Healthy Sleep Habits, Happy Child Read online

  Don't exhaust yourself. The mother of an extreme fussy infant stored breast milk so her husband could feed the baby once during the night and her mother could handle a similar daytime feeding. In this way, she was able to get some extra rest. When the baby was several weeks old, the baby's grandmother went home and the father returned to work. Now, all alone and very busy, the mother saw her previously ample supply of breast milk dwindle to almost nothing. We discussed how she had decreased her fluid intake, how she was worried about her mother's departure, and how she was generally under strain. I reassured her that while it was important to continue having the child suck at her breasts to stimulate milk production, a single bottle of formula for one or two days would not harm the baby or inhibit lactation. She increased her fluid intake, rested more, and after four to five days was again nursing with more than ample milk production. Throughout this period, the child continued to have extreme fussiness/colic spells with periods of inconsolable crying. But this mother now knew that the crying was not related to nursing.

  Another mother of one of my patients felt especially bad when nursing failed to calm her baby.

  It's early evening and my daughter is screaming and restless. Nothing seems to calm her, not even nursing. I didn't think Chelsea was colicky, but she sure was fussy. Although her fussiness wasn't an everyday occurrence, it persisted from her second or third week of life until about two months of age.

  At first I thought something I was eating was giving her gas. Then I thought her behavior was due to my inexperience as a mother. As these episodes continued, I began to feel desperate, sad, and exhausted.

  I felt inadequate as a parent. I didn't know how to comfort my child, or whether what I was doing was right. I especially felt inadequate when Chelsea rejected my breast. It seemed as if nothing could console and comfort her.

  We had visions of a child who could be comforted at the touch of her mom or dad. Soon all the sleepless nights and exaggerated feelings of incompetency led to exhaustion. Would this cycle ever end? Well, it finally did. With the help of our pediatrician, we soon began to realize that this behavior was normal and would not last indefinitely. I also found that her fussiness was neither caused nor enhanced by my behavior. Along with this realization came the light at the end of the tunnel. I then knew her fussiness would not last forever.

  I became aware of certain behavioral changes that manifested themselves either before or after each fussy period. She would startle easily, have difficulty falling asleep, and then sleep for shorter periods of time. Also, during her fussy periods, she exhibited different behavioral characteristics. She was restless and would scream with a quivering chin. She would become stiff or have rigid movements. She would not nurse, and when she did she would suck frantically. She would become overtired but would not sleep. Sometimes she would be wide awake one moment and sound asleep a second later.

  Chelsea is now three months old. Her fussy periods have ceased and she wakes in the morning with a smile that lasts all day. We really love our “perfect” child.

  Sometimes a nursing mother notices that the baby seems calmer in her husband's arms than in her own. She may feel that her husband does a better job of soothing the baby, that perhaps the baby “prefers” him to her. What is really happening is quite simple. The baby recognizes that his mother is the source of milk. When she holds him, he quite naturally squirms and twists, rooting around, looking to suck, even when he's not hungry.

  I want to encourage every mother's desire to nurse her extreme fussy/colicky baby. It is an important accomplishment for both of them. One mother called me when her extremely fussy/colicky baby was exactly three months old. She was determined to continue nursing and to start working part-time. Her husband was a fireman and found it very difficult to be around a crying baby on his days off. She was under enormous stress. All her friends claimed that if she would feed her baby formula, the crying would disappear. She wanted to—and did—keep on nursing after the extreme fussiness/colic disappeared to show them, and herself, that nursing was not the cause of the crying. Here is a report from the mother of another one of my patients; persevering with nursing helped her maintain her confidence and self-esteem.

  Both my husband and I questioned our best judgments and our ability to care for Lisa. At one point I questioned my ability to nurse and felt that I was literally poisoning my baby. Her screaming episodes came a predictable ten minutes after every feeding. At times I felt tortured. I consider myself a rational and caring person, yet often found myself crying in the shower or praying that my husband could somehow relieve the tension, anger, and helplessness that I felt.

  At six weeks, Lisa seemed to be easing into patterns and appeared to be getting good, deep sleep. Her smiling times were numerous, but she still had hours of screaming. I overcame my fear of nursing and decided to continue weeks after I had planned to stop. Nursing became the one pleasurable experience the baby and I had together. When I finally did wean Lisa, it was a sad time; we were separate after being together for so long.

  Six weeks of age or six weeks after the due date is truly a magic turning point for many babies.

  Solid Foods and Feeding Habits

  Do you remember how drowsy you feel after eating all that Thanksgiving food? Big meals make us sleepy, so shouldn't solids make babies sleep better? Wrong. Feeding rhythms do not alter the pattern of waking and sleeping.

  Sleeping for long periods at night is not related to the method of feeding, whether it be breast or bottle. This is a fact; check out some of the studies cited at the end of this book (see page 458). The studies I think are the most convincing involve comparing the development of sleep/wake rhythms of infants fed on demand with those who are continuously fed intravenously because of birth defects involving their stomachs or intestines. The babies who were fed on demand cycled between being hungry and being full. The other babies were never allowed to become hungry. The objective recordings in sleep laboratories show that there were no sleep differences between these groups of infants. Other studies involve the introduction of solid foods; they all show that solid food, such as cereal, does not influence nighttime sleeping patterns. No published studies have ever shown that the method of feeding (breast milk versus formula, or scheduled feedings versus demand feedings) or the introduction of solids affects sleep.

  Some studies, however, do indicate that formula-feeding is more popular than breast-feeding among mothers who are more restrictive. Mothers who feed their babies formula tend to be more interested in controlling their infant's behavior and like being able to see the number of ounces of formula given at each feeding. These parents are more likely to perceive night waking in a problem/solution framework and consider the social wants of the child instead of nutritional needs. In contrast, the nursing mother, perhaps more sensitive to the health benefits of nursing, might respond to night waking more often or more rapidly because she perceives herself as primarily responding to her infant's need for nourishment. After awhile, of course, the child learns to enjoy this nocturnal social contact. Over time, the baby learns to expect attention when he awakens.

  This explains why there is no difference in night waking between breast-and formula-fed infants at four months, but by six to twelve months, night waking is more of an issue among breast-fed babies.

  The bottom line is that cereal does not make babies sleep better. Formula may appear thicker than breast milk, but both contain the same twenty calories per ounce. Giving formula to breast-fed babies or weaning diem also will not directly cause longer sleeping at night, although it is possible that attitudes toward breast-feeding may indirectly foster a night-waking habit. Here is one family's account of how breast-feeding led to a night-waking habit.

  MAREN'S WAKE-UP FOR BREAST-FEEDING

  Maren was born July 18, 1984, after an uneventful pregnancy and an easy Lamaze delivery, three days past term.

  We were committed to breast-feeding, with no preconceived expectations of its duration. Maren behaved a
s a normal infant for about two weeks, at which point persistent crying jags began to occur daily. Though we were assured real colic was worse, we came to refer to these spells as “Maren's colic.” We endured the inconsolable crying without much complaint. Although her crying mostly lasted one to two hours, the worst individual days would include unabated crying spells lasting for eight to ten hours. Various experiments were tried to ease the colic suffering, including having Maren sleep with us, having her sleep on a hot-water bottle, et cetera. Predictably, none worked. At two months, the colic ended relatively abruptly.

  From two months on, a very happy, trusting relationship developed between Maren and me. For about seven months, Maren was fed virtually exclusively on breast milk. From seven to ten months, increasing amounts of solid food were introduced at breakfast and lunch. Maren has always been a happy, bubbly, joyful child. The breast-feeding seemed to contribute to this sunny disposition. Maren's nap patterns were completely normal. Generally, I would sleep with her in the morning. Part of the feeding ritual for these ten months included twice-nightly breast-feedings for Maren, interrupting my sleep.

  Massive campaigns were mounted by both sets of grandparents to convince me that breast-feeding needed to end. These began at two months and reached fever pitch around seven months. We listened politely. Except for a brief experimental period at around eight months, I didn't attempt to pump my breasts to permit me extra sleep. This was a conscious decision; direct feeding was easier and more satisfying for both of us.

  Breast-feeding, in addition to the satisfaction it provided, was an indispensable part of the sleeping ritual. From birth to eleven months, Maren expected to be held, fed, and gently rocked or lulled to sleep in the pleasant company of her mother. At around nine months, Maren's rapid growth was taking its toll. There was more solid food in the daytime now. After nearly a year without a full night's sleep, I was beginning to reach a whole new level of fatigue.

  New attempts were begun to get Maren to sleep without my direct attention. Her father would give her a bottle, rock her, sing to her, et cetera. Female friends of the family, familiar to Maren, would do the same. Maren was a good sport about these experiments but preferred my attention. At eleven months, we agreed it was time to wean Maren to a bottle.

  Maren didn't like the plan much. She obviously disliked formula as much as I disliked feeding it to her. For nearly a week she rejected cow's milk. I ended the morning nap breast-feeding ritual first. Juices (orange, apple, pear) in the morning or during car rides helped to improve Maren's familiarity with bottles. They also allowed my husband, Larry, to feed her while I rested later in the mornings. Putting cow's milk in a special bottle (formed and painted to look like a dog) allowed this unpleasant white stuff to become gradually more acceptable. After a few days, Maren started to respond more favorably to her “pooch juice” and the games I created and associated with it.

  I experienced some depression with the cessation of breastfeeding. As that special link came to an end, my contribution to Maren's development suddenly seemed more mundane, repetitive, and less satisfying. This depression came on and off for two months. It was a strange feeling, since it was offset at all times by the joy that comes from having a developing child.

  Maren was fully weaned at eleven months. The last feeding to change over was at bedtime. But even if she was given milk at bedtime, Maren continued to wake up once or twice per evening, crying to be fed. The next step was to get her to sleep through the night. We were repeatedly advised to let her cry herself to sleep. The phrase “even for five or six hours” was used, a reminder of colic days. We considered this proposition, but continued to feed Maren warm milk, sing lullabies, and rock her to sleep, once or twice per night. The big question: What was waking her up?

  We decided it was mostly habit, and that she just wanted the comfort of our company. A new go-to-sleep ritual was introduced: After much playing and affection, Maren was put to bed with her favorite doll, not rocked to sleep. If she woke, warm milk was provided, but Maren was purposely not picked up. Maren cried ten minutes when left alone the first night, then rested her head on top of her favorite doll and drifted off to sleep. After expecting possibly an hour or more of crying, this was an unbelievable, almost anticlimactic relief to us. After two or three nights of feeding without picking her up, Maren began sleeping through the night.

  At the end of month eleven, the go-to-sleep is routine. Maren rarely cries at all. Key elements: a big dinner, a bath, gentle play, eight ounces of warm milk, hugs, and her favorite doll. Even a baby-sitter can do it. At one year, Maren had finally learned to sleep eight hours straight.

  We did a few things we are sure were right. For us, especially me, we sensed Maren's needs and delivered them unasked. This created an extraordinary self-assurance in her, and led to a happy household. Maren seemed to cry less than other children and to be a bright, curious, quick learner. Other things we are happy about: lots of new games all the time; plenty of visual stimulation; rough-housing motions and playing; exposure to music, texture, any stimulation we could dream up. It all seemed to add to her alertness, her trust in us, and the regularity of her sleeping.

  There are also some things we may not have done so well. We may have gone too long before we tried to put her to sleep alone. Our parents continuously warned us we were being too indulgent. They may have been right. But then, first-time parents are like that.

  Solutions to Help Your Child Sleep Better:

  “No Cry,” “Maybe Cry,” or “Let Cry”

  There are many ways to help your child sleep. You should choose the solution that works best for you and your child. Some do not work well for the extremely fussy or colicky baby, some will be difficult to use because of limited resources for soothing, and some are appropriate only for older children. Also, one method may be more powerful in the hands of some families than in others. Often I will refer to ignoring all crying or extinction as the preferred solution to help your child sleep better because I think this works best for the 20 percent of babies who have extreme fussiness/colic; after four months of age, I think they represent the largest group of children with sleep problems or have more severe sleep problems. However, I understand that this is probably the hardest sleep solution for parents and you should always first consider trying other sleep solutions that involve less crying. This is especially true if your child does not have extreme fussiness/colic.

  “NO CRY” SLEEP SOLUTIONS

  Start early, when you come home from the hospital, to

  avoid the overtired state by trying to soothe your baby

  to sleep within one to two hours of wakefulness

  Always hold your baby, always respond and soothe your baby

  as long as needed to induce sleep, sleep with your baby

  Always respect “drowsy signs” so your baby never be

  comes overtired

  Always try to put your child to sleep drowsy but awake

  Motionless sleep

  Establish and consistently practice bedtime routines

  Practice scheduled awakening, also known as focal feeding

  Get fresh air in between naps, go for a walk Control the wake-up time

  Slowly and gradually give your child less attention around

  falling asleep or during the night, a fade procedure

  White noise

  Room-darkening window shades

  Relaxation

  Stimulus control

  “MAYBE CRY” SLEEP SOLUTIONS

  Father puts baby to sleep

  Make bedtime earlier

  Focus on the morning nap

  Sleep rules

  Silent return to sleep

  Day correction of bedtime problems

  “LET CRY” SLEEP SOLUTIONS

  Ignoring all crying or extinction

  Ignoring some crying, also known as controlled crying, or

  graduated extinction

  Check and console

  Crib tent

  MAJ
OR POINT

  Babies need to sleep after one to two hours of wakefulness.

  Parents have told me the first solution needs to be emphasized because it is not intuitively obvious that babies, who sleep so much, need to return to sleep after only one to two hours of wakefulness. In addition, this pattern of brief intervals of wake-fulness appears to help many babies avoid sleep problems throughout the first four months.

  Prevention versus Treatment of Sleep Problems

  There sometimes appears to be a contradiction between whether or not to let your child cry. For 80 percent of babies who have common fussiness, if the parents have ample resources for soothing, sleep solutions that involve no crying, such as the “one-to two-hour rule,” should work to prevent sleep problems. A few, about 5 percent, of common fussy babies do become very overtired four-month-olds. To treat or correct the sleep problem, some crying might occur. However, in this group, improvement in sleep patterns and improvement in the child is often dramatic and rapid.

  For 20 percent of babies with extreme fussiness or colic, however, if the parents have enormous resources for soothing, sleep solutions that involve no crying, such as “Always hold your baby, always respond and soothe your baby as long as needed to induce sleep, sleep with your baby,” might work to prevent sleep problems. But about 27 percent of these extremely fussy/colicky babies do become very overtired four-month-olds. Treatment to correct the sleep problem might involve more crying, and improvement in sleep patterns and inprovement in the child is often slow and not dramatic. This is especially hard for parents because they have already endured four months of sleep deprivation associated with the child's constant fussiness, crying, and not sleeping.