Dear BabyShrink,

My 8-month-old Lehua is going through a real burst right
now, and among other things has just figured out how to get herself up to a
sitting position. This is great, but it’s really messing with her naps.
Previously, she would fuss for 5 or 10 minutes, and then fall asleep. But now,
she’ll push herself up to sit and then seem to get "stuck" there.
Fussing turns into sobbing and screaming, and she never gets to sleep. This
morning she stayed like that the full hour until we went to get her. This
afternoon she dozed off for about 20 minutes and then woke up very fussy but
wouldn’t go back down because of the sitting thing. What to do? My instinct is
that she needs to learn how to do it herself and we should just tough it out a
few days until she gets it. But I don’t know. My mom disagrees of course.

Related question: what to do when she wakes up after only 20
minutes of a nap and is still fussy? Go and get her even though she hasn’t
gotten enough rest, or leave her in there fussing until she goes back to sleep?
She is taking short naps lately and it is clear she’s not rested.

In my experience, it is just so much easier to create good
habits than to break bad ones. I think our sleep situation is an example of
this, because from the beginning I was super militant about laying down good
nightime habits — never taking her out of her room once we put her down,
keeping a regular bedtime, putting her down awake and letting her fall asleep
on her own. The goal was for her to be independent in her sleep habits. But I
think I dropped the ball on naptime — I’d often let her sleep in the car, in
my arms, or in the stroller. Anyway, I’m sure there are other reasons she has
more trouble sleeping during the day, but I can’t help believe that was a
factor.

Still, it’s good to be reminded of the need to be flexible
and have a little "grace period" in times of upset. I’m kind of an uptight person, so when
things are getting shook up, I tend to cling even harder to my routines and
"good habits." I agree that, while moving in the direction of good
habits, you still need to "go with the flow."

I guess the real answer here is what you’ve talked about
before — trusting your instincts about what your own baby needs. But it’s hard
when you’re not sure what your instincts are telling you!

Ilima
Maui, Hawaii

Dear Ilima,

Wow! I can really
relate. Once you have the routine down pat, they go and change on you. I wish I
had "the answer". But since this is sort of an unavoidable part of
development, all I can do is give you some general information, and you can use
your Mommy sense to see what might work for Lehua. (You can also read my "Babies and Sleep" article here.)

First, yes, sleep is super important. BUT, a few days’ disruption does not make
for a "bad habit". I know she’s cranky, but your goal is to gently
nudge her back in the direction of sleeping through. In the meantime, one of
the things she’s looking for is some comforting through all the wild and wacky
changes she’s experiencing.

That’s one of the reasons she is waking….to look
for you. She is entering a phase where she will be more aware of you, and when
you’re gone. Separation anxiety will crop up during sleep, when she is
away from you. That’s part of it.

So: what to do when she awakens after 20 minutes, and you
know she’s still tired? There are not really a lot a great choices. I say, be guided by practicality. See
how you’re feeling that day, and see how she sounds. Is she just a little
cranky? Then let her fuss a bit. Is she just way over the limit? Hold her awhile and
see if she might go back down. If not….that’s OK. Perhaps an earlier bedtime
later that evening is called for. All is not lost. Pick her up and go on with
your day, albeit with a cranky girl.

You will also be letting her know that
flexibility and adaptation is one important way you will be helping her cope with difficult times.

(Lots
of my readers have asked about this, and it has been a discussion online here. Can
you be flexible….and still have good limits? Yes. Absolutely. More on that topic soon.)

Also, she’s not too young to start talking to her about
what’s going on. "Lehua, I know you know how to sleep nicely in your crib.
You’re tired! Mommy’s tired! Let’s sleep MORE today, ok? I know you’ll feel so
much better when you sleep. Mommy will be here when you wake up today. I know
you miss me. You’re safe, we’re here." Just a short little pep-talk is enough. She may not understand 100% of
your words, but she’ll start to get the gist, over time. And it will condition
you to start talking to her about these developmental challenges, and how you
are going to help her get through them.

So much of young babies’ sleep is constitution and temperament, not the
environment. That’s a concern I have with some of the popular baby sleep
books; the shrinks who wrote them mostly dealt with really severe sleep
problems in their practices, and developed their approaches based on those
cases. The "run of the mill" cases like yours and mine would just
never present to a sleep clinic at a major university. If we generalize
to the normal, general public, you get worried and educated parents like
you and me thinking that our kids are under-sleeping, developing bad habits,
etc.

It doesn’t take much to provide a generally "good
enough" environment for sleep for your baby. Anything beyond that is
likely to make you nuts, and waste your precious parental energy. And when baby #2 (or #4) comes along? Forget about it! You won’t be able to control the environment very well at all. But those babies still tend to sleep fine. In our house, our third is the best sleeper of the group, and let me tell ya, this house is not a quiet, predictable place!

Your point about independence is well-taken, though, as that
certainly is our ultimate goal in child-rearing. But there are developmental
capacities that need to be considered. How much independence can be tolerated
by the child at each particular age and stage? And how do we allow for the normal, needed
regressions in independence that occur regularly? True independence comes out
of a solid bedrock sense that one has a strong foundation, and that strong
foundation can only be established though reliable dependence in early
childhood.

Your baby depends on and "borrows" your care, love and strength until those feelings become internalized.
That’s the beginning of true independence.

Good luck, and keep us posted!

Aloha,
Dr. Heather
The BabyShrink

During
the first six months of a baby’s life, when the child’s sleep schedule
is virtually non-existent, parents are forced to test the limits of
their own stamina. How long can you live without sleep? Do you have
what it takes to survive?

Fortunately,
there are some simple steps you can remember and rely on to get you
through the rough times. In fact, they’re as easy as to remember as
your ABCs.

A IS FOR AGE
Expectations for your baby’s sleep depend in part on his age. A
two-day-old will sleep very differently from a two-month-old, and again
from a 10-month old or even two-year-old. Your strategies should vary accordingly (if you can keep your own eyes open long enough to think, which is no guarantee).

As
your baby goes through developmental shifts and changes, his sleep will
likely be disrupted for a short while. Babies working hard on mastering
grasping, vocalizing, sitting, or any other skill will likely have this
“drive to succeed” break into their nighttime sleep. Reassure them that
they can practice in the morning, and that it’s time for sleep.

• Newborn      (Baby Size “Small”, 16-20 weeks):
  Don’t count on much sleep, at least during the night. Baby’s rapidly
  developing brain needs a ton of rest, but this will occur in cycles
  throughout the day and night, and babies will often need to be fed
  every two hours or so. As she approaches 12 weeks, her sleep may
  consolidate considerably, and stretch for longer periods of time. Her
  memory has not developed to the point that she “counts on” a regular
  sleep routine as much as she will when she is older. Try to stick to
  the routine you had before baby was born, but make your bedtime earlier.

For
your own sanity, take “shifts” during the night with some caring and
selfless person (who may or may not be the baby’s Dad, or your mother,
or mother-in-law), or at least enough to let Mom get a four-hour
stretch of sleep in (which has been shown to make you feel more rested
than smaller chunks of rest). Moms, when it is your turn to sleep,
really sleep! Use earplugs and an eyeshade, and trust the person you’ve
left in charge of the baby. Otherwise, you’ll sleep with “one ear open”
and not rest as soundly. Mom…you just need to get thru this tough
time…it WILL pass!

• Baby Size “Medium”, Five      months – nine months:
  Baby has developed enough cognitive abilities and trust in you that she
  can be taught how to fall asleep – and stay asleep through the night –
  in her own crib. Start with having baby play when awake and happy in
  her crib. Or, try placing her in her crib when she’s already asleep, so
  she can awaken there and get used to sleeping there. Experiment with
  the use of music, noise, or light machines; some babies love those. Talk to her about sleep, and what you need from her.      She may not understand all your words, but she’ll start to get the      message.

Try this script, using a quiet, serious, but enthusiastic tone: “Baby,
we’re all tired around here. Tonight is a great night for you to sleep
for a long time in your crib. I’m going to nurse you, turn off the
lights, sing a song, and then put you in your crib. I will be here to
pat you on your side until you fall asleep. If you wake up, you are
safe; you can look around for a while and then go back to sleep. And then in the morning, mommy and baby will feel SO GOOD!”

It
may take several (hundred?) times to repeat this each night, but you
(both) will eventually get in the habit, and it will help. Don’t “push”
too firmly until you feel that she has the emotional ability to
withstand whatever degree of upset that being left alone to sleep will
cause. Some babies will only put up a token protest; others will scream
loud and long, but not really “mean it”; others will truly be terrified
and need to be supported a bit longer before they can sleep for that
long alone. You need to know your own baby, and start to trust your Mommy instincts.

• Baby Size “Large”, Nine to Twelve Months: Now
  you really have an able little learner on your hands. You can feel
  assured that most babies will certainly be capable of “going along with
  the program” by this age. Just make sure YOU know “what the program”
  is, and be consistent about it. Fussing and crying, at this age, is
  usually normal and fine; talk with your pediatrician if you have
  concerns.

B IS FOR BELLY

Tummy
troubles can spell sleep disaster for even the most prepared family.
Babies have all sorts of tummy issues throughout their first years.
When newborn, they are still adjusting to digestion, and they feel
their digestive actions quite acutely. For breastfed
newborns, moms can try adjusting their diets. Common causes of tummy
troubles in infants include chocolate, dairy, and caffeine in mom’s
diet. Check with your pediatrician, then try eliminating these foods
from your diet, one at a time, for several days. Formula-fed babies can
have trouble with dairy proteins, lactose, or soy. Ask your doctor
about trying a new formula. For older babies on solids, think back to
see if her sleep problems worsened after introducing a new food. By
process of elimination, experiment to see if removing a particular food
helps her digestion and sleep.

C IS FOR CONSTITUTION

Constitutional
factors are ingrained, probably genetically inherited characteristics,
and they have a major impact on the way your baby sleeps. Some of these
tendencies affect our personalities, emotions, and behaviors – even
from day one. Your baby was born with a whole constellation of these
tendencies, and your strategies for dealing with her will depend on
those tendencies.

For
instance, we know that overall activity level is mostly inherited.
Highly active babies tend to sleep less and need more interaction. They
can’t yet move their bodies around much to burn off their energy, so
they crave the mental stimulation of being awake. These babies don’t
want to miss anything, and will probably end up being social and
outgoing. But the price you pay is less sleep now, and maybe more
fussiness. It’s difficult to tell if your baby is fussy because of
constitutional personality factors, or if her tummy, or something else
is bothering her. Careful observation of her daily reactions and
behavior will help you decide what’s what.

An
active baby needs to have lots of interaction and “play” during the
day. Give as much “tummy time” as she will tolerate, to work her little
muscles. Engage her attention and go for the laughs; play “peek-a-boo”
games, make funny noises, do silly things; whatever brings the laughs.
This will both excite her and tire her out for better sleep later.
DON’T play with an active baby at night, though; she is never too young
to learn that nighttime is for sleep.

This
cute picture is of Daniella and David “playing”, when she was 2 months
old. Notice how they mimic each others’ facial expressions? David has
positioned her so that she can focus on him as well; tiny babies need
to see you up close and personal.

Other constitutional factors can interfere with sleep:

• Babies
  who are overly sensitive, perhaps to noise, light, skin sensations or
  body movements can have problems sleeping. Don’t assume your baby needs
  total quiet to sleep well. Some babies need “white noise” to sleep
  well; ask your doctor just how loud you can play “white noise”; babies
  are used to a great deal of noise in the womb and often sleep better
  with constant noise playing.

• Babies
  who are sensitive to the motion of their body often need to be
  swaddled, even late into their first year. There are new, larger-sized
  swaddling blankets that make this easy to do. Check out Dr. Harvey      Karp’s “Happiest Baby on the Block” for
  great tips on swaddling and calming babies. (I really do suggest you
  look at the video rather than the book; it’s quite amazing!) Don’t feel
  bad about using a baby swing, if it works, at least for the first few
  months. Neurobiologists think that a swinging motion may actually be
  helpful in brain development.

• Although illness isn’t exactly      constitutional, it’s worth mentioning. Even
  a little case of the sniffles can throw off a baby’s sleep. Just
  support him through his cold, make him as comfortable as possible, and
  get back with the program when he’s feeling better.

D IS FOR DAYTIME

What
does your baby do during the day? Until three months of age, there
isn’t much you can do to influence this; babies will sleep where and
when they want to. Until this age, they are more influenced by their
internal needs and feelings, and less influenced by external
stimulation. But after three months, you can try to limit naps and keep
her awake more during the day. Keeping her active, interested, and
engaged is the best way to wear her out for better sleep at night.

Experiment
with her nap times and overall amount of daytime sleep. If she naps
three times a day, try two longer naps. Don’t let naps run too late
into the afternoon. Or awaken her a few minutes early from her naps, to
see if she “consolidates” her sleep better at night. But DON’T make the
opposite mistake and eliminate naps; this creates an overtired baby,
and an overtired baby will sleep LESS at night.

E IS FOR ENVIRONMENT

The
environment you provide for your sleeping baby can have a big impact on
how well he sleeps. A very young baby (3-4 months) might do better in a
swing or a bouncy seat. At that age, my babies tended to sleep better
in a bouncy seat, not their cribs; I think the seat provided more cozy
support, and having an elevated head helped to clear any possible nasal
congestion, as well as being good for reflux or other tummy distress. I
moved them from the bouncy into the crib anywhere from 3-5 months.

The
right clothing for the right temperature is important too. Don’t make
the common mistake of dressing the baby too warmly. It’s easy to assume
babies get cold, but often they are too warm. Don’t judge
their temperature by feeling their hands or legs, but rather their
chest. This will give you a better sense of how to dress them for
sleep. Dressing them lightly, but fully, for sleep is a good rule of
thumb. Babies sleep better if the room is a little on the
cool side; they sort of “hibernate” and get cozy for a nice rest. Some
babies LOVE little sleep “bags”; my babies hated having their feet and legs restricted. Experiment, experiment, experiment.

Your baby’s sleep can be impacted by other environmental changes you may not have imagined:

• travel
• sleeping in a different room
• seasonal daylight changes
• different
  noise patterns in the house or neighborhood (when I was truly
  sleep-deprived, I actually thought it would be a reasonable thing to
  ask the neighbors to eliminate lawn-mowing during nap times!)

If
you need to make a major change for a short while (say, a vacation),
fall back on what works and plan to get back on track when you get back
home. Nothing is permanent, and you can all get back to a good routine
with a few nights of getting back in the habit.

F IS FOR FUSSING

I
am not a believer in the “cry it out” method that many experts, and one
of our own pediatricians, recommend. I cannot stomach the notion of
plopping a baby down in bed and closing the door. That
being said, however, a little fussing or crying is certainly fine for a
baby to tolerate. Some babies “let off steam” from their days in this
way. After all, they can’t exactly go for a brisk run to blow off their
extra energy; crying is the only way to let it out sometimes, for some
babies more than others.

So
how do you decide how much crying is enough? First of all, it should be
YOU who decides, not some “expert” who says five, or 15 minutes is OK.
Some babies can be fine with crying up to an hour at a time; others
fall apart after five minutes. You need to know and interpret your
baby’s needs. And each of your babies may be different from its
siblings. One of mine was a “fusser”. She fussed off and
on, much of the day (and night), until she started talking. And she
started talking early. This baby just needed to TALK! Once
she could start jabbering, she had no need to fuss any longer. HER
crying was not really “distress crying” (usually), but rather “talk
crying”.

Once
you sort out Baby’s sleep needs and habits thru the first year, you
have new sleep challenges awaiting you in the Toddler years. So pace yourselves, and go grab a nap!