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Sunday, January 17, 2010

Baby Sleep Problems

Rose knows over the years moms and pediatricians have tried many ways help children fall asleep and stay asleep.  Here is an article that will give you some time-tested, proven techniques for infants and toddlers.


1. Develop a realistic attitude about nighttime parenting. Sleeping, like eating, is not a state you can force a baby into. Best you can do is to create a secure environment that allows sleep to overtake your baby. A realistic long- term goal is to help your baby develop a healthy attitude about sleep: that sleep is a pleasant state to enter and a secure state to remain in. Many sleep problems in older children and adults stem from children growing up with an unhealthy attitude about sleep—that sleep was not a pleasant state to enter and was a fearful state to remain in. Just as daytime parenting is a long-term investment, so is nighttime parenting. Teach your baby a restful attitude about sleep when they are young and both you and your children will sleep better when they are older.

2. Beware of sleep trainers. Ever since parenting books found their way into the nursery, sleep trainers have touted magic formulas promising to get babies to sleep through the night – for a price and at a risk. Most of these sleep-training techniques are just variations of the old cry-it-out method. And technology has found its way into nighttime baby care by providing tired parents with a variety of sleep-inducing gadgets designed to lull a baby off to sleep alone in her crib: oscillating cradles, crib vibrators that mimic a car ride, and teddy bears that "breathe." All promise to fill in for parents on night duty. Be discerning about using someone else's method to get your baby to sleep. Before trying any sleep-inducing program, you be the judge. Research  these schemes and read other parent product reviews before trying them on your baby, especially if they involve leaving your baby alone to cry. Does this advice sound sensible? Does it fit your baby's temperament? Does it feel right to you?

If your current daytime or nighttime routine is not working for you, think about what changes you can make in yourself and your lifestyle that will make it easier for you to meet your baby's needs. This is a better approach than immediately trying to change your baby. After all, you can control your own reactions to a situation. You can't control how your baby reacts. Use discernment about advice that promises a sleep-through-the-night more convenient baby, as these programs involve the risk of creating a distance between you and your baby and undermining the mutual trust between parent and child. On the surface, baby training sounds so liberating, but it's a short-term gain for a long-term loss. You lose the opportunity to get to know and become an expert in your baby. Baby loses the opportunity to build trust in his care giving environment. You cease to value your own biological cues, your judgment, and instead follow the message of someone who has no biological attachment, nor investment, in your infant.

Especially in the first six months, avoid sleep trainers who advise you to let your baby "cry-it-out." Only you can know what "it" is and how to respond appropriately to your baby. Using the rigid, insensitive "let-him-cry-it-out" method has several problems. First, it will undermine the trust your baby has for nighttime comfort. Second, it will prevent you from working at a style of nighttime parenting until you find the one that works best for you and your family and third, it may keep you and your doctor from uncovering hidden medical causes of nightwaking. Nightfeedings are normal; frequent, painful nightwaking is not.

3. Stay flexible. No single approach will work with all babies all the time or even all the time with the same baby. Don't persist with a failing experiment. If the "sleep program" isn't working for your family, drop it. Develop a nighttime parenting style that works for you. Babies have different nighttime temperaments and families have varied lifestyles. Keep working at a style of nighttime parenting that fits the temperament of your baby and your own lifestyle. If it's working, stick with it. If it's not, be open to trying other nighttime parenting styles. And, be prepared for one style of nighttime parenting to work at one stage of an infant's life, yet need a change as she enters another stage. Be open to trying different nighttime approaches. Follow your heart rather than some stranger's sleep-training advice, and you and your baby will eventually work out the right nighttime parenting style for your family.

4. Decide where baby sleeps best. There is no right or wrong place for babies to sleep. Wherever all family members sleep the best is the right arrangement for you and your baby. Some babies sleep best in their own crib in their own room, some sleep better in their own bassinet or crib in the parents' bedroom, other babies sleep best snuggled right next to mommy in the parents' bed. Many parents prefer a co-sleeper arrangement. Realistically, most parents use various sleeping arrangements at various stages during the infant's first two years. Be open to changing styles as baby's developmental needs and your family situation changes.


Sleep is not a state you can force your baby into. Sleep must naturally overtake your baby. Your nighttime parenting role is to set the conditions that make sleep attractive and to present cues that suggest to baby that sleep is expected. Try the following sleep tight tips, which may vary at different stages in your baby's development. What doesn't work one week may work the next.

Get baby used to a variety of sleep associations. The way an infant goes to sleep at night is the way she expects to go back to sleep when she awakens. So, if your infant is always rocked or nursed to sleep, she will expect to be rocked or nursed back to sleep. Sometimes nurse her off to sleep, sometimes rock her off to sleep, sometimes sing her off to sleep, and sometimes use tape recordings; and switch off with your spouse on putting her to bed. There are two schools of thought on the best way to put babies to sleep: the parent-soothing method and the self-soothing method. Both have advantages and possible disadvantages.

1. Parent-soothing method. When baby is ready to sleep, a parent or other caregiver helps baby make a comfortable transition from being awake to falling asleep, usually by nursing, rocking, singing, or whatever comforting techniques work.

* Baby learns a healthy sleep attitude – that sleep is a pleasant state to enter and a secure state to remain in.
* Creates fond memories about being parented to sleep.
* Builds parent-infant trust

So-called "Disadvantages": Because of the concept of sleep associations, baby learns to rely on an outside prop to get to sleep, so—as the theory goes—when baby awakens he will expect help to get back to sleep. This may exhaust the parents.

2. Self-soothing method: Baby is put down awake and goes to sleep by himself. Parents offer intermittent comforting, but are not there when baby drifts off to sleep.

So-called "Advantages": If baby learns to go to sleep by himself, he may be better able to put himself back to sleep without parental help, because he doesn't associate going to sleep with parents comforting. May be tough on baby, but eventually less exhausting for parents.

* Involves a few nights of let-baby-cry-it-out
* Risks baby losing trust
* Seldom works for high-need babies with persistent personalities
* Overlooks medical reasons for nightwaking
* Risks parents becoming less sensitive to baby's cries

Remember, in working out your own parenting-to-sleep techniques and rituals, be sensitive to the nighttime needs of your individual baby and remember your ultimate goal: to create a healthy sleep attitude in your baby and to get all family members a restful night's sleep.

6. Daytime mellowing. A peaceful daytime is likely to lead to a restful night. The more attached you are to your baby during the day and the more baby is held and calmed during the day, the more likely this peacefulness is to carry through into the night. If your baby has a restless night, take inventory of unsettling circumstances that may occur during the day: Are you too busy? Are the daycare and the daycare provider the right match for your baby? Does your baby spend a lot of time being held and in-arms by a nurturant caregiver, or is he more of a "crib baby" during the day? We have noticed babies who are carried in baby slings for several hours a day settle better at night. Babywearing mellows the infant during the day, behavior that carries over into restfulness at night.

7. Set predictable and consistent nap routines. Pick out the times of the day that you are most tired, for example 11:00 a.m. and 4:00 p.m. Lie down with your baby at these times every day for about a week to get your baby used to a daytime nap routine. This also sets you up to get some much-needed daytime rest rather than be tempted to "finally get something done" while baby is napping. Babies who have consistent nap routines during the day are more likely to sleep longer stretches at night.

8. Consistent bedtimes and rituals. Babies who enjoy consistent bedtimes and familiar going-to-sleep rituals usually go to sleep easier and stay asleep longer. Yet, because of modern lifestyles, consistent and early bedtimes are not as common, or realistic, as they used to be. Busy two- income parents often don't get home until six or seven o'clock in the evening, so it's common for older babies and toddlers to procrastinate the bedtime ritual. This is prime time with their parents and they are going to milk it for all they can get. In some families, a later afternoon nap and a later bedtime is more practical. Familiar bedtime rituals set the baby up for sleep. The sequence of a warm bath, rocking, nursing, lullabies, etc. set the baby up to feel that sleep is expected to follow. Capitalize on a principle of early infant development: patterns of association. Baby's developing brain is like a computer, storing thousands of sequences that become patterns. When baby clicks into the early part of the bedtime ritual, he is programmed for the whole pattern that results in drifting off to sleep.

9. Calming down. Give baby a warm bath followed by a soothing massage to relax tense muscles and busy minds. Be careful, though, because this will stimulate some babies.

10. Tank up your baby during the day. Babies need to learn that daytime is for eating and nighttime is mostly for sleeping. Some older babies and toddlers are so busy playing during the day that they forget to eat and make up for it during the night by waking frequently to feed. To reverse this habit, feed your baby at least every three hours during the day to cluster the baby's feedings during the waking hours. Upon baby's first night waking, attempt a full feeding, otherwise some babies, especially breastfed infants, get in the habit of nibbling all night.


Many infants need help making the transition from being awake to falling asleep, which is really a prolongation of the bedtime ritual that conditions baby that sleep is expected to soon follow.

11. Nursing down. Nestle next to your baby and breastfeed or bottlefeed him off to sleep. The smooth continuum from warm bath, to warm arms, to warm breast, to warm bed is a recipe for sleep to soon follow.

12. Fathering down. Place baby in the neck nestle position (nestle baby's head against the front of your neck with your chin against the top of baby's head. The vibration of the deeper male voice lulls baby to sleep) and rock your baby to sleep. If baby doesn't drift off to sleep while rocking, lie down with your baby, still in the neck nestle position, and let baby temporarily fall asleep draped over your chest. Once baby is asleep, ease the sleeping baby into his bed and sneak away.

13. Rocking or walking down. Try rocking baby to sleep in a bedside rocking chair, or walk with baby, patting her back and singing or praying.

14. Nestling down. For some babies, the standard fall-to-sleep techniques are not enough. Baby just doesn't want to be put down to sleep alone. After rocking or feeding baby to sleep in your arms, lie down with your sleeping baby next to you and nestle close to her until she is sound asleep. We call this the "teddy- bear snuggle."

15. Wearing down. Some babies are so revved up during the day that they have trouble winding down at night. Place your baby in a baby sling and wear her around the house for a half-hour or so before the designated bedtime. When she is fully asleep (see limp-limb sign) in the sling, ease her out of the sling onto her bed. For babies who are used to nursing off to sleep in a mother's arms, fathers can wear their baby down to sleep and give mother a break.

Wearing down is particularly useful for the reluctant napper. When baby falls asleep in the sling, snuggled with his tummy against your chest or draped over your chest once you lie down, you both can take a much-needed nap.

16. Swinging down. Wind-up swings for winding down babies are a boon to parents who have neither the time, energy or creativity to muster up rituals of their own. Tired parents will pay anything for a good night's sleep. Once in a while a moving plastic seat may be more sleep inducing than a familiar pair of arms. Sometimes high-need babies associate a parent's body with play and stimulation and will not drift off to sleep in a human swing. For them the mechanical one is less stimulating, if not downright boring, and therefore can be a useful part of a sleep-ritual repertoire. Yet remember, high-need babies are notoriously resistant to mechanical mother substitutes and will usually protest anything less than the real mom. Before you actually spend money on a swing, you might want to borrow one for a week or two to see if the spell of the swing will last. You may discover that you are uncomfortable with mechanical mothering and decide to get more creative. Still, swings have their moments.

17. Driving down. If you've tried all the above transitioning techniques and baby still resists falling asleep, place baby in a carseat and drive around until she falls asleep. When you return home and baby is in a deep sleep, carry the carseat (with the sleeping baby) into your bedroom and let baby remain in the carseat until the first nightwaking. If she is in a deep sleep (witness the limp-limb sign – hands unclenched, arms dangling loosely at her side, facial muscles still), you may be able to ease her out of the carseat into her own bed.

18. Mechanical mothers. Gadgets to put and keep baby asleep are becoming big business. Tired parents pay high prices for a good night's sleep. It's all right to use these as relief when the main comforter wears out, but a steady diet of these artificial sleep inducers may be unhealthy. We remember a newspaper article extolling the sleep-tight virtues of a teddy bear, with a tape player in his stuffing that sings or makes breathing sounds. Baby can snuggle up to the singing, breathing, synthetic bear. Personally, we are not keen on our babies going to sleep to someone else's canned voice. Why not use the real parent?


Now that you've learned all the tricks of the nighttime trade to get your baby to sleep, here are some ways to keep your baby asleep. Because of the characteristics of babies' sleep cycles and easy arousability from sleep, you will notice that we purposely omit what we call the "harden your heart" method: put your baby down to sleep awake in a crib in his own room, put cotton in your ears, and let him cry himself to sleep. When he awakens, don't go into him. He will soon learn to put himself to sleep and back to sleep. We believe that this method is unsafe, runs the risk of baby losing trust, and, for infants with persistent personalities, doesn't work. Try these tips to help your baby sleep increasingly longer stretches at night.

19. Dress for the occasion. Try various ways of swaddling your baby at night. In the early months, many babies like to "sleep tight," securely swaddled in a cotton baby blanket. Older infants like to sleep "loose," and may sleep longer stretches with loose coverings that allow them more freedom of movement. Oftentimes, dressing a baby loosely during the day, but swaddling him at night, conditions the baby to associate sleep with swaddling. A baby who gets too hot or too cold may become restless. Adjust the layering according to the temperature of the room and the sleep habits of your baby. Allergy-prone babies sleep better in 100 percent cotton sleepwear.

20. Quiet in the bedroom. Since most babies can block out disturbing noise, you don't have to create a noiseless sleeping environment, yet some babies startle and awaken easily with sudden noises. For these babies, oil the joints and springs of a squeaky crib, put out the dog before he barks and turn the ringer off on the phone.

21. Darkness in the bedroom. Use opaque shades to block out the light, which may get you an extra hour of sleep if you have one of those little roosters who awakens to the first ray of sunlight entering the bedroom.

22. Sounds to sleep by. Repetitive, nearly monotonous sounds that lull baby to sleep are known as white noise, such as the sounds of a fan, air conditioner, or even tape recordings of womb sounds or vacuum cleaner sounds. Also, try running water from a nearby faucet or shower, a bubbling fish tank, a loudly ticking clock, or a metronome set at sixty beats a minute. (These can all be tape-recorded.) Try music to sleep by, such as tape recordings of waterfalls or ocean sounds, or a medley of easy-listening lullabies on a continuous-play tape recorder. These sleep-inducing sounds remind baby of the sounds she was used to hearing in the womb. (See 11 Ways to Soothe Fussy Babies for more sleep-inducing tips.)

23. Music to sleep by. Try a continuous-play tape recording of your baby's favorite lullabies, so when she awakens she can resettle herself to the familiar sleep-inducing sound of the tape-recording. You can make a medley of your own lullabies that have been proven sleep-inducers.

24. Leave a little bit of mother behind. If you have a separation-sensitive baby, leave a breast pad in the cradle, or play a continuous tape recording of yourself singing a bedtime lullaby.

25. A full tummy (but not too full). While stuffing baby with a glob of cereal before bedtime seldom works, it may be worth a try. A tablespoon or two given to a baby over six months of age may get you an extra hour or two. Tiny babies have tiny tummies, a bit bigger than the size of their fist. So, your baby's digestive system was designed for small, frequent feedings, which is why, in the early months, babies feed at least every 3 to 4 hours at night and more often during the day. (See Foods for Sleep)

26. Lessen physical discomforts.

1) Clear the nose. In the early months, babies need clear nasal passages to breathe. Later they can alternatively breathe through their mouth if their nose is blocked. Bedroom inhalant allergies are a common cause of stuffy noses and consequent nightwaking. Dust-free your baby's bedroom as much as possible. (Remove fuzzy blankets, down comforters, dust-collecting fuzzy toys, etc.) If your baby is particularly allergy-prone, a HEPA-type air filter will help. As an added nighttime perk, the "white noise" from the hum of the air filter may help baby stay asleep.

2) Relieve teething pain. Even though you may not yet be able to feel baby's teeth, teething discomfort may start as early as three months and continue off and on all the way through the two-year molars. A wet bedsheet under baby's head, a drool rash on the cheeks and chin, swollen and tender gums, and a slight fever are telltale clues that teething is the nighttime culprit. What to do? With your doctor's permission, give appropriate doses of acetaminophen just before parenting your baby to sleep and again in four hours if baby awakens.

3) Change wet or soiled diapers. Some babies are bothered by wet diapers at night, most are not. If your baby sleeps through wet diapers, there is no need to awaken her for a change – unless you're treating a persistent diaper rash. Nighttime bowel movements necessitate a change. Here's a nighttime changing tip: If possible, change the diapers just before a feeding, as baby is likely to fall asleep during or after feeding. Some breastfed babies, however, have a bowel movement during or immediately after a feeding and will need changing again. If you are using cloth diapers, putting two or three diapers on your baby before bedtime will decrease the sensation of wetness.

4) Remove irritating sleepwear. Some babies cannot settle in synthetic sleepwear. A mother in our practice went through our whole checklist of nightwaking causes until she discovered her baby was sensitive to polyester sleepers. Once she changed to 100 percent cotton clothing, her baby slept better. Besides being restless, some babies show skin allergies to new clothing, detergents and fabric softeners by breaking out in a rash.

5) Remove airborne irritants. Environmental irritants may cause congested breathing passages and awaken baby. Common household examples are cigarette smoke, baby powder, paint fumes, hair spray, animal dander (keep animals out of an allergic child's bedroom), plants, clothing (especially wool), stuffed animals, dust from a bed canopy, feather pillows, blankets, and fuzzy toys that collect lint and dust. If your baby consistently awakens with a stuffy nose, suspect irritants or allergens in the bedroom.

27. A warm bed. Placing a warm baby onto cold sheets can cause trouble. Especially in cold weather, use flannel sheets or place a warm towel on the sheets to warm them, and remove it before placing baby on the warmed sheets.

28. Create the right bedroom temperature and humidity. A consistent bedroom temperature of around 70 degrees F is preferable. Also, a relative humidity of around 50 percent is most conducive to sleep. Dry air may leave baby with a stuffy nose that awakens him. Yet, too high a humidity fosters allergy-producing molds. A warm-mist vaporizer in your baby's sleeping area helps maintain an adequate and consistent relative humidity, especially with central heating during the winter months. (And, the "white noise" of a consistent hum may help baby stay asleep.)


When your baby awakens, develop a nighttime parenting approach that respects your baby's need for nighttime trust and comfort, in addition to the need for baby and parents to quickly get back to sleep. While some babies are self-soothers, being able to resettle easily and quickly without outside help, others (especially those high-need babies with more persistent personalities) need a helping hand (or breast, or whatever tool you can muster up at 3:00 a.m.). Try these back-to-sleep comforters:

29. Laying on of hands. Determine what your baby's nighttime temperament is. Is your baby a born self-soother who awakens, whimpers, squirms, and then resettles by herself? Or is your baby, if not promptly attended to, one whose cries escalate and becomes angry and difficult to resettle? If you can get to your baby quickly before she completely awakens, you may be able to resettle her back to sleep with a firm laying on of hands. To add the finishing touch, pat your baby's back or bottom rhythmically to match your heartbeat. Remove your hands gradually – first one and then the other – easing the pressure slowly so as not to startle baby awake. Sometimes fathers, perhaps because they have larger hands, are more successful in this hands-on ritual.

30. Honor your partner with his share of nighttime parenting. It's important for babies to get used to father's way of comforting and being put to sleep (and back to sleep) in father's arms, otherwise mothers burn out. A father's participation in nighttime parenting is especially important for the breastfeeding infant who assumes the luxury that "mom's diner" is open all night.

31. Detect hidden medical causes of nightwaking. If you've tried all these techniques and your infant is still waking up frequently – and painfully – suspect there may be an underlying medical problem contributing to your baby's nightwaking. (See Hidden Causes of Nightwaking) One of the most common hidden medical causes of nightwaking (and colicky behavior) in babies is a condition known as gastroesophageal reflux (GER). Due to a weakness of a circular band of muscle where the esophagus joins the stomach, irritating stomach acids are regurgitated into baby's esophagus, causing pain like adults would call heartburn. Clues that your baby may be suffering from GER are: painful bursts of nightwaking fussiness, particularly after eating; frequent spitting up (although not all babies with GER spit up regularly); frequent bouts of colicky, abdominal pain; frequent bouts of unexplained wheezing; and hearing throaty sounds after feeding. Another hidden medical cause of nightwaking is allergies to formula or dairy products, either in milk-based formulas or in dairy products in a breastfeeding mother's diet. Clues that milk allergies may be causing nightwaking (and colicky behavior) are bloating, diarrhea and a red rash around baby's anus, in addition to many of the signs described above under GER. If your baby is not only waking up frequently, but waking up "in pain," discuss these two medical possibilities with your doctor, since both can be diagnosed and treated, giving everyone in the family a more peaceful night's sleep.

The above tools not only help your short-term goal of getting your baby to sleep, but, more importantly, create a healthy sleep attitude that lasts a lifetime. A baby who enjoys this style of nighttime parenting learns that sleep is a pleasant state to enter and a secure state to remain in. Therein lies the key to nighttime parenting.

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