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Parents Corner

Babies and Sleep

Sleep, or the lack there of, is a universal difficulty for parents. There is a myriad of research, books and articles in popular magazines telling you how to get your baby to sleep. Different things work with different children, for the simple reason that all children and families have different needs, styles and priorities. The following information from Zero to Three and Parenting magazine should provide you with some ideas to try yourself. Hopefully, some of them will work for you and you will begin to get a good nights sleep.

Don’t let the bed bugs bite!

"Parent Guidelines: Helping teach young infants to sleep through the night," Zero to Three, October/November 1998
Athleen B. Godfrey, RN, MS, FAAN
University of Utah College of Nursing Salt Lake City, Utah
Anne Kilgore, M.Ed Park City, Utah

Guidelines for parents: Helping very young infants sleep through the night

Sleep routines are habit routines. Sleep habits, even in young infants, can be changed by altering the environment and introducing routines that support the formation of new habits. The longer an undesirable sleep routine has existed, the more difficult it will be to induce change, but it can be done!
The three requisites for promoting sleep- quiet, dark and warmth- need to be promoted from the beginning. Many parents find it helpful during summer months to artificially darken the sleeping room by covering windows with cardboard, foil, etc. to maintain a dark environment for sleep.
From the first day home from the hospital the infant needs to learn to sleep on his back or side as recommended by the American Academy of Pediatrics' "Back To Sleep program", in his own bed, and, preferably, in his own room away from the parents. These are the first important environmental supports that lead to good sleep habits. Safety considerations include choosing a safety-approved crib and a firm mattress that fits snugly against all sides of the crib. Many parents find comfort in using an electronic baby-monitor so they can hear when their infant wakens or cries.
Newborns need to learn to comfort themselves to sleep. Allowing the baby to go to sleep in his parent's arms or with the breast, bottle or a pacifier in his mouth, is simply patterning the need for this association and environmental support into the infant's sleep habits.
By about 3-4 weeks of age, the newborn begins to sustain longer periods of awake time, and his sleep cycle is changing so that he spends longer time in quiet, deep sleep and stays awake longer between feedings. By late afternoon, the four week old infant is often on stimulus-overload, and overstimulation causes him to become irritable, inconsolable, fussy, and even promotes gastrointestinal distress commonly associated with "colic."
With the young infant already on stimulus overload, the additional chaos in many families during the early evening hours, created by a change in caregivers, parents coming home from work, siblings coming in from school and/or play, supper time, and a build-up of fatigue and stress in all, makes the early evening time extremely difficult for the very young infant. This is the least appropriate time for parents to plan "quality time" or rough-and-tumble play with infants and young children.
Keeping an infant (or any young child) up late for any reason does not result in the infant or child sleeping later the next morning. Instead, keeping the infant or child up late means only that valuable sleep time is lost, and both the child and family "pay the price" the following day when the infant is fussy, irritable, cranky, and/or whiny. Irritable, sleep-deprived parents are not going to be able to provide true "quality time" that will be satisfying to themselves or their infant.
Moving the bath to early evening will help the infant calm and prepare for his last "bedtime" feeding. Quiet talk, smooth movements and a rub-down or gentle massage after the bath are approaches that can comfort and calm both the infant and his caregiver at the end of a busy day.
Infants who go to bed earlier at night gradually develop longer initial periods of uninterrupted sleep in a short time, usually within 3 to 7 days. It is helpful to move the bath and bedtime forward 20 to 30 minutes per night for infants who are used to being put to bed much later until the infant is finally going to bed between 6 and 7 PM.
Allowing the very young infant long periods of uninterrupted night sleep does not lessen the total food taken in over 24 hours, nor does it lower the rate of weight gain. Infants make up for loss of night feedings by eating more during daytime feedings. Production of breast milk will naturally alter to meet the infant's needs as the infant gradually lengthens out the first uninterrupted night sleep period. In the early weeks, mothers are advised to pump as needed for comfort if their breasts fill before the infant wakens to feed.
Parents are encouraged to avoid waking the sleeping infant if at all possible. This advice is contrary to that found in several parent-directed publications including a popular book by Cuthbertson & Schevill (1985) and the common practice of waking the young infant for a II PM-midnight focal feed. With proper environmental support, most infants will gradually lengthen out both day and night sleep times to obtain sleep adequate for their health and well-being. Interrupting sleep to feed or for any reason is frustrating for both infant and parent and often non-productive as well.
Crying when put down early or after a middle-of-the-night feeding should be ignored as much as possible. If parents are anxious about the infant, they can sneak into the room to observe him every 5-10 minutes but should not turn on a light or speak to or touch him. If the infant becomes very upset, quietly pick him up and comfort him for a few minutes, then gently place him back down to sleep. These approaches might need to be repeated for several nights until the infant learns that this is not a play time and to help himself go to sleep by himself. Be patient!
Some parents worry about losing "quality time" if they put their infant to bed early in the evening. Parents and infants alike will benefit by having true quality time in the morning or earlier in the day and can enjoy soothing interactions during the bedtime routine (which will soon become anticipated eagerly by all!).
Most infants started on this routine will be sleeping for 8-10 hours after being put down for bed before 8 PM within 2-4 weeks. A middle-of-the-night feed will still be required for a time, but this need usually changes after several weeks.
Night waking for feedings can be discouraged by making this a "boring "time for the infant—no overhead lights, no talking, no changing the diaper unless absolutely necessary, and gradual reduction of the amount of formula fed or the amount of time at the breast.
Periods of illness or changes in the family routine will cause temporary disruptions in the infant's sleep patterns. After these events, parents might have to start the routine all over again to eliminate night wakings that have become habit during periods of change or illness. Parents are encouraged to maintain the late-afternoon quieting routines, the bath, and early bedtime routine as much as possible during illness or change. After the infant recovers from illness or change, parents must be prepared to let the baby fuss or "cry it out" for a few nights in order to reestablish the former sleep routine and to let the infant know that he is expected to stay in bed and go back to sleep. Often no more than three to five consecutive nights are needed for infants to get back into a regular bedtime routine if parents are consistent and don't attend to or reinforce the crying.

While beginning this routine, parents may find it reassuring to keep a written record that shows how long the infant cries and/or fusses when first put to bed, or when put back to bed after a middle-of-the-night feeding. Writing down how long the infant sleeps after his bedtime feeding and how long he sleeps after the middle-of-the-night feeding can help parents see the progress being made toward developing a good sleep pattern. For many families, a convenient place to keep this record is on a calendar.

Exceptions to use of this approach

There are always circumstances that will necessitate altering or delaying use of this routine for some very young infants. Very young infants with extreme underweight or inadequate weight gain; acute or chronic illness; or disabilities in the infant which make it difficult to maintain adequate caloric and fluid intake are conditions that require special consideration when establishing sleep routines, in these situations, parents are encouraged to establish an early bath and bedtime routine and to observe and support the infant's emerging abilities to lengthen the first sleep period of the night in any way possible.

A few additional suggestions: Excerpts from Parenting. May 1994, Laura Flynn McCarthy

Honey, the Baby’s Crying

"Good sleepers are made, not born," says Dr. Donald Shifrin, a clinical associate professor of pediatrics at the University of Washington in Seattle. The trick, Shifrin says, is to teach your baby to calm herself to sleep, instead of allowing her to rely on you to help. "Unless sleep problems are dealt with as soon as they arise, you'll have a little problem at six months, a bigger problem at 18 months, and a huge problem at 30 months," Shifrin says. So how do you get the baby to bed? No problem:

Avoid "crutches" certain ways of getting a baby to sleep seem wise at first, but in the long run they may do more harm than good. Many babies like to fall asleep feeding, for instance, but letting them do so can cause them to associate sleeping with being fed. And once that link is established, a child is more likely to cry for you when she wakes later. (If your baby starts to look sleepy when you're nursing or giving her a bottle, stop feeding her, then gently put her down to sleep.) Similarly, babies love to be rocked, and the technique can help them settle down. But a child who falls asleep while you're rocking her may not learn to get to sleep on her own, either. The same goes for giving a baby a pacifier at bedtime: It may help quiet her, but she'll only cry later when the pacifier falls out of her mouth and she can't get back to sleep by herself.

Bank on blankies Blankets, stuffed animals, and other favorite objects can all help a child feel secure as she goes to sleep on her own. From early infancy, most babies clutch and fondle something soft like a blanket. It is likely to become a token of security for her. Dr Church feels that baby can be deprived of the blanket long enough to wash it, but otherwise favors letting her have it. At bedtime the best choice may be the blanket or burping pad that you use during feedings. Because such items (which experts call transitional objects) contain the scent of both parent and child, they can help a baby feel at ease without Morn or Dad around. Baby can manage to hug a doll, squeeze a blanket, suck a thumb and finger his ear all while drifting off to sleep.

Settle the co-sleeping question Decide with your spouse early on whether you want your child to sleep by herself or in your bed. Some parents swear by co-sleeping. "We know our two-year-old Jillian feels more secure in bed with us, and it gives us a sense of closeness with her that is unmatched during the day," says Karen Levine, a Germantown, Maryland, mother. Other parents regard their bed as a refuge from the world of parenting, they sleep better without a child next to them, and they feel that it's more appropriate for a baby to sleep alone.

According to a recent University of Massachusetts study, about 55 percent of parents of two- to three-year-olds allow a child to sleep in their bed for at least part of the night. And the percentage is likely to be higher for parents of younger children. Whatever you and your partner decide to do, be consistent, so that a child can develop a dependable routine.

Factor in Ferber

Dr. Richard Ferber's controversial method for getting children to sleep has become so well-known that parents have coined a term for it: Ferberizing. The technique, as described in the doctor's popular book Solve Your Child's Sleep Problems, involves putting a baby as young as five months old in the crib while she's still awake, comforting her for a few minutes, then leaving the room. If she cries, wait roughly five minutes and then go in and soothe her, but try not to pick her up, don't stay very long, and be sure to leave while she's still awake. Continue to soothe her after gradually longer intervals of crying until she begins to settle herself down. After four nights of this routine—sometimes less, Ferber says—even children with a history of difficulty dozing off can usually get themselves to sleep. And Ferberized kids don't cry for their parents as often during the night, Ferber says. (The technique shouldn't be used on children with severe fears or anxieties, he cautions.) Critics claim that letting a baby cry without acknowledging him is insensitive to the baby and interferes with the bonding process between parent and child.

Repeatedly, from all the "experts", suggest that you rely on routines.

Performing the same simple tasks before bed each night helps signal a baby that all is well, that she's safe, and that it's time to go to sleep. Bathing a baby, brushing her teeth (or, for a younger child, wiping her gums with a clean, wet cloth), getting her into her pajamas, and reading a book together all establish a comforting, familiar pattern that your baby can come to depend on at bedtime.

Books available on the subject.

Click on to find out more.

On becoming a family: The growth of attachment (2nd ed.). Brazelton, T.B. (1992a) Dell Publishing Company.
Solve your child's sleep problems Ferber, R. (1985) Simon & Schuster, Inc.
The Sleep Book for Tired Parents

Articles available on the subject for more information

American Academy of Pediatrics Committee on Nutrition (1993). Pediatric nutrition handbook. Elk Grove, IL: American Academy of Pediatrics.
Anders, T.F., Halpern, L.F., &: Hua, J. (1992). Sleeping through the night: A developmental perspective. Pediatrics, 90 (4), 554-560.
Pinella, T, & Birch, L.L. (1993). Help me make it through the night: Behavioral entrainment of breast-fed infant's sleep patterns. Pediatrics, 91 (2), 436-444.
Schmitt, B.D., (1992a). The "two-step" approach to infant sleep problems. Contemporary Pediatrics, 9 (II), 37-38.
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Last modified: January 26, 2013