Transcription
Hi, I’m Matt Dwyer and welcome to Sleep where professor Harriet Hiscock and associate professor Emma Sciberras from the Murdoch Children’s Research Institute help you identify sleeping problems in your children from infancy through to secondary school and give you easy to understand steps to improve their sleep cycles and overall health.
So we’re moving from our children being toddlers to now starting primary school, they have a lot more starting to happen in their lives. Harriet, how much sleep did they need?
Professor Harriet Hiscock: So this, again, will be dependent on the child’s age and stage and will change a lot over those first few years, but certainly you would want a primary school, a “preppy”, to be going to bed by around eight o’clock maybe a little bit later.
They will have dropped their daytime sleeps by now. So it’s really important that they have a good bedtime routine and get a good sleep overnight. If they can go to bed at around eight and wake up around seven, that would be fantastic as well. So aiming for a good eleven hours of sleep in those early primary school years. Maybe as they get into grades four, five, six, you might be aiming for more like 10 hours of sleep, but still sleep is really important.
And they have a lot of activities that can start, early morning swimming and things like that, that can start to impact sleep.
Associate Professor Emma Sciberras: Yeah I think it’s a developmental period where you do see an increase, in other things that can interfere with sleep. So if it’s after-school activities, parent work schedules can sometimes kind of be at play, but it is a huge transition starting primary school.
There’s a lot of new demands in terms of paying attention, learning, remembering things and so it’s really important to be getting a good night’s sleep to help with learning those new academic tasks that the kids are facing in the classroom.
Matt Dwyer: [00:02:05] Yeah. So they’re starting to get into a really strict routine with school every day, Monday to Friday, but what about the weekend? Does that throw a spanner in the works of trying that routine out?
Professor Harriet Hiscock: It can, but probably less so than it does in the adolescent. My advice to parents would be to try and keep your routine within about an hour of what you normally do. So maybe let them sleep in for another hour, go to bed at maximum an hour later. If you start to do any more than that, they go to bed later, they wake up later Sunday morning, they go to bed late Sunday night, and then you’ve got problems trying to get them up Monday morning to get them off to school.
Associate Professor Emma Sciberras: Yeah, I think that’s one of the things that you start to see more at this age group is that irregular sleep-wake cycle that can then contribute to the development of sleep problems. So, as Harriet said, if it’s just that you don’t want to be rigid and doing things to the minute, within an hour is fine. When you start to see really big variations, that’s when you start to see more sleep difficulties occurring.
Matt Dwyer: When we start preparing them to go to primary school, the toddlers are having those day naps. How do we start, I guess, weaning them off that?
Professor Harriet Hiscock: They usually naturally drop them themselves. By the time kids start school in Australia, they’re usually five, sometimes even a bit older, maybe they’re four and a bit, so they’ve usually dropped that sleep. Some primary schools will start the first term with Wednesday off to allow the toddler, now the school-aged child to catch up on their sleep. So that’s one way that you can do it. They may need to have a sleep on the weekend, and that’s absolutely fine as long as it’s not interfering in a major way with going to bed that night.
Associate Professor Emma Sciberras: And, I guess just to expand on that, because it is such a huge transition and the young person’s probably gonna be really tired after a day of school, you might even be doing the bedtime a bit earlier in that first year. Getting them to bed by seven o’clock or even six thirty, in some cases, if they’re really exhausted and struggling is fine too,
Matt Dwyer: I suppose, with the huge amount of information they’re starting to learn now, that focus is so important. What happens when they aren’t getting enough sleep here?
Associate Professor Emma Sciberras: Yeah, there’s lots of research looking at this and the impact that lack of sleep has. Certainly the research shows that if you haven’t had a good night’s sleep it is harder to pay attention in the classroom. There are links between poorer sleep and memory consolidation; being able to remember the important learnings of the school day and being able to carry those forward in your learning. Also, we see behavioural difficulties too. Children are more likely to be oppositional and not want to do what you say if they’ve had less sleep, but it can also be connected to anxiety and worries too.
So I think there’s a whole host of things that sleep can influence and there’s really a lot of good evidence now that there are links between sleep and a number of these things.
Professor Harriet Hiscock: One of the things I see particularly, probably not in prep, but starting in grade one, two, and three is that children are very aware of how they’re going academically compared to their peers.
There’s a particular issue called learning difficulties when a child’s got a completely normal IQ but they struggle with certain aspects of reading or writing or math and that affects about 15% of Australian children. I start to see those children come with sleeping issues because they’re worried about maths or they’re worried about seeming dumb in front of their peers.
That has a role affecting sleep and self-esteem and learning. So they’re not dumb. These kids have a normal IQ but they’ve got specific learning issues. Part of sleep, at this age, is a bit of a Pandora’s box and it’s opening up and looking at what else might be going on in that child’s life that might be stopping them going to sleep.
We’ll probably talk about bullying a bit later on as well, which is another factor that creeps in for this primary school age group.
Matt Dwyer: So what are the early signs of primary school children not getting enough sleep?
Professor Harriet Hiscock: As Emma was saying, it will be pretty obvious that they just can’t get to sleep. So they’re struggling to get to sleep.
It might be that you have to wake them up in the morning. They’re not naturally waking up by themselves to start the day and you’re trying to get them out of bed. They’re cranky. They’re oppositional. You might get a phone call from the teacher saying they’re falling asleep in class, or certainly if they fall asleep on the way home in the car, on the bus, or in front of the television when they get home, that’s definitely a sign that they’re not getting enough sleep.
Matt Dwyer: And what sort of goals should we set for them?
Professor Harriet Hiscock: Well, I think it’s all about the routine as well for these kids and expectations of, “you still do need to go to bed at a certain time. You still need to have your bedroom free of media.” So social media is creeping in now. There’s a large proportion of primary school kids that have their own phone, particularly as parents upgrade their own and they hand their smartphone off to them. All the social media creeps in: the Snapchat, the Instagram, and you’ll hear your kid’s phone going at 12:00AM, 1:00 AM, 2:00 AM with people communicating.
So those phones have to be out of the room, preferably somewhere like the kitchen, out of reach if that’s an issue for your child. I think setting those expectations really early on is important; we’re still gonna have a sleep routine, a bedtime routine, we’re going to keep the bedroom media free, and that’s mum and dad as well. We’re going to keep the phones out of our room as well as you have to lead by example, as a parent.
Associate Professor Emma Sciberras: I think that’s a really important point because kids are really savvy. If they’re seeing you use your phone all the time, they can start to communicate the sense of injustice with that and realise, well, why can you do it and I can’t do it? and so on. I think in addition to some of the social media things, in terms of electronics at this point, you also see increases in things like gaming. A lot of that can become highly addictive and so negotiating that and having set rules around electronics use in general is really important at this age.
Professor Harriet Hiscock: Yeah, I’ve just returned from a big paediatric meeting in Baltimore and they’re studying 12,000 9 to 10 year-olds, with all sorts of things, including their use of devices and they’re doing brain scans as well. What they found is girls, not surprisingly, are more likely to be on social media than boys, but that’s actually associated positively with more extracurricular activities such as dance and sport and things. Whereas boys of this age are more likely to be on gaming activities. No surprise compared to girls but that’s associated with less extracurricular activities
Matt Dwyer: Because they’re staying in.
Professor Harriet Hiscock: Exactly, exactly. So I think it’s a whole wealth of information out there about screens and social media, but what is your child using? how are they using it? and when? and just making the bedroom a media-free zone after about 6:00 PM, probably I think.
Matt Dwyer: What are some of the other bigger causes of sleep problems in primary school children?
Associate Professor Emma Sciberras: Look, I think there are other things that can start to creep in too. The first thing is that there’s no one cause. So there’s a number of different factors that can contribute. Some of the ones we’ve talked about so far have been: having an irregular sleep-wake cycle, excessive usage of media, and screens. I think you also see changes in things like caffeine use, for example. That’s something that we see an increase of in primary school aged children, so that’s something we want to check and monitor to make sure that they’re not having too much caffeine that could be influencing their sleep.
Professor Harriet Hiscock: Yeah and I think otherwise the problems are similar to those that happened in preschooler. So the sleep association problems where they can only fall asleep if mum or dad are lying with them, that’s still a problem. Also the limit setting disorder, coming in and out of the bedroom multiple times, is still a problem in some primary school kids.
Matt Dwyer: When they are worried about the maths and English, do they also worry about if they are bedwetting?
Professor Harriet Hiscock: Yeah. So bedwetting is another one Matt, spot on with boys. I kept thinking about the behavioural things but bedwetting is very common and tends to run in families. Certainly up to the age of six we say, “it’s normal, don’t worry about it.” From six years of age and on, you can definitely do something about it which has a high success rate and that’s using a pad and alarm, which we can talk about in the next episode.
Bedwetting does tend to slowly get better over time but if there’s been a family history of it you can have the seven or eight-year-old who bed wets, and they’re about to go on school camp and they get quite upset about that, but there’s good medical treatments for that.
Matt Dwyer: I suppose that would cause a stress on them knowing that they’re probably going to wet the bed.
Professor Harriet Hiscock: Yes, and sleepovers and all of that but from six years on there’s really good strategies we have for that. Another issue that happens once kids start school is the extracurricular activities, and particularly the early morning ones, which are often swimming for some reason and rowing. For some kids that can be really tricky and often, you know, children do handle it well, they just get incredibly organised. They do their morning activity, which is good for their health and fitness, they have a day of school, they try and do homework during the school hours where possible, and then they try and do a minimal amount of homework at home and then get to sleep early.
They just have to survive those early morning activities. Then you have the other end of the day where they might have training three nights a week or other activities. So I guess it’s really just trying to keep the routine going and you may need to condense your routine. So as soon as they come home, get them to have a shower, get the dinner on get them into their pyjamas, then books and bed. You might just need to shorten it all while they’re going through that but I would caution against doing too many extracurricular activities, particularly if your child is tired and can’t get themselves up in the morning or is getting cranky and upset.
My rule of thumb is a maximum of two extracurricular activities per child at any one time but that’s not from any evidence. That’s just from my experience of seeing hundreds and hundreds of families dealing with this.
Matt Dwyer: Yeah. I guess afternoon sports, going to play footy, cricket, things like dancing, is there a benefit in terms of it making them a little bit tired?
Professor Harriet Hiscock: Well, there actually is some evidence that if you do vigorous activity, not right before sleep, but in the afternoon before the nighttime, that that will lead to better onset of sleep and better quality of sleep. There’s some work done out of Victoria that is showing that.
Matt Dwyer: Yeah.
Professor Harriet Hiscock: So the other issue that’s becoming more and more of a problem in our society and across the developed world is obesity. In Australia, we have 20% of our kids who are overweight and a further 5% are obese, and this is rising. What we do know is short sleep duration, continued short sleep duration, is associated with overweightness and obesity in children as well as in adults. There’s a number of reasons why this might be, and it’s probably not just one, it’s all of these reasons. One is that if you are not sleeping as much, you’ve got more time awake to be eating. If you’re not sleeping as much, you might be feeling that you lack energy and you’re a bit lethargic, so you exercise less.
The third reason is that there’s a particular hormone called ghrelin that is produced in our brains overnight and leptin as well. So leptin is produced more overnight and that suppresses our appetite, whereas ghrelin increases our appetite. So if you have a short amount of sleep, you get more of the ghrelin and less of the leptin being produced and that makes you want to eat more.
Then the other reason may be that if, as a parent, you find it a little tricky to set limits around your child’s sleep and routines, you might also find it tricky to set limits around their eating as well and how much they’re eating and what they’re eating.
Matt Dwyer: How do we know that they are getting enough sleep?
Professor Harriet Hiscock: Well, they’ll wake up by themselves in the morning. Usually that, and they’ll wake up happy, that’s a really good indicator, and they’ll stay awake for the day. They won’t fall asleep in class or in the car on the way home. They won’t fall asleep in front of the television at four in the afternoon.
That’s when you know they’re getting enough sleep
Matt Dwyer: With their healthy sleep cycles, how much deep sleep do they actually get at this age?
Professor Harriet Hiscock: Yeah, look it’s just a gradual progression. So they are getting more deep sleep, less of the light sleep, and their sleep cycles are starting to lengthen again.
Now, you know, 50, maybe 60 minutes of sleep cycle working up to the adult sleep cycle duration of 90 minutes on and off, on and off. Yep. So the same thing going through episodes of deep and light sleep with usually the first three or four hours of the night being deep, deep sleep before they come up into those cycles of deep and light sleep.
Yep.
Associate Professor Emma Sciberras: I think just on the note of sleep cycles, and we raised the common sleep problem that you can see before about needing a parent present to fall asleep at night, is that we see there’s a need for the environment to be very similar overnight to the way the environment was at sleep onset.
So for example, if at sleep onset, a parent is needed in the room to fall asleep at night and when the child comes out of that first sleep cycle, the parent isn’t there anymore, that’s when you can see night waking occurring and the child seeking out the parent in the nighttime.
Professor Harriet Hiscock: At this age group, they’ll come into your bedroom because they can.
Some parents will say, “I wake up in the morning and I didn’t even realise they’d come out in the middle of the night” or “they come out in the middle of the night and they take over the bed so my partner has to get out and go and sleep on the lounge.”
That’s pretty common.
Matt Dwyer: Are nightmares and night terrors still prevalent?
Professor Harriet Hiscock: Yeah, in the early years of primary school, they are. They start to level off a bit in sort of four, five, and six, but yeah, they certainly still get nightmares and night terrors particularly if they’re overtired or if they’ve got a viral illness or something else going on to make them have a fever and get a bit sick.
Matt Dwyer: What about some of the biggest misconceptions with sleeping here?
Associate Professor Emma Sciberras: That’s an interesting one. I think sleep problems are really common too in this age group and so that’s important to note. We did a research project where we looked at how persistent sleep problems were from primary school to adolescents.
We assessed for sleep problems across five points in time, this is a big study of 4,000 kids in Australia, and what we were able to show is that sleep problems really do persist. So if you have a sleep problem when you’re four years of age, that was highly associated with continuing to have a sleep problem into adolescence. The other thing that was interesting about that study is that we were trying to understand the relationship between having a sleep problem and having behavioural difficulties and anxiety and depressive symptoms. We found what we’d say is a bi-directional relationship. So we found that if you have some levels of anxiety that’s going to increase your risk for sleep problems. I’ve found that if you have sleep problems, that then increases your risk for anxiety. So really, showing the need to kind of think about each individually, but knowing if they’ve both come together it just makes things worse.
Matt Dwyer: How do we identify that anxiety early? and what are the steps to managing that and preventing that and fixing it?
Associate Professor Emma Sciberras: Yeah, there are a number of different causes of anxiety in this age group. So there are still some primary school aged children that have some of those nighttime fears where they might be scared of imaginary things but with the increasing cognitive development, you can also see more worries about life. Things like having a burglar come into your house, for example. I guess when they’re those more typical nighttime fears, using a lot of the same strategies that we’ve talked about previously can be helpful, like communicating and reassuring them about safety.
You can start to do some more creative things, I guess, with worries too. You can start to have a worry box, for example, where you might draw a picture of the thing that was making you worried and you can kind of put it away, file it away into that little box, for the day or you can scratch up the piece of paper and throw it away in a bin or things like that.
You can start to get more or creative with the way that you manage anxiety in this group. When we’re managing those kinds of worries, we can start to also use other techniques like breathing strategies. So slow breathing strategies just to come down and help the kids to get ready and relaxed for sleep.
We can also start to use strategies like more formal relaxation, where you combine breathing with a strategy that we call progressive muscle relaxation, where you tense up the different parts of your bod, and then you release them. So you kind of go through it sequentially throughout your body, but it helps you to notice the differences between being in a tense state and in a relaxed state.
You can combine some of that with visual imagery. So imagining being in your favourite place. That might be in your grandparents’ back garden or it could be on a beach or, you know, wherever that might be. You can start to use some of that imagination with some of those relaxation techniques too.
Professor Harriet Hiscock: Yeah and I certainly use that a lot with the school kids I see. I will tell them too, when they get home from school to go and close their bedroom door, lie on the floor, the bedroom floor, take off their shoes and do this visual imagery and sequential muscle relaxation, starting with their toes and moving up.
The reason I tell them to do it then, is that if I tell them to do it before bed and it doesn’t work, then they get more anxious. Whereas if I tell them to do it after school, they just naturally start to do it before bedtime anyway, but without that expectation. So I always tell parents, don’t tell them to do it right before bed in case it doesn’t work and they get more stressed. Tell them to do it when they get home from school and shut your brothers and sisters out and lie on the bedroom floor and close your eyes and do it.
Matt Dwyer: It kind of sounds like meditation. Is that something that you would introduce?
Associate Professor Emma Sciberras: Yeah, look it is really similar to some strategies you might consider under the umbrella of mindfulness and those mindful techniques that are really popular at the moment. So there are some people that I know that use apps to help facilitate some of that.
So Smiling Mind is an example of an app that helps to guide you through some more of these kinds of meditation based techniques which heaps of people seem to be using. I don’t know if you have much to say about that, Harriet.
Professor Harriet Hiscock:Yeah, look, I think the Smiling Mind has done some evaluations with school aged children and found it to be beneficial to their mental health and behaviour in the classroom as well as outside of the classroom.
I think it’s a great, inexpensive way of trying to tackle these things. So I think that’s a great one but I think, as Emma has sort of talked about, you need to have a conversation with your child as to anything that might be making them upset, whether that’s learning issues, bullying, or peer group issues.
Sometimes I draw a single line on a page and I do a sad face down one end of the line and a happy face up the other end. I say, this is school where 10 out of 10 is school is so fantastic you want to be there Saturday and Sunday, or this is the other end at zero out of 10, it’s awful, you hate it, you never want to be there. I ask the kids to put a cross on that line of how happy they are at school and that can pretty much tell straight away, is it a school issue or not? Then I give them three wishes to make school better so that if they say, “yeah, huh, more play time, more time on the computer,” that’s pretty normal. “I want so-and-so to stop being mean to me or I wish I wasn’t so dumb in math,” then you’ve got a really clear answer of what might be contributing to the anxiety. Then you’ve got to go and meet with the school and talk about those things and start to help your child.
Matt Dwyer: Do you seek professional help at that stage?
Professor Harriet Hiscock: Yes, but the first step is really going to the school. If it’s a school-based issue, particularly if it’s a learning or academic issue and saying, “you know, my kid is not sleeping at night because of this, what can we do about it? What resources do you have? How can we work together?”
Associate Professor Emma Sciberras: Yeah, I think that’s really important to have those conversations and I think thinking about when you have those conversations with your child, that’s important too. So a lot of the families that we see in clinic are doing a really great job at having these discussions with their kids, but they’re doing it right as the child’s going to bed. When you start to talk about some of this stuff and it gets really deep and it can be upsetting for the child and it can just delay sleep onset too. So finding a time during the day that isn’t just right before sleep to have these important conversations.
Professor Harriet Hiscock: Because I can say, “tell me me about your day!” And then the kid starts crying and it’s all kinds of not helpful. Yeah, but Emma what if you’ve got an anxious child and you’ve got them off to sleep at the start of the night?
What if they wake up overnight and come into your bedroom and want to hop into bed with you?
Associate Professor Emma Sciberras: So I think it depends on how far in your journey of implementing the strategies you are. If it’s the first kind of week or so, I recommend that families just try to work on sleep onset to start with ,so just focus on getting the child to bed at night and don’t even worry about what happens overnight. It’s really hard to be implementing strategies in the night and at sleep onset. So I’d say, just stick with that. What you generally see is that if you get improvement at sleep onset, you see the improvement overnight.
That relates to that idea that we talked about before around the conditions of your bedroom environment and the way that you fall asleep. Once you learn how to fall asleep at night, usually can start to implement that for yourself overnight when you wake up very briefly from your sleep cycles.
For some kids, even though you’ve been doing that and they can start to get off to sleep okay at night time, they still might wake up in the night. I guess it depends on what you want to do. You could return the child back to bed and try the same strategies overnight or, you know, that can be really exhausting, so you could even just set up a little camp mattress next to your bed. If they come into your room, the rule could be that they can come in but they go on to that mattress so at least your sleep isn’t getting disturbed.
Matt Dwyer: What about managing some of the other bigger problems? What do we do if we have a bed wetting?
Professor Harriet Hiscock: Yes, a bed wetting is a really common issue in primary school aged children and it tends to run in families as well. So if your child gets to the age of six and they’re still bedwetting, then it’s time to do something about it. That’s where the evidence comes in that we know we can (have an impact) . The most useful thing is something called a pad and alarm.
So basically it’s a little pad that goes on the child’s bed underneath the bed clothes or underneath a towel even, and it’s set up to an alarm and it triggers when there’s moisture on the pad. So once the child starts to wee, then the alarm goes off. It’s a really loud alarm. It can wake up the whole family but what it does is it rouses that child from their deep sleep. What you need to do as a parent is go in and wake up your child completely. They need to turn off the alarm, the child themselves, then they need to go to the bathroom, finish doing their wee completely, come back to bed, fresh pyjama bottoms if they need it and reset the alarm.
This is a process that takes four to six weeks to work. Typically what we do if they’re getting three or four or five dry nights in a row, then we might get them to drink a bit more fluid in the evening and keep using the alarm. Usually after six weeks, there’s about a 70 to 80% success rate with the pad and alarm.
It’s just training the brain to wake up from sleep to be able to go to the bathroom. Usually these kids are otherwise well; however, you must get them checked out by your doctor first, just to make sure there’s no underlying rare neurological problem causing this or a urine infection causing the bedwetting.
Normally it’s just something just tends to run in the family. Sometimes children will be going on a school camp or having a sleep over and again, speak to your doctor, but there are specials sprays or little wafers you can put under your tongue to help just turn off the hormone that makes you do a wee and keeps you dry for the night as well.
So that’s something you need to speak to your doctor about prescribing
Associate Professor Emma Sciberras: At this age group, we also see difficulties with limit settings where the child is basically refusing to go to sleep at the time that the parents are wanting them to go to sleep. I guess, in terms of managing this, the first thing is having really clear rules and boundaries around bedtime.
Having that clear bedtime that’s set, and that will depend on the time that the child needs to wake up the next morning, but having that clear bed time and having a set routine around that, being really firm with it. One of the things that we can see because the child ends up getting used to falling asleep much later-so if their desired bedtime is 8 but they’re doing these curtain calls-they might not actually be falling asleep until about 10 o’clock at night. So their body has become used to falling asleep later. To try to make some changes here, we use a strategy called “bedtime fading” and that’s where we put children to bed temporarily later, closer to their naturally occurring sleep onset. Then we slowly bring the bedtime forward because once you’re used to falling asleep at 10 o’clock and you try to go to sleep at 8 o’clock, it’s just impossible. So we temporarily put the child to bed at 10 o’clock.
Once they’re falling asleep within about 20 minutes, the next night we’d advance it to 9:45. Another couple of nights, advance it to 9:30 and so on until you get back to the desired bedtime. Often there are strategies needed to get the kids sleepy enough because if they go to bed not sleepy, then they’re more likely to call out and protest.
Professor Harriet Hiscock: Yeah and I think that works really well even with kids with mild anxiety who are not falling asleep because they’re just worrying about things. If they always fall asleep at 10 o’clock at night, do exactly as Emma said. Do the bedtime fading for a two week period in conjunction with your relaxation strategies or your worry box or other strategies and that can really help as well.
Matt Dwyer: Yeah. What about just before setting them to bed at 10:00 PM? Are there things that we need to make sure we do and don’t do?
Associate Professor Emma Sciberras: [00:28:48] Yes. So it’s really important to think ahead of time what those activities are going to be and they have to all be quiet activities without screens because if the child is just watching TV up until that time, then that might have influence and impact on whether they can fall asleep at night.
So doing, you know, reading, coloring in, puzzles, something kind of low key with the family is really important and to think about that ahead of time, what that will be.
Professor Harriet Hiscock: I think just for children’s anxiety in primary school, there’s an excellent book called, What to Do When You Worry Too Much: A Kid’s Guide to Anxiety by Dawn Huebner, and it’s a parent-child sort of, “how do we do this? what is anxiety? what are some strategies? how do we manage it?” So it’s not specifically for sleep, it’s just for the anxious child, generally as a workbook with pictures and drawing and activities,. It’s really powerful from about 6 years to 12 years of age, it’s really useful.
Associate Professor Emma Sciberras: So when you’re implementing a new behavioural strategies and a behavioural program around sleep, it’s really important to know that you may come across something called an “extinction burst”.
This happens in about 20% of cases where you see the old behaviour come back in and get even more intense and severe than you first had experienced. So for example, if you’re doing strategies about limit setting and keeping the child in the bedroom at nighttime, after a couple of weeks of success, you can see the child kind of revert back to refusing to go to sleep, not wanting to go to sleep, and so on. The most important thing is for parents to know that that could happen and if it does happen, all parents need to do is use the exact same consistent strategies that they’ve been using. and that will go away.
Professor Harriet Hiscock: [Yeah, and it usually goes away about three nights later, but I think it’s very important because parents think, “Oh my God, we’re back to square one. Why did I do that? nothing’s worked,” but actually it’s worked really well. Your child is now just testing the limits again for a few nights and you just need to be firm for a few nights and they go back to their good sleep habits.