Every newborn baby is unique. And the closer we look, the more we can see differences. Some of these differences reflect inborn traits and are called genetic differences. Recent sleep research has focused on the gene that controls our biological clocks, and to mothers of fraternal twins, the finding that not all clocks run at exactly the same speed will not be surprising. But other congenital differences that are not inherited are due to whether the baby was born at thirty-seven or forty-two weeks of gestation, or whether the mother smoked or drank large amounts of alcohol during her pregnancy. A new area of research, based on animal studies, is how the mother's biological rhythms may help set or influence the rhythms of the fetus and the newborn baby. Based on the regularity or irregularity of the mother's sleep/wake patterns, activity/rest patterns, or eating patterns, there may be a kind of prenatal programming affecting the baby's own rhythms.
All of these differences—in smiling, sucking, sleeping, physical activity, and so on—combine to make a baby an individual. This chapter will describe the individual sleeping patterns in babies and how these patterns change as babies grow.
THE ONE-TO TWO-HOUR WINDOW
Think and plan how you want to soothe your baby, but know that when you soothe your baby is more important.
· Babies quickly become overtired after only one or two hours of wakefulness, and some cannot comfortably stay up for even one hour! During the day, note the time when your baby wakes up and try to help her nap by soothing within the next one or two hours before she becomes overtired. Try to keep the intervals of wakefulness brief.
· Babies less than six weeks old fall asleep at night very late and do not sleep very long during the day or night. Try to soothe your baby to sleep during the day before she becomes overtired. Always respond to your baby. Avoid the overtired state.
· Eighty percent of babies more than six weeks old become more settled at night, sleep a little longer at night, and begin to become drowsy for night sleep at an earlier hour. Try to soothe your baby to sleep at an earlier hour if she shows signs of drowsiness earlier. Do not let her cry.
· Twenty percent of babies more than six weeks old do not appear to become more settled at night, do not appear to sleep longer at night, and do not become drowsy at an earlier hour. Nevertheless, try to soothe your baby to sleep at an earlier hour even if she does not show signs of drowsiness earlier. Spend extra time soothing: prolonged swinging, long luxurious baths, and never-ending car rides. Fathers should put forth extra effort to help out. Do not let her cry.
Newborn: The First Week
While recovering from labor and delivery and perhaps the aftereffects of anesthesia, you may begin to experience new feelings of uncertainty, inadequacy, or anxiety. After all, Parenting 101 probably was not one of your high school or college courses. Unfortunately, hospital schedules can serve to underline these feelings. In hospitals without total rooming-in, an artificial schedule is imposed on baby care activities. This is determined by changes of nursing shifts, visiting hours, and the need to measure vital signs, and not by your baby's needs.
PRACTICAL POINT
Your baby has no circadian rhythms or internal biological clocks yet, so you can't set your baby to clock time.
As soon as you arrive home, you need to disregard the clock and feed your baby whenever she seems hungry, change her when she wets, and let her sleep when she needs to sleep. Full-term babies sleep a lot during the first several days. They also eat very little and often lose weight. This is all very natural and should not alarm you. If your baby sleeps a lot, don't confuse sweetness with weakness.
PRACTICAL POINTS
Unplug your phone when nursing.
Unplug your phone when napping.
Unplug your phone when your husband is with you.
Consider a relief bottle (one bottle a day of formula or expressed breast milk) if you are nursing.
Presumably this calm, quiet period during the first days is somehow synchronized with the few days it takes for the mother's breast milk to come in. Babies sleep a lot, fifteen to eighteen hours a day, but usually in short stretches of two to four hours. These sleep periods do not follow a pattern related to day and night, so get your own rest whenever you are able.
Q: I heard that I am supposed to put my baby to sleep when drowsy but awake. But every time I feed her, she quickly falls asleep. Am I then supposed to wake her up and then put her down to sleep?
A: Newborns usually fall asleep during a feeding and it does not make sense to wake her. It goes against Mother Nature! Older babies will often be almost asleep when they finish sucking. When the breast or bottle is removed, older babies momentarily look around in a dazed fashion, just to check out that everything is okay, and then go into a deep comfortable snooze with you in your bed or alone in their crib.
Why then have you heard that you should not let your child fall asleep during soothing or feeding? The theory is that your child is learning self-soothing skills, and that she would not learn these if you do not do this. Consider two scenarios. First, you keep the intervals of wakefulness brief, only one to two hours, and you watch for signs of drowsiness (see page 63). At the drowsy time, you soothe and/or feed your baby and she now may be more drowsy and entering the sleep zone, but she is not completely asleep at the end of the soothing and/or feeding. Now she is able to continue to self-soothe herself to deep slumber. This is easy because she was not overtired, and 80 percent of babies (common fussiness/crying) can handle this well.
Second, you allow your child to stay up too long and he becomes overtired. He has passed through the drowsy zone and is entering the fatigue zone. Now, when you soothe and/or feed your baby, you discover that he will not be easily placed in his crib or stay asleep unless he is already in a deep sleep at the end of the soothing and/or feeding. Soothing himself to sleep is difficult because he was overtired, and 20 percent of babies (extreme fussiness/colic) are often this way during the first few months anyway. The problem is not your failure to “put him to sleep when drowsy but awake,” rather, the problem is allowing your baby to become overtired or being unlucky and having an extremely fussy/colicky baby.
This translates into the observation that when parents are successful with the sleep strategy of “put your baby to sleep when drowsy but awake,” there are fewer sleep problems, and when parents do not (or cannot) do this, there are more sleep problems. The truth is, the success of this strategy is dependent on having a well-rested child to start with. If you innocently let your child get overtired or if you have an extremely fussy/colicky baby, this sleep strategy is not going to work well.
WARNING!
The first week of life is like a honeymoon. Newborns “sleep like a baby.”
For all babies: It will become more and more difficult to soothe and sleep the baby in the evening hours at six weeks of age, counting from the due date.
For 80 percent of babies: They settle down at night a few weeks later.
For 20 percent of babies: It will become more and more difficult to soothe and sleep the baby all the time starting at several days of age, counting from the due date. These babies settle down at night at three to four months of age.
When your baby becomes more and more difficult to soothe and sleep, he appears to be more completely out of your control and your life will not be easy.
SLEEP TRAINING DOES NOT EQUAL CRY IT OUT
· Sleep training involves several general principles to use the natural development of sleep/wake rhythms as an aid to help your child learn to sleep.
· Respect your baby's need to sleep.
· Start early to plan for or anticipate for when your baby will need to sleep, similar to anticipating when your baby will need to feed.
· Maintain brief intervals of wakefulness, this is the one-to two-hour window.
· Learn to recognize drowsy cues (see page 63), though they may be absent in 20 percent of extremely fussy/ colicky babies. Drowsy cues or sleepy signs signal that your baby is becoming sleepy; this is when you should begin your soothing efforts.
· When you put your baby down or lie down with him, he may be drowsy and awake or in a deep sleep. Either way works if you have good timing.
· Develop a bedtime routine.
· Matching the time when you soothe your baby to sleep to the time when he naturally needs to sleep is the key. For 80 percent of common fussy babies, perfect timing produces no crying.
· During the first several weeks, many babies fall asleep while feeding or sucking to soothe even if not hungry. This is natural. It is not necessary to deliberately wake your baby before you put him down to sleep or lie down with him in your bed. Later, your older baby may or may not momentarily and partially awaken as you remove your breast or bottle before falling asleep. Do not force him to a wakeful state before attempting to sleep him.
Weeks Two to Four: More Fussiness
All babies are a little hard to “read” during these first few weeks. Most activities such as feeding, changing diapers, and soothing to sleep occur at irregular times. Do not expect a scheduled baby, because the baby's needs for food, cuddling, and sleeping occur erratically and unpredictably. When your baby needs to be fed, feed him; when he needs to have his diaper changed, change him; and when he needs to sleep, allow him to sleep.
What do I mean by “allow him to sleep”? Try to provide a calm, quiet place for your baby if he sleeps better this way. Many babies are very portable at this age and seem to sleep well anywhere. You're lucky if your baby is like this, and you're even luckier if he is one of the few who have long night sleep periods. Most newborns don't sleep for long periods at night.
Studies have shown that for babies a few weeks old, the longest single sleep period may be only three to four hours, and it can occur at any time during the day or night. This is day/night confusion. Extremely fussy/colicky babies may not even have single sleep periods that are this long; premature babies may have longer sleep periods.
Parenting strategies such as changes in the amount of light or noise don't appear to greatly influence babies’ sleep patterns now. In fact, specific styles or methods of burping, changing, or feeding do not seem to really affect the baby. Try not to think of doing things to or forthe baby. Instead, take time to enjoy doing things with your baby. Do the things that give you both pleasure: holding, cuddling, talking and listening, walking, bathing, and sleeping together. This active love is sufficient stimulation for now; you don't have to worry about buying the right toy to stimulate your baby.
A change will occur in all babies during these first few weeks, and you should prepare for it. When your baby is about to fall asleep or is just about to wake up, a sudden single jerk or massive twitch of his entire body may occur. As the drowsy baby drifts into a deeper sleep, the eyes sometimes appear to roll upward. This is normal behavior during sleep/wake transitions. Also, all babies become somewhat more alert, wakeful, and aroused as the brain develops. You may notice restless movements, such as shuddering, quivering, tremulousness, shaking or jerking, twisting or turning, and hiccoughs. There may be moments when your sweet little baby appears impatient, distressed, or agitated for no identifiable reason. This is normal newborn behavior.
During these spells of unexplainable restlessness, the baby may swallow air and become gassy. Often he appears to be in pain. Sometimes he cries and you can't figure out why. The crying baby may be hungry or just fussy. This is confusing to all parents.
All in all, now you may not have the baby you dreamed of having. She cries too much, sleeps too little, and spits up on you whenever you forget to cover your shoulder with a towel. Here are some concrete steps you can take to make it easier for everyone.
1. Take naps during the day whenever your baby is sleeping
2. Unplug all phones in the house
3. Go out, without your baby, for breaks: a walk, a coffee date, a movie
4. Plan or arrange for a few hours of private time to take care of yourself
5. Do whatever comes naturally to soothe your baby; don't worry about spoiling her or creating bad habits
6. Use swings, pacifiers, or anything else that provides rhythmic, rocking motions or sucking
If you find that your baby sleeps well everywhere and whenever she is tired, enjoy your freedom while you can. A time will come when you will be less able to visit friends, shop, or go to exercise classes, because your baby will need a consistent sleep environment.
Q: Why are breast-fed babies fed more often at night than formula-fed babies’?
A: It may be that the breast milk takes less time to digest so the breast-fed baby is hungrier sooner. It may be that the mother who has chosen to breast-feed is more sensitive or attuned to her baby and responds more frequently to the baby's sounds, both hungry sounds and sleep sounds. Maybe the breast-feeding mother is more committed to soothe or nurture her baby, using her breasts as a pacifier even when her baby is just fussy and not hungry. Perhaps the breast-feeding mother responds more often because her breasts feel uncomfortably full. Or, the mother who is breast-feeding is unsure whether her baby has gotten enough because, unlike the formula-fed baby, she cannot see how much her baby has taken.
Q: I've heard that my newborn should not sleep in the bassinet in my room or in my bed with me, that it will spoil him.
A: Nonsense. For feeding or nursing, it makes it easier for both of you if your newborn is close. When your baby is older, say three or four months, both of you may sleep better if he is not in your room. Anyway, by then the number of night feedings is usually smaller.
Brief awakenings in young infants under four months of age are acceptable to most parents because these usually are thought to be caused by hunger. For the older child, especially if he had been sleeping overnight previously, night wakings are often thought of as a behavioral problem. The truth is that awakening at night or complete arousals are normally occurring events, as discussed in Chapter 2. Problems in the older child may arise when he has difficulty or is unable or unwilling to return to sleep unassisted. The more often these events occur, the longer each separate awakening lasts.
Q: When will my child sleep through the night?
A: Many infants between six weeks and four months will naturally go to sleep late around 9:00 to 11:00 P.M., and sleep several hours without a need to be fed. Some call this “sleeping through the night.” After four months, infants tend to go to sleep earlier, around 6:00 to 8:00 P.M., and some now need to be fed once or twice before they wake up to start the day. After nine months, these night feedings are not needed. Except for breast-fed babies in a family bed, more than two night feedings will begin to create a night waking habit.
Weeks Five to Six: Fussiness/Crying Peaks
At about six weeks of age, or six weeks after the expected date of delivery for preemies, your baby will start to return your social smiles.
If you are lucky and have a calm baby who appears to have regular sleep periods, prepare yourself for changes resulting from your child's increased social maturation. The social smiles herald the onset of increased social awareness, and it may come to pass that your baby will now start to fight sleep in order to enjoy the pleasure of your company. This is natural!
PRACTICAL POINT
Try to meet your baby's needs. If he's hungry, feed him. If he's tired, sleep him.
When your baby appears slightly fidgety, ask yourself two questions. First, when did you last feed her? Second, how long has she been up? Sometimes you need to sleep her and not feed her.
Around the time your baby produces her first social smiles, at about six weeks of age, night sleep becomes more organized, and the longest single sleep period begins to occur with predictability and regularity in the evening hours. This sleep period is now about four to six hours long. (If your baby has extreme fussiness/colic, the longest sleep period might be less than this.) Your baby will also start to settle down more and more. She will become more interested in objects such as mobiles and toys, she'll have more interest in playing games, and her repertoire of emotional expressions will dramatically increase.
Yet many parents find this time particularly frustrating, since many babies reach a peak of fussiness and wakefulness at about six weeks. Even extremely fussy/colicky babies may be at their worst at six weeks of age.
THE SIX-WEEK PEAK
All babies are most fussy, cry the most, and are most wakeful at six weeks of age.
One mother told me, “He's a little excited about all the living going on.”
Here is a vivid description of the six-week peak.
ANTONIO'S SLEEP STORY
Like many couples today, my husband, Arturo, and I got married in our late twenties/early thirties, and waited several years before deciding the time was right for starting a family. We felt that although our spontaneous, independent lifestyle would change, we were ready for the challenge of having a baby. Our friends with kids all told us that our lives would change, but it was impossible for us to imagine just how different our lives would be after our baby was born!
Antonio was born two weeks early and without difficulty. I remember thinking several hours after his birth that he was going to be a very easy boy, since my pregnancy and delivery were both routine and relatively easy. Three days after we brought him home, however, I realized that my expectations might have been a little off. Looking back at the notes I took (I kept a spreadsheet with a sleeping/eating schedule and wrote many comments on it about Antonio's habits), Antonio started crying that day at about 8:00 P.M. and didn't stop until 5:30 A.M. After an extremely stressful night of walking Antonio up and down the hallway, rocking him, and doing everything we could think of to soothe him, he finally fell asleep, exhausted, at about 6:00 A.M. It was a terrible feeling for parents who love their baby so much not to be able to soothe or comfort him! My husband and I felt like failures, and we called the doctor the minute the office opened that morning and pleaded for help. Luckily, we found out that part of his crying that night was due to hunger, as my breast milk hadn't come in yet. That was an easy problem to fix!
We remedied his hunger quickly, but he still seemed to cry a lot. Over the next three weeks we started to notice a pattern of crying that started at about 5:00 P.M. and usually lasted for about six hours. In addition to that, Antonio awakened every two hours to be fed (as most babies do) during the night and didn't take daytime naps! During these early weeks the only way Antonio would sleep, night or day, was if either my husband or I held him. Needless to say, both my husband and I were as desperately in need of sleep, as Antonio was! At the time, my husband said that he couldn't understand why our baby cried so much and slept so little when every other baby he knew didn't seem to have these issues. In fact, of all the new parents we met through my prenatal exercise classes (there were fifteen to twenty couples we knew who had babies at the same time), only one other baby seemed to have the same type of behavior. In addition, couples with older babies and toddlers were no help whatsoever, as they all claimed to “forget” whether or not their babies were fussy. I could not believe anyone could ever forget what we were going through. My husband thought we must be doing something wrong, and I was afraid he might be right, although I didn't admit it at the time.
When Antonio was about three weeks old, I brought him to see Dr. Weissbluth. We discussed his sleep patterns (or lack thereof), and he advised me that Antonio's evening fussiness would get worse until he was six weeks old, and then it would start to improve slowly and hopefully end at about twelve weeks. I was quite dismayed to also learn that since Antonio was born two weeks early, I had to count Antonio's age from his original due date, not his birth date. So instead of having only three more rough weeks, we would probably have at least five! That's an eternity when you're sleep-deprived! I really didn't know how we were going to make it through that rough period! At one point I remember counting out the weeks until week six, as I did at least every other day, telling my husband, “We only have three and a half more weeks!” To which my husband replied, “And what if he doesn't get better after that?!” I think the biggest worry we had was that Antonio's fussiness would never end. This being our first child, we weren't 100 percent sure he would ever grow out of this! In the midst of this period, it seemed to us that this would be what our new lives would be like forever—endless nights of holding our crying baby followed by bleary days of holding him so he would sleep. We knew in our minds that he had to get better, but the big question was when.
Then, at about six weeks after Antonio's original due date, I couldn't believe it, but I actually started to notice that his evening fussiness was decreasing! It was almost six weeks to the day, and I was utterly amazed that Dr. Weissbluth's timetable was so accurate. In addition, at the same time, his nighttime sleep started becoming a little longer and he started falling asleep in his crib instead of having to sleep with me! The improvements were small, but at that point I was just ecstatic to have four solid hours of sleep at night! At about ten weeks I called the doctor and received encouraging advice. He suggested that I start putting Antonio to bed earlier at night, as this might help him feel less tired and make him fall asleep more easily. At the time, Antonio was going to bed between 10:00 and 11:00 P.M. SO I moved his bedtime to around 8:00 P.M. for a few nights, and I could not believe how well this worked! I then started putting him in his crib even earlier, as I noticed that he actually became tired at around 6:30 P.M. Antonio is now almost five months old, and he has been sleeping from 6:30 P.M.through the night to about 7:00 A.M. He has been doing this since he was twelve weeks old. He does wake up occasionally at 4:00 or 5:00 A.M. if he's hungry, but for the most part he sleeps extremely well at night, and is even starting to form regular daytime naps! Arturo and I still can't believe that our “colicky” baby is such a great sleeper now. If we had only known this back in week three, we would have been a little less stressed out! I hate to say it, but like most of my friends with older children, I'm forgetting the details of his fussy period, too! Antonio is such a joy to be with, I actually might want to have a second baby. Yikes!
Your baby may irritate and exhaust you. She may give up napping altogether and, to make matters worse, when awake may appear to be grumbling all day. You may feel battered at the end of each day; you may be at your wits’ end. This, too, is natural. Being annoyed with your baby does not make you a “bad” parent. Just understand why you're annoyed. Remember that your baby's immature nervous system lacks inhibitory control. The brain will develop inhibitory capabilities as it matures, but this takes time; things will settle down after six weeks of age.
Here is an account of one mother's first eight weeks.
“MY FIRST BATH IN EIGHT WEEKS”
Today my baby girl, Allyson, is eight weeks old. I celebrated by taking my first uninterrupted bath since her birth. Of course, she woke up just as I was toweling off, but I have learned to be grateful for small pleasures.
Allyson doesn't sleep much, and when she's awake she's usually either crying or nursing. It's been a little better the past week, but she still sleeps very little: six to eight hours at night and two to four hours during the day. And since I can't bear to hear her cry, that means she spends most of her time on my breast, where, mercifully, she can always be soothed. I feel as if I've merged with the brown corduroy chair where I nurse her.
Lately she's good for a couple often-to twenty-minute play periods (on the floor on her back, me leaning over her, or on the changing table while I change her diaper). I can't hold her and play with her; she's always squirming to get at my breast. So, anyway, she's on my breast ten to twelve hours a day.
Given Allyson's behavior (constant crying or fussiness, and a constant desire to nurse or at least hang out at my breast), I naturally concluded that my baby was starving, that I did not have enough milk for her. If I did have enough, surely she would fall asleep and stayasleep. Obviously, I thought, she was waking after a few minutes or half an hour because she was hungry. A weighing at the doctor's, where I learned that she was in the seventy-fifth percentile for growth (at three weeks) did not reassure me.
When I talked with the doctor, he said it did seem my baby was colicky, and I took his book home to read. Finally, I found descriptions by other mothers of babies like mine! I was not alone. I came to understand how sleeping problems, like those of my baby, appear to be hunger, but really aren't. I also learned that there's nothing I can do for my baby that I'm not already doing, and so I might as well turn some of my energy around and start taking care of myself. Truly, I believe that in the case of a colicky baby, who in most cases cannot be treated for her condition, it is the mother who needs “treatment” or help, and to this end I suggest:
1. Get out of the house an hour or two a day, minimum
2. When out of the house, try to get some physical exercise to burn off the tension
3. Don't feel guilty about doing anything that makes you feel good
4. Socialize as much as possible outside the home
5. Keep a diary or log of your baby's sleeping/feeding habits
6. When the baby is asleep, get some sleep yourself, unless you're doing something for your own peace of mind
And things are getting better. Last night Allyson woke up from a three-hour nap, nursed calmly, and wasn't fussy for several hours afterward. She didn't go back to sleep, but she didn't cry either. Later that evening she slipped back into her old ways, but I got to hold her and play with her for over an hour; then she stayed calm in the swing for a while.
And I got my bath this morning.
If you are lucky to have an easy baby, at five to six weeks you may have already noticed her sleep patterns becoming somewhat regular. You can try to help your baby become more regular by putting her down or lying down with her to sleep when she first appears tired, but, in any case, after no more than two hours of wakefulness. She may or may not drift into sleep easily. You do not need to let her cry at all, but some babies will fuss or cry in a mild fashion before falling asleep. If she cries for five, ten, or twenty minutes, it will do her no harm, and she may drift off to sleep. If not, console her and try again at other times. Try to become sensitive to her need to sleep. The novelty of external noises, voices, lights, and vibrations will disrupt her sleep more and more, so try to have her in her crib or your bed when she needs to sleep. Go slowly and be flexible.
Remember, sleep training means starting to respect your baby's need to sleep when he is a newborn by anticipating when he will need to sleep (within one to two hours of wakefulness), learning to recognize drowsy signs, and developing a bedtime routine. Then your baby will not become overtired.
Now you might want to try to help your baby sleep better at night. The ease with which you can accomplish this is related to whether your child is currently well rested or overtired. And this depends on whether he had common fussiness/crying or extreme fussiness/colic and whether you were able or unable to successfully soothe him during the first six weeks.
Alternatively, you might have no need or desire to try any of these three sleep training strategies. Your baby might be sleeping well at night, and there is no reason to rock the boat. Or, you are enjoying the family bed and do not wish to change or allow your baby to cry. This is fine for now, but after four months of age, you probably will want to consider some changes in sleep routines to accommodate your baby's need for an earlier bedtime. These changes do not necessarily mean that your baby will cry.
Always consider both your child's ability to self-soothe and your resources for prolonged daytime and nighttime soothing. Do what works best for you and your baby.
FOUR SLEEP-TRAINING STRATEGIES: WHEN TO TRY
· At six to eight weeks of age if you have to return to work and/or you are totally exhausted and unable to function. May work well for common fussiness/ crying babies, especially if they appear to have an easy temperament.
· At eight to sixteen weeks of age to help your baby sleep better at night for babies with common fussiness/ crying. Success may be quick and easy.
· After sixteen weeks of age to help your baby sleep better at night for babies who had extreme fussiness/ crying. Success may be slow and difficult.
1. “Let Cry,” Ignoring, Extinction
Not responding to your child at night is most difficult for parents. It is also not always clear if your baby is or is not hungry. Between six to eight weeks and four months, babies might be hungry and need to be bottle-fed two or three times a night, but after four months, only once or twice, and after nine months, not at all. The idea is to respond if you think your child is hungry but not at other times. This determination may be harder for a mother who is breast-feeding because of uncertainty regarding her breast milk supply. Fathers should give a bottle of expressed breast milk or formula to help clarify whether the baby is hungry or not.
In addition, there is almost always a temporary increase in crying at night when parents do this. While appearing harsh, it is my impression that the total amount of crying with “Extinction” is less than with “Graduated Extinction” because success occurs faster. Research comparing these two methods showed that parents using “Extinction” reported less stress in parenting. This supports my observation that parents are more willing to employ “Extinction” again following changes of sleep routines such as holiday trips, special events such as birthdays, or illnesses. In contrast, because “Graduated Extinction” often takes longer, parents are less willing to repeat the procedure when changes of sleep routines cause the child to become overtired. Another observation is that for older babies or children where there is less uncertainty regarding hunger at night, “Extinction” is simpler to execute and parents can therefore be more consistent. In contrast, “Graduated Extinction” requires a detailed plan of action to be modified gradually but consistently over several days or longer.
Here is one mother's account.
ARES
We brought Ares home from the hospital with only a ballpark notion of what it would it be like to care for a baby. As far as I knew, Ares would sleep when he needed to sleep. As the months progressed, I went to him whenever he cried and changed him and nursed him on demand. At night he woke often and slept in bed with me most of the time. Whenever Ares cried I would sort of panic. I seriously would have done anything to soothe him. All my adrenaline turned on and my heart raced. People would ask me if I had him on a sleeping or nursing schedule, and I didn't know what to say. He nursed on what seemed like a constant basis, and he hardly slept. I snuck two-minute showers listening to him cry, feeling guilty the whole time. When I asked people about babies and their sleeping habits, they would say vague things like “Babies sleep when they need to sleep, no less and no more” and “Every baby is different, like a snowflake. Some just need less sleep than others.” I found this less than helpful. I kept waiting for Ares to “sleep through the night,” but it never happened. At night he was up seven or eight times. During the day he didn't sleep much, just little short naps. Sometimes, when I nursed him to sleep and put him down for a nap, he would wake up and cry right when I put him down. I started holding him while he slept.
I read that you should always take your baby everywhere and “wear” your baby like the Native Americans did. I carried him around in a Bjorn baby carrier on walks and to do errands. By the time he was ten months old, his nighttime routine was established. I would nurse him to sleep at 8:00 P.M., put him in his crib, and he would wake up at 10:00 P.M. and cry. I would change him and nurse him back to sleep, and carefully, oh so carefully, put him back in his crib, and repeat this process all night every two or so hours. Sometimes he would wake up when I put him back in bed and I would have to start all over again. As the night progressed, and he became more and more exhausted, he was more likely to wake up when I put him down, and it took longer to soothe him back to sleep. By 6:00 A.M. he was up for the day, napping occasionally and only briefly. Sometimes I couldn't even put him down long enough to eat dinner. I held him while I ate. One night I went to him when he cried and nursing did not soothe him. He could not stop crying no matter what I did. I realized at that moment that he didn't need me so much as he needed to sleep. We were all exhausted.
We had heard about “crying it out” before, and I thought it sounded cruel. But my husband wanted to do it, and it was clear that we had to change our methods, because although I was perfectly willing to deprive myself of sleep on his behalf, Ares was clearly suffering from sleep deprivation. Ares had all the symptoms of an overtired child. He was easily startled, and cried uncontrollably at sudden or loud noises. He was unable to go to sleep on his own, and unable to stay asleep once he did. The book explained that in going to Ares every time he cried at night, I was stimulating him and keeping him awake, not soothing him and reassuring him as I had thought. All that stuff I had read about “nighttime parenting” and “attachment parenting” was not only not helping, it was hurting Ares. We decided to try Dr. Weissbluth's “Extinction” method.
The first night I put Ares to bed at 8:00 P.M. as usual, but when ten o'clock came and he cried, I didn't go to him. It was one of the hardest things I have ever done, but I wanted to give it a try for his sake. He cried for forty-five minutes. I thought I would die. My nervous system went haywire. I cried, my whole body got hot, I was shaking and sweating and my heart pounded. He's going to think I abandoned him, I thought. He will never trust me again. But once he stopped crying he slept all night long. Ares had never slept for more than four hours in a row. I thought for sure he had died. But he woke up the next morning happy and rested and then fell back to sleep a couple of hours later on his play rug, another first. Ares had never in his life fallen asleep without nursing. From then on we were convinced that Dr. Weissbluth knew what he was talking about. We worked to make sure Ares got the sleep he needed. At night we developed a sleep ritual of bathtime, reading to him and nursing him at 6:00 P.M., and putting him down sleepy but awake. He took two naps a day, following a slightly abbreviated sleep ritual, and slept for two hours in the morning and one hour in the early afternoon. For some reason he didn't cry at nap time, he just went quietly to sleep. At night, however, for several weeks he still cried for forty-five minutes when I put him down. This was extremely difficult, even painful. But once he fell asleep he stayed asleep for twelve hours, which was incredible to me, and he was so much happier during the day that we stuck with it. In the daytime, he was so much calmer; he even seemed sleepier for the first few weeks. He almost never cried anymore, and his attention span was longer. Eventually, Ares went to sleep without crying, and he still sleeps every night all night long, for at least twelve hours a night.
2. Controlled Crying, Partial Ignoring,
Graduated Extinction
This is a variation of “Extinction.” One method is to leave your baby for about five minutes, then return and soothe him back to the sleepy state or put him down after soothing. If loud crying recurs, leave your baby for ten minutes and then repeat the soothing process. If loud crying again starts, leave your baby for fifteen minutes before repeating the soothing process. This sequence repeats with an additional five minutes of ignoring his crying until he falls asleep during one of the crying spells or does not cry after your soothing effort.
Another method is to also increase the time of ignoring before checking on your baby, but increase the time by about five minutes every two days. Research has shown this method to work well over a period of four to nine nights. Again, your success depends on your child's tendency to fuss or cry, how well rested or overtired he is, and how consistent you are.
This method appears less harsh than “Extinction” and works well for many children. It is my impression that for extremely fussy/colicky babies, by four months of age, parents are worn down from sleep deprivation and the child is way overtired. In this situation trying “Graduated Extinction” often fails because the child's crying outlasts the parents resolve to be consistent and “Extinction” produces results sooner.
3. Check and Console
Responding to your child at night is least difficult for parents. You quietly enter whenever your baby cries to see that she is all right and gently soothe her in darkness but you try to not pick her up. Instead, you rub her tummy, stroke her hair, or gently rock the crib. You do the least amount of rocking, singing, and if necessary, nursing to soothe her back to a calm, sleepy state. This method appeals to those who practice attachment parenting because they believe that it provides emotional security, that their cries will not go unanswered so they can learn to trust their mothers, and they will not feel abandoned. However, there is no evidence that babies are harmed when they are allowed to cry. Furthermore, this method could teach some babies to cry more frequently and longer in order to receive more soothing. In addition, it is very hard to only partially soothe a crying baby at night. On the other hand, if your baby is well rested and did not have extreme fussiness/colic, this method might work well.
REMEMBER
Different children require different approaches.
4. Scheduled Awakenings
See page 298 in Chapter 6 for a discussion of this method.
Here is an account from one mother who needed to get her child's sleep on a firmer schedule before she went back to work. Trying her methods with a more irregular, extremely fussy/colicky child probably wouldn't have worked at this early age. But an easy, regular, common fussy baby often responds quickly to sleep-training strategies at around six weeks.
In this story, the mother incorrectly equated sleep training with letting her baby cry.
“MY MATERNITY LEAVE WOULD SOON BE OVER”
When Ron and I interviewed and selected our pediatrician before David was born, we left his office comfortable with the care we felt our child would receive. Although we knew the doctor had a special interest in sleep disorders, we never dreamed we would be faced with a baby whose internal clock thought day was night and night was day.
Oh, it didn't happen right away. In fact, the first few weeks were spent nursing and changing diapers in between David's naps. Looking back at those first weeks, Dr. Weissbluth must have really chuckled at some of the questions I asked him.
At the same time, I was beginning to relax and feel, yes, everything is going along normally, David became more alert; Ron and I knew it was a great step in his development. We looked forward to his periods of wakefulness as a time to interact with him. But a pattern began to develop: David didn't want to go to bed at night.
The doctor listened to what we were going through and assured us that, first of all, this was normal for some babies. David was really too young to go through sleep training at six weeks. So Ron and I resigned ourselves to some more of the same.
When David was two months old I began to panic. My maternity leave would soon be over. I could barely stand up most of the time, I was so tired. I also wanted to continue to nurse David whenever I was home. I knew we had to do something before I went back to work. So we called Dr. Weissbluth and made an appointment to see him.
First, the doctor checked David's physical condition. He was in perfect health. Then we talked. Dr. Weissbluth explained that we would have to make some changes in the way we handled David's sleep periods. David was to have a quiet, darkened room when sleeping. No more night-light, music, et cetera. Naps should last at least forty-five minutes to an hour. If David got up sooner, we were to leave him there until he got the rest he needed. Instead of letting David stay up late, we were to put him to bed between 7:00 and 9:00 P.M. NO rides in cars, strollers, or swings, where sleep occurred for a short time.
We decided to start that next Monday, since Sunday was Mother's Day. I nursed David at 9:00 P.M., and by 9:30 he was asleep in my arms. I tiptoed him into bed and crept back to the living room and turned on the intercom. It was quiet until 9:45, when I heard David sucking his fingers. I thought, Okay, he'll get back to sleep soon, but by 10:00 the crying began. David cried until 12:30—two and a half hours. For every cry I heard I shared his frustration, anger, and seeming pain. And I was angry—at David, the doctor, Ron, and myself. Finally, David fell asleep, and he slept until 6:45 the next morning, when I woke him to nurse.
The morning wake-up was planned and agreed to with Dr. Weissbluth. The idea was to get David to wake before I left for work so that I could nurse him. David seemed fine. I was exhausted.
Tuesday I let David wake himself up. That day he took naps ranging between two and three and a half hours, but his schedule was rather loose. At 8:30 that night, when he woke up, I fed, bathed, and played with him until he had one last nursing and I put him to bed, although he was not asleep, at 10:50. This time he cried from 10:50 until 11:15. Only twenty-five minutes? Could it be this easy? I was very encouraged. Weeks of David's inability to get to sleep at night seemed to be at an end. Even Dr. Weissbluth seemed surprised at David's progress. Once again he slept through the night.
Although we were still unsuccessful at getting David to bed early, the periods of crying himself to sleep were getting shorter. On day three he cried for twenty-one minutes and then didn't let out another peep until the next morning.
Just when Ron and I began to let out our breaths, David put us back in our places. On day four David cried for nearly an hour and a half. My spirits dropped. Was this just a temporary setback or had the last three days been a fluke? When I called the doctor the next morning, he told me to continue the training. David would have some off days, he explained.
We found that if we responded to him quickly, assuming he wanted to nurse, he became irritable and difficult to feed. Those were the nights the crying seemed to go on forever.
We continued to check in with Dr. Weissbluth, but less frequently. At the end of our third week of sleep training, David, Ron, and I really had our acts together. Ron and I could tell when David was ready to call it a day, and we didn't push him to stay up any later than he wanted.
When Ron and I started sleep training, we kept a log of David's wakings and sleeps. We still do—not because he's still in training, but with my return to work and Ron's busy schedule, we are better able to understand David's moods and hunger patterns when the sitter lets us know what's gone on during the day.
Weeks Seven to Eight: Earlier Bedtimes and Longer Night Sleep Periods Develop
The major biological changes starting now are a tendency to go to sleep earlier at night and for longer periods of uninterrupted night sleep. Do not try to force an earlier bedtime on your child; rather, watch for drowsy signs developing earlier in the evening.
As we have seen, every baby behaves differently during these first few weeks. Your own baby most likely will fall somewhere in between the common fussy or “easy” baby and the extremely fussy/colicky infant. And even if your baby has been “easy,” this may well be a period in which she “forgets” what she has learned.
Common Fussy or “Easy” Baby
“Easy” babies are placid and easy to manage, quiet angels most nights. Sure, they may have a fussy period in the evening, but it's not too long, intense, or hard to deal with. They appear to sleep well anywhere and anytime during the day and quite regularly at night. In fact, the early development of regular, long night sleep periods—starting well before the age of six weeks—is a characteristic feature of “easy” babies. These kids are very portable, and parents bask in their sunny dispositions.
But shortly … dark clouds may gather. The baby starts to have some new grumbling or crabbiness that does not occur only in the evening. In fact, the quiet evenings might now be punctured by new, “painful” cries suggesting an illness. Or, it might now take longer to put the baby to sleep. What has happened to your sound sleeper?
HINT
Be careful, but… No set schedules. No rigid rules.
Irregularities of sleep schedules, nap deprivation, and too late a bedtime are the chief culprits. Now is the time to become ever more sensitive to your child's need to sleep.
After about six weeks of age, the best strategy still is to try to synchronize your caretaking activities with your baby's own rhythms. You should try to reestablish healthy sleep habits by removing the disruptive effects of external noises, lights, or vibrations. Although it may be inconvenient for you, try to have your baby back in her crib after no more than two hours of wakefulness. Consider this two-hour interval to be a rough guide to help organize the day into naps and wakeful activities.
Q: How long can I keep my baby up ?
A: No more than two hours.
Two hours of wakefulness is about the maximum that most babies can endure without becoming overtired. Sometimes a baby may need to go to sleep after being up for only one hour. Often this brief wakeful period of only one hour occurs early in the morning. Try to soothe him to sleep before he becomes overtired—before he becomes slightly crabby, seems irritable, pulls his hair, or bats at his ears. Expect this type of behavior to develop within two hours of waking up if he is not put to sleep when he first shows signs of being tired. Look for drowsy signs (see page 63). Please do not mistake this two-hour guide to mean that he should be up for two hours and then down for two hours. Rather, two hours is the time interval during which you should expect to put him to sleep.
When you have been out for a walk or running an errand with your baby, watch the clock and try to have her asleep within two hours after she wakes up. If upon returning home during this time interval you notice that she is becoming overtired, say to yourself, “I blew it this time; next time I'll return home sooner.” By paying attention to clock time, you will discover how much wakefulness your baby can comfortably tolerate.
Expect your overtired child to protest when she is put down to sleep. This is natural, because she prefers the pleasure of your soothing comfort to being in a dark, quiet, boring room.
Keep in mind the distinction between a protest cry and a sad cry. You are leaving your baby alone to let her learn to soothe herself to sleep; you are not abandoning her.
Q: How long should I let him cry?
A: Not at all if you want to lie down with him in your bed and soothe him to sleep, or start with five, ten, or twenty minutes. Try to decide whether your child is tired, basing your judgment on (1) his behavior; (2) the time of day, and (3) the interval of wakefulness—how long he has been up.
When you have decided he is tired or overtired, put him down to sleep—even if he doesn't want to sleep. Sometimes he'll fall asleep and sometimes he won't. When he doesn't, pick him up and soothe and comfort him. You may try again after several minutes to allow him to go to sleep on his own, or you may decide not to try again for several days. But remember, if your baby cries hard for three minutes, quietly for three minutes, and then sleeps for an hour, he would have lost that good hour-long nap if you had not left him alone for six minutes.
Remember that this baby was once a good sleeper, and is now fighting sleep for the pleasure of your company. At those times when he needs to sleep but wants to play, your playing with him is robbing him of sleep.
Keep a log or diary as you go through these trials to see if any trend or improvement occurs. Here's an account from Allyson's mother, who helped her baby make a dramatic—and permanent—improvement in her sleep habits at this time.
ALLYSON'S SLEEP DIARY
Day 56: Allyson woke up from an afternoon nap, and I thought she was ill—she was so calm! No jerky movements or agitated behavior, which I guess I'd assumed was just “normal” for her. About this time, though, she still cried a lot when not nursing, and she still had trouble falling asleep.
Day 59: Let her fuss one hour—and she went to sleep for three and a quarter hours (5:45 to 9:00 P.M.).
Day 60: Allyson fussed all morning and wouldn't sleep, but I kept her in her crib from 10:15 A.M. to noon, staying with her most of the time. Got her up to nurse at noon. That night she woke up at 2:30 A.M.—for the first time in several weeks. I nursed her until 3:00 and then put her down. She fussed off and on until 4:00, when she went to sleep.
Day 63: Breakthrough! She went to sleep for forty-five minutes in the morning and took a really long nap in the afternoon (12:45 to 5:00). But she woke in the middle of the night again (3:20 A.M.). She went back to sleep at 4:30 and slept until 8:30. She was happy in her crib—no screaming as I changed her diaper, which was new behavior!
Careful records show that up to Day 59, the total sleep duration per twenty-four hours was about six to twelve hours. After Day 63, the total sleep duration was longer—twelve to seventeen hours. The four-day training really helped the child sleep longer.
Day 64: Two wonderful things happened. First, Allyson took a morning nap (10:45 A.M. to 1:30 P.M.), and when I put her down for the night, with her eyes wide open, she did not fuss at all. I quickly left the room and heard nocrying. She slept from 8:35 P.M. to 5:05 A.M.
Days 87-96: Allyson is just about perfect. If she starts to fuss, I know she is hungry, wet, or tired. If she's tired, I simply put her in her crib and within two minutes she is asleep. It's a miracle!
Sleep Log
The sleep log is a tool to help you see how your baby is sleeping—or not sleeping. A diary like Allyson's, which lists the events of the day, is difficult to scan visually; you want to see the forest, not the trees. Here's how to make a sleep log. Each twenty-four-hour day is shown as a separate bar on a graph with the horizontal axis as the day of the week and the vertical axis the time of day. So what you see is a series of bar graphs. Each bar is color-coded for sleep times and wake times. Other times such as crying times, feedings, periods in crib awake, periods in crib asleep, or periods asleep in parent's arms may be included. What happens is that you begin to pay closer attention to the timing of these events. You have some baseline data with which to compare an intervention such as an earlier bedtime. Spotting trends such as less crying or longer naps is often easy. When some success is observed, you are motivated to persist despite some crying or inconvenience for you.
For twins and triplets, instead of a single bar for each day on separate graphs for each child, put two or three bars, one for each child, next to each other for a given day on the same graph so you can see for any period of days whether one sibling's schedule can be slightly modified to help synchronize the entire group.
Extremely Fussy/Colicky Infants
In contrast to babies who are common fussy or “easy,” there are extremely fussy or colicky infants. Colicky babies are difficult to manage for three to five months because they are intense, wakeful, stimulus sensitive, irregular when they do sleep, and sleep for brief periods. They have long periods of fussing and crying. And, unlike Allyson, often a portion of their crying is inconsolable. Because of their irregularity and alert/aroused state, it doesn't make sense to try to schedule their sleep at this time. They are hard to read. Most parents have difficulty telling whether they are hungry, fussy, or plain overtired. So leaving them alone is confusing to everyone. The following hints and the information in Chapter 4 will help you get through the rugged first few months.
Helpful Hints for Parents of Colicky Kids
Pamper yourself; remember, this is smart for the baby, not selfish for you. If you feel better, you will be better able to nurture your baby.
Forget errands, chores, housework
Unplug the phone
Ignore your baby's sleeping sounds
Nap when baby sleeps
Hire help for housework or breaks when baby is most
bothersome
Plan pleasurable, brief outings without baby (swimming,
shopping, movies)
Hints to Help Soothe Colicky and Noncolicky Babies
DEFINITELY HELP SOOTHE
Rhythmic rocking
Sucking (A pacifier on a very short ribbon attached to a
pillow cover or pajama top; ribbon must be short so
that it cannot go around the child's neck)
Swaddling
QUESTIONABLY HELP SOOTHE
Lambskin rug
Warm-water bottle placed on abdomen
Heartbeat sounds in teddy bear
Low-volume recording of vacuum cleaner or running
water Removal of stimulating toys from crib or bright night
light
Placing a soft blanket in baby's hand
Putting the child's head against a soft crib bumper or laying
a clean cloth diaper over the head like a scarf
PRACTICAL POINT
Don't save your smiles until colic ends.
Crying should not be thought of as a test for you. Don't feel that you are creating a crying habit because of your prolonged, complex efforts. Your first test to help your baby sleep will come later, at three to four months of age, when the colic subsides.
You can't treat colic with smiles, but there will be less crying in a home where there is a lot of social smiling. Practice smiling; smile broadly; open your eyes wide, regard your child as you nod, and say “Good boy” or “Good girl.” Do all these especially when your baby calms down or smiles at you.
Months Three to Four: Extreme Fussiness/
Colic Ends. Morning Nap Develops at
9:00 to 10:00 A.M.
Let's consider the ways in which your child has changed. More smiles, coos, giggles, laughs, and squeals light up your life. Your child is now a more social creature. She is sleeping better at night, but naps may still be brief and irregular.
Become sensitive to her need to sleep and try to distinguish this need from her desire to play with you. She would naturally prefer the pleasure of your company to being left alone in a dark, quiet bedroom. Therefore, she will fight off sleep to keep you around.
In addition to your presence, which provides pleasurable stimulation, your baby's curiosity about all the new and exciting parts of her expanding world will disrupt her sleep. How interesting it must be for an infant to observe the clouds in the sky, listen to the trees moving in the wind, hear the noise of barking dogs, or focus on the rhythms of adult chatter.
Become sensitive to the difference in quality between brief, interrupted sleep and prolonged, consolidated naps. Your child is becoming less portable. As her biological rhythms evolve for day sleep, your general goal is to synchronize your caretaking activities with her biological needs. This is no different from being sensitive to her need to be fed or changed.
When your baby needs to sleep, try to have her in an environment where she will sleep well. As she continues to grow, you will probably notice that she sleeps poorly outside of her crib.
I have examined many children who cry with such intensity and persistence that their mothers are sure they're sick. During their crying, they may swallow air and become very gassy. If this happens, it is tempting to assume that their formula doesn't agree with them or that they have an intestinal disease—but only at night? These children are healthy but overtired. Not only do they cry hard and long when awake, they also cry loud and often during sleep/wake transitions.
PRACTICAL POINT
The crying baby may be hungry or just fussy. Or the crying baby may be overtired.
Most of these children are overtired from not napping well or from going to sleep too late. They are not napping well because they're getting too much outside stimulation, too much handling, or too much irregular handling.
A sleep problem that is easy to deal with is the baby of about three months of age who had been sleeping well but now wakes up crying at night and during the day. The parents also may note heightened activity with wild screaming spells. These are regular, adaptable, mild infants who matured early but, at three months, began to decide they would rather play with their parents than be placed in a dark, quiet, and boring room. Parents who have not had enough experience believe this new night waking represents hunger due to a “growth spurt” or insufficient breast milk.
When these parents begin to focus on establishing a regular daytime nap schedule, when they put these babies in their cribs when they need to sleep, and when they avoid overstimulation, the frequent night waking stops. If the children had developed irritability or fussiness, this disappears, too.
REMEMBER
The more rested a child is, the more she accepts sleep and expects to sleep.
What is a good sleep strategy for your child at this age? As with the easy six to eight-week-old, plan to put your three-or four-month-old child somewhere semiquiet or quiet to nap after she's been awake for no more than about two hours.
Q: When I put my child to sleep after no more than two hours of wakefulness, how long should he sleep?
A: At this point, the naps may be either short or long without any particular pattern. This variability occurs because the part of the brain that establishes regular naps has not yet fully developed. Watch for signs of tiredness to help you decide whether a particular nap was long enough.
The two-hour limit on wakefulness is an approximation. Often there is a magic moment of tiredness when the baby will go to sleep easily. She is tired then, but not overtired. After you go past two hours, expect fatigue to set in. When the baby is up too long, she will tend to become overstimulated, overaroused, irritable, or peevish. Please don't blame changes in weather—it's never too hot or too cold to sleep well.
Many parents misunderstand what overstimulation means. A child becomes overstimulated when the duration of wakeful intervals is too long. Overstimulation does not mean that you are too intense in your playfulness.
PRACTICAL POINT
Do not think of overstimulation as excessive intensity with which you play with your child, but rather too long a duration of baby's normal period of wakefulness. It's not too much of a good thing, it's just being up too long.
Become Your Child's Timekeeper:
The Morning Nap Develops at 9:00 to 10:00 A.M.
Watch the clock during the day and expect the baby to need to sleep within two hours of wakefulness. Use whatever soothing method or wind-down routine works best to comfort and calm your baby. This may include a scheduled feeding, non-nutritive (“recreational”) nursing, a session in a swing or a rocking chair, or a pacifier.
After a while you may notice a partial routine or a rough pattern of when your child's day sleep is best. Based on your child's behavior, the time of day, and how long she has been awake, you may reasonably conclude that she needs to sleep at any given time. However, she may want to play with you instead. Please try to distinguish between your child's needs and her wants. Have the confidence to be sensitive to her need to sleep and lie down with her or leave her alone a little to let her sleep. How long should you leave her alone? Maybe five, ten, or twenty minutes; there's no need for a rigid schedule. Simply test her once in a while to see whether she goes to sleep after five to twenty minutes of protest crying. If this approach fails, pick her up, soothe her, comfort her, and then either try once more to get her to go to sleep, or play with her for a while and try again later.
This lack of rigid scheduling is appropriate for children a few months old who are biologically immature. However, as the child gets older, extreme inconsistency will produce unhealthy sleep habits. Be flexible, but also become sensitive to your child's need to sleep.
When put down to sleep drowsy but awake, you are giving her the opportunity to develop self-soothing skills, to learn how to fall asleep unassisted. Some children learn this faster than others, so don't worry if your child seems always to cry up to your designated time. Perhaps she was too young; try the technique again another time.
Always going to your child when he needs to sleep robs him of sleep. Never letting your child cry might reflect confusion in your mind between the healthy notion of allowing him to be alone sometimes and your own fear that he will feel abandoned.
Here's an account from the mother of a three-month-old infant.
IT GOES AGAINST HUMAN NATURE
To leave a baby crying and not pick him up goes against human nature. However, after three days of teaching Katie to sleep and having to listen to her crying and being helpless, her hysteria was almost completely solved!
It started at just twelve weeks. Katie was so fatigued she would cry for hours, screaming completely out of control, scratching her head, pulling her ears. Holding her didn't help, so it wasn't hard not to pick her up—she screamed anyway.
Instituting a new day schedule was easy. As soon as she started getting cranky, I rushed her to her crib to sleep. She would watch her mobile, and then sleep for hours at a time. The first week, she was so tired that she only stayed up thirty to fifty minutes at a time and slept three to four hours in between. The key for me was to get her down before she got really upset.
The afternoon was when she was awake the longest, and then it was hard getting her to sleep at night. The first few nights under our new regime were the worst. Positive reinforcement from my doctor was important then. I had to hear several times that this “cure” was the best thing to do.
The first night under our new strategy, my husband lay on the floor in her room (I guess to make sure she didn't choke) while I sat crying in our living room. Finally after forty-five minutes Katie was quien Hurray! Each night she cried less and less, and I handled it better and better. After a week, her hysteria was gone! Sure, she cried a little sometimes, but now she was on a schedule. She napped two or three times a day, two to four hours at a time, and slept twelve to fifteen hours a night. Sleeping promotes more sleep, and makes it easier to fall asleep. It's a catch-22.
Writing down the sleep patterns helped, too. For one week I kept track of every time I put her down and every time I picked her up from her nap. At the end of the week I noticed a distinct pattern. She fell into it herself!
MAJOR POINTS
Letting your baby “cry it out” is not the only way your baby will learn to sleep.
Babies and children learn to sleep when parents focus on timing, motionless sleep, and consistency in soothing style.
As Katie's mother noticed, sleep begets sleep. This is a true statement. Even though it is not logical, it is biological!
Q: My three-month-old used to take very long morning naps, but now at four months, they are shorter. What happened”?
A: Between three and four months, your child went to sleep later at night, he now goes to sleep earlier, wakes up better rested in the morning, and no longer needs a very long morning nap.
Preventing and Solving Sleep Problems
Sleep periods develop as the brain matures. This means that there are times during the day and night when your baby's brain will become drowsy and less alert. These time “windows,” when the sleep process begins to overcome your baby, are the best times for him to be soothed to sleep, because it is easier to fall asleep at these times and because the restorative power of sleep is greatest when your baby's brain is in a drowsy state. Your child is able to sleep at other times, but going to sleep is more difficult and its restorative power is then much less. Unfortunately, your baby's brain may not be drowsy when you want him to sleep. You cannot control when he will become drowsy any more than you can control when he will become thirsty. As your infant's brain matures, these biologically determined periods of drowsiness will become more predictable and longer.
After your baby is born, there is a quiet and calm honeymoon during which he is very sleepy. This ends when he is a few days old, or a few days after his due date if he was born early. You may not have a honeymoon if your baby was born late! After a few days of life, the sleepy brain wakes up, and during the first six weeks of life infants display increasing amounts of fussiness, crying, or agitated wakefulness, during which they swallow air and become gassy. The duration of these periods peak and become more common in the evening hours at six weeks or six weeks after the due date. During these first six weeks, the longest single sleep period is not very long and can occur at any time; this is day/night confusion. At about six weeks of age, something dramatic occurs naturally. Your baby begins to produce social smiles, and the evening fussiness begins to decrease. One mother asked me if she could “fast-forward to six weeks” and skip the hard part. Sorry.
REMEMBER
Long night sleep periods will develop first, so you will notice longer sleeping periods at night before you will notice longer naps.
The onset of social smiles followed by a decrease in fussiness reflects maturational changes within your baby's brain. In addition, the brain becomes more able to inhibit the stimulating effects of the sights, smells, sounds, and other sensations around her. Your baby is more able to console herself—she is becoming more self-soothing. As a result of these biological changes, at six weeks of age your baby develops night sleep organization. This means that her longest single sleep period now occurs at night. This is the end of day/night confusion. This longest night-sleep period may be only four to six hours long, but it regularly occurs at night. You cannot control the exact time when this long sleep period will occur, but at least you now know that you will get a little more rest at night.
Night sleep usually develops without problems at six weeks of age because:
1. Darkness serves as a time cue
2. We slow down our activities and become quieter at night
3. We behave as if we expect the baby to sleep
These three factors may be absent during the day, and so the major way to prevent sleep problems from developing is to focus your efforts on helping your baby nap during the day.
There are three factors that will help your baby sleep well during the day: timing, motionless sleep, and consistency in soothing style. If you have experience because you have more than one child, start early; if you have a colicky baby, start later.
Timing
Keep the intervals of wakefulness short. Look at the clock when your baby wakes up in the morning or after a nap. After about one hour, begin a soothing process before your child appears grumpy, crabby, or drowsy. Usually the total duration of wakefulness plus the time of soothing should be less than two hours. This does not mean that you keep your baby awake for about two hours before trying to soothe him to sleep. The point is that young infants cannot comfortably tolerate long periods of wakefulness. In fact, some babies go to sleep after being awake for only one hour.
MAJOR POINT
Perfect timing produces no crying.
Think of surfboarding. You want to catch the wave of drowsiness as it is rising to enable your baby to have a long smooth ride to deep slumber. If your timing is off and your wave crashes into an overtired state, then the ride is bumpy and brief. If your timing is off, you have accidentally allowed your child to become overtired, then there will be some crying, which you may ignore. Crying is the consequence of becoming overtired. Think of how your baby behaves when she becomes overly hungry. She twists, turns, and may dive-bomb at the breast for a few minutes before she settles down to suck well. Similarly, the overtired baby takes a few minutes to settle down to sleep. Crying is the consequence of becoming overtired. At this particular time your efforts to soothe—hugging, rocking, talking—may be stimulating and interfere with the natural surfacing of the sleep process. After all, your baby does not fall asleep immediately in the same way a light switch is turned off. Rather, the sleep process takes time. Remember, it is easier for her to fall asleep before she becomes grumpy, because when she becomes overtired—from nap deprivation or any other reason—her body produces stimulating hormones to fight the fatigue. This chemical stimulation interferes with sleeping well. This is why sleeping well during the day will improve night sleeping and why, conversely, nap deprivation causes night waking.
One mother told me that her child had been extremely fussy/colicky, but that at twelve weeks of age, he began to slip into a better sleeping routine at night and began taking longer naps during the day between twelve and sixteen weeks of age. She was breast-feeding and used the family bed; her child went to sleep at about 10:00 P.M. around twelve weeks of age. Her two-year-old son was not sleeping well at night either and he distracted her, and this allowed the baby to become overtired, and now the naps were a mess. The baby was “napping” between 5:00 and 6:00 P.M. By sixteen weeks of age, the baby was asleep for the night between 7:00 and 8:00 P.M. She recognized that the baby should be falling asleep for the night around 6:00 P.M., not napping then. Here was the solution that eventually corrected the overtired state.
Temporarily, her baby was put to sleep at a very early time, between 5:30 and 6:00 P.M. The plan was to help the child get more rested at night. The mother was to soothe her baby at night and then either lie down with him or put him in his crib. She wanted to use the crib because the hour was so early and she had a two-year-old to deal with. Because of his age, because he had been extremely fussy/colicky, and because he had become accustomed to sleeping with his mother in her bed at the breast, we knew he would protest our plan. We decided that we would ignore his protest crying at the onset of sleep and we would use the father to soothe him at night when he might cry but was not hungry. During the day, the mother would do whatever worked to maximize sleep and minimize crying to keep him as well rested as possible. The two-year-old made this part of the plan a little difficult. Within eight days, there was substantially less crying at night, and longer and fewer naps were occurring during the day. Now that he was better rested, he was able to stay up a little later at night. However, he still needed to go to sleep between 6:00 and 6:30 P.M.
EARLY BEDTIMES
A common complaint is “We don't get to eat dinner as a family.” Or, “How can we play outside as a family after dinner?” My answer is that what is most important is a well-rested family.
Motionless Sleep
How well do you nap in a car or on a plane compared to in your bed? I think babies have better-quality, more-restorative sleep when they are sleeping in a stationary crib, bed, or bassinet. Vibrations or motion during sleep appear to force the brain to a lighter sleep state and reduce the restorative power of the nap. I explained to the mother of one child that her baby would not sleep well while she was shopping, walking in the park, or doing something active with her friends. The mother discovered that this was true, that her baby napped best at home, but she also found it very difficult to spend more time at home during the day, as she and most of her friends were outdoorsy people. On the positive side, her child no longer cried before going down for a nap.
You may wish to use a moving swing or a calm ride in the stroller or car for a few minutes as part of the soothing process, but after your baby falls asleep, drive home, turn off the swing, or stop walking with the stroller. Although your baby may appear to be in an awkward position, don't disturb him if you notice that he always wakes as you try to move him to a crib. It doesn't hurt children to sleep in their swings or car seats. Your baby might also sleep well outdoors in a stationary stroller, especially if it's a quiet neighborhood. In general, however, as the brain matures, the child's increasing curiosity and social awareness make it more difficult to have good naps outside, so be careful.
Consistency in Soothing/Sleeping-Style Naps
Parents often assume that there is a right and wrong way to soothe a baby to sleep. This is not the case. Falling asleep is simply learned behavior, a habit. Your child will learn best if you are consistent in how you soothe him to sleep for naps. Below are two popular ways to soothe a baby to sleep. Either will work as long as you are consistent.
IMPORTANT POINT
One method is not better than another; both Method A and Method B can help your child sleep well. There is no reason to be judgmental about soothing styles or brand other parents as “bad” simply because they do not agree with you. Different methods will seem more natural or more acceptable to different parents, and different methods work better for different children.
Method A: At nap time your baby sometimes soothes himself to sleep unassisted. After soothing your baby for several minutes, you always put him down to sleep whether or not he is asleep. The soothing is a winding down, a transition from active to quiet, from alert to drowsy. Soothing may include breast-or bottle-feeding. Contrary to popular belief, your child will not develop night-sleeping problems if you include breast-feeding as part of the soothing process. Also, contrary to popular belief, it is not necessary that you always put him down fully awake. The key is that you consistently spend a relatively brief period of time soothing your baby to sleep for naps. Because he is not necessarily always asleep when you put him down, he eventually learns how to soothe himself to sleep without being held. Method A may be viewed positively (creating independence, learning self-soothing skills, acquiring the capacity to be alone) or negatively (creating insecurity, neglecting or abandoning your baby, selfishness in the mother).
Method B: Your baby always begins naps with your help. You always hold and soothe your baby until she is in a deep sleep state, no matter how long it takes. You may then lie down or sit down with your baby, nap with her, or perhaps put her down only after she is in a very deep sleep state. Your child learns to associate the process of falling asleep with the feel of your breast, your breathing and heart rhythm, and your body's scent. Method B may be viewed positively (providing more security, is more natural) or negatively (creating dependence, spoiling). Contrary to popular belief, this association, in and of itself, does not automatically lead to a night-waking problem. A night-waking problem sometimes occurs when the mother indiscriminately responds to normal arousals, misinterprets them to reflect hunger, and inadvertently fragments the child's sleep. Perhaps this situation occurs more often in those mothers who choose Method B for naps.
Be decisive; choose a soothing style and be consistent. Consistency helps your baby sleep better, because the process of falling asleep is a learned behavior. Review the “Resources for Soothing” on page 177. Grandparents and baby-sitters should handle your baby as you do. Sometimes grandparents are a major problem, interfering with the baby's sleep schedule. They want to come over to play with their grandchild when it is convenient for them. This is a difficult problem without a simple answer because, in addition to wanting your child to be well rested, you want to maintain family harmony. If the grandparents are the primary caregivers during the day, it may be difficult. Try to teach them how important sleep is for their grandchild.
Q: When should I start to try to establish regular naps’? When should I start to become consistent in how I soothe my baby before naps?
A: Day-sleep organization develops at twelve to sixteen weeks of age. A regularly occurring midmorning nap appears first, followed several weeks later by a regularly occurring early afternoon nap. The age when you start nap training depends on your experience and your baby's temperament.
Regardless of when you begin to start nap training, the sooner you develop a consistent approach, the easier it will be for the family. Please begin to be consistent around six weeks of age, when your child is clearly becoming more social and everyone is getting more rest at night. For babies born before their due date, these changes occur about six weeks after the due date, and that is when you start.
I encourage fathers to become as involved as possible—for example, on weekends—so that sometimes the mother breastfeeds the baby and then passes the baby to the father to be soothed to sleep. As I said, either soothing method works well, but my observation is that for well-rested babies whose parents have consistently used Method B and sometime later decide to switch to Method A, the transition is made with very little or no crying. However, the children of parents who use Method B inconsistently may never develop regular naps; they then become overtired, and when the parents switch to Method A, the overtired child cries a lot. For some parents, then, it is simply easier to be consistent using Method A.
If you have more than one child, it is very difficult to consistently use Method B, even with full-time help, as an older child's demands may make it impossible to devote so much time to getting the younger child into a deep sleep before putting him down. Therefore, it is more practical to use Method A. Because of your experience, you can begin helping your younger child sleep well as soon as you get home from the hospital. With two children, starting sleep training early for your newborn is especially important. Also, fathers need to help out more. As one basketball fan said, “Now I have to shift from one-on-one to zone defense!”
Here is an account from a mother who started early with her second child using Method B.
GOOD SLEEP HABITS
START WITH TWO. …
As patients of Dr. Weissbluth, we were ready to commit ourselves to promoting good sleep habits in our children. When our son, Hayden, was born, it was easier said than done, being a new mother and not knowing what the different cries meant, we would pick Hayden up at the slightest whimper. We were quick believers when at four months we were a bit more seasoned and we decided not to rush in at the first cry. The cry lasted fifteen minutes and then it was smooth sailing; he gradually went to bed earlier and earlier until we reached a 6:00 P.M. bedtime with a 6:30 A.M. wake-up, and then naps at 9:00 A.M. and 1:00 P.M. This pattern still holds true minus the first nap and bedtime is at 6:30 P.M. at almost three years old. He is social, happy, sweet, and most of all well rested.
With the birth of our second child, a girl, Lily, we were busy with Hayden, now a toddler, and were quite the experts on all the “signs” babies give out. We had a rule: If she was not crying (even at a few days old), she was to be put in her bassinet. We still played with her and enjoyed her, but we were not walking around the house with her twenty-four hours a day. We also provided Lily with the same nighttime routine we give Hayden, dim the lights, give a massage, bath, bottle, book, and bed. This prompted Lily to develop a quicker sleep schedule, and we found by two and a half months she was sleeping through the late-night feedings. By three months she was going to bed at 5:00 to 5:30 P.M. and sleeping until 6:30 A.M. Also at three months we began putting her down for her morning nap two hours after she woke up, and that began her nap schedule. Now Lily, almost one, wakes up at 6:30 A.M., takes her first nap at 8:15 A.M., takes her second nap at 12:30 P.M., and is in the bathtub by 5:00 P.M. and asleep by 5:30 P.M.
We are vigilant about not letting either child nap in the car, strollers, or for that matter miss naps or have delayed naps. Once our children are in their cribs for the night, we don't hear from them until the morning … no night waking or games! We greet them each morning with a smile on their faces.
We are committed to having well-rested children and will defend our decisions with any naysayer suggesting we don't get to be with our children at night or we are too strict with the daytime schedule. We find too often it is the parent who is putting the child on their schedule instead of vice versa.
Babies yearn for routines and respond unbelievably to them. Again, we feel that we have two of the happiest, sweetest children, and knowing that teaching them good sleep habits and, more importantly, the ability to fall asleep unassisted is the best gift you can ever give!
Your goal is to synchronize your caretaking with your baby's needs: feed her when she's hungry, change her when she's wet, play with her when she's awake, and help her sleep when she's tired. Because of the irregularity with which these events occur, it is hard for first-time parents to “read” their baby's needs, but experienced parents should trust their instincts and put the baby to sleep when she is tired.
If you have an extremely fussy/colicky baby, one who is more irritable, wakeful, harder to soothe, and harder to read, you may find that only with Method B will these babies sleep or rest without crying. Later I'll give more specific advice on making a transition from Method B to Method A in the colicky baby.
COMMON NAP MISTAKES
Keeping the intervals of wakefulness too long
Using swings, cars, or strollers during sleeping
Inconsistency in methods used to soothe your baby to sleep
Q: Do I have to become a slave to my baby's nap schedule?
A: Not at all. Simply respect his need to have good-quality naps. Try to distinguish between routine days and exceptional days. On routine days, try to partially organize your activities around the naps. On exceptional days, naps may be lost because of special events.
If you suffer the inconvenience of hanging around your house on routine days when you think your baby will need tonap, then between twelve and sixteen months (or somewhat later in colicky babies) you will notice that your child takes fewer and longer naps, longer periods of wakefulness will develop during the day, there will be no late afternoon fussiness, and your baby will have longer periods of night sleep.
REMEMBER
Sleep quality depends on:
· Timing of sleep periods
· Consolidation of sleep periods
· Duration of sleep periods
Action Plan for Exhausted Parents
All babies become fussy a few days after they are born, or a few days after the expected date of delivery if they are born early. Parents do not cause the fussy behavior. The exact cause is not known. About 20 percent of babies will develop extreme fussiness/colic and, again, parents are not the cause. When babies fuss or cry, they do not sleep. When they do not sleep, mothers do not sleep. Mind-numbing fatigue from lack of sleep is your main enemy!
HOW TO SOOTHE AND HELP YOUR BABY LEARN
TO SLEEP: BIRTH TO FOUR MONTHS OF AGE
Encourage sucking; do not worry if your baby falls asleep while sucking
Rhythmic rocking motions
Swaddling
Massage
Respect your baby's need to sleep: the one-to two-hour window. Think and plan how you will soothe your baby but when you soothe is more important.
· Babies quickly become overtired after only one or two hours of wakefulness. During the day, note the time when your baby wakes up and try to help him nap by soothing within the next one or two hours before he becomes overtired. Try to keep the intervals of wakefulness brief.
· Babies less than six weeks old fall asleep at night very late and do not sleep very long day or night. Try to soothe your baby to sleep during the day before he becomes overtired. Always respond to your baby. Avoid the overtired state.
· Eighty percent of babies more than six weeks old become more settled at night, sleep a little longer at night, and begin to become drowsy for night sleep at an earlier hour. Try to soothe your baby to sleep at an earlier hour if he shows signs of drowsiness earlier. Do not let him cry.
· Twenty percent of babies more than six weeks old do not appear to become more settled at night, do not appear to sleep longer at night, and do not become drowsy at an earlier hour. Nevertheless, try to soothe your baby to sleep at an earlier hour even if he does not show signs of drowsiness earlier. Spend extra time soothing: prolonged swinging, long luxurious baths, and never-ending car rides. Fathers should put forth extra effort to help out. Do not let him cry.
· Use consistent soothing styles for naps.
· After a few weeks, sleep in a quiet and dark place.
· At six weeks of age, watch for an earlier bedtime in common fussy babies. Extremely fussy/colicky babies may show an earlier bedtime when older.
· At four months of age, your baby will have longer periods of wakefulness, but you should still synchronize the beginning of your soothing efforts with the beginning of your baby's drowsiness. For common fussy babies, this may appear to be highly predictable or “by the clock.” Extremely fussy babies may appear to have predictable and regular sleep times when much older.
· After four months of age, “let cry,” controlled crying, or check and console might be needed for a formerly extremely fussy/colicky baby. Rarely, this might be done for a younger baby.
Review
· Drowsy signs, page 63
· Soothing strategies, page 63
· Resources for soothing, page 73
· Bedtime routines, page 75
· “Let cry” versus “no cry,” page 103
1. “Let Cry” with no time limit (Extinction)
2. “Let Cry” with time limit (Graduated Extinction)
Delayed response for soothing
Gradually increase the delay
Increase the delay on the same night versus subsequent nights
Soothe until drowsy versus soothe until deep sleep
3. “Maybe Cry” (Check and console, sleep away from parent)
Prompt response for soothing; never delay
Repeat as often as needed
Soothe until drowsy versus soothe until deep sleep
4. “No Cry” (Sleep with parent, family bed)
Prompt response for soothing
Repeat as often as needed
Soothe until deep sleep
WEEKS TWO TO FOUR
· Prepare for peak fussiness/crying to occur at six weeks of age. Try to get help then. If your baby is showing extreme fussiness/colic, read Chapter 4.
· Keep the intervals of wakefulness brief: one to two hours.
WEEKS FIVE TO SIX
· The worst is almost over for 80 percent of babies.
· Keep the intervals of wakefulness brief: one to two hours.
WEEKS SEVEN TO EIGHT
· Look for drowsy signs earlier and move the bedtime earlier.
MONTHS THREE TO FOUR
· Watch for drowsy signs around 9:00 A.M.
· The morning nap develops around 9:00 to 10:00 A.M.
Motionless sleep is best.
Consistency in soothing style for naps.
1. Always lie down with your child or put him down only after several minutes of soothing.
2. Always soothe your child until he is in a deep sleep, no matter how long the soothing takes, before lying down with him or putting him down to sleep.