Healthy Sleep Habits, Happy Child Read online

  Rhythmic Rocking Motions

  Rhythmic motions are one of the most effective methods of soothing your infant. Use a cradle, rocking chair, baby swing, or Snugli; take the baby for automobile rides, dance with her, or simply walk with her. Rocking motions may be gentle movements or vigorous swinging, depending on what your child responds to. Gently jiggling or bouncing may calm your baby. Some parents claim that raising and lowering the baby like an elevator is effective. Perhaps these rhythmic movements are comforting because they are similar to what a baby feels in the womb.

  Swaddling

  Gentle pressure, such as that experienced when embraced or hugged, makes us feel good. Swaddling or gentle wrapping, sleeping in a car seat or being held in a soft baby carrier or sling are other ways to exert gentle pressure. Here, too, perhaps the sensation of gentle pressure resembles a state of comfort that the baby feels before he is born. Both rhythmic motions and gentle pressure may be effective because perhaps human babies are born too early. The theory is that human babies are born earlier compared to other primate babies because as the pelvic bones developed to support an upright posture, they became narrower. So human babies had to be smaller at the time of birth. If correct, then it is likely that rhythmic motions and gentle pressure exert their soothing effects because they partially re-create the sensations that the baby felt in the womb.

  Massage

  Massaging babies has been observed in many different cultures and has a long history. It is not just a new fad. One particular benefit from massaging your newborn is that the mother or father directly benefits from this activity. While lovingly stroking your baby, you smile at your baby, talk softly, or you might sing or hum. These efforts, while focused on your baby, also relax you! Since fathers cannot breast-feed their babies, I encourage them to develop an intimate bond with their newborn by practicing baby massage right away—even before any fussiness begins. Using a natural cold-pressed fruit or vegetable oil, gently stroke the skin and gently knead your baby's muscles. All the movements are performed gently—books with pictures and videos are available to assist you. Baby massage is not a gimmick or a cure for extreme fussiness. However, it does soothe babies. Equally important, it provides you with a singular opportunity to be completely focused on your baby—turn off the phones and pagers. You are doing something quite different from feeding, changing, and bathing. Comforting your baby this way will give you an inner calmness that will help you get through possible rough times when your baby is extremely fussy and not very soothable.

  Respect Your Baby's Need to Sleep:

  The One-to Two-Hour Window of Wakefulness

  Immediately after the baby is born, you will see what people mean when they say “sleeping like a baby.” For a few days, babies sleep almost all the time. They barely suck and normally lose weight during this time. If your baby was born early, this very drowsy time might last longer; if your baby was born past the expected date of delivery, the drowsy period might be brief or nonexistent. A few days later, babies begin to wake up more. This increased wakefulness reflects the normal maturation of your baby's nervous system. I tell families that the brain wakes up after three or four days just in time to catch the breast milk that is just now available in ample amounts. He looks around more with wider eyes and is able to suck with more strength and for longer periods. Within days, the weight loss stops and a dramatic growth in weight, height, and head circumference begins. Also, longer periods of wakefulness begin to appear after a few days. Although your baby is intently interested in you and is quickly able to recognize your face and voice, he is not yet curious about objects such as toys or mobiles. He does not appear to care about the general buzz or noises, colors, or other activities surrounding him, and therefore, he falls asleep almost anywhere. The extremely fussy/ colicky baby is not like this and appears to have difficulty falling asleep and staying asleep even at only several days of age. All babies gradually seem to become more aware of action, motion, voices, noises, vibrations, lights, wind, and so forth as they become more curious. Now they often do not “sleep like a baby.”

  During the day, within a one-to two-hour time “window” of wakefulness, your baby will become drowsy and want to go to sleep. I discovered this window during my research on naps. If you soothe a baby during the beginning of drowsiness, most will easily fall asleep. The exception is the extremely fussy/ colicky baby who might fall asleep but not easily; these babies need longer and more complex soothing efforts to help them fall asleep. The other exception is during the evening fussy periods and especially around six weeks of age.

  Here are some ways to note that your baby is becoming drowsy. Watch for the drowsy signs—quieting of activity, less movement of the arms and legs, eyes that are not as sparkling, eyelids that droop a little, less-intense staring at you, and sucking that may be weaker or slower. If your baby is over six weeks old, you may notice less socially responsive smiling or your baby may be less engaging. This is the time to begin soothing to sleep. All babies become this way within one to two hours of wakefulness.

  What happens if you miss this one-to two-hour window? Your baby will become overtired if she cannot fall asleep because of too much stimulation around her. When you or your baby becomes overtired, the body is stressed. There are chemical changes that then occur to fight the fatigue, and this interferes with the ability to easily fall asleep and stay asleep. Babies vary in their ability to self-soothe and deal with this stress, and parents vary in their ability to soothe their babies. So not all babies go bonkers if they are kept up a little too long. But you will have a more peaceful and better-sleeping baby if you respect his need to sleep within one to two hours of wakefulness. I consider this to be the beginning of sleep training for babies.

  Sleep training begins with developing a sense of timing so that you are trying to soothe your baby at the time when your baby is naturally getting drowsy before falling asleep. Some young babies will need dark and quiet environments to sleep well and others will appear to be less sensitive to what is going on around them. Respect your baby's individuality and do not try to force him to meet your lifestyle. I like the analogy with feeding: We do not withhold food when our baby is hungry. We try to anticipate when he will be hungry, so he will be somewhere calm where we can feed him. We do not feed him on the run. The same applies for sleeping.

  If your young baby does not sleep, continue trying to soothe. Do not let him cry or ignore him. You cannot spoil a baby. You cannot teach a baby a crying habit.

  Other Soothing Methods

  Be skeptical about the supposed miracles accomplished with crib vibrators, hot-water bottles, herbal teas, or recordings of heartbeat or womb sounds. There has been a great deal of nonsense written about burping techniques, nipple sizes and shapes, baby bottle straws, feeding and sleeping positions, lamb's wool pads, diets for nursing mothers, special formulas, pacifiers, and solid food. There is no good evidence that chiropractic spinal manipulation helps babies. These items have nothing to do with extreme fussiness, crying, temperament, or sleeping habits.

  Many useless remedies can be purchased without a prescription. Antigas drops, such as simethicone, have not been shown to be more effective than a placebo in well-conducted studies. One popular pellet contains chamomile, calcium phosphate, caffeine, and a very small amount of active belladonna chemicals (0.0000095 percent). Another remedy contains natural blackberry flavor, Jamaica ginger, oil of anise, oil of nutmeg, and 2 percent alcohol. Maybe enough alcohol will sedate some infants! Please read labels carefully—any natural substance, flavoring agent, or herb can have pharmacological effects. Call a school of pharmacy or a medical school to find experts in pharmagnosy, the study of natural herbs and plants, to find out if a particular plant or herb is dangerous.

  Beware of gimmicks. Newborns have been drowned in rocking waterbeds, strangulated by having their necks overhang a trampoline-like crib platform, and suffocated by burying their heads into pillows. Beware of prescribed drugs. The London Times head
line of May 22, 1998, screamed, “Baby died after drop of medicine for wind.” A midwife had “diagnosed trapped wind” and prescribed what was thought to be peppermint water.

  Also be cautious in using home remedies. One mother almost killed her baby by giving a mixture of Morton Salt Substitute with lactobacillus acidophilus culture, as prescribed in a popular book.

  Everything Works … for a While

  When you believe that something is going to calm your baby—herbal tea, womb recordings, lamb's wool blankets, you name it—often it appears to work, for a while. You are emotionally expecting relief because you trust the advice of an authority. Your fatigue may breed inflated hopes for a cure, and the day-by-day variability in infant crying creates the illusion that a particular remedy works. What is really happening is a placebo effect, the emotional equivalent of an optical illusion.

  Mothers may fool themselves into believing their babies are better because of a new formula or special tea. Of course, reality sets in after a few days and shatters the illusion. Some mothers sincerely believe that their babies habituate to, or become accustomed to, the benefits from the new formula or tea much like a dope addict needs increased doses to produce the desired feeling. Some doctors believe the mothers’ reports and agree that the babies really did improve for a day or two because the babies received novel stimulation.

  Novelty is unlikely to be important because parents report that upon reintroduction, weeks after the special tea or gimmick was discarded, they see no improvement. In other words, there was no placebo effect the second time around. Naturally, if the baby coincidentally outgrows extreme fussiness/colic when a useless remedy is introduced, the mother, the family, and even the doctor might become convinced that the useless remedy actually cured the extreme fussiness/colic!

  Resources for Soothing

  Some families have vast resources to invest in soothing their babies, but other families are not so fortunate. Twenty percent of babies have colic and require much more soothing, and families with a colicky baby and limited resources to soothe might easily become overwhelmed and frustrated. The other 80 percent of babies are more easily soothed and usually do not overly stress their parents. So you want to pay attention to whether your child has colic or not, and take some time to reflect on how able you will be to enlist help to soothe your baby. It is often more than a one-woman job! If you have a baby who fusses and cries a lot and is difficult to console, and your available resources for soothing are limited, you might modify some of the plans you made before your child was born regarding a family bed or crib.

  Consider a balance between the baby's disposition to express distress and the parents’ capability to soothe their baby. Not only do babies vary in their expression but parents also vary in their capability to soothe. The resources for parents’ ability to soothe fussiness and crying and promote sleep in their baby include the following.

  RESOURCES FOR PARENTS’ ABILITY TO SOOTHE

  Father involvement versus absent father

  Agreements or disagreements between parents regarding child-rearing such as breast-versus bottle-feeding or crib versus family bed

  Absence or presence of marital discord

  Absence or presence of intimacy between wife and husband

  Absence or presence of baby blues or postpartum depression

  Absence or presence of other children requiring attention

  Ease or difficulty in breast-feeding

  Absence or presence of medical problems in child, mother, father, or other children

  Number of bedrooms in the home

  Absence or presence of relatives, friends, or neighbors to help out

  Help or interference with sleep routines from grandparents

  Ability or inability to afford housekeeping help

  Ability or inability to afford child care help

  Absence or presence of financial pressures such as mother having to return to work soon

  Bedtime Routines

  Just as soothing helps your child feel safe and secure, bedtime routines help all children calm down before falling asleep, because both are associated with the natural state of relaxed drowsiness. As with soothing, bedtime routines should be started early, before sleepy signs change into overtired fussy signs. Older children and more regular babies will develop predictable sleep times, and these children might be “slept by the clock.” Pick and choose from the following list based on your child's age and your personal preference. Try to follow the same sequence at all sleep times.

  BEDTIME ROUTINES

  Before sleep times, reduce the amount of stimulation: less

  noise, dimmer lights, less handling, playing, and activity

  Bedroom should be quiet, dark (use room-darkening shades),

  and warm, but not too warm

  Bathe

  Massage after bath with smooth, gentle motions

  Dress for sleep

  Swaddle if it comforts and relaxes your baby, use a warm

  blanket from the clothes dryer

  Lullaby, quiet singing or humming—be consistent

  Favorite words, sounds, or phrases—be consistent

  Feed

  May put down drowsy but awake, but do not deliberately

  awaken before sleeping. This often fails for colicky babies

  and all six-week-olds in the evening

  Do not rush in at the first sound your baby makes

  In addition to being consistent in your bedtime routines, you must cultivate patience, because it may take time for your child to get the message that this is not the time to be playing. I would also add that, except for premature babies and trying to correct a sleep problem, you should never wake a sleeping baby.

  Breast-feeding versus Bottle-feeding and Family Bed versus Crib

  How you feed your baby and where you sleep with your baby might depend on many factors, including whether the baby is easy or difficult to soothe and whether you and your baby are well rested or not. Ask yourself these questions:

  Do you spend a total of more than three hours per day soothing your baby to prevent crying? That is, when you add up the total amount of minutes spent walking, rocking, driving around in the car, swaddling, singing, humming, running water, offering the breast or bottle even when not hungry, using a pacifier, and so forth, does the total exceed three hours?

  Do you behave this way more than three days per week?

  Have you been doing this for more than three weeks?

  If you answered “yes” to all three questions, then your baby has colic. There may be no crying because of your soothing effort, just endless fussing. Or, she might sometimes cry anyway despite your soothing efforts. If you answered “no” to some of the questions but your baby fusses often, especially in the evening and especially around six weeks of age, then your baby has common fussiness. If you answered “yes” to all three questions, please stop here and skip ahead to Chapter 4 to better understand the challenges you will be up against.

  Breast-feeding versus Bottle-feeding

  Breast-feeding is considered best for baby and mother. The decision on how to feed your baby may be influenced by the support or lack thereof from your husband, your mother, or other family members. However, many babies are bottle-fed because of adoption, prematurity, or medical problems with the baby or mother. Bottles can contain expressed breast milk or formula, so “bottle-feeding” may include feeding breast milk. Formula-fed babies grow up to be just as healthy as breast-fed babies. Many studies have shown that breast-feeding does not prevent extreme fussiness/colic, does not prevent sudden infant death syndrome, and does not prevent or cause sleeping problems. At night, breast-fed babies are often fed more frequently than formula-fed babies, but it is not known whether this is caused by the breast-feeding mother responding more promptly to her baby's quiet sounds or whether breast milk digestion causes the baby to wake up more often. In general, research has shown that sleep/wake rhythms evolve at the same pace whether the baby is breast-fed, form
ula-fed, demand-fed, schedule-fed, or whether cereal is given in the bottle or by spoon. Some babies with a birth defect of the digestive system are fed continuously by vein or tube in the stomach. Because of the constant feeding, they are never hungry. These babies develop the same sleep/wake rhythms as all other babies. This is why I tell parents that “Sleep comes from the brain, not the stomach.” Although there are rare medical exceptions, changing formulas will not reduce fussiness/crying or promote better sleeping.

  Of course, if your baby is not being fed enough, then she might be too hungry and fuss/cry or not sleep well. In this situation, the child will not be gaining weight and some help will be needed to establish a better breast milk supply or evaluation for medical problems that are causing poor weight gain. In my practice, I encourage first-time mothers to give a bottle of expressed breast milk or formula once per twenty-four hours when their baby is two to three weeks old. This allows fathers and other family members to have the pleasure of feeding the baby, as well as giving the mother a mini-break once a day to rest and allow for the healing of cracked or painful nipples. It also gives the parents the chance to have a date to recharge their energy. Fathers can be more helpful during fussy/crying periods or middle of the night feedings to allow mothers a little more sleep. Some experienced mothers, who have previously breastfed successfully, give the single bottle sooner. They have confidence in their ability to breast-feed and either give formula in the hospital or start pumping sooner. They know that the single bottle does not confuse the child or interfere with breastfeeding. The reason the bottle is given every twenty-four hours is to keep the baby adapted to taking the bottle. Some babies do well with less frequent bottles, but others will reject all bottles if days go by without having had one.