Sleep tidbits part one/infants

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 these tips are a good start

For the most part I am a big believer that decisions involving sleep are very personal choices Many 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. Some families are fortunate enough to have a night nurse present for the beginning stretch.

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 unique family. Some people live in close quarters and others have plenty of space so that any crying won’t impact others. Ideally both parents have been able to discuss this and be comfortable with their sleep plan.

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. The essential starting point is to accept that 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 fully awake!! 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 enter a lighter sleep cycle they become aware that something is amiss. Hey, where is that breast, bottle, pacifier, rocking body?

With a new baby, most parents are just trying to figure things out. If we train our babies that the best way to fall asleep is with rocking and feeding. That is the lesson they learn right from the start. I once heard this referred to as accidental parenting. That term fits.

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. If they are awake, 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.

Sleep consultant, Anya Furst, says that once you get to eye rubbing it might even be too late. Her suggestion is to first watch for several days to get familiar with the general amount of time between your baby’s waking and their first eye rub. When you have a good sense of your baby’s pattern, try putting them down ten minutes before they are actually showing that they are sleepy. Babies often take a few days to adjust to new routines so don’t give up if the miracle you’re looking for doesn’t happen overnight. 

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. Daytime feedings can be fun; it’s light in the room and you can interact with your baby as much as you like. Nighttime feedings are business; keep the room dark and interactions to a minimum. During the day, I would encourage you to feed every 2 ½ -3 hours and 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, on occasion, 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. Don’t let the  daytime naps that last longer than 3 hours become a habit.

Once your baby is over 3 months of age and at least 11 pounds, they can start giving you a longer stretch without eating. The goal is for that stretch to be at night.

Keep an eye out for their ability to sleep for longer stretches at a time. 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. 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. Imagine if you woke up in the middle of the night and someone offered you a lovely warm chocolate chip cookie. Of course you would accept it. That doesn't mean you need it!

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. You will have much more success with sleep training if the non-breastfeeding partner is involved. Breastfeeding parents should not enter the room until it is actually time to feed. The baby might need some type of comfort measure but feeding should simply not be 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 chocolate chip cookie.)  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.

Some  methods involve 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 fuss, you can do the “pick up/put down” method. This method takes a tremendous amount of patience and takes much longer than the simple let them fuss strategy.

If they are in a full scream, pick them up and jiggle and shoosh until they are calm. Avoid eye contact. 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. 

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. 

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. Many parents make the argument that you don’t have teenagers crawling into bed with their parents, but sleep specialists see this all the time. The later sleep training is done, the more difficult it is. 

·         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.

Extra Tidbits

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·                     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.

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·                     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.

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·                     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.)

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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.There are also some special sleep sacks that ease this transition. 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 their new found freedom. Once they have learned to reliably flip over, they may well end up on their tummy. It is not reasonable for parents to wake up constantly to put the babies back onto their backs. Instead, it is very important to make sure that their crib is safe.

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

Are you concerned 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.