Wednesday, May 14, 2014

5 Baby Sleep Strategies

Looking For Lala Land
It sounds simple enough: Bathe, feed, cuddle, place in crib. Maybe you will even get one of those really good-natured guys or gals who fall effortlessly into a predictable eating, sleeping, and napping routine. Maybe you'll also win the lottery and never have to worry about the cost of college. But if you're like most of us, figuring out how to get your baby to fall asleep at the right time and in the right place will take you a good part of the first year of her life -- sometimes longer, but we won't go there just yet.
 
We at Babytalk have been saying for a while now that there is no one right way to put your baby to bed: What matters most is that you feel good about how you're handling your baby's nighttime routine. A strong sense of security is going to be a far better predictor of how your baby sleeps at night than how much he weighs, how much he eats, where he sleeps, and how many months he's logged here on Planet Earth -- or whatever else you heard at your last mommy group. That said, here are five baby bedtime strategies worth a try. It's up to you and your baby to figure out what it will ultimately take to ensure that everyone in your family is getting as much sleep as possible.
 
1. The Drowsy Tuck-In
Almost regardless of where you turn for sleep advice, you will discover the golden rule of baby bedtime: Tuck your baby in sleepy but not yet konked out, so he learns to self-soothe and nod off on his own. The benefits to this approach are many: For starters, your bedtime routine will be shorter and less stressful. For another, your baby will go back to sleep more easily after his nighttime feedings. Finally, after he reaches the blessed point that he no longer wakes for nighttime feedings, he will still wake intermittently (as we all do), but he'll be able to roll over and go back to sleep on his own. In short, you won't be his sleep crutch, which means more rest for both of you.
 
How to get to that heavenly place? The general wisdom is to begin to establish a routine -- including a bath or massage, for example -- that lets your baby know nighttime is near. Of course you can do some preliminary soothing -- you'll want to feed him, and maybe rock or sing or read -- but then lovingly deposit him into bed groggy but still awake and lying on his back to minimize the risk of SIDS (sudden infant death syndrome). Then whisper your good nights and good-byes and hightail it outta there.
 
2. Soothing Your Baby to Sleep
This is more a natural instinct than a method. Of course your early attempts at inducing sleep are going to include feeding, rocking, singing, and swaddling. And all babies do need a wind-down routine. The catch is that not all babies tolerate the drowsy tuck-in that's supposed to follow. Some resist loudly when unceremoniously plopped into the crib, and some moms feel like crap walking away from those wails. Or you may have a "high-need" or "challenging" baby (politically correct terms for colicky, fussy, difficult, or whatever else you really feel like calling her by now). This type of baby might want to be held constantly, fuss or cry often, and demand her dinner loudly. It's fine to rock a baby like this to sleep if that's what your instincts tell you to do. If she loves sucking, lay in a stash of pacifiers -- especially if you're nursing, so you don't become a human pacifier. Then once your baby is out cold, hold your breath, rise from your rocker ever so gently, tiptoe across the room, and lower her slowly, slowly, slowly into the crib. One of the biggest challenges of this approach is that babies often wake up the minute your arms are no longer around them--and you'd jump out the window yourself if there wasn't a window guard on it! Here's a good tip if you find yourself in this situation a little too often: Since a cold sheet can be a rude awakening for these sensitive babies, keep a blanket over the sheet until just before tuck-in, and the sheet will feel warm and cozy on her little body.
3. Co-Sleeping
If you like following the concept of attachment parenting, the style of childrearing that involves lots of close physical bonding (breastfeeding, babywearing, et cetera), you may love the close connection of sleeping in the same bed with your baby, too. Some moms like the idea of this approach even before their baby is born. They may have been raised this way themselves or are attracted to the emotional connection that lots of physical contact brings. Moms who are exclusively breastfeeding may find that sleeping alongside their baby makes the constant nighttime feedings of the early weeks and months easier to manage. Still others have a high-need baby and fall into the so-called family bed because it's pretty much the only way anyone in the family can seem to get any sleep. A baby who is fussy and demanding, or shy and introverted, may really thrive on this intimacy and immediate meeting of his needs. Bear in mind, however, that there are some infants who are easily overstimulated and may not do so well in the bed with Mom, and you may have to accept that even if it's not what you had in mind (it's just one of the first clues you will get that your baby makes plenty of the decisions!). If you go the family-bed route, you also need to realize that babies who sleep with their parents are at a higher risk for sudden infant death syndrome. In 2005, the American Academy of Pediatrics came out with a strongly worded policy stating that infants under 6 months should not sleep in the same bed with their parents because research shows it ups the risk of SIDS. In fact, nearly 50 percent of babies who die of SIDS are in a bed-sharing situation, according to the AAP. One in about two thousand babies dies of SIDS each year -- not a huge number, but huge to the devastated parents who lose their children this way.
 
As the AAP's new guidelines indicate, a co-sleeper, crib, or bassinet next to your bed is safest, but if you choose to go to sleep with the baby in your bed (or it's the only way to get your little guy to nod off), make sure you are vigilant about these ground rules:
  • Keep your baby safer by putting him down on his back.
  • Keep him away from any blankets or pillows.
  • Don't sleep with your baby on a water bed, on a sofa, or in an armchair. These are even more dangerous than a traditional adult bed.
  • Maintain a smoke-free environment.
  • Never use alcohol, drugs, or any medication that might make you unaware of your baby's presence.
  • Remember that your baby's bedtime should be before yours, so avoid keeping him up until you turn in. Lie down with your baby to get him to sleep somewhere between 6 and 8 pm, and then move him into a co-sleeper by your bed so he's safe until you return. Move him next to you when you go to bed if that's what you choose to do.
  • Babytalk contributing editor William Sears, MD, co-author of The Baby Sleep Book, recommends that babies sleep next to their mothers, rather than between both parents, because he feels a mother will be more aware of the baby's presence and less likely to roll over on him.
 
4. The Gentle Good Night
If you began your sleep routine with lots of soothing in the early months and now find yourself wearying of all the work, yet you don't have the nerves for crying, or a baby adaptable enough to segue smoothly into a drowsy tuck-in routine, there is still another in-between solution for older (at least 5 months old) babies: You can attempt to gradually wean your child off an extended bedtime routine with what experts refer to as deconditioning or modified sleep training. You can try it on any baby, but it may work best on one with a fairly easygoing disposition; babies who are clingy and sensitive or high-energy and intense may put up more resistance. The big benefit here is that you get to take back your night eventually, with fewer baby tears and less maternal angst than traditional cry-it-out methods entail. The downside: You have to be very patient and very consistent for several weeks.
 
Here's how it works: Adopt a very consistent bedtime wind-down routine (always nurse or give a bottle in the same spot, then read a book or sing a song); then tuck your baby into her crib while she's still awake, only instead of hoofing it out of there, pull up a chair next to her crib. If she fusses -- and she probably will at first -- talk to her and touch her intermittently (patting her tummy, back, or head) to soothe her. Try not to pick her up -- but you can do so briefl y if she's really hysterical. Stay as long as it takes for her to fall asleep, then leave the room; repeat the method if she wakes during the night. Perform this routine consistently for the next three days at nap- and bedtime. On day four, move your chair about halfway across the room, between the crib and the door, and reassure your baby verbally from there until she falls asleep and you can leave. Again, stick with this routine for three days. On days seven and eight, move the chair all the way to the doorway and if necessary again give your reassurances verbally from there. By about day nine, with any luck you should be able to tuck your baby in and promptly leave without wails.
 
5. Ferberizing
Okay, you're in the same place as the last mom: Your're fed up with the complicated routine and night wakings, but you want faster results and think you can handle some crying. And deep down, you know you'll be a better, more loving parent when you get your life in order again, too. If your baby is no longer a newborn, you can try Ferberizing -- a method popularized by Richard Ferber, MD, in the classic book he recently revised, Solve Your Child's Sleep Problems. Over the years (the book was first published in the 1980s), critics have dubbed Ferberizing the "cry-it-out" sleep method, and possibly because he himself wearied of the callous reputation he'd developed, the new edition offers some caveats. Ferber now emphasizes that his method doesn't always work, especially on really sensitive infants, so consider your baby's personality before you attempt it. Ferberizing is best used after 4 months (you should always respond quickly to newborns) and before 8 months, when babies haven't fallen into hard-to-break habits. It's also ideal for an initially easy baby who may be getting more active and thus more resistant to going to bed because his world has suddenly become much more engaging. You yourself will need nerves of steel. If you're the type who feels like crying whenever your baby does, don't even bother to read on. But if you're exhausted and just can't take it anymore, here's how it works. Begin with your usual bedtime routine, but (and by now you know what's next . . .) tuck your baby in when he's sleepy but still awake. If he cries -- and he will if he's not used to being deposited in his crib awake, no matter how lovingly -- respond by consoling him with a soft, reassuring voice and by rubbing his tummy, but explain that it is bedtime and you are going. Your soothing tone should help even when he can't understand the words. Leave the room for a brief period -- about five minutes at first -- then return to console him if he is still upset, but don't take him out of the crib. Repeat this pattern until your baby falls asleep on his own, and do so again if he wakes in the middle of the night. Each consecutive night, lengthen the time you let him fuss by a few more minutes, then go in to comfort him, until it is no longer necessary.

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