna really love having a look at those daily rhythm charts to help them kind of work out what a good daily rhythm could look like.
Dr Laura (55:22)
Yeah.
Dr Fallon (55:25)
So yeah, if you want to come and join, please do. You'll be sending in your own questions before you know it and we'll be answering them on the podcast. So thank you everyone again for tuning in and you'll hear from us again next week.
Dr Laura (55:39)
Thanks everyone, bye bye.
