Baby Won’t Sleep: Here’s Why

HELP! MY BABY WON’T SLEEP!!!

You’re not alone. I know someone else who said that a few years back… ME.

Our first little one arrived 2 weeks early. But he fed well. He gained terrific weight. He hit all his milestones. There’s just one thing he didn’t do. LO did. not. sleep.

We tried everything (or rather, we thought we tried everything!) We rocked him in our laps for what seemed like days at a time. We walked the floor with him at 2 AM night after night. We tried leaving him to cry (against all recommendations). We used pacifiers, white noise machines, bouncy seats and baby swings. Everything worked… for about 10 minutes.

We asked friends with babies for advice. We even borrowed a copy of Ferber (and read it!)

Reading Ferber for me was the proverbial light at the end of the tunnel. In this book I first encountered the concept of “sleep associations“. It was a kind of epiphany for me. And my journey began. I started reading more about sleep and infant development. Then it all fell into place. I had planted the germ of and idea that was to evolve into my sleep coaching business.

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Don’t wanna sleep right now

I discovered that a powerful potential for normal sleep resides in every human being. The trick is to unlock it. There are no ‘sleep problems’ per se. There are only barriers that stand in the way of a baby or child and a restful night’s sleep!

Over the years, I’ve heard the cries of “Help! My baby won’t sleep!” hundreds, maybe thousands of times. Each story is unique. Each child and family has their own set of issues that contributes to a sleep problem.

But very often, each of these unique cases can be classified in its own group. I’ve made a catalog to share with you here. I’ll explain the broad sleep issue, then explain the elements of the fix. The key thing to remember is that each child is unique, so your story may be different, as will the remedy. The underlying elements, however, are the same.

Why Your Baby Won’t Sleep

1. She’s Not Tired

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I will sleep later

It’s 9:00 PM. You’ve been up since 4 AM with your 2-month old. You’ve fed and changed her what feels like a dozen times. You’ve gone shopping. You’ve done four loads of laundry. Oh yeah, and you cooked dinner for your husband, who strolls in at 6 PM looking fresh as a daisy. You look like you’ve been in a fight gone bad. You can barely keep your eyes open. So why is it the baby won’t sleep?

It could be that she’s already slept 16 hours in the last 24, and she just got up from a 3 hour nap at 7:00 PM! She’s just not tired enough to go to sleep yet!

Babies develop sleep-wake cycles just like we do. When they are very young, their stomachs usually set the clock. After a few weeks, they begin to respond to the structure imposed by the sun. That is, they learn that day is light and night is dark! They also respond to the structure imposed on the day by their parents: the day tends to start at the same time. She eats at the same time. She plays at the same time. And she naps at the same time.

The Fix

For a baby like this, I first make sure she’s healthy and getting enough to eat. Then we talk about her sleep patterns. We talk about a typical day for her. In this case, when she’s just had a huge nap in the afternoon, I recommend some tinkering with the nap schedule. It may involve moving the afternoon nap earlier in small steps, say 15 minutes at a time. Again, the fix when the baby won’t sleep because of the recent long nap is only an example. There are always little tweaks that I recommend for families.

2. She’s Overstimulated

baby won't sleep 1
But I kinda LIKE stimulation!

Overstimulation is a real thing. It really can rev a baby’s motor so high that she cannot calm down enough to go to sleep. Maybe there’s been too much activity. There was a party in the morning. You listened to a rock station on the radio on the way home. You played all afternoon when she wasn’t napping. By the end of the day the poor baby is wired up!

Newborns and some young babies are able to protect themselves from overstimulation. They do this by ‘shutting it down’, and going to sleep. I call this “The Tilt Function“. As they develop, babies lose the Tilt Function and expose themselves to the risk of overstimulation on those really busy days. Some babies can handle a lot of stimulation, but some cannot!

Sometimes the baby becomes overstimulated because she has lost one of her naps that she really needs. Sometimes this happens ‘accidentally’ and sometimes it happens by design – at day care.

The Fix

The best way to fix overstimulation is to avoid it to begin with! If the baby’s day is too much for her senses, try cutting back on activities. If she needs that third nap and isn’t taking it, I can teach you some tricks to get that nap back!

On the day that the baby won’t sleep because she really is overstimulated, you may need to bend a few rules. That means, you may need to sit or rock with her for a while. Do this in a dark, calm place. You can run a white noise machine or hum quietly to her. It may be a bad night. But you’ll know how to avoid such nights in the future!

3. She’s Hungry

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I’m a kitten. I’m always hungry

This one is more common than I thought it would be. Babies are growing faster in their first year of life than they will ever grow later. They need a lot of calories. Some exclusively breastfeeding moms worry that their babies aren’t eating enough. This is natural because it’s hard to know how much the baby is eating if you can’t measure it! But sometimes a baby won’t sleep who is exclusively bottle fed! Rarely, a baby who has started taking solids is still not getting enough calories during the day.

In all these cases, the baby won’t sleep because her stomach keeps her awake. It’s a good thing, in a way. A baby needs to grow!

The Fix

The first step is to consult the pediatrician. You want to know if they baby is getting enough calories for her weight during the day. You want to know if she is gaining weight along her growth curve appropriately. If she is not getting enough calories, work with your pediatrician, or perhaps a nutritionist, to figure out ways to feed her up. A baby who eats well, sleeps well (and vice versa!)

4. She’s Over-Fed

This is the opposite of #3. Sometimes a baby won’t sleep at night because she’s eaten too much, not too little. Their stomachs are working double time to try and digest all the formula (and solids?). These babies are gassy and colicky. Often they are constipated. In that case, the baby won’t sleep because she needs to poop and cannot. Or sometimes she poops to much, and her full diaper won’t let her rest.

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Too much?

I see this a lot in babies who drink “spiked bottles”. These are bottles of formula or pumped breast milk that you’ve added cereal to. There is no reason to spike bottles, people (see below).

The Fix

Just as in #3, the first step is to consult the pediatrician. You want to know if the baby has a good weight for her age. You want to count up the calories she’s eating per 24 hours. This number varies, but she should get around 50 calories per pound of body weight per day. If she’s eating substantially more than this, this could be the reason baby won’t sleep. You should discuss it with your pediatrician. He/She will probably recommend that you cut back on calories. One thing is pretty certain, however. The pediatrician will recommend you stop spiking the bottle if that is what you are doing! Formula or breast milk are perfect by themselves!

5. She’s Got Bad Sleep Associations

This is a major cause of “baby won’t sleep”. It may be the major reason. Sleep associations are, very simply, those things that your baby associates with going to sleep. Some typical ones are darkness, swaddling, sucking on a pacifier, being rocked.

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But she won’t sleep without her binky!

What’s the difference between a “good” sleep association and a “bad” one? A good sleep association is something that will stay with the baby all night. Baby sleep cycles from shallow to deep, just like ours does. A bad sleep association is something that disappears, or is taken away, after we fall asleep. When we get to shallow sleep, we ‘take an inventory’ of all the things around us (our sleep associations), make sure they are all there, then we roll over and fall back asleep. We don’t even remember these partial awakenings.

A baby does this too. What if one of her sleep associations is being held by you? Unless you plan to hold her all night, she’s going to awaken partially at midnight and wonder where you went! That’s why being held is a bad sleep association.

Very often, the baby won’t sleep because the binky (pacifier) has become a bad sleep association for her. When the binky falls out of her mouth, as it surely will, she’ll ‘look around’ for it in the dark. Then she’ll get ticked off and become fully-awake. Then you have a crying baby!

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The Fix

Pay close attention to the events that surround the moment of sleep. Is she surrounded by all the things that will be there in 90-120 minutes when she partially wakes up? Do you hold her or rock her until she falls asleep? If so, she may associate holding and rocking with being asleep. No holding? No rocking? Baby won’t sleep!

Each case is different, but in general parents and I work on ways to put some time between the bad sleep association and the moment of sleep. First a few minutes, then more minutes. It’s essential to dis-associate these things in order to allow the baby to master her natural self-soothing technique.

6. She’s Got Colic

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No. That’s “cow lick”

I call this the “C” word. I hate colic. Everybody hates colic. By definition, no one knows what colic really is. The incessant crying for hours at a time, every night, at the same time, is enough to drive any parent nuts! I’m talking about babies who eat well and nap perfectly throughout the day. Then they turn into little devil-babies at night. It begins at 3 weeks of age and continues until 12 weeks.

Colic is a “diagnosis of exclusion”. That means, once you exclude all the other reasons why baby won’t sleep, you can call it colic. Some of these reasons are reflux (see below), over-feeding (see above), or under-feeding (also above).

The Fix

Parents hate this answer. You have to wait it out. If you and your pediatrician figure out that there’s no other reason why baby won’t sleep, then you have to wait. At 12 weeks of age, it will stop. These may be the longest 8 weeks of your life. But you will survive it. We all did.

7. She’s Got an Inconsistent Schedule

Again, this reason why baby won’t sleep turns out to be a lot more common than I imagined. It turns out that some (many?) babies are creatures of habit. They like having a regular day. They like things predictable. They don’t like change. They don’t like inconsistency. Having said all that, there are many babies who don’t mind chaos at all! But if the baby won’t sleep because she needs consistency and her day is chaos, you may have a difficult problem on your hands!baby won't sleep 9

Sometimes the schedule is fairly consistent except for one part of the day. I’ve had many clients who believe the baby won’t sleep because Dad comes home late and the baby wants to play with him! They’re right! She probably does want to play with him. The problem is her regular sleep-wake cycle wants her to be going to sleep at 9 PM, not to be playing with Dad.

The Fix

Easier said than done. For many families, chaos is more or less a way of life.  It would be great if every day were more or less the same, but the reality is that this just doesn’t happen for some families. But in every family, there are some ways that the day can be made as regular and as predictable as possible. For example, there may be a four-hour stretch at the beginning of the day when mom and baby are alone together. This is a good time to try and establish a routine of eating, playing, and sleeping. If you can succeed in introducing order in one part of the day, then you can work on other parts of the day as well.

8. She’s Got Reflux

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Wrong way. Should be down

Sometimes the baby won’t sleep because food comes up instead of going down. That’s reflux in a nutshell. Milk or food that is supposed to pass into the baby’s intestines comes back up toward her mouth instead. Sometimes acid from the stomach irritates the baby’s esophagus. These babies seem to be in pain. They make funny faces. Many, but not all, of these babies also spit up. Not every baby who spits up has the painful symptoms of reflux.

Some parents tell me that the baby won’t sleep unless she’s being held upright. Or she won’t sleep unless she’s in the bouncy chair. This is a clue. Other parents tell me that the baby always seems fussiest right after eating, especially if they put her down right away.

The Fix

The first step, once again, is to discuss the possibility of reflux with your baby’s doctor. While you are doing this, there are some things you can try. I call these “anti-gravity methods”. The point here is to let gravity be the baby’s friend, not her enemy. If food is supposed to travel down, let gravity help it go down. I recommend keeping these babies up on an angle virtually all the time, except when changing their diapers. An angle of 30 degrees is possible, but you may have to buy more than one wedge at the baby store. When I say “angle” I mean the entire body, not just one part of it. You don’t want the baby to do an “abdominal crunch’; this might only make the reflux worse. You wan’t her entire body ‘planked’ up at an angle of 30 degrees.

Sometimes doing smaller feeds more frequently can cut down on reflux. If anti-gravity alone doesn’t work, I sometimes recommend adding this technique.

If neither trick works, your pediatrician and you can try some other methods. There may be dietary changes she can make. Sometimes medications can help. The good news is that practically every baby with symptomatic reflux gets better by her first birthday.

9. She’s Sick

Sometimes the baby won’t sleep because there’s something wrong. She’s coming down with something. Or she’s already caught something. Usually you can tell this reason from the other reasons because the baby won’t be right throughout the day, not only at sleep times. She may or may not have a fever. Sometimes, the best way to tell if a baby is sick or not is to ask how well she is feeding. A baby who is feeding well may be sick, but she’s not SICK, if you know what I mean. I worry a whole lot less about about when a baby won’t sleep but continues to eat well, than I do about a baby who won’t sleep and won’t eat!

The Fix

If you have any concerns or question at all that the baby may have an illness, consult your pediatrician. The overwhelming majority of the time, when the medical problem is fixed, the baby will go back to sleeping well again!

10. She is Hypersensitive

Finally, the baby might be more sensitive to the sensations of her world than other babies. For example, the baby won’t sleep because she hears every toilet flush in the house and it wakes her up. Or if you go in her room to check on her and you ever-so-slightly jostle the crib and it wakes her up! Or the baby won’t sleep if there is too much light in the room.

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So I’m sensitive, so what? I’m also cute!

These are real example from families I’ve helped. On further questioning, I often learn that one or both the parents were “just like this” when they were babies. Grandparents can be a helpful resource when trying to figure out why the baby won’t sleep.

The Fix

Create a “sensory deprivation space” in the baby’s room. Install black-out shades and carpeting to muffle footsteps. The exception may be a white noise machine. Sometimes, but not always, these devices can help filter out noises from around the house that might wake the baby. It sounds gross, but sometimes I recommend that the parents wait until the baby is awake to flush the toilets. I’ve actually seen this work at least once.

Sleep, Baby! is Here for You

If these ideas don’t work for you, or if the reason your baby won’t sleep doesn’t appear on the list, contact me. 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!

Guest Post: Pam Edwards – How the Wonder Weeks Affect Sleep

Today we feature a guest post from sleep consultant Pam Edwards. Pam is a Certified Infant & Child Sleep Consultant and founder of Wee Bee Dreaming Pediatric Sleep Consulting in Grande Prairie, Alberta. Healthy sleep is addicting and she has made it her life mission to help families all across the world get the sleep they deserve – a good night’s sleep doesn’t have to be a dream!

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Have you guys heard of the ‘Wonder Weeks’? The Wonder Weeks is a book that was written by two doctors and describes ten developmental growth spurts that baby goes through in her first 82 weeks of life. These developmental growth spurts aren’t the same as the physical growth spurts, although they do occasionally overlap. During these developmental growth spurts, or ‘Wonder Weeks’, baby is putting so much effort into learning new skills that she begins to act out of sorts (what they describe as the 3 C’s – clingy, crying, and cranky). Not surprisingly, and what I want to talk to you about, is that these Wonder Weeks can affect baby’s sleep. Read on for a description of the different Wonder Weeks and how they can throw a wrench in your baby’s sleep schedule.

 

Wonder Week 5 – The World of Changing Sensations

Previous to this leap, your baby’s perspective of the outside world is soft and undefined – in other words, it hasn’t changed much in his mind from life in the womb. Suddenly, he is able to make more sense of this new world, and this is very overwhelming to him.
How does this affect sleep? This is the age where the evening fussy period begins to develop. A big cause of this evening fussy time is overstimulation from the day, and over-tiredness. The evening is often the busiest time of the day in a family’s household – dinner is being prepared, older kids have activities and need to do their homework, mom or dad is just coming home from work. That means that sometimes baby can be kept up awake much longer than he should be (remember, at this age it shouldn’t be any more than 1 hour max). To help combat this fussy time, make sure baby is still soothed to sleep every hour, even during this busy time. Try to keep the house as calm and relaxed as possible, to make the transition from day to night easier on baby.

Wonder Week 8 – The World of Patterns

Babies at this age are now experiencing the world in a whole new way. They start to recognize simple patterns (not just visually, but things like ‘I have 2 hands!’ or ‘I can move my leg like this!’) Baby starts to be able to focus on things for longer periods of time, and becomes more curious about the world around her.
How does this affect sleep? This increasing alertness makes it all the more important that baby’s environment is conducive to sleep. If her sleeping area is too bright, she may have trouble shutting off her brain. If it’s too loud and chaotic, she may have a hard time powering down for sleep. Ideally, baby’s bedroom should be pitch black, and playing white noise can help reduce stress and help baby sleep better.

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Wonder Week 12 – The World of Smooth Transitions

One of the big physical milestones that baby will have hit around the 8 week mark is the ability to bat at and kick objects with her arms and legs. These movements were often very jerky and clumsy – which is normal for a baby who is just learning how these limbs work! But approaching Wonder Week 12, baby’s movements become smoother, more precise. As well, baby is also starting to perceive more changes in the world around him – how moms voice goes higher when she’s singing a song, how the room becomes dim when the sun goes behind the clouds, how the dog always barks when the doorbell rings. The world is becoming a more organized place to baby!
How does this affect sleep? Around this age, as baby becomes stronger, he may start to break out of his swaddle. Many parents take this as a sign that baby no longer wants to be swaddled, but at this age most babies still do have at least a touch of the startle reflex and thus swaddling is still necessary. Oftentimes, we need to switch up our swaddling technique so that baby isn’t able to break-free. Check out this video below for the most amazing swaddling technique out there (and trust me, my baby was a Houdini and I tried everything!)

Wonder Week 19 – The World of Events

As adults, there are a lot of things that our brain does that we just don’t think about, such as our ability to predict the outcomes of certain events. For example, we know that when someone jumps in the air, they will come down. This is what baby’s brain is working on during this Wonder Week – learning very simple sequences of events (I drop my toy, mom picks it up, I drop it again, mom picks it up again – fun!)
How does this affect sleep? Now that baby is able to (somewhat) predict what will happen next in certain circumstances, having consistent routines becomes even more important. Babies do not like surprises, they thrive on routine and predictability. Your baby is now able to understand that a warm bath means it’s bedtime soon, or that when mom sings ‘Twinkle Twinkle’ it means it’s nap time. Click here for ideas on how to begin a flexible routine with baby. Wonder Week 19 also coincides with the ‘4 month sleep regression‘. Read up here to prepare yourself for this change in your baby’s life.

Wonder Week 26 – The World of Relationships

Babies at this age start to be able to perceive distance between objects (or between people). To baby, the world is now a very big place and he is so very tiny. Things he wants are out of reach, and when mom leaves the room, there is no way to get her back! Therefore, babies at this age begin practicing ways of getting to these things that they want – by crawling, scooting, or rolling!
How does this affect sleep? As you can imagine, this new-found realization of how big the world is can bring with it some anxiety. Unless you are co-sleeping with baby, sleep times are a time of separation, and baby may begin to fight them! Help baby to realize that just because you’re not right there beside her, doesn’t mean you are gone forever. Play peekaboo, or practice leaving the room for short periods of time and then returning with a big smile on your face. Soon she will realize that you are still there for her even if you’re not next to her 24/7.wonder weeks 2

Wonder Week 37 – The World of Categories

Babies at this age love to start experimenting. They like to see the way food feels when you squish it, but that’s it’s different from the way yogurt feels. He is now able to group people, objects, animals, sensations into categories.
How does this affect sleep? Baby may start to experiment in other ways, perhaps in how acting a certain way affects the way his parents react. When I wake up throughout the night, how do my parents react? Does my mom rush in with a bottle or a boob and help me back to sleep? Or does my crying at night not serve much purpose, perhaps mom pops her head in to say ‘it’s okay, go back to sleep’. Baby may start to test these limits to see what will happen, and if baby gets what he wants, then these tests not become new habits (or if baby has always awoken many times at night, these habits continue or become worse). Obviously there are times when baby’s cries can signal a need vs. a want, but if these cries are occurring 8 times a night every single night, then it is no longer something a baby at this age needs.

Wonder Week 46 – The World of Sequences

During this Wonder Week, baby is now learning that there is an order to things in life. There is a certain pattern of events that needs to occur before he is successful at something (big block goes on the bottom, then the smaller one goes next, then the smaller one goes after).
How does this affect sleep? While some parents may have become more relaxed with baby’s routine, it is still so important at this age. If nothing else, make sure you continue a consistent bedtime routine with your child. Repetition and structure help children feel safe. Bedtime declares that the day is over. When you are loving and firm about when it is time for bed, you are building your children’s confidence in their world. Repetition for young children is comforting — ever wonder why they want the same story over and over? The repetition of the getting ready for bed routine (getting into pajamas, brushing teeth, a drink of water, a story, a hug, goodnight) lets your child know what to expect and helps him or her feel secure.

Wonder Week 55 – The World of Programswonder weeks 3

This Wonder Week begins your baby’s journey into toddlerhood. He has made so many big discoveries in the past year but he still has so much to learn about the world around him. This Wonder Week brings with it the understanding that there are multiple means to an end (in other words, different sequences can accomplish the same thing).
How does this affect sleep? Lots going on around this time! Many babies may just be learning to walk, weaning from breastfeeding may occur around this time and a lot of moms (or dads!) may be returning to work. Not coincidentally, this is also the age where separation anxiety is at its peak, and it can most certainly affect sleep. So what can we do to ease the anxiety that your toddler may be feeling during this time (keep in mind too that separation anxiety can hit at any time throughout baby’s life and often seemingly comes out of nowhere):

I know you’re tired of me saying it but…consistent and soothing nap and bedtime routines are increasingly important during the throws of separation anxiety.
Check yourself. Your baby can feed off of your emotions and if you’re anxious, tense, upset, or worried, then chances are your child will feel those emotions right along with you. When you’re putting baby down for sleep, be relaxed and confident, and it will help your toddler feel that way as well.
Help him feel better about good-bye. Sneaking away is one of the worst things you can do and will only compound your child’s feelings of anxiety. The last thing you want an anxious child to think is that by letting you out of their sight, you’re gone forever (well, it feels like forever to them!) Say a loving, confident, firm good-bye and let your child see you leave. He will learn that when you say good-bye, it still means you’ll come back.
Comfort your child but don’t create new (and bad!) habits. If your child is fitfully protesting at naptime, or waking throughout the night in tears, then you should absolutely comfort them. Your child’s psychological needs must be met as well! But keep these interactions short and sweet – this is not the time to sing songs, read books, turn on a TV show, bring baby into bed with you, or lay on the floor in baby’s room (guilty of this one!) New habits are created at lightning speed, so even after the separation anxiety is gone, the new habit is here to stay.

Wonder Week 64 – The World of Principles

Your toddler is now starting to think about different ways to accomplish his goals, and what the consequences of his decisions are. He may start to imitate others or role play his daily life. He may begin nagging/whining to get his way, or showing signs of aggressive behavior, and he is starting to figure out how to get someone to do something for him.
How does this affect sleep? When it comes to sleep at this age, you need to start thinking of your ‘baby’ as a toddler. Sleep issues at this age are not usually sleep-related, and are now discipline-related. A child this age is learning how to get his way, and what actions get him those things (crying at bedtime means I get to stay up later, crying throughout the night means I get mom’s attention, crying during nap time means I don’t have to nap!) Breaking the cycle of positively reinforcing negative behavior is key. Children learn from repetition, therefore just as soon as he can figure out that his negative behavior elicits a positive reinforcement, he can learn that his negative behavior does not elicit a positive reinforcement.

Wonder Weeks 75 – The World of Systems

During this final mental leap (which occurs around 17 months), your child is now able to perceive ‘systems’ (meaning your family is different from a friend’s family, etc.) He is also now understanding that he can choose how he wants to act; helpful, patient, careful, etc. His little conscience has begun to develop!
How does this affect sleep? We discussed limit testing during Wonder Week 37 but this Wonder Week is where it really comes into play. As written in the Wonder Weeks book, “You can’t spoil babies, but you can toddlers! By understanding what is happening inside that little head of your newly formed toddler – and remember, they are pretty savvy – you can shape the future behavior of your toddler and set values and norms that will carry him through life.” This can be applied to our child’s sleep as well – whatever he has come to expect with sleep times at this age will shape how he feels about sleep for the rest of his life. While setting limits is hard (nobody likes to see their child upset!) it is an absolutely essential part of parenting. The first limits that a child can test are those that come to sleep (and unfortunately, these are the limits that parents are often the most lax with!)

Overstimulation: It’s Keeping Your Toddler Awake

To explain what overstimulation is, and what it has to do with sleep, I have to tell a joke:

This economist, Dr. Schwartz, sits down in his local diner, as he does every weekday morning. Millie, who has worked at the diner as long as anyone can remember (and has a pencil permanently embedded behind her left ear) approaches with a pot of hot coffee.

“So, Dr. Schwartz,” Millie asks “How’s your wife?”

Schwartz is an economist, so he answers as only an economist would:

“How’s my wife?” He shrugs, “Compared to what?”

What Do You Mean By “Overstimulation”?

The joke reminds me that “overstimulation” assumes that we know what a normal amount of stimulation is! Over-stimulated compared to what?

One expert defines “overstimulation” as more experiences, sensations, noise and activity than [the child] can cope with. This means there are two sides to the overstimulation problem. There’s the stimulus, and there’s the child. Depending on the child’s temperament, she may handle lots of stimulation without a problem, or she may easily melt down.

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The “Filter Function” and the “Tilt Switch”

Your child’s temperament might depend in part on her ability to filter out sensory information. Newborns have a neat way of dealing with this. As I’ve explained elsewhere:

overstimulation 4
Overstimulated?

The reason you are able to read this is that you are able to filter out most of the sensory inputs that are coming your way. You don’t pay attention to the lights in the room or to extraneous sounds coming from outside. You probably are also filtering out the scents around you and the taste in your mouth.

Now imagine that you are forced to pay attention to all these sensations equally. If you were, you’d be incapacitated. You’d be forced to stop everything and go lie in bed. This is what the world is like for a newborn. Fortunately, newborns are lying down already. This is why most babies prefer low-sensory environments. They do well in places where there isn’t too much light, noise, and temperature fluctuation. They tend to prefer dim lighting, near silence, and contact with warm human bodies. We can tell that babies prefer these conditions and do well in them because they eat and sleep better than in noisy, light, cold, and hot environments.

Switch Failure

Because babies are unable to filter out sensory stimulation, they’ve developed a way to protect themselves from overstimulation. I call it the “tilt” function. In the era of desktop-based and hand-held gaming, fewer and fewer people remember old-school arcade pinball machines, complete with silver-ball plunger, electronic bumpers, and flashing lights. Classic pinball machines all came equipped with a “tilt” switch, which prevented you from cheating by jiggling the machine to make the ball go where you wanted. If you jiggled the machine, a “tilt” light came on, the machine went to sleep, and you lost the ball…

Parents often find out just how overstimulated their baby is when she becomes incredibly fussy later— after the sensory overload— when she has difficulty going to sleep or even feeding”.

Loss of the Tilt Switch

By toddler-hood, most children acquire pretty good sensory filters, but they lose the tilt switch. This means they can no longer “shut it down” when too much stimulation comes their way.

overstimulation 2
Over the top

How much is too much stimulation depends not only on the child’s filter, but also on the child’s sensitivity to any stimulation.

It’s interesting to note that some adult conditions, such as chronic fatigue syndrome and fibromyalgia, might really be disorders of filter function. Patients suffering from these disorders list sensory overload and physical activity among the most common triggers of their symptoms.

Obvious Sources of Overstimulation

Parents can usually tell when a day is going to be stimulating for a toddler. There’s a special occasion like a birthday party; or you take a long day trip to a zoo; or you have a particularly crazy day where you’ve raced from one activity to another. Fireworks displays are other obvious sources of overstimulation: they’re bright and loud! It might also seem obvious that the child can be overstimulated by being frightened by something she sees in a video or on TV.

Not-So-Obvious Sources of Overstimulation

overstimulation 3
umm… bedtime

Some children, especially sensitive types, may be overstimulated when they meet new people, or do an activity that they do not usually do. You may not discover that the child has been overstimulated until bedtime, when she may be unusually cranky or fussy.

Book-reading time may be a source of unexpected overstimulation. You probably already avoid scary or overly exciting stories before bedtime. But did you know that funny books can be overstimulated? Just try falling asleep when you’ve got a case of the giggles.

TV and Screens

For some families, video-watching is part of the bedtime routine. Even if the toddler is watching calm, soothing stories, she may be getting too much stimulation from the screen. This is because the blue light emitted from most screens inhibits her brain from sending out melatonin, the signal for the rest of her brain to shut down and go to sleep. The same goes for hand-held devices like cell phones. Children love to play games on their parents phones. But the hours before bedtime would not ideal, especially if your child is particularly sensitive to the blue light effect.

How to Prevent and Manage Overstimulation

Some sources of overstimulation cannot be avoided: there’s that birthday party for Grandma that everyone has to go to, etc. If you know ahead of time that a day is going to be busy or hectic, or if the child is sensitive to meeting new people or new activities, I recommend breaking the day up into chunks. Between each chunk, try to give the child some down-time.  This is a period, an hour or so, of quiet and relative absence of activity. If the sound and sights and other sensations cannot be avoided, try to sit with the child and do a quiet activity. This can help “turn down the volume” on the stimulation she is receiving.

When she is older, she may learn to self-select what activities she does, avoiding the overstimulating ones. She may buy clothes that don’t irritate her. She may avoid large crowds, or jobs that involve constant contact with other people. In other words, she’ll find a way to get through life happy and well-adjusted. But during childhood, she’s largely at the mercy of her caregivers. If you aren’t sensitive to her sensitivities, you may be exposing her to more stimulation than she can cope with.

Pay attention! Follow her cues.

 

 

Why Your Toddler Won’t Nap… And How to Fix It

Q: My toddler won’t nap! What can I do?

She is 2 years and four months old. Until about two weeks ago she took a nap every afternoon after lunch for two hours. Now at nap time she complains that she wants to do something else. Anything else but nap. By 6 o’clock she’s so cranky that she throws tantrums and she never throws tantrums! Help!

True story… This is a very common situation. I get a lot of questions like this. In order to answer them, I need a lot more information!

A: So, your toddler won’t nap!

First, I need a lot of background. I ask about the child’s sleep history and her developmental history. Was she full-term or premature? Did she feed and grow normally during the first two years (I ask specific questions about milestones). Then I ask a sleep history. What is her current daily routine like? I’m particularly interested in nighttime sleep: how many hours does she get? Does she sleep continuously or does she wake up? If so, how many times? I also ask about diet and exercise (Really! These things matter!)

With this toddler, it turns out she was getting enough sleep – but the way her sleep was distributed was a little screwy.

Her parents had a terrific bedtime routine: everything from dinner time to bedtime was completely regular and predictable. The girl went down without a fuss at 7PM sharp (in her toddler bed!). She would wake up at 7AM, have a bottle in her bed, and a short time later would fall asleep again until 9AM, when she’d be up for the day. For several months, she’d take a brief nap in the afternoon. Now she wasn’t napping at all, and the tantrums were beginning.

The Routine

toddler won't nap
I’M NOT CRANKY!!!

Her parents didn’t count the 7 AM bottle as an awakening and a nap, they counted it as part of her nighttime sleep. This little girl was getting 14 hours of sleep per day, which is on the high end for a toddler of her age. But she was getting all this sleep basically in one shot.

When most children drop down from two naps to one, it’s the morning nap that goes. They tend to keep the afternoon nap. This child kept her morning nap but lost the afternoon nap. As a result, by bedtime she would have stayed up 9 straight hours, which was a lot for her. She would become overstimulated and cranky. This actually made it more difficult for her to go to sleep at night!

Her fix

toddler won't nap
I LOVE daycare!

I explained to these parents that their daughter was getting great sleep at night: 12 hours! By the afternoon, she was not getting sleepy, because she had already taken a two-hour nap in the morning!  I thought that when she woke up in the morning, she should be up! But instead, she was conditioned to have her bottle and fall back to sleep. I pointed out that what she was doing was holding on to her morning nap beyond the point where she really needed it. She probably still needed the nap, only later in the day.

The fix was remarkably simple. Frankly, I was surprised how easy it was. I recommended that at 7AM, mom should start a new morning routine. She’d invite the girl to get up, have her bottle in the kitchen, eat a healthy breakfast and start her day. This activity alone was enough to stimulate the girl enough to convince herself she was awake and ready to play. By 1 o’clock in the afternoon, she began to get sleepy and went down for a nap. She’d get up at 3, and then would go down for the night at 7PM.  No crankiness, no tantrums.

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Overstimulation

There are many other reasons why a toddler’s nap schedule can get screwed up. Some toddlers have the kind of temperament that makes them sensitive to stimulation. In order to nap, they need low light and quiet. If there is too much sound, light, or activity, they will want to pay attention and stay awake.

Many toddlers nap badly at daycare. Even though most daycares do a terrific job of lowering the lights, playing soft music, and limiting noise and activity, sometimes it doesn’t work. The sensitive toddler won’t nap because she’ll be stimulated by whatever sound and activity is going on at nap time.

On the other hand, some parents tell me that daycare sleep is great but the toddler won’t nap at home! With further questioning, I usually find that the toddler is being overstimulated at home more so than at daycare!

toddler won't nap
Yeah.. no

In both these situations, if your toddler won’t nap and the reason is overstimulation, the fix is to try to reduce the amount of activity, sound, and light as much as humanly possible.

The Cheetos Sweetos Nap

Diet matters. Sorry, folks, it just does.

Here’s another true story: I did a consult for a family that had three children. One in first grade, a pre-schooler (age 3), and a baby just turned one. The reason for the consult was that the 3-year old wasn’t napping.

The mom had all three children with her when we sat down to talk. I spotted the sleep problem immediately before we even started getting to know one another. There was an open bag of Cheetos Sweetos being passed around and all of them were eating them… even the baby! Everyone had a sippy cup of juice.

Sure, they’re tasty. But Cheetos Sweetos is not food. It is the enemy of sleep. These poor kids were so amped up on sugar that it’s a wonder any of them slept at all. They got plenty of activity – this was obvious from watching them, but their diet was awful.

The Three Legs

I never get tired of reminding people that all of health and wellness stands on three legs: diet, exercise and sleep. All three of these are closely related to one another. Good habits in one domain reinforce the other domains. For example, kids who eat well tend to get better exercise, and they sleep better. Kids who sleep well tend to have more energy for exercise… and so on.

But you can also see how poor habits in any one domain can throw off the others. In the case of the Cheetos Sweetos family, poor diet was probably the most important key to understanding why the toddler won’t nap. So the take home messages are identical to the three legs of health:

  • Eat Real Food: If it doesn’t look like it did when it came out of the ground or from the animal, it’s not real.
  • Get Plenty of Vigorous Exercise: Humans are meant to move. Make sure the kids get at least an hour of real physical activity every day.
  • Get Plenty of Sleep: Keep consistent, predictable schedules, as much as possible. Avoid overstimulation. Listen to sleep cues, but provide structure!

 

 

 

 

 

How Much Should My Baby Nap?

Parents often ask me how often the baby should nap, and for how long. Often what they’re really asking is “Am I doing this right?”

Sometimes they ask because their friend’s baby is the same age as yours and she’s napping three times per day and yours is only napping twice. Or maybe it’s the other way around.

Behind all these questions is the very real and important question: “Is my baby getting enough sleep?”

How Much Sleep Does My Baby Need?

I’m indebted to my colleagues at “Get Your Baby to Sleep” for creating the tables and charts below (so that I didn’t have to make them!!!)

Baby Age Nighttime Sleep Daytime Naps Total Sleep
Newborn to 2 months 2-4 hours between feedings 4-5 naps 16 to 18 hours
2 to 4 months 4 hours between feedings 3 naps 14 to 16 hours
4 to 6 months 5-8 hours 2-3 naps 14 to 15 hours
6 to 9 months 8-10 hours 2 naps About 14 hours
9 to 12 months 10-12 hours 2 naps About 14 hours
12 to 18 months 11-12 hours 1-2 naps 13 to 14 hours
18 to 24 months 11-12 hours 1 nap 12 to 14 hours

 

I should emphasize here that not every baby has “read the book”, or even “Googled it”, as I guess I should say these days: these are averages. Some babies sleep more than others. That’s why I like to provide ranges and use terms like “about”.

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Total Hours of Sleep

For readers who prefer graphs (as I do) this one gives a better idea of how total sleep decreases through the first year of life. Out of a 24 hour period, the average newborn (0-30 days) will sleep 18 hours! This will gradually decrease to 12 hours, or half the day, by a year of life. Take home message: babies sleep a LOT!

Nap
Total Hours of Sleep per day, by age

How Many Times Per Day Should the Baby Nap?

In some ways the question begs another question: what do you mean by “nap“? The indispensable Dr. Weissbluth (see below) explains that, starting around 4 months of age, the first of the day’s three naps is basically a continuation of the previous night’s sleep! This nap is rich in REM sleep, when we believe the baby does much of her learning and processing of all the information she’s been receiving during the brief times she’s awake. The three naps per day generally decreases to two naps by 6 months of age.

nap
Number of naps by age

 

When Am I Going To Sleep Through the Night Again???

The answer to this question, as with so many other parenting questions is “it depends”. In this case, it depends on what you mean by “through the night”.  Some parents define it to mean the usual 8 hours they enjoyed before baby came in to their lives.  They should be so lucky! To other parents, “through the night” means  “the baby wakes up once to feed but the whole thing lasts five minutes so I don’t even count it”. For me, “through the night” means six hours straight, followed by the delightful early morning awakening which lasts 1-2 hours, followed by a few more hours of blissful sleep. This schedule can be achieved at about 6 months for most babies (see the table above).

nap
Uninterrupted sleep, by age

 

Well, How Did I Get Here?

One of the joys and fascinations with baby sleep is that the tables and graphs I’ve shown you do not depend at all on the type of sleep method you employed to get your baby to sleep! Whether you are an on-demand feeder, a baby-led scheduler, a parent-directed feeder, a contented baby enthusiast, a Baby Whisperer, or an attachment parent, all methods seem to lead to the same result: by one year, baby sleeps 10-11 hours and takes two naps!

I believe that all methods end up like this for a very important reason: Sleeping, and napping, are natural parts of a baby’s life. Given the right combination of reading the baby’s cues and providing structure, every parent can have a happy, healthy baby who sleeps well!

More from Dr. Weissbluth:

Cry It Out: Is There Such a Method?

Cry It Out: You read so much about it on the internet, you’d think it’s a thing.

Is it?

Cry it Out IS a Thing. Sort of.

Every day, on internet forums, there will be dozens of discussions of “CIO”, as it’s referred to. Almost without exception, CIO is help up as a sinister element that lurks out there in the world. I’m almost tempted to read CIA.

Sometimes I wish I could send a group message to the tens of thousands of mothers (and fathers): STOP IT!

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But then I have to stop myself and think: Thousands of mothers on the internet refer to CIO, so whether I like it or not, Cry It Out exists. Sort of.

cry it out
We have ways of making you sleep

Cry It Out did exist. Once upon a time. 1894, to be exact, with the publication of “The Care and Feeding of Children” by Luther Emmett Holt. Here is what Holt had to say on the subject, in its entirety:

How is an infant to be managed that cries from temper, habit, or to be indulged?

It should simply be allowed to “cry it out.” This often requires an hour, and in extreme cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary. Such discipline is not to be carried out unless one is sure as to the cause of the habitual crying.

Note that Holt places the expression in quotation marks. This suggests to me that the phrase had some currency in the late 19th century. Perhaps CIO was the preferred method? But now read closely: Holt recommended CIO only in the case of an infant who already has a sleep problem that was the result of what we’d call today a bad “sleep association“. I’m speculating as to the meaning of  “temper”.

Okay, so this is now the 21st century. Does any modern sleep expert recommend Cry It Out as a sleep training method? Again the answer is ‘No. Sort of.”

Meet Gina Ford

Gina Ford, the author of over 30 parenting books, is a Scottish-born former maternity nurse. In 1999, she published “The Contented Little Baby Book“. The major distinguishing feature of “CLB”, as it became known, was Ford’s recommendation of strict scheduling, down to chunks of five minutes. Despite scathing criticism, CLB has become a best seller. The closest Ford comes to recommending Cry It Out is her reference to something called “crying down”.

It’s a Scottish Thang

Prior to reading Ford, I was unaware of the expression crying down  as a troubleshooting method. Perhaps it’s a Scottish phenomenon. I can’t be sure. Here’s what Ford has to say about “crying down”:

Crying down can be particularly helpful when feeding problems have been resolved and a baby or toddler has only mild sleep association problems or has difficulty falling asleep because he is over-tired or over-stimulated… Reassurance must be kept to a maximum of one to two minutes. Parents should then wait a further 10– 15 minutes before returning. For this technique to work it is essential that the baby is not picked up and that he is allowed to settle by himself in his cot… Provided a baby has been well fed and is ready to sleep, I believe he should be allowed to settle himself. [Crying down] works not only for over-tired babies but also for babies who fight sleep…

It is my belief that, in the long-term, allowing your baby to develop the wrong sleep associations and therefore denying him the sound night’s sleep he needs in order to develop both mentally and physically is a worse option than hearing him cry for a short while. Allowing your baby to learn to go to sleep unassisted is your aim, and it is important to remember that this will prevent much greater upset and more crying if waking in the night is due to your baby not knowing how to go back to sleep after having woken in light sleep (emphasis added).

I’ve quoted Ford at some length because I wanted to highlight three things. First,  Ford’s similarities to Holt’s advice (already cited) emphasizing that crying to sleep might be necessary only for a baby with a bad sleep association or who was overstimulated (I regard “over-tiredness” and overstimulation as the same thing). Second, Ford emphasizes that neither a hungry baby, nor a baby who is not tired, should be put down to sleep. Finally, Ford places herself firmly in favor of good sleep associations, over most other considerations.cry it out

So is there really such a thing as “Cry It Out”?

Gina Ford tells us, correctly in my view, that crying down should not be necessary in the first place. Ford identifies the “need” crying down as bad sleep associations and allowing a baby to become overstimulated. She believes both could be avoided if the baby were put on a schedule from the get-go. Ford truly does not want your baby to cry to sleep. I don’t believe anyone want this, including Luther Emmett Holt.

In fact, if you read closely, Gina Ford is more of a “combination scheduler” than you might think at first blush. It’s true that she advocates a fairly strict schedule. But notice also that Ford insists that you make sure the baby is well fed. Notice also that she doesn’t recommend putting down a baby that isn’t tired!

Slightly Different

Just as virtually all 21st century sleep experts, Gina Ford joins the consensus about baby sleep, if perhaps in slightly different form. Like Baby Wise, Ford might say: Provide structure, but follow the baby’s cues. Sears and Spock might say “Follow the baby’s cues, but provide structure”.

Either way we end up with a method that recognizes a broader consensus about all of human behavior. We are not just a bunch of genes (the “Nature” part of “Nature vs. Nurture”). But neither are we blank slates, requiring inscription by good parents (the “Nurture” part). We all are born with certain biological traits that are then molded and shaped by our environments. And for virtually all babies ever born, the first and most important “environmental factor” is mom.

CIO2 CIO1

Baby Wise: Parent-led Schedules

Ezzo, Gary, and Bucknam, R. “On Becoming Baby Wise”. Mount Pleasant, SC: Parent-Wise Solutions, 2012

Gary Ezzo is a lucky man.

“On Becoming Baby Wise”, as of this writing, ranks #1 for sleep disorders in Amazon Books. This fact speaks volumes for the message, especially in light of the fact that the messenger, Mr. Ezzo, has been the recipient of some withering criticism for his parenting advice, but especially for his religious beliefs. Some of that criticism, sadly, comes from Ezzo’s own church, or I should say former church. Despite all this, the Ezzo collection has grown to nine volumes. That’s impressive.

baby wise X

When I read “Baby Wise” for the first time, I detected no hint of any religious world-view whatsoever. I did not know of the controversy surrounding Mr. Ezzo and I’m glad I didn’t. I appreciate that the first edition of the book expressed this world-view explicitly. Not so with subsequent versions.

My ignorance allowed me to judge the “Baby Wise” message without regard to the messenger. This is as it should be. Here’s what I took away from it:

Baby Wise

The lesson I took away was the commonsense observation that a baby who has just finished a good feeding is probably not hungry. If one hour later, the baby starts fussing and crying, many experienced parents understand that what is bothering the baby cannot be hunger. Because the baby just ate! “Baby Wise” suggests that parents first seek to find what’s bothering the baby before reflexively feeding her.

This is what happens in the real world. What mother has not looked into the bassinet at her crying baby (whom she finished nursing 30 minutes ago) and thought, “You can’t be hungry, I just fed you!” Mom then proceeds to see if the baby had gas, or needed a diaper change.

Another Fact of Life

“Baby Wise” recognizes a fact of life about babies: they are not born knowing how to get along in this world. They are equipped with certain biological set-points, but becoming a person requires nurture as well as nature. Most parents understand this implicitly.

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Ezzo suggests that babies need to be nudged, gently, in the direction of sleeping when it’s time to sleep and eating when it’s time to eat. This may involve staying with the baby for a few minutes to stroke her back, to sing to her, or to give her a fingertip to suck on. I believe that even parents dedicated to attachment methods recognize this truth. I believe “attachment parents” do a fair bit of nudging themselves, though they might not care to acknowledge it!

Baby Wise Claims the High Middle Ground

It has become fashionable in the Baby Sleep World to claim that one’s own method is “centrist” or a “combination method“, and that all the others are either “baby-led” or “parent-led” extremists. Everyone clamors for the exalted, er, middle ground. Ezzo is no exception.

[Parent-directed feeding] is the center point between hyper-scheduling and the re-attachment theories. It has enough structure to bring security and order to a baby’s world, yet enough flexibility to give Mom the freedom to respond to any need at any time. It is a proactive style of parenting that helps foster healthy growth and optimal development. For example, a baby cannot maximize learning without experiencing optimal alertness, and he can only experience optimal alertness with optimal sleep. Optimal sleep is tied to good naps and established nighttime sleep. These advanced levels of sleep are the end result of consistent feedings. Consistent feedings come from establishing a healthy routine.

baby wise
Who’s the director?

Ezzo then goes on to mis-characterize the so-called “baby-led schedule” and “attachment theories” and exhumes the body of Luther Emmett Holt’s clock-feeding schedule.

I wish Ezzo and others were lumpers instead of splitters. We are all “combination schedulers” now. This is where the “debate” has led us.

Off the Rails

Where Ezzo over-promises and under-delivers comes with his discussion of sleeping through the night.

In fact, healthy, full-term babies are born with the capacity to achieve 7-8 hours of continuous nighttime sleep between seven and ten weeks of age and 10 to 12 hours of sleep by twelve weeks of age. But these achievements require parental guidance and a basic understanding of how a baby’s routine impacts healthy outcomes.

I’m not sure where Ezzo gets these optimistic numbers from, but they do not square with observed data, as in this study:

Continuous night-time sleep for at least 6 hours was noted in 35% of the infants under 3 months old and the proportion increased to 72% by the age of 9–12 months. The youngest infants were fed on average 6–7 times per day at 2- to 3-hour intervals in the daytime and at 4- to 6-hour intervals at night.

Ezzo also nods with his misunderstanding of circadian rhythm. “Babies do not have the ability to organize their own days and nights into predictable rhythms, but they have the biological need to do so.” In fact, babies do have the ability to organize day and night, if they are permitted allow synchronize their sleep-wake cycle with the cycle of day and night. This requires no effort on the parents’ part at all. Just allow daytime to be light and nighttime to be dark. You don’t need to train the sun.

I’m not sure what Ezzo means by a “biological need” to organize day and night. There’s a need to sleep, and it’s probably the case that we do better when we sleep long periods at night. Is this what Ezzo means? Perhaps.

baby wise
Oops. Ran out of track

Back on Track

The remainder of the book gives solid common-sense advice about the hazards of overstimulation and bad sleep associations (though Ezzo refers to the latter as “props”, confusing cause and effect). The chapters on crying, feeding, baby care and troubleshooting are all pretty standard fare.

In short, the similarities between Baby Wise and other baby sleep books are greater than the differences. The latter are cosmetic, the exceptions having been noted.

Summary

  • Ezzo may be a religious man, but “Baby Wise” is not a religious book
  • Apart from some unrealistic expectation management regarding uninterrupted sleep at night, the advice is solid.

Troubleshooting Sleep Problems

If parents have followed my sleep method and it’s still not working, there are a number of ways of troubleshooting sleep problems that we pursue until we solve the problem.

Overstimulation

Troubleshooting 101:
I start by asking parents to describe their bedtime routine. I think of the bedtime routine as a series of highly predictable events that begins at your baby’s dinner time and ends when she falls asleep. The time frame we are talking about may be anywhere from 30 to 60 minutes in length. I listen particularly for indications that the baby may be overstimulated during this period. For example, is the lighting bright and harsh? Is the television on, even softly? Is there music playing? Are there a lot of people talking loudly? Is everybody passing the baby back and forth among themselves? If it turns out that there are too many stimuli, I discuss ways to reduce them, which sometimes is more easily said than done. In some homes there are simply too many people and too much surrounding chaos to reduce stimulation. Dr. Spock would argue that this is not necessarily a bad thing and that babies will get used to it, but Dr. Weissbluth and I would not agree with him. In general, less stimulation is better than more, and the empiric research seems to corroborate this. The trick is finding a way to reduce stimuli. The solution may be to find a quiet but well-ventilated corner of the house or apartment where light, sound, and tactile stimulation can be kept to a minimum.

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Teething

Teething pain often interrupts the process of getting a baby to learn to go to sleep. At around four months of age, give or take, a baby may start drooling much more than before and may start grinding her fist into her mouth. This is likely the start of the teething process, though actual teeth may not appear for eight months.

Colic

Colic almost always happens when babies and their parents want to be sleeping. Once all the other causes of crying have been ruled out (baby just ate so she can’t be hungry, diaper is clean, she’s not constipated, and so on), you might settle on colic as the cause. Troubleshooting colic is a subject unto itself, and beyond my scope in this post!

Constipation

This is actually a subcategory of colic. Many babies wake up crying because they have to poop and they can’t. There are many easy ways to help a baby through constipation problems. Your pediatrician can help you with these

Need for more calories?

Many of my mom-clients are so successful that their babies outgrow their supply! A healthy baby that is born to a healthy mother and grows as fast a human being can grow eventually reaches the point where 20-calorie-per-ounce breast milk or formula is no longer sufficient for her needs throughout the entire day. Sometimes the baby will signal this change by waking up in the night at times when she used to sleep. This phenomenon is real but is often short-lived because feeding is so often a self-regulated phenomenon. Breast-fed babies will stimulate their mothers to make more milk during the day, and formula-fed babies will drink larger or more frequent bottles. Sometimes it works, sometimes not.