Sleep: Every New Parent's Dream -- Elizabeth Pantley -- 10/16/2003

By Elizabeth Pantley
WebMD Live Events Transcript

For most new parents gold, silver, and winning lottery tickets are all worth less than a few good hours of precious sleep. If you and your baby need more Zs in your day, read sleep expert Elizabeth Pantley's tips on helping the whole family sleep tight. She was our guest on Oct. 16, 2003, as part of the WebMD "Baby Bootie Camp" University.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD University: "Bootie Camp: A 4-Week Guide to Baby's First Year." Your instructor today is Elizabeth Pantley, author of The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night. Today she will share her tips on helping the whole family sleep tight.

Support for this WebMD University course provided by Blue Cross Blue Shield of Massachusetts.

Member question: How much sleep does a baby need? How will I know if she is getting enough or too much sleep?

Pantley: Great question! In my book, The No Cry Sleep Solution, I have a chart of average hours of night and nap sleep, keeping in mind that babies are different; they all have similar sleep needs. You can usually tell if your baby is not getting enough sleep if he falls asleep anytime you are in the car! Babies lacking sleep can also be very fussy and hungry and unsettled. As an example, a 9 month old should have two naps of about two to four hours and sleep 11 to 12 hours at night (not unbroken -- of course!)

Member question: Are you saying two naps of two to four hours each? My 7 ½ month old only naps about 2 1/2 hours (in two separate naps) a day!

Pantley: Your 7 month old should nap a total of about 4 hours, broken into two naps. And lots of little ones don't nap enough and it causes more night-sleep problems. Let's talk about naps a minute. Good naps make for better night sleep. And better night sleep makes for better naps. It's a circle. So, here are a few ideas to encourage better naps.

First, watch your baby for any of these signs that she is tired and immediately put her for nap:

  • Losing interest in playthings
  • Rubbing eyes
  • Looking glazed
  • Fussing
  • Yawning

Sometimes babies give tired signs and we launch into a long getting-ready-for-bed routine and by the time you get him to bed he's got a second wind and won't nap!

Another idea is to put a reluctant napper into the stroller in the house! Walk around over doorway bumps and lull him to sleep. Park the stroller, and if he stirs then jiggle or bounce him back to sleep until he's had a full nap. Better naps will improve nighttime sleep; longer naps equal longer night sleep. Strange but true!

Member question: I have a question about lengthening naps. You say that if the baby is waking up from the nap and you are fast enough to "resettle," and if you are consistent, within a week or so the baby should start sleeping longer. We've been trying this for about two months and our son still needs to be "resettled" every single nap (he wakes up after 30 minutes or so).

Pantley: Have you tried the stroller idea? Sounds like your baby is still dependant on you to help him to sleep. Remember the "condition" story -- if you fall asleep with a pillow and blanket, but wake up on the kitchen floor you'll look for your pillow and blanket to go back to sleep. Help your baby accept a different condition for going back to sleep -- like the stroller or a swing, or a bouncy cradle. Also make sure you're watching for those sleepy signs. Consistent white noise helps too -- it drowns out the noise of outside (a fan, bubbling fish tank, etc.).

Member question: At what age do you think it is too early for an infant to sleep an eight-hour stretch?

Pantley: Again, every baby is different. But most babies wake two to three times a night or more up to 6 months old, and once or twice a night up to a year. Many continue with one waking a night until about age 3. The medical definition of "sleeping through the night" is a five-hour stretch. That's not by any means my idea of "through the night" but it is a baby's!

Although babies are all different, there are lots of ways to encourage longer sleep stretches, such as keeping the room dark at night and minimizing interaction (in other words, no nighttime play sessions!)

Member question: Hi EP! My 5 month old is a breastfed, co-sleeping girl. She used to sleep in two to three hour stretches with occasional four-hour stretches. Now it's one- to two-hour stretches with rare three-hour stretches for the past three weeks. Is this a phase?

Pantley: You sound like about 20,000 of my other readers! We so love our babies, but it can be very hard to be woken up every few hours. I've been there! Some babies are grand newborn sleepers but then around 4 to 5 months old begin to change their sleep habits -- then we have to change what we do. What you may be doing -- as lots of co-sleeper/breastfeeding moms do -- is responding to every little grunt, movement, or sniff with an automatic feed. Instead, wait a minute and see if this is just a sleeping noise. If you wait she may go back to sleep on her own. You'll be surprised.

We almost teach our baby to expect a feeding at every night waking -- and all human beings have many natural wakings. The key is to be patient to see if your little one really needs to be fed, or if she can fall asleep without your assistance. That's the sleep-association thing. When your baby always falls asleep the same way, she will always expect those conditions. You want to slowly and lovingly modify the conditions so that you aren't one of the key components.

Also, always remember how fast babyhood passes. My oldest is turning 16! She drives a car and has a boyfriend. Now I'm the one staying up all night, LOL.

Member question: Is it necessary to put them to nap in their nighttime sleeping location -- the crib?

Pantley: Your baby can nap and night-sleep in two different places. That's very common. Perhaps a cradle in the family room for naps, or a crib for naps and a crib for night or co-sleeping at night. All combinations work. Babies like routines and many get very used to the two-location idea.

Remember parents: If you've tried for 15 to 20 minutes to get your baby to nap and he won't sleep then he's not tired. Go play for an hour and then try again. Don't frustrate yourself trying to get a not-sleepy baby to sleep.

Member: I'm on the first 10 days of my sleep program. I do wait to see if she'll settle on her own. It works maybe one in five times.

Pantley: One in five is a great start! Keep with it and you should see more improvement.

Member: She seems to get frustrated with the PPO technique. It can go on forever, it seems.

Pantley: Ah yes! The famous PPO. Let me explain for those that don't know it. It's my creation for helping the baby who must breastfeed (or bottle feed or pacifier) to sleep every single time until he is totally asleep and the nipple falls out of his mouth. Lots of you are probably there! Sucking to sleep is the strongest sleep association because it has so much pleasure for baby.

The Pantley Pull-Off is an idea to help your baby not need to suck to sleep, but requires no agony of crying for either of you. Instead of just saying "no more" and dealing with hours of crying, this is how it works:

  • Let your baby suck until he is very sleepy but not yet totally asleep, then break suction and see if he'll accept that.
  • He may root for the nipple, then go ahead and give it back (breast, bottle, or pacifier)
  • Count to 10 -- one thousand, two thousand and so on.
  • Then try again -- break suction and see if he will accept this.
  • You might even gently close his mouth for him with your finger on his chin.

Most parents report that at first it takes five to 10 removals before baby finally 'gives up' and turns over and goes to sleep. But over the next week gradually your baby gets used to falling asleep without sucking and eventually he'll even unlatch himself and roll over and go to sleep! It's an amazing moment!

Member question: My baby only seems to get agitated by PPO, how many weeks should it take her to get used to this?

Pantley: It depends on how important this is to you. If you really want it to work, the key is to remove your baby earlier in the process and pat, rub, or rock her to sleep. As I've said, that sucking to sleep pattern is the very hardest to break because babies love it so much. But -- gosh -- it sure keeps us mothers awake!

The Pull Off should be modified to fit you and your baby. Maybe you decide that six times is your limit. At six give it up and let her suck to sleep. No sense in you getting angry about it. It takes time. Also, try to use different falling asleep methods for the first falling asleep of the night -- singing, rocking, swinging, swaddling, anything but sucking. It's a challenge -- but can be a real key for helping Baby sleep without your constant supervision.

Member question: My son has no trouble falling asleep but he keeps waking himself up as he has just learned to roll over onto his stomach. Should we let him cry or continue to get up and roll him back onto his back? We've been doing this for two weeks now.

Pantley: Oh yes, those developmental milestones: Rolling, learning to crawl, learning to stand, and learning to walk. All these can wake a baby who hasn't yet mastered the skill. As long as your baby isn't a newborn (all newborns should sleep on their backs -- newborns should be gently returned to sunny-side up) you can wait and see if he falls back to sleep on his own. Also, practice rolling all day long to help him master the skill!

Member question: I was motivated to move my baby to his crib after he became an all-night nurser. I read your book and the Pull-Off method didn't work for him, and I was not responding to every grunt or movement. It was his way of putting himself back to sleep and staying asleep. We still have this problem, as he starts out the night in his crib but after a couple wakings we cave in and go get him. He is capable of putting himself back to sleep but keeps waking anyway. Help!

Pantley: Well, he's a smart little guy and knows what he wants! You need to make a sleep plan and follow it. When you say you always 'cave in' he knows that and just waits for you to bring him to bed. You might try putting a mattress on the floor in his room -- very safe room of course -- and help him to sleep there, and then leave when he's sleeping. Lots of people use the crib mattress and set it up just like the crib was, transferring to a toddler bed of sorts on the floor so you can parent your little one to sleep and then leave to let him learn how to sleep on his own. Baby steps -- just like all sleep ideas!

Member question: At night, my daughter thrashes her head back and forth, makes "unh" sounds, and grabs blankets to her face. When she does this I pick her up and nurse, apply Pantley's removal technique, and lay her down again while she's still drowsy so that she'll learn to fall back asleep on her own. This occurs every two hours all night! My question is whether these are some of the "sleeping noises" I'm supposed to ignore while she works through them? The longer I wait to see if she'll fall back asleep, the more voracious she is at the breast. I suspect she was really hungry/thirsty and if that's the case, then I don't ever see changing this routine of every two hours.

Pantley: Depending on how old your baby is you'll be able to determine if she's truly hungry. If she's hungry feed her of course. If she's just doing the sleeping noises thing then wait. You might also feed her more during the day -- see if that helps.

Member question: My son goes to sleep each night around 7:30. At around 4:30 every morning he wakes up alert and ready to go. It takes about a half hour of rocking and soothing to get him back down. Once I do this he sleeps until 6:30 a.m. or 7 a.m. I have found that if I do not get him back to sleep when he wakes up, he is cranky and fussy the next day. Is there anyway to avoid this 4 a.m. waking thing he has?

Pantley: Actually a half hour is not bad at all. You're doing the right thing if he goes back down 'til 7 a.m. Keep up the pattern and keep the room very dark and quiet and over time you'll see him give up this awakening.

Member question: Why do all of the other mothers I talk to tell me that their children are sleeping eight hours at a time by 2 months?

Pantley: They aren't being truthful? All kidding aside, my research showed that very, very few babies are sleeping all night at 2 months. I had one of four and that was just pure luck! Eight hours is really too much for a 2 month old who needs to feed more often. A few do this, but it's only OK if they are feeding well at all other times and of a good height and weight. Lots of people don't like to admit that their baby keeps them up all night!

Member question: What do you do when your baby has learned how to stand up and you want to put him down sleepy, but he just stands up again, because he wakes up fully?

Pantley: This is that developmental surge stage that passes usually quickly. I would settle him back down, rub his back or pat him and help him to settle down. Also soft music, white noise, and a dark room can be helpful.

Member question: Our son was sleeping 10 hours straight from 1 1/2 months through 3 months, then at 3 months old, he started waking up in the night and not napping as well as he was. I tried the suggestions in your book, but nothing is working consistently. The last two nights he has been up every hour, and then up from 2 a.m. to 5 a.m. straight, just talking and playing with his feet.

Pantley: Someone earlier talked about that -- Some babies are great newborn sleepers but then show their true colors at about 3 to 5 months of age. Following a complete sleep plan is important, since all the pieces come together like a puzzle. So many things affect baby's sleep: teething, growth, learning, and routines. Which reminds me! It's so important to have a complete prebedtime routine to create going-to-sleep cues for your baby. Having a bath, a massage, getting into jammies, soft music, and nursing. These are all part of a good prebed routine.

Member question: My son uses my face as a lovey, poking my eyes, nose, mouth, etc. He has never accepted a lovey; he just throws it away and goes back to my face. Is there any way I can wean him off of this annoying habit without him screaming and crying because he wants to touch my face? It just seems much easier to give in, because he'll fall asleep soon after, but it makes it difficult to get past phase 2.

Pantley: Oh, my yes -- this one is so common! I remember years ago one mom telling me her 4 year old still had to rub her breast to fall asleep since he did it while nursing and she never stopped the habit!

This is one you can change by putting a tiny, soft lovey toy in his hand when he is rubbing your face. Don't demand that he have it; instead just gently introduce it. Also, try turning him over and giving him a back rub or foot rub. That way you can break the pattern. Or try giving him a two-handled sipper cup and telling or reading him a story, changing the usual routine to exclude this.

Member question: What exactly is a lovey? A blanket? A toy?

Pantley: A lovey is a very small soft toy (like a stuffed animal) without buttons or other hazards. Many companies make "Lovies" just for young babies. They help a baby feel comforted when you aren't there, such as during sleep.

Member question: My baby gets so cranky by 6 p.m. that the only prebedtime routine we can manage is getting her jammies on and nursing her. Is this enough?

Pantley: Yup. As long as she's tired -- just put her to sleep.

Member question: We are having a really hard time right now. Our son just moved from his crib to a toddler bed, because he really hated his crib and we couldn't get to him to comfort him. Anyway, he is nursing quite a bit in the middle of the night and we want to try to limit the night feedings, but he won't stay in his bed. Is there any pleasant way to wean the baby from night feedings?

Pantley: Yes. There are lots of ideas!

  • Try white noise to keep him sleeping (a fish tank works well, no fish necessary).
  • Also make sure he likes his bed and room -- maybe rearrange it.
  • A lovely can help, if he has a special stuffed animal.
  • If you go to him during the night and settle him, it's important that YOU don't fall asleep and stay there -- because you become the lovey. You have to stay awake and go to your own bed.

Member question: What are the current safety rules about blankets, comforters, and pillows in a crib? Are bumper pads around the crib good to use?

Pantley: You've brought up a very important point. A safe sleeping place is key. I don't recommend using pillows or blankets with a young baby; blanket-sleeper-pajamas are much better. Bumper pads are OK as long as they are tightly secured with short strings in many places.

In The No Cry Sleep Solution I have safety lists for co-sleepers and for crib sleepers. Safety is most important! You can find some of this on my web site. My web site is easy: pantley.com. You can even see photos of my precious children there.

Member question: Is it OK to have some toys in the crib? Or does this make the crib a play place instead of a sleeping place?

Pantley: You are right. One or two small soft lovey toys are all that should be in there. Too many toys makes it playtime!

Member question: At what age may a baby be left to sleep on her tummy when she rolls over?

Pantley: This is a hard question to answer, and no expert will give you an exact age. A baby must not be a newborn. He must be strong enough to hold his head up and roll over on his own. Also make sure there are no blankets or pillows! In research to combat SIDS, studies have proven conclusively that babies who sleep on their backs are less susceptible to SIDS than those who sleep on their tummies. Face up is the recommended sleep position for most healthy, full-term infants. You can ask your doctor about whether it's OK for your baby to sleep on his tummy.

Member question: Is it possible that adult and canine snoring is waking our little co-sleeper at night? She seems to be able to sleep through much noisier things during the day!

Pantley: Yes, indeed! Our own noises and movements can add night wakings. Babies can be more sensitive to noises and movement at night than during the day for naps.

Member question: Only three people can get our son to sleep: me, my husband, and my mom (she baby-sits regularly). We would like to have other people baby-sit for us, but we're worried about someone new having problems and not knowing the little details of how to get him to sleep. Should we go ahead and try a new baby-sitter now, or wait 'til he can get himself to sleep without so much help?

Pantley: That depends on how important it is to you. If you need times to have a baby-sitter, you can teach the sitter how to help relax your baby. If it's not frequent don't expect miracles! Lots of babies will only sleep for mommy or daddy. That's natural. Usually by age 2 or 3 that stops being a problem. If you have one person who will be sitting frequently, have that person over a few times so that baby gets comfortable with her.

Member question: If I play a lullaby while putting my baby to bed, won't she need me to come and turn on the lullaby in the middle of the night so that the conditions are the same as when she went to sleep?

Pantley: It depends on the baby. The key is to keep the music rather quiet. Many babies just need it to fall asleep. Some do benefit from having white noise on all night (like the comforting sounds of the womb). A fan or music tape that plays nature sounds (rain/ocean waves) can run all night on low volume with no harm. Babies outgrow this need.

Member question: My 2-year-old co-sleeper still wakes up to nurse three to five times a night. But she doesn't really wake up or open her eyes -- she just cries/wails/whines and it seems like she is still asleep -- and then she nurses for just a few minutes. I don't really have time to do the removal. But if I don't respond to her she will eventually wake up fully and then it will be a longer nursing session.

Pantley: Again, the answer lies in your heart and in your home. If this works for you, then don't worry about it. If it is disturbing to you then try substituting a pat or rub, or soft words for nursing. Remember to always have realistic expectations for your baby.

Member question: Any suggestions for daylight savings?

Pantley: Good question! It can be a challenge, but the best thing is to go by the clock for a few days and modify your baby's routine to suit the time. It can take a week for your baby to adjust but it will happen. Keep the room dark during sleep to encourage the adjustment, and open the blinds in the morning using light to signal wake up time!

Member question: My 5 month old will sleep for three to five hours in her swing in the wee morning hours, but wakes frequently in bed with us. Should we just be thankful that she sleeps in her swing and go with it, or should we try weaning her off of it?

Pantley: Lots of babies love sleeping in their swing because the movement resembles what they felt in the womb. Most outgrow this by 5 to 6 months of age. You can adapt the movement to a cradle or they even sell an attachment that "vibrates" a crib to create movement. I'd let her nap in the swing since the naps are so important to her (and to you!) You can move her after she's asleep if you'd like to see if you can help her adjust to a crib for naps. This will happen over time.

Member question: It seems we've been trying to improve our son's sleep patterns forever. He only seems to improve when he's ready. Is there a general age when children developmentally improve? I've heard people say that 18 months is an age when things tend to get better

Pantley: Every child is so different from every other child. I had one who didn't sleep all night until age 2 and one who slept all night at 6 weeks old! There are so many factors. But keep in mind that there are lots of things we do can help any baby sleep better. We've covered lots of those ideas today -- white noise, dark rooms, bedtime routines, earlier bedtimes, reading the baby's sleepy signals, and of course, patience.

Moderator: Before we wrap up do you have any final comments for us, Elizabeth?

Pantley: It's been wonderful chatting with all of you. Always remember that no matter what any expert says -- even me -- follow your heart when it comes to your baby. You know your own baby better than anyone else. Let your knowledge and your love -- in equal parts -- guide your parenting decisions.

Please visit me for more information on my web site at pantley.com and of course, my book is available to you at any online bookstore. If we haven't answered your question here today, please feel free to send me a brief email to elizabeth@pantley.com. God bless you and your babies.

Moderator: Thanks for joining us, members, and thanks to Elizabeth Pantley for sharing her expertise and experience with us. For more information, please read her book, The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night, and The Mother of All Baby Books by our course leader, Ann Douglas.



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