Healthy Sleep Habits, Happy Child, 5th Edition
Chapter 1Step-by-Step Program for a Good Night’s Sleep
Are you sleepy? You might be feeling very sleepy because you are pregnant or you have a new baby, or your child is not sleeping well. If you are sleepy, of course, you want more sleep for yourself and you want your child to sleep well. Perhaps you just want me to tell you the right way to get better sleep for your child. In pediatrics, knowing the right thing to do is sometimes easy. For example, preventing infections may be as simple as handwashing; treating an ear infection may be as easy as prescribing an antibiotic. However, I am sorry to say that parenting decisions regarding sleep issues are not so straightforward. There isn’t one right thing to do. There are so many different choices, so many opinions, and so very little strong science. Also, unfortunately, even if you know what to do, your own sleepiness might make it extra hard for you to actually do it.
But take heart; forget all the doom and gloom you probably heard about how kids always fight sleep and how all new parents become sleep-deprived zombies. Read this short recipe, follow the instructions, and you will make an angel-food sleeper! Or just jump in and get going. It’s not rocket science, it’s more like baking a cake; just remember that there are many different recipes, all of which will still make a sweet treat. To be safe, check out the American Academy of Pediatrics Safe Sleep recommendations for preventing sudden infant death syndrome (SIDS). I have italicized key words and phrases (like SIDS) that are in the index, where you can find more information.
Chapter 1 outlines what you can do to help your child sleep better. The following chapters explain how these methods work and why sleep is important. Perhaps healthy sleep for your child is currently a low-priority item that you plan to work on in the future, or you think that healthy sleep isn’t a big deal, or you want a quick preview of the proven benefits derived from healthy sleep. In the latter case, please look at my blog (marcweissbluthmd.blog) or read, in the very brief chapter 13, the US Department of the Army summary on what to do to promote healthy sleep and why healthy sleep is important. For the US Army, sleep is indeed a serious subject.
All right, here we go!
Prevent Sleep Problems How to Help Your Child Fall Asleep Easily at Nighttime and Nap Time
The most common pitfall parents encounter when trying to get their child to fall asleep is not recognizing subtle drowsy signs.
Drowsy signs are the early warning system, signaling that you need to find shelter and start the soothing process to sleep. Then sweet sleep is almost guaranteed. Fatigue signs occur when the storm has hit, you were too late; you can make the best of it, try to find safety, but finding sleep might be rough. If your child becomes overtired because your soothing was too late, expect him to have more difficulty falling asleep and staying asleep. The most common mistake made by parents is mistaking fatigue signs, which come late, with the drowsy signs that appear early and signal the rising of the sleep wave.
Now we can get to the three-step process to helping your child fall asleep at nighttime or nap time. The following three steps are sequential based on the corrected age (counting from the expected date of delivery, not the birth date) of your child.
Step 1. Younger than 6 Weeks: Encourage Self-Soothing
Do A, B, and C, below, when you come home from the hospital with your newborn or as early as possible:
A) Drowsy but Awake
Practice putting your baby down to sleep after soothing, when he’s drowsy but still awake. If your baby has colic, try this at 2–3 months of age. Begin your soothing efforts at the onset of drowsy signs, not fatigue signs. Never forget the one sleep tip that will help all children sleep better. For all children, the single most important sleep advice can be stated in one word: timing.
You should try to start your soothing-to-sleep routine just as your child begins to become drowsy. You are using the start of his natural sleep rhythm as a tool to help him sleep better. When you do not let your child become overtired, then easier bedtimes, uninterrupted nighttime sleep, and better naps occur. Think of surfing: You anticipate the wave, you move as the wave approaches to catch it as it rises, and then you have a long, easy ride. Here the wave is drowsiness, the ride is slumber, and remember, the key to catch the wave is timing. Try to not miss the wave. Please be patient; it may take some practice.
Put your baby down, drowsy but still awake, as often as you feel comfortable. You may do this once a week, once a day, or more often. If your baby cries hard after being put down, immediately pick him up and resume soothing. Try again some other time, but this time, shorten the interval of wakefulness before the expected sleep period. If your baby quietly whimpers, immediately pick him up and resume soothing, or, if you are comfortable with this, wait a very brief moment to see if he drifts back to sleep. After you put your baby down, and there is no crying, you may wish to stay in the room awhile, but your baby will learn how to self-soothe faster if you leave the room.
Put your phone down; watch for drowsy signs. Be emotionally available when soothing to sleep.
B) Many Hands
Get Dad on board; try to have Dad and others soothe your baby to a drowsy state before your baby is put down to sleep. If you are breastfeeding, after feeding, sometimes pass your drowsy, but not completely asleep, baby to your husband for soothing before he puts your baby down. Fathers might be more successful than mothers in putting the baby down drowsy but awake. In addition to directly helping with nighttime parenting, during the day the father’s support of the mother in general indirectly helps care for the baby. This general care, during the day, supporting the mother, may actually be more powerful regarding baby’s sleeping than father’s directly caring for the baby at night.
C) Many Naps
Brief intervals of wakefulness between naps prevents your baby from becoming overtired. Experiment with the first morning nap beginning after only one hour of wakefulness from night sleep. This will prevent a second wind. Brief intervals of wakefulness and brief nap durations will result in many naps each day. Parents have told me to emphasize the point that babies need many naps because it is not intuitively obvious. Babies need to return to sleep within one to two hours after waking from a nap.
Step 2. At 6 Weeks: Early Bedtime
Repeat the protocol outlined in step 1, plus create an early bedtime based on drowsy signs, not fatigue signs. Also, begin bedtime routines, and be consistent. After the bedtime routine and after your child has been put down to sleep, leave the room.
A common pitfall is to only pay attention to clock time instead of focusing on your child’s drowsy signs. Perhaps it is late when you get home from work and/or you are tired and distracted at the end of the day, so it may be easier to quickly glance at the clock than to pay close attention to your child. Or perhaps you are innocently masking subtle drowsy signs with intense play or screen time.
Step 3. At 3–4 Months: Establish a Nap Schedule
Continue with protocols for steps 1 and 2, plus establish a nap schedule.
How to Help Your Child Sleep through the Night
All babies make vocalizations during the night. The sounds may be quiet and may or may not indicate distress. Some may sound like a quiet or intermittent whimper. Sometimes your baby will have a loud and persistent cry that might indicate that he is hungry, wet, soiled, or in distress.
All babies have moments of light sleep and moments of deep sleep. During a period of light sleep, your baby might drift toward being partially awake and then return to sleep unassisted (self-soothing) or call out for help from you to return to sleep (signaling).
Based on your child’s age, try drowsy but awake, many hands, many naps, earlier bedtimes, and establishing a nap schedule. Helping your baby learn self-soothing at sleep onset may help him self-soothe during the night.
The First 2–3 Months of Life
A mother of a newborn might appropriately immediately respond to every sound the baby makes during the night because of complications or issues around the pregnancy, delivery, or breastfeeding. A first-time parent, because of inexperience, will likely have more uncertainty or anxiety about whether the sounds the baby makes indicate distress or non-distress and thus appropriately always immediately respond to every sound the newborn baby makes. A parent of a baby with extreme fussiness/colic might appropriately immediately respond to every sound to prevent full-blown crying spells. Babies vary in their capacity for self-soothing, and parents vary in how quickly they respond. Always immediately responding to every sound may be appropriate during the first two or three months and may not create any future sleeping problems in the baby, but it might exhaust a parent, with adverse consequences. Remember, get Dad on board! Dad might immediately respond with soothing but not feeding.
Alternatively, a parent of a newborn might try to discriminate between distress and non-distress sounds during the night and implement a very brief delay (maybe a minute or less) in responding to non-distress sounds.