Monday, February 25, 2013

Little Secrets of a Sleeping Baby

1.    Know that crying is normal. It is how we respond that matters.

When I was pregnant with BabyC, I knew that for the first few months of her life, she would wake often during the night, but I envisioned sweet nights with her – a dim light, a comfortable rocking chair, nursing her until she faded back to sleep. And in my imagination, these scenes of maternal bliss were always quiet. So I was not prepared for the nights during those early weeks when BabyC would wake at 2 AM and I would do everything I knew to do – nurse her, burp her, change her, hold her, rock her, try nursing again – and she would only cry. There were nights when she would wail, eyes squeezed shut, for hours, while I tried everything to soothe her. Looking back, I realize that in my mind, I believed that my success as a mother was tied to my ability to stop my baby's cries, as quickly as possible. If she cried, I felt that I was failing.

With this mindset, when Husband and I discovered that bouncing BabyC stopped her crying, we latched on to that as our life vest for parenting. Bouncing became the way that we put BabyC to sleep every single time. We thought we had discovered a genius secret for curing babies' cries. Every parent needs one of these exercise balls, we told our friends.

Of course, it was no wonder that BabyC couldn't sleep well when every time she transitioned from one sleep cycle to the next, she needed to be bounced up and down, for longer and longer periods of time. Bouncing may have stopped her crying for a while, but by using this technique, we were completely overriding whatever self-soothing abilities BabyC might have had if given the chance to use them. And as her parents, we were missing valuable opportunities to really listen to her cries, learn to understand them, and develop appropriate responses.

There is a significant body of research that shows that infants will learn to self-soothe if given the chance. As a new mother, I wish that I had paused to listen before jumping to stop BabyC's cries and, in doing so, perhaps given her a chance to develop her own ways of soothing. I wish that I had thought carefully about what my soothing techniques were teaching her about sleep. And I wish that, at least occasionally, I had given her the chance to try to fall asleep without my intervention. After all, she might have surprised me. It would have been easier for me to think clearly about these things if I had thought of my job as being to support my baby in learning how to sleep rather than being to stop the crying.    

Since those desperate days of early motherhood, I have learned a great deal about respecting and listening to babies from the writing of Magda Gerber. She wrote,

"[Crying] is the way a baby expresses her feelings and she should be allowed to do so. Rather than trying to stop your child from crying by distracting her, try to figure out why she is crying so that you are able to help her."

BabyC cried because she was tired. I responded by distracting her with bounces until she was lulled to sleep. I now realize that what she needed was to be heard, not hushed. I am  not suggesting that we should ignore babies' cries – not at all – but simply that we be thoughtful about responding in a non-intrusive way that is consistent with how we want the baby to eventually learn to sleep. In reality, this may be just a small shift in our actions, but it is a huge shift in our intention, and it actually requires greater attention to our babies. I believe that this simple shift in thinking may have prevented the sleep problems we found down the road.

2. Develop predictable routines for both the day and night.

Exposure to light during the day and darkness at night helps new babies to develop circadian rhythms and sleep more at night. Getting fresh air and sunshine during the day is good for parents and babies alike. A study of 6- to 12-week-old infants found that those that slept well at night were exposed to more light during the early afternoon . In addition, following a consistent bedtime routine improved sleep in a large randomized controlled trial of infants and toddlers identified as having sleep problems . In this study, babies that received a bath, massage, and snuggles each night were quicker to fall asleep, woke less in the night, slept for an average of 36 more minutes per night, and were in a better mood in the morning! It is never too early to develop these routines.

3. Be emotionally available at bedtime.

In a study of babies aged 1-24 months, the more emotionally available mom was at bedtime, the easier it was for baby to settle to sleep and sleep well during the night [3]. Other factors such as where the baby slept and whether nursing was part of the bedtime routine were found to have little effect on sleep in this study. The authors described emotionally available moms as:

Sensitive – "affectively attuned to their infants, demonstrated a clear awareness of infant cues, interpreted them accurately, and responded contingently and appropriately." 

Structuring –  "prepared their infants for bed using positive, quiet, soothing bedtime routines that gently guided the infant toward sleep."

Nonintrusive - "showed recognition of their infants' need to sleep by not initiating new interactions with the infant and avoiding high-volume, intrusive talk."

Nonhostile – "showed no overt or covert irritability or anger toward the infant at any point during bedtime."

An emotionally available parent makes the baby feel safe at bedtime, even when saying goodnight is difficult. 

If your current sleep situation is not working and it is affecting the health of your family, you may wish to lovingly and respectfully make some changes to your baby's sleep habits. Encouraging your baby to self-soothe will make it easier for her to transition from one sleep cycle to the next during the night without your help. Change is always hard for babies, and this is especially true around bedtime. Here are some things you can do to ease your baby through this transition:

4. Consider your baby's stage of development.

Young babies (<3-4 months) need our help with regulating stress and should not be left to handle it on their own for prolonged periods. In addition, there are developmental stages that are particularly difficult times to make changes to sleep routines. For example, between 4 and 6 months, babies are experimenting with their new-found power to elicit a response from a caregiver (I smile at you and you smile back!). Between 8 and 11 months, most babies go through a period of separation anxiety. Decreasing parental involvement at bedtime during these developmental stages can be confusing and distressing for babies [4]. Unfortunately, these same stages often bring some natural struggles with sleep, but it is best to ride these periods out and wait until your baby is in a more stable place. Be mindful of other transitions in your baby's life as well. If she is going through changes in childcare or working on a new skill such as crawling, wait until these have passed before attempting changes in her sleep. And be aware that some children, particularly if they are fearful or anxious, may just need closeness at bedtime for a while. For an in-depth understanding of child development as it relates to sleep changes, I highly recommend the book Bedtiming by developmental psychologists Isabela Granic and Marc Lewis. Other sleep advice books and sleep researchers largely ignore these ideas, and I'm convinced that appropriate timing is a critical factor in both the stress and success of attempting sleep changes.

5. Talk with your baby about the upcoming changes.

Babies almost always understand more language than we realize. Do not underestimate the value of helping your baby prepare for a transition. In one study of babies entering daycare for the first time, when mothers spent more days preparing their babies for the transition by attending daycare with them, they were more likely to maintain secure attachment during this change .

6.  Be present and supportive for your baby during bedtime changes.

If you are encouraging your baby to self-sooth and learn to sleep on her own, you eventually need to decrease your presence and soothing at bedtime. Several studies have measured cortisol in rhesus monkey infants separated from their mothers. They found that when infants were separated to a different cage but were still able to see and hear their mothers, they cried more but had little to no cortisol response compared to babies that were totally isolated from their moms. Staying close to your baby during this transition may mean that she protests more, but your presence is still helping her cope with the change and regulate her stress. That may mean staying in the room at first and gradually withdrawing your presence, or it may mean returning to reassure your baby periodically. Either way, you are telling your baby, "I know this is hard for you, but I'm still here."

This last point highlights another shift in my thinking about infant crying. Once we realized that we had saddled BabyC with an association between bouncing and sleeping and that this was interfering with her sleep, I started trying to let her fall asleep in my arms without movement. She cried and cried and cried, pleading with me to stop being silly and start bouncing her. In my desperate new mama mind, I thought, "This isn't working. She won't stop crying. I'm clearly not helping her." Again, I was tying my success as a mother to my baby's cries, and I felt that I was failing. I finally set her down in her bed and left the room, returning every few minutes to reassure her. Ultimately, I think that this method can be an acceptable way of supporting babies through this transition, but I wish that I had tried letting her fall asleep in her bed while I sat close to her. I wish that I had known that her crying didn't mean that my presence was meaningless to her, that me being there as she learned to sleep may have reduced her stress through the transition.

Many sleep experts advise that extinction – letting babies cry-it-out without any reassurances – is the fastest way to good sleep and results in less crying in the long run. They're probably right, but again, I think we need to stop measuring our success by minutes of crying. A more gradual approach may take longer and require more patience, but it is likely less stressful to the baby. A crying baby may be protesting, struggling to fall asleep in a new way, or frustrated by the change, but she is not necessarily in distress or despair. When we let our babies know that we hear them and acknowledge their emotions, they'll probably keep telling us how they feel for a while, and that's OK. Every baby is different, but I now believe that most babies benefit from a gradual approach with more parental support. 

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