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The Iron-Sleep Connection
by Tammy Rueger
Zachary was placed with me through a domestic adoption when he was six months old. From the day I got him he struggled with getting enough quality sleep. At first I believed it was all emotional. Although the agency told me he had been well cared for up until then, it was clear from the moment I got him that he was a very traumatized baby. At first he woke up every 1-2 hours, just to see who he was with and where he was. As time went on, he had more and more difficulty falling asleep and would be awake for long periods of time at night. No matter how hard he tried to sleep, he simply couldn’t. Believing it was all trauma related, I did everything I could to work on his attachment problems and help him feel safe, especially at night. I even moved his crib into my bedroom. Months went by and still he had problems sleeping. We were both utterly exhausted.
After about 6-7 months, the attachment finally started falling into place. However, his sleep wasn’t getting any better. I searched and searched for answers. I read sleep books. I read articles by the leading experts about trauma, adoption and sleep. My pediatrician told me to just let him cry it out because he was manipulating me. I switched doctors and my new pediatrician said he was perfectly fine. I had early intervention come out, who declared him to be perfectly healthy. I talked to other parents who commiserated with me on not getting enough sleep but somehow their stories felt very different than mine. Everyone told me, “Some kids just don’t sleep”. But it seemed to me to be so much more than that. He was really trying hard to sleep. He would close his eyes, lay still and suck on his fingers. After an hour or two of trying, he would often start crying because he was so exhausted but he couldn’t fall asleep. This was a not child who was trying to practice new milestones or wanted to stay up and play or whatever else kids usually do to avoid sleep. Zachary *wanted* to sleep. He was trying his hardest but simply couldn’t.
The lack of sleep was seriously impacting him during the day. It is hard to work on attachment when a child is so tired. He cried at the smallest of things. He was completely overwhelmed at day care and I ended up only sending him three days a week and hiring someone to care for him at home during the remaining two days. He had complete meltdowns at the grocery store and in restaurants that did not stop until I finally put him to bed. Despite how exhausted he was, he could only sleep at home in his bed. He rarely fell asleep even in the car.
At 18 months of age, I took Zachary to an Occupational Therapist (OT) who diagnosed him with Sensory Processing Disorder. Finally there were some answers and some real solutions to help us both get some much needed sleep. I couldn’t wait to put the new strategies into practice and prayed they would help. And they did help…sometimes. After about 8 months of OT, Zachary’s world was finally calming down. But he still struggled with sleep. I was using all sorts of interventions. He took Melatonin, used weighted blankets, a sound machine, had night lights that gave off just the right amount of light in just the right places, even used a memory form mattress to give him sensory input at night. I made sure he did his sensory diet every day, had a very strict routine, never missed a nap and we never watched TV before bedtime. He finally fell asleep easily and seemed to be sleeping long enough. He would get 11 hours at night and then take nearly a 3 hour nap. But he was always tired, no matter how much he slept. He was extremely restless at night and I knew he was waking up quite a bit still.
Zachary was a little over two years old when we did his sleep study. The sleep study confirmed what I was seeing. He was waking up much more than what was typical for a child of his age and he was extremely restless. At one point during the sleep study he actually went up on his knees, while he was still sleeping. The doctor confirmed that these sleep patterns were problematic and probably contributed to the constant fatigue. However, she could find no physical cause and referred me back to the psychologist we had seen, saying it could be due to emotional issues. I was beyond frustrated. We had made good progress on the emotional side of things and it just didn’t feel like an emotional issue. We had dealt with those many times and the sleep issues felt more like a physical problem.
Around this same time, I was talking to other parents online about his sleep issues. Several parents told me about the connection between low ferritin levels and sleep problems. Ferritin is the measure of how much iron is stored in your body. Low ferritin is known to cause sleep disorders, most notably Restless Leg Syndrome. They encouraged me to have Zachary tested. I talked to the sleep doctor about it and she ordered the tests. His ferritin levels came back at an 11. They should be 30 or higher.
The sleep doctor prescribed iron drops with orange juice twice a day for three months. It was the easiest therapy we had ever done! It took the entire three months of iron drops before I saw any progress. However, his sleep finally started being more solid, which meant he was feeling rested during the day. His behavior got better and his attention span improved dramatically. It felt like Zachary could finally enjoy being awake, instead of spending his entire day struggling to get to the next nap.
Low ferritin can be a completely normal developmental problem. Sometimes kids simply grow faster than their body can keep up with. However, it can also affect kids who have not gotten the nutrition they needed when they were young or who are such difficult eaters than they don’t get proper nutrition. A simple blood test can diagnose it but the doctors need to test specifically for ferritin levels, as simply testing iron levels will not test for ferritin levels. A person can have normal iron levels while still having low ferritin levels. Many times once the ferritin levels go back to normal, you don’t have worry about it again. However, if ferritin levels continue to drop then your child needs to see a doctor because that indicates something else is wrong.
Zachary is now a bouncing three year who never sits still. Getting enough quality sleep continues to be a struggle sometimes but overall his sleep is much more predictable and he can usually catch up on his own. Getting his ferritin levels up was the final piece of the sleep puzzle that has finally allowed us both to feel well rested.
Click here to read more about iron deficiency and adopted kids: http://adoptionnutrition.org/what-every-parent-needs-to-know/common-nutrient-deficiencies/.
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