SLEEP RED FLAGS

The potential “why”
behind sleep challenges

A central tenet of how I support sleep is getting to the why behind a baby or toddler's sleep challenges.

Is it a sleep problem, or is the poor sleep a symptom of something else?

If there’s an underlying medical issue causing the sleep challenges, it can be easy to see how any sort of behavior modification strategy (like sleep training) will be both ineffective and leave the heart of the issue completely unaddressed.

Some common sleep disrupters that aren’t actually a “sleep” issue perse, and more a medical one, are listed below:

Pauses in breathing, choking, or sudden gasping

Pauses in breathing can indicate obstructed sleep apnea (OSA), a medical condition that can cause poor-quality sleep. When each pause occurs, carbon dioxide builds up in our bloodstream. This signals our brain to wake us up so we can take a breath and restore oxygen levels.

These repeated wakes naturally cause sleep disturbances. Sleep apnea can occur when children have enlarged tonsils or adenoids, are overweight, or have oral ties.

Open mouth breathing, snoring, or noisy breathing

We are all meant to sleep with our mouths closed, our lips gently sealed, our tongues suctioned to the roof of our mouths, and breathing easily through our noses. If your baby or toddler is sleeping with their mouth open – even if they're breathing through their nose – we need to figure out why this is happening (the only exception is if they're sick or congested).

Some possible causes can include oral restrictions (tongue or lip tie), high palate, enlarged adenoids, and food intolerances.

Oral restrictions (tongue or lip ties)

The natural resting position of the tongue is sealed at the roof of the mouth, with the lips gently closed. This can be impaired when there is an oral restriction. If the tongue stays on the floor of the mouth, the vagus nervous system - which is located at the roof of our mouth - cannot being stimulated, impacting our child's ability to get deep, restorative sleep.

Having the restriction revised and / or doing exercises and bodywork helps restore the tongue's full range of movement so it can rest at the roof of the mouth like it’s supposed to.

Restless legs

A baby or toddler who frequently and involuntarily moves or jerks their arms or legs in their sleep might be suffering from restless legs syndrome (RLS), which is often a symptom of low iron and/or low magnesium. Restless legs can make it difficult for your child to fall asleep and stay asleep.

Increasing your child's exposure to iron-rich foods can help, as well as using topical magnesium lotion and/or Epsom salt baths.

Nutritional Deficiencies

Iron

The biggest nutrient culprit that I see as it relates to sleep and nutrition is low iron. Babies are born with their own iron stores that carry them to around the 6 month mark. At this point, they need consistent exposure to iron-rich foods to ensure they are meeting their iron needs. As amazing as breastmilk is, it is a low source of iron. If the birthing person was anemic during pregnancy, the baby's iron stores could be 'used up' before the 6 month mark.

Low iron can present as taking a long time to fall asleep, early wakes, frequent night wakings, moving around a lot while sleeping, dark circles under the eyes, light pink or even white under the eyes where it should be red, and recurrent bouts of fatigue / low energy during the day.

Iron rich foods, such as liver, red meat, and dark green vegetables are a great way to help your toddler meet their iron needs. I recommend iron-fortified foods / cereals as a last resort, as getting these nutrients from a varied, whole-foods diet will help your toddler hit many of their other nutritional needs as well. Anything fortified with iron can also be hard on your child's stomach and that, in itself, can cause discomfort at nighttime. Cooking with cast iron pans can help increase the iron content of the foods you are serving.

vitamin d

Vitamin D deficiency can present as difficulty falling asleep, sleeping less overall hours than the child needs, and frequent wakes at night. Although the best source of vitamin D is via sunlight, red meat and eggs, especially from free-range animals who are given plenty of time to roam outside, can help boost our vitamin D levels as well.

Magnesium

Another essential micronutrient that impacts sleep is magnesium. Magnesium deficiency is extremely common and can present as cramps, headaches, restless legs while sleeping, and difficulty staying asleep.

Offering a magnesium-rich bedtime snack can keep your child full throughout the night while simultaneously helping meet your child’s magnesium needs. Think foods like banana, rolled oats, chia seeds, almonds or almond milk, etc. It’s also possible to help your toddler absord magnesium via their skin. Epsom salt baths and / or topical magnesium lotions for kids are available.

vitamin b12

Having enough vitamin B12 in our diet is essential for the production of melatonin, the hormone that makes us feel sleepy. If our toddlers are deficient in vitamin B12, it could be hard for them to fall asleep and stay asleep. We see lack of vitamin B12 most often in vegans and vegetarians, so if your family avoids animal-based products and you're struggling with sleep challenges, it's worth ensuring you're getting your family's vitamin B12 needs met another way.

Calcium

Calcium is needed to produce the hormone tryptophan, which is the precursor to melatonin. Calcium deficiency can cause problems falling asleep. If your family consumes dairy products chances are good your toddler doesn't have a calcium deficiency perse however, inadequate consumption of other nutrients like vitamin D and magnesium are required for your body to process calcium.

If you don't consume dairy then focussing on dark green vegetables, almonds, chia seeds, fish and tofu can help ensure you're meeting your family's calcium needs.

Eczema

All of us have difficulty sleeping when we're uncomfortable, so it's not hard to understand why a baby struggling with eczema might wake frequently in the night. Topical creams can help relieve the symptoms of eczema, but we still want to work to find the root cause.

Food intolerances (including food proteins passed through the breastmilk) are a common trigger, but certainly not the only cause.

Reflux

Some babies are what we call “happy spitters,” which is when spitting up doesn't bother them and they continue to thrive. In this case, the reflux is not concerning. However, reflux can be extremely painful for some babies, so it becomes necessary to address the reflux before addressing the sleep challenges (since the sleep challenges likely result from the reflux).

Some common causes of reflux are food intolerances, oral restrictions, less than ideal latch, or too much air in formula preparation.

Food allergies

While it's true that IgE-mediated food allergies are uncommon in babies and toddlers, non-lgE-mediated allergies (often referred to as intolerances) are not uncommon at all.

Babies can have a food intolerance to a food their breastfeeding parent is eating, even if they haven't started solids yet. Food allergies can cause reflux, painful gas, diarrhea or constipation, eczema, enlarged adenoids, congestion, blood or mucous in stool, and more, all of which can cause a lot of discomfort and difficulty sleeping.

The top 12 allergens for children under two are cow milk protein, soy, egg, wheat, corn, legumes, peanuts, beef, oats, rice, tree nuts, and chicken.

It’s important to note that most babies and toddlers don’t struggle with any of these things.

Sleep in the early years can be so hard, confusing, and up and down. So much so that we can find ourselves starting to pathologize their sleep, desperate to find “the reason” why it’s so hard.

When really, there’s a good chance it’s just normal baby/toddler sleep!

Nevertheless, it’s still important to know what the red flags are so we can distinguish between what’s normal and what warrants further exploration. If there’s one thing I know for sure, it’s that sleep training won’t solve an issue that actually has nothing to do with sleep! Sleep training is a Band-Aid solution to these problems and if anything, delays us getting our child the support we need to get to the root cause.

If you’re seeing one or more of these red flags and need someone who can help you determine your next steps, or you want some help identifying what will go away on it’s own, what can be tweaked with some gentle sleep support, and what’s a red flag, consider booking a consult with one of my Baby and Toddler Sleep Specialists today!

What makes my approach *different:*

The whole gist behind most sleep training programs is that you have to follow their rules for it to work… even if it feels awful.
That’s not what we do here. I will never ask you to do anything that goes against your intuition.
**You’re the expert, and you get to call the shots.**

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