Tuesday, September 02, 2008 Sleep and sleep disturbance
PARENTS want their children to go to bed without resistance and to sleep through the night. They look forward to a time when they can again have 7 or 8 hours of uninterrupted sleep.
Newborns however have a limit to how many hours they can go without a feeding (usually 4 or 5 hours). By 2 months of age, some 50% of bottle-fed infants can sleep through the night. By 4 months, most bottle-fed infants have acquired this capacity. Most breast-fed babies can sleep through the night by 5 months of age.
Good sleep habits may not develop, however, unless you have a plan. Consider the following guidelines if you want to teach your baby that nighttime is a special time for sleeping, that his crib is here he stays at night, and that he can put himself back to sleep. It is far easier to prevent sleep problems before 6 months of age than it is to treat them later.
Newborns
* Place your baby in the crib when he is drowsy but awake. This step is very important. Without it, the other preventive measures will fail. Your baby's last waking memory should be of the crib, not of you or being fed. He must learn to put himself to sleep without you. Don't expect him to go to sleep as soon as you lay him down. It often takes 20 minutes of restlessness for a baby to go to sleep. If he is crying, rock him and cuddle him; but when he settles down, try to place him in the crib before he falls asleep. Handle naps in the same way. This is how your child will learn to put himself back to sleep after normal awakening. Don't help your infant when he doesn't need any help.
* Hold your baby for all fussy crying during the first 3 months. All new babies cry some during the day and night. If your baby cries excessively, the cause is probably colic. Always respond to a crying baby. Gentle rocking and cuddling seem to help the most. Babies can't be spoiled during the first 3 to 4 months of life, but even colicky babies have a few times each day when they are drowsy and not crying. On these occasions, place the baby in his crib and let him learn to self-comfort and self-induce sleep.
* Carry our baby for at least 3 hours each day when he isn't crying. This practice will reduce fussy crying.
* Do not let your baby sleep for more than 3 consecutive hours during the day. Attempt to awaken him gently and entertain him. In this way, the time when your infant sleeps the longest will occur during the night. (Note: Many newborns can sleep 5 consecutive hours and you can teach your baby to take this longer period of sleep at night.)
* Keep daytime feeding intervals to at least 2 hours for newborns. More frequent daytime feedings (such as hourly) lead to frequent awakenings for small feedings at night. Crying is the only form of communication newborns have. Crying does not always mean your baby is hungry. He may be tired, bored, lonely, or too hot. Hold your baby at these times or put him to bed. Don't let feeding become a pacifier. For every time your nurse your baby, there should be four or five times that you snuggle your baby without nursing. Done let him get into the bad habit of eating every time you hold him. That's called "grazing".
* Make middle-of-the-night feedings brief and boring. You want your baby to think of nighttime as a special time for sleeping. When he awakens at night for feedings, don't turn on the lights, talk to him, or rock him. Feed him quickly and quietly. Provide extra rocking and playtime during the day. This approach will lead to longer periods of sleep at night.
* Don't awaken your infant to change diapers during the night. The exceptions to this rule are soiled diapers or times when you are treating a bad diaper rash. If you must change your child, use as little light as possible (e.g., a flashlight), do it quietly, and don't provide any entertainment.
* Don't let your baby sleep in your bed. Once your baby is used to sleeping with you, a move to his own bed will be extremely difficult. Although it's not harmful for your child to sleep with you, you probably won't get a restful night's sleep. So why not teach your child to prefer his own bed? For the first 2 or 3 months, you can keep your baby in a crib or box next to your bed.
* Give the last feeding at your bedtime (10 or 11 pm). Try to keep your baby awake for the 2 hours before this last feeding. Going to bed at the same time every night helps you baby develop good sleeping habits.
Two-month-old babies
* Move your baby's crib to a separate room. By 3 months of age, your baby should be sleeping in a separate room. This will help parents who are light sleepers sleep better. Also, your baby may forget that his parents are available if he can't see them when he awakens. If separate rooms are impractical, at least put up a screen or cover the crib railing with a blanket so that your baby cannot see your bed.
* Try to delay middle-of-the-night feedings. By now, your baby should be down to one feeding during the night (two for some breast-fed babies). Before preparing a bottle, try holding your baby briefly to see if that will satisfy him. If you must feed him, give 1 or 2 ounces less formula than you would during the day. If you are breast-feeding, nurse for less time at night. As your baby gets close to 4 months of age, try nursing on just one side at night. Never awaken your baby at night for feeding except at your bedtime. (To be continued)
