Mommy Training Part One – Resources on Baby Sleep and Routines

"Ok, so you thought newborn sleep was bad..mwahahaha!"

“Ok, so you thought newborn sleep was bad..mwahahaha!”

First, a note-

Common sense

(Smack it up, flip it, Rub it down…er,highlight this)

Seriously, a parent that uses common sense and never reads a book is better than a parent who follows one book/philosophy religiously. I’ve seen more harm done with, “But Dr. So and So said this!” than, “Oh, huh, maybe she’s hungry. Let’s figure this out together”. I can’t stand going into forums for different parenting styles where parents try to mold their babies or lifestyles into what is clearly NOT working for them. Use your heads. Pediatricians can be stupid too. On that note, don’t blindly listen to even your own pediatrician or nurse, unless you want backup for a parenting decision you’ve already made.

On to the books…

Happiest Baby on the Block by Dr. Harvey Karp

Pros: Ok, this all seems like a no brainer to most experienced parents, but it was mind blowing when I read it years ago. Newborns are in their “fourth trimester” until they are 3 months old. They still need to feel like they are in the womb. Hence, swaddling, rocking, white noise, etc. Genius. Get the DVD if you’re too busy to read.

Cons:  No exit strategy, especially for swaddling. Luckily I”m a worry wart and immediately was like, “well, if I swaddle now, what happens at four months when she might no longer need to be swaddled but she thinks she needs it and….aaah!”. So we slowly around 2.5 months started experimenting with loose swaddles, or deswaddling her, etc.  Nothing really worked until about a week before she turned four months, when she fell asleep readily with only one arm swaddled. One week later, she was fully deswaddled. So this isn’t a major complaint about the book, because I think Dr. Karp believes babies will develop and let you know when they are ready to stop being swaddled, and that was true for us. But so many parents TIGHTLY swaddle (like legs and everything, which we didn’t do) until four months, and then they have a heck of a time weaning the baby off of it when they start rolling, or when the blankets get too small for them. I’m glad we started the deswaddling process slowly and without any time pressure. It worked great for us.

My son, on the other hand, didn’t really love swaddling or white noise in general,but in a pinch, using the 5 Ss (Ssshing, side/stomach, swinging, sucking, and swaddling) were super helpful.

For a really controversial take on the Happiest Baby on the Block, look here. I suspect the author is a proponent of RIE (Resources for Infant Educarers) which I hope to get into in another post.

A side note on swaddling..

There is definitely controversy on swaddling methods. Here is Dr. Karp’s swaddling guide.  However, not only are there concerns regarding hip displaysia (go here for hip friendly swaddling methods), there is controversy regarding putting the baby’s arms by its side (which is how I swaddled) vs. crossing them on their chest (which is considered by many parents ‘less cruel’).  There’s the ‘Aussie Swaddle’, which allows the baby to suck on his or her thumbs. There is apparently research out now that indicates that the baby’s arms should be completely free so the hands can touch, allowing for neurological development (I do not have a source on this one, and will try to find it…but I suspect as long as the baby isn’t swaddled all day long, this shouldn’t be a problem). Finally, there is the belief that swaddling may increase SIDS risk, because of a.) overheating and b.) the fact that the baby does sleep too long and too well, therefore not allowing the baby to wake up if there is a problem (many things that ‘lower the SIDS risk’ are actually tied to making sure the baby isn’t sleeping too well – ex: pacifier, breastfeeding [baby wakes up more to eat], and tummy sleeping [although there are other aspects of this including breathing, one is that the baby sleeps too well on his or her tummy].

On the other hand, I see claims that swaddling lowers the SIDS risk for the exact same reason (babies who are swaddled wake up more easily to problems, goes this hypothesis).  This means I absolutely have to do a Controversies post on swaddling!

Wonder Weeks by Hetty van de Rijt Ph.D.

Pros: It’s amazing in explaining why babies sleep well, then sleep badly, then sleep well – especially the dreaded 4 month sleep regression (yep) and the 18 month sleep regression (double yep). (Try having a four month old and an 18 month old at the same time.  Four months is when a lot of parents start cry-it-out techniques because their good sleeper all of a sudden turns horrible. I didn’t because I knew what was going on – a major developmental spurt that kept her awake. Also gave me peace of mind that she’d grow out of it after a month (until about 6 months when sleep turns a bit crappy again).

Note – I wrote most of the above when my eldest was 5 months old.  I tried the same philosophy with my son. He did not grow out of the 4 month sleep regression…instead he picked up a lot of bad sleep habits that I still haven’t quite broken.  In fact, I’ve found many previous ‘good sleepers” start going downhill at 4 months – due to the sleep regression – and then continue on with the habits learned while parents try to cope with the regression. Lesson learned – shortcuts (cosleeping, etc) are well and good for your sanity, but keep in mind those may become habits later (this does not apply if you have no problem cosleeping, no problem nursing to sleep, etc – this is only for parents who prefer their babies laid down awake in their cribs).

Cons: None really, because it’s not a parenting philosophy book. It doesn’t tell you what to do – it just tells you what’s going on.

For more information on regressions and wonder weeks, go here,here, and here.

There is a Wonder Week iphone app and this is the Wonder Week website.

Healthy Sleep Habits, Happy Child by Dr. Marc Weissbluth

Pros: Great research on how sleep is SO important and how naps are different from nightsleep (ex: a good night’s sleep does not make up for lack of napping – uses different parts of the brain). Explanations on how much sleep a baby actually needs (11-12 hrs of nightsleep, napping varies with age) Explanations on how long a baby can happily stay awake. Very helpful info.  Talks about teaching a baby to fall asleep on her own, so she doesn’t need to be rocked or nursed to sleep every times she wakes up.

Cons: Advocates in “extreme” cases the extinction method – which is just letting a baby cry forever, without even checking in.  Totally against “attachment parenting” (which I’ll discuss later) including EVER nursing or rocking a baby to sleep. I think you do what works. With my super-sleeper (my eldest), I tried to put her down “drowsy but awake” like they advocate, and it worked 95% of the time. But sometimes she needed to fall asleep eating, or be rocked to sleep. I really didn’t care, as long as I mixed up the various tricks to get her to sleep so she wasn’t dependent on one.  Same with my second child – who picked up habits more. When nursed to sleep a lot, that’s all he wanted to do to go to sleep. Right now he won’t sleep without being in bed with me. I’m at peace with that, but if it concerned me, the key is to start mixing up “going to sleep’ methods.

For more information on sleep training, go here. For wake time charts, go here.

On Becoming Babywise (Gary Ezzo) and Solve Your Child’s Sleep Problems (Dr. Richard Ferber)

Pros: I have not read either book. However, it generally does advocate the basic philosophy of cry-it-out with checks. Ferber has become the synonym for cry-it-out. Parents just a little older than us usually call it “Ferberizing”.

In addition, Babywise (like a few other books) advocates the Eat,Sleep, Play routine, something that worked really well with my elder child.

Cons: A few notes again on common sense – I like using things like Eat, Play, Sleep and maximum wake times as guidelines – but I by no means am slavish to the schedule. Some strict followers of Babywise really end up screwing their breastfeeding relationship because they are so focused on sleep and schedules. Breastfed babies are hard to fit into your convenient lifestyle. They are very inconvenient! It’s not really the fault of these books – it’s parents who are ‘all in’ or nothing.

Also, Babywise advocates Parent-Directed Feeding, which is in sharp contrast with the current zeitgeist of On-Demand Feeding. A comparison of the two (and the claim that on demand feeding raises IQ points) will make a good Controversies post.

The AAP has written an anti-Babywise commentary, linking it to failure-to-thrive. I again suspect some of this is related to the misuse of the Babywise idea. However, on a personal note, although I believe in on-demand breastfeeding, I did unconciously start scheduling my eldest’s feeds due to these ideas, which led to the death-knell of our breastfeeding relationship. My younger baby was completely on-demand while we were breastfeeding. The reason he is no longer breastfed has nothing to do with the success of our breastfeeding relationship and instead due to medical necessity.

Go here for more info on Babywise.

The Baby Book/Nighttime Parenting by Dr. William Sears

Pros: Your life DOES change when you’re a parent. Babies are supposed to be inconvenient, and they need you.  Great on breastfeeding advice (fully endorsed by La Leche League and every lactation consultant I’ve ever met). Love the relaxed attitude to parenting..love em, rock em, sleep with em, wear em, nurse em on demand…so lovingly earth-motherish. Oh and babies cry because they are trying to tell you something. Figure it out. The less babies are allowed to fuss or cry during the day, the better they sleep at night and the more confident they grow up as adults because they learn they matter.

Cons: Oh man, I feel like I can’t get into the cons without angering some parents. Let’s say it this way –  I’m not much of an attachment parent and my eldest wasn’t an attachment baby.  Cosleeping didn’t work for us, breastfeeding didn’t work out for us, baby wearing didn’t work out for us until she was older. We don’t quite look like an AP family, do we.. But we did what worked, adjusted ourselves accordingly, and many APers will subsequently see us as bad parents, even though I was as hyper-attentive to her needs as most APers are, to sometimes the detriment of myself.  There can be a lot of stress associated with the AP philosophy – but as I’ve indicated above, there can be a lot of stress associated with the Babywise philosophy too regarding sleep habits and schedules.

Go here for more Dr. Sears

Secret of the Baby Whisperer by Tracy Hogg

Pros: Eat, Activity, Sleep, You Time (EASY routine). That’s what my eldest did usually – she ate, she played, then she slept, all on a beautiful 3 hr schedule. Reading this helped me figure out my baby.

Cons: She dictates a three hour schedule then a move to a four hour schedule.  I don’t think it’s beneficial to dictate a schedule for a baby. Recognizing when a baby is likely to be hungry and likely to be sleepy has been a Godsend for me, but internet forums are full of parents trying to MAKE their kid eat every 3 hrs on the dot or make their kids wake up after eating. EASY works pretty well with formula fed babies (like my first) but difficult to implement with breastfed babies (like my second) In addition, a four hour schedule is quite difficult for any baby, including formula-fed ones.

Go here for the Baby Whisperer forums.

The books above vs. the books below

I actually wrote about the above books when my eldest was 5 months old, and then just went through and edited the reviews to make more sense in the context of now (and tried to edit down my biases).  At 6 months old, we had a few more sleep issues and I ended up doing some cry it out, with the support and advice of this forum. ( Before that 6 month mark, I was actually super-anti-cry it out, which is easy to be when you have the BEST sleeper ever.

Modified cry-it-out (I did a slightly more gentle/instinctual version than the strict Ferber method) worked great for my eldest and it wasn’t a big deal. There were still times when she was a crap sleeper, and there were still times I didn’t want to do any CIO and just ‘gave in’ like sleeping in bed with her. Again, this is where “what works for you” comes in. But anyway, the books I read gave me the tools I need, whether it was Dr. Sears or if it was Dr. Weissbluth.

Go here for the researchy take on the cry it out controversy.

Then my son came along. Slept through the night as an exclusively breastfed newborn. Hit the four month sleep regression hard. Needed to be nursed down to sleep even with brief night wakings, got to the point he didn’t want to sleep without being held upright or without being in his Rock N Play sleeper. At 6 months, I tried cry-it-out. Worst decision ever. He is way too sensitive a soul. It did nothing, and he ended up hoarse. (Go here for a discussion on tension releasers vs increasors). So I picked up two other books I had heard about but hadn’t had the occasion to read. (Spoiler alert- things got better, fast. Then I went away for a week, things were in upheaval around my house, and I came back to a baby who wouldn’t sleep unless he was in bed with me. Now we are cosleepers, but he is a great cosleeper who goes to sleep with no intervention as long as he’s in bed with me, and sleeps all night without waking once. I’ll take it.)

So I ended up reading the following two books:

The No-Cry Sleep Solution by Elizabeth Pantley

Pros:  This is perfect for the APer who is anti-sleep training but cannot take the family sleep situation any longer. Has tips on every stage and age. Advocates using gentle techniques to avoid crying. Focus on understanding why baby is waking and fixing problems with routines, new associations, and gradual changes in patterns. Supportive of breastfeeding and co-sleeping as well as crib sleeping and bottle feeding. Ideas like the ‘Pantley Pull Off“,which is delatching the baby before he completely falls asleep.

Cons: Only small incremental changes.  Will likely take more than the two weeks she’s talking about to see results,especially if you yourself are resistant to change (ie: believe there’s no way the baby will go to sleep without nursing completely down,and therefore don’t do the ‘Pantley Pull Off’ method appropriately. A lot of common sense stuff, so some parents may feel as though they did not get their money’s worth.

Go here for a Mothering.com support thread on the No Cry Sleep Solution. Take heart that your sleep situation is probably way way better than theirs.

I got frustrated with No-Cry and moved on to Good Night,Sleep Tight, butlLet me give it a plug – because of the No Cry Sleep Solution, I was able to implement the Good Night Sleep Tight method much more effectively.   I hadn’t realized it at the time, but the No Cry method did teach my son how to fall asleep by patting/shhing instead of nursing, which made it a lot easier when he woke up in the middle of the night or woke up as I tried to lay him in the crib.

Good Night, Sleep Tight by Kim West (aka the Sleep Lady)

Pros: This is sold as the gentle approach to cry-it-out.  Ideas on how to teach your baby how to sleep from birth onwards (gently) and thereby avoiding sleep problems later.  (Ideas on how to teach a newborn how to sleep are things I did instinctively with my first – I sat with her as she fell asleep on her own for all naps and bedtime for a while, and eventually she could do it herself. I credit that with the good sleeper she generally has been). Goes through each age/stage.  Advocates sitting with your baby as he falls asleep and then gradually moving further and further away. There will be tears involved, but most likely just some frustrated crying and/or fussing.

Cons: Don’t get me wrong. This is cry-it-out.  For highly sensitive babies like mine who screamed the minute he was laid in the crib, it was just as bad the first night as implementing Ferber.  For other babies, it probably is much more gentle, as the child can see you sitting right there.  She advocates not picking the baby up unless he is hysterical and that it is unlikely that the baby will be hysterical – my child was hysterical the entire time. What kept me going is that he was being hysterical at every bedtime and naptime no matter what – whether I was rocking him, or nursing him, or bouncing him, or sitting right there next to him. But I had to be prepared for those tears. After that night, it was much better – some tears, but no more screaming – however, I adjusted for his sensitive nature and picked him up much more than recommended and took much longer to move through the “shuffle” (moving my position farther and farther away from him). Also, for some babies, sitting with the baby may be worse than just leaving the room, because being right there may frustrate them more.

My recommendation

I really like the Good Night Sleep Tight method for parents who want to try cry-it-out but still freak out the entire time because they want to reassure their babies. Sitting with the baby really does help alleviate a lot of those feelings (although like I said, for some babies, leaving the room may actually help them more than sitting there where they can see you and be frustrated). I even implemented some of the methods with my elder child, who decided all of a sudden that she wanted to sleep in our bed, not hers, even if I was sitting right next to her in the room. I spent one night sitting on the cot next to her bed as she cried. She was old enough to tell me if something was wrong, and I was there next to her so she didn’t feel abandoned. That gave me incredible peace of mind (again, especially because she is a toddler and could tell me if something were wrong). After that, she slept fine in her bed, although right now she wants one of us on the cot next to us, which is a whole another issue (that we are indulging for now, because she’s at the age that separation anxiety gets pretty bad).

And yes, that means every night, the baby is in the big bed with me, while my husband is sleeping on the small cot next to the toddler’s bed. It happens.

For the most comprehensive and ridiculous review of infant sleep I have ever seen, go here.

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