Healthy Sleep Habits, Happy Child
Page 26
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
So
othing strategies, page 63
Resources for soothing, page 73
Bedtime routines, page 75
“Let cry” versus “no cry,” page 103
“Let Cry” with no time limit (Extinction)
“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
“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
“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.
Always lie down with your child or put him down only after several minutes of soothing.
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.
Months Five to Twelve
Our goal is to establish sleep habits, so we don't want to get sidetracked by worrying too much about crying. When your two-year-old cries because he doesn't want his diaper changed or your one-year-old cries because he wants juice instead of milk, don't let the crying prevent you from doing what is best for him. Establishing healthy sleep habits does not mean that there will always be a lot of crying, but there may be some in protest. If you find this to be unacceptable when your child is four months old, then please reconsider this chapter when he is nine or ten months old.
Months Five to Eight: Early Afternoon Nap
Develops at 12:00 to 2:00 P.M. Variable Late
Afternoon Nap at 3:00 to 5:00 P.M.
As months three to four blend into months five to eight, behavior does not change sharply. Nonetheless, a distinct shift occurs at about the age of four to five months. Increased sociability permits more playfulness and gamelike interactions between you and your infant. Your child may roll over, sit, imitate your voice with babbling, or respond quickly to your quiet sounds. This increased social interaction certainly makes having a baby more fun.
Infants really do enjoy their parents’ company; they thrive in response to your laughter and smiles. However, your baby is not like an empty vessel you can fill with love, warmth, hugs, kisses, and soothing until it is full, thus leading to satisfaction, blissful contentment, or undemanding repose. The more you entertain her, the more she will want to be amused. So it is natural and reasonable to expect your baby to protest when you stop playing with her. In fact, the more you play with your child, the more she will come to expect that this is the natural order of things. Nothing is wrong with this, except that there are times when you have to dress your baby or leave her to amuse herself for a while, and she will probably resist the partial restraint or curtailment of fun and games. When this happens, please remember that leaving your baby alone protesting for more fun with you while you get dressed is not the same thing as abandonment. Similarly, leaving your baby alone protesting for more fun when she needs to sleep is not neglect. You have become sensitive to your child's need to sleep, and she is now old enough to set her clock at a healthy sleep. Our goal is to synchronize caretaking activities with her need to be fed, to be kept warm, to be played with, and to sleep.
After four months of age, an infant's sleep becomes more adultlike. Infants younger than this enter sleep with a REM sleep period, but around this age they begin to enter sleep with a non-REM sleep period, like adults. Sleep cycling, from deep to light non-REM sleep with interruptions of REM sleep, also matures into adultlike patterns around four months of age.
As discussed previously, the five elements of healthy sleep are (1) sleep duration (night and day), (2) naps, (3) sleep consolidation, (4) sleep schedule, and (5) sleep regularity. Now let's look at Figure 7. This circle graph is a navigational aid for parents to help them understand sleep/wake rhythms. Although I designed this graph, I did not create it any more than a mapmaker creates the shape or location of an island. As your child gets older, the times when he will become sleepy are becoming more predictable. Another way of saying this is that the biological sleep/wake rhythms mature. This allows you to change your strategy for keeping your child well rested. Previously, the focus was on brief intervals of wakefulness to avoid the overtired state; now you can begin to use clock time as an aid to help your child sleep well. Some parents call this sleeping “by the clock,” or BTC. Stated simply, you are using your child's natural sleep rhythms to help him fall asleep. Let's start in the morning and go around the clock.
FIGURE 7: HEALTHY SLEEP SCHEDULE FOR INFANTS FOUR TO EIGHT MONTHS OLD
How to Teach Your Baby to Sleep or to Protect His
Sleep Schedule
You are now about to learn how to help your child learn to sleep well and to protect a naturally developed, healthy sleep pattern.
The Wake-up Time
Some babies tend to wake up early, 5:00 or 6:00 A.M., and return to sleep after a brief feeding or diaper change. This is a true continuation of night sleep and not a nap. Other babies wake up later but start the day then. Most children will awaken to start the day about 7:00 A.M., but there is a wide range (between 6:00 and 8:00). In general, it is not a good idea to go to your child before 6:00 A.M., even if he is crying, because if you do, he will begin to force himself to wake up earlier and earlier in order to enjoy your company. The natural wake-up time seems to be an independent, neurological alarm clock in these young infants that is somewhat independent of the part of the brain that puts them to sleep or keeps them asleep. In fact, despite what is commonly believed, you cannot change the wake-up time by keeping your baby up later, feeding solids before bedtime, or awakening your baby for a feeding before you go to sleep. The last seems insensitive, anyway. How would you feel if someone woke you from a deep sleep and started to feed you when you weren't hungry? The sleep strategy called “Scheduled Awakenings” will be discussed later.
Morning Wakeful Time
Let's focus now on how brief intervals of wakefulness develop into “windows” of clock time. These are periods during which you will watch your baby and the clock to determine the time when it is easiest for your child to take an age-appropriate nap. These windows of “sleep propensity” open and close, and they represent times during which it is easiest to fall asleep and stay asleep. Morning wakeful time will last about two hours for four-to five-month-olds or about three hours for eight-month-olds. Some easy babies or babies born early may be able to stay up for only one hour at four months of age. Then, plan a wind-down or nap time ritual of up to thirty minutes. You decide what you want to do: bath, bottle, breast-feeding, lullaby, massage—but limit it, because hours of holding your baby produce only a light or twilight sleep state, which is poor-quality sleep. Begin this ritual about half an hour before the end of your baby's wakeful period, not after it's over. At the end of your predetermined nap time ritual, whether your baby is asleep or awake, lie down with her or put her in her crib. As one mother commented to me, “I cannot te
ll you what a liberating experience it was to be able to put my baby down in her crib before she fell asleep in my arms.” She may now cry a little, a lot, or not at all. The temperamentally easy child cries very little, and the routine is repeated for an early afternoon nap. The temperamentally more difficult child, who may have also been an extremely fussy/colicky infant, might now cry a lot. The preemie also may cry a lot, and the following approach might be de-laved until four months after the exnected date of delivery.
Nap #1: Midmorning
This nap develops first, usually between twelve and sixteen weeks of age or twelve to sixteen weeks after the due date for premature babies. It occurs about 9:00 A.M. and may last an hour or two. Sometimes you can stretch the child's morning wakeful period by a few minutes each day to get to this time, or you might wake him up at 7:00 A.M. in order for him to be able to take this nap. This violation of the rule “Never wake a sleeping baby” is to help maintain an age-appropriate sleep schedule for the benefit of the baby. The rule mainly applies to waking babies for our social convenience, to their detriment. Try to anticipate your child's best nap time. If he takes this nap too early or too late, then it will be difficult for him to take the second nap on time.