13 Months Old and Still Not Sleeping (allergies and separation anxiety)

by Jennifer
(Seattle, WA)

Question: Our son is 13 months of age, has severe separation anxiety, still nurses a few times throughout the course of the day/night, and is an extremely poor sleeper. His poor sleep habits are hurting the health of our family.

He wakes up after an hour's time during the day (nap), in which he needs a lot of coaxing and help to get him to sleep longer....many times this results in having to transfer him to the bed rather than the crib simply so he will resume sleeping. This is completely unsafe as he has fallen out of the bed several times. At night, he wakes up every 1.5 - 2 hours every night. It's been a year and a half since my husband and I have had a full night's sleep and the lack of sleep is getting to the point that it is unhealthy for all of us.

We are looking at ceasing breastfeeding in order to get our son away from comfort feeding and needing to be in bed with us. I'm starting to have physical pain in my shoulders and neck from contorting my body every night to accomodate feeding in bed (laying down). We are also wondering if we should adjust his bedtime (currently 7:30pm), but are fearful to make it earlier or later because he wakes up at 5:00am every day. Help! We need change and we need it soon.

Added info: As it may appear that our situation is similar to inquiries you've had in the past, I assure you we are in dire straits here.  Our son is wide awake at 5:00, 5:30 am ish every day after getting very little sleep at night - waking up every 1.5 - 2 hours. 

We want to cease breastfeeding, but he is terrible at taking fluids and we're worried about possible dehydration.  We are lucky if he'll drink 6 ounces (a day) of soy formula mixed with pediasure through a straw sippy cup.  He will not take a bottle and had problems when milk was introduced awhile ago.  We offer the sippy cup to him all day long and he barely drinks :(  On a positive note though he is a good eater.  He eats as much, if not more than our toddler and upon doctor recommendation we've been adding formula mixed in to his food. 

Lastly, our son also has a mastocytoma on his backside, which supposedly causes a release of histamines and makes him have various allergies and sensitive skin.  Lastly, we recently started our son on infant dosage of Singulair for allergies because he would literally rub his nose all day long and he sleeps face down with his face pressed into the mattress.  We are not advocates of giving children medicine, but we thought giving Singulair might help....at this point I'm considering stopping the medication.
 
Lastly, our son sleeps in a crib in our bedroom near my side of the bed.  Yes, we rush to him every time he makes a peep because we have a toddler daughter and neighbors we don't want to wake, but the sleep deprivation is really hard to bear at this point.  We did resort to having me sleep downstairs and my husband upstairs with my son for a week and that seem to work a little with the sleep patterns, but now we're back to the same old thing again.
 
Any advice you can provide us with would be appreciated.  We are pretty desperate at this  point.

Heidi's Answer: Dear Jennifer,

That is tough I know, the continued broken nights you've been having this past year and a half.

From what you have written, the allergies clearly show as the main underlying cause of the sleep issues your son is experiencing. They affect his feeding and his overall feeling of well-being and comfort … making restful sleep simply difficult for him.

Let's have a look at food first. I am assuming you use soy formula because of his allergies. However, many who are allergic to cow's milk are also allergic to soy – soy being one of the common foods causing allergies in young children.

So your son may be instinctively refusing the soy formula (at least when it is pure, and not mixed in his solids) because of that. Of course he may simply not like the taste of it or even drinking from the sippy cup may be something he just took a dislike to.

Either way, it would be best to be absolutely certain that he is not allergic to soy before still offering it to him.

Depending on his specific food allergies, there are alternatives you can use such as rice milk with suitable additives and highly hydrolyzed formulas. Ideally you would discuss this with your doctor or a specialized allergy-nutritionist to decide which will be best suited.

Breast milk would be easiest and the best non-allergenic option but I understand that you want to wean from that now. Yet if possible practically and you want to, you can consider delaying that weaning for a little while more, while you find out about his precise allergies. Then you will have a safe alternative when you start weaning for real.

Have you been confirmed that he has allergies such as to dust mite, pollen, dog/cat hair, … that may be causing his nose rubbing? In that case, have you been able to eliminate all sources of those? Such as an allergenic mattress cover, no fabric in the room, no curtains, … ?

If not, that definitely is a path to look into.

I understand that you are not all for giving medication to small children, and I agree. But in some situations it is simply necessary. If you doctor recommends it and especially if the Singulair is helping, then it is fine. But even then it is of course critical to remove the possible sources as much as possible.

That may help so well that the medication can then be decreased or even stopped.

Then for the night time. You mention that the sleep patterns seemed to improve a bit when your husband slept downstairs with your son. Even if it did not continue, it can teach you a lot about what would help going forward.

It may have mainly be the fact to not have you near, meaning no breastfeed "temptation". That may have instinctively led him to not wake so often for a comfort feed.

It can also have been simple practical things like the place where he then slept being darker or lighter, cooler or a bit warmer, noisier or quieter, …

Go over it carefully and try to find out which of the factors that were different may have been most important. Then try to reinforce that, even now that you all sleep in the same room again. One thing I definitely recommend is to have your husband tend to your son at part of the night awakenings, to start reducing the comfort feeds.

You could start with each doing half of the awakenings: daddy the first, you the second, he the third, … and so on. Later on, you will then gradually reduce the amount you offer during the feeds you do give (i.e. offer one side only, and then shorter and shorter each time).

That said, you also mention his extreme separation anxiety. That may make it harder to wean from the comfort feeds and to wean from being in your bed at night. First of all, do work on the anxiety during the day. I list several effective techniques on my separation anxiety page here, that will help him build the confidence he needs to get through the anxiety phase.

If necessary to help him sleep at all, I have nothing against taking him in your bed. You all need your sleep so you should maximize that. Once his sleeping has quieted down, we will then still have time to help him sleep in the crib all night.

But if you take him in bed, you must make sure it is safe for him, and comfortable for you. Falling out of bed may not only injure him, he may also be traumatized, not an association with sleep you want him to make.

To make it safe, you may consider placing your mattress on the floor (take it off the bed base), shift it against a wall or install a bed rail (which can still serve later on when he transitions to a big bed). For more info, have a look at cosleeping safety guidelines and bed rail ideas.

Lastly about his bedtime: if he is very tired, or even over-tired, by 7.30pm now, you should definitely set an earlier bedtime. This will not make him wake up earlier. On the contrary, a well-timed bedtime gives a better onset of the night and results in deeper and more restful sleep. And longer nights.

So if he seems readily tired by about 6pm or 6.30pm, that will be his best bedtime. If you hesitate then don't go in one drastic step but bring it to 10 minutes earlier every day. Give the new final bedtime at least a week or two to set and for your son's body to become used to it.

Summarizing, to me the allergies are definitely worth looking into in more detail. Avoiding any foods that he is allergic to and eliminating all allergy sources in his environment can make a huge difference, also on his sleep.

For sleep itself, work on the separation anxiety, progressively reduce comfort feeding and set his best-suited bedtime.

Best of luck to you,
Kindly,
Heidi