I can only imagine a mom and dad who are as tired as anyone
can be, eager to see this article on sleep, and finding that we
had made it unavailable for a little while!
We had to do that because I didn't write the article clearly
enough and need to clarify some very important facts.
It would be hard to find as strong a proponent of the family
bed as I am. Yet, I have received email commenting that there
were sections of this "plan" which were easy to misinterpret
as being just another angle on "sleep training" for
young babies. It is not meant to be that. Not even close to an
endorsement of the benefits of getting your baby to "soothe
herself to sleep" during the first year.
Here's what I really want to do: I want to offer an alternative
to Ferber and Weisbluth and the Whisperer. I never want to see
my ideas applied to a four month old or even a seven month old
baby. As a matter of fact, I am not too excited about pushing
any baby around at night but I know that sometimes it will be
done and I'd like to offer a gentle, supported plan for after
the first year.
Before I go any further, let me express my overriding concern.
Babies do better when we answer all their questions as best we
can and meet their needs as best we can.
Most of the families I have
taken care of in my pediatric practice sleep in a family bed.
Their babies tend to breastfeed for more than one year and they
don't sleep through the night any better than most of us would
if we napped and cuddled within inches of the best restaurant
in town and knew it was open 24 hours a day.
This arrangement is not just adequate and tolerable, but actually
feels easier to moms who can just roll over, nurse a while and
fall back to sleep with their babies rather having to get out
of bed to nurse or, alternatively, refuse to nurse and get their
babies back to sleep some other way.
Lots of parents continue this pattern through the first year
and well into the second and beyond, but some get tired of it
-- or just plain tired -- after a while and are looking for a
way to change things. Saddest of all, some moms and dads think
that total weaning from breastfeeding is the best way to get more
sleep. They choose not to look into nighttime weaning as a good
option instead.
There are dozens of confusing books and magazine articles implying
that there can be some quick and easy way to get your baby to
sleep or to not nurse through the night. I have yet to read one
which told parents the complete truth: It's not easy, it's rarely
quick and it's usually a little loud and heartbreaking for a few
nights . . . or more. I have seen too many families needing help
and getting offered choices they didn't like at all.
I have a better alternative to completely weaning or to letting
the baby cry it out. Babies wake up for the optimal interaction
with their moms, breastfeeding back to sleep. If we offer them
a little less than that for a few nights and then a little less
and still less in the ensuing nights, gentle behavior modification
will lead them to realize that it might not be "worth it"
to knock on the door of a closed restaurant, so to speak.
I don't recommend any forced sleep changes during the first
year of life. Probably the only exception to this would be an
emergency involving a nursing mom's health. There are many suggestions
in books and magazines for pushing "sleeping through the
night" during a baby's early months or during the first year.
I don't think this is the best thing to do and I am quite sure
that the earlier a baby gets "non-response" from parents,
the more likely he is to close down at least a little.
Don't get me wrong. I love the family bed, child-led weaning
and cuddling all through the first, second, third year or more
if it's working well and if the family is doing well.
Don't let anyone convince you that this is a harmful choice
or that there will be "no way" to get him out of your
bed if you don't do it now. Don't believe anyone who says that
babies who cuddle and nurse all night long "never" learn
to self soothe or become independent. This is simply not
true but it sells books and the myths stay in our culture.
Some moms just don't want to do this after some months or years
and there should be a third choice to the dichotomy of crying
it out or giving in to all-night nursing. Again, I support the
family bed and frequent night nursing for a long time and even
attempt to pull some parents along "just a little farther,"
but I often have to switch tacks and support and help families
with difficult choices.
Here's what I recommend for older
babies:
Choose the most valuable seven hours of sleep for yourselves.
I personally prefer 11p.m. through 6 a.m. but you might have a
slightly different idea.
Change the rules during those hours and be comfortable that a
"well-built" family bed baby's personality can withstand
this rule changing and the mild inconsistency of getting everything
he wants all the time . . .oops, almost all the time. That's the
word we want to show this baby. The word "almost." If
only we could explain to him that "tired moms and dads take
their children to the park a little less and that children of
well-rested parents get to go the zoo and for hikes a lot more
than children of exhausted parents." If that explanation
only made sense to kids somewhere before the third birthday (and
it doesn't!) they would simply roll over, say, "See you in
the morning," and let us get the sleep we want.
I try to do this in three- and four-night intervals.
I'm assuming that you have a wonderfully healthy
12-, 15-, 20- or 30-month old baby who still loves
to wake up every 2 to 4 hours to cuddle, eat or . . . whatever.
I'm assuming that you have thought this through, decided you want
to make changes and alerted the neighbors that it might be a little
noisy for a week or so.
I'm assuming that both parents agree -- or almost agree -- that
this is the best thing to do. And, most important assumption of
all, you are willing to go "in a straight line" to the
goal of seven straight hours of sleep.
The reason for that last statement: If your baby learns that
crying, squirming and fussing (euphemisms, let's just say "crying"
. . . sorry) for an hour will get him fed you will set yourself
back quite a bit. This is the best program I have seen but it's
far from easy. And now, to say it again, I really like what you've
been doing. Cuddling, nursing, hugging through the night. Don't
change this with my program or any other if you're happy doing
what you're doing. But . . .
The First Three Nights
At any time before 11 p.m. (including 10:58) nurse to sleep,
cuddle and nurse when he wakes up and nurse him back to sleep,
but stop offering nursing to sleep as the solution to waking after
11 p.m.. Instead…..
When your baby awakens at midnight or any other time after 11
p.m., hug him, nurse him for a short time but make sure he does
not fall asleep on the breast and put him down awake.
Rub and pat and cuddle a little until he falls asleep but don't
put him back on the breast (or give him a bottle if that's what
you've been doing). He must fall asleep with your comfort beside
him, but not having to nurse to feel comforted enough to drift
off.
Now, he will tell you that he is angry and intensely dislikes
this new routine. I believe him. He will also try to tell you
that he's scared. I believe he's angry, but a baby who's had hundreds
of nights in a row of cuddling is not scared of falling
asleep with your hand on his back and your voice in his ear. Angry,
yes. Scared, no, not really.
During these first three nights, repeat this pattern
only after he has slept. He might sleep for fifteen
minutes or he might sleep for four hours, but he has to go to
sleep and reawaken to get cuddled and fed again.
These will be hard nights.
You may have decided you're really not ready to do this. That's
OK. Stop and start over again in a few months if you like. Choosing
the right time is crucial and many people choose a time suggested
or pushed by friends, doctors or in-laws. This doesn't work as
well.
Is it better to do this in the family bed, a crib in the same
room or using a crib in another room? I prefer to continue the
family bed even though it might seem harder at first, but it has
always seemed harder to me to be putting a baby in and out of
a crib. However, a crib or toddler bed in your room may be what
works best for you. Another option is to expand your bed's limits
by placing another mattress against your mattress. A bit more
space for each family member may help to solve some of the sleep
issues. My least favorite choice is a crib or bed in a separate
bedroom.
Again, during these first three nights, between 11 p.m.
and 6 a.m., cuddle and feed short, put him down awake, rub, pat,
talk until he falls asleep and repeat this cycle only
after he's slept and reawakened. At 6:01 a.m., do whatever you
have been doing as a morning routine ignoring the previous seven
hours' patterns. Many babies will roll over, nurse and cuddle
back to sleep and give you an extra hour or so. Some won't.
For me, one of the most reassuring parts of this "sleep
plan" is seeing that babies wake up fine, happy and grudge-free
about the change in the rules. You'll see what I mean, even if
the first few minutes of the morning are not exactly as they've
always been.
The Second Three Nights
Again, the nursing to sleep stops at 11 p.m. When he wakes up,
hug him and cuddle him for a few minutes, but do not feed
him, put him down awake. Putting him down awake
is a crucial part of this whole endeavor because it really does
teach him to fall asleep with a little less contact and then a
little less. Not feeding is the big change during these
three nights. One-year-old babies
can easily go for those seven hours (or more) with no calories.
They like to get fed a little through the night, but physiologically
and nutritionally, this is not a long time to go without food.
If I could wake my wife a few times each night, ask her to squeeze
me a little fresh orange juice (my favorite drink) and rub my
back while I drank it, I wouldn't choose to voluntarily give up
this routine. My wife might have some different ideas and get
tired of the pattern quickly. Babies rarely give up their favorite
patterns and things -- day or night-- without balking and crying.
I really don't like listening to babies cry. I actually hate
listening to babies cry. Unlike them, though, we adults can truly
understand the implications of lack of sleep for a family of three,
four or more people. Sleep patterns sometimes have to be changed.
The incredible safety and reassurance the family bed has provided,
and continues to provide, supplies the best context and location
for these changes.
During these second three nights, some babies will cry
and protest for ten minutes at a time and some will go for an
hour or more. Your toddler is aware that you are right beside
him, offering comfort and soothing. It just isn't the mode of
comfort he wants at the moment. It is hard to listen to him fuss,
but it will work. I believe that a well-loved baby,
after a year or more in the family bed, will be the
ultimate beneficiary of his parents getting more sleep. Not coincidentally,
the parents benefit "big time," too.
"Yes, for the past many months we have enjoyed voting "1
to 2" -- non-democratically -- in favor of . . . the baby.
'Anyone want to get up all night, feed and walk the baby and be
really tired all day and the next day too?' Well, the vote is
1 to 2 in favor of the baby."
Now, what we're saying is, we will sometimes be voting two
to one in favor of the baby's family. This "baby's family"
concept may be abhorrent to he who considers himself the King
of England, or Emperor of the Whole World, but our knowing he
has that feeling of power allows us to confidently demote the
dictator to a majority-respecting member of the family. His family.
By the end of the sixth night, your baby is going back to sleep
without being nursed or fed. He's going back to sleep after a
nice hug, a cuddle and with your hand on his back and your words
in his ear.
If, at any point this is feeling
"wrong" to you, stop, wait some months and start over.
Don't go against your "gut instincts" which tell you
that this is the wrong time to get longer sleep intervals from
your baby. Your instincts are better than any sleep-modification
program ever written.
The Next Four Nights
Nights seven, eight, nine and ten. Don't pick him up,
don't hug him. When he awakens after 11 p.m., talk to him, touch
him, talk some more, but don't pick him up. Rub and pat only.
No feeding either, obviously. He will fall back to sleep. Repeat
the rubbing and talking when he reawakens. By the end of the ninth
night, he will be falling back to sleep, albeit reluctantly for
some babies and toddlers, with only a rub and a soothing voice.
After
After these first ten nights, continue to cuddle and feed to
sleep if you like and he wants to, but do nothing when he wakes
up except to touch a little and talk to him briefly. This may
continue for another three or four nights but occasionally keeps
going for another week or more. Then . . . it stops. He has learned
that he is just as well-loved, gets virtually everything he needs
and wants all day, but must give seven hours per night back to
his parents and family.
What happens if you travel, he gets sick or some other circumstance
demands a return to more nighttime interaction? Nothing. You do
what you need to do (cuddle, nurse, walk, in the middle of the
night, as many times as you need to) and then spend a night or
two or three getting back to the new pattern the family has established.
By the way, pay the baby. Make sure that he really does
get a lot of the benefit of your getting a good night's sleep.
Go to the park more often. Do all those things with him you
said you'd do if he ever let you sleep longer. Explain it
to him as you're doing it. He'll understand in an ever increasing
way and will be OK with all this.
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