Extreme fussiness/colic certainly does not cause the parents to have difficulty separating from their child! But it is more than a sufficient stimulus to cause them to regress toward the least adaptive level of adjustment. The result is severe, enduring sleep disturbance in the child. In this setting, simplistic suggestions to help the child sleep better often fail to motivate a change in how the parents approach the problem. Thus, while it is the wakeful child who may be brought for professional help, it is often the parent who has the unappreciated problem.
Extreme fussiness/colic is the most obvious example of extreme crying, but please remember that any painfully overtired infant or child might cry. In some nonindustrial societies, babies rarely cry, because they are always held close to the mother in a carrier. However, even in cultures where there is constant holding and unrestricted breast-feeding throughout the day and night, babies still cry and fuss. Here, too, the crying and fussing peak at about six weeks of age! Of course, these babies are less likely to have any congenital tendency toward fussiness exacerbated by overtiredness. These mothers do not drive cars, wear watches, or keep many daily appointments to which they must drag their infants. Also, there is less environmental stimulation, so the baby might sleep well outdoors when the mother is planting rice or cooking. Our lifestyles are different, and may cause our children to be overtired more often.
IMPORTANT POINT
Because all babies fuss and cry, some a little and some a lot, it's best to think of colic as something a baby does, not something a baby has. It's a stage of life, not a medical problem.
Summary and Action
Plan for Exhausted Parents
Sleep and Extreme Fussiness/Colic
All babies fuss and cry for no apparent reason during the first several weeks.
Babies who require more than a total of three hours a day of soothing to prevent crying, for more than three days in a week, for more than three weeks have extreme fussiness/colic. Fussing occurs more than crying. Fussiness is a precry state that will often change into crying if parents are unable to soothe their baby; some fussing leads to crying despite parents’ soothing efforts.
Twenty percent of babies have extreme fussiness/colic.
It starts around a few days of age
It occurs in the evening
It ends around three to four months of age
They start to fuss/cry when awake and stop when asleep
Unfortunately, many extremely fussy/colicky infants do not show drowsy signs.
During the first few months, these babies not only fuss and cry more, they also sleep less. Soothing these babies might lead to less crying, but not necessarily more sleeping. Review “Drowsy Signs” on page 63.
Review “Soothing to Sleep” on page 63.
You cannot spoil your baby, so do whatever you can to maximize sleep and minimize fussing and crying.
Unfortunately, for extremely fussy/colicky babies, many simple soothing methods do not work. Constant holding, breast-feeding, and sleeping with your baby may be required for soothing.
Review “Resources for Soothing” on page 73.
Make plans to enlist extra help from family, neighbors, and relatives.
If sleeping with your baby is the only way to soothe him and get some sleep, then sleep with him, even if you did not want to do so, for four months.
It is far better to let your baby cry than it is to shake him, so if you are completely exhausted and in pain from sleep deprivation, take a break to recharge your battery … even if your baby is crying.
Maternal depression, anxiety, exhaustion, and marital stress are likely to develop.
Extremely fussy/colicky infants are more likely to develop a night-waking habit after four months.
Extremely fussy/colicky infants are more likely to develop a difficult temperament after four months.
RISK FACTORS FOR ENDURING SLEEP PROBLEMS
Extreme fussiness/crying plus maternal distress about fussing and crying at five months of age.
Extreme fussiness/crying plus sleep problems at five months of age.
Extreme fussiness/crying alone is not a risk factor for enduring sleep problems.
Temperament at Four Months
How does your child interact with the environment? If he is intense, slowly adaptable, negative in mood, withdrawn, and irregular, then he is difficult to manage. He has a difficult temperament. At four months of age, I think this represents an overtired child. Sleep modulates temperament, so helping your child sleep well will make him easier to manage.
Connecting Sleep, Extreme Fussiness/Colic, and
Temperament: Different Approaches for Different Babies
Plan for your baby's tendency to fuss/cry and your baby's temperament
For a hundred babies:
At birth, 80 percent of babies have common fussiness. Of these, 49 percent (thirty-nine babies) will become easy, 46 percent (thirty-seven babies) will become intermediate, and 5 percent (four babies) will become difficult.
At birth, 20 percent of babies have extreme fussiness/ colic. Of these, only 14 percent (three babies) will become easy, 59 percent (twelve babies) will become intermediate, and 27 percent (five babies) will become difficult.
Match your parenting decisions to your baby's evolving temperament
Family Bed: All the time, part-time, never, with or with out a cosleeper.
For about 80 percent of babies—those who have common fussiness—an early commitment to a family bed usually works well. Sleep problems later are unlikely.
For about 20 percent of babies—those with extreme fussiness—an early commitment to a family bed may be associated with sleep-deprived parents for several weeks, but the strong soothing power of bodily warmth, close physical contact, sounds of breathing, or hearing a parent's heartbeat when sucking at the breast, or the smell of breast milk may make the effort worth it. Sleep problems later might occur if the child is allowed to stay up too late when about four months old.
During the day, some parents with extremely fussy/colicky or common fussy/crying babies are overwhelmed because they may have limited resources for soothing. For babies whose parents initially did not want to have a family bed, but later made that decision because of its soothing power, sleep problems are more likely to occur. The sleep problems are more likely to occur not because of the family bed but because of limited resources for soothing to continue.
Breast-feed: All the time, part-time (expressed breast milk versus formula), never.
For about 80 percent of babies—the common fussy/ crying babies—mothers are better rested and feeding is mostly for nutrition. Breast-feeding is usually easy.
For about 20 percent of babies—those with extreme fussiness/colic—mothers are fatigued from being sleep-deprived. The stress from loss of sleep might inhibit lactation. Breast-feeding may be difficult because breastfeeding is used for nutrition and soothing. Nursing more frequently and for longer durations might cause more discomfort or pain if the skin of the breast becomes cracked or dry. The mother might worry that she doesn't have enough breast milk or that her diet is causing the breast milk to upset the baby because of the extreme fussiness/crying. Consider a single bottle of expressed breast milk given once per twenty-four hours by someone else.
Sleep Training: Start early, drowsy cues, one-to two-hour window, consistent soothing style for naps, quiet and dark place to sleep, earlier bedtimes, synchronize soothing with drowsiness, by the clock. “No-cry,” “maybe-cry,” or “let-cry” sleep solutions depend on your baby's tendency to fuss or cry, your baby's temperament, and your resources for soothing.
Postcolic: Preventing Sleep Problems After
Four Months of Age
49 percent of babies have an intermediate temperament (thirty-seven had common fussiness; twelve had extreme fussiness/colic)
42 percent of babies have an easy temperament (thirty-nine had common fussiness; three had extreme fussiness/ colic)
Parents are not likely to be st
ressed
Infant is likely to be well rested
Infant is likely to be able to self-soothe
At night, consolidated sleep (long sleep duration) develops early
During the day, regular and long naps naturally develop
early, without parental scheduling
If sleep problems exist, “no cry” solutions usually work
9 percent of babies have a difficult temperament (four had common fussiness; five had extreme fussiness/colic)
Those four babies who had common fussiness/crying might have been kept up too late, missed naps, or received too much attention at night. Or perhaps die families had limited resources for soothing and/or were overwhelmed by the demands of parenting. Reflect on how you handled sleeping during the first four months and how you might be able to get more help in caring for your baby.
Parents are likely to be stressed
Infant is likely to be overtired
Infant is likely to be only parent-soothed
At night, fragmented sleep (night waking) persists
During the day, irregular and brief naps persist
If sleep problems exist, “let cry” solutions might be
necessary
Different sleep styles work better for different temperaments.
What will work for one family may not work for you and your baby.
Concentrate on caring for your baby, not looking for a cure for extreme fussiness/colic.
Watch for an earlier sleep time at night developing and soothe your baby to sleep earlier.
For the family bed, lie down in your bed and use a safe nest in your bed, a cosleeper, or a crib only for sleep onset at the earlier bedtime.
If you use a crib, fathers can help put their babies to sleep; at the first night feeding, return her to her crib or bring her to your bed for the remainder of the night.
If you use a crib, try to feed your baby no more than two times at night; otherwise, you might create a night-waking habit.
For the family bed, breast-feed as often as you wish.
The morning nap develops first, around 9:00 to 10:00 AM. Use this nap rhythm as an aid to help your baby fall asleep.
Extremely fussy/colicky infants might have to go down for their first nap after only one hour of wakefulness.
The afternoon nap develops second, around noon to 2:00 P.M.
Extreme fussy/colicky infants might have to still be put down to sleep after one to two hours of wakeful ness following their morning nap.
Switching from “sleepy signs” to sleeping “by the clock” (BTC) may occur in common fussy babies who are temperamentally very regular at three to four months of age.
For extreme fussy/colicy infants, the development of nap rhythms and long naps occurs when they are older.
Try the “Fade procedure” described on page 295 and 346 at four months.
Try to “focus on the morning nap,” described on page 251 at four months.
Plan to switch from “sleepy signs” to “BTC” only when much older.
Different Postcolic Groups
After extreme fussiness/colic winds down—around four months of age or sooner—your child may be overtired and not sleeping well and difficult to manage. But not all difficult to manage four-month-olds have colic. I suspect that there are two groups of children at four months of age, both of whom have difficult temperaments (see page 175).
The first group with a difficult temperament came from the large group (80 percent) of infants with common fussiness/ crying. Only about 4.5 percent of these children, or four infants out of a hundred, fall into this category. I think they are less overtired than the second group. When parents put forth great effort to help them sleep better, there is relatively fast improvement. They are more adaptable and it is easier to change their sleep routines. “No cry” sleep strategies are likely to work well (see page 103).
The second group with a difficult temperament came from a small group (20 percent) of infants with extreme fussiness/ colic. About 27 percent of these children, or five infants out of a hundred, fall into this category. I think they are more overtired than the first group. When parents put forth great effort to help them sleep better, there is relatively slow improvement. They are less adaptable and it is more difficult to change their sleep routines. “No cry” sleep strategies are not likely to work and parents have to consider “let cry” sleep strategies.
How Parents Can Help
Their Children Establish
Healthy Sleep Habits
YOU CAN PREVENT SLEEP DISTURBANCES
FROM INFANCY TO ADOLESCENCE
Months One to Four
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 sl
eep 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.
Healthy Sleep Habits, Happy Child Page 21