Friday, May 8, 2015

Sleep tidbits part one/infants




I spend a lot of time talking to parents about sleep. Most folks have told me that they have had at least some measure of success from the following tips. For the tough cases there are some great sleep consultants out there in the community, but you may as well start here. This post will not cost you the $$$ that the sleep specialists charge. Happy Mother’s Day!

The next several weeks will all be sleep related:
* just starting out/the first year
* toddler/preschool sleep tips
*Transition from crib to bed
*Bed time book
* Insomnia/ general sleep tips for teens and adults

For the most part I am a big believer that decisions involving sleep are very personal choices made by each family figuring out what fits their own unique situation. Most families do some sort of co-sleeping for the first couple of weeks. Some folks are happy keeping a family bed. Others move the baby out to a separate room fairly soon. Each family has a different tolerance level for how much crying they are comfortable with. Everyone needs to figure out what works best for their family (and hopefully both parents have been able to discuss this and be comfortable with their decision.)


I tend to fall somewhere in between the attachment parenting and the cry it out methods. I do NOT worry that your baby will have future psychological damage or attachment issues from a bit of  crying at night. That is a lucky thing, because I also have found that even with the best routines, and watching for sleep cues, it is the rare infant who learns how to fall asleep without some fussing.


There are many books out there on the subject and many of them make good points.

Dr. Ferber (who tends to be one of the “cry it out” guys) says something that really resonated with me. We ALL have sleep cycles and may have periods during the night where we are semi awake. You might fluff your pillow, go to the bathroom or have a sip of water and then go back to sleep. But if you woke up and your pillow was missing, you wouldn’t simply turn over and go back to sleep. You would be up!! Where the heck is your pillow?


Guess what. If you are nursing your baby, they fall asleep and you sneak them into their bed, it is no surprise that when they come to a light sleep cycle they become fully awake. Hey, where is that breast, bottle, pacifier, rocking body?


As much as our instincts lead us to PUTTING the baby to sleep, we are better off letting them soothe themselves down with a minimum of assistance. It is certainly okay to pat them or put a firm loving hand against their forehead or chest. Go ahead and surround them with gentle shushing noises. Of course it’s fine for your baby to fall asleep during a feeding, but every time you are able to put your baby down while they are still drowsy, you are a giant step closer to getting a baby who can sleep through the night. Don’t sneak them into bed. Let them be aware of how they get there. Watch for little cues that they are getting sleepy. Rubbing the eyes is a classic one. Believe it or not it is much easier to get a baby to go to sleep if you catch them before they are over-tired.


Feeding at night

Young infants need to eat around the clock. but I really want them to start learning the difference between day and night as soon as possible. I would encourage you to feed every 2 ½ -3 hours during the day. Don’t let any nap go longer than 2 ½ hours. I fully acknowledge that not everyone agrees with me about that. Some people would claim that it feels criminal to wake a sleeping baby. Listen, if they are taking a super long nap and you are in heaven with a bit of free time, go ahead and let them sleep. Once your baby is over 3 months of age and at least 11 pounds, they can start giving you a longer stretch without eating. We want that stretch to be at night.


Watch their pattern. Once they have shown you that they can go 4 or 5 hours at night, try not to backslide. It is okay to comfort them if they wake up, but I would do my best to avoid falling into the “feeding because it is easy” trap. Their little bodies have a lot of growing to do while they are sleeping.


Eventually we want your baby’s nighttime to be food free. There are plenty of books by experts who say that an 11 pound baby can give you 11 hours. If they naturally do it, fabulous; enjoy. But don’t worry if they don’t. I don’t usually start to really focus on dropping 100% of the night feedings until they have started solids, and you are sure they are getting adequate calories during the day. But if your 11 pounder is not giving you at least a four hour stretch, you need to take some action.

There are lots of lessons that must be taught in the quest for your child to sleep through the night. First is learning to fall asleep on their own. Second is learning the difference between day and night. Finally when they have started solids, it is time for the all important lesson. Nighttime is NOT the time for a meal. One of the things I like to say is to imagine if you were up in the middle of the night and having a hard time getting back to sleep. Someone is trying to help you. They might rub your back or stroke your hair. They might offer you a sip of water. They would likely not offer you a turkey sandwich.

 

I don’t know of ANY sleep training that doesn’t involve some fussing, but my method is relatively gentle. I tend to start with fairly low expectations. If a baby is getting adequate milk during the day, no one should need to eat more often than every 3 hours during the night (let’s consider nighttime as soon as you go to bed and until the sun comes up.) If they wake up sooner than 3 hours, someone can check on them (better to not be the mom who is nursing) but food is simply not an option until the magic 3 hour mark. After a few days stretch it to 3 ½ hours and so on. You can certainly check on them, change the diaper, even offer ½ ounce of water. If you think they might be teething go ahead and try some homeopathic teething gel. You are present for them, just not offering food (think turkey sandwich.)  If you want to sit next to the crib and sing, that is up to you. The main lesson is that nighttime isn’t meal time.

Liore, one of my reader/moms shared an even better analogy. If you woke up and someone offered you a lovely warm chocolate chip cookie, of course you would accept it. That doesn't mean you need it!


The Ferber method involves going in to check on them and trying to settle them in increasingly longer increments. First time might be 5 minutes, then waiting 10, then waiting 15…etc.


I have actually found that some babies tend to get much madder if you go in at all and  many parents just leave them awake and crying until the next feeding opportunity has come. You guys need to figure out what works best for you.


If you absolutely can’t bear the thought of letting them cry, you can do the “pick up/put down” method. If they are in a full scream, pick them up and jiggle and shoosh until they are calm. If they were really furious, this might take a while. Don’t say much. The minute they are calm. Place them back into the bed. Yes I know, they will immediately go back into fury mode. Once again pick them up until they quiet, and then put them down. This method takes a tremendous amount of patience and takes much longer than the simple let them cry strategy.

 

No one can dispute the clear message you are giving. “I am here. If you are crying I will calm you. It is time for you to be in bed. It is not time to eat.”  Sometimes your job as a parent involves saying “NO”. I am the parent. I need to show you the rules.

Night time feedings should always be dark, quiet, and business like. Once babies learn to fall asleep on their own and don’t expect to eat at night, you will be headed in the right direction. I understand that it is really wrenching to let your baby cry. In my case I had to remind myself often of what we were doing and why we were doing it. It also helped that my husband accepted the responsibility of being the primary sleep “trainer.”


Here are some of the factors that convinced me that it had to happen:

·         Many people are lousy sleepers their entire lives. If you can potentially give your child the tools that it takes to be a good sleeper, and it only costs a week or two of crying, it is worth it, and you are giving them a gift for life.

·         You have to “put your own oxygen mask on first”. Sleep deprivation is an awful thing. In order to be the best parent that you can possibly be, you need to be rested.


Take shifts.

If you are lucky enough to be in a two parent household, there is no reason for both of you to be up all night. Figure out a way for each parent to get a three or four hour shift of being off duty. Once you have spread out the feeding expectations, this will get easier to figure out. It is amazing how wonderful that little stretch of being off duty feels. No guilt. You each get a turn.

Even the best sleeper will need a tune up once in a while. Traveling babies almost always need an adjustment but these little tweaks are much easier than that first round of sleep training.

If you suspect that your baby may be ill, in my opinion, that is not a good time for ‘crying it out’. I often get folks into the office for a quick visit with their doctor so that we can make sure they are well (sometimes ear infections can cause sleep disruption.)

Common questions:

Pacifiers, good or bad? I would rather have a baby be in charge of their environment but some folks find that pacifiers make falling asleep much easier. Unfortunately some parents end up being woken up every hour or so to replace the pacifier. That sucks (sorry I couldn’t resist.) Some of my parents end up putting dozens of pacifiers in the crib with the hope that the baby will be able to reach one and manage to replace it on their own. Personally I would either keep them out of the crib completely or let them fall asleep with it but then let them figure out how to self soothe once it falls out.

Swaddle: what to do when they grow out of it? At some point every baby is going to have that transition. There are current swaddle blankets that can work with larger babies than there used to be. I also just learned about something called the Merlin suit from one of the dads in my last class. He called it a miracle suit. Do make sure you do daily tummy time. The sooner your baby can master rolling in both directions, the easier it is for them to deal with the post swaddle.

Turning over: They are finally out of the swaddle and turning onto their tummy.

http://nursejudynvp.blogspot.com/2013/07/crib-safety.html

 

Worried about disturbing your neighbors with night time noise? Sometimes a proactive bottle of wine, some ear plugs and little note explaining that you are sleep training goes a long way.

May the force be with you. You will get through this.
Good night.



2 comments:

  1. Judy,

    thanks for your advice. However, nothing seems to be working for me and my twins for 16 months now.

    I ran into a product called Sleepy BabySleep and I am wondering whether you, or anyone, canshare any experience with it before I buy?? It's this thing: www.sleepy-relax.com

    Looking forward to your reply,
    Lizzy

    ReplyDelete
  2. I just heard about the Merlin and thought it looked amazing. Normal swaddle is working for us so we were not really considering it yet.

    I did run across this post on Baby Bargains that recommends against it because of some safety concerns. I know there are many opinions out there, but BB has been pretty reliable and seems to do quite a bit of testing.

    For what it's worth - http://www.babybargains.com/baby-merlins-magic-sleepsuit-review-not-recommended/

    -Rich

    ReplyDelete