Childhood Vaccinations – Helpful, NOT Harmful

Children are given shots (vaccines) at a young age because this is when they are at highest risk of getting sick or dying if they get these diseases. Newborn babies are immune to some diseases because they have antibodies they get from their mothers, usually before they are born. However, this immunity lasts a

Image result for childhood vaccinations safefew months.
Most babies do not get protective antibodies against diphtheria, whooping cough, polio, tetanus, hepatitis B, or Hib from their mothers. This is why it’s important to vacci nate a child before she or he is exposed to a disease.

 

What is a vaccine? Why are they so important?
Vaccines are our best defense against infections that may have serious complications such as pneumonia, meningitis, cancer, and even death.

  • The Center for Disease Control and Prevention (CDC) recommends vaccinations before the age of two years to protect children against 14 infectious diseases: measles, mumps, rubella (German measles), varicella (chickenpox), hepatitis A, hepatitis B, diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenza type B (Hib), polio, influenza (flu), rotavirus, and pneumococcal disease (CDC, 2015).
  • Vaccines contain weakened or killed versions of the germs that cause a disease. These elements of vaccines, and other molecules and micro-organisms that stimulate the immune system, are called “antigens.”
  • Babies are exposed to thousands of germs and other antigens in the environment from the time they are born. When a baby is born, his or her immune system is ready to respond to the many antigens in the environment and the selected antigens in vaccines.

Image result for 2018 CDC recommended immunization schedule

Vaccine Safety – Debunking the Myth

Vaccines are safe, effective and save lives (Knopf, 2017). Because vaccines are given to millions of healthy people,  including children, to prevent serious diseases, they’re held to very high safety standards.

Many parents have common misconceptions about childhood vaccinations and believe they may cause serious side effects – like autism- and choose not to vaccinate their child. Others believe there are too many recommended vaccinations compared to 20, 30 years ago. Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature (Knopf, 2017).

Vaccinations save thousands of lives every year and have eradicated many diseases such as the measles, mumps, and rubella. However, because parents are choosing not to vaccinate their children, these diseases are making a comeback and claiming the lives of innocent children.

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How are vaccines tested for safety?

Every licensed and recommended vaccine goes through years of safety testing including:

  • Testing and evaluation of the vaccine before it’s licensed by the Food and Drug Administration (FDA) and recommended for use by the CDC.
  • Monitoring the vaccine’s safety after it is recommended for infants, children, or adults

Vaccines are tested before they’re given to the public

Before a vaccine is ever available for use, it’s tested in labs and this process can take several years.  The FDA uses the information from these tests to decide whether to test the vaccine with people (Gould, 2017).

During a clinical trial, a vaccine is tested on people who volunteer to get vaccinated. Clinical trials start with 20 to 100 volunteers, but eventually include thousands of volunteers. These tests take several years and answer important questions like:

  • Is the vaccine safe?
  • What dose (amount) works best?
  • How does the immune system react to it?

Throughout the process, FDA works closely with the company producing the vaccine to evaluate the vaccine’s safety and effectiveness. All safety concerns must be addressed before FDA licenses a vaccine.

Every batch of vaccines is tested for quality and safety

Once a vaccine is approved, it continues to be tested. The company that makes the vaccine tests batches to make sure the vaccine is:

  • Potent (It works like it’s supposed to)
  • Pure (Certain ingredients used during production have been removed)
  • Sterile (It doesn’t have any outside germs)

FDA reviews the results of these tests and inspects the factories where the vaccine is made. This helps make sure the vaccines meet standards for both quality and safety.

Vaccines in the Media

In 1998, an article was published by Andrew Wakefield in the Lancet paper that stated that the MMR (measles, mumps and rubella) vaccine contained toxic substances that went into the bloodstream, traveled to the brain, and caused children to develop autism (Gould, 2017). However, Wakefield had been paid by a company with a patent pending on a rival measles vaccine as well as acted unethically and participated in slander and fear mongering for to gain profit. This discovery was too late to reverse the public’s belief that vaccinations were unsafe.

Public figures like Jenny McCarthy and the President of the United States (POTUS) Donald Trump have vocalized their opinions regarding the correlation between childhood vaccinations and autism. Political figures and celebrities have created confusion and fueled inaccurate discussion on this topic for years (Gould, 2017).

In this video clip from CNN during the Republican Presidential candidate debate, Donald Trump, states he is in favor of vaccinations, but believes the doses are too big for children. He then tells a story about a two-year-old child who was perfectly healthy prior to receiving vaccinations, but then developed autism a week after receiving vaccinations.

  • Even though evidence-based guidelines and professional recommendations have been published, the public still believes public figures and celebrities over proven data (Gould, 2017).

This video clip posted by CNN debates Jenny McCarthy’s beliefs that vaccinations cause autism. The narrator discusses how in this celebrity suffused culture, McCarthy’s claims could have a deadly impact on scaring parents away from vaccines. Jenny McCarthy is one of the first celebrities to publicly claim vaccinations cause autism after her son was diagnosed with developmental delays. In this video, she states vaccinations “triggered” her son’s autism.

Why is there an uprise in Autism today?

Prevalence of autism has changed because of advanced diagnostic fashions, changing diagnostic criteria, and more trained diagnosticians, a willingness to accept a particular diagnosis, earlier age diagnosis, and better recording systems (Taylor, 2009).  Basically, it’s a big coincidence that there are more vaccinations recommended by the CDC and the uprise in autism diagnoses. The CDC supports the Institution of Medicine’s (IOM) conclusion that there is no relationship between vaccinations and autism (Taylor, 2009).

This video clip by CNN interviews two mothers and why they chose not to vaccinate their children. One mother claims there are too many vaccinations recommended by the CDC. Another claims she does not trust the MMR vaccination because she believes her children are healthy.

Anti-vaccination believers argue that autism has been increasingly more prevalent today compared to 20 years ago, and there are more required vaccinations children need today than there were back then (Knopf, 2017). Vaccinations against infectious diseases has been advancing with the increase of available technology, which explains why there are more vaccinations required for children to receive compared to 20 years ago.

Don’t wait, vaccinate!

The CDC website provides an excellent venue for curious citizens inquiring about vaccination safety and how they work. It also has the most up to date schedule recommended for children to receive certain vaccinations. Vaccinations are safe, effective, and they protect the public from deadly diseases.

https://www.cdc.gov/vaccinesafety/index.html

 

References

Gould, K. (2017). Vaccine safety: evidence-based research must prevail. Dimensions of Critical Care Nursing, 36(3), 145-147.

Knopf, A. (2017). Vaccines do not cause autism: Pediatricians fight back against anti-science. Brown University Child & Adolescent Behavior Letter331-2.

Taylor, B. (2006). Vaccines and the changing epidemiology of autism. Child: Care, Health & Development32(5), 511-519.

https://www.cdc.gov/vaccinesafety/concerns/autism.html

https://www.vaccines.gov/

Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disorder that develops before the age of three and involves impaired social interaction as well as communication. Also commonly seen is a small range of interests and activities for a person with ASD. Originally this disorder was discovered in 1943, by child psychiatrist Leo Kanner. The people with this disorder can have various levels of intelligence ranging from low to normal, as well as difference in severity of symptoms. The key component in all of these children is the lack of social and communication skills.

1 in 68 children in the US have ASD. This is a 30% increase from two years ago, in which it was 1 in 88 children were diagnosed. The reason for this dramatic incline is unknown, it is also possibly that awareness has made it easier for children to be diagnosed earlier during there development.According to Autism speaks many symptoms of the disorder consist of but are not limited to…

Possible signs of autism in babies and toddlers:                            By 6 months, no social smiles or other warm, joyful expressions directed at people
By 6 months, limited or no eye contact
By 9 months, no sharing of vocal sounds, smiles or other nonverbal communication
By 12 months, no babbling
By 12 months, no use of gestures to communicate (e.g. pointing, reaching, waving etc.)
By 12 months, no response to name when called
By 16 months, no words
By 24 months, no meaningful, two-word phrases
Any loss of any previously acquired speech, babbling or social skillsPossible signs of autism at any age:
Avoids eye contact and prefers to be alone
Struggles with understanding other people’s feelings
Remains nonverbal or has delayed language development
Repeats words or phrases over and over (echolalia)
Gets upset by minor changes in routine or surroundings
Has highly restricted interests
Performs repetitive behaviors such as flapping,                          rocking or spinning
Has unusual and often intense reactions to sounds, smells, tastes, textures, lights and/or colors

Children may demonstrate some of these behaviors, but not all. Also children who develop some of these behaviors, may not be autistic. If you believe your child may have ASD, contact your pediatrician for testing. Early intervention is extremly important for these children.

Many interventions for ASD are home bases therapies such as

  • Applied Behavioral Analysis
  • Occupational Therapy
  • Speech Therapy

Causes of ASD… These can be genetic in origin from either parent on chromosome 16 or even a spontaneous gene change during embryonic development. Increase age of either parent also increases the risk, as well as birth complications, premature birth and the birth of multiples such as twins and triplets. ASD is also linked to abnormal brain development at an early age. Women who have been exposed to German Measles or during the course of their pregnancy also put their child at t a higher risk of developing the disorder. Although it is a common myth, vaccines do NOT cause Autism Spectrum Disorder! 

These children are also at risk for many other comorbidities. Such as…Epilepsy, gastrointestinal problems, selective or restricted eating habits , sleep disturbances, Attention-deficit/hyperactivity disorder (ADD and ADHD), Anxiety, Depression, and Obsessive compulsive disorder (OCD). Those who have ASD also commonly engage in self injurious behaviors such as but not limited to…head-banging, hand-biting, and excessive self-rubbing and scratching. Which if not monitored can lead to concussions and life-long brain damage. These behaviors tend to be coping mechanisms for too much sensory stimulation, whether it be environmental or internal stressors. With help from early intervention sometimes these self-injuries behavior can be replaced with functional and non-destructive behaviors.

In Conclusion…ASD is a disorder of sensory processing. What may feel normal to a neurotypical brain could be extremly distressing to the ASD brain. These children can lead very happy and healthy lives with early intervention services as well as love and understanding. Remember April is ASD awareness month, more information about advocacy events can be found at www.autismspeaks.org.

Great Informational References  

Causes: https://www.autismspeaks.org/what-autism/learn-more-autism/what-causes-autism

Warning signs: https://www.autismspeaks.org/what-autism/from-first-concern-to-action/learn-signs

Services: https://www.autismspeaks.org/what-autism/from-first-concern-to-action/access-services

Autism Friendly Events: https://www.autismspeaks.org/autism-friendly-events

For those who are more audio or visual learners, I attached two great videos to help explain Autism Spectrum Disorder. The first is an animated explanation of the disorder. The second video is facts about ASD and even covers popular myths about the disorder as well.

The Truth About Weight-loss Surgery

Mama June has recently made headlines for her tremendous weight-loss. She is the newest celebrity to add her name to the list of people attributing their weight-loss to bariatric surgery. Other celebrities on the list include Star Jones, Randy Jackson and Al Rocker. These celebrities make it look easy; obese one day, thin the next. But what happens in between the before and after picture? The public has a perception of weight-loss surgery as the ‘easy’ way out, the ‘quick fix’ for obesity. However, research shows, that while the results may happen fast, there is nothing easy about undergoing weight-loss surgery.

Here is what the women of The View had to say about Mama June’s recent weight-loss.

Discussions like these lead to more questions rather than answers. Weight-loss surgery is more than just a before and an after. It is an entire journey. Here are some misconceptions and facts about weight-loss surgery.

People who undergo weight-loss surgery are lazy.

Wrong! Americans are constantly trying to lose weight, but many are failing at the attempt. People are not overweight because they are lazy. American culture makes it difficult to maintain a healthy weight. An estimated 34.2% of U.S adults aged 20 years and older are overweight, 33.8% are obese, and 5.7% are extremely obese (Nardulli, 2012). Once a person reaches the point of obesity it is very difficult to get back down to a healthy weight and maintain that weight. Obesity is a chronic disease that presents significant challenges for treatment long term. For lifestyle interventions, only 20% of people attempting weight loss can achieve and maintain 5% weight loss over a year (Stoklossa & Atwal, 2013).

Surgery is a quick fix for rapid weight-loss.

Wrong! Surgery should not be viewed as a cure, or quick fix. Instead, it is a tool to help get someone to their weight-loss goal. Diet and exercise are still important components to overall success. Patients must adhere to a strict nutritional regimen to ensure safety and success. Also, patients who undergo surgery must consider the risks of surgery as well. When examining a laparoscopic sleeve gastrectomy, the perioperative and postoperative mortality rates are 0.29% and 0.34%, respectively, with complication rates of 13%.14,23 Rare complications occur in the early postoperative period. Serious complications include difficult-to-remedy proximal leaks (4.9%) and bleeding from the long gastric staple line (2.4%) Most complications occur in the late postoperative period. These include gastroesophageal reflux (23%), vomiting (18%), gastric tube stricture (2.3%;), stenosis (2.4%), leak (2.4%), incisional hernia (2.4%), gastrocutaneous fistula, and weight regain (Ma & Madura, 2015).

The Doctors discuss the science behind bariatric surgery.

Does insurance cover weight-loss surgery?

This is often determined by the individual insurance company. Some companies will cover the cost without issue. The easiest way to get covered is through the recommendation of a doctor. However, this does not always mean the insurance company will cover the cost. Coverage is determined on a case by case basis so individuals interested in undergoing weight-loss surgery should check with their insurance carriers.  The cost of the surgery, without complications, is approximately $13,000 dollars (Nardulli, 2012).

Is weight-loss the only benefit of surgery?

No! Quality of life and reduction of comorbidities are other major reasons why individuals seek surgical intervention. Obesity contributes to approximately 300,000 premature deaths each year because of health-related complications (Agala, 2017). Obese individuals often suffer from a variety of comorbidities that negatively impact their overall health and well-being. Some comorbidities include hypertension, diabetes, sleep apnea and hyperlipidemia. Those who are overweight also suffer from psychological issues like anxiety and depression (Parks, 2015).

Who qualifies for weight-loss surgery?

  1. A person with a BMI ≥ 40, or more than 100 pounds overweight.
  2. A person with a BMI ≥35 and at least two obesity-related comorbidities.
  3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts (Agala, 2017).

The Doctors discuss another celebrity who had great results with bariatric surgery.

Weight-loss surgery is not a quick fix, it is a journey. It is not as simple as the media portrays it to be. It is a choice for a better, healthier lifestyle!

References

Agala, R. A., Almusaiad, S. M., Alsufi, A. M., Aldhiafah, Z. A., Muzaffar, A. H., Al Ghamdi, S. S., & … Alaeq, R. A. (2017). A Critical Review on Risks versus Benefits of Bariatric Surgery. Egyptian Journal Of Hospital Medicine, 279-284

Ma, I. T., & Madura II, J. A. (2015). Gastrointestinal Complications After Bariatric Surgery. Gastroenterology & Hepatology, 11(8), 526-535.

Nardulli, J. A. (2012). The Road to Health Is a Battle Hard Fought: Support for Requiring Coverage of Bariatric Surgery for an Expanded Group of Qualified Individuals. Journal Of Legal Medicine33(3), 399-415.

Park, J. (2015). The meanings of physical appearance in patients seeking bariatric surgery. Health Sociology Review24(3), 242-255.

Stoklossa, C. J., & Atwal, S. (2013). Nutrition Care for Patients with Weight Regain after Bariatric Surgery. Gastroenterology Research & Practice, 1-7.

 

 

 

 

 

 

 

What We Really Know About Obesity

 

In the United States, more than 2 in every 3 adults are classified as overweight or obese as well as more than 1 in every 3 children. With so much media attention directed towards the obesity epidemic occurring throughout much of the world, it can often be difficult to determine what information is fact, fiction or an over-simplification. The goal of this article to look at various claims made in the media regarding the causes of obesity and compare them with peer reviewed evidence.

Clip #1:

This initial clip takes aim at the efforts to place a junk food tax on items containing high levels of sugar and saturated fat that contribute substantially the problem of obesity. The types of items most prominently targeted include soda and fast food. The narration of the video uses a relatively neutral tone about the issue, but the individuals interviewed here are strongly in favor of this kind of policy that would in turn use the new tax revenues to provide subsidies for fresh produce and other healthy options. It’s suggested that this new cost dynamic will modify people’s behavior in a way that makes them more likely to buy healthier options, thus improving the health of the population overall. Evidence suggests however that solely changing the cost of different kinds of food has minimal effect on overall health. (Silva, Leng, Rawof & Vilakazi, 2016)

Despite higher taxes on junk food showing some decreases in consumption, there is a lack of evidence for any connection to improved rates for obesity. People eating less junk food is certainly a good place to start, but as a self contained method for decreasing obesity it’s lacking. There are also ethical issues raised that go unaddressed in this news piece. Such a tax would undoubtedly be regressive in how it prohibits low income individuals the autonomy to eat what they chose to at its actual market value. (Silva et al., 2016) While those involved in public health policy are decidedly against obesity, for many this issue boils down to a political debate of whether or not government should intervene in such a punitive way on these products.

Clip #2:

This next topic explores the role that proximity to supermarkets plays in the prevalence of obesity, produce consumption and intake of sugary drinks throughout various communities. This video clip from a PBS news hours segment places significant blame for the obesity crisis on lack of easy access to supermarkets for families who live in these “food deserts”. The video explains how for individuals without means of transportation and who live in areas with only convenience stores or fast food easy available, that obesity rates will be higher.

Research does support that people targeted for an obesity intervention, focusing on nutritional education, who lived closer to large supermarkets had better outcomes. (Fiechtner, Kleinman, Melly, Sharifi, Marshall, Block & Taveres, 2016) This leaves a much more nuanced conclusion that supermarket proximity can positively influence reduction in BMI for those actively working towards improved nutrition, but shouldn’t be considered an isolated modification that can significantly alter obesity rates on its own.

Clip #3:

The final source examined is a TED Talk given by a chef named Jamie Oliver called “Teaching Children about Food.” In his presentation he advocates a number of interventions aimed reducing childhood obesity. Among the concepts talked about were early childhood education in school about the importance of eating fresh, whole foods as well as the removal of sugary drinks from the cafeteria. Oliver makes positive claims about the effectiveness of this approach as he’s already begun to see results in his own community.

Our peer reviewed source uses a systematic review of intervention programs targeting obesity in elementary school children. Requirements for inclusion in this study were methods revolving around increased consumption of fruits and vegetables, as well decreases in sugar sweetened beverages. In addition, the students were educated about nutrition as well given increased opportunity for physical activity. A majority of these studies found a positive connection between intervention and a reduction in BMI. (Brown, Buchan, Baker, Wyatt, Bocalini & Kilgore, 2016)

 

References:

  Brown, E. C., Buchan, D. S., Baker, J. S., Wyatt, F. B., Bocalini, D. S., & Kilgore, L. (2016). A Systematised Review of Primary School Whole Class Child Obesity Interventions: Effectiveness, Characteristics, and Strategies. Biomed Research International, 20161-15. doi:10.1155/2016/4902714

  Diniz Silva, A. C., Hiang Leng, T., Rawof, N., & Vilakazi, B. (2016). Implementation of a “food tax” to prevent obesity: A critical appraisal. Diabetes & Primary Care, 18(3), 126-130.

Fiechtner, L., Kleinman, K., Melly, S. J., Sharifi, M., Marshall, R., Block, J., & … Taveras, E. M. (2016). Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity. American Journal Of Public Health, 106(3), 557-562. doi:10.2105/AJPH.2015.302986

Does Lack of Sleep Cause Behavior Problems in Children?

sleeping-child

What does Keiki have to say?

Behavioral Insomnia in Children

One of the most common complaints encountered when raising children, are sleep difficulties.   Fifteen to 30 percent of children are having problems either falling asleep or experiencing frequent waking throughout the night.  The article goes into detail about each of the possible disturbances.  These can include prolonged night waking secondary to children needing to fall asleep under certain conditions, as well as children protesting bedtime.  Suggestions on how to improve your child’s sleep habits were provided.  Sticking to routines and establishing set bedtimes were the most emphasized strategies.

This article seemed to be the most closely related to the media clips.  It really focused on the behavioral implications.  In all three of the media clips, they primarily focused more on how to get your child to bed at a reasonable time, as well as how to improve their sleep quality.  This article had multiple suggestions similar to the ones stated by Dr. Oz and the other professionals.  Routines and strict bedtimes were both highly stressed.

Nguyen, K., & Soultan, Z. (2015). Why Doesn’t My Child Sleep?”-Behavioral Insomnia in Children. New York Family Medicine News, 28-30.

 

How about America’s favorite doctor?

Relationship Between Children’s Sleep and Mental Health in Mothers of Children with and Without Autism
This study researched the correlation between mothers sleep patterns with those of their children. Two groups were researched. One group had children with Autism Spectrum Disorder, while the other was a typical group of children. Research suggests that rearing a child with developmental disabilities may negatively impact a parents’ mental health. This in turn could cause poor sleep patterns for the parent. If the parent is stressed and has lack of sleep, they can potentially hinder sleep in their own children, thus causing spikes in behavior. Mothers of children with ASDs reported more problems with their own sleep, greater stress, and poorer mental health; however, children’s sleep and maternal sleep were more closely related to maternal stress for mothers of typically developing children. This proves that the disability itself with ASD is what is causing the mothers symptoms, rather than solely the lack of sleep.

Hodge, D., Hoffman, C., Sweeney, D., & Riggs, M. (2013). Relationship Between Children’s Sleep and Mental Health in Mothers of Children with and Without Autism. Journal Of Autism & Developmental Disorders, 43(4), 956-963. doi:10.1007/s10803-012-1639-0

More from the Doc!

Waking Up to a Problem
This article focused on what could possibly happen when a child is sleep deprived. They tend to have behavior problems and frequent temper tantrums. They might be impulsive and have difficulty following directions. Many children resemble a child that might be diagnosed with ADHD. And many children, who actually are diagnosed with this disorder, suffer from an underlying sleep disorder. This would act as the primary problem. An interesting part of the article suggested that later start times in school shows improvements in grades. However, this is difficult to schedule due to sports conflicts and extracurricular activities. Recommendations were also provided. This included actual amounts of hours required for each age. Elementary age children should be getting around 11 hours of sleep while adolescents should be getting 9 hours. Decreasing screen times, as well as limiting caffeine were also some suggestions.

MITCHELL, K. (2016). Waking Up to a Problem. Businesswest, 32(20), 40.

What can happen if a child isn’t getting enough shut eye?

behavior-sleep

  • Irritability
  • Poor school performance
  • Characteristics of ADHD (Attention-Hyperactivity Deficit Disorder)
  • Poor tolerance for change
  • Increased behavior problems
  • Depression
  • Obesity

Is your child getting enough sleep? Take the test

If you can answer yes to all of these questions, your child is getting enough sleep:

  • My child falls asleep in less than 20 to 30 minutes of bedtime.
  • My child wakes up easily in the morning, at the expected time.
  • My child appears well rested during the day.
  • My child stays awake without taking a nap during the day. (This question only applies to children that have outgrown their daytime nap.)
  • My child stays awake during quiet activities, such as driving in the car or watching television.

Symptoms of not enough sleep

If you or his teacher can answer yes to any of these questions, your child is not getting enough sleep.

  • My child has a hard time waking up in the morning.
  • My child falls asleep after being woken up and needs parents to wake again or repeatedly.
  • My child yawns frequently during the day.
  • My child complains of feeling tired.
  • My child prefers to lie down during the day, even if it means she’ll miss activities with friends and families.
  • My child wants to nap during the day.
  • My child lacks interest, motivation, and attention.
  • My child falls asleep or seems drowsy at school or at home during homework.

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What Can You Do?

1. Avoid feeding your child big meals close to bedtime, and don’t give her anything containing caffeine less than six hours before bedtime.

2. After dinner, avoid all stimulating activities, says Carol L. Rosen, M.D., medical director of pediatric sleep services at Case Western Reserve University’s School of Medicine at Rainbow Babies and Children’s Hospital in Cleveland.

3. Warn your child that bedtime is in five minutes, or give him a choice — “Do you want to go to bed now or in five minutes?” — but do this only once.

4. Establish a consistent and relaxing bedtime routine that lasts between 20 and 30 minutes and ends in your child’s bedroom. Avoid scary stories or TV shows. It’s better to read a favorite book every night than a new one because it’s familiar.

5. Avoid singing or rocking your child to sleep, because if she wakes in the middle of the night she may need you to sing or rock her back to sleep — a condition known as sleep-onset association disorder. (If you have already been doing this, try to phase this behavior out gradually.) Instead, have her get used to falling asleep with a transitional object, like a favorite blanket or stuffed animal.

6. Make sure your child is comfortable. Clothes and blankets should not restrict movement, and the bedroom temperature shouldn’t be too warm or too cold.

7. If your child calls for you after you’ve left his room, wait a few moments before responding. This will remind him that he should be asleep, and it’ll give him the chance to soothe himself and even fall back asleep while he is waiting for you.

8. If your child comes out of her room after you’ve put her to bed, walk her back and gently but firmly remind her that it’s bedtime.

9. Give your child tools to overcome his worries. These can include a flashlight, a spray bottle filled with “monster spray,” or a large stuffed animal to “protect” him.

10. Set up a reward system. Each night your child goes to bed on time and stays there all night, she gets a star. After three stars, give her a prize.

http://www.parents.com/kids/sleep/10-tips-for-helping-your-child-fall-asleep/

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