This is a second guest blog post by Dr. Stephen Boos with Baystate Children’s Hospital Developmental and Behavioral Pediatrics clinic (Baystatehealth.org). If you missed his first guest blog post, please make sure to check it out (Developing a Sleep Routine) as it has a wonderful handout for having families make their own visual schedules.
Sleep can always seem very elusive, especially in the newborn period and in the setting of sleep and behavior problems. When the child is not sleeping, this usually translates to one or both parents not sleeping…which means no one is sleeping well.
The best way though to deal with sleep challenges is to try to prevent them in the first place. This is where Dr. Boos second guest blog post comes in handy!
Developing good sleep habits, step by step
Contributed by Dr. Stephen Boos
Pediatricians get a lot of questions from parents who are having trouble with their child going to sleep at night. While we have some solutions for those problems, we would rather prevent them in the first place. The following tips will prevent many of the common sleep problems that we hear about.
Whatever we or anyone else tells you about sleep, your first goal needs to be safety. Every year one or more babies die, in our area, in their sleep. Putting your baby to sleep ALONE in their own bed, leaving them on their BACK, and only letting them sleep in a CRIB is your best chance of preventing this terrible thing from happening to your baby. In addition to the ABC of sleep safety, we suggest that babies wear only enough clothes to keep warm, never hot. Blankets, bumper pads, stuffed animals and other loose things should not be in the crib during baby’s sleep. Using a pacifier and keeping the crib in your room for the first year are also recommended.
Attachment, the foundation:
Attachment is a word we use for the trust that develops between children and their parents. A child needs to know that someone will be there to protect them and to love them, no matter what happens. When there is a healthy attachment, a child can tolerate challenges, like waking up in a dark room, better. For new babies, attachment is built by responding quickly to cries, giving babies what they need to stop crying and feel comfortable, and spending face-to-face time with your baby. At first we want to give babies everything that they need as quickly as they want it. You don’t have to worry about spoiling the baby. As they get older, are more capable, and have developed a good attachment, we can begin to ask them to tolerate a short wait, or mild discomfort, to help us. Finally, babies pick up on whether you are safe, healthy, and happy too. Taking care of yourself is important to your baby.
RELATED: Bonding with Your Baby (HealthyChildren.org)
Self-Regulation, baby’s most important skill:
Everyone has strong feelings, and that includes babies too. Some people, and some babies, are good at controlling themselves, and settling down when feelings are too strong. Some are not. Everyone can learn how to do this better. Babies learn this by watching you. When your baby cries, they need you to be calm, to talk to them about how they are feeling, and to tell and show them that things will get better. Get face to face with your crying baby, and let them see your calm. Talk sweetly and soothingly to them. Label their feelings and their troubles. Tell them it will all get better. Rock and comfort them. When your child sees you keeping your calm, hears you labeling emotions,and letting them know it is all right to feel that way, and feels your efforts to settle them, they will gradually learn to do these things themselves. Their self-regulation will improve as they grow.
RELATED: VIDEO-How to Swaddle your Baby (Babycenter.com)
Develop a day-night schedule:
Some babies are very regular, while others have a hard time adopting a schedule. All babies begin to develop a rhythm beginning at age three-months. By age two to three-months parents can encourage babies to develop a schedule that fits the normal day. In the morning, open up the blinds and let sunlight into the room. If the baby wakens, take care of their needs, but also spend lots of time face-to-face talking to them and showing them things. Play physical games, like putting them in tummy time, pulling them up by their hands from lying on their back, bicycling their legs, bouncing, playing with rattles and baby toys. As evening comes, lower the lights, turn off the TV, computer, video games or other screens in your home. Engage in quiet activities like quiet talk, reading books to your baby, listening to quiet soothing music. When night time comes, don’t respond to every noise or movement your baby makes, see if they will settle themselves. If your baby cries, respond right away, and take care of any need, but keep the lights low, talk a minimum amount, try to get baby calm and then back in bed. You are teaching your baby the difference between day and night
Develop good sleep cues:
Everyone wakes up at night, including babies and young children. Whatever your baby is used to when they fall asleep, they will want it again if they wake up at night. Between three and four months, most babies don’t really need a middle-of-the-night feeding. Wouldn’t it be nice if they could just roll over and fall back asleep? They are more likely to do that in the middle of the night, if they do that at the beginning of the night. Try to develop a sleep routine, so that your baby falls asleep alone and in their crib. That means keeping the baby awake through the last bottle or breast feed, through the last diaper change, up until you settle them in their crib, where you leave them quiet but awake to fall asleep on their own. Many pediatricians encourage use of a pacifier, but your baby may lose that in the night and call you to help find it. Many parents use a wind up swing or mobile when babies fall asleep. If that runs down in the night, the baby will want you to start it back up again. You want your baby to fall asleep with nothing that requires your help. Then, when you hear them making little noises and moving in the night, you can just wait and see if they have learned to put themselves back to sleep.
Deal with separation anxiety:
Around age eight-months, children figure out that you don’t magically disappear and then reappear when you are called, like Aladdin’s Genie. They understand that you still exist somewhere else, do other things, and can abandon them if you want. For many children, this is very scary. You may see them cry more when you leave the room. If they are mobile, they may try to follow you around the house. When they wake up, alone in bed, they may cry out for you, even if they used to “sleep through the night.” This stage is much easier to handle if your child has a healthy attachment to you, has been learning good self-regulation skills, and is used to sleep cues that don’t require you to be there. The traditional way to deal with separation anxiety is the game peek-a-boo. In peek-a-boo, you disappear, but reliably come back. The child learns to tolerate you being away, and anticipate your return. Some rules to follow are:
- Never sneak out, always let your child know that you are leaving
- If they are afraid, don’t tell them not to be afraid, tell them it is OK to be a little afraid, that way they can be brave when you are away
- Let them know you will come back. Tell them when you will come back, if you know
- Start practicing these steps in easy situations first. Begin with short separations during the day, when they are playing. Make your time away longer, little by little.
- Then work on your child falling asleep alone at nap time, and delay your return until the time you have planned to end the nap, unless the child is clearly terrified.
- If naps are going well, you should be able to do the same thing with bedtime and night awakenings.
Dealing with lights and screens:
Sunrise and bright early morning light wakes you up and gets your brain going for the day. Sunset and twilight naturally tell the brain that night time is coming, and it is time to go to sleep. Electric lights and brightly lit screens (TV, computers, video games, tablets, cell phones) interfere with these natural sleep cues. Controlling your child’s light exposure during the daytime will help them feel sleepy in the night time. Try to get the lights up in the morning. Sunlight is best but bright electric light can work too. After the first birthday, many children are introduced to watching videos or playing video games. Get this “screen time” scheduled for early or mid-day. Your child shouldn’t be on the computer or tablet, watching a television, or playing video games in the hours before bed. If you are used to having a TV on all day, you may need to change this when your child has their first birthday. Sometimes parents think that it is a good idea to put a TV in their child’s room. This may be good for daytime play, but it is often very bad for night time sleep. For many reasons, we recommend that children’s TVs and computers be in public areas, like the living room.
Develop a daily schedule:
Bedtime is more likely to happen at a reliable time if daytime has a reliable schedule. Between age one and three children become more complicated and active. Your life is sure to be hectic too. Building a daytime schedule will help everyone feel more comfortable, secure, and on-top of things. Some kids are naturally irregular. We cannot force them to stick with a schedule, and we have to be careful about creating conflict that challenges attachment, but having a general schedule to flex is better than chaos.
Try to wake your child up at the same time every day, weekends too. Have a morning routine that starts the day and gets the child ready for the day’s activities. Plan some active time for play early and mid day. Work screen time into the schedule, so that you can limit it and prevent it from coming too late in the day. Between ages one and three, children are still taking one or two naps a day, sometimes more. These should be in the schedule too, but not too close to bedtime. Meals and snacks don’t need to be complicated, but should be part of the schedule. Meal-time is often a good time for family time. Meal time should not be screen time. Finally, between one and two is a good time to develop a bedtime schedule that will last for the next five years or more. A quiet, calming activity; a relaxing bath; toileting and tooth brushing; bedtime stories, songs or books; kisses and hugs; lights out or down; and your last good nights should be a regular, reliable and reassuring routine.
RELATED: Healthy Sleep Habits: How Many Hours Does Your Child Need (HealthyChildren.org)
Most children can sleep through the night by age four to six months. Many will wake up again at eight months, around 18 months, and when they are upset or sick. These setbacks should be expected, accepted, and brief. Sleeping is a skill that your baby learns as they grow into a toddler and young child. By paying attention to developing good, age appropriate sleep skills, you make it easier for your child. And a sleeping child makes it easier for you.
RELATED: Parents’ Guide to Sleep (Purple.com)