We consider a sleep period to be a restorative nap if it is about an hour or longer. Forty to forty-five minutes is sometimes enough, but most babies in this age range sleep at least a solid hour. Certainly sleep periods shorter than thirty minutes should not count as naps.
If you are using Method A for naps (see page 235) or have a temperamentally easy baby, after putting your baby down for this nap, leave him completely alone to allow him to (1) learn to fall asleep unassisted and (2) return to sleep unassisted until he has slept about an hour in an uninterrupted fashion. Easy babies may cry very little or not at all; the temperamentally more difficult child may cry a lot. Remember, you are responding sensitively to his need to sleep by not providing too much attention. You are decisive in establishing a routine because you are upholding his right to sleep. Be calm and firm and consistent, because consistency helps your baby learn rapidly.
He will pick up on your calm/firm attitude and will learn quickly not to expect the pleasure of your company at nap time. You are not abandoning your child in his moment of need; you are giving him all the attention he needs when he is awake. Now he needs to be alone to sleep.
Q: How long do I let my baby cry?
A: No more than one hour.
Q: What do I do if the nap is short? When I put my child down to sleep, she cries a long time, but for less than an hour, and then falls asleep, but she doesn't sleep very long. Do I let her cry again”? Sometimes, she doesn't cry when I put her down for a nap, but she still doesn't sleep very long. Do I let her cry after the brief nap to see if she will sleep longer?
A: If the nap is substantially less than thirty minutes, you might try to leave her alone for an additional thirty to sixty minutes, even if she cries, to see whether she will return to sleep unassisted. If the nap is substantially more than thirty minutes, it is less likely that she will return to sleep unassisted so you might want to leave her alone for an additional thirty minutes or go to her immediately and not let her cry anymore. In general, the shorter the nap and the less restorative it appears, the longer you should leave her alone. Alternatively, you might want to try to lengthen the nap by rushing to your child at the first sound of awakening from a brief nap (less than an hour) and attempting to soothe your child back to sleep for a continuation of the nap. For some babies, this might be counterproductive and simply stimulate them to fight sleep more for the pleasure of the parent's company.
Q: After one hour of crying, what do I do?
A: Go to your baby and soothe her. Now you have two choices. Your baby might be wakeful, and you might decide that this was so stressful for you or her that you want to go outside for a walk, relax, and try again the next day to get a morning nap. Or your baby might be falling asleep in your arms after all this crying; if you feel that she will now be able to fall asleep, put her back down to see if she will nap. But do not let her cry for another full hour.
Q: What's wrong if I quickly check my baby when she first cries and I give her a pacifier or roll her back over”? She always immediately stops crying and returns to sleep.
A: Checking on your baby like this when she should be napping may not interfere with naps or night sleep in some infants between four and six months. But please be careful, because eventually all babies learn to turn these brief visits into prolonged playtimes. This learning process may develop slower if it is the father who does the checking and provides minimal intervention.
Q: My child had extreme fussinesslcolic and she is now about five months old, how do I get her on a 9:00 A.M. and 1:00 P.M. nap schedule?
A: Make sure she is sleeping well at night.
Control the wake-up time; try to start the day around 6:00 to 7:00 A.M. by not going to her before 6:00 A.M. or waking her up at 7:00 A.M.
Try intense, but brief, stimulation outdoors. Expose her to wind, rustling leaves, moving clouds, street noises, voices, barking dogs, sand in the playground, motion in the jogger or soft sling on your chest, swings, “swimming” pool splashing, and so forth.
Try to stretch her wakeful period to about 9:00 A.M. but be mindful not to allow her to become so frantically overtired that she will not be able to subsequently sleep well. She will get a little geared up and might get close to but not make it to 9:00 A.M.
Tone it down a little as you get close to 9:00 A.M.
Plan for a much longer and relaxing soothing-to-sleep routine before her morning nap because she will be a little overtired. Consider including a bath for relaxation, not for hygiene. Bathing might be stimulating but more often it is calm fun for babies.
Around 9:00 A.M., lie down to sleep with her or put her down to sleep. Review the sleep training strategies on page 211.
If she has a decent nap of close to one hour, repeat the same steps for her 1:00 P.M. nap.
If she does not nap in the morning, get out of the house and try to not let her sleep until about 11:00 A.M. Try the same soothing-to-sleep routine around 11:00 A.M. This means no car rides at 10:00 A.M.
Parents of postcolic babies or babies with a more difficult temperament (babies who are not self-soothing or who are irregular) might want to begin to practice Method A at this time. Many of these parents have been using Method B (your baby always begins naps with your help), as discussed in the previous chapter. Ideally, you have been very consistent with Method B up until now; the better rested your baby is when you make the transition from Method B to Method A, the easier it will be.
WARNING
It may be very difficult to establish regular naps at four to five months of age in some babies because their biological nap rhythms are maturing very slowly. Some babies don't evolve into a schedule of regular long naps until five or six months of age, especially if they had extreme fussiness/ colic when younger or if their parents were inconsistent or irregular about naps during the first four months.
For the difficult-temperament or postcolic baby, establishing the morning nap may be the toughest parenting maneuver that you have attempted so far. By focusing on the morning nap we try to help a postcolic baby learn self-soothing skills. It's best to begin establishing an age-appropriate nap schedule with the morning nap because it is the first one to develop; it is the nap that should be the easiest to obtain, because your baby is most rested from die night sleep, and parents usually can be more consistent in the morning, when scheduling conflicts are less likely to develop, than in the afternoon.
After your child's day starts, look at the clock. Within one hour of wakefiilness, clean, feed, and soothe using Method A. This ultra-short period of wakefiilness is designed to prevent the overtired state from developing.
Another reason why it is important to establish the morning nap by keeping the interval of wakefiilness very short is that the morning nap might represent a continuation of night sleep. The morning nap contains more REM sleep than the afternoon nap, and large amounts of REM sleep are a characteristic feature of a baby's night sleep.
“HE DID BEST WITH
HIS FIRST MORNING NAP”
The hours between 5:00 P.M. and 3:00 A.M. were the most difficult. When Eric was awake, he fussed or cried. The only way he would sleep was in our arms. My husband would cut up my food so I could eat with one hand while holding Eric with the other. I would nap from 8:00 to 10:00 P.M. to recharge for the next five hours. While I slept, my husband would alternately rock, walk, and bounce Eric. The routine was nearly unbearable. Eventually we made a chart to show Eric's schedule to Dr. W We determined that we were holding Eric eighteen or nineteen hours a day. No wonder we were exhausted.
I'll never forget the night and early morning at about three months of age when Eric was so sleep-deprived he could not go to sleep. I tried everything—nursing, rocking, walking, bouncing, singing. Eventually he did fall asleep while I pushed him around the house in the stroller listening to his favorite CD, only to wake up the second I tried to move him into his crib. The hours stretched on and Eric became more and more tired, overstimulated, and agitated. He began trying to pick the
flowers off my pajamas. Though he seemed to want to go to sleep, he appeared unable to get there. I felt I didn't have any choice but to put him in his crib—awake and crying. After about twenty minutes of crying, he fell asleep.
He did best with his first morning nap, crying only one or two minutes, if at all, before going to sleep. The evenings remained the most difficult. The longest crying episode was twenty-one minutes. My husband and I would sit in the den holding hands, listening to the baby monitor, and engaging in self-doubt. Does he need us? Are we bad parents for letting him cry? We kept reminding ourselves that Eric was learning a valuable skill that would serve him (and us!) well for life. After about three days, we felt he had achieved success. He has been a terrific sleeper ever since. Now, at age eleven months, he sleeps from 7:00 P.M. to 7:00 A.M. and naps twice for an hour or two. Everyone who meets him says he is happy, joyful, and alert.
If there is bright morning light during this hour, open up all your shades, because exposure to morning light might help establish sleep rhythms. If there is no bright natural light, make the room as bright as you can with room lights. Darken the room as you begin your soothing to sleep. After several minutes of soothing, which may include breast-or bottle-feeding, put your baby down. If there is crying, ignore the crying for between five and twenty minutes. You be the judge of how much crying you think is appropriate, but watch the clock, because three minutes of hard crying might feel to you like three hours. The reason we do not let difficult temperament or postcolic babies cry for an hour, as we can with easier babies, is that they have increased difficulty falling asleep unassisted. Their parents are usually extra stressed as well. I would, however, like to point out that some babies scream their brains out for two minutes, moan and whimper for three minutes, and then go to sleep for a great nap! You might lose the chance for a long nap if you do not let your child blow off steam for a minute or two. As before, when you feel there has been enough crying, rescue your child and try it again the next day—or maybe put him back down if you think he will now go to sleep. For the remainder of the day, try to keep each interval of wake-fulness to no more than two hours, do whatever works to maximize sleeping and minimize crying.
An alternative to putting children in their crib for naps is to sleep with them in your bed. This may work well for first-time mothers who do not have other children to care for. However, as your child becomes older, she becomes more aware of her environment while awake, drowsy, and asleep. So you might have to use a sidecar arrangement with her crib next to your bed so she is not stimulated by your body movements, coughing, or snoring.
As you read the following story, please try to notice features such as controlling the wake-up time, the ultra-short interval of wakefulness before the morning nap, making the bedtime earlier, and transitioning from Method B to Method A.
“HIS SLEEP SCHEDULE
WAS OFF KILTER”
Even when Patrick was only a few weeks old we noticed that he was becoming a night owl. He had what we called the “late-night fussies” in which Patrick would fuss and cry until he fell asleep. This would begin between 7:30 and 9:00 P.M. and last until around midnight. He was going to sleep at night much too late and would not fall asleep unless one of us was holding him.
Our main concern was his crankiness at night and his inability to fall asleep at a normal hour. Dr. Weissbluth asked me to keep a record of Patrick's schedule for ten days. I created a bar graph for each twenty-four-hour period and color-coded it to show when Patrick was awake, asleep, or crying.
Dr. Weissbluth's conclusion was that we needed to alter Patrick's sleep schedule. The goal was to get him to sleep earlier at night and to wake him up by 7:00 A.M. We began this by not letting him sleep past 7:00. If he awoke on his own between 6:00 and 7:00, great. If not, I had to get him up. I would then have one hour to change, feed, and play with him. During this hour I was to keep him in bright sunlight or well-lit rooms to establish morning wake time. After he had been up for fifty minutes I was to begin “quiet time” for ten minutes. This meant any soothing techniques I wanted to use to get him ready for his nap. I then had to put him in his crib awake and leave the room. If Patrick cried, my instructions were to leave him alone for five to twenty minutes to see if he would fall asleep on his own.
The first day I woke him at 7:00 on the dot. He was in a great mood as he ate, and we played in the light. At 7:50 I turned down the lights, read him a book in the rocking chair, and walked him around the room singing lullabies. At 8:00 I put him in the crib and closed his bedroom door. He began to cry lightly as soon as I left. Knowing that it would be hard for me to listen to the crying and not go in to pick him up, I took my shower. This was the only way to force myself to stay out of his room. After exactly fourteen minutes he stopped crying and fell asleep for an hour! I couldn't believe how easy it was.
The next step was to put him down for a nap after he had been awake for two hours. We again did the same soothing techniques for ten minutes and I put Patrick in his crib awake. Unfortunately, things didn't go as well this time. Patrick cried for fifteen minutes and kept crying after I picked him up. His crying in my arms became louder, which was unusual, and eventually I was crying with him. I finally got him calmed down but had to wait until he fell asleep in my arms before I could put him back in his crib. I decided that we had to conquer the morning sleep before we could continue with the other naps.
I made my graphs of Patrick's sleeping habits and gave them to Dr. Weissbluth. After reviewing them, he said that the progress was good, but now we needed to concentrate on getting him to sleep earlier at night. His ideal pattern should be to wake up at 7:00 A.M., with naps at 9:00 A.M., 1:00 P.M., and possibly 5:00 P.M., with bedtime around 7:30 P.M.
That night we began quiet time at 8:30. Although Patrick had been happily playing with us, he began to yawn. He eventually fell asleep in my arms without a fight and slept in his crib through the night. What a relief!
It was now time to start putting him down awake for his second nap. I began this by using the same soothing techniques for his second nap as I used for the first, only I did not have a time limit. I would walk while singing quietly until Patrick began to close his eyes. I then put him in his crib awake but tired. Patrick would fuss for a few minutes and then fall asleep.
As the days went by and we felt comfortable with his ability to fall asleep for the first two naps, we tried the same technique on his occasional third nap and his evening bedtime. The end result is that we have a happy baby who takes great naps, falls asleep on his own at night, and is an absolute joy. We still have some challenges. There are days when Patrick wants to take his nap after he has been up less than two hours and others when he wants to stay awake longer. If he fusses in his crib for more than fifteen minutes we pick him up and try again later. Bedtime at night is absolute. We put him in his crib for good around 7:30 P.M. Sometimes he fusses for a few minutes, but most nights we don't hear a peep until the next morning. It took a long time to get to this point and it was not easy, but it was definitely worth it.
Midday Wakeful Time
Expect your baby to be ready for another nap after two to three hours of wakefulness. In general, avoid long excursions, which might lead to mini-snoozes in the car or park. Although I've been emphasizing sleep rhythms, remember that there are also wake rhythms—times when the body clock automatically switches to a wakeful mode, just as it switches to sleep mode at night and at nap times. Wakefulness turns on as sleep turns off.
If your child did not take a morning nap, do not allow him to take a snooze in the car or stroller at a time when he should be awake. If your baby naps when he should be awake, it throws the remaining sleep/wake schedule off kilter.
The development of wakefulness is an active process; it is not just the turning off of sleep. During a wakeful mode, it is hard to fall asleep or stay asleep. If you do fall asleep during a wakeful mode, the ability of this sleep to restore alertness and a sense of well-being is less compared to t
he same amount of sleep occurring during a sleep mode.
For adults, there is a dramatic wakeful mode associated with a period of physical relaxation between about 6:00 and 9:00 P.M. Even if you are drowsy or sleep-deprived, it is hard to fall asleep during this time. This distinct zone of decreased sleepiness or increased arousal during the early evening hours has been called the “forbidden zone” for sleep. This wakeful period has been recognized by television people, who have labeled it “prime time.” This is the time when most adults do not and cannot sleep. Recent research also shows that there is a “forbidden zone” for sleep in infants.
MAJOR POINT
It is as important not to let children sleep when they are in biological wake mode as it is to help them sleep when they are in biological sleep mode.
Usually if a nap doesn't occur, it is best to keep your baby awake and go to the next sleep period, whether it is another nap or nighttime sleep. Probably this next sleep period will take place a little earlier because of the missed nap. Try to strike a balance between not letting your child become extremely overtired and preserving or protecting’ the age-appropriate sleep pattern.
Nap #2: Early Afternoon
The second nap usually occurs between noon and 2:00 P.M., most commonly around 1:00 P.M., but in any case it should usually begin before 3:00 P.M. The nap should last about an hour or two. Then go out afterward and enjoy this longer period of wakefulness.
Please remember, this is an outline of a reasonable, healthy sleep pattern, not a set of rigid rules. In order to describe sleep patterns, we have to use clock time and the number of hours of sleep, but it is more important to watch your baby than to watch the clock. There is nothing absolute about napping at 1:00 P.M. or any other time in this sleep schedule. You'll have to make some adjustments to fit your own lifestyle and family arrangements. There will be special occasions when your child does not get the sleep he needs. He will recover from these exceptions faster if you have a regular pattern on most days. The problem with some families is that they never have a regular day, so the child is always somewhat overtired.
Healthy Sleep Habits, Happy Child Page 27