Blog Post 20-Baby’s Sleep

Healthy Sleep Habits, Happy Child
by Marc Weissbluth, M.D.

A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.

“Sleep Readiness” is the title of Chapter 11 of the United States of America Department of the Army field manual (FM 7-22) that prepares young men and women to become soldiers.  It is the official document that describes how all young recruits will acquire necessary skills during the process that is sometimes referred to as basic training or “boot camp.”  Updated in 2020, it is based on empirical data using traditional scientific methods.  Sleep is serious business. 

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial, from the point of view of the United States of America Department of the Army.  I have lightly edited, added emphasis, and condensed Chapter 11 in order to show you how “Sleep Readiness” can also help parents help their child sleep better.

Initially, I posted Chapter 11 (Blog Posts 1 through 5) to emphasize the value of healthy sleep.  Based on the material presented in Chapter 11 of the Army field manual, Blog Posts 6 through 15 show how basic principles of sleep apply, not only to military basic training, but also to parenting.

Going forward, I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. For now, only read the single, age-appropriate Chapter for your child.  Later, if you wish, read Chapters on What is Healthy Sleep, Why Healthy Sleep is Important, and Preventing Sleep problems.  Finally, if needed, read the Chapter on Sleep Solutions.

            Let’s go!

WHY DO SOME BABIES SLEEP BETTER THAN OTHER BABIES?

            Some babies fall asleep easy; sleep for long periods, both during the day and at night. Except for feeding or diaper changing, they seldom awake at night; and if they do have an unexplained night awakening, it is brief and they are easily soothed back to sleep. Some babies are the opposite.  What might cause these differences among babies?

                        · Genes influence sleep and account for some individual variation in how our babies sleep.

                        · During pregnancy, the mother’s behavior (smoking, alcohol, drugs) may adversely influence the baby’s brain development causing baby sleep problems.  However, the mother’s behavior may be caused by the father’s behavior (an absent, alcoholic, abusive, addicted father) so the specific family circumstances are important (Blog Posts 14 and 17.)

                        ·  After delivery, our culture, our family, and our partner influence how our baby sleeps (Blog Posts 17 and 18).  An additional factor is ‘actor effect’ versus ‘partner effect’.  If a child has a sleep problem, the sleep problem in her baby might directly contribute to the mother’s report that she, herself, has insomnia (‘actor effect’) and influence how she cares for her baby.   Separately, the father might complain to the mother about their child’s sleep problem, and his complaining might indirectly contribute to the mother’s insomnia (‘partner effect’), thus, his complaining might influence how she herself sleeps and how she cares for her baby.  Insomnia in the mother is a risk factor for postpartum depression.  Instead of simple one-way associations between a parent and child, there are complex, cross-partner associations.  “Relationships in which partners were perceived as critical, coercive, or intimidating were associated with significantly more depressive symptoms in individuals as well as their partners.”

SLEEP DURING MONTHS 2 THROUGH 4

            During the first 2 to 4 months, there appears to be an association between how well a baby sleeps and how much they fuss and cry.  The more a child fusses or cries during the first 2 to 4 months, the more likely sleep is disturbed.  The same three bullet points above influence fuss or cry behavior.

Babies fuss and cry even when they are not hungry, wet, or soiled and do not appear to be ill with fever, vomiting, or diarrhea.  The definitions of unexplained “fuss” and “cry” behavior vary among researchers. But measurements (whether objective, using audiotape, videotapes, sleep sensors or subjective, using parent reports) can be made of how many episodes (or ‘bouts’ of fuss or cry behavior) occur and the total duration (minutes) of fuss or cry behavior.  Because of the variability in definitions and measurements, hard conclusions are elusive.  Nevertheless, all babies exhibit these behaviors; some a little, some a lot.  Those babies with a lot of fuss and cry behavior are more likely to have disturbed sleep during the first 2 to 4 months which directly stresses parents, who now have less sleep for themselves, and indirectly stresses parents who naturally worry about when it will end, what is wrong with my baby, or what am I doing wrong?

            Extreme fussiness/crying, in English speaking countries, is called “infant colic” or “three months colic”. In China, it is called “one hundred days crying”; in Vietnam, “three months plus ten days crying”, and in Japan, “evening crying”.   The Western view is that this is a medical problem needing treatment, but the Asian view is that this is a normal, but difficult, stage of life.  This behavior occurs in about 20% of babies.  It disappears in about 50% of babies by 2 months, an additional 30% by 3 months, and an additional 10-20% by 4 months.

Invitation
Please comment
What is “colic” called in your country? How do you deal with it?

            Those babies with the most amount of fussiness and crying during months 2 through 4 might:

                        · Not show drowsy signs (Blog Post 9) and quickly crash from awake to fussiness when sleepy.

                        · Have difficulty self-soothing at sleep onset (Blog Posts 10 and 16); require immediate soothing at night to prevent a storm of fussiness and crying (Blog Posts 11 and 18); have an irregular sleep schedule (Blog Post 12).

                        · Defy any sleep plan that you design (Blog Post 14).

                        · Create stress in either or both parents and the marriage (Blog Posts 17 and 18).

            If you are facing these difficulties, you might find yourself in survival mode.  Your strategy is coping and caring for your baby during this difficult period. There is no “cure” for the fussiness and crying. Seek help (Blog Post 17), take breaks, without guilt, and recognize that your child is, and needs to be, parent-soothed because your child is not able to learn how to self-soothe during this temporary difficult period.

            Here is what you can do to help:

                        · Move the bedtime earlier at 6 weeks of age (Blog Post 7).

                        · Even a few minutes earlier bedtime might help (Blog Post 6).

                        · Practice putting your child down to sleep drowsy but awake (Blog Post 9) at 2 months of age.  If this fails after a few trial days, forget about it, and try again at 3 months of age.  If this again fails after a few trial days, forget about it, and try again at 4 months of age.

IT IS NOT NECESSARY TO MAKE YOUR CHILD CRY TO HAVE A GOOD NIGHT’S SLEEP

WHAT A PARENT CAN DO

•  Some babies sleep better than other babies. Develop coping strategies to reduce stress if your baby has extreme fussiness or crying.  Plan to encourage self-soothing skills at 2 to 4 months of age.

•  ‘No Cry’ sleep solutions (‘Fading’ and ‘Check and Console’) may solve sleep problems. Blog Post 19

•  Communicate with each other and coordinate nighttime parenting practices.  Consider delaying your response to nondistress sounds your baby makes at night by 5-10 seconds, especially after 3 months of age.  Blog Post 18.

•  Encourage partner to help care for baby daytime and nighttime.  Be emotionally available at bedtime.  Seek help if your child is not sleeping well and there are symptoms of anxiety or depression for yourself or partner.  Blog Post 17.

•  Encourage self-soothing; the earlier the better.  Consider leaving the room after putting your child down to sleep. Provide opportunity for naps based on drowsy signs.  Encourage partner to help care for the baby daytime and nighttime. Blog Post 16.

•  Plan for healthy sleep by focusing on sleep quality, not just sleep quantity. Provide opportunities for naps. Blog Post 15

•  Make a sleep plan that you are comfortable with; be flexible and tolerant.  Blog Post 14.

·  Become more aware of the difference between how you feel when well-rested versus mildly sleepy. Blog Post 13.

·  Try to maintain a regular sleep schedule.  Blog Post 12.

·  Try to not respond immediately to every quiet sound your baby makes at night.  Blog Post 11.  

·  Practice soothing to sleep and bedtime routines, every night, if possible. Blog Post 10.

·  Watch for drowsy signs. Blog Post 9.

·  Respect your child’s natural sleep rhythms.  Blog Post 8.

·  Encourage an early or earlier bedtime (even a slightly earlier bedtime may produce better sleep.  Blog Post 6) especially at 6 weeks.  Blog Post 7.

∙ Recognize that a healthy brain requires healthy sleep. Blog Posts 1, 2, 3, 4, and 5.

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