Experts sleep tips



Crying it out

To save baby's tears, and your own, our experts come up with  their best tips on how to get little one off to dreamland.


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In the words of a… mother
Femke Batenburg
Damon Batenburg, aged two and a half, must be a dream baby. His sleep habits would have other mums shedding tears of envy. He's in bed at 7pm after his bath. He gets a kiss and a cuddle and is asleep soon after. He wakes between 7-7.30am and has a two-hour nap in the middle of the day.
     Femke says she's not complaining but it didn't happen by itself.
     When Damon was around eight months Femke was so exhausted she could barely look after her little boy. He was waking up many times in the night for a milk feed, despite eating well on solids during the day.
     Femke and her husband are both originally from the Netherlands and took baby Damon home for a break when he was six months. Inevitably while staying with others, they got into bad sleep habits and, once home again, Damon's night-waking spun out of control.
     "We just needed to draw the line.  I couldn't cope I was so exhausted. So I decided no more bottles of milk after his dream feed at 10 o'clock.
     "The first night was horrendous. He cried and cried. I would go in and give him water but he didn't want that."
     Femke went in after five minutes, 10 minutes, 15 minutes and finally every half hour. She cuddled and tried to comfort him but he cried for two hours.
     The next night wasn't much better and on the third night his crying lasted one hour.
     On the fourth night he slept through and he's done that ever since, bar a few of nights of teething.
    "It was awful at the time but I didn't have any other choice," says Femke.
     Damon has always been a healthy toddler and responded well to the "cry it out" method. Now both of them are well rested during the day and enjoy their time together.
     "For me it was the best thing to do," says Femke, "but it's not for everyone.
     "You need to do what you feel comfortable with.
     "It depends on your parenting style and it depends on the personality your child has."But if you're thinking of trying it, make sure your child is well. A sick child needs lots of TLC, day and night.



In the words of a… baby whisperer
Dorothy Waide
When people refer to "crying it out"  we all think of a baby being put into bed and left on his own until he falls  asleep, exhausted.
     My understanding of crying it out is letting the baby wind down to find his sleep and intervening at the appropriate time, definitely not putting him in his cot, shutting the door and ignoring him. 
     The alternative to teaching him to self-settle is to feed or rock him to sleep. Both of these will work with younger babies but you need to remember that the baby determines when this stops, not the parent, and it might be easy while the baby is little but some parents find it physically and emotionally impossible to continue into the toddler years.
     It is easier and less taxing to teach a younger baby to self-settle than to have an older baby who doesn't sleep through the night and keeps the household up.
     For me, how long to leave a baby  to cry depends on the age of the  infant but the goal is to give the baby time to de-stress/wind down and find  his own sleep. If you intervene too early it takes longer to get him to sleep and leaving him too long leads to the baby getting stressed, so it's about working out the right time frame for you both.  I find that the older the baby, the longer it takes for him to wind down. However, in my experience most babies naturally fall asleep within 20 minutes and I use this as my guide.

under
 six 
weeks
You can start to teach a baby to  self-settle in your arms from birth.  I recommend swaddling him "snow angel" style (see www.babyhelp.co.nz for instructions) and then sitting down with him "engulfed" in your arms with no movement. Allow him to sleep in your arms and offer a dummy and pat and "sshh" to settle, if required.

between
 six and 12 
weeks
If you want to start teaching self-settling from six weeks this is best done in a cot, only letting your baby cry for a very short time before intervening.  The routine I recommend for this age group is:
-  Put in bed awake.
-  Allow to cry up to one minute (extend up to five minutes as the baby grows).
-  Comfort - "sshh, sshh" noise, patting (no eye contact) for a short time (shorter than the crying time), then leave.
-  Repeat four times and then finally, offer a dummy with more "sshh" noise and patting. Stay in the room until he goes to sleep.

12
 weeks and 
beyond
Before putting a baby to bed the first question I ask is when they last fed. It is important to make sure your baby has a full tummy before bed, otherwise you could confuse the going-to-sleep cry with a hungry cry. This applies in particular to breastfed babies. There is no book that says you cannot feed a baby more than once when he's up. The routine is:
-  In bed - awake.
-  Cry from five to 20 minutes (time is extended as baby grows).
-  Comfort, as per six to 12 weeks,
-  Repeat four times and then finally, offer a dummy with more "sshh" noise and patting. Stay in the room until he goes to sleep.
     I also tend to let a baby cry longer  for the first part, say 15 minutes, as I find that at this age a baby takes longer to wind down and self-settle and then reduce this amount of time between each intervention.
     It takes time, acceptance, consistency and touch (TACT) to teach your baby how to self-settle  and resettle. It may seem like a huge effort on your part but it is easier and less taxing teaching a younger baby to self-settle than to have an older baby who doesn't sleep through the night and keeps the household up. So an investment of time up front will pay dividends in sleep in the future.
Dorothy's website - babywithin.co.nz
Dorothy's Facebook page - facebook.com/BabyWithin 




In the words of… Plunket
Clinical Adviser  Allison Jamieson
Gone are the days when Plunket will advise you to let your newborn cry herself to sleep... But Plunket encourages parents to put their baby to bed when she's drowsy but awake. The first step is to recognise when baby is getting tired - something that's not easy to spot, especially if you're first-time parents, as sometimes it looks as if baby is fully awake and ready to play. Watch carefully for the following:
-  Jerky movements of arms and legs
-  Clenched fists
-  Eye-rubbing
-  Staring into space, rather than looking around or focusing on something
-  Yawning
-  Grizzling
-  Startling easily
     At this stage move quickly. Swaddle the baby and put her in her bed.
     It's good to have a set routine before bed time, with curtains drawn, the room calm and quiet. A wind-down period might include cuddling, talking in a soothing voice or singing. The idea is that, through these sleep associations, baby will learn to feel comfortable in her cot and to fall asleep on her own.
     Pop her in bed and either leave the room or sit down quietly away from the cot or bassinet.
     She might cry but it's important to distinguish between a tired grizzle (a "wah-wah" sound) and a high-pitched cry of pain.
     A tired grizzle is likely to lead to sleep but if baby starts to wind up, or scream as if in pain, go back in, pat or rock her while she's in her bed, or if necessary, pick her up for a cuddle.
     Plunket believes it's important for parents to feel in control so don't do anything you're not comfortable with. Listening to a baby cry for one or two minutes is more than enough for many parents so don't feel you have to tough it out.
     If your baby seems reluctant to get back into bed, go through the checklist. Could she be hungry? Have wind? A dirty nappy?
     If all else fails try a top-up feed and then start the routine over again. Over time, she'll get used to the idea of going to bed.
     It's important to ensure that your newborn has fed well  before being put to bed. The routine is eat, play, sleep over  a three-hour cycle, with two hours for sleep, then it's time to  wake up, have a good feed on both sides of the breast, with winding and a nappy change in between, and then maybe 20 minutes for play.
     Babies are all different and have different needs at different times. In the early stages, it's important to respond to baby's needs while gently guiding her to learn to go to sleep in her own bed.
     Often babies will start to wake after 40-45 minutes. Listen to see  if she can re-settle. If not, go in and gently try to pat or rock her back to sleep.
     If you're baby is unwell, has colic or refux, it's likely that all thoughts of sleep training will need to go on hold until your baby's health has improved.




In the words of a… psychologist
Epenesa Olo-Whaanga 
Sleep training is something that many parents want help with. A method that is sometimes used is the "cry it out" method, with the usual assumption being that infants will tire themselves out by crying and will then sleep. It was also popularised by the fear that a baby could be "spoilt" by being picked up each time he cried or fussed. It is also assumed that an infant can put himself to sleep and is often left on his own to do this. However, getting off to sleep is a skill that develops over time.
     Crying is a signal that infants use for communication. Different messages may be conveyed and often parents say they can distinguish between a hungry cry, a cry of pain, and a dirty nappy cry. Letting infants "cry it out" teaches them that their needs will not be attended to when they cry. Sometimes people marvel that it took only a few nights of "crying it out" before it stopped. Although baby may stop crying, his needs are not met.
     It is increasingly recognised that infants develop secure attachments when their cues are sensitively attended to by their caregivers. This has important implications for optimal development and mental health.
     While there is no scientific evidence on the negative effect on the brain of crying it out, we have no evidence that it is not harmful either. However, we do have evidence of the negative impact that cortisol has on the brain. Cortisol is released when one is stressed. Trust your instinct. An infant's crying is distressing to most people for good reason - it requires a response.
     Sometimes parents can have unrealistic expectations of sleep and so it is important to clarify what the usual expectations are at different ages and stages of development. Sleep problems may not be classifed for babies up to 12 months because sleep patterns do change in this time. It is important to consider an infant's individual characteristics, age, developmental stage and capacity. Some infants require more holding, rocking and containment.
     Infants have shorter cycles of sleep and will wake more often. It is unrealistic to expect infants to sleep through the night. They do wake and if you haven't been aware of it, it is because they have gone back to sleep without waking you.
    0020Although it is important for parents to have time-out, it can be useful to ask who is being affected by the infant's lack of sleep? Do you need a break? If so, can you enlist the support of others? Is the infant growing and developmentally on task? If so, this infant may need less sleep than others of the same age or his overall sleep routines may be different to other infants.
     In considering how to help your infant's sleep, it is best to think holistically about his waking times as well. Think of his patterns of activity - social, physical and emotional.
     Sleep times should also be factored in. Long daytime naps will affect night-time sleep. Sleep routines should be kept as consistent as possible during the daytime and evening. Is there a song, cuddly rug, teddy bear that you use at bedtime? Use these each time to indicate it's sleep time. You may notice more yawning, eye-rubbing to indicate tiredness.
     Getting off to sleep requires infants to shut out stimulation. You can help this by ensuring the environment is conducive to this. The first part of your baby's sleep rhythm is very light and takes about 20 minutes to change into a deeper level of sleep. If he wakes in the night, keep stimulation to a minimum to help him get back to sleep if he needs help with this. Keep the lights dimmed or off, keep your voice gentle and use minimal words. Pat him gently to reassure him. If he needs a feed or a nappy change, do this with minimal stimulation. He needs to know it is not time to wake up or play. Take turns with your partner if this is possible and if the night waking is happening often. 
 


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