sleep schedule

SLEEPING SAFELY IN A CRIB

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
SLEEPING SAFELY IN A CRIB
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. With the new precautions for SIDS in the crib, how do I help my infant learn to comfort himself? We follow the current thinking to keep a crib uncluttered with pillows and blankets.

In your books you suggest a “lovey” or a blanket for transition time. My son hasn’t yet found such an attachment.

We’ve gotten him to sleep in his crib at night, but he resists bedtime and is inconsolable at nap time. Instead, I continue to lie next to him on our bed, which isn’t safe if I leave the room.

A. The Back to Sleep campaign, sponsored by the National Institute of Child Health and Human Development, nichd.nih.gov/sids, has reduced the incidence of SIDS (Sudden Infant Death Syndrome), also known as “crib death.”

We should all stick with the campaign. Back to Sleep recommends placing babies on their backs to sleep. But we are still learning about the impact of altering infants’ spontaneous sleep positions and of giving up traditional ways to help them stay asleep.

Many parents find that their infants have trouble settling into a restful state when placed on their backs to sleep. In this position, babies can’t easily curl up into the more familiar fetal position or get their hands to their mouths to suck and soothe. Swaddling can help babies settle down to sleep. Swaddling’s pressure may feel like the womb’s support.

We agree with you that infants must learn to console and comfort themselves. The ability to experience distress, and to overcome it, is developed early and lasts a lifetime. The ability starts with a parent or other caregiver’s soothing a baby, who gradually learns to imitate and then internalize it.

Infants discover how to comfort themselves – sucking a thumb or finger, or stroking their cheeks or a blanket’s soft satin border. You can introduce your baby to his thumb, or to a small stuffed animal or a piece of soft cloth – be sure that there’s no possibility it could obstruct his nose or mouth.

Hold the object close while you lie with your baby so he connects the comforting feeling of your skin, warmth, breath and heartbeat with something small and safe that may even take on your familiar smell. Try a soft piece of one of your own old shirts. Other ways to make a crib more welcoming: Record yourself singing your baby’s favorite lullaby and play it softly as he goes to sleep. Or try a CD of lullabies by others.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

WHEN A TODDLER SUDDENLY DEVELOPS SLEEP PROBLEMS

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN A TODDLER SUDDENLY DEVELOPS SLEEP PROBLEMS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. We have read “Touchoints” cover to cover. We keep our tattered and torn copy on the coffee table for easy access, but we are at a loss.

Up until a week ago, our 25-month-old daughter was the “perfect child” – our pediatrician often asks to adopt her if we tire of her! She has always has been able to self-soothe and go to sleep on her own. She is not having any problems at nap time (noon-2 p.m.) She eats fairly well, is active and well ahead of the curve in her language skills.

Last week, she started a pattern of not being able to/wanting to go to sleep in the evening (7:45-8 p.m.). We keep a very regular schedule and bedtime routine (bath, brush teeth, books in the rocking chair and then bed).

Now, we are having to actually get her into a sound sleep and when we finally get her to sleep, she experiences long spells of night waking – anywhere from one to four hours of screaming, crying, pleading with us to rock her, hold her, take her to our bed, stay in her room, rub her back, etc.

She’s not waking regularly at 10 p.m., 2 a.m. and 6 a.m., but rather wakes once and can not/will not go back to sleep. She repeatedly is crawling out of her crib. It is almost more than we can take to allow her to be in such a state.

A. At what time of night do these awakenings occur? Night terrors usually occur during the first few hours of sleep, while nightmares tend to occur in the last hours of sleep, in the early morning.

During night terrors, children are not really awake or conscious. They’ll suddenly sit bolt upright in bed and let out blood-curdling shrieks. Inconsolable, they often become more agitated when parents try to talk to them or comfort them. The best bet is to stay out of their way, if they are safe, and let them fall back to sleep on their own. They’ll have no memory for the event, since they never really were awake, even though it seems as if they are.

Nightmares, on the other hand, really are dreams, and children usually can remember them, and when they’re old enough to speak, talk about them.

Does your child really keep screaming for 4 hours even if you do hold her, stay with her, or bring her into your bed? It does sound as if she is conscious – not having night terrors – if she is pleading with you to stay with her and comfort her.

At 25 months, she is a little young to be having the kinds of nightmares that 3- and 4-year olds have when they begin to become aware of their own aggressive feelings and begin to scare themselves.

It sounds as if this has only been going on for about a week, but if it has persisted, we would suggest you consult with your pediatrician, who might refer you to a pediatric sleep expert.

Have there been any recent changes or stressors for your family? Her new resistance to going to bed, and her new demands for you to stay close during the night, raise the possibility that something has happened that has frightened her and makes her more hesitant to separate from you.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center.  Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.