Your Kids Will be Fine with Dr Milobsky

Understanding Toddler Sleep and Parenting Approaches

This episode explores the essentials of healthy sleep routines for toddlers, addressing common challenges like bedtime anxiety and early wake-ups. Learn about the role of routines, melatonin, and environmental factors in optimizing sleep. Dr. Milobsky also discusses effective parenting styles and approaches tailored to unique child needs.

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Duration:: 18m
Broadcast on:: 02 Jan 2025
Audio Format:: other

This episode of the podcast is brought to you by FOCO, that's FOCO, F-O-C-O. If you are a parent of a child or teen with ADHD, you know how challenging it can be to keep them focused and engaged. FOCO is the all-natural solution for ADHD, whether it's for school, homework, or just everyday activities. FOCO helps your child or teen stay calm and attentive. Before trying prescription drugs like Adderall that can come with hard side effects, I recommend you try FOCO. Visit ThinkFOCO, that's T-H-I-N-K-F-O-C-O. ThinkFOCO.com for more information. Welcome to the Your Kids Will We Find Podcasts. As always, I'm Dr. Michael Mollopsky, board certified pediatrician. In Parent of Seven, at Your Kids Will We Find, we're here to help parents overcome the information overload of today's parenting and try to cut through to what's really important, help parents understand that there are lots of right ways to do the same thing, and that maybe that your kids will be fine. Today, we are continuing our series on toddlers. Remember, you can find your Kids Will We Find at every podcast platform. Also, find us on YourKidsWillWeFind.com, where you can download every episode, leave us comments, and show suggestions. Continuing our favorite group of people, toddlers, focusing on kids who are usually between one and three years old. We talked about toddler behavior, toddler eating. We're going to get into toddlers and sleep. Sleep is a huge topic for parents of children of any age. Parenting and being a new parent, especially in the first four to five years, is really for a lot of people, the first time in your adult lives that you are forcibly going without sleep or without adequate sleep for long stretches of time. It's probably the most physically taxing and demanding part of having a newborn and raising kids through their toddler and preschool years. We hope that most toddlers will develop healthy sleep routines. Here's some things to expect from normal toddlers in sleep. First is that toddlers thrive on structure and routine, meaning one of the most important ways to encourage your toddler to have healthy sleep routines is to have a routine. Structure, predictability, repetition. Toddlers love all of those things. If you are a parent of a toddler, you'll know this in lots of ways that they conduct their lives. Toddlers love reading the same book over and over and over. Toddlers love doing the same things in the same order. It brings them a sense of predictability and security and makes them happy. Same thing with sleep, having a routine. Keys to a good toddler sleep routine is one, starting bedtime early enough. Here's the thing about most toddlers is that toddlers don't sleep in. There are definitely going to be people out there listening that say, "Hey, my toddler sleeps till eight or nine o'clock." That's wonderful. That hasn't been my experience with all seven of my children. As a pediatrician who speaks to families all day, it is far more common that all toddlers, almost regardless of what time they go to sleep, are up at the crack of dawn. They're either well rested because they went to bed at a predictable early bedtime or their miserable because they were up too late. Keeping children up later does not translate into sleeping in important concept. And your bedtime routine, having all the elements of low lighting, calm, quiet environment, lots of books, lots of physical closeness, all help toddlers transition into healthy sleep. Toddlers often develop anxiety around going to sleep, going to sleep on their own in a room in a space separate from your parents. Once you reach that age is anxiety provoking and it's very, very normal and very common for kids to fight it. They want people to stay close to them. They want their parents with them so they can fall asleep and feel secure. And there's no absolute right or absolute wrong way to approach them out. It is certainly okay to find a gradual way to separate from your toddler over time and give them the competence they can fall asleep on their own. But that isn't everybody. And a lot of toddlers with repetition and practice get really good at simply getting into their sleep space and falling asleep on their own and waking up usually in the five to six o'clock hour. You know, remember that toddlers like the rest of us have a system in their brain that programs their circadian internal 24 hour clock. And part of that system is melatonin. A lot of families that I work with use melatonin often. So I think it bears a quick discussion on healthy, appropriate use of melatonin who really needs it and who benefits the most from it. Melatonin is a hormone that our brain produces in response to darkness that resets our circadian rhythm in our internal 24 hour clock to sort of balance our sleep weight cycles with our light dark cycles that we live in. What happens normally is that usually in the latter last third or quarter of the day, our brain produces a slight surge of melatonin you're talking on the magnitude of 0.3 milligrams. And then that helps us transition our brains that's our clock to get drowsy and fall asleep as the sun goes down and it gets dark. The things that I naturally optimize and promote that healthy melatonin surge in our response to it are lots of outside time and lots of exercise. So having our toddlers have lots of time outside and lots of busy time and it really, really helps promote a healthy natural optimization of that melatonin surge. So our too much screen time can hurt them as well as screen time that goes too late into the day and crosses over into the evening times which prevents the normal surge of melatonin that we normally see that sets our brain and our brain clock ready to go to sleep on time and can sometimes disrupt normal sleep function. So doing what we can to optimize that, turning off artificial and blue light and screens several hours before the target bedtime and engaging in all those late day and evening activities that promote the transition to drowsy sleep to optimize that normal melatonin surge is the best thing to do. There are some children because of because of certain conditions they just produce less melatonin and those kids can benefit from supplemental melatonin. The first are kids who are autistic, kids on the spectrum, definitely under produced melatonin. A lot of them need and do really well with melatonin supplementation. However, I think most of the supplement the supplemental melatonin that's used is too high. We want to mimic the natural pattern of our melatonin with a small surge three to four hours before target bedtime. So that's usually on the order of one half to one milligram, especially for a younger child. I'm talking to a toddler aged child, maybe one to two milligrams for a school aged child, three to four hours before the target bedtime to go to sleep. Also kids with severe ADD, and that's usually an older kids, and also kids with neurocognitive deficits, kids who are ex-premise and have neurocognitive disabilities because of that. Kids who have traumatic brain injury, all of those children can benefit from supplemental melatonin if used properly, but it's important to understand the factors that optimize our natural melatonin to promote sleep. So now we're going to move on to a big topic that also I think a lot of our families and a lot of our parents really get into when it comes to toddlers is really start understanding and delving into parenting styles. Now, there is any enormous amount of content on social media and the internet on parenting styles and what kind of approach and there's gentle parenting and permissive parenting. There's helicopter parenting, there's using the models of the engineer and the gardener, all kinds of metaphors. What has been shown consistently over and over when we look at the people who study this and people who are developmental and behavioral psychologists and specialists who spend most of their time on this, there isn't any one parenting hack or parenting style that is always the same for everybody. The truth is, as a parent of seven, all seven of my kids were very different people. They had very different personalities that emerged on their own and they all required somewhat different approaches to our parenting to give them what they needed to help them in the ways that they individually, that helped them thrive individually. There wasn't one way we could simply apply across the board that made everyone that worked the same for everybody. People are too complicated. In general, having the concept of kindness with firmness and structure and then being able to plug in what your child needs around that idea is usually going to work, well, and usually going to be allow the parent to adjust as they learn about each child's individual needs. I had children who were so self-sufficient and so self-regulated and generally not didn't get, have emotional highs and lows as much and I had kids who were supremely sensitive children and very reactive. Both of those kinds of kids need a special approach to address their needs, to help them thrive. And so, you have to be able to change gears and do it within the confines of kindness and structure. So, parenting styles, I think, gives people, I think, the idea that there's some magic bullet for every kid and that's simply not the case. Russell Barkley is really well published PhD author. He's an academic behavioral psychologist that specializes in child development and he's fond of saying that your child is born with over 400 psychological traits that will all emerge as they mature and get older and they have nothing to do with you. Your child is an amalgam of your genetic ancestry that came together and produced the person that you have in front of you. It is a fallacy to think that you can engineer any particular outcome in a child and that taking the approach that you provide similar to a shepherd and their sheep, you provide a stable loving and nurturing environment, you provide nourishment, you provide the field that they graze in and the protection and watching over them and guidance knowing that the outcome is going to have everything to do with who they are and what they were given and not anything that you do or don't do. So obviously, I'm excluding extreme psychological trauma and emotional trauma that parents can inflict on their children, but that's not the norm. So when I was raising young kids, I think the single best parenting advice I ever got when it came to managing toddler life was the 80/20 rule. And that is, is that 80% of your interactions with your toddler and young child should be either neutral or positive. And only 20% of the time are you really setting a boundary that you're really saying, hey, this is an absolute. And no matter what your response is, this is that important that we're going to abide by this regardless of how it makes you feel. That shouldn't be most things in the life of a toddler, meaning that if your house is messy, your house is messy because you have toddlers, and it isn't something you have to chase your toddler around and constantly correct them for making a mess or picking up a message, just not something that is appropriate for them to do. It's not appropriate for them to be quiet and calm all the time. So it, to prevent it from bothering you, it's not appropriate for them to sit still in a single place and clean their plate at every meal. You need to have the 80/20 rule allows parents to let go of a lot of things so that the vast majority of your engagement is neutral or positive. So when you do really do need to set a limit and a boundary, like bedtime is a limit and a boundary that needs to be set. Certain elements around safety, you know, brushing your teeth, sitting in a car seat. Those are examples of things that can't be negotiated and are hard boundaries. But those are much more meaningful. And plus your life isn't revolving around having conflicts with your toddler and your three-year-old over things that probably aren't that important. So when we adopt the 80/20 rule, it's really up to us to change and truly up to us to structure our lives to optimize a positive environment, a parenting environment for our young child. So last topic that I want to touch on has a lot to do with childhood autism. The toddler years are when most kids end up being evaluated and diagnosed with autism and as much of my audience now knows rates of autism have continued to climb through the last several decades. Usually it stands at 1 in 36 children or ultimately diagnosed with an autistic spectrum disorder. As to why that is and the factors behind that, I think there's several theories. No one has all the answers. But what it seems to be clear is that one, our understanding of what constitutes autism has broadened greatly over the last 20 or 30 years and kids who are seen as mentally disabled or cognitively disabled are now, before are now being labeled would fall under the umbrella of being labeled with autism now. So there are more kids who weren't previously diagnosed with autism who are now considered to be autistic. Two is that there are certainly environmental factors in our children's prenatal and postnatal life that we think might be also contributing given the fact that we know that certain viruses, illnesses that women can get in early pregnancy can affect neurocognitive outcome. Certain medications that women take can affect neurocognitive outcome. And things like air pollution, things like perhaps blood sugar disturbance or illnesses in early brain development after birth can all perhaps have impact and we're not previously recognized. One thing we know for sure and one thing that is not really considered a question is the impact of vaccines. It is abundantly clear after study dozens of studies and the truth, the simple truth is that there has been almost no topic in pediatric medicine studies as much as the connection between vaccines and autism and these studies were done in multiple parts of the world on different populations of children now numbering in the many many tens of thousands with different vaccines and the answer has always been and continues to be the same when the question is asked is that rates of vaccines and using certain vaccines especially MMR have zero impact on rates of autism. So that we know is it as a truth. We certainly haven't answered all of the open questions around rising rates of autism and I think we'll continue to look into it. Children in our practice and most practices are formally screened for autism at 18 months and then again at 24 months. There are several tools for that. There is now coming out a actually a fascinating tissue sampling that can be done anytime after birth that has a high rate of sensitivity and specificity and diagnosing autism early compared with standardized testing like the ADOS which is concurrently the gold standard for diagnosing autism and it's clear that autism on most levels is a genetic disorder which has some different expression based on environmental factors that you're exposed to. So I think that's our current understanding we use the M chat which is a highly reproducible and highly precise parental questionnaire given at 18 months in it too in order to help identify as early as we can kids who might be on the autistic spectrum almost every pediatric should be doing some formal formal autistic screening in the first in the first or second year of life. If you are not in receiving that your pediatric office you certainly want to ask about it. There are also more formal ways to get your child evaluated. There are teams in every community of of psychologists who perform some standardized testing in one-on-one and in-person situations to help diagnose more precisely autism and and so you certainly want to ask your pediatrician about that. Next time we're going to move on into the early school age and preschool years and talk about that entire period of life in parenting and we're looking forward to if you have any questions please or suggestions once again go to our website your kid will find.com found us find us any place where you get podcasts and we're looking forward to the next episode.