Bedside Manners




0–24 months. Adopt these parent behaviors recently found to help babies sleep. By Nancy Gottesman

In May 2011, something curious happened on amazon.com’s bestseller list. A little humor book reached #1 months before its scheduled release date—thanks to a wholly unintended viral campaign by parents of young children. The title? Go the [Bleep] to Sleep, written by Adam Mansbach, an obviously exasperated and exhausted father. The title may be crude, but it clearly resonated with legions of parents whose infants and toddlers have trouble getting to sleep and staying asleep. “When babies aren’t sleeping well,” says sleep researcher Douglas Teti, PhD, a professor of human development, psychology and pediatrics at Pennsylvania State University in University Park, “it can be more stressful to the parents than it is to the child.”

Sleep is essential for physical and emotional health. If your child doesn’t get enough, she’s at higher risk for childhood obesity and poorer cognitive functioning. (Your health also suffers from a lack of z’s.) Here are the recommended numbers of total sleep hours (including naps and nighttime sleep) by age:

Newborns: 16 to 20 hours
1 to 4 months: 14 to 15 hours
6 to 12 months: 13 to 14 hours
12 to 24 months: 12 hours

Sleep patterns among children in this age group vary a lot, and they learn to sleep through the night at different points in development. Some may sleep more during the day than at night, while others take short naps and sleep mostly at night. These sleep styles may have a genetic component or they may be a result of family lifestyle. Up to 30 percent of healthy young children have difficulty falling and staying asleep at night—which explains why Mansbach’s little sleep book struck such a far-reaching chord. If your child is one of them, we’re betting that you share the author’s frustration.

Fortunately, pediatric sleep scientists who’ve been investigating why some young children fall and stay asleep more easily than others do have discovered specific parenting behaviors that can significantly improve a child’s sleep habits. Try the behavioral interventions that follow, and our experts say that both you and your child will be getting a good night’s rest in one to two weeks—tops.

(Note: Some babies and toddlers have medical conditions—such as snoring, allergies or reflux—that impede sleep. To make sure your child’s sleep problems are not health-related, make an appointment with your pediatrician.)

 

Develop a Three-Step Routine

“Creating a bedtime routine is a simple change that can dramatically improve both the

child’s sleep and the mother’s well-being,” says Jodi A. Mindell, PhD, associate director of the Sleep Center at Children’s Hospital of Philadelphia, whose research bears this out. In one study, Mindell examined 206 babies, 7 to 18 months old, who had sleep problems such as three or more nightly wakings, waking up for 60 minutes or longer each night, or having a total daily sleep duration of less than nine hours. Mothers were asked to institute a three-step bedtime procedure: bath, massage and quiet activity (such as cuddling or singing), with lights out within 30 minutes after the bath. The results were astonishing: The infants’ longest sleep period increased by two hours and

the number and duration of their night wakings dropped. Toddlers in the study (18 to 36 months old) had similar success with a three-step bedtime routine: Their longest sleep period went up by one

hour and they had fewer night wake-ups.

Young children with bedtime routines have lower stress levels, says Mindell. Reduced stress leads to fewer arousals and enhanced sleep quality. “Mother also gets more sleep, which can make a huge difference in her energy and mood,” she adds. The activities can vary. You can try music-book-rocking or bath-singing-cradling—whatever works best for you and your family. Just make sure your routine doesn’t take longer than 30 minutes. Then, put your baby on his back to sleep.

 

Be Emotionally Available

Your emotional state at bedtime may be even more important to your child’s sleep than a routine. In a recent issue of the Journal of Family Psychology, scientists videotaped the sleep habits of 1- to 24-month-old children as well as their mothers’ behaviors at bedtime. The kids whose moms were the most emotionally receptive went to sleep more easily and reduced their

number of night wakings.

“Bedtime can be an emotional time of day,” says study author Teti. “It heralds a time when an infant or toddler will be separating from his parents—and some children find this separation stressful.” Which is why your emotional availability is vital. When you’re sensitive to your baby’s signals to interact, he understands that it’s safe to sleep and that you’ll be

there for him. “This helps him feel secure,” says Teti. “Because he trusts his environment, if he wakes up, he’ll be more likely to go back to sleep on his own.” However, if you’re anxious or impatient, you’ll make him anxious and reluctant to fall and stay asleep. Is it really any surprise that calm, secure babies and toddlers sleep better than worried ones?

 

Above All Else, Be Consistent

After the bedtime routine, put your child in her bed. Don’t kid yourself: The first few times you try to institute these changes, your child is likely to cry. It’s okay to let her cry for a few minutes, says Bobbi Hopkins, MD, a pediatric neurologist/sleep medicine physician in the Texas Children’s Hospital Sleep Center in Houston, Texas. “Check in and make sure she’s okay, but limit physical contact,” she adds. If you keep offering a hug, story or nursing-feed, your child will remain dependent on you for getting to sleep.

Do the same thing when she wakes in the night. By 6 months old, a baby no longer needs a nocturnal feeding. You may have to check in multiple times the first few nights you make these changes, but eventually, your child will learn that you’ll always be there when needed—and that feedings, books and cuddles won’t happen during the night anymore. You’ll see rapid improvement in four to 14 nights, say experts. “But you must be consistent,” stresses Hopkins, or it will take much longer to establish new sleep habits.

Lighting helps to establish your infant’s biological clock. Keep lights bright during your child’s waking hours and dim lights an hour before bedtime. At naptime, shut blinds and do bedtime-routine activities, but for no longer than 20 minutes. Check in if your child cries, then leave again. Illnesses, vacations and other out-of-the-ordinary situations can reverse progress, so be prepared. You may need to reteach your child, but the second time around won’t take as long or be as draining. “If you do the same thing every night at the same time, over and over, your child will learn to go to sleep by himself,” assures Hopkins. “And everybody in the family will feel better.”

Nancy Gottesman is a regular contributor to Baby & Toddler.

 

Snooze Control

If your baby isn’t sleeping, neither are you. These resources offer some rest for the weary mom and dad.

The Customized Sleep Profile at johnsonsbaby.com/sleep

Input your baby’s personal sleep habits into this interactive online tool and—voila!— out pops an individualized profile with solutions to your baby’s sleep issues. In a new study published in the journal Sleep, mothers of infants and toddlers who used this Internet intervention reported that their babies’ night wakings decreased by 50 percent or more, and that the longest period of sleep increased by two hours.
Sleeping Through the Night: How Infants, Toddlers, and Their Parents Can Get a Good >Night’s Sleep (Revised Edition)

by Jodi A. Mindell, PhD

(HarperCollins, 2005)

Author Jodi Mindell is the associate director of the Sleep Center at Children’s Hospital of Philadelphia and really knows her sleep stuff. Her book outlines a kinder, gentler approach to developing successful sleep routines and overcoming bedtime struggles. A useful chapter on co-sleeping offers practical advice on when and how to make the transition to a crib or child-bed.

 

The No-Cry Sleep

Solution: Gentle Ways to Help Your Baby Sleep Through the Night

by Elizabeth Pantley

(Cont emp orary Books, 2002)

The author of six “No Cry” books (e.g., no-cry potty training, no-cry separation anxiety), this popular parenteducator proposesa middle-ground solution (between cry-it-out and learn-to-live-with-it) using sleep diaries and logs.

Solve Your Child’s Sleep Problems

(New, Revised and Expanded Edition)

by Richard Ferber, MD

(Firesid e, 2006)

More relaxed in tone than Ferber’s original best seller of 25 years ago, this is a guide to sleep woes in children 12 months and older. Once known as the “Cry It Out” Doc, Ferber never really advocated leaving baby alone—and howling—for long periods. He does recommend a soothing bedtime routine, then putting baby to bed awake (yes, even if he cries) while you check in regularly.

 

Your Room to Baby’s Room

6–12 months

Many babies sleep in their parents’ bedrooms in a bassinet or co-sleeper attached to Mom and Dad’s bed. (The American Academy of Pediatrics does not recommend bed-sharing in the first year of life; it can be dangerous to infants.) When you’re ready to transition your baby to his own room, you may find that it’s easy and takes just a day or two. “But for some, the transition may take longer and might be more easily made in phases,” says Teti. For example, if your baby has been sleeping in a bassinet or co-sleeper, move him into a crib next to your bed and maintain your bedtime routine, waiting when he cries to see if he’ll soothe himself before reassuring him. Allow your baby a few days to get accustomed to his new bed, then move the crib into his room. Use the same bedtime routine and gradually increase the time you wait when he cries to see if he soothes himself. If you bring him back to your room thinking Just this once, “once” could revert to every night.

 

Sleep Stimulators

0–3 YEARS
sound effects

White noise—repetitive rhythmic frequencies of droning sounds such as a fan or vacuum cleaner, or even womb sounds and heartbeats—is soothing to babies (and adults!). The First Years Sounds for Silence Premium Sound Machine comes with settings for white noise and Mozart melodies as well as an MP3 plug so you can lull your wee one to sleep with custom playlists from your own music player. It also features a convenient nightlight and a 60-minute timer. For more help, consult pediatricianrecommended tips in the included Baby Settling and Health Guide. $40 at amazon.com

0–3 months
simple swather

An age-old method for soothing a fussy newborn, swaddling mimics the warmth and security of the womb and may help prevent babies from waking themselves with the startle reflex. The JJ Cole Swaddle Pouch makes the wrapping technique a no-brainer; just slip baby into the pouch, align his shoulders with the top of it and secure the open flap to the opposite side with a Velcro strip. 7 to 14 pounds. $11.95; consult the store locator at jjcoleusa.com for a store near you

0–5 YEARS
delightful turtle

Give your child a lovable toy that doubles as a nightlight. The CloudB Twilight Turtle has a plush body with a hard plastic shell that fills baby’s room with a soft, starry nighttime glow in your choice of amber, blue, purple or green. Within the restful universe of stars the turtle projects on the ceiling are eight constellations that, when your little one is old enough, the two of you can identify with the enclosed star guide. Requires three AAA batteries and includes a 45-minute auto-shutoff function. $29.95 at twilightturtle.com

0–1 YEAR
blanket statement

Keeping baby warm and comfortable is crucial for inducing sleep, but loose blankets in the crib are a suffocation hazard. That’s why nurseries in more than 600 hospitals nationwide use the Halo SleepSack Wearable Blanket. The SleepSack comes in 100 percent cotton or microfleece fabrics, and has a sleeveless, ventilation-encouraging design to prevent overheating. “Back is best” is embroidered right on the front, reminding parents to put babies on their backs to sleep to prevent Sudden Infant Death Syndrome (SIDS). A portion of every SleepSack sale is donated to the First Candle/SIDS Alliance and the Canadian Foundation for the Study of Infant Deaths. $32.95 at halosleep.com

1–3 YEARS
security system

As baby gets older, a special blanket may comfort her during the nighttime separation from Mom and Dad and could be just the thing to get her off to sleep. The ultrasoft and fluffy Little Giraffe Bella Blanky is an enticing choice. The satinbordered snuggler comes in five dreamy colors and is small enough—14x14 inches—to go with her everywhere. $36 at littlegiraffe.com

—Maureen Healy