From Monday 6 July to Friday 10 July were are lucky enough to have CharmaineChamp with us to answer any questions you had about continence and sleep issues.
This topic is now closed, but please do read Charmaine's amazing posts for advice and information for anything to do with continence and sleep.
Charmaine is a Continence Consultant and Trainer, and she specialises in Continence, Sleep and Behavioural Assessments, support, advice and training. She also the author of two books. You can find out more about her here - healthunlocked.com/user/Cha...
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I am really looking forward to supporting you all through this exciting event, taking place here, online during the 6th and 10th July.
As a Continence Consultant and Trainer, I specialise in continence, sleep and behavioural individual assessments, support, advice, and training for all children, including children with autism, learning disabilities and complex needs.
My background includes being a registered nurse in learning disabilities since 1994, community nurse specialist for children, specialising in the promotion of continence and management of incontinence, being part of the Hansel Trust Research and Sleep Practitioner training and group, and promoting positive practices in behavioural support, IABA. My work has taken me all over the country supporting children and their families. I also support clinics, public and private sectors, nurseries, schools, care homes, residential homes, charities, organisations and professionals all have the same aim, of providing support, advice and information for individual children and their families to enable them to be successful with their continence, sleep and behavioural needs and promote a consistent approach.
Through my role I support children and their families with being successful with sleep, exploring and supporting: "Where to start with sleep?" "Introducing a sleep routine?" "Supporting with how to encourage children to settle at night and sleep through the night?" Exploring the physical and sensory aspects of sleeping, and many more areas.
I also support children and their families in being successful with their continence needs, through exploring: "Where to start with night-time wetting?" "Day time Wetting accidents?" "Poo accidents" "Holding on to poo and wee?" "How poo affects day time and night-time wetting?" "Where to start with potty and toilet training?" "Wearing clothes and potty training?" Exploring the continence and sensory needs when being successful in "sitting" on the toilet!, and many more areas.
If you or any of your family have any concerns, queries or questions about your child's continence (wee, poo or toileting needs) or sleep needs (being unable to settle until late, waking too early, waking in the night, or sleeping for a short amount of time), then please feel free to forward any questions you may have. I will be more than happy to explore these with you and help in what ever way is possible!
For any further advice and support, in between or following this event please feel free to visit my business page: facebook.com/ContinenceCons...
I look forward to supporting you all through this lovely event!
My boy is 7 years old, has Global Delay and is awaiting for an autism assessment. He has been reliably dry for four years but has made no progress at all about soiling himself every day. He will sometimes take himself off including to hide under tables to poo rather than go to the toilet. And will sometimes become agitated before it actually happens. He is starting to ask for help in clearing up and we are supporting him to do this himself but other times he will just sit in until he is discovered.
There appears to be no reliable pattern to his pooing so we have to be on active clean up standby. He will rarely Cooperate with sitting on the loo to try and can be either passive or extremely vocal and agitated.
He has speech and language difficulties but can reliably tell you what should happen - including toilet games with teddy etc - but he isn’t able to articulate what is going on for him.
He is very vigilant/reactive and vocal about dog pop on the street and will make a big fuss when he sees it including shouting and repeating the word again and again.
Any advice about what approach we should take jointly with school or across the Summer holidays?
Thankyou for your questions and sharing your sons continence needs.
When considering being successful with continence needs we need to "Be Prepared" by being in tune with your child’s wee and poo!
Because….The key to successful toilet training is knowing your child’s wee and poo habits, identifying any complications and addressing these….before moving forward, we can almost view these needs as the foundations of success.
By exploring poo, and how we poo we can understand how and why behaviours occur. When a poo reaches the rectum, the muscles stretch, this stretching sends a message to the brain indicating that we need to poo. If the urge to pass a poo is not acted upon, the poo is returned to the colon, where more water is absorbed, and the poo is stored, the poo can then become hard and dry, and poo becomes "stuck" causing a "poo traffic jam" resulting in constipation.
Many people believe that constipation is just when a poo is “not” passed. Not passing a poo for three days, can mean constipation, because Constipation "is" when poo gets stuck!
However, poo "can" continue to be passed, either a more liquid type poo, leaking around lumps of poo, or passing small or parts of a poo. Resulting in incomplete evacuations. When this occurs, this is referred to as Constipation with overflow. The liquid type poo can appear as soiling, stains within the pants or accidents. Also, children can hold on to there poo, because it can be uncomfortable, and hide to pass a poo.
When this does occur, children are unaware that they have a build up of poo or have a poo traffic jam because the rectum is already stretched with the stored poo, so "no" new messages are received by the child.
As a Continence Consultant and Trainer I always start with a comprehensive assessment. Through an assessment process, poo and wee are able to be explored in depth:
. With poo, looking at the time children poo, where, the type according to the Bristol Stool Chart, size, appearance and childrens behaviour
. With wee, looking at the time wee is passed, size, appearance, the types of drinks and when drinks consumed as well as childrens behaviour
As a family you too can explore poo and wee in depth by introducing the Bowel and Bladder Assessment Pack with your child.
The Bowel and Bladder Assessment Pack is designed to support families, carers and professionals by
. Identifying childrens presenting needs, poo patterns through the Bowel Monitoring chart
. Wee and drinking patterns through the Bladder and Fluid Monitoring chart
. And Eating patterns, through the Food Monitoring Chart
. The assessment pack also provides an assessment which helps you identify poo and wee complications, detailing what to do when “Finding” a complication and the “Action” required
The assessment pack enables you to gather “all” relevant information and ensure “all” aspects of a child’s continence needs are considered “and” addressed.
I have produced a series of videos for families, offering help and support around childrens continence and sleep needs, I will attach the video focussing and discussing where to start and how to monitor poo and wee:
With regards to promoting a joint approach between the family home and school in helping your son move forward with his continence needs, I would recommend:
. Introducing the monitoring charts described above, within both areas (if at school before the summer holidays) or you could implement this approach within the summer holidays within just the family home. Then either feed this information back to your GP or liaise with myself about what further support options are available.
. Introduce and revise structured routines and visual aids, to support changes to your sons routine. Routines can provide comfort, calmness and provide self-regulation. Visual aids can provide an easier communication method, to make sense of what is happening, what is expected, and confirmation of what changes may be required.
The full purpose of a visual timetables are not just to let the child know what's going on and in what order but also as an important teaching tool too. The two main benefits to promoting and implementing Visual Aides are:
Developing memory and recall skills. Seeing the structure of the day or activity can help with memory skills for children who are able to think better in pictures than in verbal language.
Teaching organisation and independence skills. The child should be managing their own timetable. That means self-checking what they should be doing and where they should be, managing to take off the symbols and putting them in the finished pocket themselves.
Visual timetables grow with the child and should therefore be age and developmentally appropriate
You are able to find out more about communication approaches and visual aids, through the following links:
•Microsoft Word: common symbols are available in the Wingdings font.
Using rewards is highly recommended. There is a lovely website which prompts the user to follow some simple instructions and create your own star charts:
According to Carol Gray a Social Story describes a situation, skill or concept in terms of relevant social cues, perspectives and common responses in a specifically defined style and format. The goal of a Social Story is to share accurate social information in a reassuring manner that is easily understood by its audience. You can learn more about social stories and how to write and use them by visiting the official website thegraycenter.org/socialsto... where you will find lots of information, links and resources.
. An example of a Social Story which is ready to use is: Bobby Can Use The Toilet. Through this picture, story, it clearly states what happens when going to the toilet, where wee and poo goes and breaks the steps down. Through another of my videos I have discussed and shared this, I will attach it for you:
. I would also recommend building upon your sons association of "where" poo goes. For further information about this, please view this video of where to start:
Through this response I have tried to share that there are several approaches in supporting your son in moving forward with his continence needs, and hopefully haven't overwhelmed you with this. As I have mentioned in other posts, please don't feel like you are on your own with this situation, help really is available.
I am more than happy to speak to you and your family about any concerns you may have about poo or wee, through a FREE introductory telephone call (UK) or online Zoom call for families living outside of the UK, to discuss how I can support you further.
Speak soon
Charmaine
Continence Consultant and Trainer
Providing Specialist Continence Sleep and Behaviour Assessments, Advice, Training and Published Book Information
My son is 11 but we still accidents at night. He was very late potty training, but we eventually got there.
He has a pretty regular night time routine. To be honest, the issuee isn’t the sleep – it is the fact that he is so deeply asleep that he doesn’t realise he needs the loo.
Until recently he wasn’t too bothered about this, but increasingly he finds it very embarrassing.
We currently cope with it by having a waterproof sheet and doing a lot of washing.
Any thoughts? I have to say I feel ridiculous complaining that he is sleeping too well as a few years ago I would have said getting him to sleep was the biggest issue we faced.
Thankyou for your question about accidents during the night for your son. Night-time wetting affects half a million children across the United Kingdom, however sadly help is often "not" obtained due to the embarrassment you mentioned, so it really is fantastic that you have been able to raise this question, because help "is available", sometimes its taking the first steps.
Night-time wetting or nocturnal enuresis is wetting occurring at night in a child aged five years or over and is identified as being present when a child age five years or older, wets the bed twice a week for at least three consecutive months or experiences significant distress
The impact of night-time wetting on the child and family can result in:
Low self esteem, low self confidence,
bullying and teasing by siblings or friends,
Children can appear withdrawn and anxious,
Sometimes children can have difficulties making and keeping friends,
Children can feel isolated by opting out of sleep overs,
And night-time wetting can affect under achieving at school
To help children over come the impact of night time wetting, we need to look at how we wee! And Where wee comes from to understand what the possible causes of the night time wetting are
and how we can help!
Most of us have two kidneys, the role of the kidney’s is to filter the blood, taking out the waste, the waste is wee! Kidneys are like wee factories
The Long thin tubes called ureters, carry wee, to the bladder
Bladder. Wee is stored in the bladder.
The Bladder is like a balloon, stretching to hold our wee. The stretching sends a message to brain when bladder is full. when the bladder is full, we can go to the toilet our bladder muscles squeeze and keep squeezing until the wee is gone!
There are two sets of muscles to keep wee safe, holding on ones at the bottom to keep the wee in
And stretchy squeezy ones which relax to hold wee and squeeze when its time to empty
All Muscles need to be exercised to keep fit! When we are helping our children to be successful with their continence, being successful with wee, we need to ensure we encourage our children to fill and empty their bladders, throughout the day. Which means "drinking and weeing".
Not having enough drink or drinking the wrong drinks can lead to an unfit bladder! And wee difficulties, including night time wetting.
It is recommended that we “all” drink 6-8 cups of water, across the whole day. And ensure all drinks are stopped an hour before bed.
When reviewing drinks, it is also vital to consider not only how many, but when drinks are being consumed AND what is being consumed.
Water is best, however we all appreciate that not all children drink water, so we need to encourage drinks that are mixed with water, like squash. Then we can look to make the squash weaker, diluting the squash to ensure there is more water content.
Certain drinks can irritate the bladder, like:
blackcurrant squash,
Fizzy drinks like Diet Coke
Hot Chocolate.
These drinks are some of the known fluids that irritate the bladder, through there caffeine content.
Caffeine stimulates the bladder through increasing bladder activity including higher urgency and frequency to pass a wee, meaning you go to the toilet or feel like you need to go “more”, which means your bladder does not fill and empty as it should. This can contribute to increased night time wetting.
There are several causes of night time wetting
Genetic, Emotional difficulties, Constipation, Urinary Tract Infections and bladder difficulties and sleep arousal to name a few,
I would recommend the following as a starting point:
You can start by helping your son drink 6-8 cups of water or water based fluids across the whole day
Reviewing the types of drinks your son has
And when they have their drinks
And ensure their last drink of the day is an hour to an hour and a half before bed
I would also recommend monitoring your sons wee and poo habit's in the day.
I have produced several videos for families offering help and support around continence, sleep and behaviour. I will attach one of my videos focussing upon how to monitor your sons wee and poo to help you start moving forward with this:
ERIC The Childrens Bladder and Bowel Charity have also produced amazing resources to help manage the night-time accidents, I will attach their website for you to view the other products available to support your son:
As a Continence Consultant and Trainer I am also more than happy to help you further with your sons needs, if you would like any further information and advice I am more than happy to discuss the support options available:
Thankyou so much for taking the time to ask your question, I hope this information helps you and your family and provides a starting point with your son. If you would like any further information, please try not to feel like you are on your own with this, help really is available!
Speak soon
Charmaine
Continence Consultant and Trainer
Providing Specialist Continence, Sleep and Behavioural Assessments, Support, Advice, Training and Published Book Information
So glad to have found this ask the expert - exactly what I needed!
My sister is 29, diagnosed with CHARGE syndrome but also development delay. She wears incontinence pads constantly, day and night, and changes them regularly. She went to the GP at my parents urging and they offered her physio, but nothing came of it and she was very resistant. She won't talk about it with any of us and gets embarrassed, so we don't know if it is a physical problem or one caused by anxiety. She didn't have this problem as a child, but has had for the past 7 or 8 years. It may be that this is just how it is and she will always wear pads, but if there was a way of getting her to a place where she didn't need to wear them, it would really improve her quality of life.
Any advice on what to do or further places to look for information would be wonderful.
Thankyou so much for taking the time to share your sisters situation, I am so pleased you have been able to find Mencap support page.
When looking at being successful with using the toilet and reducing and then stopping using continence aids, pads, we need to explore wee and poo equally. Often poo difficulties present as wee symptoms, which is why it is so important to examine both!
As a starting point I always recommend monitoring wee and poo over a fourteen day period, through this approach patterns, habits and any difficulties can be identified and followed-up and support provided, before moving forward.
I have produced several videos offering advice and information for families, I will attach one of my videos focussing on how to monitor wee and poo to support you with this:
My background is community nurse specialist for children and adults with a learning disability and complex needs, therefore although the videos may focus on children the fundamental principles and approaches have been utilised and implemented with adults as well.
Poo can affect daytime and night wetting, but how?
Constipation can be the cause of daytime and night time wetting accidents, because when a bowel is full of poo it can press against the bladder. The bladder becomes squashed and struggles to expand fully to hold lots of wee. And as a result, people can feel the urge to wee more frequently and either do lots of small wees or not be able to wee at all!
Following monitoring of wee and poo, if you identify the following, I would recommend contacting the GP, or myself for further advice, if:
. Painful poos, runny poo, small blobs of poo or poo that looks like rabbit droppings
are passed
. They poo less than four times a week
. Their toileting routine is very inconsistent
. They have lots of poo marks in their underwear (called faecal soiling).
As a family, you can also support your sister with her day time wetting and night time wetting by:
Encouraging Drinking plenty
Drinking plenty means drinking 6-8 cups of water based drinks throughout the day, and stopping an hour to an hour and half before bed.
Well-diluted fruit juice or squash can also be included. Avoid drinks containing caffeine like tea, coffee, hot chocolate, cola and energy drinks.
Do bladder exercises
Overcome wetting by exercising the bladder, this means filling and emptying it properly at regular times
throughout the day.
We need to empty bladders between four and seven times a day. This means ensuring your sister has four to seven opportunities of using the toilet each day.
If your sister waits too long between wees, the bladder muscles will do too much stretching and not enough squeezing. If they forget to go to the loo, they could use a special watch that vibrates to remind them to go.
Another way to help is: helping your sister relax
The best way to empty their bladder properly is to make sure she can relax while she wees.
You can help, by encouraging her to sit comfortably with her feet flat and firmly supported on a box or stool. Her knees should be above her hips. You may need to review the toilet seat to help get them into a secure comfortable sitting position.
Thankyou so much for taking the time to ask your question today, I hope this information helps you and your family, in making a start with identifying wee and poo patterns and habits and any possible difficulties before then moving onto to supporting your sister in being comfortable upon the toilet and using the toilet regularly.
As a Continence Consultant and Trainer I am more than happy to support you further with this, please feel free to contact me:
Hi. I am also pleased to have spotted this. Very timely. I have posted here before about sleep issues. My son is 5 and was a very bad sleeper (but we have made some progress on this). but he is still an early riser.
We are now struggling to potty train him. He is now of an age that he thinks it is something for babies. We’ve abandoned pottys but many toilets are hard for him to use. Between communication issues and co-ordination issues we don’t seem to be making much progress.
He doesn’t seem very worried when he doesn’t make it time. To be honest I don’t think is worried about wearing nappies at all, and I ask much as I would like this to change I don’t want to make him worry.
He is very active so nappies are a pain.
I would love him to manage it as it would free him up to do more things.
I have read you other posts and there is some good stuff in there. I just wondered if there was different. Thank you. Adam
Thankyou for taking the time to share your sons toileting and sleep needs. I am really pleased to hear that you have found some of the information I have already shared useful and to hear that your son has been progressing with his sleep, that's fantastic!
With regards to encouraging your son to sit on the toilet, comfortably and looking at moving away from nappies, I would recommend starting to encourage your son to recognise wee and poo signals and encouraging him to drink a minimum of 6-8 cups of clear drinks, every day! Water is best or drinks that contain water like a weak squash. And ensuring we Spread the number of drinks over the whole day! And stopping an hour to hour and half before bed
Why? Because by drinking regularly ensures our bladders and rectums are full.
When we have a full bladder, the muscles stretch, its this stretching that sends a message to the brain, letting our child known that they need a wee. By drinking regularly also ensures our poos are soft and passed regularly. When poo reaches the rectum, the muscles stretch and send a message to the brain, letting our child know that they need a poo. Drinking is vital, in enabling our children to recognise wee and poo signals
Children often fear the unknown. Developing your own family routine provides consistency, security and sets your child up with good habits for life. A consistent routine in the home will have fewer variables so your child can relax in knowing what to expect.
Routines include drinking and eating as well as set times for potty and toilet training.
Once you have implemented monitoring charts about when, how, and identified the type of wee and poo passed, and rules out any urinary tract infections and constipation, you can also support your son in understanding the signals of weeing and pooing, by wearing clothes as part of the potty and toilet routine. When starting the routine, you can introduce boy pants.
Yes, it is true your child will have wet pants. But, this really is ok, this is how they will learn! Your child will Learn to associate that this means they need a wee or a poo!
You can help your son, by ensuring they have enough pants. You can also help your child by ensuring they have enough easy to pull on and off trousers, etc
Children have always been used to having there wee and poo collected within a nappy. The role of a nappy is to absorb the wee, and dampness from poos, removing any sensation and feeling for our children. For babies, this is great because it reduces the occurrences of rashes and discomfort and provides comfort and security.
However, during the potty and toilet training stage, nappies and pull ups do not provide the opportunity for children to feel wet or damp and associate this with needing or using the toilet.
There are many ways of helping your child recognise that they need a wee or a poo.
One of the ways we can help our children is introduce a routine of wearing a product like: Dry like me, potty training pads. This product can be placed within a child’s pants, either used at the front for wees, at the back for poos or for both!
Through utilising the pads at specific times of the days enables your child to build an association of weeing and pooing, while wearing clothes, as well as reducing smaller accidents.
Dry like me are available via ERIC The Childrens Bladder and Bowel Charity.
We can also help our children associate weeing and pooing in the toilet, by ensuring “all” toileting activities taking place in the toilet / bathroom area.
This means encouraging your child to sit for one minute for each of there years. For example if your child is five encourage your child to sit for five minutes.
It also means emptying the potty contents in the toilet “and” any accidents that take place in the pants being tipped / emptied into the toilet and the toilet routine continued, for example wiping of the bottom, flushing the toilet, washing and drying hands and your child rewarded for participating in part of the toilet routine.
By having the toilet routine, in the toilet / bathroom, your child will then associate that area with wee and poo!
As a Continence Consultant and Trainer I have been producing a series of videos. One of my videos focusses on sitting on the toilet, looking at the reasons why this may be difficult and how to over come this. The video also explores different supporting options that your son could possibly use to be able to sit comfortably on the toilet. I will attach the video for your information:
With regards to waking early each morning. We need to look at how we develop a successful bed time routine.
Successful bedtime routines, always start with the circadian rhythm and biological clock. The circadian rhythm is identified as a twenty-four hour internal clock, which is running in the background of the brain and cycles between sleepiness and alertness at regular intervals. Circadian rhythm's help determine sleep patterns. The body's master clock controls the production of melatonin, a hormone that makes you sleepy. It receives information about incoming light from the optic nerves, which relay information from the eyes to the brain and helps us sleep and wake at regular times each day.
The biological clock is about every tissue and organ within our body operating according to biological rhythm's. The so called biological clock, keeps body processes running according to a schedule. During my previous series of sleep videos I have explored how, what we eat and drink and when we eat and drink affects our internal body and when and how we can sleep. When our internal processes are irregular, our sleep can then be disrupted.
One of the ways of supporting your son, in being successful with his sleep is introducing a bed time routine. This means having a set time of going to bed each night “and” having a set time of waking each morning. By having a routine and regular time of going to bed and waking each morning means our internal body is able to process and run affectively and prepare and maintain a sleep routine and enable your child to receive the sleep that they need.
A bedtime routine can be promoted through introducing structured activities following the evening meal, at the same time each evening.
Please feel free to view: How to help with sleep? video for further information on my business page, link is below.
If you would like any further information about the topics I have discussed as starting points, in helping your son move forward with his toileting and sleep needs, please feel free to contact me:
I just thought I would share a sleep situation for you all, I have supported many families through sleep difficulties, and thought I would share where to start, if this sounds familiar with your child:
How can you encourage your child to settle in bed and sleep through the night?
There are many factors that can affect children going off to sleep and settling in their beds to sleep through the night.
External factors affecting sleep can include:
Light
Noise
And Temperature
Sleep wake cycles have been identified as a 24 hour daily sleep pattern, with Circadian rhythms regulating the body's master clock, releasing hormones and regulating body temperature changes. The cycles have been identified as being synchronised to daily light and dark cycles of the environment, affecting sleep and wake times.
Therefore ensuring that a bedroom is not too hot and not too cold and reducing the light within a room, can dramatically improve a child's sleep.
To reduce the light entering a room, you can introduce:
A blackout blind
Or a Gro anywhere blind, which attaches to your window using suction cups and is fully adjustable to fit the window
Or hang towels over your existing curtain pole
Babies are used to hearing constant noise, when within the womb, even repeating the words “shhh” “shhh” mimics a mothers heart beat. However, often when babies are born, noise is removed and a “don’t wake the baby approach” is implemented.
However, “white noise” can create a calming and soothing environment for our children and even us as adults. As adults the sea or calming acoustic music are the go to sounds to help us relax, children prefer noises that are constant and in the background, such as washing machines, vacuum cleaners, fans or running water.
Every child is different, so its about finding the right noise that works for your child, as well as one you are happy to listen to as well.
White noise works, in helping settle your child to sleep, because your child can focus upon the noise / sound.
Within my first sleep series video I discussed the importance of routine and explored how, what we do in the day affects how and when we sleep.
When considering the factors which affect our children settling to sleep, external factors have been confirmed, however it is also important to consider Internal Factors.
Internal Factors affecting sleep, can include:
Anxiety and Stress
Consumption of Caffeine
Physical Health Needs
And Sensory Needs
Anxiety and Stress are proven primary causes of settling to sleep difficulties. When your mind is preoccupied with a lot of thoughts and worries, laying in bed can be a time of tossing and turning without falling asleep and translates into worrying instead of sleeping and anxiety increasing. Anxiety can be displayed within children, through frequent tummy upsets, appearing irritable, tearful, angry or withdrawn.
There are many ways to support children with anxiety and stress and promote successful sleep. An example of how to support children with this includes:
Introducing a Worry Monster, soft toy, enabling worries to be eaten and taken away
Or Introducing an opportunity to discuss and write down the worries in a notebook
Caffeine is a known stimulant. Caffeine is also present within many foods and drinks, including chocolate. Therefore, a review of a child’s food and drink intake is essential when considering difficulties in settling to sleep.
Physical health needs are also an internal factor. Physical health needs can include an illness, pain or discomfort as well as poo and wee patterns. Check out my continence series of videos exploring the bowel and bladder, poo and wee for further details.
For further information about how to settle your child to sleep and encourage your child to sleep through the night, please see my sleep series videos, which can be found over on my business page:
If you would like any individualised support or advice, please feel free to contact me, even if its just to have an opportunity to speak about your child or family members needs, its always good to talk.
Also feel free to share any questions you may have with regards to continence and sleep needs.
Speak soon
Charmaine
Continence Consultant and Trainer
Providing Specialised Continence Sleep and Behavioural Assessments, Support, Advice, Training and Published Book Information
Hello. I know this advice is aimed at children but I also struggle with sleep. I find it hard to switch off. Particularly as I'm listening out for children all night. I fidget a lot too. I'm driving my partner mad.
Me too. I find it so hard to switch off at night. I guess it is part of being a carer - but it is exhausting. For me it helps to share night times with my partner (I am very lucky) so we have someone in charge each night. I still listen out though. I have even been known to go downstairs to sleep, but the sofa isn't as comfortable. Any ideas of anything could try. I don't drink caffine and try not to look at my phone before bed. Still exhausted. Thanks
I am sorry to hear that you have been experiencing difficulties in settling to sleep. Yes, it is true my advice has been aimed at children, including children with a learning disability, Autism and complex needs, as this is my current role. However, I have working experience in supporting children and adults. Therefore all of the principles discussed would all be relevant to adults as well.
Please feel free to view the three sleep videos I have produced, which explore what we do in the day and how this affects our sleep, why we need to go to bed and wake up at the same time, and how to settle in bed.
In addition, I would also like to share with you the "Fidgetbum" product (please do not take offense to this, this is the name of the product) The Fidget bum enables you to be supported in bed and can help reduce movement in a calming way. They are available in a single mattress size (as well as a toddler bed size). In this situation it may be possible at looking at two single mattresses' to enable you and your partner to be together, but have your own separate covers. Ill attach the details for you:
My son is almost 8 years old and has Down Syndrome. He has always been a very early riser. He was 18 months before he slept past 5am, but normally in summer it’s 4-4.30am wake ups and in winter 5.30am at latest. He’s also up numerous times a night. Twice would be a great night, it’s often 4/5 times.
He has a good bedtime routine and is in bed by 7/7.15 for some downtime and normally lights out and we’ve said goodnight by 7.30. He settles himself although he is normally quite sleepy by time we leave.
He normally goes through to midnight or so (although occasionally wakes in the evening). After that it can be hourly wakes, sometimes even more frequent. He seems to wake, immediately jumps out of bed and wanders out into the landing. He claims it’s too dark and that’s why he’s up. His room is dark but not pitch black as there’s a crack of light around his window. At vague hint of morning (4am onwards) he will try to go sneak downstairs when he wakes.
We’ve tried nightlights to help with the fear of the dark (since he started expressing that this last year or so) but we’ve tried a few and I think they’re all too bright as he woke even more and was harder to settle with the light.
We tried a fan for white noise at one point, but that didn’t help. Should we try an alternative form of white noise?
He still wears nappies to bed, and occasionally they leak but not because they’re overly heavy but because he spends a lot of time on his front wriggling. I’ve also tried taking him to the toilet when I’m going to bed at 11ish but that has had no impact on frequency of wake ups. Toileting he poos regularly once a day and although he isn’t a big drinker, does pee a good few times too.
We’re at a loss to stop the frequency of the wake ups and the early rising. Have you any advice? We’ve now got to a point with the early rising that one of us takes him back to his bedroom but we have to get into his bed at that point otherwise he’s up and down every few minutes. Lying with him can often settle him back over for another hour maybe more, but often by that point he’ll have woken one or both of his younger brothers. We’re at breaking point with the broken sleep. Would exercise help? At a specific time of the day?
I am so sorry to hear of the difficulties you have been experiencing and I am also so pleased you have been able to take the time to reach out through this lovely event that Mencap have organised, because help is available!
Through my previous posts I have been able to confirm that successful bedtime routines, always start with the circadian rhythm and biological clock. The circadian rhythm is identified as a twenty-four hour internal clock, which is running in the background of the brain and cycles between sleepiness and alertness at regular intervals. Circadian rhythms help determine sleep patterns. The body's master clock controls the production of melatonin, a hormone that makes you sleepy. It receives information about incoming light from the optic nerves, which relay information from the eyes to the brain and helps us sleep and wake at regular times each day.
The biological clock is about every tissue and organ within our body operating according to biological rhythms. The so called biological clock, keeps body processes running according to a schedule. Therefore what we eat and drink, when we eat and drink, when we use the toilet and when we exercise affects our internal body and when and how we can sleep. When our internal processes are irregular, our sleep can then be disrupted.
One of the ways of supporting your child, in being successful with their sleep is introducing a set routine of eating and drinking in the day. This means having breakfast and a drink, snack and a drink, lunch and a drink, snack and drink and an evening meal and a drink at regular times each day. By having regular times of eating and drinking means our internal body is able to process and run affectively and prepare for sleep.
Another way of supporting your child, in being successful with their sleep is introducing a bed time routine. This means having a set time of going to bed each night “and” having a set time of waking each morning. By having a routine and regular time of going to bed and waking each morning means our internal body is able to process and run affectively and prepare and maintain a sleep routine and enable your child to receive the sleep that they need.
A bedtime routine can be promoted through introducing structured activities following the evening meal, at the same time each evening. Activities can include reading, looking at a magazine, colouring in pictures, sticking either gluing or sticking, playing Lego, calming relaxing sensory activities, hand and foot massage to name a few.
When supporting a child with autism, a learning disability or complex needs with their sleep you can also introduce visual aids and a visual timetable to support a bedtime routine and a set time of going to bed each evening and waking each morning. Visual aids enable children to develop an understanding of bed times and waking times, where and when they take place. Visual aids also promote and develop memory and recall skills as well as a being a way of learning organisational skills.
A wake up time indicator clock can also be introduced to regulate the time your child goes to bed each night "and" wakes each morning, enabling your child to have another visual clue. Examples of wake up time indicator clocks include:
Claessens Kids Sleep , this is a sleeping bunny character being asleep when the child needs to be asleep and awake when the child needs to be awake, This includes a sleep training option
Gro-Clock, displays a moon when it is sleep time and a sun when it is time to get up. This includes a book to read with your child as well
Skip hop sleep trainer night light, is a light that changes colour red when it is sleep time, yellow when almost time to get up and indicates green when it is ok to get up. This also includes a soother mode playing either white noise, gentle rain or a lullaby.
There are many factors that can affect children going off to sleep, settling as well as waking in the night.
External factors affecting sleep can include:
Light
Noise
And Temperature
To reduce the light entering a room, you can introduce:
A blackout blind
Or a Gro anywhere blind, which attaches to your window using suction cups and is fully adjustable to fit the window
Or hang towels over your existing curtain pole
“White noise” can create a calming and soothing environment for our children and even us as adults. As adults the sea or calming acoustic music are the go to sounds to help us relax, children prefer noises that are constant and in the background, such as washing machines, vacuum cleaners, fans or running water.
Every child is different, so its about finding the right noise that works for your child, as well as one you are happy to listen to as well.
As an example one of the families enjoyed Back to the Future theme tune, on repeat, personally I wouldn't have been able to sleep with this, but for them, it was just right!
White noise works, in helping settle your child to sleep, because your child can focus upon the noise / sound.
The key, is what ever you introduce when going to bed, needs to be present throughout, as these can then be triggers for waking if they are not present.
Within my series of sleep videos I discussed the importance of routine and explored how, what we do in the day affects how and when we sleep.
When considering the factors which affect our children settling to sleep, external factors have been confirmed, however it is also important to consider Internal Factors.
Internal Factors affecting sleep, can include:
Anxiety and Stress
Consumption of Caffeine
Physical Health Needs
And Sensory Needs
Physical health needs are also an internal factor. Physical health needs can include an illness, pain or discomfort as well as poo and wee patterns. I would just like to share an example of this, several families I have supported identified sleep difficulties of settling to sleep and waking in the night, several times. Following a comprehensive Sleep and Behaviour assessment I was able to explore their childrens sleep needs in depth and identify the cause, reason for the behaviour, the waking being an impacted bowel, constipation. These children were exhibiting night time wetting and waking due to feeling uncomfortable. I am not implying that this is the same situation with your son, as I have not completed an assessment, however I just wanted to share that there can be several underlying reasons why children wake in the night.
Constipation can be the cause of daytime and night time wetting accidents, because when a bowel is full of poo it can press against the bladder. The bladder becomes squashed and struggles to expand fully to hold lots of wee. And as a result, your child feels the urge to wee more frequently and has to do lots of small wees.
ERIC The Bladder and Bowel Charity, recommend that families, speak to their GP if:
. Your child does painful poos, runny poo, small blobs of poo or poo that looks like rabbit droppings
. They poo less than four times a week
. Their toileting routine is very inconsistent
. They have lots of poo marks in their pants (called faecal soiling).
I hope the information shared, provides you with ideas of where to start with your sons continence and sleep needs. But, more importantly, I hope you can see that help is available and with support, sleep and continence can be achieved. As a Continence Consultant and Trainer I am more than happy to speak to you and your family about any of the concerns you may have about poo, wee or sleep, through a FREE introductory telephone call to discuss how I can support you further through either a starter or solution package of support. Also, please feel free to view my series of supporting videos exploring sleep, continence and behaviour, including sensory needs:
We had very similar issues for a while. I really dreaded the summer months when we had some very early starts. The expert's advice about routine is hard to put into practice, but it really did work for us. We (all of us) eventually developed a better set of habits and it did improve. Waking younger siblings is an issue, but surprisingly ours become quite used to it (we were lucky that when they woke up they did go back to sleep). A few things that did help for us were a special clock that says clearly if it is too early to get up (I think they are called sleep training clocks) but it will depend on your child. The other was a weighted blanket. Not ideal in summer but we seemed to have less fidgeting. Good luck.
I am so pleased that you have had experience of some of the approaches I have discussed within my posts, and had success with these. You are absolutely right, it is not easy implementing or changing routines but with support children really can be successful with their sleep.
Thankyou again
Speak soon
Charmaine
Continence Consultant and Trainer
Providing Specialist Continence Sleep and Behavioural Assessment, Advice, Support, Training and Published Book Information
Thankyou so much for enabling me to be part of this exciting online event, during the 6th and 10th July 2020.
I have really enjoyed meeting you all virtually and being able to provide support and advice around continence and sleep needs. Thankyou so much to all of the families that were able to post a message, and to all the families that have been able to follow my responses of support.
It really has been a fantastic week!
We have been able to explore Continence in relation to:
. The importance of identifying poo and wee habits and becoming "in tune". Confirming how you as a family can assess your child or young persons needs within the home through poo, wee, fluid and food monitoring as well as receiving additional support.
. Where to start with potty and toilet training
. Introducing Visual Aids, Visual Timetables and Social Stories in promoting communication approaches with toileting
. How to build association of where to wee and poo
. Promoting the next steps to toilet training
. Night time wetting
. Exploring how the bladder and bowel work
. The impact of poo upon the body
. The importance of fluids and the types and number to consume
. Resources available to manage wetting accidents
. The affects of sensory needs upon continence and how to manage these
As a Continence Consultant and Trainer, specialising in continence, sleep and behavioural needs of children with autism, learning disability and complex needs, I have been able to share my series of supporting videos, addressing "all" of the issues discussed confirming where and how to start.
However, I completely understand that children are all individual and many children have complex needs, please, don't worry, help is available!
If you or any of your family have any concerns, queries or questions about your child's continence (wee, poo or toileting needs) or sleep needs (being unable to settle until late, waking too early, waking in the night, or sleeping for a short amount of time), then please feel free to contact me via my supporting page upon Health Unlocked or:
I will be more than happy to continue to explore your child's needs and support you as a family in being successful with their continence, sleep and behavioural needs through individualised online Teletherapy support, where ever you may be in the country.
Thankyou again for enabling me to be part of this lovely event and I look forward to continuing to support you in the future!
Thank you for making this event such a success! Also a big thanks to Charmaine for her wonderful posts and advice.
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We will have some more expert events running soon.
I am in discussion to have a back to school expert event at the end of August/September. Please message me if you have any suggestions about expert events that you would like to see.
Bye for now.
Sarah
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