Set Your Infant's Clock
Reviewed By Gary Vogin
Jennifer Drobny says that life with her 8-month-old daughter, Olivia, had become exhausting. The baby had never slept through the night. "We'd have to hold her and 'dance her' to sleep for an hour. Then she'd give us at most two hours' sleep and be awake again," says Drobny.
"I thought with my experience, we wouldn't have behavior problems," adds the 30-year-old mother, a graduate student at the University of Nebraska Medical Center. But after eight months of being awoken every two hours every night, Drobny was exhausted. Then she happened to run into psychologist Brett Kuhn in a hallway one day at the university. Kuhn, an assistant professor and pediatric sleep specialist, asked Drobny how she was doing. "I just started crying," she says.
Kuhn offered Drobny a solution to her (and her baby's) troubles: Let Olivia "cry it out."
That approach seemed awfully harsh to Drobny, at least at first. "I couldn't go cold turkey," she admits. After 10 days of preparing the baby for the change, Drobny left the house for two nights and let her husband Jeff launch the effort. Night 1 brought lots of awakenings and even a 90-minute crying fit. On night 2, things seemed to get better. Nights 3 and 4 were worse. Then a miracle: "She slept through the night last night," Drobny said after the fifth round.
Her advice to exhausted parents of night-rowdy infants: "Don't wait to get help."
And if you're stumbling through the day red eyed because your baby won't let you get sleep, there's more good news: The approach that proved successful for Drobny isn't the only thing you can try.
Night Means Sleep
Experts agree that there's not much parents can do to affect a baby's sleep cycle for at least the first month. The baby has no concept of day and night and doesn't associate night with sleep.
That means: Be prepared to feed, rock, dance, sing, or hum the little one to sleep. "Baby rules" for this period, advises psychologist Jodi Mindell, associate director of the Sleep Disorders Center at the Children's Hospital of Philadelphia and author of Sleeping Through the Night.
But at weeks 3-5, parents can start signaling their infant that night means sleep, says Kuhn. Keep the lights off or very low during night feedings. Keep sounds quiet. After feeding, put baby back in the crib. Don't socialize.
Between 6 and 12 weeks, "start developing sleep habits," says Mindell, who is also a board member of the National Sleep Foundation. Start a routine of laying the baby down for naps and overnight sleep at the same times every day and night. "Like adults, babies have an internal clock, and you want to get it set," she explains. The routine can include putting on pajamas, feeding, and singing a song. "You want the signal to be: When these things happen it means time to sleep," says Mindell.
So what if you lay your baby down and the crying starts? Leave the room for two to five minutes, Mindell advises. "Give the baby a chance to fall asleep alone." If the crying continues, go to your baby and give a backrub or more rocking. "Don't wait too long," she adds, or your baby can get so worked up sleep will be impossible. Most infants, however, get the "signal" in this "preventive stage."
If, at about six months, your baby is still waking up at night, begin leaving the room for 15 minutes. "Just tell them, 'Night-night,' and leave. If you have to go back in, reassure the baby, but do not pick him or her up. The calmer you are as a parent, the easier it will go ... Baby will take the signal," says Mindell, who's known for this "gentler" form of the "cry-it-out" method touted by Richard Ferber, MD, a widely known sleep specialist at Children's Hospital in Boston.
'Cry It Out'
Ferber says he believes in letting older infants cry themselves to sleep over several nights so they learn that, without question, night is for sleep. "My wife thought it sounded cruel," admits Kuhn, the Nebraska professor who is also a psychologist at the medical school's Munroe-Meyers Institute.
Kuhn's first daughter was about 4 months old and still waking up at night crying before his exhausted wife gave in and agreed to the cry-it-out approach. The baby cried 40 minutes nonstop the first night, 25 minutes the second, and, on the third, "It was just a whimper ... then she slept through the night after that," says Kuhn.
"And I kept getting smarter," he adds. With his second daughter, they started the approach younger and kept the baby up 30 minutes later than usual on those nights so she would be good and tired. With their third daughter, "Our biggest prevention strategy was to not hold her until she fell asleep, but put her in the crib while she was awake," says Kuhn. At 6 weeks, she was sleeping through the night.
Since most mothers have "a heck of a time letting baby cry," Kuhn tells fathers to lead the effort.
"It's worked for just about every kid I've ever seen at the clinic. And I've seen hundreds. By the third night, they fall asleep by themselves, sleeping through the night," Kuhn assures. He knows some people -- including Sears -- say the technique may harm a baby's trust in parents. But Kuhn disagrees: "Your 8-month-old is not going to grow up to be an 18-year-old on a psychiatrist's couch saying, 'My mom and dad let me cry myself to sleep when I was 8 months old.'"
'Parenting' Baby to Sleep
Babies need to be "parented" to sleep, not "put" to sleep, says William Sears, MD, an associate clinical professor of pediatrics at the University of California at Irvine and author of 27 books on child care.
It's also important, for babies and parents to get a restful night's sleep -- "otherwise babies, their parents, and their relationship won't thrive," says Sears, who is a father of eight.
But, Sears warns in his article, "31 Ways to Get Your Baby to Go to Sleep and Stay Asleep Easier," parents need to develop a "realistic" attitude about baby's sleep: "Sleeping, like eating, is not a state that you can force baby into," says Sears. "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."
Trained in pediatrics at Harvard Medical School, Sears opposes the "cry-it-out" approach some doctors and sleep specialists recommend. He calls that a "rigid, insensitive method" that may undermine baby's trust in parents, prevent the development of what he calls a "nighttime parenting" style, and hinder the parents' detection of any medical causes of nighttime waking.
But one of Sears' own philosophies -- encouraging a "family bed" approach, in which the baby is allowed to sleep with the parents if that's where the little one seems to sleep best -- is nearly as controversial. Though Sears is a fellow with the American Academy of Pediatrics (AAP), that organization cautions against "family bed" methods: "Try to avoid letting your child sleep with you. This will only make it harder for your child to learn to settle himself or herself and fall asleep when alone," advises an academy article, "Establishing Good Sleep Habits."
Sears' advice includes getting your baby used to a variety of actions that will be associated with sleep: Sometimes rock or nurse your baby to sleep, sometimes switch so your spouse does the job, and sometimes lay your baby in bed to fall asleep to singing or soothing tape recordings, for example. Set consistent nap and bedtime routines and rituals. And "tank up" your baby with feedings every three hours during the day so they'll be less apt to wake hungry during the night.
When all else fails, Sears advises on his web site at www.askdrsears.com, use a mechanical swing, drive the baby around in the car (the engine hum usually begins a relatively quick nod-off), or use "mechanical mothers"--gadgets like stuffed bears with tape players in their tummies making singing or breathing sounds.
But he adds, "Before trying any sleep-inducing program, you be the judge. Run these schemes through your inner sensitivity ... Does this advice sound sensible? Does it fit your baby's temperament? Does it feel right to you?"
Tips from the American Academy of Pediatrics to establish good sleep habits include:
- Not letting your baby sleep as long during the day.
- Putting your baby in the crib at the first sign of drowsiness.
- Delaying your reaction to infant fussing starting at 4-6 months.
Tips for New Parents
Newborns sleep a total of 16-18 hours a day, but that is broken into 2-3-hour sessions. They sleep in shorter, lighter cycles than adults.
Some researchers say they believe light sleep ("active" sleep, when there is a lot of rapid eye movement) helps the infant brain develop. The higher centers of the brain keep operating and blood flow increases, perhaps speeding up brain growth. So take heart: "If that is true," one tired mother told Sears, "my baby is going to be very smart."
Between 2 and 4 months of age (depending on your baby's temperament), clear sleep patterns begin to emerge. Total sleep drops to 14-15 hours in every 24-hour period, including a couple of daytime naps. Night sleep usually lasts 10-11 hours, but the baby may awaken at least once for a feeding. This is the stage when experts say it's important for parents to begin habits that "set the baby's internal clock," as Mindell describes it. Establish a bedtime routine.
Anticipate your baby's need for a sleep program and plan for it. Before or soon after the birth, read advice from experts on how to help your baby sleep through the night. Choose an approach and, when it's needed, stick to it for 10-12 nights. All babies are different, and the approach may have to be changed, but give the effort a chance to take effect.
Both parents in a two-parent household should agree on an approach and follow through. "Sleep is just the first issue parents run into that will bring out different parenting styles," warns psychologist Brett Kuhn. If each parent adopts a different approach, it's likely neither one will work. Consistency is key.
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