11.09.2010

Sleep Advice Re: Infants

I have recommended to many a book called "The No Cry Sle.ep Solution" by Elizabeth P.antley.  I read the book while pregnant with Charlie, and knowing I would be sleep deprived, made myself some "cliff notes."  I thought I would share these tips for anyone interested.  Note: I am really not totally anti crying it out.  I do think sometimes babies just need to fuss/cry on their way to sleep.  I still found this book incredibly useful, putting most of the ideas to use.  Charlie was pretty textbook, thankfully.  He sleeps very well (7pm-7am with a 2 hr nap from 12-2 and rarely wakes at night), so for that I am grateful!  I know there are a lot of varying opinions on sleep and this book's view may not conform to yours, but I thought it was pretty non-controversial :)  Anyway, these ideas are all from the book and passed my own "behavior background" filter.  Hopefully others will find them useful.

“Around the fortieth week the baby has started waking and going to sleep about the same time each day…” We cannot force a baby to conform to a parent’s desire for a pleasant day, a lengthy nap, and a long night’s sleep. We need to make the baby’s world conducive to sleep in every way we can. We must remove obstacles to peaceful nighttime sleep, and wait patiently for nature to what’s best. Some babies do it more quickly and some require longer…”


Safety when sleeping-in crib or following anywhere else (daycare, stroller, etc):
• Nothing in bed with baby, even a blanket (use a sleep sack instead) or stuffed animal (no animal until 4 months old). Don’t hang objects over a sleeping baby, including mobiles.
• Lay on back to sleep always (p. 31 has ideas if baby resists this).
• Avoid being around smoke
• Keep baby warm, but not too warm. Keep room 65-72 degrees. Ask doctor how long baby should wear a hat to sleep
• Avoid dressing baby in loose fitting or cotton blend clothing. Should be flame-resistant and snug fitting.
• Avoid placing your baby to sleep on soft surfaces (water bed, pillow, sofa, beanbag, foam pad, etc). Babies should be on a firm mattress with wrinkle free sheet that is firmly fastened down. Mattress can’t have gaps on any side (more than 2 fingers).
• Keep electrical and things on the wall/window treatments way from baby sleeping area; keep a working smoke detector near baby’s room
• Call doc immediately if baby is sick or feverish, never shake a baby, keep regular doc appts
• Never tie a pacifier to baby with any string type item. Remove decorative ribbons, bows or strings from bedding.
• Never leave baby unattended while in stroller, car seat, swing, baby seat, etc.
• Keep environment clean-wash bedding often, wash hand after diaper baby and every time before feeding. Wash baby’s hands and face frequently.

Sleep Norms:
• We cycle through sleep like a wave, ranging from light sleep to deep sleep
• Babies’ internal clock that regulates this isn’t mature until six to nine weeks of age and doesn’t work smooth until about four or five months.
• Babies sleep cycles are shorter and more numerous than adults and spend more time in light sleep with more brief awakenings-they may briefly wake and not be able to go back to sleep if the things they associate with sleep are no longer there…(nursing, pacifier, blanket, mom, etc)
• Up to 12 months, some children are hungry after sleeping for about four hours and you should feed them if that is truly why they are awake. Babies may need one or two night feedings up to about 9 months of age.
• Most babies wake 2-3 times a night for up to six months, 1 or 2 times for one year; once a night from 1-2 years old.
• “Sleeping through the night” is five consecutive hours.
• Newborns sleep when they are tired and wake when they are ready
• Newborn’s pattern revolves around their stomach-tiny tummies and breast milk digests rapidly!
• Newborns need to be fed every 2-4 hours and will have growth spurts too.
• Most newborns can only handle about two hours of wakefulness
• See table 4.1 for avg number and length of naps based on age-from 4 months on.

Things to do/not to do from the start re: sleeping:
• Spend time in the room for things other than sleeping or things related to your sleep routine so the room is a nice place
• When newborn, arrange schedule around baby so you don’t disrupt bedtime routine and stay out too late.
• Include awake baby in everyday chores-don’t just wait for baby sleeping to get things done.
• Set up a typical daytime routine and adjust it daily based on baby’s cues and other situations that may arise.
• Relax and rest when your baby feeds, make sure you are comfortable (drink, phone off, pillow, all you need is close, etc).
• Make sure baby is getting enough to eat (amt each and how often) during the day so that it will need less to sleep longer at night; especially make sure last feeding is complete. Notice if things you eat affect the baby’s sleep/behavior.
• Avoid too late of naps or neg effect bedtime-if 3 then mid morning, early afternoon, early evening; if two midmorning, early afternoon; if one early afternoon. Base them on babies’ natural time to be alert or tired and put to bed quickly when show signs of tiredness (no lengthy routines).
• Nap routines should be different from bedtime routine
• Put baby to sleep as soon as shows signs of being tired (quiets down, lull in movement, loses interest, looks away, looks glazed, rubs eyes, yawns and/or fusses).
• Experiment to find baby’s bedtime (p. 105) from 6:30pm on watch closely for signs of tired. Adjust it by 15-30 min every 2 or 3 nights and pay attn to the effect it has.
• Keep in mind overtired babies don’t always act tired.
• Help baby make distinctions btw daytime and nighttime-daytime naps in lit room where noises of day are evident; talking and singing okay. Don’t let baby nap for 3 or 5 hours during day or he/she will get up frequently at night. Once hits 2-3 hrs, wake gently and encourage to stay awake and play. Naps less than one hour in length don’t really count, just take the edge off, but don’t complete the sleep cycle, so baby could be fussier in the long run.
• The hour before bedtime should be quiet and dim. Nighttime and bedtime routines involve dark and quiet (no talking, singing, or lights on in the middle of the night). Use white noise to cover is house is loud when baby goes to bed at night. Start routine 30 min early, specific nighttime things into routine that starts at the same time-bath, pjs. Keep nighttime feedings quiet and mellow (no talking or singing). Keep all you need close for min disruption. At night, only change diapers if you have to and quick and quiet with tiny night light and warm wipe.
• As time passes, add flexibility to routine-shorter steps when baby is really tired, bring in other people to do it, etc when baby is ready.
• If baby is sleeping well on their back, avoid putting baby down in exact same position to sleep every night (move head, different places in crib, etc), avoid leaving baby lying on her back in stroller, car seat or swing for long period of the day (head will flatten).
• Set healthy nighttime associations: avoid doing things (nursing/sucking/in arms/etc) till baby is fast asleep; stop and put in crib when settled and sleepy, but not fast asleep. Let baby settle self the rest of the way.
• Make sure baby is comfortable so won’t wake for this reason at night: swaddle, smaller space within crib or nest car seat, stroller, etc, soft sounds or white noise, good smells (like smells like mom), warm bed, absorbent diaper , etc. Make sure last feeding is a complete one.
• When baby wakes during the night, do not talk except to say “sshhh” or “night night” and def do not turn on any lights.
• Shorten your helping go back to sleep routine each night.
• Pick up when hungry to feed at night, and feed quickly and baby will go back to sleep quickly. Baby will get more awake if has to cry it out for awhile. But, make sure really hungry.
• Be careful not pick up when making regular sleep noises and going through typical light phases. If waking for comfort, work on changing those associations.
• When waking a baby-try to wake when in lighter sleep stage, diaper change or use damp cloth to wipe face, strip down clothes, burp sitting, back rub, mess with feet, move arms and legs in exercise fashion, prop baby up in seat in middle of family activity, sit up and sing to baby (you may want to do this after daytime nap is more than 2-3 hours, so they will sleep well at night).
• Expose baby to natural light when he wakes in the morning.
• Waking at the same time each morning can help set your baby’s biological clock.

After four months:
• Babies are primed for early bedtime-as early as 6:30pm or 7; it isn’t early to bed, early to rise and most people put their babies to bed too late, causing overtired and meltdowns, etc-for time with baby after work change it time in the morning

Breaking Habits:
• Babies will love to fall asleep in mom’s arms, so try to put to bed when sleepy but not totally asleep so they can get the rest of the way on their own without mom (if trouble, p. 74, 147).
• Introduce a lovely (p.117)
• Pantley’s Gentle Removal plan (p. 126) for breast, bottle, or pacifier

Other things:
• Have tummy time for play
• Starting solid foods too early leads to more food allergies

14 comments:

Second Chances said...

As I'm reading this I'm trying to sleep train Dominic. It's totally not working! I read the book and have been putting him down sleepy but not sleeping and he just starts bawling everytime. Is he too young? 8 weeks this week.

Leila @ Little Catholic Bubble said...

These are very helpful! Of course, anyone who knows me knows that after eight kids, the only thing I swear by is the Miracle Blanket. www.miracleblanket.com. (Or, check the reviews on Amazon.) I don't know how I lived without it before baby number six. I wish I had known! I never had sleep issues after I discovered it, and the babies never had to cry it out. A win-win! :)

Sew said...

I actually thought this post was going to say:

Go with the flow.... hahahahaha

WheelbarrowRider said...

SC, I think at that age I knew these things were the goal, but they didn't always work that young. So I kept trying, but if I had to rock him to sleep, I did and just knew that I was trying to get away from that when possible. I never really let him cry hard for any extended time until after six months. Does that help? I didn't mean to make it sound like magic, but I know some many who weren't moving towards these ends and it really backfired on them later. But it is okay to flexible or you will go crazy, as you know. And I didn't mean to sound "perfect" either. Charlie slept 3 hrs every time I put him in the sling, so I did that for convenience, tried to move from it, and did have some issues when I finally said enough is enough, he can't do this forever. There was a period when, after no more sling sleep, he would only take 4 30 min naps (around 4 months or so). I realized I was paying for that convenience later.
Sew, there is definitely some go with the flow involved, not trying to sound overly prescriptive. But like I said, I think it is good to know what is ideal, and in general try to move in that direction without making either of you crazy. :)
Leila, I value your input so much. MUST CHECK OUT THIS BLANKET!
Btw, I don't think I have on here that I was very big into happiest baby on th.e block and so we did a tight swaddle, white noise, etc esp as an infant. Swaddling is huge! I loved my Ha.lo brand swaddl.e sleep sack combos I bought where you simply velcro the swadle part on and can still use the sleep sack beyond when they like to be swaddled. I want to do a "products I love post" but I am afraid I am running out of time. May start drafting one though, while my brain isn't mush...

WheelbarrowRider said...

Yup, miracle blanket is similar to my sle.ep sack swaddle-good stuff!

In case I left you with too dreamy of a picture, C had BAD reflux and we had to have him sleep on a wedge and get him on the right medicine (preva.cid dissolving tablets, which took forever to determine). It was one of the hardest to learn how to give/for him to take so young, but it was the only one that would work. During these times we dealt with my mastititis 5 separate times (which lead to him not getting enough food) and also battled colds that lasted over 4 weeks with congestion, which always ended with ear infections, which lead to multiple abx, which lead to GI distress and finally tubes around 15 months (in hinsight I would have done tubes sooner!). In there we had teething. But I am super grateful that somehow we had enough "normal" days, that I could trust my gut and know when and why my baby wasn't himself. Dh and I would say, he knows how to sleep (he slept his first 8 hr stretch at 8 weeks), but we would say "there is just something always going on, always an exception" so we didn't get those long stretches very often-only in btw the issues :) I am grateful we knew he could do it and could identify the issues. Again, trust you gut!

Thankful said...

Thanks for posting this! Does Charlie still need white noise to sleep? That is my only worry with using it.

WheelbarrowRider said...

Charlie has always slept without white noise for childcare, so I can pretty much guarentee he doesn't need it. We still use it to block out our noisiness at home. However, one thing I would have done differently is been louder while he was sleeping so he would have been more used to noise. I agree they really only need the white noise as infants for familiarity as they adjust to life outside the womb. Us using it to block out other noise was probably not wise, long term, because I don't think he is a very sound sleeper like second babies usually are.

Second Chances said...

Last night after reading your post and trying to sleep train Dominic, I realized that his nose was all stuffy. I think laying flat on his back made it difficult for him to breathe. So I swaddles him and put him in his infant rocker and he went right to sleep! We had a good night. So, yes, flexibility with the above being the ideal. Great post!

WheelbarrowRider said...

SC, I became a big fan of my congestion routine: suction the nose, run the humidifier and have baby sleep elevated (either in his carrier, the swing, on a wedge). The sleeping at an angle (at minimum) is also important for reflux and ear infections. We became all too familiar, and when we knew he needed them we def made these changes and it made all the difference. Glad he did better after this!
Must haves: good humidifier, good swaddle blanket, sling or other hands free carrier that you find comfortable, comfortable set up to nurse if applicable...my list is growing!

Megan said...

I love this book! It really helped me develop good sleeping habits for the girls!

Beth said...

Definitely going to try swaddling and laying him down awake this time! Luckily my kids are great sleepers now :)

allyouwhohope said...

Great info! My problem is C gets visibly tired or even falls asleep around nap time, yet when I put her down in her crib she clings to me and screams when I lay her down. She then cries for anywhere from 3-30 min. (and then takes a good nap). If I didn't let her cry, she'd never nap! And, like I said, she clearly needs one, she just completely wakes up and becomes super alert as we approach her crib. I HATE listening to her cry! It's heartbreaking. And it wouldn't be so bad of it had only lasted a few days but we're going on months.

Anyone have any suggestions? It's only during her naps.

Kaitlin @ More Like Mary said...

Thanks for posting this! I will definitely be checking back!

And I've seen the Miracle Blanket in action. We WILL have one of these before leaving the hospital!

Kelly said...

Very good suggestions. There is a "No Cry Sleep Solution" for toddlers and preschoolers too.