Long term complex issues - Help!

[chell]

Hi, I am helping someone out at the moment and would like some advice, particularly on sleep issues. She has a 2 year old with the following problems:

- Still uses a pacifier and has regular bottles for milk/juice, I think speech may be affected by these things
- Eating - fussy eater but often Mum gives in and gives him desert, as she thinks 'at least he's getting something'
- Mum unable to leave room , due to separation anxiety.
- Irratic routine, waking up depends on bedtime ie: could be bed at 12pm up at 11 am therefore mealtimes etc are irregular.
- Tantrums - her lo will hit her or throw things at her or others.
 
Lo's bedroom is full of toys etc, perhaps this is overstimulating?

- Sleep - one nap at 4pm, for about 1 hour, after falling asleep on her lap.
   Nightime - Falls asleep on Mum or more recently has been sleeping in their bed. He has slept in his own cot but would wake several   
   times throughout the night, every 2-3 hours or so. Now they have moved a single bed into the bubs room and Mum and Dad take it
   in turns to sleep with him.
( Mum is having help from the Health visitor, but htey have really only suggested controlled crying and Mum does not want to do this)

These are the things I have suggested:

1. sorting out a structured routine with one 1 hour nap after lunch and a bedtime of 7-7.30

2. Tantrums- ignoring or helping her lo to calm without praise, plus praise for calming down

3. sleep - I have suggested she sleeps next to him in a blow up bed, until he's asleep, then over a period of a few nights, moving the bed towards the door, and eventually replacing it with a chair and doing the same with that.
Is this right? Should she stay with him all night at first, or should she do pu/pd instead when he wakes?
also he still has his cot for naps, although he is nearly able to climb out ...should she just use the bed?

Am I on the right lines??

Sorry that this is so long, but I really want to help her get things sorted. I look forward to reading your ideas.
What should I

[jessica and emilys mummy]

Okay.
The sep anx and sleeping is exactly the same as Emily.I tried staying in the room and gradually moving out
and it didn't work.I agree that she needs to get a proper bedtime.I would start with 6.45pm.
Start her straight away with walk in/out.
Lay him down,go out,count to 10,go back in,lay him down,go out,count to 10 and carry on this.
The first night is a nightmare so tell her to persevere.It took us 3 nights before she finally went to sleep
on her own and didn't wake during the night as she was overtired anymore.
That's the first thing I would do.If she gets the sleeping sorted out,then the rest will fall into place.
The juice in the bottle is a problem as it will affect the enamel on the teeth as well as speech in some (not all)
cases.She may find it helpful to take lo shopping to choose his own cup.
I'm still working on the sep anx and have been for months.It takes lots of praise and making lo hold her hand if they want
to go with you to the kitchen etc.It can sometimes take me 5 or 10 mins to persuade Em to hold my hand instead
of a cuddle,but when she does I go way overboard on the praise.
The sleeping helps with sep anx as well,as they are well rested and not so cranky.
Naps,I would tell her not to let him nap after 3.30pm.But when he's sleeping properly this should be better.I would get him to nap after lunch,by doing walk in/out for a while.
I wouldn't put him in a big bed until this is better.
Let me know how you go.
I promise it will work.If it worked for Emily it'll work for anyone
But please stress to her the first night she'll want to @*(&@
but after 3 nights it'll be better

[chell]

Thanks for your reply. Do you use walk in walk out, instead of pd because he is now 2 years old or is it to do with the sep anx? and you stick to waitng for 10 seconds instead of increasing the time, as you would for controlled crying?

[jessica and emilys mummy]

yes fro me it's Emily's age and also if I tried to cuddle her for pu and
then put her down,she'd freak even more.Whereas when I lay her
down from standing it's better.She tried to grab me,but I'm quicker than
she is
I always stick to the count of 10.It doesn't have to be seconds,you can
make the count last as long as you like:
12345678910 or 1...............2................3......................4 etc
If you get what I mean.
HTH

[chell]

Ok,thanks.

[Lan]

IF he has been used to going to bed late and sleeping in till late it might take a month for him to get used to going to bed and getting up earlier - like he's got a form of jetlag and his body clock needs to be adjusted. So I'd start by waking him 15 minutes earlier every 2 days until wake up is around 7.30 am. Then of course all the other meals/nap/bedtime need to be moved forward too.

IF speech is being affected try gradually replacing the bottles with a cup until there's only 1-2 bottles a day. There might be a fair bit of resistance to this though! Could also try restricting the pacifier till bedtime too- making sure he has another comfort object to replace it.


It might be easier to change things 1 thing at a time, working on getting rid of jetlag first. Then the bottles, then sleeping through the night in his own bed last.  The tantrums might need to be dealt with straight away to, although if the sleep gets better the tantrums might improve too.  I think that is the order that Tracy made mutiple changes?

it does sound like the mother is having trouble changing things - sounds like she needs some help from someone who can be firm and consistent - but understanding too. Nice of you to help out!

[SophieB]

Just on the bottle / cup thing - if they're using an avent system, there are these sippy cup style teats you can attach to a bottle as the first stage of weaning them off the bottle.

I used them with my LO (although she's a lot younger) and they worked a treat.

Ahh - here's a link.  It's the soft spout that I used.  http://www.aventamerica.com/products/bottlefeeding/bottlefeeding_trainer.asp

HTH.

[chell]

Thankyou! I'll let you all know how we get on!!

Lan - do you know where in Tracys book it talks about the order in whihc to resolve problems?

[Lan]

I

Lan - do you know where in Tracys book it talks about the order in whihc to resolve problems?

I don't have the book at the moment, but in her latest book (the 'solve all your problems' one)  she gives list of questions to aks and the order to fix them in in one of the chapters - one of the last chapters I think. I haven't looked at the book lately so I'm going on memory.

[chell]

Thanks, I'll check it out.