Babies’ sleeping issues

Hello everybody! Welcome to the Chicago Tribune health chat on infant and baby sleep issues. We will be getting started at noon.

OK, let’s get started as we already have questions pouring. I’m Julie Deardorff, your moderator. I’m also the mother of two young boys who tried both sleep training and the more gradual, gentle approach advocated by those who oppose “cry it out.” When I wrote about it, I quickly learned that putting an infant to sleep is one of the most emotionally charges issues parents face.
Today, we’re lucky to have two of the top experts in the field; pediatricians Dr. Marc Weissbluth and Dr. Bob Sears.

Dr. Weissbluth a professor of pediatrics at Northwestern Memorial Hospital, is a leading researcher on sleep and children, is probably best known for coining the phrase “sleep training” and his books, including “Healthy Sleep Habits, Happy Child” in which he stresses that children need to be put to sleep before they’re overtired.

Hi Dr. Weissbluth. Welcome to the chat.

Thank you. i am glad to be here and help.
Marc

We are also pleased to welcome Dr. Bob Sears, a pediatrician, and co-author in the Sears Parenting Library, including “The Baby Sleep Book,” which he co wrote with several family members, including his father, Dr. William Sears. Dr. Sears supports parents who choose co-sleeping as a nighttime parenting approach and is a frequent speaker at parenting conferences across the U.S.
Thank you being here.

Hello – I’m happy to be on the chat today

I want to start this off by asking why we need to be taught how to get our babies to sleep. Shouldn’t this be instinctual?

Parents today are busier than ever and more women are working outside the home. This means that babies and small children maight be kept up too late and they might not get great naps in day care. Also, digital distraction means that parents might miss drowsy signs and the child becomes way over-tired.
Marc

I don’t think most parents even need to be taught. Like most aspect of parenting, the choices we make regarding sleep can be just as instinctual. Most parents and babies DON’T have sleep problems at all. The thing is, we don’t hear from those parents. We only hear from those who do have problems. In my opinion, that’s actually the minority. I think most parents just naturally learn how to help their baby sleep well and how to get a good night sleep despite having a baby

Do what ever you can to maximize sleep but watch your baby closely over the next few weeks. Soon, you will note specific and responsive social smiles (about 6 weeks after the due date). When this occurs, your baby’s brain will allow your child to sleep 4-6 hours at night and the baby will want an earlier bedtime. Instead of falling asleep at 9-11pm, your baby will want to fall asleep between 6-8pm. Than it becomes important to put your baby to sleep at an erlier hour. This is the beginning of the night sleep rhythm.
Marc

Honestly, I think virtually every breastfeeding baby is going to wake during the night at least once, as long as the breastfeeding relationship continues. It’s really part of what you sign up for as a nursing mom (and more power to you). Nightnursing peaks at about 15 months, then starts to subside on its own in many cases. And she’s too old for an easy cry it out approach. So, if you can hang in there a few more months, things should get better. It’s VERY hard to purposely say no to nursing at night at this age, BUT by around 18 months, you can start saying no and teaching her that the breasts are asleep at night and they’ll wake up in the morning to nurse when the sun is up.

I really hear what you are saying. This won’t be easy. My suggestion would be to FIRST start putting her to bed in the crib (you’ll have to “parent” her to sleep for this), but when she wakes during the night, bring her into your bed. That’s really the easiest way for her to learn about the crib, for you to get some alone time, AND then for all of you to sleep through the rest of the night. What you’ll find is that as she gets older, she’ll start waking up later in the night, spend more hours in the crib, and eventually sleep through – meanwhile, you all get to enjoy a good night’s sleep (even though your child is in bed with you – you’ll all sleep anyway). Honestly, and THIS age, it’s very hard to transition COMPLETELY to the crib – your child won’t buy it. You’ll have to make it gradual

The single most important fact to remember is that the time when sleep occurs is more important than the duration of the sleep period. You can¿t fight circadian rhythms! We all have internal clocks that are genetically controlled. These clocks create an internal timing mechanism for sleep. These clocks evolved from dark (night)/light (day) cues. This signal is very primitive because it is based on the rotation of the earth on its axis. Sleeping in synch with circadian rhythms is more restorative, of better quality, than sleeping out of synch with circadian rhythms. Jet-lag syndrome is an example of sleep not in synch with circadian rhythms.
With an earlier bedtime (6-8pm) your child will sleep better.
Marc

Actually, a 1 hour nap is ok for that age. There’s no requirment for a baby to take LONG naps. I know it’s nice when it happens, and I think that once he starts crawling he’ll start getting more worn out and take longer naps. But for now, I’d just let him take whatever length of nap that he naturally does. He might grab an extra nap each day or he may not.

Nap rhythms emerge between 3-4 months of age. The morning nap rhythm starts mid morning around 9am and the mid-day nap between 12-2pm. When your child naps is most important and usually if the naps occur when the child is becomming drowsy, the naps should be longer.
Marc

I know that’s hard. (Actually, I don’t know – I slept thru most of this while my wife got up with the baby – kidding – I helped some). This actually sounds like teething pain. Many babies sleep great from 1 to 4 months, then teething hits and waking starts. So, I’d look for some good natural teething remedies like homeopathics or oils or numbing gels. Maybe ibuprofen or acetaminophen on occasion. PLUS, I would try shushing your baby back to sleep without nursing – let baby suck on your finger, try a pacifier, wake your spouse (if you can) and have him rock her back to sleep.

Back sleeping reduces the chance of SIDS.
Marc

Is there any truth to the notion that children sleep better on their tummies?

Some children sleep better on their stomach and some children in my practice sleep better on their back but all babies should be placed on theri back to prevent SIDS.

This again is likely teething – see my answer above. It maybe food sensitivities if you’ve started feeding him in the evenings. Work on the teething and see if that helps.
Sometimes, babies just wake up in that pattern and it can be normal. I know it’s not convenient, but this is somewhat a part of being a parent. IF you feel comfortable with your child in your bed, you could consider bringing him in at the first or second waking – maybe baby will sleep better the rest of the night.

Feed your baby if your baby is hungry. Most babies are fed once or twice overnight but if you are breastfeeding and your baby is in a co-sleeeper you might feed your baby much more often.

Actually, I would accept this as normal and count your blessings. One nightwaking is a dream for most parents.

This is very common – you can WEAR your baby in a carrier for naps. YOur or your wife could nap WITH him (that usually buys a longer nap). You can close the shades and put on some white noise or quiet music and that might help him nap longer alone, without you.

This sounds like it might be Sensory Processing Disorder. Now, don’t be scared by the word “disorder.” But it involves a baby’s sensory system being overloaded by sensations during the night and causing alot of nightwaking. You can talk to an OT who specializes in infant SPD.

The biological rhythms develop counting from post conceptual age so at 46 weeks post-conception, night sleep rhythms emerge (or 6 weeks after the due date).

I think that parents who don’t have a problem don’t talk much about it. Those who are having trouble, talk more about it and seek help. BUT YOU ARE RIGHT – every single parent doesn’t get as much sleep as they’d like to. But what I mean about what you asked is that most parents just accept it as a fact of parenting – they’d signed up for it and are willing to survive through it. Those parents whose babies wake MORE and really rob them of much needed sleep DO need help and solutions. That’s why we are hear. BUT I would say that many parents don’t actually consider it a problem.

There are published studies that show that when children are given the opportunity to learn to fall asleep unassisted (acquire self-soothing skills) no harm occurs. There are no published studies that show that when babies are allowed to cry in order to learn how to sleep better that harm occurs. This is discussed in detail in my blog (weissbluthmethod.wordpress.com)

I wouldn’t say BRAIN DAMAGE. And I would say that mild CIO is fine for babies. But I worry about INTENSE WEEKS of crying night after night. Here are some thoughts:
INTENSE CIO RAISES CORTISOL AND CAN CAUSE STRESS IN THE BRAIN:
Circulating throughout the bloodstream of every person, even tiny babies, is an adrenal hormone called “cortisol.” Produced by the adrenal glands, this hormone helps major systems of the body function normally. The body needs just the right amount of cortisol at the right times. Too much or too little, and the body is not in tune, sort of like an engine trying to run with the wrong mix of gasoline and air. Adrenal hormones are also known as stress hormones. Levels rise quickly to help a person react to a threat. Although stress hormones are needed in times of danger, if they remain too high for too long, the body becomes overstressed and certain systems, such as the immune system, can’t function as well. Experiments on both human infants and infant experimental animals showed these fascinating results about attachment research. :
* Human infants with the most secure attachment to their mothers had the best cortisol balance.
* The longer infant animals were separated from their mothers, the higher the cortisol levels, suggesting that these babies could be chronically stressed. The mothers also experienced elevated cortisol levels when separated from their babies.
* Prolonged cortisol elevations may diminish growth.
* Prolonged cortisol elevations may suppress the immune system.
* Infant animals separated from their mothers showed imbalances in the autonomic nervous system — the master control system of the physiology. They didn’t show the usual increases and decreases in heart rate and body temperature, had abnormal heartbeats (called “arrhythmia”), and showed disturbances in sleep patterns, such as a decrease in REM sleep (the stage of sleep in which an infant is most arousable in response to a life-threatening event). Similar physiological changes were measured in preschool children separated from their parents
* In addition to the agitation caused by prolonged elevation of adrenal hormones, separation sometimes caused the opposite physiological effect: withdrawn, depressed infants who had low cortisol levels.
* Separated infants showed more irregular heart rates.
* Infants separated from their mothers were less able to maintain a stable body temperature.
* Infant animals who stayed close to their mothers had higher levels of growth hormones and enzymes essential for brain and heart growth. Separation from their mothers, or lack of interaction with their mothers when they were close by, caused the levels of these growth-promoting substances to fall.
Clearly, the continued presence of a nurturing mother is important for the infant’s physiological and emotional well-being. A secure mother-infant attachment helps an infant’s physiological systems work better. Attachment organizes a baby’s overall physiological systems; separation disorganizes them.

The Myth of Total Sleep Duration
Some parents observe that their child is getting 12 hours of sleep (e.g. 9pm to 7am plus a 2 hour nap) and therefore they think that there is no problem. Sleep duration is probably less important than sleep quality (intensity, consolidated, and in phase with circadian rhythms). Watch your child betwen 4-5 pm to determine when the best bedtime is. Try an erlier bedtime for 3-5 nights.

Beth – In my opinion babies don’t need to learn to self soothe. They’ll learn that in time as they mature. Having said that, babies CAN learn to self soothe if that’s what the parents want or need. But some parents don’t want to teach self soothing early on. Some parents like to be the soother. And that’s fine. Such parents are signing up for the long haul, and such babies will require nighttime parenting for some years, but that’s a fine choice for any parent who wants that approach.

After night sleep has improved, it might take about a week for the morning nap to improve and another week for the mid-day nap to imporve. The overall improvement is sequential, not simultaneous. Be pateint!

I can’t condone putting a baby to sleep on the stomach, as this increases the risk of SIDS. For a colicky baby, consider food allergies as a contributor to nightwaking – go gluten free and casein free for a while and see if that helps. Probiotics can also help soothe the tummy to help.

I think such kids really need an attachment-style of parenting and nighttime parenting. They need to re-connect and attach to the care-giver. So, I would support a very attached approach in such cases.

Healthy Sleep Habits, Happy Twins will give you detailed information on how to sleep and co-sleep with your twins.

Try some gas drops with the bedtime feeds. If formula-feeding, ask your doctor about switching to a less gassy formula. If breastfeeding, have mom go gluten and casein free and take other gassy foods out of the diet. You can also repeat the gas drops during the night if needed. If breastfeeding, have your wife call La Leche League and ges some tips about reducing gas while nursing.

Most babies at 4 months of age do not need to fed more than twice at night. A test bottle of expressed breast milk given by father will clarify whether or not your baby is truely hungry at other times.

This is difficult. Our first baby did this, and we ended up just NOT putting our baby to bed early. We did a late afternoon nap, then let him stay up with us playing happily for the evening. He’d sleep until 10 am the next morning. This way we weren’t wasting our whole evening by trying to enforce sleep. If that doesn’t sound good, you could just wear him in a sling for the evening while he sleeps. You could also try a SWING for the evening. I don’t know if there’s an EASY solution to this.

Twins’ naps are tricky but you want to think of leeway. This means that you might have to wake one twin from a nap in order to maintain a semblence of a schedule for your own sanity! Separation of twins for naps is sometimes needed.

Healthy Sleep is Like Healthy Food
Consider the similarities between food and sleep. Let’s first think about food and food quality. Food is a biological need. Food is energy for the body. Poor quality food “junk food” damages the body by causing all manner of medical issues including malnutrition, anemia, diabetes, heart disease, and obesity. A little junk food is O.K., a lot is not.
Now let’s think about sleep and sleep quality. Quality sleep means consolidated sleep occurring in phase with circadian rhythms. Sleep is also a biological need. Sleep is energy for the brain; poor quality sleep harms the brain. Think of poor quality sleep as junk sleep. Junk sleep is just as bad for our children as junk food. Just as you read labels on food to determine quality, think of sleep quality for your child. You would not starve your child by withholding food; try to not let your child get short on sleep.
Junk sleep causes many problems. All of these points are based on peer-reviewed published research. These are not my opinions.
* Exhaustion, and we all know what that feels like!
* Impaired mood. Children become more irritable, angry, and easily upset; later on, junk sleep can cause or exacerbate depression and marijuana use in adolescents. Less able to regulate emotions.
* Impaired social and academic performance. Kids who are lacking sleep will be more hyperactive, oppositional, and aggressive. Less able to accurately recognize human emotional expressions
* Impaired cognitive development. Sleep incorporates learning into permanent memory, sleep causes memory consolidation, sleep enhances organizational skills, planning, multi-tasking, and executive functioning.
* Impaired personality. Children become fussy, more intense, more frightened, and less adaptable. ¿ Impaired hand-eye coordination (which impacts a whole host of functions like athletic performance and fine motor skills).
* Systemic inflammation, increased blood pressure, increased stress hormones, increased susceptibility to infections.
* Impaired glucose control which is a factor in diabetes, obesity.
* Maternal depression.

It’s hard to put an age limit on it, but in my opinion when a baby has co-slept and experienced “the good life” (from his perspective), it’s very hard to enforce CIO now. I think he might just not understand it and it might be too tough.
I’d work on the night-nursing and try to decrease that. It doesn’t have to be CIO. But you can say no to nursing.

It’s NOT about whose right and whose wrong – it’s all about YOUR parenting choice. Parenting ISN”T a science. It’s intuition. Now, IF you want to read some good science, there are some parenting books that discusses the science of attachment.
In my opinion, attachment science is very strong. But ultimately, YOU have to choose.

Just move her to the crib. Not to worry!

If she’s only waking once a night, I’d consider that sleeping pretty well. ALL of my kids won’t up once a night until they were about 4 or 5 – we just let them walk down the hallway and climb into a futon next to our bed. We wouldn’t even try to put them back down in their own bed – that was too much trouble and interupted our sleep too much. We made it easy on ourselves.

IT’S NEVER TOO LATE.
Sleep and Brain Development
Never Forget: Sleep Helps the Brain Develop
1. The sleeping brain is not a resting brain.
2. The sleeping brain functions in a different manner than the waking brain.
3. The activity and work of the sleeping brain are purposeful.
4. The process of falling asleep is learned.
5. Providing the growing brain with sufficient sleep is necessary for the ability to concentrate and an easier temperament.
Sleep is the power source that keeps your mind alert and calm. Every night and at every nap, sleep recharges the brain¿s battery. Unlike a light bulb that shuts down completely when it is turned off, your child’s sleeping brain is active and purposeful. Providing your child’s growing brain with quality sleep is necessary for its development. Sleeping well increases brainpower just as weightlifting strengthens muscles. Sleeping well makes your child physically relaxed and mentally alert; he is at his personal best. Sleep is not a luxury, sleep is a biological necessity.

Every child is an individual and we can’t always fit every child into our mold of what we think sleep should be. Sounds like she just has some unique needs for now and you are willing to meet those needs. This can just be a normal high need situation.

FOCUS ON SLEEP,
Crying is hard but sleeplessness is harder.
Sleep is a natural process and there will usually be few difficulties if we are patient and don’t interfere with it. Timing is most important but there are genetically-controlled individual differences between children regarding when their sleep rhythms develop and how long they sleep so don’t compare your child with other children. Naps and night sleep are related and both need to be in place to avoid sleep problems. Our goal is to have well rested families. But always remember, the amount of sleep our children need is measured by mood, behavior, and performance…not hours on a clock. The best advice I can give is: Let your child’s natural sleep rhythms do their job without interference from parents!

This is so common. It’s very normal. And it’s ok to continue to do what you are doing for now. You could lay down with him for the beginning of the nap, get some very dark shades and put on some white noise or music. That might help keep him asleep. Also, it’s OK to go with short naps – you could just let him do that. The dark room with music or while noise may eventually help.

My husband and I didn’t agree either and it made it much tougher. We tried sleep training, which I detailed here http://featuresblogs.chicagotribune.com/features_julieshealthclub/2007/08/the-agony-of-sl.html, but it was critical to see eye to eye on the issue.

I think that if there is disagreement between parents, the path of least stress should be taken regarding the child’s sleep until the parents can get on the same page. Remember, the child and the family will suffer if the child remains sleep deprived.

You can consider food sensitivities (casein and gluten) through the breastmilk. Also, consider GER as a cause of nightwaking. Check out info in our Baby Book or Portable Pediatrician Book

When the Bedtime is Too Late
What occurs when children are allowed to fall asleep too late at night? They wake up short of sleep in the morning. When you are short on sleep, then, even without caffeine, you get “keyed up” because your body produces stimulating chemicals such as cortisol, adrenaline, and noradrenaline. Then, if you suddenly go on vacation, it takes you a few days to “unwind” or dissipate the effects of the stimulating chemicals. This burst of energy is a primitive biological adaptive response so that early man could fight harder, hunt longer, or flee faster for survival. It’s like a turbo boost that we often call a “second wind.” When present, you are in a state of higher neurological arousal. When the bedtime is too late, he wakes up in the morning in a state of higher neurological arousal which causes him to have difficulty or inability to nap well.
The consequences of not napping well means that by the end of the day his sleep tank is empty and he is in an even higher state of arousal so it becomes more difficult for him to easily fall asleep and stay asleep at night. Parents might not see bedtime battles, long latency to sleep, or night waking resulting from a bedtime that is too late. But of course, he eventually crashes late at night. But this is preceded by an unhealthy state for the child, stressful interactions with him, and stressful interactions as a couple, and stress for each parent as an individual.
Sometimes the naps are very long and late (e.g. 1-4pm) because the bedtime is too late and the child’s sleep deprivation is masked by parents returning home from work and playing with the child.

That’s all we have time for; sorry we didn’t get to all the questions. Thanks to our experts for an interesting discussion!

Thanks everyone. Good questions here today. Thanks Marc for your input.

Thank you. Always remember that our goal is a well rested family!

Don’t forget out next chat on Thursday at 11 a.m. CT when Tribune reporter Bruce Japsen will discuss how health care reform will affect the role of neighborhood pharmacists.