Infant Sleep Tip #7

Infant Sleep Tip #7: Put your baby down drowsy but awake at least once every 24 hours (ideally bedtime or first nap).

Holding our baby as she falls asleep in our arms is one of the most precious parenting moments we get. Feed, nurse, rock, bounce her down in your arms as much as you want those first few weeks/months, without any guilt about “creating bad habits.” Your young baby and you both benefit from that close contact and time together.

At some point – and there is a huge range for this – parents and/or babies do better falling asleep on their own. Some parents need a break to care for other children, work, cook, or simply take a few minutes for themselves. Likewise, some babies may only sleep for short times in someone’s arms.

I remember frequently swaying my firstborn to sleep as she cried, only to have her wake again as soon as I transferred her to her crib. At some point, I realized that she was crying herself to sleep regardless, so why not just have her fall asleep in her crib and avoid the transfer drama? I felt less guilty about the crying if she was in my arms, but it was starting to feel ridiculous. And I was exhausted. That was what prompted me to try a new approach.

Bear in mind that the easiest time to fall asleep in the 24-hour period is at bedtime, provided she’s not overtired, or first nap. When you are ready, try putting your baby in her crib/co-sleeper/bassinette drowsy but awake at one of those times.

What does drowsy but awake mean? Imagine a scale of 1 to 10, with 1 being wide awake and 10 being sound asleep. Aim for a 7. She should be fed, clean, snug, and ready for sleep. You can do some singing, bouncing, etc. and when you see her eyelids getting heavy, try putting her down. She might fuss or cry a bit, but you can try some patting and shushing, or of course you can pick her up and try again then or another time. A few sleep experts encourage multiple pickups and putdowns, though depending on temperament, for some babies this can be very stimulating. With alert babies, less is usually more.

More tips to follow soon. In the meantime, wishing you and yours a wonderful holiday.

Rebekah

Approaching the End of Daylight Savings Time

I know I’m not the only one noticing how much shorter our days are getting already. Daylight savings 2015 will end on November 1st. Clocks are moved back one hour from 2 a.m. DST to 1 a.m.  For parents of early risers, the upcoming change can be nerve-racking. “He’s already waking up at 5:30 a.m. Does this mean he’s going to start waking up at 4:30 a.m. now?!” Thankfully the answer is no. You are going to gradually shift his schedule to the new time, just like when you are traveling.

So what will it look like? You have a few options. One is to allow your child to wake up at his natural time on the morning of the 2nd. According to the clock, it will be an hour earlier than usual. If he usually wakes up at 6:30 a.m., he will likely awaken at 5:30 a.m. That’s fine. It will be short-lived! Try to keep things low key for 30 minutes until you are ready to start the day. Base the day’s routines (meals, naps, etc.) around the new clock time. If your son’s bedtime was 7:30 p.m., the clock will now read 6:30 p.m. Aim for good naps that day so he can make it to at least 7 p.m. (new time). You can gently push his bedtime back to 7:30 p.m. over the next few nights.

Alternatively, if going “cold turkey” doesn’t appeal, you can also approach the time change incrementally, starting the week before. Push naps, meals and bedtime back 15 minutes later each of the days leading up to the end of daylight savings. For example, if his usual bedtime is 7:30 p.m., he can go to bed at 7:45 p.m. on October 29th, 8 p.m. on the 29th, 8:15 p.m. on the 30th, and 8:30 p.m., on the 31st. By the time daylight savings ends, he will already be adjusted – or at least well on his way.

Regardless of which approach you choose, stay consistent and try not to let him eat or really start his day before 6 a.m. (new time). He’ll be adjusted within a week.

If your child had too late of a bedtime before the time change, this is your chance to move it earlier without too much fuss.  The ideal bedtime for most children is between 7-8 p.m.  So if your son’s bedtime was too late, don’t move it later; just put him to bed at the new time of 7 or 8 p.m.

Note: If your little guy seems plagued by early rising, it’s time to get to the bottom of it. Click here to read my earlier post about the common causes of early rising and how to address them.

*Includes information from Kim West’s Good Night Sleep Tight.

 

 

 

Infant Sleep Tip #6

Happy August to all. Hope your families have been able to enjoy the abundant sunshine and summer action. Life with 3 young ones has proven to be as fabulous – and as full on – as friends had promised. So I apologize for writing so little recently.

Infant Sleep Tip #6: Encourage soothing techniques other than feeding.

When we hear our babies crying, many parents and caregivers instinctively reach for a bottle or the breast. While comfort feedings can be a wonderful bonding time for you and your little one, it’s important to remember that we have lots of options in our soothing toolbox. This can be a game changer for nursing moms, who were feeling like they were walking pacifiers, partners of nursing moms who were feeling inadequate because they didn’t have the “secret weapon,” and all caregivers who were feeling like they were perpetually overfeeding their baby just to keep them from crying. 

So what are our options? Wear your baby, swing, rock, swaddle, sing, shush, offer a pacifier, massage, take a walk outside, repetitive soothing sounds or music, bounce, or let a partner, friend, or grandparent try their luck. Sometimes a change of chemistry or scenery is all it takes.

If you haven’t found a carrier that is comfortable for you yet, make that one of your first goals. Many swear by the k’tan wrap, Ergo (the new Ergo 360 allows for a forward facing hold as well as all the other positions, which is great when your baby is eager to check out the world), the Beko Gemini, or Moby wrap. As some carriers are expensive, try out friends’, buy a slightly used one, or go to a local store where the salespeople have real know-how. If all the options are overwhelming, I strongly recommend www.carrymeaway.com. The website offers excellent explanations as well as an online form you can fill out for a personalized recommendation from the Sling Lady. They also offer email and phone support and free returns, making it super parent friendly. Laurel was a great support to my family in helping us find carriers that would be comfortable for both my husband (who is 6’2”) and me.

Dr. Harvey Karp in Happiest Baby on the Block offers detailed explanations for the benefits of the 5 S’s – swaddling, side or stomach, shushing, swing, and sucking. Some babies may benefit from all of them done simultaneously, while many babies are comforted by one or two of these techniques.

There is no one size fits all here. Each baby has preferences and naturally those preferences will change over the course of the day, weeks, and months. But mixing it up and trying new techniques can be hugely liberating.

Infant Sleep Tip #5

Happy spring to all! My apologies for being slow to post more infant sleep tips. My household has been busier than usual this month, partly due to my son’s recent obstructive sleep apnea (OSA) diagnosis and subsequent tonsillectomy and adenoidectomy. Much more on that very soon. Suffice it to say, I am now on a crusade to tackle pediatric OSA.

But for now, here are another tip for your infant’s sleep. If you missed the first few, please click here.

Infant Sleep Tip #5: Create a quiet, sleep-friendly environment.

Your baby’s environment strongly affects her sleep. Whether she sleeps in your room or her own, the space should be peaceful, safe and generally free of stimulation. This means room darkening shades and calm soothing colors in the bedroom and on her sheets. In short, the sleep environment should be B-O-R-I-N-G! Comfortable, cozy, but boring! Avoid mobiles, lights, crib toys, and busy patterns. When I walk through the bedding department at stores, the incredible number of boldly patterned crib and bedding accessories always surprises me. At bedtime, we want the message to the brain to be “Slow down,” not “Stay up and focus on the fuchsia colored giraffes lining your crib!” This is particularly true if your child has an alert temperament.

We also want the crib to be a place for sleep and maybe a few minutes of quiet play after waking. It’s not a place to park the baby while you wash the dishes or a pen for the baby to play in when she begins to crawl. Those associations make a difference.  Again, we want the message to be clear: this is the place where you sleep.

As Dr. Harvey Karp recommends in Happiest Baby on the Block, white noise can be very calming, particularly for alert babies because it helps them shut the world out. If you have a busy, noisy household with older children, barking dogs, ringing phones, or street noise, white noise can be a game changer. I recommend white or gray noise because they are constant and buffer noise best. Sounds like crashing waves, chirping birds, etc., which may sound nice to us, do not work well in this regard. Be mindful of the volume – which should be relatively low – the sound is meant to buffer noise, not block it out completely.

Motion sleep can trip up parents. Babies are very portable. They can sleep wherever you put them – car seats, strollers, swings, carriers, and noisy cafes. But even though they can do this, it doesn’t mean they should. It’s ok some of the time, especially in the late afternoons when their naps are shorter and less restorative anyhow. But try to have them nap in a quiet crib or bassinet most of the time – especially after the first few months. Motion sleep keeps the brain in a light sleep and as babies mature, they need deeper sleep as well. Think about it, when you doze off in a car, do you feel as refreshed as if you had slept in a bed?

Getting her out of the car and into the crib may mean that you will be more housebound, until your baby develops more predictable nap patterns. If you go stir crazy, invite a friend to visit, make a deal with your partner so you can get some time off. You don’t have to be super rigid; an occasional stroller or car nap is fine. But respecting your baby’s need for quality sleep is important and will pay off in spades.

Enjoy this time with your little ones. More tips coming soon!


Springing Forward

Today’s post will come as good news to many of us who are sick of being buried in snow and/or coping with our children’s early rising. Daylight saving time starts this weekend. At 2:00am on Sunday, March 8th, 2015, we will turn our clocks ahead one hour. The start of daylight saving time assures us that spring is indeed on the way, even if it is still 17 degrees outside.

What does this mean for our children’s sleep? Generally speaking, it’s a good thing. Children who were waking up at 5:30am will now be waking at 6:30am, a far more civilized hour.  However, those with late sleepers, may need to rouse their child so they don’t sleep the morning away.

What should we do in anticipation of the time changes? We’ve got two options. One is to do absolutely nothing. Just go with it. On Saturday night, put your child to bed at the usual time and allow her to wake at her usual time (though of course, the clock will read an hour later – i.e. 8am instead of the usual 7am). For the next few days, naps and bedtime may all feel a bit too early. For example, if your child’s bedtime is 7pm, you will be putting her to bed at the “new” 7pm, which is really 6pm. However, with a consistent bedtime routine and other good sleep habits, she will adjust within the week. This is a great option for families with early risers.

Alternatively, you can gradually adjust your child’s internal clock to the time change. Put her to bed 15-20 minutes earlier each night over the next few nights. For example, if her bedtime is 7pm, put her to bed at 6:45pm Monday and Tuesday nights, 6:30pm Wednesday and Thursday, and 6:15 on Friday and Saturday. Naps and meal times will need to be adjusted in the 15-minute increments as well. This method is usually recommended for young babies and children with already early bedtimes and/or struggling with naps.

Regardless of what approach you opt for, exposing your child to morning sunlight (if you can find some!), focusing on good naps, a predictable and calming bedtime routine (without screen time), room darkening shades and/or white noise, and following your child’s sleepy cues will make the transition smoother all around.

Also remember that if your child was waking early due to another reason (nap deprivation, too long of a wakeful window between nap and bedtime, etc.), it’s likely that the early rising will return in a few weeks. If so, take a look at this earlier post.

Infant Sleep Tip #4

Infant Sleep Tip #4: Manage day and night feedings so that caregivers can get some rest too.

Even though she’s ready to hit the sack around 6 or 7pm, a later evening feeding works well for babies and parents. Rouse her for full, boring feeding 2-3 hours later (around 9-10pm), then put her straight back to bed. Then YOU go to bed too!

Babies can naturally take one long stretch per 24-hour period. At first the long stretch may just be 4 hours, but it will lengthen over the upcoming months to 5, 6, 7 hours and will eventually become her night sleep. We want to encourage the long stretch to be at night after that last 9-10pm-ish feeding. If she takes it during the day in the form of an epic nap, she will legitimately be up all night making up for calories didn’t receive during the day. (Yes, that means wake a sleeping baby from a nap so that she doesn’t sleep through a daytime feeding.) And if she does her long stretch from 6-10pm, then you haven’t benefited from it. So encourage her little body to take its long stretch after that last evening feed.

Note: If mom really needs some more sleep, see if another caregiver can do the next feeding (probably around 1-3am) so that mom can get a solid stretch herself. If breastfeeding, this can be a bottle of expressed breast milk. As the saying goes, “if mama isn’t happy, ain’t nobody happy.” Knowing how intense as the first few months can be, we need to do what we can to support ourselves. An uninterrupted 6+ hour stretch of sleep can do wonders for a mom coping with baby blues, postpartum depression, or simply trying to regroup after a challenging postpartum time.

Infant Sleep Tip #3

Happy New Year! This is the third part of a series dedicated to laying a good foundation for sleep with babies under six months of age.

Infant Sleep Tip #3: Look for natural day/night cycle to emerge – usually 6am-6pm or 7am-7pm

Most babies fall into a 6am-6pm or 7am-7pm (or thereabouts) schedule. During the day, we want to focus on full feedings every few hours, outside time, floor time to practice new skills, and napping at appropriate intervals. When you notice your little ones starting to fall apart around 6pm or 7pm, she’s probably ready to call it a day.

Many parents mistake this fussiness as a need for one more nap. But after a 12-hr day, her central nervous system is taxed, and it is time to get her into a less stimulating, more sleep friendly environment. Bring her to the bedroom, give her one last feeding, change her diaper, dim the lights, turn on some white noise (especially if the rest of the house is still up and at ‘em), sing her a song, swaddle her up (if she’s into that), and put her to bed.

Infant Sleep Tip #2

This is the second part of a series dedicated to laying a good foundation for sleep with babies under six months of age.

Infant Sleep Tip #2: Create a flexible feeding and sleeping routine

A flexible routine does not mean a minute-by-minute schedule, but rather a sensible framework so that full feedings and sleeping are prioritized. Almost every sleep book on the market agrees that in general, an “eat – active time – sleep” cycle (in that order) is beneficial. In other words, feed your baby “up.” When she wakes, give her a full feeding (and burping). Then encourage her to stay awake for a short period. This is the time to engage with your baby, give her some tummy time, take her outside, etc. How long this active time should last is dictated by her age (wakeful windows get increasingly longer) and your baby’s cues. When she starts to show her sleepy cues – yawning, rubbing her eyes, zoning out, mild fussiness, etc. – you’ll know it’s time for her to rest. This cycle can be continued throughout the day, at least until the afternoon when her central nervous system is more taxed.

The beauty of this routine is that it makes parenting easier. Infants don’t differentiate their cries right away, so it can be hard figuring out why she’s not happy. However, if you know she has had a full feeding, she’s been appropriately stimulated, and now she’s fussy, she’s probably ready to sleep. On the other hand, if she’s had a partial feeding because she fell asleep during the feeding, it’s hard to read her cues. Is she hungry again? Did she not rest enough? Is something else wrong?

The “eat – active time – sleep” cycle brings other advantages too. It helps to disassociate falling asleep and eating (though it’s fine for infants to fall asleep at the breast/bottle sometimes). And for babies dealing with reflux, having upright time after feedings is crucial.


Infant Sleep Tip #1

Most of my sleep advice is directed toward children six months and up. By that age, babies are decreasingly reliant on nighttime feedings (though some may still need a few) and more responsive to behavior modification. That said there are some basic, developmentally appropriate ways in which we can begin to lay a solid sleep foundation with babies under six months. And in the case of parents returning to work, coping with postpartum depression or blues, or simply burnt out from sleep deprivation, some early interventions may be necessary.

Over the next few posts, I will focus on how we can gently introduce positive sleep habits for our very young babies. Hopefully new and expectant parents will find these suggestions helpful. On a personal note, my third baby is due in a few weeks so I’ll be using these techniques right along with you!

First, a word about sleep advice from well-intentioned family and friends…

Like parenting in general, how we approach sleep is very personal. Parents must decide for themselves what they feel comfortable with, what meshes with their values and philosophy, and what works for their child’s unique temperament and feeding needs. Lots of friends and family like to opine about sleep, but it is essential that parents listen to their gut and understand that just because an approach worked for one family, does not necessarily mean it’s a good (or healthy) fit for theirs.

There are significant individual differences between all children (and adults!), particularly in babies under six months. This is why one size does NOT fit all and what worked for a friend and her baby, may not work for you. For example, some infants may be able to consume large amounts of breast milk or formula, enabling the baby to go 3.5 hours without another feeding. Another baby with a smaller capacity may truly need to eat every 2 hours. Both are healthy and normal for this variable age group, but clearly the babies have very different feeding needs. Alternatively, one baby’s mother might have an abundant milk supply, while the other’s mother’s supply might be perfectly adequate, though not sufficient to stretch out feedings. Attempting to do so would actually put their otherwise healthy baby at great risk. For this reason, any recommendation from a book, friend, or family member for scheduled feedings should be taken with a big grain of salt.

Infant sleep

Your infant will probably sleep much of the time, but she won’t sleep deeply. Infant sleep is not well organized neurologically, which means it’s a very light slumber. Hold her, rock her swing her, do what feels right and comfortable for the first few weeks/months. When you are ready, start weaving sleep friendly routines and patterns into her life. This is a gradual process so don’t expect huge, dramatic changes in her sleep patterns immediately. But you are laying the groundwork for improvement in the coming weeks and months.

Infant Sleep Tip #1: Establish a healthy feeding pattern as soon as baby is born

With young babies, everything revolves around feeding, including sleep. Making sure their feeding needs are being met is essential to their health and growth, as well as any sleep success. Most infants need approximately 6-7 full feedings between 6am–10pm, plus more at night depending on their growth and individual needs. “Full” is the operative word here. If breastfeeding, this usually means emptying both sides. The goal is to avoid snacking throughout the day, though shorter cluster feedings in the late afternoon are perfectly fine.

If there is any concern or doubt about whether the baby is getting sufficient calories during each feeding – or if breast or bottle-feeding become challenging – consult your pediatrician and/or lactation consultant promptly.

Note: Babies usually have growth spurts around 3 and 6 weeks, and 3 and 6 months. It is essential that they receive additional calories at these times and if breastfeeding, that they go to the breast more to up their mother’s milk production so that she can meet their need.

More infant sleep tips will be coming in my next posts. In the meantime, wishing everyone a good night’s sleep.

 


Nightmares and Night Terrors

Happy September everyone. I apologize for contributing so infrequently recently. My mother passed away from metastatic breast cancer in June, and as the primary caregiver for my children and her, it has been an epic roller coaster. But as our children constantly remind us, life marches along – and alas, so do sleep challenges!

I’ve had a lot of questions recently about nightmare and night terrors. Knowing how to differentiate between them is essential to figuring out how to tackle them.

Nightmares are common, particularly in children between 2-3 years old when their imaginations are developing but the lines between reality and fantasy are blurred.

·      Occur during REM sleep
·      Child will seek comfort from parent and recognize you
·      Child can recall nightmare, or parts of it
·      It may take time for them to get the frightening thoughts of their mind and fall back asleep
·      Can occur during times of stress or when a child is reliving a traumatic experience, but also normally occur in well-adjusted, happy children every once in a while

What you can do:

·      Avoid playing scary or stressful games
·      Avoid exposing your child to potentially frightening shows, videos, books, and stories (children are far more sensitive than we often think)
·      Make sure room decorations are sleep-friendly and calming
·      During episode, respond quickly and sensitively, calmly reassuring them of their safety
·      Make sure your child is getting enough sleep (11 uninterrupted hours at night, plus a nap, is typical for most young children) as sleep deprivation can increase nightmares
·      Avoid high-dose vitamins prior to bedtime and check with your pediatrician to make sure medications are not interfering with your child’s sleep
·      Don’t lead the witness! If your child learns that night awakenings elicit overly sympathetic reactions from you (“Oh no! Did you have that scary nightmare again?! Oh my poor baby…!”), you may be inadvertently feeding a much larger behavioral pattern.

Night Terrors look (and are) very different from nightmares.

·      Occur during NON-REM sleep, usually within 2 hours of falling asleep
·      Child may scream, appear anxious and/or have a racing heartbeat
·      Child may be inconsolable
·      Child often does not recognize you and may seem frightened by you and/or push you away
·      Episode usually lasts 5-15 minutes
·      Child usually doesn’t remember it (though parents sure do!)

What causes night terrors?

·      Occur more often in boys
·      Child more likely to experience them if either parent had a parasomnia disorder such as sleep walking, sleep talking, or night terrors themselves
·      Commonly triggered by sleep deprivation or a disturbance in the child’s sleep pattern (jetlag, sickness, obstructive sleep apnea, stress)

What you can do:

·      Ensure your child is physically safe during the episode but avoid interfering, which can make things worse
·      Consistently put your child to bed earlier at night
·      Keep your child on a regular sleep schedule
·      Do not discuss the terror with (or in front of) your child
·      If the night terrors are persistent, keep a log to help identify any patterns (occurring at the same time each night or during weeks when bedtime was late)
·      If you find the night terrors are happening at the same time, rouse your child 15 minutes beforehand so that she mumbles or rolls over, every night for 7-10 days.

As upsetting as nightmares and night terrors can be for parents, it’s important to know that they are normal experiences and not necessarily signs of major stress or unhappiness. The calmer and more reassuring you can be in the heat of the moment, the less disruptive the episodes will be for everyone.

A Great Night’s Sleep for the Entire Family

Many times after working with a family to solve their child’s sleep challenges, parents ask me for sleep tips for themselves. My training does not include adult sleep issues, but below are some excellent suggestions from Kim West that often solve the problem. 

In addition to the following tips, I also highly recommend www.lowbluelights.com, who make night glasses and other products that block out blue light, thereby tricking the brain into secreting melatonin while lights are still on. In my household, we use the glasses, night-lights, iphone covers, and lightbulbs.

Here is to a great night's sleep for your entire family!

Tips for Sleeping Well Every Night by Kim West

Did you know that getting 7-8 hours of sleep at night can help you live longer, be thinner, think clearer and look younger? Despite these incredible benefits more then half of U.S. adults get less then 7-8 hours of sleep at night!

If you are one of the 75% of adults who report having a sleep problem, consider some of these helpful sleep tips to start to get the sleep you need and your body craves.

* Go to bed and wake up at around the same time every night (and while you have young children you might want to set your bedtime earlier than usual). Even on weekends, try not to modify it by more than an hour. Routines "condition" us for sleep, psychologically and physiologically, and the conditioned response then makes it easier to fall asleep and stay asleep. This tip is essential for children's night sleep and naps too!

* Give yourself one hour before lights out to wind down, letting your body and mind become more relaxed and ready for sleep. Listen to quiet music, take a bath, or read a book. Some people find that light stretches, meditation, creative visualization, or progressive relaxation helps. The average person (adult or child) takes 15-20 minutes to put her/himself to sleep.

* If you need to catch up, rather than tinker too much with your nightly sleep schedule, take naps. But either take a short twenty- to thirty-minute nap or take a longer ninety- to hundred-minute nap so you don't wake up during a non-REM sleep cycle and feel groggy. Before I learned that, I used to set the alarm for one hour and wake up feeling lethargic and lousy, like I needed a major infusion of caffeine.

* Make sure your bed and your bedroom are sleep friendly. Your room should be quiet, dark, and secure, and your mattress, pillows, and sheets should be comfortable. Sort out any temperature-control issues with your partner or spouse!

*Avoid any "screen" time for one hour before bed. That means turn off the TV, computer and cell phone and don't bring them in to the bedroom. The light from the screen tells the body not to secrete melatonin, the drowsy making hormone, making it more difficult to go to sleep.

* Exercise at least twenty to thirty minutes three times a week, but try to do it in the morning or during the day, not in the evening. If possible, leave at least three to four hours between strenuous exercise and sleep, and you certainly don't want to work out right before you go to bed. The same goes for rough housing with your child before bed, try to keep things quiet and mellow at least an hour before bed.

* Try to get some natural light in the afternoon. Go for a walk or sit in a sunny room, and try to get out of the house or at least briefly escape your artificially lit office cubicle. This tip will help your child too!

* Eat dinner at least three hours before going to bed. This of course does not apply to babies.

* Reduce your caffeine consumption (two cups maximum), and don't have any caffeine for at least six to eight hours before bedtime because it stays in your bloodstream. Caffeine doesn't just mean coffee--it means tea, many sodas, chocolate, and some over-the-counter cold and headache remedies. We become more sensitive to caffeine as we approach our forties.

* Nicotine is a stimulant, so if you haven't stopped smoking, poor sleep is yet another incentive.

* Watch your alcohol consumption. Alcohol may help you fall asleep, but more than three to five glasses, even less for some individuals, fragment our sleep. We wake up more often at night and earlier in the morning.

*See your doctor if you or your child has asthma, allergies, reflux, anxiety, depression and significant stress to make sure it is not interfering with your sleep.

Sleep is as important as a good diet! Sleep deprivation can cause depression, heart disease and weight gain...not to mention it makes you age faster. There really is such a thing as "beauty sleep.”

Make it a priority to get 7-8 hours as an adult, and remember that children need between 10-11 hours of sleep at night for the first 10 years of their lives!

Escape Artists

1:30pm. I’m working on my computer as my two-year old daughter settles down for her nap in her crib. Or so I thought. Suddenly I hear the pitter patter of little feet. She appears around the corner, looking quite surprised – and pleased – with her newfound skill…

My daughter was a great napper and loved her crib. Whatever possessed her to climb out?! And how do I respond?

Temperament and age are big factors here. Some children simply need a few, firm reminders to keep them from trying again. Others just can’t resist the temptation to test their skills, climbing out over and over again whenever they have the chance. Some are old enough to safely and smoothly transition to a bed, whereas others, particularly those under 2.5 years, are usually too young to make the switch.

Most children under the age of 2.5 years old lack the cognitive ability to fully understand the concept of “staying in bed all night long.” With a lot of effort and patience, some can learn to sleep successfully in a bed (more on that in another post!). But generally speaking, transitioning to a bed prematurely can lead to LOTS of struggles and safety issues (i.e. wandering around a dark room/house alone in the middle of the night).

I believe most early climbers actually do find tremendous security in their cribs, and their climbing should not be misinterpreted as a sign that they are ready for a bed. Just as babies practice their rolling, sitting, pulling up, walking, and talking in their cribs – sometimes to the detriment of their sleep – so too with climbing.

Toddlers and many preschoolers truly benefit from the comfort and cozy containment that a crib provides. Now that crib tents have been recalled, unfortunately our options for physically keeping young climbers in their cribs are more limited. But here are some suggestions, starting with the most minimal interventions.

·      Make sure her crib mattress is set to the lowest possible position. Baby's Dream makes a crib with an extra low mattress (6" lower than usual), though it is expensive.

·      If the back crib railing is higher, you could try wedging the crib in a corner with the taller side facing out.

·      Remove large stuffed animals she may have used as a launch pad.

·      Place pillows on the floor for safety.

·      Start putting her to bed in a sleep-sack, which limits her ability to hoist her leg up and over the railing. Or try a long t-shirt. Some parents find it discourages them from swinging their legs up. There are also product - Cribberz  and Crib Pants - on the market that I've heard good things about. Of course, if she’s using her arms to pull herself out, these interventions won’t really help.

·      If she climbs out, put her right back in her crib with minimal interaction – a firm, “No climbing” will do. Then position yourself nearby, out of her line of vision (just outside the bedroom door). When she goes for her next attempt(s), remind her, “No climbing,” and return her to her crib if necessary. Your response should be minimal, firm, boring, and consistent.

·      If she is persistent but not ready for a bed, there are some tent-like options out there that enable you to zip them in, such as the Nickel Bed Tent by ReadySetBloom. It’s a sturdy, tent-like structure that secures to a twin mattress. Nice colors to choose from and great for travel too. Many kids love the feeling of being contained and cozy in a tent, especially when it is pitched as a fun, special place (and not "this is to keep you in your bed!").

Just remember, your child may not be thrilled about the changes you make. Chances are, the “it’s for your own good” rationale will be lost on her. But don’t second-guess yourself if she protests. You are setting her up for good sleep, while ensuring her safety – one of your most essential jobs as her parent. She will get over it soon enough and will go back to sleeping like a champ. And so will you!

Don’t “Fall Back” into Poor Sleep Habits!

 

I know I’m not the only one noticing how much shorter our days are getting already. Daylight savings 2013 will end on November 3rd. Clocks are moved back one hour from 2 a.m. DST to 1 a.m.  For parents of early risers, the upcoming change can be nerve-racking. “He’s already waking up at 5:30 a.m. Does this mean he’s going to start waking up at 4:30 a.m. now?!”

Fortunately the answer is no. You are going to gradually shift his schedule to the new time, just like when you are traveling.

So what will it look like? You have a few options. One is to allow your child to wake up at his natural time on the morning of the 3rd. According to the clock, it will be an hour earlier than usual. If he usually wakes up at 6:30 a.m., he will likely awaken at 5:30 a.m. That’s fine. It will be short-lived! Try to keep things low key for 30 minutes until you are ready to start the day. Base the day’s routines (meals, naps, etc.) around the new clock time. If your son’s bedtime was 7:30 p.m., the clock will now read 6:30 p.m. Aim for good naps that day so he can make it to at least 7 p.m. (new time). You can gently push his bedtime back to 7:30 p.m. over the next few nights.

Alternatively, if going “cold turkey” doesn’t appeal, you can also approach the time change incrementally, starting NOW! Push naps, meals and bedtime back 15 minutes later each of the days leading up to the end of daylight savings. If his usual bedtime is 7:30 p.m., he can go to bed at 7:45 p.m. tonight, 8 p.m. on October 31st, 8:15 p.m. on November 1st, and 8:30 p.m., on the 2nd. By the time daylight savings ends, he will already be adjusted – or at least well on his way.

Regardless of which approach you choose, stay consistent and don’t let him really start his day before 6 a.m. (new time). He’ll be adjusted within a week.

*If your child had too late of a bedtime before the time change, this is your chance to move it earlier without too much fuss.  The ideal bedtime for a child is between 7 and 8 pm.  So if your son’s bedtime was too late, don’t move it later; just put him to bed at the new time of 7 or 8pm.

Note: If your little guy seems plagued by early rising, it’s time to get to the bottom of it. Click here to read my earlier post about the common causes of early rising and how to address them.

(Includes information from Kim West’s Good Night Sleep Tight.)

How Much Sleep Does My Child Really Need?

Sleep is a vital need, essential to a child’s health and growth. Quality sleep promotes alertness, memory and performance. Children who get enough sleep are more likely to function better and are less prone to behavioral problems and moodiness. That is why it is important for parents to start early and help their children develop good sleep habits. Below are some general guidelines for how many hours of sleep the average child requires at various ages. Remember, every child is different – some need more or less sleep than others – but variations are minimal.

As you can see in the attached chart, most children need about 11 hours of sleep for the majority of their first ten years. Ideally, parents will come to learn their child’s sleepy cues (more on these in a later post) and put them to bed when their child’s body is ready. Otherwise, parents can count 11 hours backwards from the child/household’s wake-up time and aim to have their child asleep by then (i.e. not just starting the bedtime routine). For example, if everyone in the house is up by 6:30am to get to school and work, the child should be asleep around 7:30pm.

Click here to download a chart of sleep averages.

Dressed for the Occasion

Does your little one leak through his diapers? Like to strip down before falling asleep? Wake up whenever you cover him? If so, here are some practical tips to avoid these common sleep interruptions.

Leaky diapers. There are a number of simple solutions for a baby or toddler struggling with leaky nighttime diapers.

·      Use diapers one size larger than his regular, daytime diapers. We use Bambo diapers for day and night, but use one size up at night.
·      Or try an extra absorbent nighttime diaper. Huggies overnites are another highly absorbent option.
·      If you find yourself without a nighttime diaper, consider placing a maxi pad inside his regular one or doubling up.

Disrobing. Yes, you will certainly look back at these moments and laugh. But, when your toddler decides to strip as part of his falling asleep routine, it can wreak havoc on his (and your!) nights. My advice is to head him off at the pass.

·      A strip of electrical tape, strategically placed across the top of his diaper (covering both tabs), can work wonders for keeping a diaper intact.
·      Try placing his zippered pajamas on backwards (zipper up the back).

Blanket Replacing. Summer is around the corner, but on the Cape and Islands, evenings are almost always cool. If you are losing sleep wondering if your baby has rolled out from under his blanket again or he wakes every time you cover him, it’s time to try a new approach.

·      Layer up with two sets of pajamas or a onesy underneath his pajamas.
·      Use a sleep sack over his regular pajamas. It will keep his body and toes warm without impeding his movement. And it has the added benefit of preventing a would-be crib climber from making his escape (at least until he figures out how to work the zipper!). There are many on the market, but my children use this one in the summer and this one for the rest of the year.

Good Night Stars, Good Night Air, Good Night Noises Everywhere

All children take great comfort in predictability; it helps them make sense of their world and regulate their states of being. The bedtime routine is a wonderful opportunity to incorporate soothing rituals into our children’s daily lives, while improving sleep habits at the same time.

As adults, we have learned how to relax ourselves in preparation for sleep. We bathe, dim the lights, read in bed, beg our partner for a foot rub, listen to mellow music. Likewise, our children, including babies and school-age kids, benefit from calming, predictable rituals before going to bed. Activities should all be comforting and quiet. Save the wrestling, tickling, scary stories and tv shows, and anything else that’s potentially stimulating for another time of day.

Here are activities that work well as part of a bedtime routine. Pick 3 or 4 based on your child’s age and preferences.

·      Bath
·      Put on pajamas
·      Brush teeth
·      Go to the bathroom
·      Read books
·      Bottle or nursing
·      Massage
·      Swaddle or sleep sack
·      Plenty of hugs and kisses
·      Sing a (short) lullaby
·      Tell a (short) story
·      Share 3 things about your day
·      Say good night to dollies or objects in room
·      Listen to quiet music
·      Small cup of water with books
·      Prayers, blessings, or send love/kisses/wishes to others

Encourage buy-in. If your child is asserting his independence these days, empower him to participate actively in the routine. He can pick out his pajamas, choose the book, say goodnight to his special dolls, and turn off the light. But you set the time frame.

Anticipate your child’s reactions. If there is one part of the routine that your child resists (perhaps brushing his teeth or combing his hair), get that part over first, before he settles into his snuggly mode.

Think about timing. Your routine could be anywhere from 15 minutes (for a baby) to an hour, depending on your child’s age and temperament. Some need more time to switch gears than others. Keep an eye on the clock though – if your child’s natural bedtime is 7:30, remember to start the routine early enough so he has plenty of time to fall asleep by then.

Follow at naptime too. The naptime routine can be an abbreviated version of bedtime, 1-2 calming activities in your child’s room.

Let him get himself to sleep. Your routine should be relaxing, but not enough to put them to sleep. We want them doing that part themselves. So if your baby keeps conking out reading or nursing, move that activity up in the routine. If it still happens, try shifting your routine earlier.

(Some excerpts from The Good Night Sleep Tight Workbook ©2010 Kim West LCSW-C, The Sleep Lady ®)

Co-Sleeping Safely

The overwhelming majority of parents co-sleep with their children at some point. Kim West, author of Good Night Sleep Tight, divides them into three categories: committed co-sleepers, short-term co-sleepers, and reactive or “we didn’t plan it this way!” co-sleepers. Committed co-sleepers believe in the family bed philosophy and bed-share for years. Many parents opt for short-term co-sleeping during the newborn stage, while others end up doing it reactively (i.e. when it’s 3am and they are too tired to take on another waking).  Regardless of the reason or rationale, it is essential that parents take precautions to ensure that their little one is safe.

The US Consumer Product Safety Commission (CPSC) and The American Academy of Pediatrics have formally recommended against co-sleeping with a child under two years of age because of the risk of death or injury. First Candle, an organization dedicated to reducing sudden infant deaths, cites research that suggests that 80% of sudden infant deaths occur when the baby is sleeping with a parent or other adult.

However, as Dr. Harvey Karp states in Happiest Baby on the Block, “The vast number of infant deaths in bed are preventable by taking a few reasonable precautions. For example, 80% of the deaths noted by the CPSC could have been avoided by filling the spaces around the bed to keep babies from getting wedged in and by never sleeping on waterbeds. Most of the remaining 20% of deaths could have been prevented by using a co-sleeper attachment.”

A co-sleeper, such as Arm’s Reach Co-Sleeper Bassinet, is a great option. It allows parents to sleep alongside their baby, easily bringing them into bed for feedings, without worrying about their baby rolling off the bed or getting accidentally smothered.

What follows is a list of safety tips from various sources, including First Candle, Dr. Harvey Karp, Kim West, and SafeBedSharing.org.

·      Your baby should sleep on a firm surface, covered by a well-fitted sheet that can’t be easily pulled off.

·      Avoid pillows, toys, or loose bedding (including quilts, sheepskins, blankets, mattress pads, etc.) that could smother your baby.

·      Never leave an infant or toddler unattended on an adult bed.

·      Never let your baby sleep on a waterbed, sofa, or another soft, flexible surface.

·      Eliminate spaces between the mattress and the wall or nearby furniture, or the mattress and the structure of the bed (headboard, footboard, side rails and frame), where your baby’s head might get trapped.

·      Let your young baby sleep only on his back.

·      Never let another sibling sleep next to your baby. Children sleep deeply and may roll over onto the baby.

·      Never sleep next to your baby if you are intoxicated or have been using drugs, are taking medications, are overly tired or in any other way feel that your ability to be aroused could be affected.

·      Do not sleep with your baby if you are very obese.

·      Do not let your baby overheat during sleep.

·      Do not smoke around your baby or allow anyone else to do so. Smoking exposure may increase the risk of SIDS.

·      Tie back very long hair in a pony tail or braid it. Long hair could cause suffocation or strangulation.

There’s a lot of contradictory information floating around and recommendations are always changing, so it is best to regularly re-visit safety issues with your pediatrician.

For more information, here are some helpful starting points:

www.healthychildren.org

www.firstcandle.org

www.safebedsharing.org

*Information for this post came from First Candle, Good Night Sleep Tight by Kim West, The Happiest Baby on the Block by Dr. Harvey Karp, and SafeBedSharing.org.

Ensuring Good Sleep, Even on the Road!

Here are some tips to make your vacation as smooth as possible, sleep-wise.

Prepare a sleep-friendly environment. Whether you’re staying in a hotel, rental house, or with family, try to create a sleep-friendly environment for your little ones. Bring along unwashed crib sheets (the familiar scent will be soothing), favorite loveys and blankets, sound machine, and night light. If you’re not sure the window shades will be dark enough, pack black trash bags and masking tape or thumbtacks for makeshift blackout shades. The Phil & Teds “Traveller” cot is a great alternative to traditional pack n plays; it is small and light enough to fit inside your suitcase, has no uncomfortable crossbars, and has the added advantage of an optional top in case you’ve got a climber on your hands. (More on that subject in another post!)

Respect your child’s need to sleep – even on vacation. Yes, your child may miss a few naps due to travel and bedtime may be a little later due to older cousins. But try to not abandon your child’s schedule altogether, particularly if you are away for more than a few days. If normal crib naps are not possible, plan to drive during nap times, squeeze in catnaps to take the edge off, and opt out of a late dinner if your little one is showing signs of fatigue. You’ll be glad you made the sacrifice – over-tired children usually don’t make the best travel companions anyhow.

Maintain the rituals. Try to maintain your family’s pre-sleep routine, or at least an abridged version of it. The familiar books, songs, and other positive sleep associations will be especially comforting to them as they adjust to their new environment.

Talk to your children. Even one year olds often understand a lot more than we think. Let your little ones know that you are doing things differently than usual because you are traveling. “Today we are going to take our naps in the car because we have a long drive to grandma’s house. You can rest in your car seat, and we will wake you up as soon as we get there!”

Avoid using the same crutch you just broke. Sure, some sleep regressions may happen during travel. However, if you have recently worked hard to stop nursing your baby to sleep, try rocking her or patting her down instead. It’s less confusing and less intermittent reinforcement, which means ultimately it will be easier to undo.

Nip bad habits in the bud. Let your little ones know that once you are back home, it’s back to business as usual. So if you had a co-sleeping nurse-athon in order to keep her quiet at your in-law’s house, the “open bar” officially closes when she kisses grandma goodbye. It’s much easier (i.e. less crying) to tackle new sleep issues before they are fully engrained.

Enjoy your vacation!


Bon Voyage!

Planning a family trip this summer? Wondering how to prepare for airplane travel? Not sure what to pack? Hopefully these suggestions will alleviate some of your pre-travel stress.

Carry-On Packing List

·      Loaded diaper bag – extra diapers, wipes, sanitizer, washcloths, diaper trash bags, etc.
·      Ziploc medicine bag – Ibuprofen, Rescue Remedy, Arnica, diaper cream, etc.
·      1-2 extra outfits for child (and shirt for mom!) plus sweatshirt/fleece
·      Snacks – LOTS! We bring a whole reusable shopping bag full. All of her favorites and then some. Save a few good ones for the last 30 minutes when you are landing. Fresh berries (washed in plastic container), cookies, clementines, edamame, Bunnies, raisins, cheese sticks, baby carrots, apples, organic food pouches, water bottle, etc. Plus a little container so she can feed herself.
·      Books – a few favorites (paperback!)
·      Toys – favorites plus new ones that are still in packaging – they take a few minutes to unpack and on some flights, every second counts! Matchbox cars, little dustpan and broom, doll with accessories, lacing cards, magic drawing board, magnetic things
·      Arts – stickers, crayons, notebook for doodling, stamps and stamp pad, pipe cleaners and beads with wide hole (get your toddler making bracelets for everyone!), play doh
·      Portable DVD player or iPad and headphones (if appropriate) with favorite home videos/DVD’s
·      Playaway (portable books on tape player) with headhones
·      Carrier – particularly important for long flights if child having trouble resting/napping, can be very soothing to just snuggle in with mom/dad; also helpful in airport
·      Stroller (to gate check) – helpful for lugging children and/or gear around airport

Checked Luggage Packing List

·      Sleep essentials – lovey, special blanket, sleep sack, night light, white noise machine, big trash bags and pushpins or electrical tape (if may not be curtains where you’re staying)
·      Portable crib if needed and sheet (unwashed crib sheet from home can be a real comfort)

Products I Like

·      Classy Kid Keep Me Tidy Biodegradable Diaper Sack
·      P'kolino Triangular Crayons (won’t roll off tray easily)
·      Lacing Cards
·      My First Sticker Encyclopedia series and Ultimate Sticker books
·      Phil & Teds Traveller Crib – compact enough to fit in suitcase, fits most preschoolers, comfortable. Can order sunproof top separately.
·      Phil & Teds Lobster portable high chair – very compact, works on most tables
·      www.totsonthego.com and www.travelingwithkids.com and www.onestepahead.com
·      101 Activities for Kids in Tight Spaces (Carol Kranowitz) – great tips for travel & home

On-Flight Tips

·      Don’t underestimate the novelty factor – borrow/buy lighter, travel friendly toys
·      A well-rested child travels much better. Morning flights are usually easier than late afternoon ones. Try for a good night’s sleep or normal nap leading up to flight if possible. Bring your carrier even if it's for a nap before the flight in the airport
·      Easy slip on/off shoes for getting through security quickly
·      Befriend flight attendants during boarding.
·      Try to nurse/sippy cup/food pouch during takeoff and landing.
·      Keep your sense of humor, ignore the haters, and bring yourself a treat too ;-)

Consolidating Naps: A Tricky Dance

Most toddlers are ready to transition from two naps to one around 15-18 months. That said, if your toddler’s naps are going well, leave them alone! But when things start to get funky on the nap front, it might be a sign that she is preparing to consolidate her naps. Your toddler is ready to transition to one nap when she:

·      Consistently gets 10-11 hours of uninterrupted sleep at night (if she’s not, work on improving her nighttime sleep before tackling naps)
·      Consistently takes longer and longer to fall asleep for her morning nap
·      Consistently takes shorter morning naps or sleeps too long in the morning then refuses her afternoon nap

If your toddler’s afternoon nap isn't going well, try shortening her morning nap – don't let her sleep longer than an hour. Maybe even 20-30 minutes. Think of the morning nap as a catnap to take the edge off, so she isn't overtired for the more important afternoon nap. Eventually she will drop the morning nap altogether. But catnaps can be a really good stopgap measure, buying her body a few more weeks/months to adjust.

When the time has truly come to kiss the morning nap goodbye, brace for a 7-10 day process. Gradually push her morning nap later – 11am for 2 days, 11:30am for a few days, then noon, etc. Don’t let the nap get stuck in the late morning. Your goal is for her nap to start between 12:30-1pm and last at least 2 hours.

Some children adapt quickly to an “after noon” naptime, while others really struggle. I found that keeping my toddler out of the house from 9-11am made a big difference. Keep her busy at the playground, library, or a friend’s house before bringing her home for lunch and then nap. Just don’t let her fall asleep in the stroller or car ride home!

If your sleepy toddler wakes up from her nap after only an hour, try to encourage her back to sleep using whatever method works best for her and you. Consistency is crucial here. If all else fails, you can always let her crash in the car or stroller so that she isn’t falling apart by 5pm.

Bear in mind: this is a significant transition that can last anywhere from a few weeks to a few months. It often leads to short-term sleep deprivation since toddlers typically go through a "two naps are two many but one is not enough" stage. During that time, put her to bed earlier than usual and be open to an occasional two-nap day if you sense she is getting over-tired.

(Some excerpts from The Good Night Sleep Tight Workbook ©2010 Kim West LCSW-C, The Sleep Lady ®)