Wednesday, October 12, 2005

sleeping through the night


Sleep training involves teaching me to go to sleep by myself and to sleep through the night. This does not mean that I will not wake up during the night. It means that I will have the skills needed to put myself back to sleep without your help. Most children older than six months of age are capable of sleeping through the night, and can learn how to do so if they are not. If I have a central nervous system disorder, I am on medication, or I am ill, discuss my sleep issues with my pediatrician. Follow the guidance of my pediatrician regarding sleep training.

There are four basic steps to teaching me how to sleep. To teach me to sleep through the night as quickly as possible, be consistent with each step. Most parents see improvement by the third night. By the end of one week, I should be sleeping through the night.

Step 1. Implement a Bedtime Routine.

Take from ten to thirty minutes each night to set up a consistent routine that I will associate with getting ready for bed. Examples of appropriate activities include brushing teeth, taking a bath, putting on pajamas, reading a story, singing a song, and saying prayers.

Step 2. Put me into bed using the Gentle or the Regular Technique.

Gentle Technique

In my dimly lit and quiet bedroom, put me to sleep any way that you like. When I am asleep, put me into bed. If I wake up once I am in bed, I must return to sleep independently. Implement the 2-In & 15-Out or the Gradual Method if I wake up or have difficulty going back to sleep. Most young children can learn to go to sleep one way and to go back to sleep another way. The important distinguishing factor is my bed. If I am in my bed, I must go to sleep by myself.

Regular Technique

Put me in my bed sleepy but awake so that I will put myself to sleep independently. This way, when I experience a brief arousal during the night, I will know how to put myself back to sleep without your help. After completing the bedtime routine, put me to bed and explain that it is time for me to go to sleep and for you to leave. Give me one more kiss and leave the room. Implement the 2-In & 15-Out or the Gradual Method if I have trouble falling asleep. Use the same method if I wake up during the night and have difficulty returning to sleep. If I sleep in a crib, use the Regular Technique before changing me to a bed. Also use the Regular Technique if, while using the Gentle Technique, I resist going to sleep or wake up as you put me to bed.

Step 3. Facilitate sleeping through the night using the 2-In & 15-Out or the Gradual Method.

2-In and 15-Out Method

The 2-In & 15-Out Method is the fastest way to teach me to sleep through the night. Using this method most children can learn to sleep through the night in less than one week. When I fuss after you leave the room at bedtime or when I awaken during the night, wait a few minutes to see if I will calm down and go to sleep independently. [Important Note: If I am crying and may be hurt, come into my room immediately. Be sure to know when I am crying to complain versus crying because of pain.]

If I continue to cry, come into my room for two minutes to reassure me that you are there and that I am okay. During this time rub my back, explain that nighttime is for sleeping, and tell me that you love me. However, do not take me out of my bed. After spending two minutes with me, leave the room for fifteen minutes. Continue coming in for two minutes and leaving for fifteen minutes until I fall asleep by myself. Expect me to cry when you leave the room. Crying is a normal reaction--you are not doing things my way and crying is my way of protesting the change. Staying out of my room for fifteen minutes before returning may be difficult for you, but I will need this long to calm down and fall asleep. I may cry for an hour or more before finally going to sleep. Continue coming in for two minutes and leaving for fifteen minutes until I fall asleep. You may want to take me out of my bed and rock me to sleep after an hour of crying, but don't unless I am crying because of pain. Doing this will teach me to cry for a very long time to get what I want. As a result, I may cry longer the next night. If you are consistent with the 2-In & 15 Out Method, we should both be sleeping soundly through the night in less than one week.

Gradual Method

Teaching me to sleep through the night will take longer if you use the Gradual Method. However, this methods feels better to some parents. It allows you to do the 2-In & 15-Out Method gradually. The Gradual Method involves slowly moving farther away from me in three-night intervals. As with the 2-In & 15-Out Method, use the Gradual Method whenever I am in my bed and have trouble falling asleep. On the first night, instead of leaving the room after my good night kiss, sit near my bed until I fall asleep. After three nights, sit near the doorway until I go to sleep. On night seven, sit outside the doorway with the door open until I fall asleep. While you are sitting near me, keep interactions to a minimum. Every fifteen minutes, spend two minutes reassuring me that you are there and I am okay. Explain that you will sit with me until I fall asleep, but that you will not sing, read stories, or lie down with me. Tell me that you love me but that nighttime is for sleeping. Don't take me out of bed during this time unless necessary. After two minutes, return to the spot were you were sitting. Continue to reassure me every two minutes and to sit for fifteen minutes until I fall asleep. Starting on the tenth night, close my bedroom door and use the 2-In & 15-Out Method if needed.

Step 4. Provide a Morning Signal.

A morning signal lets me know that it is time to wake up and get out of bed. It helps me understand when you will and will not let me get up. Examples of morning signals include turning on the light, opening blinds, and singing a good morning song. Provide me with the same signal each morning. After initial sleep training, I will probably go back to sleep with little protest if I do not get the signal when you enter the room.

Teaching me to sleep through the night will be one of the most difficult things you will have to do. But once it is done, you will see it as one of the best things you have ever done. Remember, if I am crying and may be hurt, come into my room immediately. Be sure to know when I am crying to complain versus crying because of pain.

http://www.parentingme.com/sleeping.htm

Tuesday, October 11, 2005

toilet training

Toilet training involves teaching me to go to, and use the toilet. It includes my recognizing the need to go to the bathroom, pushing my pants and underwear down, getting on the toilet, and urinating or having a bowel movement. It also includes my getting the right amount of toilet paper, wiping clean from front to back, putting toilet pater into the toilet, getting off the toilet, pulling up my underwear and pants, flushing the toilet, and washing and drying my hands. Most training will occur during the six weeks that follow the start of my toilet training. The whole process, however, may take a long time. It is not unusual for a child to need help until the age of four or five. I may need help wiping after a bowel movement or a reminder to wash my hands. The key to making this a short and stress-free experience is to make sure that I am ready for toilet training when you begin.


Readiness Signals

Most children have the muscle control to regulate themselves between eighteen months and three years of age. Children with disabilities may not have this ability until a later age. Certain medical problems may delay or prohibit a child from developing the muscle control needed for self-regulation. More important than chronological age is my level of readiness. There are 14 readiness signals. I do not need to exhibit all of these before you begin training. However, the more signals that I exhibit, the easier and faster training will be.

READINESS SIGNALS

* Over the excitement of learning to walk and run.
* Able to sit down and play quietly for about five minutes.
* Able to help dress and undress self.
* Shows imitative behavior.
* Wants to put toys and other possessions where they belong.
* Able to understand and follow simple directions.
* Takes pride in accomplishments.
* Not in a period of negativism.
* Has bowel movements at regular times every day.
* Bowel movements are well formed.
* Able to remain dry for about two hours at a time.
* Able to urinate a good amount at one time.
* Aware of the process of elimination.
* Has a name for urine and bowel movement.

In addition to considering readiness signals, make sure that I am not experiencing a stressful situation when you start toilet training. Stressful situations may include weaning from the breast or bottle, the birth of a new baby in the family, and changes in child care arrangements. Wait four to six weeks after the stressful situation before beginning toilet training.


Pre-Toilet Training

Pre-toilet training activities lay a solid foundation for toilet training. Engaging in these activities with me make the training process an easier one for both of us. You can begin pre-toilet training as long as I am fifteen months of age. This process should continue until I have enough readiness signals to begin toilet training. If I am ready to begin toilet training now, you should first spend at least one week in the pre-toilet training phase. This will allow me to enter the toilet training process with the skills and knowledge that this phase provides.

There are four aspects to pre-toilet training. Naming urine and bowel movements is the first. When you notice that I have a wet or dirty diaper, mention what has happened, using the words that you have chosen, for example, "You have 'poopoo' in your diaper." The second aspect involves allowing me to watch you or other family members use the toilet. This provides me with opportunities to see, ask questions, and learn. The third aspect revolves around the issue of changing my diaper. Change my diaper as soon as possible after it becomes wet or dirty to prevent my becoming comfortable with, or even liking, wet and dirty diapers. When you change my diaper, never make me feel bad for wetting or soiling it. If possible, change my diaper in the bathroom. This will accomplish a few important toilet training tasks before initiating training. Dropping the discards from the diaper into the toilet will help me learn that the toilet is where "poopoos" go. If you encourage me to help flush the toilet, I will learn how to flush. Finally, praise me when I tell you verbally or with a gesture that I have gone "peepee or poopoo." Once I develop voluntary control, I will tell you before the fact. Be sure to provide praise then, too.


Toilet Training

Once I have enough readiness signals and once I have spent at least one week in the pre-toilet training phase, you can begin toilet training. There are seven basic steps to toilet training. I should master and feel comfortable with each step before moving onto the next. The time frame presented is meant only as a guideline, so please be patient with me.

Week One

Step 1. Keep a running list of when I urinate or have a bowel movement. This will help you identify my elimination pattern. Implement steps 2 and 3 while you collect this information.

Step 2. Casually introduce me to my potty. Put the potty in the bathroom and wait for me to inquire about it. This gives me not only the role of initiator but also a sense of control. It also avoids a negative response to your initiating the process--"No, I no wanna see potty."

Step 3. Have me sit on the potty several times a day with my clothes on. This will get me into the habit of sitting on the potty in a non-stressful manner. Encourage me to sit on the potty by providing a special activity to do, for example, playing with a bowl of large shells or drawing on a chalkboard. To keep the activity desirable to me, only allow it when I sit on the potty. Engaging in an activity will keep me from becoming tense and bored while I sit on the potty.

Week Two

Step 4. Encourage me to sit on the potty several times a day with my pants and diaper off. The goal for me at this point is to become comfortable sitting on the potty, my skin against plastic. A good time to put me on the potty is close to the time I usually urinate or have a bowel movement (from information gathered in Step 1). A natural time is at bath time, when my clothes are already off. If I urinate or have a bowel movement while I am on the potty, make a big deal out of it and give me praise.

Week Three

Step 5. For a block of time each day, leave my diaper and pants off. This will help me learn that "peepee and poopoo" come from me. The longer the time the better, but a minimum of 30 minutes is best. Accidents will occur, so you should think carefully about where you will and will not allow me to wander. When you take my diaper off explain that big boys and girls go "peepee and poopoo" in the potty. Show me where my potty is, and tell me to sit on the potty when I have to go "peepee or poopoo." Reassure me that you will help me and then allow me play. If I am successful, praise me and positively reinforce me. If I sit on the potty and try to go, but don't, still praise me for trying. When I have an accident simply say: "Uh, oh. You had an accident. Let's clean it up. Maybe next time you'll get your "poopoo" in the potty." Typically, a young child will have many accidents in the beginning. Gradually the accidents will decrease and successes will emerge. Remain in step 5 until I have had 10 successes.

Week Four (or Five or Six...)

Step 6. Transition me into training pants and then underwear. First, have me wear training pants all the time instead of a diaper. It may take a couple of months of training before I can go a few days without having an accident. When I can do this, let me wear underwear instead of training pants.

Week Seven (or Eight or Nine...)

Step 7. Transfer the toileting functions that you are now performing over to me. This includes pushing pants and underwear down, getting on the toilet, getting the right amount of toilet paper, wiping clean from front to back, putting toilet paper into the toilet, getting off the toilet, pulling up underwear and pants, flushing the toilet, and washing and drying hands.


Working Out Problems

If you run into a problem during the toilet training process, stay at the step we are on and address the following questions:

1. Was my child ready for toilet training when I began?
2. How far did I get before we ran into the problem? Did something happen before that point that may have been a contributing factor?
3. Are there any other issues that might be interfering with the toilet training process?

Besides addressing the questions above, discuss the problem with my pediatrician or our family practitioner. My doctor should know me well and may be able to provide some very useful advice.


http://www.parentingme.com/toiltrng.htm


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