Sleep Issues with Adopted, Foster, or Relative Children

How do you handle sleep struggles when raising a child who has been impacted by trauma, prenatal substance exposure, or other challenges? Listen to our conversation with Dr. Chris Winter, a sleep researcher and neurologist who has practiced sleep medicine and neurology since 2004. He is also the author of The Rested Child: Why Your Tired, Wired or Irritable Child May Have A Sleep Disorder--And How To Help, and hosts the podcast Sleep Unplugged with Dr. Chris Winter.

In this episode, we discuss:

• Understanding the value of sleep and reframing the conversation about expectations and what your child needs to support overall health, development, and wellbeing.
• What makes adopted, foster, or kinship children particularly vulnerable to sleep challenges?
• How might a child’s early trauma and experiences of loss — such as separation from birth families or multiple moves — show up in their sleep patterns?
•  What effects do frequent environmental changes have on a child’s sleep?
• How might prenatal exposure to substances (e.g., opioids, alcohol, others) impact a child’s sleep?
• What may be the challenges that children with neurodiversity (Down syndrome, ADHD, ASD etc) experience?
• What are the practical strategies you have found successful in helping families with sleep disturbances?
• Why is it important to teach our kids the value of rest—even without sleep?
• What should we consider when setting up a consistent routine and sleep-friendly setting for our kids?
• When is it time to seek professional evaluation—like a sleep study or specialist referral for our kids?
• What guidance do you offer caregivers to help them stay consistent, avoid burnout, and model healthy sleep habits?

Chapters

• 1:02 Understanding the value of sleep and reframing the conversation about expectations and what your child needs to support overall health, development, and wellbeing.
• 3:41 What makes adopted, foster, or kinship children particularly vulnerable to sleep challenges?
• 8:22 How might a child’s early trauma and experiences of loss — such as separation from birth families or multiple moves — show up in their sleep patterns?
• 12:52 What effects do frequent environmental changes have on a child’s sleep?
• 17:11 How might prenatal exposure to substances (e.g., opioids, alcohol, others) impact a child’s sleep? What may be the challenges that children with neurodiversity (Down syndrome, ADHD, ASD etc) experience?
• 23:45 What are the practical strategies you have found successful in helping families with sleep disturbances?
• 34:46 Why is it important to teach our kids the value of rest—even without sleep?
• 43:19 What should we consider when setting up a consistent routine and sleep-friendly setting for our kids?
• 54:21 When is it time to seek professional evaluation—like a sleep study or specialist referral for our kids?
• 57:27 What guidance do you offer caregivers to help them stay consistent, avoid burnout, and model healthy sleep habits?

Transcript

Please pardon any errors, this is an automated transcript.

to help their athletes optimize sleep. He is also the host of the podcast Sleep
Unplugged with Dr. Chris Winter. Welcome, Dr. Winter. We're glad to have you here.
Thank you very much for having me. So we're going to dive right into a basic
understanding of sleep because we do have some maybe new parents in our community
that don't necessarily understand how core sleep is to a child's overall health and
development. Why don't you just kind of give us that basic rundown of why sleep is
so important and why we need to pay attention to sleep habits? Yeah, I think you're
right to start with an educational piece. As a, you know,
looking and dealing with a lot of parents, I think that's a place to begin, not
only practically in terms of understanding sleep allows you to know what to do and
to handle situations, but I also think that a foundation of sleep knowledge really
takes a lot of fear and uncertainty out of a situation. And I think sleep embodies
a lot of that for all kinds of parents. I think that it's sort of natural that
when you're waiting on a child, you're hoping for, you know, 10 fingers,
10 toes and that they're a good sleeper. Like that's sort of in the back of your
mind. It was for me anyway. I didn't care about gender. I didn't care about if
they had any interest that eventually mirrored mine. I just wanted them to be able
to sleep so I could get some things done and put some groceries away. So I think
that starting with that education is really helpful for a lot of parents.
And I don't think that sometimes that is given. And what we give instead is a lot
of sort of expectation and maybe science that reinforces a feeling of,
if we don't get this right, all kinds of bad things are going to happen. And I
think sometimes we are given sort of an expectation that we have a lot more control
over it than we really do. It's almost like the media telling you to have a short
child, they're going to struggle. So what you really want is a tall child. They'll
get picked first in all the sports. They'll be able to reach the spices a lot
easier on that top shelf. It's just going to be an easier life for them all
around. But you're never really told, well, how do I make them tall? Like, you
know, what do I do? When, in fact, you don't. Like, they kind of end up the
height they're going to end up. Maybe give them some extra protein and milk it
might influence it. But your control over the height variable is kind of small.
And I think in some ways, sleeps like that too. That, you know, for a lot of
individuals, it becomes less about trying to control it and maybe more about working
with what you got. So let's drill down on that a little bit. We're talking to a
population of parents and caregivers who are raising kids with very unique needs
compared to the general population. What would make an adopted foster or kinship
child particularly vulnerable to sleep challenges? I think a lot of things.
I think that anytime we are dealing with young people that are changing their
circumstances pretty radically or feel uncertain or unstable in their situation.
It's often going to be reflected in terms of sleep. I think that for a lot of
parents that they think of sleep is a bit static, it's a very dynamic variable.
The place where I like to start with all families, particularly maybe the families
within your population, is a very simple fact, which is every individual,
every human on this planet is going to sleep. So what we want to very quickly
eliminate from the decision -making matrices here is this idea that I've got a child
who can't sleep, which is never the case. That's sort of like saying, I've got a
child who does not consume fluids. that would be devastating and,
you know, lead to death in a few days. Like everybody's drinking a little fluid,
eating some food, they're breathing air and they're sleeping. Those are kind of non
-negotiable. So it's very helpful with parents if we can get them to a place to
start the conversation from, I've got a child whose sleep needs or patterns are not
meeting my expectation or that they're
questioning that theory, we went along with it and continued not we.
I wasn't a part of that team. Thank God. Giving him a drug. That drug didn't,
yeah, right. I have nothing to do with that pop star. The pop stars I work with
are much more like B and C tier. So anyway, so it starts the process in a much
healthier place. And I also think that it feeds backwards to the parent's
relationship with a child, which is, it's okay, you're going to sleep.
Like, there's a lot of messaging that happens with sleep that can be really healthy
or really problematic. I always tell the story. I've got three kids. And around the
time they were, I don't know, five or six, I told them, you can go to bed
whenever you want to. It doesn't really matter to mom and dad. Like, you just do
what you want. So So if you're reading your magic treehouse book or you're playing
with your dolls or whatever, you do it. When you're ready to sleep, you can go to
sleep. Now, the rules are you have to be in your bedroom. So you can't keep coming
out and asking me for a glass of water, that creepy thing where a kid walks out
of their bedroom and stands next to you in bed. And you wake up and there's like
this person. They're just kind of staring at it. Like, none of that. I always told
kids, you come out of your room if you smell smoke or you see somebody you don't
recognize. Otherwise, please stay in your bedroom. But what we didn't tell them was,
okay, go to bed whenever you want to, turn the light whenever you want to. I'm
going to wake you up about the same time every day. That was sort of the unspoken
part of the deal. So what we wanted our kids to sort of develop was sleep's
important, but you're not going to get in trouble if you're having trouble falling
to sleep tonight or it doesn't happen the way you want. So, you know, trying to
start from a very young age with all children developing a sense of sleep as a
positive.
It's kind of a reframing. Yes, 100%. It's saying, let me help you develop a healthy
positive relationship with sleep. And let's not see it as punitive or the pressure.
I did have one child in particular who felt tremendous amount of pressure to fall
asleep when we told them to go to bed. And us telling them to go to bed doesn't
necessarily mean I'm telling you to fall asleep, but that's the internalized message.
Yeah. So how might a child's early...
What a nightmare is and is like a comfortable bed and you have family around you
that really cares about you and some dolls and trucks and toys and art supplies.
Like that's pretty awesome. Like so maybe not meeting an expectation, but how have
we gotten to nightmare? You know, so to me, I think that's really important. So for
for parents, I think that thinking about those expectations are really important And
that framing becomes really important because we as parents have these expectations as
well as the kids. And so you can imagine to answer your question, a kid with
trauma during the day when you're running around and doing stuff and you've got a
family that's really excited that you're there and they're doing all kinds of things
to welcome you and make you feel at home and ease and provide that,
those symbols of stability, all that kind of disappears at night, especially when
you're in your own bedroom. You're back to being alone. And I think sometimes for
some people that being alone and, you know, not distracted by other circumstances can
be really problematic. You're in the dark. It's reminiscent of being alone in that
other place. And so I think that the night, not just for kids, but for everyone,
can be a place of real concern, horror,
anxiety. Vulnerability.
I've been left so many times. It's kind of like a little mini leaving. Okay,
goodbye. We're leaving and going to our place and we're leaving you here by yourself
in this room that you have no attachment to, you know, whatever. So I think that
that's a very sensitive time for kids. And again,
like you said, reframing, we're trying to frame that as a positive. This is
something we do with adults all the time that if somebody said, you know, Chris,
what's the key to great sleep? It's being equally happy in bed asleep as you are
awake. Like that, and that's tough for some people to get to. It's kind of like me
saying, well, don't be scared of heights. You're like, well, great. Like, you're
telling me this, but every time I get up high, I'm scared. You know, like, right.
So it really takes time. And I think it gets magnified or amplified by something I
say to parents all the time, which is I think parents can handle anything if
they're getting their own sleep and private time relatively protected. If you know
that you're going to put that child down and they're going to fall asleep and you
can catch an episode of the Gilded Age, get some work done, balance the checkbook,
pay some bills, do something that you like to do to kind of decompress and de
-stress. I think you can pretty much handle anything that a kid throws at you. I
think when you start getting a situation where sleep is not a certainty,
it's not only harmful to the child like you're talking about and kind of creates
these relive traumas and things of that. But for the parent, it's that uncertainty.
And we all felt it as young parents. Like, put the kid down, okay, and you tiptoe
out of the room, close the door. And you don't do anything for the next hour
because you don't expect to be able to do anything because you're like, oh, they're
going to wake up. You get the baby monitor, you know, glue to your ear or
whatever. So to me, it's really about at the same time simultaneously trying to
create structure and order for the family and the parents so they can be at their
best, but also for this new amazing member of the family that's coming in and
trying to assimilate. I think that becomes the, that's the objective. And it's a
tough one. It really is. So what are some of the things that we would see showing
up in a child if those experiences are not conducive to them having that sense of
calm and rest when they're in their bed. Yeah, I mean, I think there's a lot of
things. I think they can be subtle. The curtain calls we call them. You know, you
put them in bed, and then they come out. I'm thirsty, and you get them a glass of
water, and you come back. I heard something, you know, I go, okay, well, we live
in a world with sound, so let's check this all out or whatever. I think there's
something under my bed. So those things can be kind of maddening. And so I think
that's probably the one that we're most familiar with. And they can escalate all the
way up to nightmares and night terrors. And night terrors, meaning abnormal awakenings
out of a deep sleep. So this is the sleepwalking, screaming at night,
and you walk in, and they seem kind of disoriented and out of it, have no memory
of it the next day versus the nightmare where maybe an older child is able to tell
you a story. Oh my God, there was a thing underneath my bed and it reminds me of
the place where I came from. And so there's more of a story and memory to it.
Night terrors are interesting. A lot of times, you know, a family will put a kid
down and literally before you can get down to the couch and, you know, sit back
there. They're screaming. And it feels made up like,
oh, there's no way they were asleep and they're screaming and kind of acting
strangely. But, you know, for a lot of those kids, that parasomni can really happen.
You know, regressive behaviors, a child who was not really struggling with bedwetting
or things of that nature is now bedwetting. That's probably the most common one that
we see. But, you know, sleepwalking, kids are, you know, getting out of their bed
and falling asleep on the couch couch or in your own bed and having little memory
of those types of things to eating unusual things, leaving the house. I mean, we've
seen all kinds of things like that. So I think that those kinds of behaviors are
something you just kind of have to prepare for. It's like there's a medication I
use for narcolepsy for some of my patients that can in very rare cases cause
bedwetting. And man, I tell them like, prepare for the bedwetting. And it rarely
happens. But I just want people to know.
advice, it's release expectations. Yeah. Yeah.
And that's hard. We went through, it's probably oversharing, we went through a
process of trying to adopt and eventually just it, it was international countries
were closing down and at war. They didn't have copy machines. It was just a
nightmare. The whole process was release one expectation after another.
Yes. I can still mentally visit my expectation of what was going to happen.
And yeah, it was just an exercise of, you know, you've got to let go of all these
expectations and let it play out and react to the reality, not the different, that
delta, that difference between the reality you've been given in what you expected.
Yeah, we find very often that that gap between expectations and reality is what can
set parents off track and just make them feel like they can't cope with what's in
front of them to cope with. I think sleep is a microcosm of exactly what you do.
I'm going to go to bed tonight. I'm going to be sleeping two minutes and we'll
sleep all the way through the night, no pee -breeks, and I'm going to wake up in
the morning and feel great and let's do it if it works out great, but it might
not. And are you ready for it not working out? It's a rare child, especially in
our demographic where we're talking today. Many of the families that we're supporting
and serving have children with prenatal exposure to alcohol or drugs,
and those things can definitely impact a child's regulatory system,
including their sleep regulatory system. What specific things would be seen in a
child like this in addition to some of the other things that you've already
mentioned. Yeah, so that's a great question. I think the first place that we can
start is, you know, if you look up the National Sleep Foundation, if you type in
National Sleep Foundation, Sleep Need by Age, literally from birth until senior
citizen discount, it'll tell you the average amount of sleep that group is getting.
And it does a good job of giving you the average number of hours and then sort of
a range on either side of, but you might in 10 % of the time see this much or
this few. So sleep's a bell curve. It's like height, you know what I mean? And I
think what you're describing with these prenatal exposures, think about the average
child's height and maybe what's something like prenatal exposure to alcohol does to
development height expectations. It might offset that a little bit. Now you're going
to work hard with good nutrition and all these things to try to overcome these
things and often people do. But my guess is if you look as a population, they're
going to be shifted to the left a little bit based upon this thing that was really
outside of their control. So sleep's kind of like that too, that when you look at
these norms or you're sitting in your Kinder music class or parenting group or
whatever you're doing with all the other parents of their children of different
backgrounds, that you might be a little bit on the outside of that bell curve.
And so going right back to the expectation, I think that's the first one is if
you're expecting your child to get the same amount of sleep that you're.
So I think, again, it's like the E &T, when we set out thinking, okay, if we can
get six hours or seven hours, that would be a great night, you're already kind of
on the right track there. And if you're surprised by the child getting eight hours,
wonderful. I mean, I see kids that, you know, they're getting put down at, you
know, seven o 'clock, and they're expecting them to sleep till seven o 'clock the
next day. Well, that's what my other child did, or That's what I need as a parent.
And that's a tough one. Like, well,
your new child doesn't really care in that way what you need. And so we need to
figure out how can we get you what you need, but also understand that supporting
your child and their specific need can be two different things. And that's where you
start to see a lot of parental interaction you know, clinicians and pediatricians,
why does this child take this medication? Well, it's to help him sleep. What
prompted this? Well, we'd put him down and he'd be awake for two or three hours
before he'd fall asleep. Right. Because that's the amount of sleep that he seems to
need at this time. So is that medication designed to improve his sleep?
Or is it designed to give you more time to which which is a weird situation to be
in sometimes, where as a sleep provider, I need to be respectful and try to support
the parents and getting what they need to be effective, but also understand that the
child's need may be radically different from, and I feel like a lot of sleep
providers, just a little disclaimer, I think the average pediatrician has gotten
something one hour of sleep education, 25 % have gotten none. So a lot of times
sleep,
you have a lot more issues related to maybe underdeveloped upper airway or
musculature, hypotonia, and these things can result in all kinds of, you know, a
subtle breathing disturbances. So we think of sleep apnea as the 250 -pound truck
driver guy, and it can be a young person. We see a lot in Down syndrome, bigger
tongue, smaller airways, so they have a lot of an airway obstruction that can be
quite silent. And so they're not snoring everybody out of the house, but they're
struggling to maintain their airway throughout the night. And to do that, they're
waking up constantly through the night. Their airway collapses, their oxygen is
dropping, and their CO2s going up a little bit and say, they wake up and catch
your breath. Uh, mom, and you're screaming out. And he just wakes up all the time
or he's so tired during the day. So, you know, looking out for airway disorders,
seizures can be very common in some populations particularly
when mom comes in there in the morning to get everybody up, the sheets are all
pulled off and the pillows on the ground and, you know, it's like a tornado's kind
of gone through there. So paying attention to those types of things can give you
little clues as to, is there a disorder here that we could, you know, address and
specifically pinpoint to perhaps make their sleep a little bit better? I'd like to
interrupt this interesting conversation about sleep for just a minute and tell you
about our library of 15 free courses from the jockey being.
Let's jump into some of the practical strategies that you have found successful for
helping families whose children, you know, are impacted by trauma or are impacted by
prenatal exposures or neurodiversity, all of which are very common in our community.
Yeah. So, I mean, I think that I guess the first sort of thing that I like to
talk about is this process is going to take a little time. I think you can't hear
that enough as a parent. And with sleep specifically,
because I felt it myself, you just want the sleep thing fixed as quickly as
possible. Because, I mean, every night. You're tired. Yes, and irritable.
And you feel, I mean, My worst parenting happened when I was, I mean,
so my first child was born when I was finishing up medical school. My second child
was born when I was a first year neurology resident. And my third child was born
when I was in my sleep fellowship. And, man, like, those are not the greatest of
sleep times in your life. And I just remember thinking to, remember one time,
I'm a kid crying or doing something that kids do. It was nothing out of the
ordinary. Right. And at some point, I just said, oh, go to sleep,
you idiot, to like a baby. Right. And I just kind of froze.
I guess it's like, it's like when you're locking your keys in your car, as you're
closing the door, you're thinking the keys are in, no, no, no, and you do it
anyway. Like, So I can almost see these words coming out of my mouth, like trying
to collect them and shove them back in my, and I said it, and I just kind of
paused in my wife and I looked at each other and we just started laughing. Like,
what are you talking? What are you yelling idiot for? Like, you know, you need to
get some sleep. So I think that trying to set the expectation of it's not going to
happen as quickly as you think, but there are things that we can do. And this is
where I really feel like a partnership of parents is such an advantage. You know,
it's like somebody saying to me, Chris, I'm having triplets. What do you think I
should do? That's where I fake like a drop call. Like, when somebody calls me, I'm
having triplets. I need some help with my sleep. I just like hang up. Like, I've
got nothing for you. There's nothing. Get more parents in the house. Yeah, call your
in -laws, I guess. Get some help. You know, What was it, what is that? It's like
DoorDash, but it's like for help with stuff. Oh, wouldn't that be lovely? Call those
people up, give them, you know, 20 bucks an hour to like, you know, tip up and
now with your kids and play music. But so, you know, to me, I think that there
are things that we can do, but it's just, you know, starts with like managing
everybody's expectations. And I think for a starting point,
I think it really has to be looking at some sort of scheduling or consistency.
And it's interesting, I'm old. So I have been through, I've been doing something
related to sleep since I was an undergrad in the early 90s. And it's interesting
when people first started paying attention to sleep, it was all about amount. Got to
get the right amount. And that's valid, absolutely. You've got to eat the right food
or you know whatever and then it became okay it's not just amount but quality
because you can't be having sleep apnea restless leg or narcolepsy and so it's the
right amount and good quality sleep yes absolutely what's really interesting when you
look at research now within sleep or you head out to a scientific conference it's
all about consistency meaning that you can have the best sleep in the world and
you're getting your seven hours or your eight hours. And seven hours is tied most
directly to adult health positivity. You know, it's not eight. So, you know,
whatever, seven eight. But you could get seven hours by sleeping, you know, midnight
to seven a .m. And then two weeks later, your shift at the nuclear power plant
changes, and you sleep from noon to 7 p .m. And there's a lot of places that do
that. You're 7A to 7P for 14 days, and you flip. So these individuals are getting
the right amount, great quality sleep, but their consistency is terrible. You're a
pilot, and she likes if she falls all over the world, and you never know what city
she's going to be in, but she's able to get enough sleep, the airlines, making sure
that it's blocked off, but it's always switching time. And these are devastating to
our health. Right. And one of the things a mentor told me in neurology was brains
love a schedule. And we all feel that. You know, when we're in a really good
schedule, everything's happening at the right. Like, all of a sudden, at 7 .30 in
the morning while you're walking the dogs, you feel yourself get hungry. Like you
weren't hungry at 725, but now it's 7 .30 and you're like, well, I'm hungry. Right.
Not because your body suddenly ran out of fuel. It's your body knows the bagel and
the orange juice is getting ready to come. And when you think about sleep, it's not
just what we do right before we go to bed, which is important. So if you're a
parent and you have, okay, we do dinner and then we do one 30 -minute door The
Explorer, and we read books, and we do bath time, and we dim the lights, and we
do the lavator spray, that's great. But that kind of thoughtfulness of schedule
really needs to happen 24 hours a day because that's where
Right, right. May because, oh, our warning, we're leaving it and out. Oh, mommy,
wait, we haven't even gotten to it. You know, like, so whatever. So you have to
give it. So our brains are looking for those things. If we can give them to them
24 hours a day, two things happen. One, it really helps a child sleep better.
Number two, it really gives a parent a sense of control. Like, you can control.
Like, what time is breakfast? Well, it depends on how well they slept that night.
That's trouble. And I understand that instinct of.
And with an attitude, and it's acting to the level of Daniel Day Lewis,
which is we're happy about, hey, it's the morning. Let's get going.
Oh, my God, we're going to have a great day today. And your mother's making
pancakes and those good stuff and we're going to have a great day. And I feel
terrible. I feel terrible. And versus get up. This is awful. I feel terrible. You
know, you really have to sell it. You know what I mean? So you don't want them to
feel bad about it because it's their fault. You would have slept great the night.
They were up looking around for, you know, I heard a sound. Yeah. So what I'm
hearing you say is the good morning song that I used to sing to my children every
weekday morning as they were getting up was a good thing and they're not going to
be able to tell me otherwise. Every kid in the world right now. If you call them
up, I'm going to call up somebody. He's 57 years old. He lives in Cleveland. Seeing
the song, your parent sang when they woke you up in the morning. My wife can.
I forget what the song was. It was her father saying to her. And so it's one of
two things. It's the morning song, everybody knows, or they remember a parent coming
in with a vacuum. I hear that all the time. It's like, we're coming in 6 a .m.
with the vacuum, vacuuming up, whatever. But there's something kind of wonderful about
that what we call a zeitgiver or a time cue. Yeah. Here comes mom with the vacuum
every morning at 6 o 'clock. So your brain starts to understand. It's like being in
the military. It's like my middle child went to the Naval Academy. And I remember
him telling me like the first time I got to speak to him. It's like an abduction.
And then all of a sudden he resurfaces, you know, four weeks later. He gets a
phone call. Like, you know, leave the money at this place or you'll never see me
again. I kind of had that kind of feel to it. I remember that phone call well.
Yeah. Did you have, you have somebody who was in the military? Yeah, one of my
sons is an army reservist. It's the same thing. Total radio silence for the kid who
can't do anything for himself. And then now he's gone and, you know, your mind goes
to places. But anyway, I remember him calling up and saying, no insomnia around
here. Right. Because. Right. No.
and support and fun. Hey, I know you had a bad day, but we're going to get up. I
had a bad day, too, a bad night, and we're going to get up, and we're going to
do this thing together. And that consistency is tough, but it will pay off very
quickly. It's sort of like, I can't get my son to eat dinner. Okay, well, take
away his lunch and half his breakfast and watch what happens in a few days, right?
So we're not going to sidestep eating. At some point, your child will eat.
Sleep's kind of the same thing. You just need to kind of create a situation where
his brain has no other option but to kind of do what you wanted to do.
And that takes a little, take some courage, but it can be done. You know, I
remember going camping one time with our kids and we were up with some other
families and they were like, I was like, okay, guys, it's time for y 'all to go to
bed. And they were, okay, and they put their little s'more sticks down. And they
all went into the same tent and went right to sleep. And I remember this other
parent was like, holy hell, what, how did you are so lucky that you,
they said, you were so lucky that you have good sleepers. I'm like, listen, brother,
it is not luck. I said, that is, that is years of
right now, you know, in the kindest of ways, you know, so. Right. The most positive
of ways. Yeah, the most positive of ways, right, exactly. Well, and I think when
we're very consistent and we hold to those routines and those structures, you know,
it creates such a sense of safety that they can trust us when we say, okay, now
it's time to go to bed. And they can trust us that they'll be safe while they're
in bed. Absolutely. And so that consistency of day start, night end,
and all that goes in between that, it creates predictability, it creates trust,
and it creates safety. I love what you said about rest, even without sleep,
being restorative. And I'd love to hear a little bit about how that plays out,
because we do have many families whose children go to bed, but don't necessarily
sleep right away, like you mentioned earlier. Yes. I think this is really important.
So important that that is why I called my second book, The Rested Child, and it
was a massive mistake. Because it sort of within the publishing world separated out
as a sleep book into something completely different. I have no idea. But I stand by
the least the rested child, the publisher came up with a little byline, which I
always thought was kind of hokey. But anyway, but I think resting is so important.
And it's one of those messages that you can start to promote to your child
immediately, or all of your children. And it's something that you can take some safe
harbor in in the sense that you've put some, you know, your kids, it's a quiet
time and you have a little chance to catch up on some rest because last night was
a disaster. Lying down somewhere where it's relatively quiet and closed.
and this breed, all that stuff is really restorative. And one of the messages that
I really tried to reinforce with my entire family was getting rid of this idea that
you get in bed, and if you don't fall asleep quickly, that's wasted time. And it's
really not. It's a, it's a wonderful, glorious time. And so this idea that,
well, I try to nap, but I can't fall asleep, so I just abandon it. Well, no, what
you want to do every day is maybe, and we all have rest time. That was rest time.
resting. You're not missing out on anything unless you find me in a horizontal
position with my eyes closed, exciting. You're not missing anything. So we're all
going to rest. It's important to us. It's important to the family. We're doing the
same thing. We're putting our phones away and all that good stuff. And that this is
a time that's going to be very restorative to you. And I think when you talk to a
lot of adults and maybe older kids and ask them the question, when you have that
rest period, even if you don't sleep, how do you feel afterward? You can feel quite
amazing. I
and closing my eyes for 30 minutes. And if sleep happens, awesome. But that's sort
of the message you want to give the kids. Hey, how was resting? Oh, it was good.
I got in bed. I tried to go to sleep. I didn't fall asleep. But did you rest?
Well, yes. Oh, then you did a great job. You did it. Like, that was the objective.
And if your sister falls asleep, well, that's great too. Oh, you fell asleep. Oh,
that's good too. But, you know, the point is resting is always under our control.
Sleep isn't. We are going to sleep eventually, but in terms of this moment right
now, it seems kind of hard to do that. So what you're also teaching a child is,
I'm going to give you a task, which is to go into your room and close your eyes,
lie horizontal, and rest for a few minutes. You can do that. You can be successful.
That is a choice. And I think that when kids start to understand that that's the
and not, I need you to fall asleep. I catch you with that book in bed one more
time, you're in big trouble. Or if you don't get the sleep you need, you're going
to fail your test, and you're not going to get a good job and your career is
going to be a design. Like, wherever people, you're not going to make the team.
Catastrophizing. You know, when catastrophizing starts, it doesn't start when you're 37
years old. It starts when you're seven years old. Right. So we can, in some ways,
help to shape those beliefs, at least around things like sleep and eating and things
of that nature from a very young age. So these kinds of things, I think can be
really important for kids. And I also think it's important, too, that we can also
share how we're feeling about things. You know, mommy needs a rest because last
night, I think you would agree, partner, it wasn't a great night. Like you woke me
up 17 times or something of that nature. So I'm feeling pretty depleted right now.
So I really need a rest because of that. It's not a guilt thing. It's just a
statement of fact. You had a difficult night and it's impacted me.
So I'm going to really need this rest. I mean, I think it's okay for a parent to
say, I don't know that we're going to be able, you know, I don't think we're going
to be able to go get that ice cream today that we had talked about. I'm pretty
tired. I would really like to get ice cream. I'm sure we can later in this week.
But right now, I've got a lot of things to do. I've got to take this rest because
last night was very difficult. I know you had a hard time. But don't worry, we're
going to get the ice cream when we, when we have a little bit of a better day.
Like it's almost like a sticker chart, but it's not a a punishment. It's a
statement of, I don't know that I can operate the car to drive to the ice cream
parlor because I'm so tired right now. And I think it's okay in a non sort of
passive aggressive way to say to a child, I have needs and I'm going to be better
able to support yours when I get what I need because I'm part of this family too.
It's one of my favorite things to ask.
It's questionable, but when I see kids in the clinic and, you know, the kid wakes
mom up 30 times during the night, I always ask, why do you wake your mom up? I
love asking that question. They never have an answer for it. You know, do you think
it's kind of mean that you wake her up? I mean, do you think she can actually put
you back to sleep? No. Don't you think it's kind of mean? Because she's kind of
take care of you and do all the things for you. And then you just go in there
and wake her up, why do you do that? And it's really interesting to see a kid ask
that question for the first time because they've never really considered it. It's
just sort of a force of habit. I woke up, so I got to go wake up everybody else
in the house. So these old conversations, if done kindly and respectfully,
I think can be very helpful to kids. Yeah, that's pretty groundbreaking for a lot
of families, I'm sure. That's probably not the tradition they've followed thus far.
Well, it's hard because the kids new, the kids new to your class, you're laying out
the red carpet for them. Do you know what I mean? Like to have those kinds of
conversations feel sort of counter, you know, it's like every, I'm not a own dogs.
I'm no dog expert. But I'm always feeling like when I speak to people who are much
more expert about it, they're like, you know, the dog wants you really does want
you to enforce that thing because eventually it will make them happier because they
understand what their role is and where they fit into something. So you letting them
roll over the place during the walk, you feel like is helping them, but it's
actually kind of confusing to them. So I think there's some parallels there, not to
compare our children to dogs. Everybody knows that dogs are much more wonderful than
our when they're in their teenage year. You know, this is not an insult to dogs.
That's what I'm saying. Oh, that's funny. But anyway. But it's true that children,
especially children, who've been impacted by trauma or loss or multiple placements and
multiple household environments, when they have parameters that they know they're safe
to operate within, then their bodies can come down and relax and their nervous
system can calm down and relax. And when that all comes together in a calm,
relaxed state, they are much more likely to be able to fall asleep and stay asleep.
And in the interest of helping our kids, we have control over their environment in
sometimes ways that they don't know that they can participate in. How can we set up
a calming, sleep -friendly environment that will,
at the minimum, lead to good rest, restorative rest, but eventually maybe lead to
some good restorative sleep, too? I love what you said. Also, within that setting up
parameters where they understand when they don't meet an expectation, that's going to
be met with something constructive and full of love and not something else. Right.
It's
mom and dad are on a couch at a friend's house. I mean, there's all kinds of,
like, parameters here that are very difficult. And I think that's its own
conversation in some ways. But, I mean, I think that what you're trying to do in a
lot of ways is create an environment that they feel very safe in. I don't think
that that has to be something full of toys and kind of over the top, which I
always feel like seems to be the parental compensation. We want them to come into a
room that seems like an FEO Schwartz on steroids kind of thing. Like it just, there
needs to be ownership. And I think that ownership starts with the child kind of
dictating what that looks like and what that is. Walking into a bunch of stuff that
is foreign to them, I think, is a little bit scary. I also think it forces this
idea of if things don't go well, this will just be an amazing thing that I'm going
to lose in a few weeks as I move on to the next place. Like it almost becomes, I
don't want to invest in the ownership of all these amazing things you've got me
because everything up in this point my life has been transient. So I think that
starting off with a place where they feel comfortable that they know that you are
close by if they're going to be in a room separate from you. And I think that
it's okay in some situations for a child maybe to not be in that.
I mean, when we bring babies home, they always are, you know, typically in the room
with the parents for a period of time and then they're in the bassinet next door.
So I think there's a lot of situations where that might be the smarter thing to
do, transitioning to a new home and new brothers and sisters and new everything. And
by the way, I'm going to abandon you in a few hours for this room that you've
never been in your entire life. I think it's difficult. I think that's where things
start with spending a lot of time in the child's bedroom, doing fun things during
the day where you might not ordinarily spend that time. You might be in the living
room or the kitchen and doing things like that. So really trying to create a
situation of, we'll play in here and we'll do this fun little project we've done or
we're going to make a scrapbook of you as part of our family, whatever you do, but
you're still going to sleep with us right now. So you start to develop a comfort
level with that room and an association of this is where all the good things
happen. And I would stress that that if you do have difficult things to talk to
your child about or issues, I would recommend physically going somewhere else to do
that. You really want to try to create that room as the space of their own.
Haven. That's a great word for it. And I think that the other thing, too, is that,
you know, as we were talking about curtain calls earlier, you really want to create
this environment of making your child feel like that's the better place to be,
you know. Now, I think that, you know, that separation from mom and dad, they get
up, they come in, they want to get in bed with mom and dad, can be difficult. And
there's lots of little ways to handle that as the child starts to adapt to the
home. And you're feeling like, this is going beyond what would typically be normal
and becoming more of a habit. You know, when my, my youngest son would do that.
When he would come in, I would say, oh, I'm so glad you're here. I've got some
cleaning up to do in the garage. And so we would go down the garage and, like,
sweep up cobwebs and spiders.
we would do it for 10 minutes and now I would put him back in his bedroom because
I wanted to sort of tilt the scale a little bit towards if he needed me he could
come in there like it wasn't like I made it very clear you do not have to come
down with me in the garage if you don't want to but you know kind of this feeling
that if I wake up why do I want to go in there we're just going to like clean
up some cobblets at a young woman who I was seeing and I was like how are things
going she says it's really good I said what did you decide to do how did you
figure it out she said well we just clean toilets
You know, so it's not about being mean, or one of my friends said, maybe you
should, like, put a little mannequin clown in your bedroom. Like, no, no, you don't
want to scare the kids into a creepy clown. But you do, maybe like, this isn't
going to be the picnic that you think it is, you know, kind of thing. So anyway,
I think that, you know, trying to figure out ways to make their bedrooms special, I
like your word, Haven. And then again, it's probably going to require something that
you're spending quite a bit of time in there upfront, you know, doing family things
and fun things where they start to really associate that place with a really good
time. Yeah, I think when we're talking about this population in particular,
it's probably also really good to, as they are getting older, ask them,
I mean, when they're little, they don't necessarily have the language for this. But
as they're older, if you're welcoming an older child home, you know, ask them what
would make this room feel safe or warm or welcoming? What kinds of things do you
like to surround yourself with? Some kids will come to you with a special teddy
bear or a special blanket. And, you know, keeping that, don't wash it as soon as
they walk in the door when it's a new foster child or a new kinship child, don't
wash that blanket, don't wash that teddy bear, allow them to have the sense and the
textures that come with a well -worn, well -loved teddy bear. We talked a lot as our
kids were learning how to sleep on their own about that this is their special
place, that this is theirs, and they can make it their own. And mommy is more than
happy to come in and, you know, sing that song with you or rock, in
guys or whatever, just get a pillowcase that your girlfriend or your partner uses
and don't wash it and take it on the road with you if you have trouble sleeping.
So when you get to the four seasons, put the pillow inside that pillow case and
you can, or even like a t -shirt that she wears at night or something like that.
Because those smells tie very directly into memory. And so I think your point of
that. And I think you also need to abandon all expectations of the way that room
is going to look at least initially. Yeah. You know, they've made this weird little
thing or they've got this thing that maybe is something that I don't, you know,
busted up, you know, G .I. Joe, a foot tall G .I. Joe guy with no arm.
Like, I don't really like this whole military thing here and it's got more arm. And
this is tiny. Just let them Let them have it.
Absolutely. What was that? There was a show recently. I can't remember what it was
either a show or a movie, but the main character just felt more comfortable sleeping
on the ground. And I thought that was a really interesting detail in the show
because I'm sorry, I can't remember what it was. And it was distressing to the
family because they would come in and he would be sleeping on the ground. But
that's kind of what he was at. The bed just made him feel uncomfortable. And that's
okay. Just try to support them and things will morph.
safe and they need to be able to rest. And if that's what's happening, they're not
going to go to college still sleeping on a mattress next to your bed. That's what
I always say, that, you know, if your child is sleeping in between the two of you
and asking for calculus help on their assignment, yeah, you might have missed some
opportunities along the way. You might have missed that window. I've never been
presented with that problem. You know, mom, palms tomorrow. Can I sleep in bed with
you guys because I'm so nervous about it. Yeah, that's probably not going to happen.
One more interruption to tell you about our interactive training and support
curriculum for foster, adoptive, and kinship families. You can find it at parent
supportgroups .org. That's parent supportgroups .org. It's a turnkey small group learning
opportunity with guest expert videos, thought -provoking discussions and practical tips
to help families strengthen their parenting tools and strengthen their relationships
within the family. If you love learning as much as we do, then you should check
out that curriculum today. And while you're at it, if you love learning about sleep,
you should tell a friend about this podcast because they might want to learn more
about sleep too. And we would always be appreciative of passing the word along
because word of mouth is the best way to learn about a new podcast. So let's go
back to the conversation about improving the conditions for sleep in our home and in
our families. When should a parent or a caregiver consider seeking professional help
for sleep issues for an adopted foster or kinship child? My answer to that question
is always as early as you like. I've never encountered somebody.
In fact, I just had a patient recently who he was on with his mother. He was an
older child, probably in the 15 or 16. And I was like, you know, tell me what's
been going on. Well, I always been a good sleeper, but last month was having some
trouble. And here I was like, wow. So this all started a month ago. And here you
are. Like that never happens. It's always started during the, you know, the first
Bush administration. Like, man, that was a long time. Like, why have you waited so
long and made this? Because this is where you change sort of in a behavior versus
something that's ingrained in somebody. Do you what I mean? And so I think the
earlier, the better. I don't think you're ever going to encounter a doctor who says,
ooh, you're here way too early. That's one of the things that really frustrates me
within my own profession is look up the definition of insomnia it's got all these
weird times to it has to be going on for more than 90 days has to happen at
least three days out of seven so if your kids freaking out two days out of seven
what the medical community ignore oh it's okay because he's like destroying your life
two days out of the seven but call me if it's three and we can help like that's
these are done Like so to me, I think it's never too early to align. I almost
think of sleep interventions like therapy. You don't have to have catastrophic things
going in your life to benefit from maybe seeing a therapist. And so to me, it's
whenever you want to. And the little caveat I'll throw in there is if you have a
pediatrician or a clinician that seems resistant to helping with that referral,
I'd get another clinician or a pediatrician. Like, that should be a no -brainer. Why
not? Like, you know, I'm eating pretty well, but I'd like to talk to a nutritious.
Maybe it could be a little bit better. Great. Talk to a nutritionist. They're either
going to say, you're perfect, which nobody is, or you're some ideas to make your 94
% awesome nutrition, 97%. And I think sleep's exactly the same way.
So I don't think it's ever too early to take a look, 99 % of the time,
my thought after intervening with a family or a parent or a patient or a team or
a player, whatever, is, what took you so long? This would have been so much easier
to deal with when you were in seventh grade versus now that you're married and have
three kids. We're having to unroll and unwind a lot of just Just bad thinking
about, yes, exactly, exactly. And that resonates with this community because we
regularly recommend that you proactively seek therapy and even consider setting up a
relationship with a therapist before the child comes home so that you have them on
speed dial and you're ready to go. Absolutely. I couldn't agree more. So there's no
sleep deprivation like overwhelmed, tired parent sleep deprivation.
We feel like we're running on empty, we're running on fumes. What guidance do you
offer to caregivers and parents so that they can do that consistency and avoid the
burnout and be able to respond to their children in those calm and loving ways?
Yeah, I mean, I think if you're in it with a partner, you partner,
tag teaming is always really helpful. I'm going to make sure that, you know,
Wednesday night, you sleep in the guest bedroom, I will deal with whatever the
night. It's almost like being on call, you know, as a resident. Like, you go home,
I'm going to take the call tonight and whatever. And trying to be sort of
disciplined about that, even if it's, well, we can't do that all the time, but I'm
going to let my partner, you know, sleep in the guest bedroom. Wednesday, they let
me sleep in the guest bedroom on Friday.
but if you had a very difficult night, I think it's perfectly fine for you to seek
a little bit of rest, especially if you're saying, look, I would have slept great
last night, but these things happened. So using resting to kind of supplement that
can be really, really impactful. And, you know, the third thing that I think is
important, it kind of goes along with that dialogue within the family, is
understanding that parents need free time, They deserve periods where they can rest.
All of these things are things that we should be talking about. Like, my family
never talked about money. I always thought was weird. Like, so then you grow up not
really understanding how it works. And so when I'm not grateful for you paying for
my college, is it really me to blame or you? Because I don't, I thought you just,
you just had some money and just paid for, I don't know how much college costs.
Like, why would you think that? So to me, about, wow, that was a, that was a
tricky night for us last night. And I think we're all feeling a little depleted.
And like, just having those conversations, you don't have to have a solution for
them. But it becomes, these things happening are impacting my family in ways that
kind of impact me. So I think there's a way you can have that conversation without
being angry or mean or assigning blame or guilt. So I think all those things are
really important and sort of some for everybody kind of being on the same page as
you kind of move forward. Yeah. Establishing a consistent bedtime for myself was such
a game changer when my little one, she had multiple surgeries over the course of
the first two years that she was home with us. And making myself go to bed at the
same time every night was such a game changer. It gave me something to look forward
to, first of all, because there is nothing that feels as good as climbing into bed
at the end of a long day. And then it also modeled for the kids like, hey, mom
is depleted. Mom is exhausted. And mom's been doing some beyond the ordinary care of
this child after, you know, two major surgeries. And I feel like it was one of the
things that I was most proud of during her, both of her recovery period.
the little twist is you're telling your kids, this is our bedtime. Everybody's going
to go to their bed at their certain bedtime. Whether or not you fall asleep right
now is okay. So I always tell you when I said to our kid,
you know, you can go to bed wherever you want to. Oh, they were in their bedrooms
by 7 .30. You know what I mean? Like that. But in terms of when you decide to
turn your little light out over your bed, I think that's what you want to leave up
to them and then really be focused on consistent wake -up time. But yeah, I think
that, you know, and it's hard for caregivers because you get everybody in bed and
the sleep happens on a Tuesday night. It's really tough not to indulge yourself in
activities that you've missed out on because your life is so upside down right now.
And that can easily lead to what you're saying is you stay up a little bit later
because I haven't been able to watch my favorite show in a long time or get caught
up with these things. And it really takes a lot of self -discipline to say, no, you
know, yes, I would love to get caught up on the emails and this and that. But
I've got to protect myself first and do what I can do to protect, you know, not
only my health, my abilities to be a good caregiver right now, and that's sleep.
And everybody else can just wait. It's like Ashton Kutcher said, I love this
quotation. My inbox, my email inbox is just other people's to -do list for me.
I always thought was great. It's like, it's right. It's not my to -do list. Like,
I'll send you that thing when I need to send you that thing. But right now, I'm
going to get some sleep. Yeah. Well, it sounds like great advice for any parent or
caregiver who's not just struggling with their own sleep, but maybe with their kids
sleep too. So Dr. Winter, thank you for