Sleep Training While Teething

Q: What happens to sleep training while teething?

A: It’s a good question. The answer depends on a lot of factors.

First: What is Teething?

 

I define teething as the process involved in the eruption of baby teeth. Some people prefer to define teething as the one or two bad days a baby has while the teeth are actually breaking through the gums. This is a good definition, but anyone who has actually had children knows that the discomfort associated with teething starts long before the teeth actually break through.

How many of you have found that the only way to soothe your fussy baby has been to rub her gums with your finger? You can call it what you want to, but it sure seems like teething to me!

First teeth often appear between 4 and 6 months months. The earliest first tooth I’ve ever seen was in a 9-week old baby! But the first tooth can sometimes wait until a year of age to break through. After that, the process will continue until all 20 baby teeth have come through. This can take up to two years!

Teething Myths

There’s a long history of teething being blamed for all kinds of nastiness. In the early part of the 20th century, teething was still appearing on infant death certificates! Also on the historical list of teething symptoms is “blinking eyes, vomiting, neuralgia, severe head cold, weight loss, toxemia, tonsillitis, paralysis, cholera, meningitis, tetanus, and insanity.”  Fortunately, we’ve stopped believing teething was fatal, but we continue to think all kinds of symptoms are related to teething.

sleep training while teething 2
teething stinks

Fever is probably the most common. The latest evidence from the medical literature suggests that teething can lead to an increase in body temperature, but not to a level that could be characterized as a fever (100.4 F rectally).

This is a good time to emphasize a point. A true fever should never be brushed off as “only teething.” If the baby has a real fever, you should pay attention to it. Contact your pediatrician if you have any questions or concerns about a fever in your infant.

These days, teething is blamed for causing diarrhea, facial rashes, diaper rashes, runny noses, and sleeplessness (more on this below!) But the best evidence we have today suggests that teething causes really only two things: 1) Drooling, and … 2) Teeth.

Can the Baby Do Sleep Training While Teething?

But let’s face it: for many babies, teething hurts! These babies are fussy more often. They want to bite on anything that gets near their mouths. They try to insert both hands in their mouths simultaneously (anyone seen a baby try this?) They swat at their ears (anything to get at those painful gums!)

One thing teething should not do is interfere with sleep. Teething pain almost never wakes a baby from sleep, but a baby who does not yet know how to sleep on her own will not be helped out much by a mouth that bothers her!

The Answer is YES

sleep training while teething 4
The face of teething pain

Sleep training while teething is possible. Sleep training while teething is doable. And I recommend doing it! If you’ve started the process of allowing your baby to learn to self-soothe, there’s no reason why you should stop because of teething.

If the baby has already fallen into a daily routine (because you’ve paid attention to her cues and provided her with structure!) then small disruptions from night time teething should not cause you despair. There are many things you can do to try and make her more comfortable, and to continue with your routine.

Pain Medication

Always discuss dosing with your pediatrician before you give your baby Tylenol or Motrin. The doctor will probably tell you that you should not give Motrin to a baby less than 6 months of age. You should never give higher doses than recommended, and never more frequently than recommended. My own experience taught me that Tylenol is not anti-inflammatory enough to make any real difference to a baby who is dealing with gum inflammation from teething. So if she’s younger than 6 months old, you can try Tylenol, but rubbing her gums with your finger may be her only relief!

NO ORAGEL!

What you should not give is a topical anesthetic like Oragel or Anbesol. It’s true that the FDA has issued a warning that these medications should not be used in children younger than 2. But I have an even better reason to avoid these medications: they don’t work! The inflammation from teething occurs too deep below the surface of the gum to be touched by a topical anesthetic. It’s not worth it.

A Confession

I confess I gave homeopathic teething tablets to both my boys when they were toddlers. Most teething tablets are made of Calcium Chloride, chalk basically. I knew these tablets would not actually treat teething pain. I also knew they were completely harmless. What they did do was convince my boys that their teeth would stop bothering them. The “placebo effect” worked. They would stand inside their cribs with their hands out waiting for the tablets every night. It became part of the bedtime ritual. Bedtime rituals are good! We stuck with it because it did no harm.

Other Tricks

sleep training while teething
Yup. The old toothbrush trick

There are a ton of teething products on the market, but the truth is you don’t need to waste your money on them. If an item is clean and she can safely put it in her mouth, you can use it as a teether. We and other parents have tried the toothbrush. The frozen washcloth is always worth a try. But it my experience, nothing works better than the pad of a finger rubbing the baby’s gums. The problem of course is that you cannot keep your finger there all day.

Sleep Training While Teething Take-home Messages

  • By all means, the baby can continue sleep training while teething.
  • Consult your pediatrician about pain reliever doses and dosing intervals
  • Don’t give Oragel! It doesn’t work!
  • If you try all these things, and you need a sleep coach, I can help!

 

Premature Baby Sleep Training: When and How

Premature baby sleep training is a special kind of sleep training.

The basic principles of sleep training apply, with a twist. We have to pay attention to a couple key questions. “What is your baby’s corrected gestational age?” and “Does your baby have any special difficulties related to her prematurity?”

I will review some basics about preemies and sleep training. Then I’ll talk about which sleep training methods are best for premature babies and why.

Premature Baby Sleep Training

The most important thing to know about premature babies is the most obvious. They were born early! But it might be better to say that they were born before they were ready. Harvey Karp would argue that even full-term babies are born before they are ready to be here on earth, but that is another subject!

Sometimes a premature baby will be born before her lungs are ready to breathe air on earth. These babies obviously need to stay in the Neonatal ICU (NICU) until they can breathe on their own. Still other preemies are born before they are able to eat on their own. They too need to stay in at least a special care nursery until they can “remember to eat”.

But the most important difference for our purposes is premature baby sleep. Premature babies sleep differently from full-term babies because, just like their lungs and stomachs are immature, so are their brains.

Turn Down the Noise!

An important difference between us grown-ups and babies is that we have a filter. We can filter out sounds, feelings, smells, tastes, and sights that interfere with our ability to focus. Babies can’t do this. They have to pay attention to everything. And so it’s easier for babies to become overwhelmed by too much sensation. This is what we mean by “overstimulation”. When babies get overstimulated they get fussy, they cry more, they eat poorly, and they don’t sleep! Premature Baby Sleep Training 2

How ever you decide to sleep train your preemie, you have to keep this in mind, particularly if she is still younger than her due date. The risk of overstimulation can be too high with babies with a corrected gestational age less than 40 weeks. For these babies it may be best to put off sleep training.

So You Say You’re Ready for Premature Baby Sleep Training?

Maybe so, but is the baby ready? There are a couple of ways to tell. First, does the baby weigh around what a full-term baby weighs? If she weighs less than 5 lbs 8 oz, it may be difficult. She’ll need to do a lot a feeding for catch-up growth. I recommend discussing with the pediatrician if you want to start at a smaller weight.

Does the baby have any problems related to her prematurity? For example, many preemies have reflux. A premature baby with reflux may be fussy and have trouble settling. Other premature babies go home from the hospital needing oxygen. These are babies I might not recommend sleep training until they are breathing room air. Again, this is something to discuss with the pediatrician.

Premature Baby Sleep Training MethodsPremature Baby Sleep Training 3

All the various sleep training methods fit into two broad groups: baby-led and parent-led. Briefly, baby-led methods lean heavily on paying attention to the premature baby sleep cues. These are eye-rubbing, yawning, and beginnings of fussiness. Parent-led methods lean heavily on providing structure for baby sleep. This includes starting meals at the same time every day, and encouraging naps at the same time every day.

The reality of premature baby sleep training is much simpler: it’s a combination of baby-led and parent-led methods. This is sometimes referred to as “combination” sleep training. That is to say that the most successful baby sleep training that I know of involves a combination of following baby’s cues and providing structure. This is the method I recommend in my practice.

I do make a slight exception for premature babies. Because feeding and growing is so important, I lean more toward following her feeding cues. Your pediatrician may have given you target for the number of calories she should have every day. If so, it’s best to do what you can to make sure she gets enough formula or breast milk to do catch-up growth.

The Ideal Age for Premature Baby Sleep Training

So what is the ideal age to sleep train a premature baby? The key is corrected gestational age. If the baby were full term, the ideal age for sleep training would be four months of age. Prior to that age, you have laid most of the groundwork already. You’ve learned baby sleep cues, and you’ve started providing structure to the baby’s day. You might not even need to sleep train at this point! If you’re doing premature baby sleep training, you want to aim for four months corrected. For example, if your preemie were born at 36 weeks (4 weeks early), your goal should be five months of age. At this point the baby can be expected, reasonably, to achieve the sleep patterns of a four month old full term baby.
Premature Baby Sleep Training 4
I say “ideal age” for premature baby sleep training, because this is the age at which I believe you’ll have the most success. Four months corrected is about the age when a girl baby can soothe herself to sleep. You can put these girls down in the crib fully awake. And they can learn to fall asleep without assistance. For boys, the age is somewhat later. Certainly by six months (corrected) a boy can master the self-soothing skills needed to settle himself… and to sleep through the night (if he’s well-fed!)

Summary

  • Premature baby sleep training is just like full-term sleep training, with some exceptions. You need to pay attention to any health issues related to prematurity. And you should lean more towards following her cues.
  • Providing structure is still important. Whichever method you choose to sleep train your preemie, she’ll do better if her day is as regular and as predictable as possible.
  • Expect a girl preemie to sleep through the night at around 4 months (corrected), and a boy by 6 months (corrected)
  • If there are any health concerns at all, please contact your pediatrician.
  • If the baby’s health checks out, you still are having sleep difficulties, I can help!