The American Academy of Pediatrics has recently revised its advice on how to avoid SIDS. Some of their rules may contradict the suggestions in this article. Please see aap.org for the new guidelines.
Excerpted from The Parent's Problem Solver by Cathryn Tobin, M.D. (Three Rivers Press, 2002).
Jan and Steve. This charming couple, unaware that bad habits were being established, rocked Hal for forty minutes each night before he nodded off. This wasn't a problem at first, but by nine months of age, Hal was too heavy for his mom to carry. Hal knew no other way to go to sleep, and what followed was months of frustration.
Helen and Rick. Helen wasn't worried about letting nine-month-old Manny cry for a few moments, but Rick couldn't bear listening to his little one in distress. At the first sign, Rick would dash into Manny's room and pick her up. The amazing thing was, one winter when Helen and the baby were visiting her parents down south, Grandma suggested that Helen allow little Manny to fuss for a moment before intervening to see whether she would fall back to sleep on her own. Much to Helen's surprise, the first night and every one thereafter, Manny grunted and squirmed briefly before dropping right back to sleep. Which meant that all along, Rick had been waking Manny up, not the other way around.
Tanya. Being a single mother meant that there was no one to take turns with during the night. So, Tanya and little Susie shared her bed from the start. But Tanya was worried that she'd roll over, and as a result she slept only fitfully. After six months, Tanya was drained. She wasn't meeting deadlines at work, and she was short-tempered at home. Tanya felt "stuck"; she didn't want to share her bed with Susie any longer, but she couldn't stand to let her cry.
Many parents assume that a child's poor sleep habits are a stage that will eventually disappear. But in reality, old patterns of behaviour will not fade away until parents take active steps to encourage new ones. Recent research shows that preschoolers with sleep problems are more likely to have behavioral and learning problems, so I highly recommend that you deal with these problems early on.
As a working mom with young children, I have to be practical when it comes to my little ones' sleep habits, as I suspect you do, too. I want to give my kids all the love and attention they need; nonetheless, I absolutely need uninterrupted sleep. What I have come to see is that these priorities are not mutually exclusive. The following guidelines will help you get your baby's sleep on track in a manner that respects her need for comfort and meets your need for more sleep.
The younger the baby, the easier it is to teach her how to fall asleep independently. I suggest that you begin to work on sleep habits once your baby is gaining nicely and well established in her feeding routine. Generally speaking, you should begin by two months of age.
Sooner, not later. It is easier to put a baby or child to bed before he's totally exhausted, because it's easier for him to deal with the stress of separation while he still has some reserve. If you start the bedtime routine at the first sign of tiredness, he'll doze off with less fussing.
Day/night reversal. Many babies sleep for long periods during the day and are completely awake at bedtime. But recent research suggests that babies can learn the difference between day and night early on if they're given the proper signals. You can do this by exaggerating the difference: In the daytime, talk to your baby while you feed her, stroke her, play energetic music, keep her bedroom bright and colorful, and change activities as often as needed. At nighttime, darken the room, whisper, don't stroke her during feedings, skip diaper changes if at all possible, then gently pop her back into bed.
Create rituals. Babies thrive on routine. Anything a parent can do to make the child's world more predictable will help him gain a sense of control over events in his life. Try different routines until you find one that allows your baby to wind down. This may mean a massage, a bath, story time, or feeding. TIP: Don't let your baby fall asleep during the bedtime ritual.
Eyes wide open. After feeding and the bedtime ritual, it's time to put your sleepy but awake baby into bed. If she cries, and most likely she will, pat her on the back and whisper words of reassurance: "Shhh -- it's okay. Mommy's here." Comfort her when she cries, but stop patting her when she's quiet, otherwise you'll simply be exchanging one bad habit for another. On average, a baby takes five to twenty minutes to fall asleep. Guide and support her through this learning period, and she'll soon be nodding off on her own. If she cries for a prolonged period, pat her gently, jiggle her, sing to her, even give her a top-up of milk, but don't let her fall asleep in your arms.
Truthfully, the biggest challenge is the one that takes place in our heads. Many parents struggle with the question "Am I hurting my baby by encouraging her to be independent?" Let me reassure you, independence is a good thing. Not only because it gives you more free time and because you'll get more sleep (although who's complaining?), but because it boosts self-esteem. The true first step to solving sleep problems is to wholeheartedly believe in your baby. Most babies are born strong (just go take a Iook at your own baby pictures and you'll see what I mean). Work with the assumption that your baby's capable and tough, and you'll send the message that you have confidence in her.
What to expect. It will take determination, resolve, and stamina not to cave in when your infant cries, especially the first few nights. Your baby will cry, and despite your reassurance, patting, and high hopes, things may very well get worse before they get better. Your baby may cry harder and longer as she tries to convince you to revert to the old routine. But although you may find it hard to do, if you persist a little longer, your baby will discover new ways of comforting herself back to sleep. How long it takes will depend on your child's age and temperament. Many parents expect the worst and are pleasantly surprised by how quickly the baby learns a new routine.
Talk shop. In my office, I consider it a matter of respect to explain to a baby or child what I'm going to do before doing it. For instance, I jabber away while I'm examining a newborn: "Now I'm going to check your hips, and then I'm going to shine a light in your eyes" I carry on a conversation as if the baby understands me; I know she doesn't understand my words, but my tone of voice hopefully conveys reassurance. Talk your baby through sleep problems in the same way by saying, "Okay, pumpkin, it's bedtime. I know you like to fall asleep with a bottle, but you're tough, and I know you can learn to fall asleep without one." If your baby cries, reassure her by saying, "It's okay, you're a strong baby and I have confidence in you.
Pacifier penalties. In my experience, a pacifier causes as many problems as it solves. A baby who is put to sleep with a pacifier will wake up from a shallow sleep state when his prop is lost. He can't doze off without it, yet he can't find it on his own. You're better off to put your baby to bed without a pacifier and avoid this trap altogether.
Weed out nighttime feedings. Many parents assume that a baby wakes up at night because he's hungry. According to the American Academy of Pediatrics, by the time your baby is four months of age, he should be able to go eight hours without feeding. But what if your baby disagrees with the American Academy of Pediatrics and continues to want to feed in the night? Ask your pediatrician whether your baby is gaining well enough to skip a nighttime feeding. In reality, most babies wake up because they've reached a shallow level of sleep and don't know how to get back to sleep without you. They nurse to go back to sleep, not to satisfy hunger. To help your baby learn how to fall back asleep soundly when he's in a shallow sleep, give him an opportunity to comfort himself when he begins to squirm. Don't rush in. If it doesn't look like he's able to get back to sleep, then go and comfort him. But remember to put him back in the crib while he's awake so he gains the experience of falling asleep independently.
One strategy that has helped many babies under my care to sleep longer is to give the little one an extra feeding before you go to bed. You should be able to quietly feed the baby without actually waking him up.