Category Archives: Newborn sleep

Building your bedtime routine

A question I hear all the time from new parents revolves around bedtime routines. How do we create one? What goes into a bedtime routine? Why should we do a bedtime routine? When do you do the bedtime routine? Here are some answers to all of these very important questions.

Even as adults we have a bedtime routine. For adults, this may mean that we brush our teeth, we wash our face, we change into pajamas or something different then we were wearing during the day, maybe we read a book or some adults watch TV (which is the number one sleep crutch among adults in the US but that is a topic for another article). This process is important because it helps our brains prepare for the process of falling asleep and also helps it begin to produce melatonin, the hormone that helps us to fall asleep and stay asleep for long stretches at a time. The bedtime routine for a baby or child serves the same purpose.

Babies as young as about 8 weeks old can begin to appreciate a bedtime routine. Sometimes the question of what point in the night to start this becomes a challenge to figure out because bedtime may not yet be a fixed time. In fact, newborns typically have very late bedtimes (starting as late as 11 or 12 at night and gradually creeping earlier) until about 3-4 months old when it usually shifts to some time between 6 and 8pm. Yes, I realize that for newborns, bedtime really may just be when you finally turn out the lights and change into a different pair of sweats and try to catch a couple of hours of sleep before the next waking and feeding. As your baby approaches 8 weeks, it is a good idea to begin to incorporate a bedtime routine prior to whatever seems like it will be bedtime.   Don’t worry if your child doesn’t actually fall asleep soon after the bedtime routine. That is okay. Eventually it will become easier to determine when that day’s bedtime really is (I say “that day’s bedtime” because until nap schedules start to evolve, which may not be until close to 6 months or sometimes a few months later, the actual bedtime may move around a bit based on when your child woke from their last nap).

Bedtime routines for babies

I will typically encourage parents of babies to keep bedtime routines pretty short and concise. It doesn’t need to be longer then about 20 mins and this is often including a feeding. This is partly because babies are sometimes very tired by the time the day comes to an end so a long drawn out bedtime can lead to them becoming more overtired and exhausted. The other reason to keep it short is because as your child grows and you move into the toddler and preschool years, your child will likely want to add on to their bedtime routine with an amazingly creative variety of stall tactics. If your routine was pretty short to begin with, it has some room to grow before it is taking 45 minutes to an hour to get through your bedtime routine. For babies, bedtime often entails a short bath or maybe just a brief washcloth wipe down. When you come into the room where your baby will be sleeping, it is a good idea to turn down the lights and turn on a white noise machine if you are going to use one. You are then light and sound changes to create associations between the things that are changing in your child’s environment and what is about to be happening (going to sleep for the night). Many families like to do a short infant massage as they are putting on lotion, a diaper and pjs. You can certainly attempt to read a short book if your child isn’t too tired, but for many infants, they don’t have the attention span to read a book or they are so tired that they are trying to eat the book or hit it away. If this is the case, don’t stress, there are plenty of other great opportunities in the day to read to your child. For babies there is often a feeding as part of the bedtime routine. Where to put this feeding in the process is often related to how old your child is and if you need to use the feeding to help your child fall asleep at bedtime. I speak with moms all the time who will say “I nurse my baby to sleep…I know this is bad” or “my baby falls asleep drinking his bottle…I know this is bad.” Neither of these things is bad. It is only something to change when it is no longer working well for your family and also when your child is at an age when he is more capable of putting himself to sleep without needing the help of a sleep crutch to fall asleep. When you are no longer nursing to sleep or feeding with a bottle to sleep, I have parents move the feeding to before the bath or before the pjs go on. I will also often suggest to families that they just walk around the room, saying good night to three things in their child’s room and sing a song before putting their child in the crib for sleep. These are further associations that your child will make between what happens prior to going to sleep and then what is coming next.

Bedtime routines for toddlers and preschoolers

For older children, more often they may have a bath regularly at bedtime, especially in the warmer months when they are outside, playing hard and getting dirty, or after a particularly messy dinner. Following last trips to the potty and teeth brushing, return to your child’s room for pjs and stories. As children reach the toddler years, the more parts of your bedtime routine that you child can make choices about, the better as going to bed is not a choice. For instance, your child can choose which toothbrush from 2 or 3 he wants to use, he can pick out his pjs, he can choose a few books to read (be sure to set consistent limits with books otherwise you will end up reading until you fall asleep yourself!). Some families prefer to play a quiet game or do a puzzle before bed. These are also great ideas. Then come kisses, maybe a song and the final tuck in. I always found it helpful to also ask my kids of there was anything else they wanted to ask me before I say good night. They often asked some silly, nonsensical question, but this seemed to head off a call back as it gave them a chance to get the last of their words out for the day. While bedtime for toddlers and preschoolers may sometimes feel like the home stretch after a long day, keeping that routine consistent and predictable is essential and will set you up for a smooth transition to sleep.

Sweet dreams!

Baby’s growing up: Transition from the swaddle

swaddled babyWhen babies are first born, they are a bundle of nerves. Every little thing can startle them. When it comes to sleep, there is nothing more frustrating then putting in all the work to get your newborn to sleep and then having them startle awake 20 minutes later. Since we now know that it is safest for babies to sleep on their backs, swaddling has become a more common place solution to helping babies sleep and not startle awake. It is likely that when you were a baby, you slept on your tummy whereby the mattress muffled the startle reflex. This is why many grandparents today don’t understand the need for swaddling.

Some babies hate being swaddled. They fight it, they struggle when swaddled and many a persistent parent has thrown in the towel and their baby has eventually adjusted to sleeping unswaddled. However, some babies LOVE it and their parents’ couldn’t imagine them ever sleeping without it.

Swaddling isn’t meant to be a long term situation though. At some point, your baby will outgrow their need to be swaddled or you may find it necessary to stop swaddling. This can be a scary prospect if you wondering how you are supposed to get your baby to sleep without the swaddle. On average, most babies are swaddled until somewhere between 3 and 4 months of age. Some outgrow it on their own and sometimes you need to put in more effort to wean it. There are some clear reasons to stop swaddling. Those are:

  • If your baby rolls over in the swaddle, you will need to stop swaddling. This becomes a safety issue because if your child rolls in the swaddle and is now on his tummy without access to his arms to push himself up, it can be dangerous. Please don’t misunderstand though, you do not need to stop swaddling if your baby has just rolled over for the first time in a non sleeping/non swaddled circumstance. It may still be quite some time or never when he attempts this trick swaddled.
  • If your baby is fighting the swaddle and seems happier and is sleeping better unswaddled, no matter the age, then it may be that he is ready to not be swaddled anymore
  • You notice that your baby isn’t really startling

If either you have had to stop swaddling for any of the reasons above or you feel like the time has arrived to stop swaddling, here are some tips for helping everyone make it through the process a little easier.

  • Know that there is likely to be some regression when your baby first starts going to sleep unswaddled. This is a big change for your little one and one that will take some adjustment. Be patient. Once babies can roll themselves from back to front and front to back, most pediatricians will agree that your child can sleep in whatever position he gets himself into. There are two reasons for this:  1) because your child is then strong enough to maneuver himself out of an uncomfortable position and 2) because there is little you can do (other then hover over your baby’s crib all night) to keep your baby on their back at that point. Please check with your pediatrician to find out their recommendations.
  • Parents often report to me that their baby has “crazy hands” when unswaddled. This most often resolves itself when your child is old enough to begin self regulating and putting himself to sleep. He will also figure out what to do with his hands. In the meantime, however, you can start by only unswaddling one arm initially. I typically suggest the nondominant arm which most often is the left arm. It tends to be less “flaily.” I will also often suggest continuing to swaddle a baby around their core area. This will continue to create the pressure that your baby is used to while still giving him access to his hands. This can be done with a swaddling blanket (assuming it can be done safely and stay tucked in) or if you are using a Halo sleep sack, rather then wrapping the arm flaps around the arms, you would just wrap them around your baby’s abdominal area.
  • You can also introduce a security object that your baby can hold onto while falling asleep. This can often give your baby something to do with his hands, and it is also extremely helpful when creating sleep a new sleep association as the swaddle doesn’t just muffle the startle reflex, but it is also a strong sleep association for your baby.
  • If your baby is younger then 3-4 months, on the bigger and of the growth chart, and is not able to be swaddled anymore, another option is to transition to the Baby Merlin’s Magic Sleepsuit. The Magic Sleepsuit was developed by a pediatric physical therapist. It is a padded suit that is designed to create pressure on your baby’s body that will prevent him from startling. The other purpose is if you have a baby who wants to roll himself from his back to his front but is then stuck on his belly and very unhappy there, the Sleepsuit will keep him on his back and prevent him from rolling. It comes in two sizes, 3-6 months and 6-9 months. I find that bigger babies do better in it because they “fill it up” more, creating more soothing pressure on the body.  ***if you purchase the Sleepsuit on their website, enter promo code sleeplady20 for a 20% discount.
  • There is no rule that says you have to unswaddle for naps as well as night sleep. Night sleep and day sleep are controlled by two different parts of your baby’s brain and at a young age, it is not typically confusing to unswaddle at night but not during the day. If you have stopped swaddling for both nights and days and find that your baby is now waking from naps much sooner then he did with the swaddle, it is okay to go back to swaddling for naps until your baby is a bit older and can handle not being swaddled for naps. Children sleep in a deeper stage at night then they do during the day and in the early months, this can make it much harder to stay asleep during the day without needing a little “help.” Day sleep does not come together for many babies until closer to 6 months.

Hope these tips are helpful! Have no fear, your child will not still need to be swaddled in kindergarten 🙂

Pacifier pros and cons

pacifierI frequently hear from parents that before their child was born, they thought they would never use a pacifier.  Then once their baby arrived and had a strong urge to soothe by sucking, all those firm beliefs went out the window.  Pacifiers can be a great tool, especially for babies who want to be sucking all the time, and it doesn’t have to be a problem unless it becomes a sleep crutch. 

Here are some of the pros and cons of the paci and ways to figure out what to do about it and when to make a change if it has become a sleep crutch.

PROS

Pacifiers can be a great way to soothe your baby.  Don’t forget that your baby was likely to be sucking on his hands when he was in utero.  Sucking is one of Dr. Karp’s essential 5 Ss to help soothe your baby.  In the first 3 months, your baby has very limited ability to soothe himself.  Unless your baby has successfully figured out how to suck his thumb and then remembers that it makes him feel better, the pacifier can be a very helpful tool.

There is also research that suggests that pacifers can help prevent SIDS.

CONS

For young babies who are still being swaddled, the unfortunate news is that when your child doesn’t have access to their hands for soothing, you are going to be the human “rebinker.”  Since children don’t typically have the pincher grasp required to put the pacifier back in their own mouth until about 8 months old (although I have seen some particularly determined children do it around 6 months), it is likely that until he is able to pop it back in on his own, you will need to do it for him.

If you keep the pacifer until your child is a toddler, inevitably, there will come a day when you have to get rid of it.

Pacifers have also been linked to higher rates of ear infections in children.

What to do when the pacifier that has become a problem

If your baby is not at an age when he is ready for sleep coaching, you will probably need to keep the paci until you can begin sleep coaching.  This can happen as soon as 4 months for some babies while others need to be closer to 6 months.   If your baby is ready for sleep coaching and you want to be done with the paci (at least at night), then I typically recommend getting rid of it at the same time you do sleep coaching.  There is no way to wean the paci, it is either in or its out.  I find that cold turkey is the only option.  After 2 or 3 nights, your child won’t remember that he ever used it.

If your child is able to put the paci in his own mouth but just doesn’t do it (meaning you have seen him do it during playtime or he is able to pick up pieces of food and put them in his mouth), then it is time to encourage some paci independence.  You can start with putting the paci in his hand and then guiding his hand up to his mouth, then just put it in his hand and eventually pointing to it on the mattress in his bed and saying “here is your paci, put it in your mouth.”

Hint:  if he loses the paci in the crib during the night, put several in there and use a breathable bumper to keep the pacis from falling out through the crib rails.

Getting rid of the paci for an older child

I don’t typically recommend getting rid of the paci for a child over 15 months (children become very attached to things at about 15 months and will begin to experience another burst of separation anxiety) until he is 2 or 2½ and has a bit more ability to have a conversation about what to do about the paci (more on that in a bit).  Truthfully, by about 9 months, the paci has become your child’s security object and taking it away will be likely to produce a great deal of distress.   If you are going to do away with the paci between 9 and 15 months, introduce a security object or lovey.

If your child is an age when you can have a conversation about saying good-bye to the binkie (around 2 or 2 ½ or even 3 years old), begin talking about what is going to happen a few days before getting rid of the paci so that you can help your child prepare for the changes.  Make sure that you are not choosing a time of new stresses like moving into a big bed, right before a trip, or when a sibling is about to arrive on the scene.  You can read a few books that address the topic like Little Bunny’s Pacifier Plan by Maribeth Boelts, No More Pacifier for Piggy! by Sam Williams, or Goodbye Binky:  The Pacifier Fairy Story by Sinead Condon.

Here are a couple of ideas of plans you can make with your child:

  • Give the pacis to the “Paci Fairy” who can exchange them for a new special toy to sleep with.
  • You can pack them all up and bring them to your pediatrician to give to less fortunate children who need pacis.
  • You can take a paci to Build a Bear and your child can put it inside a new stuffed animal to sleep with.

Whatever you decide to do, make a plan and stick with it consistently.  Expect that there will be tears of frustration and a few rough nights ahead but trust that your child can learn this.

Do you know your 5 Ss?

Swaddled Baby(2)Dr. Harvey Karp, renouned sleep guru and author of Happiest Baby on the Block, Happiest Toddler on the Block and now The Happiest Baby guide to Great Sleep, has developed and excellent method for helping your newborn get some much needed sleep.  These are your tools for surviving the first 3 months of your baby’s life.  The Happiest Baby on the Block is an essential read (or viewing if you are short on time and want to watch the DVD) for any expectant parent.  Here are your 5 Ss:

• Shushing-anything from lots of SHHHHHH sounds, to a hair dryer or vacuum running, to a white noise machine.

• Side lying -simply laying on the side either in your arms or on their bed in a solid suface, carfully propped so they won’t roll onto their front

• Swinging-either in your arms or the car seat or a swing on the cradle setting

• Swaddling-swaddle ’em up good and tight.  Your baby may fight it but they secretly love it.  Its discerning for a newborn to have arms and legs flailing

• Sucking-either on the breast, a pacifier or even your clean finger will do

Sometimes you may only need one of these Ss, sometimes you may need only a few or even all 5.  These tricks work great, until your baby is about 3 months or so.