High need babies not only need help falling asleep, they often need help staying asleep. Here are ways to keep them asleep so that you can stay asleep, too.
1. Sleep where baby sleeps best. Every mom, dad, and baby must work out and keep evaluating what sleeping arrangement will get everyone a restful night's sleep most of the time. Some high need babies seem to have a critical distance for contented sleeping. For some, sleeping too far away from their parents gives them an acute case of nighttime separation anxiety, causing them to awaken frequently. Other babies get hyperstimulated by sleeping too close to the parents, and awaken frequently there. Parents also vary in the amount of nighttime attachment that gives them the most restful night's sleep. Some mothers do not sleep well with their babies too far away from them, some fathers do not sleep well with their infants too close, and sometimes both parents are very anxious about one extreme or the other.
When baby sleeps too close to me he fusses. When he sleeps too far from me he fusses. I keep experimenting with different sleeping distances, and it changes from week to week.
There came a point where exhaustion overwhelmed me. Our other two children had slept with us as babies, but I was afraid to put our 3-pound, 13-ounce premature baby in bed with me. I feared I'd fall asleep and my breast would smother her. Her nose was the size of my pinky finger. But one night after weeks of walking the floor with a crying baby, I snuggled her in bed with me and figured one night without bottles or breast pumping would be okay. We were there for seven hours. It was heaven! From then on we went to bed together, and we slept! She would nurse frequently during the night, but she never cried. This was the beginning of our sharing sleep together. I was amazed at her needs for physical closeness to me, despite the fact that she'd spent most of her short life alone in ICU. I embraced this need with joy. Those primal instincts are not easily squelched. I began to see her high need personality as a positive sign; looking on the bright side, high need babies have finely tuned survival instincts.
I resisted any idea of sleeping with my baby until one night I thought, "Well, we slept together for nine months and it didn't kill either of us. Defying everything I had been told, and following my instincts I took her to bed with me.
2. Vary your nighttime response. Whether nightwaking is the result of a need or a habit is a judgment call, and a difficult one. Babies would claim they need comfort; sleep trainers claim it's a habit. The goal of nighttime parenting is to make it more attractive for baby to stay asleep than to wake up.
For example, if every time the older baby awakens you "reward" the awakening, you set yourself up for many more wakeful nights. Yet, it's a natural maternal instinct, especially for a breastfeeding first-time mother, to rush to comfort a toddler back to sleep using his favorite pacifier. Suppose each time you awakened, your favorite person instantly rewarded you with your favorite treat. How motivated would you be to stay asleep?
At the other extreme is playing deaf to all nightwaking to "let baby cry it out" and "break the nightwaking habit." This is common advice given by sleep trainers and well-meaning friends who are not there at 3 a.m. and who have no connection to the baby who is awakening. Few mothers are able to be insensitive to their baby's nighttime needs, and besides, most high need babies will outlast any scheme to let them cry it out. They just keep on crying. They don't learn to put themselves back to sleep. They just get angry and frightened.
It helps to have a variety of ways to comfort nightwakers, so baby learns that nighttime needs can be filled, many different ways. Develop a large repertoire of nighttime responses depending on the age of your baby:
- feeding (a newborn needs to be fed; a one-year-old probably doesn't)
- sucking
- tummy-patting
- singing a lullaby
- rocking
- snuggling
- reassuring voices
For nighttime sanity's sake, it's helpful for mother and father to share night-comforting. You'll appreciate one another rather than resent one another.
We took shifts during the nighttime hours. I would get up and nurse her or I'd just pull her next to me in bed. If she wouldn't fall asleep, Michael would walk with her or we would just both get up together. Sometimes we'd watch this hilarious 3 a.m. television show. If Michael was walking with her then I'd get some letters written or do some reading, and make it productive time instead of just feeling frustrated that it was a waste.
Realistically, high need babies are notoriously resistant to most nighttime tricks, especially the popular sleep training strategies which are just modern versions of the ancient cry-it-out method. As described on page these babies have a strong mindset. They want what they want, and any alternative is met with a wailing protest. If babies awaken expecting their mother's breasts but get a plastic plug instead, most babies will indignantly protest your trick to the entire neighborhood.
Keep in mind that your goal is to condition your child to sleep, not awaken. Try to meet his nighttime needs in a relaxed and boring fashion. Give him a sense that nighttime is different from day, and we don't usually play in the middle of the night. It's not that you don't meet your baby's needs at night, but you recognize that the main need at this time is for sleep and a well-rested mother in the morning. Once again, what helps to keep you calm so you can truly help baby be calm is to let go of the expectation that you should be getting an uninterrupted stretch of sleep.
3. Time your response and be boring. Keep working at your cry response until you find the one that resettles your baby the fastest and disturbs your rest the least. Some mothers find a quick response works best; they know from experience that those first sounds will escalate into a family-arousing wail if ignored. At the first whimper, you immediately comfort your baby by letting him suck, tummy-patting, holding, rocking, singing softly, hand on tummy putting pressure to make baby feel held and warm, rock the cradle, whatever works before baby completely awakens -- and you completely awaken. If baby is in bed next to you, try hugging him in close to you in the teddy bear snuggle. Bottle babies may settle if you help them find a thumb or pacifier. Sometimes just helping an older baby find a better sleep position works. Many mothers find this quick response works best for high need babies because you get to them before they get revved up to a full awakening, from which it will take longer for both you and baby to resettle. This approach works best if baby is nearby or in your bed rather than in his own room, unless you have a very sensitive monitor and sleep with one ear awake.
Other mothers find the slow response works better. If you don't rush in to comfort baby at the first whimper, baby may not awaken fully and will drift back into deep sleep without intervention or baby may awaken and resettle herself back to sleep without your help. Babies with easier temperaments and older babies are more likely to resettle themselves.
There are risks and benefits to both approaches. Responding too quickly may reward the baby for waking and short-circuit his developing ability to self-comfort. Responding too slowly allows baby to fully awaken and become frightened or angry at the slow response. This will make it more difficult to settle baby and yourself back to sleep. Somewhere between these extremes is the right response for your family, and it may change at each stage of baby's development.
When comforting a nightwaker, try not to reinforce the waking. If you rush in and scoop up baby with a panicky voice and tense arms, you convey that there really is something to be scared about at night. Instead, be quiet, calm, soothing while you give an "It's okay to sleep" message.
4. Detect irritants that could cause restlessness. Remember, many high need babies are hypersensitive to noise and uncomfortable irritants. While most infants are not awakened by these stimuli, supersensitive babies are. As much as you can, minimize noises that startle and bodily discomforts that irritate. This requires putting on your detective cap, analyzing your baby's sleeping environment and, as much as possible, removing any stimuli that could awaken baby. Use the following checklist as your guide.
Stuffy noses. Plugged noses awaken tiny babies. Babies under six months don't readily switch to mouth-breathing if their noses are plugged. Keep baby's sleeping environment as free of nasal irritants as possible: cigarette smoke, animal dander, mother's perfume or hairspray, dust from stuffed animals, etc. Clues that a nighttime, stuffy nose is the problem include: persistent restlessness; noisy, throaty breathing; and difficult nursing at night. In addition to removing possible nasal irritants, "hose your baby's nose" using over-the-counter salt-water nose drops and an infant nasal suction bulb.
Irritating sleepwear. Some babies cannot settle in synthetic sleepwear. Change to 100 percent cotton clothing to see if your baby sleeps better.
Environmental irritants. The same things that can cause a stuffy nose (see above) can also cause a general irritability at night. If you've ever experienced a tickle far back on your palate that you can't get to, you'll have some idea what an internal irritation can do to disturb baby's sleep. This irritation may be present at other times besides sleep time, but baby won't usually notice it in his busy waking hours. Like teething pains, physical discomfort is so much worse at night because there is no distraction from it.
Dietary sensitivities. Hypersensitive babies may have food intolerance's. Like environmental irritants, certain foods in baby's diet (and your diet while you are breastfeeding) can cause internal irritation.
I want to thank you for your sensitivity and intuition as Ian's doctor. When I brought him into you I was "beside myself," "at the end of my rope." He wasn't sleeping at all during the day or at night. At night it was the worst. From 8:00 p.m. till 2:00 a.m. he would wrench up, pull his knees up to his chest and scream. It was impossible to calm him, hold him, or even nurse him. I tried everything; swinging, rocking, walking and sleeping with him. The list is endless. I refused to believe he was colicky. I explained to you what he did and you said it sounded like something external rather than internal.
I thought about what you said and thought the only time he is content is when we change him and he has no clothes on. I realized I was putting him in 100% polyester nightgowns in the evenings when he was the worst. He was totally miserable. During the day he was usually in something 50/50 cotton/polyester and was less miserable.
So I came home and put him in 100% cotton diapers, cotton clothes, cotton blanket, and cotton bedding. I couldn't believe it! I had a new baby in my arms. He was totally calm and content. He even started cooing and smiling and seemed happy. It seemed too good to be true, but the next day he even took several naps! Just like a real baby!
He is finally out of his misery. I am so glad we didn't just write it off as a colicky baby. I can now enjoy my baby. He is now a happy, content, cooing, and smiling baby!
Tummy trouble. Hypersensitive babies often have hypersensitive intestines. Like environmental irritants, certain foods in baby's diet (and your diet while you are breastfeeding) can cause internal irritation somewhere in baby's body. If you've ever experienced a tickle far back on your palate that you can't get to, you'll have some idea what an internal irritation can do to disturb a baby's sleep. This irritation may be present at other times besides sleep time, but baby won't usually notice it in his busy waking hours. Like teething pains, nighttime discomfort is so much worse at night because there is no distraction from it.
Startling noises: oil squeaky cribs, warn older siblings not to slam doors, remove noisy clocks, etc. Sounds that are sudden, loud, and unfamiliar awaken these babies. Other sounds may settle them.
When our first baby woke up wet during the night, I would take her into the changing room, turn the lights on, take off her wet diaper, cleanse her, and put a new diaper on. By that time she was totally awake and I had to nurse her back to sleep. With our second baby, a friend of mine convinced me I didn't have to change a baby's diaper during the nighttime. Initially, I was afraid it would leak all over the place and the whole bed would get wet, but here's what I did. I covered his bottom with a zinc oxide barrier cream, put three cloth diapers on him, and sometimes even used a diaper cover. When he woke up at night I didn't change him. I just pulled him next to me and nursed him. I did everything I could to keep it quiet and dark and not to stimulate him anymore by getting up and changing his diaper.
I wrapped him in a nice warm blanket so that only his head poked out right before I nursed him to sleep in the rocker. Then when I go to put him down he still feels warm and secure. It worked. I took that a step further and put flannel sheets on our king-size bed so that the sheets wouldn't be so cold so as to wake Philip up during his nighttime sleep.
5. All-night nursing. In my practice, some mothers relate that their high need babies and toddlers do seem to nurse a lot at night. How you approach this depends on how old the baby is and whether or not you are actually waking up feeling sufficiently rested First refer to the section on "Medical Causes for Nightwaking." A baby of any age deserves to have his nightwaking investigated for medical and physical causes. Younger babies almost always have legitimate problems (even to our adult minds) which cause waking, and they sleep much better once these problems are addressed.
We have found in our own experience with several of our babies that as they became toddlers the amount of nightwaking Martha was able to handle changed. This was especially true with our last several toddlers, due to increased stress in our lives (and probably the fact that Martha was getting older). When Erin was a bit past two, Martha began setting limits on night nursing because she was pregnant. She literally could not stand lengthy feedings, especially at night, so she'd let Erin nurse for 2-3 minutes and then ask her to stop (Erin was not always willing), and Martha cuddled her up close. What saved the situation was that Martha discovered that Erin would relax if she could put her hand on Martha's breast. In fact, she fell asleep faster doing this than if she were allowed to keep sucking. Martha also discovered that Erin relaxed off to sleep much more quickly when Martha was able to stay peaceful herself.
6. Just say no! When our Matthew was two, Martha felt desperate for sleep if awakened more than two times. I would wake up to hear a dialogue like "Nee" (his word for nurse)..."No"..."Nee!"..."No!"..."Nee!!" "No, not now, in the morning. Mommy's sleeping. You sleep, too." A firm but calm, peaceful voice almost always did the trick. You can manage to stay peaceful in this situation when you know you are not damaging your very secure, attachment-parented child.
When Stephen was at this age (20-22 months), he was typically nursing twice at night, occasionally three times, and Martha was fine with this. Actually, she found it enjoyable. But he hit a stage where he started waking 4 and 5 times and Martha tried the calm, peaceful "No" dialogue. Every child is different, and Stephen wasn't buying it. So we devised the plan we wrote of in THE BABY BOOK. Martha would nurse Stephen the first two times he woke. Then if it was still a long time till morning, I would pick him up and walk with him the next time. He cried, but it did not escalate to panic, and I lasted him out. After nearly an hour he fell back to sleep in my arms and I laid him back down next to a sleeping Martha. After 3 or 4 nights (with less and less crying), he stopped the frequent waking, and all was well again. And stayed well. He learned what our limits were!
In some families with different temperaments and levels of ability to cope, we have learned that this "cry-it-out-in-Dad's-arms" advice may not work. One mom had this to say:
I would suggest that a toddler waking frequently at night to nurse will not do well crying it out in Dad's arms. What he may need is to learn to sleep alone on a separate mattress or with a sibling, because the proximity to mom is stimulating the waking. It's time for a positive weaning from the family bed (see p. ), not a negative you're-stuck-with-Dad experience.
We have learned that the "just say no" approach also isn't right for all toddlers. I was on a talk show once giving this suggestion to a caller who had a sixteen-month-old waking 2-5 times at night. ("Mommy and Daddy go night-night, baby go night-night, and nummies go night-night.") A week later I got a letter from a mother who had identified with the caller's situation and had tried out the advice herself. She was amazed at how well it seemed to be working and wrote to thank me. However, a few weeks later she called Martha, very confused because everything had deteriorated. Her sixteen-month-old who had actually managed to sleep for nine hours with one or two brief wakings of a few seconds without breastfeeding, was now a very clingy, weepy child by day. She wondered if it was connected to the night situation. Martha helped her understand how to "read" her child to assess results of any technique. She included the insight that radio talk shows can not allow for a complete exploration of problems and solutions (especially when the adviser is male and the show's host is male!) Her thank-you letter (addressed to Martha this time) said, "You really helped me put it all into perspective! I've been a much more "go with the flow" and intuitive parent. Not letting my daughter breastfeed at all during the night was clearly too much for her to handle right now." In my defense, I didn't mean to imply that she not nurse her baby at all at night, but I guess that's what came across. I guess I'll never know what happened with the caller's baby.
Since our youngest child is ours by adoption, and since she was no longer breastfeeding when she was a toddler, Martha had to learn a new way to deal with Lauren when she woke at night. Thankfully, she was usually a "good sleeper;" yet there were times when she would wake and think it was time to play, or times that she was sick and couldn't get back to sleep. Martha, by now an expert on not having nighttime expectations (we'll discuss daytime expectations in the "Mother Burnout" chapter!) would simply get up with her and take her down to the living room where no one else would be disturbed. She'd rock Lauren or let her play in the dark while Martha would lie on the couch and rest.
