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 no crying. 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 t
o 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.
Healthy Sleep Habits, Happy Child Page 24