15 mo foster, bad sleep issues

[jussiemariee]

Last week we got a 15 mo foster child.  She is a very unhappy child, who in my opinion has the coping skills of a new born.  It seems her family just keep a full bottle of milk in her hands at all times.  This has led to her walking every night at 11, 1, 3.  When she wakes she is violent and inconsolable.  The only thing that can soothe her is a bottle (water sometimes works. )

How would you go about helping her transition to a more sustainable way of living, sleeping and  coping.  Any advice will help. She is 26 pounds and it is hard for me to help her when she is violent.

[deb]

Oh my goodness, the poor thing! 

You probably already know this, but this very likely isn't a sleeping and eating problem; it's more of a stress problem. I assume since she's with you, and since she gets so violent, that there is probably trauma or neglect at play here more than anything. As much as it may be crazymaking for you, if she is used to actively being fed at those NW, might be best for the time being to continue that and use that time for lots & lots of cuddles, maybe some quiet songs. You've only had a week to counteract 15 months of her life, the details of which I can only guess at (I don't know how much information they give you), so a healthy dose of patience - the kind you'd need with a newborn, really - to go with the lots and lots of love, all the time, is called for here for sure.  As she feels more secure with you, she'll be more likely to settle better with things other than milk/food, but for the time being, easy does it.

[jussiemariee]

We don't really know much about why she was taken.  I can only guess by her behavior.  I think your right about the newborn patience, but she is so big and so violent. She is almost as big as my 6 yo, weight wise.  I am not sure she has ever been comforted.  She won't rock, or allow comfort.  I can only put the bottle in the crib with her.  And let her drink it.  It is heartbreaking. 

[jussiemariee]

Follow up question... She seems most comfortable with being given a bottle of milk and being allowed to feed to sleep.  I know in my heart of hearts that that is not the best thing for her. But would you continue to allow it for know? Just continue the bad habits, and worry about them down the road if we still have her?

[Buntybear]

Hello, I imagine that fixing her needing to feed to sleep issues is going to take a while and lots of patience so it is up to you whether you give it a go. I guess that she may go back to her parents soon so is it worth you trying to fix it? I would be tempted to stick to her routine for bedtime and see if you can try and change it up for her nap - she could be easier to get to sleep then without a bottle?

[deb]

Does she have any other comfort item - stuffed animal, blanket, whatever? If not, maybe see if she'll take to one so when the bottle *does* go away, there's something to fall back on for self-soothing.

[We Three]

 Poor baby. I honor you for stepping in and caring for her, and I pray she feels your love and comfort on some level.
 Keep up with the lovey for sure. Put it in her hands when you give her the bottle, so she will start to associate the lovey with comfort also.
 Does she allow you to touch her in these times? Once she has the bottle, can you stroke her head or even just talk quietly and sing to her?

 Is she angry all the time or just overnights when she wants a bottle?

[jussiemariee]

She is angry a lot of the day, but the violent anger is mostly at night. If I give her a bottle, I do think she would let me touch her.  She calms right down when she has the bottle.  She won't let me hold the bottle or feed her though.  It seems like the bottle is her lovie she won't always drink it all, but will cuddle it and hold it.  She gets upset if you try to remove it.

[deb]

Yeah, you're probably not going to get far in terms of better sleep until she feels secure enough, and it's been such a short time she's been with you - best thing you can do is anything you can to help her feel safe & secure. 

You might try experimenting with lavender in her sleeping space: some folks use dried lavender in sachets, or you can put some in a spray bottle and spray it around, or lavender essential oil on a diffuser - you don't need much, but it might help calm her down and help her associate the scent with sleep so you can use it as a sleep cue later on if you have her long enough.

[Haribo2012]

Poor little one sounds like she's very stressed out. Hopefully with your kindness and patience she will start to trust you and feel more relaxed.
Dread to think what's she's been through. Will she let you put the lovies in her bed?

[We Three]

 My instinct is for you to give the bottle, with the lovey, then stroke her and a slow and gentle mantra phrase..... gentle "Its ok....you're ok....rest now....."   If you have her long enough, and do try to remove those bottles, the lovey and your mantra phrase should be of comfort.  For the sake of her weight and health, I might do 1/2 bottles...? Would that suffice do you think?

[creations]

Nothing to add to the previous advice really but wanted to stop by with a hug and support. What a wonderful job you are doing.

My heart hurts for a child who is so clearly distressed and has only attached to milk as comfort.

Many hugs x

[jussiemariee]

Things are still really rough here.  It looks like she may be with us for a while, though that could change at any time.  I am really struggling with the lack of sleep.  She is a high needs toddler all day, and a high needs infant all night. 

I guess, if I were to try to start trying to slowly fix this, what would step one be? Is there any way to lengthen the time between wakings? She is currently at 9-11-1-3.  I really feel like this is excessive.  I Am going to really focus on routine and predictability. I'll do some soothing bed time stuff.  What

[deb]

You could start by getting some sleep cues into her day & night: saying something soothing, maybe some quiet music you use at sleep times, when she lets you touch her a soothing gentle stroke, definitely the lovey, maybe the lavender. Until she feels safe & secure, everything else is seriously going to be secondary, including sleep.

I forget, is she napping during the day? What's that like?

[jussiemariee]

Yes, she naps though not sure if 1 or 2 works better for her.  1 is not enough two is too many.

I am not sure that she is feeling unsafe.  She is not really showing fear.  I really think that she is acting "spoiled" for lack of a better word.  She is used to getting her milk when she wants it all day and night. I think it is a habit of needing a bottle to get back after a sleep cycle or to fall asleep in the first place. She has no self soothing skills. 

[deb]

A child waking inconsolable and needing comforting to get back to sleep is a child who doesn't *yet* feel completely safe & secure IME; that kind of stress can manifest in ways other than what we adults think of as "normal" ways of showing fear. (I've worked with kids who come from environments where they're under stress of one kind or another 24/7 and are in a constant state of arousal and fight-or-flight, and it sometimes manifests in behaviors like what you've described.) Not trying to diagnose here, but what you've described sounds almost word for word like what I see and what their carers see; it's not that they're overtly afraid, but that their bodies are overdosing on cortisol and adrenaline, which affects their behavior (imagine a small child having been given a megadose of caffeine THAT NEVER WEARS OFF ); the stressful situation - whether fear or anger or a combination - causes the physiological changes that in turn manifest as violent outbursts or withdrawal tics or an abnormally strong dependence on some sort of comfort, whether food or hugs or rocking - sometimes alternating among some or all of those and more. There's very likely indeed a habit aspect to her needing the bottle - but would she demand it so forcefully if she didn't need the comfort? If she's been in this environment for 15 months, you and she have a lot to overcome, and I'm glad she has you to help her. 

Some other thoughts: is she cutting any teeth? This was about the age when my DD1 started cutting her canines and would wake inconsolable in the night when the bedtime pain meds had worn off; we started keeping a syringe of liquid ibuprofen already filled on her dresser, and a container of Orajel. What's her diet like? Is she getting any exercise during the day? Trying to think of other things that might be interfering w/sleep or might help sleep along...

[jussiemariee]

She is cutting molars. I may try to dose pain meds at night.  I need to get with the caseworker on otc meds protical.

Thank you for the stuff on stress, I'm sure that is somewhat true.  I guess, I had no idea just how "high needs" a toddler could be all day, and how needy at night.  My DD was a fussy kid, but this is a new level of needy.  She won't go in a play pen or in a safe  play room that is gated off.  I literally have not had a second for my 6 year old, without listening to her scream since she got here.  I'm sure it is just going to take time, I just don't want to being making her more dependent on false comfort by always giving her a bottle. I need to see some sort of moving forward I guess to keep me from giving up in frustration.

[jussiemariee]

Adding, I got the baby wisperes toddler book from the library and she sounds exactly like the sleep issue child in the book except being addicted to a person(mom's boob) it is the bottle.  Right down to freaking out in the crib. I may try to follow Tracy's plan for making her more comfortable being alone and being in bed and work from there. 

[We Three]

 I think it's important too not to underestimate the depth of trauma that comes with being removed from her home and caregivers. No matter what sort of situation she was in, it is all she knows on this planet.  I think that even under the best circumstances, (a child who is bonded, and has self-soothing skills), that separation would be a primal wound. But add to that a child who has additional underlying issues (neglect?abuse? Chaos?) and it's easy to see that she may just really not be capable of coping yet. All you can do is be kind, consistent, and gentle. It's heartbreaking, really, and I'm glad you're there for her.