Part 23 ? When the child is in bed at night
Does the child need help when they are in bed at night? Yes
Tell us about any help the child needs when they are in bed at night
DD1 can wake up to twice or three times in the night in the early hours, for varying reasons.
DD1 has leg pains that seem to occur mainly at night. She has attended A&E on around 5 occasions, although the leg pains occur many more times than that. The general thought is that these are likely to be Transient Synovitus of the hip, presenting as knee pain, following a cold, although Dr x suspects strongly that there is also a behavioural element to it. There is no pattern to the leg pain, so it can happen once in one month, or several times per week in another.
When her legs hurt, she calls out crying, and is rolling around on the bed clutching her knee. She gets very distressed, and becomes quite hysterical. We have to rub and massage her leg, and give her paracetamol. To calm her down, we have to cradle her tightly, and sing ?rock a bye baby?. Once she is calm enough to lie down, we have to tell her a ?special story? about her leg pain, which involves telling a story about how she woke up, and her leg was hurting, which made her very, very sad. Then Mummy came in and rubbed it better and gave her medicine. Then it was time to sleep again. This story calms her.
We then have to go through her bedtime routine from scratch, so making sure that her weighted blanket is in place, that her ceiling fan is on, that she has her bear comforter, that her toy cat is behind her head and her musical star is on. If we do not follow this routine, it is much more likely that she will stay awake. We sometimes have to give her a repeat dose of melatonin at this time, but it is rarely as effective during the night as it is before bedtime. We then need to stay awake to listen for her, to make sure she has returned to sleep.
We cannot go to sleep until we are sure that DD1 has settled, because she climbs on her bedroom furniture and is at risk of injury. She will also wake her sister, and stop her from returning to sleep. When her leg hurts, we have to be up for at least 45 minutes for the initial episode, then dependant on whether DD1 settles successfully, we may be going backwards and forwards between our room and hers for a further 20 minutes.
DD1 is totally incontinent of urine at night. She has no control whatsoever over her bladder at night, and is showing no signs of becoming dry at night. She wears a pull-up to bed, but this frequently leaks. We have to change her bedding in the night up to 3 or 4 nights per week. When we do so, we have to strip her bedding, change her pull-up, replace her sheet, check her weighted blanket to make sure it isn?t wet, and then follow her bedtime routine as outlined above. Again, I have to tell her a ?special story? about how her pull-up leaked, and Mummy came and changed her sheet, and then we got a new pull-up on, and then it was time for sleep, to calm her. Her reaction to wetting the bed is variable. Most times she will cry and scream that her bed is wet, and so we will know. However, on two occasions recently, we have heard the click of the light switch, and found DD1 naked, sat on a small chair in her room, huddled to try and warm up. For some reason she had not alerted us to her state. This is obviously worrying, and we now check her in the night.
When DD1 has wet her bed, we spend around 10 minutes changing her bed and her pull-up, a further 10 minutes doing her bedtime routine and telling her ?special story? then a further 10-15 minutes listening out for her to make sure she has settled. If she settles, we can then sleep. If not, we will spend a further 20 minutes or so going backwards and forwards to her room. So at these times we are awake for 30-55 minutes. Again, we are unable to simply go to sleep if we are not absolutely sure she is asleep, because she is a danger to herself and will disrupt her sister, and indeed the whole household. We also have to be mindful of the fact that she managed to climb over the stair gate on the porch, and the only thing that stops her from wandering is the stair gate on her bedroom door. If she manages to climb over that, she will be in real danger, especially as her balance and co-ordination are so poor at the best of times, let alone when tired and sleepy. She would also have ready access to the bathroom, which is a particular obsession and very dangerous for her. So we have to be very cautious and not take for granted the protection the stair gate on her bedroom door gives.
DD1 wakes every day between 5 am and 5.30 am, and will not then return to sleep, even if we follow her bedtime routine, regardless of what her sleep disturbances have been in the earlier part of the night. We would not by choice get up before 7am, and at the weekend perhaps even 8am. However, if DD1 is up we have no choice but to get up, because she is not able to be left unattended at any time. Her need for continuous supervision at all times is well documented. She is a danger to herself with her climbing, and she is loud and wakes the entire household.
A typical 4½ does not wake several nights per week, and does not wake so very early in the morning, especially if they have woken in the night. A typical 4½ year old would be able to play quietly or watch television. If they wake at night, a typical 4½ year old would be able to be reassured briefly and return to sleep. They would not need constant supervision and extensive routines to return to sleep, and would not need watching over to keep them safe. They do not need Melatonin to get to sleep or return to sleep.