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February 13, 2011

Baby Sleep Advice

By Glenn Fleishman

I used to dispense a lot of advice about helping babies sleep, because we had so much trouble early on with Ben, and then ongoing difficulties with the first year for Rex, that we learned a lot about what worked for them. Many of our friends tried some of what we learned, often to good effect, but it shaped the advice I give, too. A colleague asked on Quora about help with getting a 5-month-old to sleep, and I wrote a long response that I reproduce here, because with Quora you never know if a response will wind up staying in place or not:

I have a sample size of two, so take that for what it’s worth (one is now 3 and the other 6, so this is still sharp in memory).

Swaddling: You have to do it consistently for it to work, based on my experience and those of what seems like dozens of friends and correspondents back when I posted a swaddling video on my blog six years ago. We used to go to “first weeks” groups here in Seattle, which were facilitated by an RN/lactation consultant, but meant for support and information exchange among new parents. I learned a lot about swaddling there, including from second-time parents who had a round the first time.

Swaddling is an art, no matter how easy the baby video makes it. I watched Happiest Baby a million times, and could never keep our older in the swaddle. There’s a double-blanket swaddle that worked well for us, plus the Miracle Blanket, which is a kind of prefab/velcro swaddling kit around which you can wrap a warmer receiving blanket in winter months. (Both our kids had terrible reflux, too, even when treated with medication, so they slept for their first six months on a prescription wedge from the local children’s hospital. Swaddling was critical so they didn’t slip out of the wedge in their cribs.)

However, at five months, you’re at or past the swaddling point for most kids. You use a swaddle to prevent the Moro Reflex, one of a few atavistic baby actions that they all grow out of. The Moro is the startle reflex which causes them to put out all their limbs and try to grab; makes sense if you’re a baby ape falling off your mommy. Not so much trying to sleep on your back. The other is the flailing hands, with which a baby wakes him- or herself. When the Moro Reflex fades (which is does around this point from my reading and observation), and kids are more coordinated with limbs (they want a thumb now), the swaddling is far less necessary.

In your room: If you’re not engaged in attachment parenting, which it sounds like you’re not, there’s not much point for a healthy baby who doesn’t need nighttime monitoring to be in the same room if you have the space to move the baby elsewhere. You and they wake each other up. He can also smell you, and he also knows you’re waking up and responding if you’re trying to lie there still. So that’s a thought. Our post-partum doula (more on her in a moment) made that an early suggestion with our firstborn, and it was a great one at the point at which we could do it. (She said have him nap in his crib even when he was in a cosleeper in our room at night as part of the transition of spending sleep time in another room.)

“the only thing that consoles him is feeding”: This is a tricky subject. I am not a doctor nor lactation consultant, nor pretend this is medical advice. Nor have I seen your baby, so there’s that, too. But I will tell you from my kids and my community of babies/toddlers/kids I have known over the last seven years, there are two main factors at play here.

One: Does the baby need to feed based on actual need overnight? Only your pediatrician or nurse practitioner can advise you on that. On the whole, clearly by this time, very few babies actually have the requirement of feeding at night more than once, and many not at all. Past six months, and I believe the received wisdom is that they can sleep overnight (meaning maybe 8 or 9 pm to 5 or 6 am being “overnight”) without a feeding.

However, your baby is low percentile, and your medical authority may have other advice. (Part of the percentile issue is whether or not a kid is on the curve. If they started 50th and declined to 10th, it’s a very different issue than if they started at 10th and remained squarely on 10th.) We have a friend nearby who just had her third kid. Her first two are perfectly healthy, and had metabolisms that were insane. They lost weight while you looked at them. Her doctor advised supplementing breastfeeding with half-and-half (I kid you not), and that did help increase body weight until they could eat substantial solid food.

Two: How much can you tolerate of your kid complaining, crying, wailing? It’s a very large issue. I have had friends where the instant the baby cried, they were in the room, and, consequently were helping the child get to sleep for the next four years every night. There was no self-comforting, which is a critical skill. (Attachment parenting folks have a different orientation on self-comforting, but it’s there just the same; it’s a different kind of facilitation at different ages, not pandering to the baby.)

We had a very low tolerance for crying/wailing (crying = distress, wailing = complaint; I know we’re not unique in differentiating those two, but some parents hear them and some kids make them the same way). When our first baby was just a bear about sleeping, we hired a post-partum doula. She gave us advice on the “crying it out” subject. In her view, that could mean 10 seconds, 1 minute, a hour—whatever we could tolerate as long as we knew the baby was fine. She recommended a baby video monitor so we could be sure our kid wasn’t in actual danger or distress. This was a great idea.

We could not get through the night with our older, and after getting this advice, we let him cry for a few minutes, comforted (no feeding) briefly, then left the room, let him cry a bit longer, same routine; longer intervals each time. The first night, this went on for an hour. Then he slept all night. Holy cow! The second night, five minutes. We basically never had nighttime sleep issues again.

Our second was much fussier, and we went through rounds of this for months, with weeks at a time going well, until he hit 14 months. It wasn’t torture, but it was difficult, as we didn’t have a third room to put him in, and he couldn’t be in with his brother, as his nighttime cries would wake his brother up. Our second didn’t wake every night, but he was a lighter sleeper. However, feeding him at night after about 6-8 months didn’t help him sleep better, so we just had to work through him learning to comfort himself. (From 14 months to present, he generally sleeps well at night, though. He’s still more mercurial than his brother. Personalities win over sleep training.)

The period between five and six months is always hard, from what I have seen and read. All of our friends who had babies later than us have gone through this. A friend a few months ago was complaining that his baby’s regular sleep was all wonky, and I said, he just turned 5 months, right? The answer was, yes, just a few days before. It’s part of the development cycle.

Finally, consider outside help, whether a parenting group, a consultation with a lactation consultant or practical nurse or whomever who specializes in sleep and feeding, or a post-partum doula, which profession is sometimes specialized into sleep coach in parts of the country.

In Seattle, we turned to Mary Ellen Gabrielson, who helped us with sleep for both kids. She was invaluable. She is part of a tradition of doulas and post-partum doulas in the Northwest (which is where, I think, both professions spread from). Where a doula is there to be a mother’s assistant during birth, a post-partum doula is there for the baby and family to help them make the transition into family life without going insane. Mary Ellen cooked and cleaned, dispensed lactation advice, gave us tips and demonstrations on getting the babies to sleep, and so forth. She is a gem, but there are many people in that position you can find. Doula Match is likely a good place to start, but then make sure and get personal recommendations from a couple people at least for anyone you might hire. I don’t believe any state has any kind of licensing guidelines, so you want references as a result.

Posted by Glennf at 1:13 PM


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