Healthy Sleep Habits, Happy Child Read online

  Family Bed versus Crib

  Our goal is a well-rested family, and a family bed—sometimes described as cosleeping or bed sharing—may be right for your family. The decision to sleep with your baby might be made before the child is born because this is what you want for your family. You might decide that unrestricted breast-feeding day and night, always caring for your baby, and sleeping with your baby at night or day and night will promote a tighter or more sensitive bond between you and your baby. Parents then begin the practice of cosleeping as soon as the baby is born. Researchers use the term early cosleepers to describe these children. Alternatively, you might not have thought about or not really wanted to have a family bed, but you discovered that because your baby was so fussy/colicky, or when your child was older and not sleeping well, that the only way anyone got any rest was to sleep with your baby in your bed. Researchers use the term reactive cosleepers to describe these children. Scientific studies have shown that cosleeping in infancy is often associated with the later development of sleep problems. I suspect that the majority of these problems occur among the formerly “reactive cosleepers.” In other words, some parents find that the family bed is a short-term and partial solution to sleeping problems, and that the sleeping problem continues long after the child has been moved to his own crib or bed.

  About a third of white urban families frequently sleep together in a family bed for all or part of the night. By itself, this is neither good nor bad. Studies in the United States suggest that the family bed might encourage or lead to a variety of emotional stresses within the child; opposite results were found in studies conducted in Sweden. This probably reflects differences in social attitudes toward nudity, bathing, and sexuality. Think of it as a family style, one that does not necessarily reflect or cause emotional or psychological problems in parents and children.

  But when someone is not getting enough sleep, either parent or child, the family bed can cause potential problems. I suspect this often develops in older toddlers because by the age of one to two years, sleeping together is often associated with night waking. Once there is a well-established habit, the child is unwilling to go to or return to his own bed.

  So if you want to enjoy a family bed, fine. But understand that your cuddling in bed together may make any future changes in sleep arrangements difficult to execute. Remember, while it sounds like an easy solution to baby's sleep problems, you may wind up with a twenty-four-hour child even when he gets older.

  In contrast, many families use a family bed overnight only during the first few months, and then shift baby to her own bed for overnight sleep. Then at 5:00 or 6:00 A.M., parents might bring their older infant or child into their bed for a limited period of warm cuddling.

  Sleeping with your baby might include day and night or just night, all night or part of the night, in your bed or using a small crib attached to your bed, with other children in your bed or other children in your bedroom but not in your bed. All of these variations are collectively called “family bed.” In many cultures, families sleep together because of tradition or a limited number of bedrooms. It is rare in Japan or in traditional or tribal societies for children to sleep apart from their parents. There is a great appeal for sleeping together. A powerful word to describe soothing is “nestling,” and this easily brings forth the image of creating a nest for your baby in your bed.

  Both the U.S. Consumer Product Safety Commission and the American Academy of Pediatrics actively discourage the family bed because of the risk of entrapment between the mattress and the structures of the bed (headboard, footboard, side rails, and frame), the wall, or adjacent furniture. There is the hazard of suffocation or overlying by an adult who is in an unusually deep sleep caused by alcohol or mind-altering drugs. Also, soft surfaces or loose covers can cause suffocation. They point out that there is no evidence that bed-sharing protects against sudden infant death syndrome. Also, there is no evidence that bed-sharing prevents extreme fussiness/colic.

  So, if you want to use a family bed, try to make it a safe environment by not drinking or taking drugs at night and making sure your baby is always sleeping on his back. Also, fill in the spaces between the bed and any walls or furniture and eliminate loose bedding.

  Different Decisions for Different Babies

  Research—both my own and others’—has shown that about 80 percent of babies have common fussiness and 20 percent have extreme fussiness, also called “colic.” What happens to these babies over the first four months? At four months of age, some children are super-calm, regular, smiling all the time, and good sleepers, while other babies are the opposite. The good sleepers are described as having an “easy” temperament; the opposite have a “difficult” temperament. Some children are more in-between and are described as having an “intermediate” temperament. How you care for your baby influences the temperament at four months of age.

  These temperaments are explained in detail in Chapter 4. For now, I will just lead you through a numerical exercise involving a hypothetical group of a hundred babies. The reason this exercise is useful is because it might:

  Help you set your expectations on what you will need to do with your baby, both during the first several weeks (for soothing) and the following several months (to prevent sleep problems)

  Help you decide whether you will breast-feed or bottle-feed

  Help you decide whether you will use a family bed or crib

  Out of a group of one hundred babies, 80 percent (eighty babies) will have common fussiness, and 20 percent (twenty) will have extreme fussiness/colic. My research has shown that these two groups of babies differ in how their temperaments develop.

  Consider the eighty common fussy babies at four months of age:

  49 percent, or thirty-nine babies, are temperamentally easy

  46 percent, or thirty-seven babies, are temperamentally intermediate

  5 percent, or four babies, are temperamentally difficult

  Consider the twenty extremely fussy/colicky babies at four months of age:

  14 percent, or three babies, are temperamentally easy

  59 percent, or twelve babies, are temperamentally intermediate

  27 percent, or five babies, are temperamentally difficult

  Of the original hundred babies, the largest temperament group is “intermediate.” Forty-nine babies (49 percent) are in the temperamental category of intermediate. Temperament measurements form a gradation and the temperament categories represent arbitrary cut-off points. So it is possible that the thirty-seven babies in group B, who had common fussiness, tend toward being temperamentally easier and the twelve babies in group E, who had extreme fussiness/colic, tend toward being more difficult. I suspect that the parents of the twelve babies in group E had to put forth much more soothing effort into this intermediate temperament group than the parents of the thirty-seven babies in group B.

  Of the original hundred babies, the next largest temperament group is “easy.” Forty-two babies (42 percent) are in the temperamental category of easy. Of these, thirty-nine babies in group A were born mellow, self-soothing, and calm, and/or their parents were unusually skillful in soothing and/or their parents had vast resources to help them soothe their babies. Not so with the three babies in group D. These babies had extreme fussiness/colic at birth. They were not born mellow, self-soothing, or calm. I think these lucky three babies had super-hero parents who put forth enormous effort to soothe and probably also had lots of other resources to help them maintain this effort over four months.

  The smallest temperament group is “difficult.” Only nine babies (9 percent) of the original hundred are in this temperament category. The four babies in group C had common fussiness, but they may have been almost, but not quite, extremely fussy/colicky. Remember, the measurements used to determine whether a baby has common fussiness or extreme fussiness/ colic are graded, and arbitrary cut-off points are used to make the determination. Alternatively, for these four common fussy babies, maybe something went
wrong with the parents’ ability to soothe. Why might parents be unable to really soothe their baby? Some reasons may include maternal depression, an un-supportive husband, too many other children to care for, illness, financial problems, stress from the extended family, and marital problems between husband and wife. The five babies in group F may have overwhelmed all the resources that the parents could bring to bear on soothing their baby. This implies that factors within the baby were so powerful that no matter what the parents did, the baby's extreme fussiness/colic led to a difficult temperament at four months of age. It is also possible that the difficult temperament evolved because there was a combination of factors within the baby in addition to the problems within the parents or family that conspired to create an overtired child. Preexisting problems such as marital discord only get worse when parents are trying to cope with an extremely fussy/colicky baby. Parents’ inability to soothe may grow out of, or be a response to, the fatigue, frustration, and exhaustion of trying, without much success, to soothe an extremely fussy/colicky baby.

  I believe that how babies sleep influences the development of temperament at four months of age. And how babies sleep during the first few months is a combination of both factors within the child and the parents’ ability and skill at soothing. It is also my belief that at four months of age, the difficult temperament represents an overtired baby and the easy temperament represents a well-rested baby. The temperament that your baby has at four months of age is not permanent. Temperament changes over time as babies develop and parents change how they soothe their children. Stability of individual temperament measures does appear to develop during the second year of life or shortly after the second birthday. If you are reading this book before you have had your baby, be prepared to invest enormous efforts in soothing and consider yourself unlucky if your child is among the 20 percent of extremely fussy/colicky babies. However, if you have already had your baby and you are in the midst of suffering through four months of extreme fussiness/colic, reevaluate some of your decisions, if necessary, regarding how you soothe your baby and what is best for your baby and family. Be optimistic because everything settles down at about four months. Everyone gets a second chance at about four months to help their child sleep better.

  Common Fussiness

  Eighty percent of babies have common fussiness, and the parents of these babies are lucky. These babies do not require a lot of parental soothing. They tend to be self-soothing, mild, and calm; they fall asleep easily and sleep for long periods.

  Breast-feeding these babies is relatively easy because the mothers tend to be better rested and the babies tend to be more regular. The duration of a breast-feeding, how long you nurse, may be relatively short and infrequent because nursing is mainly for satisfying thirst and hunger. When these babies are fussy, methods of soothing other than breast-feeding often work. In fact, the popularity of many techniques or strategies for soothing babies is due to the fact that, for these babies, most everything works well!

  Bottle-feeding these babies either formula or expressed breast milk with or without breast-feeding is a family decision that is usually easily made. Some considerations are to allow the father or other children the pleasure of feeding the baby, thus enabling the mother to get some needed extra sleep at night, to return to work by continuing to pump her breasts at work, or to make it easier for the parents to arrange an evening for an old-fashioned date.

  Before your baby is born, you might decide that you want to sleep with your baby or that you want to use a crib or bassinet. For 80 percent of all babies, those with common fussiness, it doesn't matter, they are fairly adaptable and self-soothing. You can sleep with your baby at both naps and at night, or only at night. Or, you might sleep with your baby when she first falls asleep, put her down in her crib, and then at the first night feeding, bring her into bed with you. Or, you might have a cosleeper attached to your bed and use it for part or all of the night. You can put your baby to sleep within one to two hours of wakefulness. Watch for drowsy cues that are usually obvious in these babies, then any soothing-to-sleep method is likely to work and the baby and parents usually sleep well. Parents are at a low risk for feeling distressed, and I think maternal depression is not very likely. Some of these common fussy babies, however, will occasionally behave like the extremely fussy/ colicky baby and your plans might have to be altered. Only about 5 percent of these babies seem to develop into overtired four-month-olds.

  During the first four weeks, your baby is really “sleeping like a baby.” Elliot, my first son, described his first son as having a look on his face like “I didn't do it,” or seeming almost intoxicated during this time. Sleeping with your baby in your bed or placing your baby in the crib is usually a piece of cake. During weeks four through eight, your baby will become more wakeful and alert and have more evening fussiness. Elliot said that his son now had a more quizzical look, like “Who are you?” and “Give me back my pacifier.”

  Extreme Fussiness/Colic

  Twenty percent of babies have extreme fussiness/colic, and the parents of these babies are unlucky. These babies require a lot of parental soothing. They tend not to be self-soothing and they often appear intense, agitated, and have difficulty falling asleep and staying asleep.

  Breast-feeding these babies is often difficult because the mothers tend to be exhausted or fatigued from sleep deprivation and the babies tend to be irregular. The duration of the breast-feeding, how long you nurse, may be long and frequent because in addition to satisfying thirst and hunger, much of the nursing is for reducing fussiness. When these babies are extremely fussy, methods of soothing other than breast-feeding often do not work. Frustration or despair is common because many of the popular techniques or strategies for soothing babies fail, even though many other mothers (80 percent) swear by them.

  Some considerations going through the mind of the mother are whether something is wrong with her breast milk, whether her breast milk is sufficient, or whether her diet or the current formula is causing the extreme fussiness/colic. Because soothing at the breast often seems to work when other soothing methods fail, the mother does not want to give it up. But painfully dry or cracked skin around the nipple may make breast-feeding an ordeal. The discomfort and pain associated with breast-feeding, plus unrelenting exhaustion from sleep deprivation, may conspire to cause so much stress that the breast milk supply becomes insufficient. Mothers who have enormous support—a dedicated husband who spends a lot of time soothing, housekeeping help, or baby care help—can get through this difficult time much easier than mothers who lack a support system. Mothers who have other children to care for, pressure to return to work, medical problems, baby blues, or postpartum depression may find the additional stresses associated with breast-feeding these extremely fussy/colicky babies to be overwhelming.

  Bottle-feeding these babies either formula or expressed breast milk can be a benefit to some mothers or create more stress in others. The benefits of complete or partial bottle-feeding is that the mother might get more rest because others can feed her baby, and the parents are calmer because they know for certain that their baby is not hungry because they can see how much the baby is swallowing. In other mothers, giving bottles can create the feeling of having failed as a mother. Recognizing that bottles are not as soothing as the breast, these mothers feel guilty because they think they are causing their babies to fuss/cry more, and they worry that something in the formula is causing the fussiness/crying. If you want to breast-feed, a compromise position is to have someone else give a single bottle of expressed breast once per twenty-four hours. This will not cause “nipple confusion” or interfere with lactation. It will give the mother a mini-break, will allow her to get a little more sleep, and it will allow the parents a night out.

  Before your baby is born, you might decide that you want to sleep with your baby or that you want to use a crib or bassinet. But for 20 percent of babies, those with extreme fussiness/colic, the plans that you made for sleeping with y
our baby might have to be altered because these babies tend to be difficult to soothe and have difficulty falling asleep and staying asleep. Watching for drowsy cues is usually frustrating in these babies because they are not obvious, and even if you keep the intervals of wakefulness less than one to two hours, it is still difficult to soothe them. When they finally do fall asleep, they do not stay asleep for long. As a result, parents are often sleep deprived. Parents are at a high risk of feeling distressed and I think that maternal depression is more likely to occur.