Is your child struggling with sleep? Rule out these red flags first

When your child is waking up almost every hour, struggling to go to sleep, get adequate naps, or any other combination of intense sleep struggles, it can feel overwhelming to try and figure out what is truly causing their sleep struggles.

At My Sweet Sleeper, we place a big emphasis on getting to the root of the sleep issues, rather than sleep “training”, because ultimately if the root cause isn’t addressed, the child will continue to struggle and their sleep challenges may even become worse. One of the ways we do this is by looking at all areas of sleep foundations- routine, sleep environment, awake windows and schedules, nutrition/activity, and emotional connection. Often when one or more of these areas are addressed, we are able to uncover the root cause and make some changes to help the child get healthier sleep.

However, there some situations that a child’s sleep issues persist, even after addressing the core foundations, and even focusing on your approach to wake-ups and soothing (aka, sleep teaching). Whenever I see a child is not improving after truly focusing on these areas, and giving it enough time (at least two weeks), I start to take a closer look to see if there are any red flags or symptoms of a deeper rooted issue. Some of these issues may also present immediately as symptoms or things that are “off” in the child’s sleep patterns.

Here are some of the most common red flags in pediatric sleep that you need to be aware of…

Allergies- Environmental and food allergies are unfortunately common, even in young babies and can present as early as a couple months old (or even from birth). Common food allergies in infants include: milk protein, dairy, wheat, soy, nuts, and eggs. And while, of course, a two month old baby is not eating solids yet and so is (hopefully) not ingesting any of these foods, they can have a reaction to them through breastmilk and their mother’s diet. Unfortunately babies are not able to communicate when they are having a reaction, so some symptoms to be aware of are: constant fussiness or gas, arching of the back when feeding or when trying to poop, excessive spit up, trouble eating or disinterest in eating, vomiting, diarrhea, and/or a rash. In severe cases they may have trouble breathing, but this is not as common in infants unless there is a severe allergy. While some of these symptoms can be normal and/or signs of reflux, if you notice that it is persistent, it is worth raising to your pediatrician to discuss potential allergies. Many babies also have sensitives to certain types of formula and will need to be on a hypoallergenic formula that you can discuss with your medical provider.

For older children, food allergies are more common and can show up as soon as they start eating solids. This is one of the reasons that your pediatrician will likely recommend introducing one new solid food at a time and keep a food journal, to ensure your child doesn’t have a reaction, and if they do, that you are able to determine which food it was from. In addition to the symptoms above, your older infant/child could experience hives, an itchy throat, and in serious cases, trouble breathing which would indicate an anaphylactic response. If this does happen, you should seek medical attention immediately.

Environmental allergies are also common among older children and can certainly disrupt sleep if they are being irritated in their sleep environment or their home. Common environmental allergies include: dogs and other pets, pollen, dust mites, mold, trees and flowers, and fragrance (to name a few). If your child shows symptoms of itchy or red eyes, hives or a rash, trouble breathing, persistent coughing and/or sneezing, headache, or other similar symptoms, it is possible they are being irritated by something in their environment. When this is the case, their sleep will likely be disrupted if they are not able to get comfortable throughout the night or during naps. If you suspect your child has any allergy (food or environmental), it is recommended to get allergy testing and then remove that allergen from the home or diet, which should help immediately improve symptoms. Running an air purifier in the room can also help remove toxins from the environment. You should also speak with your medical provider about other treatments such as medications if necessary.

Asthma- Asthma is another red flag that is more common in older children, and usually can’t be diagnosed until age three. However, some younger infants may struggle with reactive airway disease, which presents similarly. Symptoms of asthma include: trouble breathing (labored or retracted breathing), persistent coughing, low oxygen levels, wheezing, blue lips, and a faster heartbeat. Asthma can be triggered by viruses/illnesses, cold weather, allergies, or too much physical exertion/activity. While again, it is not as common in infants, you might notice that your child struggles with these symptoms often when they are sick, causing them to struggle with breathing which is a medical emergency. If you are noticing these symptoms you should alert your medical provider or seek out medical attention immediately. Asthma interferes with sleep when a child is coughing frequently or struggling to breathe well and in this case I often recommend that parents room-share with their child when they are having these symptoms (even if they are older) to monitor their breathing and oxygen.

Sleep apnea (or other sleep disorders)- Sleep apnea is a sleep disorder that causes pauses in breathing due to the muscles being too relaxed in the back of the throat, or the airway being obstructed, and unfortunately is common in pediatrics. Symptoms of sleep apnea include loud snoring, sleeping with the mouth open, restless sleep, bedwetting, fussiness, and feeling unrested. Because sleep apnea can cause pauses in breathing, it is very important to have your child seen if these symptoms are presenting as sleep apnea can be a serious condition. Other sleep disorders such as RLS (restless leg syndrome) insomnia, and arousal disorders, could also be present, so if you notice your child is experiencing symptoms out of the ordinary, it is important to raise these with your pediatrician for a diagnoses and/or treatment options.

Eczema- Eczema (or atopic dermatitis) is common among infants and toddlers, and can be present from birth. Eczema often presents as itchy and red skin, inflammation of the skin, raised bumps, or bleeding and crusting skin (often in cases that the child itches the skin frequently). Eczema can be extremely uncomfortable for children and affect their sleep if they are constantly up itching and struggling to get comfortable. While eczema can be genetic, it is often triggered by environmental allergens such as fragrance, certain soaps and body wash products, pets, dust mites, mold, etc. Eczema can also be triggered by food allergies. When a child is experiencing eczema, one of the best ways to treat it and help them become more comfortable is to switch to using all fragrance free products in the home (especially laundry detergent), bathe your child frequently and immediately apply cream approved for eczema, and use clothing that is soft and gentle such as bamboo or organic cotton. You can also speak with your medical provider about additional treatment options.

Note that eczema, allergies, and asthma are often interconnected and you may find that if your child struggles with one of these, they struggle with all of them. In this case, I would recommend seeing a specialist to ensure the proper treatment and management of these conditions.

Chronic ear infections- If your child has reoccurring ear infections and displays symptoms such as a high fever, pulling at the ears, and generally seems fussy and in pain, this is something that will certainly affect their ability to sleep well. While it is common for children to get ear infections at some point, getting them frequently is more concerning. If this is something you are dealing with, you will want to put sleep work on pause, and consult with an ENT (ear nose and throat specialist), to see what treatment options are available. Often getting tubes in the ears, and/or getting adenoids removed are one route specialists will take to help prevent the ear infections from reoccurring and to help manage symptoms. Because this can be extremely uncomfortable for children, waiting until these issues are resolved before focusing on other areas of sleep (especially independent sleep) is necessary.

While of course there are other conditions and underlying medical issues that could be present in your child, these are just a few to be aware of if your child’s sleep is not improving after working on sleep for several weeks or months. Any of these conditions can cause discomfort in the child, and cause them to reject sleep or have a hard time staying asleep. Once you are able to address these challenges you will likely see a huge difference in your child’s sleep and likely their overall mood and temperament as well!

*Please note that this is not medical advice and you should seek care from your medical provider if you suspect that any of the above conditions are present.

References:

https://www.nhs.uk/conditions/asthma/symptoms/

https://www.yalemedicine.org/conditions/pediatric-obstructive-sleep-apnea