Every time I counsel families to make diet and dietary habit changes in their children, we openly discuss their natural skepticism that changing a child’s routine and habit is possible. The immediate assumption and reaction is often one of skepticism, especially for the toddlers whom I am asking the parents to take away the bedtime milk. I have learned from a variety of reactions and the conversations that follow and want to share them with you.
Let’s start with toddlers (age 12 months to 3). These parents often react with, “I am not sure that’s going to fly….he won’t go to sleep without it.” I acknowledge their skepticism and the likelihood of protest from toddlers who hold their sippy cups sacred like their Heisman Trophy. These are the toddlers who come to the office with sippy cups full of milk, and have gotten used to enjoy their liquid gold multiple times throughout the day and evening. Acknowledging the parent’s anticipation that the “change” may not be easy let them know that I know what I am asking seems impossible. I offer tips such as start by giving the milk 5-10 minutes earlier each night on sequential nights, such that after 1-2 weeks, the last milk consumed should be easily 90 minutes to two hours before bedtime, with the goal of milk with dinner and not again if possible. This is a difficult time as infants often transition from breast milk/formula to cow milk, and likely whole milk. Those who may be lactose intolerant may start so show symptoms such as chronic nasal stuffiness and runny noses, when there are no apparent colds or symptoms suggestive of allergies to animals or even less likely, aeroallergens like trees, mold, grasses, and pollen.
I will write a separate blog post about changing a child’s diet, but for this one I will focus on a child’s sleep. For toddlers whose parents fess up to giving a bottle in the middle of the night if their child wakes and cries, instead of judging them and making them feel bad, I let them know that I totally get it. We talk about sleep training, but first the milk has to go because of the physiologic reflux it causes which is what wakes them from sleep as I explain in the book “A Healthier Wei”. Even though I never gave Clare bedtime or middle of the night milk, between the ages of 2-3 Claire truly tested our sanity and marriage by coming into our room EVERY night and waking us night after night. She had transitioned out of the crib into a cute sleigh bed. Despite reading many top rated books on training children’s sleep, I found myself increasingly dreading nighttime and bedtime knowing that she would wake us and another interrupted night lays ahead of me. This period of our lives made residency training seem like a piece of cake, since I never had to take call EVERY night, and not getting continuous sleep can easily lead to very irritable parents no matter how loving. Nothing scared me more than when she would stand next to me in the dark, with her hair in her face, quietly staring at me, such that I would open my eyes and yell “Ahhhhh……” as I wake to the image similar to that child from the movie “The Ring”!
Our pediatrician suggested something that worked well. We made a palette on the floor in our room. If she stayed in her room all night, then in the morning after breakfast she was allowed to pick out 10 M&Ms from a bowl. If she came into our room, and went straight to the palette and goes to sleep without waking us, then she can pick out 5 M&Ms. If she wakes us, then no M&Ms. That trick worked, at least for a little while.
My favorite story which I have shared with may exhausted parents occurred when the M&Ms stopped working. We had decided one night prior to bedtime that enough was enough, so we locked our door. Just as we expected, she was on the offensive around 3am, knocking on our door in the dark. “Mommy, open the door.” She started to raise her voice as we kept silent. Then came the whining, crying, alternating with demanding and authoritative declaration, “Julie Wei, open this door right now!”. Dave and I tried not to laugh, and I tried not to cry. I realized that she was well aware of what she was doing, because anger would quickly turn into sweet pleading, “Mommy, I just want to come in and be with you guys……please…please Mommy?”. Then she asked, “Mommy, it’s me Claire, can you see my lips?” My precious daughter was laying on her stomach, talking to us through the little crack under the door, and still we did not give in. Finally, after about 30 minutes, it all stopped. I am certain we drifted in and out of sleep, and at 6am I got up to get ready for work. I opened our door fully expecting to see her asleep outside our door, but she was not there. I went to her room, and when I saw the empty bed my stomach came up into my throat and panic washed over me like tsunami. I will never forget as I turned around to run back in to our room to tell Dave she was “missing”. As I passed the door to the guest room, there she was. My sweet angel was fast asleep on the guest bed. After that night she slept in the guest room for the next 8 months. We survived that period and she continues to be a good sleeper. I know we are blessed and I have learned that routine and sleep “hygiene” is critical and must be developed and maintained throughout childhood.
There are certainly medical conditions and medications which may adversely affect sleep, such as stimulants used to treat ADHD. But for otherwise healthy children, bodies can be trained to follow a schedule and the circadian rhythm. For older children and teenagers, I emphasize the importance of not having excessive sugar and even caffeine especially in the afternoon and evenings. Avoidance of violent video games, television shows, and stimulation from computer screens and hand held gaming devices are all important to start the calming of the mind in preparation for rest. I am still surprised by the number of families I meet every clinic day whose toddlers go to bed way too late, or stay up with the adults and older siblings. While I respect every parent’s right to choose their child’s routine, I can only imagine that unfortunately the adults do not have any free time to devote to themselves and their relationships if there is no free time without an active and awake young child in the evenings.
Change seems impossible because we are all creatures of habit and routine, yet once implemented, it si no longer a change but simply a new routine. Children like routines and I believe they respond well to structure and function well when given clear expectations and guidelines. If bedtime as well as not eating and drinking before bedtime is established as the “norm”, then they truly will adapt. The most difficult part, I believe, is for parents to understand that denying our children bedtime snacks does not mean that we want them to go to bed hungry, or that we don’t love them. Try it, your child may just sleep better.
Dr. Julie Wei is a pediatric ear, nose, and throat specialist and the author of A Healthier Wei. As a mother herself, Dr. Wei is a passionate advocate for improving children's health through better diet and dietary habits. She has been committed to helping parents learn how to eliminate their child's ear, nose, and throat problems simply by reducing excessive sugar and dairy intake, as well as minimizing habitual late night snacking. She hopes to raise awareness for the need for accountability by both medical professionals and parents to ensure that children are not prescribed or take unnecessary medications long term.
When she is not in the clinic, operating room, or conducting research, you will find her in the kitchen preparing food with love along with her daughter Claire. If you sit next to her on the plane, she will likely share with you information about how to minimize choking hazards in young children, and many other tips for improving your child's health.