Getting sleep back on track after illness
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When your baby or toddler is sick, sometimes you need to deviate from your normal routine to help your little one feel comfortable (to learn how to manage during illness, see this blog). Although slipping into survival mode is usually ok, deviating from your child’s normal sleep habits will often lead to new sleep associations. This blog will help you get your child's sleep back on track.
The Science Behind Illnesses and Sleep
Children under two will experience an average of six respiratory illnesses each year. Babies and toddlers in daycare experience higher rates of illness and may seem to be perpetually sick.
Even a mild illness can cause frequent night waking due to congestion, coughing, and sore throat. A child who was sleeping independently before illness may have difficulty falling asleep at bedtime and during night waking due to discomfort. During this difficult time, you may need to spend additional time with your little one holding, rocking, or even offering extra feedings to get through the night. While comforting your child during this time is absolutely appropriate, your child may re-develop a sleep association as a result of your extra comforts. As a reminder, a sleep association is simply the series of experiences or tools that your baby needs to fall asleep. A sleep association could be your child’s crib, rocking, bouncing, feeding, going for a walk in a carrier or stroller, a pacifier, or any combination of those or other things. You will need to teach your child to fall asleep independently after s/he is well again in order to reduce frequent night waking when s/he feels better.
Need More Help?
We offer several options for optimizing your child's sleep:
SLEEP TRAINING CLASS (for well babies 6-15 months)
PHONE CONSULTATIONS (with one of our sleep experts)
THE SECRET TO NAPS (downloadable e-book)
How do you get your child's sleep back on track after illness?
The best way to get back on track depends on how your child's sleep was before s/he got sick and also how you responded to your child while s/he was unwell. Each section below covers how to get back on track for different situations in detail, but here's a simple framework for getting back on track:
Step 1: Rebalance your child's calorie intake if you ended up offering more night feedings while away.
Step 2: Put your child down awake at bedtime and nap time using your preferred sleep training method (our class offers four different options).
Step 1: Rebalance your child's calorie intake if you ended up offering more night feedings when your child was sick
If your baby or toddler started eating a lot more overnight while sick, then work on re-balancing those extra nighttime calories back to daytime (see our blog on reducing feedings or make a night weaning plan using our self-paced class).
In brief, you will need to reduce your child's nursing time or bottle size, while increasing your child's daytime calorie intake. Some babies will be awake after a shorter nursing session or smaller bottle and you will need to teach your baby how to fall asleep after the reduced feeding. You can do this by using your preferred sleep training method, but if you aren't quite ready to take that step, then you can begin by rocking and comforting your baby after the feeding. Your baby might not love that interaction, but imagine that you are telling your baby through your actions, “I know you would prefer to stay latched, but I know that you can fall asleep without nursing.” Rocking is still a sleep association, of course, but some babies will get back on track simply by moving away from all-night feedings.
Step 2: Put your child down awake at bedtime and nap time using your preferred sleep training method (our class offers four different options)
For babies and toddlers who were sleep trained before illness: As soon as your child is symptom-free (or mostly symptom-free, your pediatrician can help you determine when to work on sleep if you aren't sure), begin "reminder" sleep training (this is covered in our sleep training class). For example, let’s imagine that your child had RSV and you ended up holding your baby upright on your chest to sleep because s/he was uncomfortable. Then, your baby started feeling better and started to expect to be held for naps and began waking during the night at sleep cycles looking held again. Since your baby already knew how to fall asleep before getting sick, you can take advantage of that understanding and put him/her down awake at bedtime once symptoms have subsided. Your little one may struggle with falling asleep independently again, but if you go back to whatever sleep training method you used to teach your child to fall asleep in the first place, then your child should quickly re-learn how to fall asleep and stay asleep independently again. By returning to a familiar set of sleep cues, you are basically saying “Hey sweetie, I know you enjoyed being held for sleep, but you're feeling better now and I know you know how to do this.” Your baby might wake during the night on the first few nights, in which case you would just repeat your sleep training. In situations like this, it typically only takes 1–3 days for a historically good sleeper to get back on track.
If you sleep trained your child as a baby, but your child regressed as a toddler, then you may need to shift to an age-appropriate strategy to get your child back on track. Our blog on toddler bedtime battles should help with this, but we can also help devise a plan with you in a one-on-one consultation if you aren't sure what to do.
For babies and toddlers who do not know how to fall asleep independently: Sometimes your child will be dependent on sleep associations that are manageable, but then sleep will take a turn for the worse during illness. For example, let’s imagine that you nursed your eight-month-old to sleep and s/he woke up twice during the night, but because he/she was sleeping in your room it wasn’t too bad, and everyone was getting reasonable sleep. Then, your baby got sick and started waking hourly or wanting to stay latched while sleeping. Now your little one is feeling better, but s/he wants to stay latched continuously in order to sleep. In situations like this, you need to make a plan to teach your baby how to fall asleep on his/her own in order to alleviate the sleep association. In this case, you will need to make a plan to teach your baby how to fall asleep on his/her own at bedtime (our sleep training class offers four different options on how to do this). If you aren't ready to sleep train, then work on giving your child practice lying in bed awake and try to slowly work up to having your baby fall asleep independently. During night waking, work on trading down sleep associations by unlatching your baby after a prolonged nursing session in favor of rocking/shushing/snuggling. It won't be easy, but it will help your baby move away from the expectation that nursing is required for sleep.
Other things to consider:
Are your sleep expectations in line with what your child is capable of doing?
Babies and toddlers change fast! Sometimes illness can coincide with, or even trigger, developmental milestones. For example, your baby might need a different amount of sleep (maybe fewer naps, for example) than before illness. See our sleep chart to make sure your baby’s needs are in line with what you are asking him or her to do. Similarly, if your baby got sick right before his/her four-month birthday, he/she may have gone through the four-month regression while sick. Other sleep regressions happen with explosive development around nine months, around 18 months, and during the development of new motor skills. In all of these cases, it’s important to reassess your child’s changing understanding of what you are doing. As always, if you just need to have a conversation to work through what's happening with your child's sleep, then we are happy to help.
References:
Toivonen, L., Schuez-Havupalo, L., Karppinen, S., Teros-Jaakkola, T., Rulli, M., Mertsola, J., Waris, M. and Peltola, V., 2016. Rhinovirus infections in the first 2 years of life. Pediatrics, 138(3).
Nafstad, P., Hagen, J.A., Øie, L., Magnus, P. and Jaakkola, J.J., 1999. Day care centers and respiratory health. Pediatrics, 103(4), pp.753-758.
Simpkin, C.T., Jenni, O.G., Carskadon, M.A., Wright Jr, K.P., Akacem, L.D., Garlo, K.G. and LeBourgeois, M.K., 2014. Chronotype is associated with the timing of the circadian clock and sleep in toddlers. Journal of sleep research, 23(4), pp.397-405.
Price, A.M., Wake, M., Ukoumunne, O.C. and Hiscock, H., 2012. Five-year follow-up of harms and benefits of behavioral infant sleep intervention: randomized trial. Pediatrics, 130(4), pp.643-651.
O’Shea, K.J., Ferguson, M.C., Esposito, L., Hammer, L.D., Avelis, C., Hertenstein, D., Gonzales, M.S., Bartsch, S.M., Wedlock, P.T., Siegmund, S.S. and Lee, B.Y., 2021. The impact of reducing the frequency of night feeding on infant BMI. Pediatric Research, pp.1-7.