Category Archives: Baby Sleep

Baby’s Sleep Environment

Baby Sleep

Your Baby’s Best Sleep happens in a room that is Cool, Dark and Quiet

Use light and dark to reinforce sleep and wake cycles. Keep lights dim for the 30 minutes before sleep, and during nighttime soothing, feeding or diaper changes. Light is a significant biological driver of the circadian rhythm, and can be used to help reset sleep and wake times in babies once sleep has consolidated, from about 5 months onward. Research suggests that exposure to light will suppress melatonin, the sleep-inducing hormone, just as darkness encourages release of melatonin, which encourages sleep.

Keep the lights dark from the desired bedtime, to the desired morning wake up time, to help reinforce the sleep cycle. If your child is waking too early, true room-darkening shades are important. Early morning light creeping in will encourage an earlier wake up time. If there’s enough light in the room to read by, it’s too light. Avoid gaps at the sides of shades that allow a strip of light at the edges. Using aluminum foil on the windows to block light may not be attractive, but it’s certainly effective.

Continuous White Noise is an underused sleep aid. Not just any white noise, but continuous white noise is essential because it helps muffle random sounds at the most vulnerable times: during light sleep stage. Rather than sound machines that shut off after an hour, make sure it plays all night. Position your sound machine between the baby and the noise. Determine if you’re most concerned about outside sounds, or household noises. When a baby is in a deep sleep, he might be oblivious to even a loud sound. When he is in a light sleep, even a quiet sound like a sneeze or a toilet flushing in another room might be enough to rouse him. Continuous white noise also serves as a sleep association that is easy for anyone to replicate and can travel when you do.

A Cool, Ventilated Room 
A cool, dark and quiet room works best. When the season has warm days and cool nights, it’s reasonable to open the windows for fresh evening air. However, with the windows open, the birds and outdoor sounds will be even louder at 5 AM. A fan in the room to help circulate air is a good option if the windows are closed. Keep the room temperature at 64-69°F for sleep. During cooler months, keep feet warm at night. Remember:  “warm feet for better sleep”. Don’t worry if your baby’s hands or face feel cool to the touch. Slip your hand under your baby’s shirt: if his tummy and chest are warm, he’s warm enough.

Changes in Routine over the Holidays

Baby Sleep, Breastfeeding, Infant Health & Safety, New Moms, , ,

It’s easy for everyday routines to be disrupted over the busy holiday weeks. Travel, visitors, parties, new decorations, and changes in childcare or playgroup routines , plus alterations in meals, nap and bedtime routines may result in both excitement and stress for infants, toddlers and parents.

Some simple steps may help to maintain a sense of security and routine during these busy days:

Keep mealtimes as regular as possible, or offer healthy snacks if a family meal is being held later than your child might like. Most toddlers have a short attention span in the highchair, so bring along some appropriate diversions to keep a child content at the table a little longer, or allow him to play with quiet toys on the floor next to the table if appropriate.

When traveling overnight, bring along some favorite toys, books, music and blankets and try to keep to your regular bedtime routine, even if it’s a little briefer or later than usual. If you usually bathe, read, rock, sing with your little one at bedtime, follow that pattern. Your baby will recognize the familiar rituals, even in a new environment. White noise may help mask unfamiliar city or party sounds.

Unfamiliar faces or crowded rooms at parties may take your child some time to get used to. Sometimes visitors are so eager to see the baby that they want to rush in and envelop the baby in a hug. Explain to visitors and relatives that most young children need some time to acclimate to new places and people (even grandparents, if it’s been awhile since their last visit). Hold your child and let her watch you interact with friends and relatives first. Wait until she seems more relaxed and shows a willingness to explore the environment or be held by someone new.  Using a sling or frontpack is a great way for relatives to see and interact with the baby, while parents are still able to maintain a sense of safety and security.

Keep extra-vigilant at holiday gatherings and parties when there are many adults and children present. It’s often assumed that someone else is watching a child, when in fact the toddler may be unobserved exploring an area that is unsafe or mouthing a potential choke-hazard. Sometimes a well-meaning relative may give a baby or toddler a food or plaything that is unsafe or not age-appropriate. Party foods (including candy, nuts, chips and baby carrots), festive decorations and toys for older children are all tempting and potential hazards for a crawling baby or young toddler.

 

Baby’s Head Shape: Flat Spots, Torticollis & Plagio

Baby Sleep, Infant Health & Safety, New Moms, , , , , , , , ,

Does your baby have a flat spot on the back of his head? Many babies do. Fortunately, most flat spots, called Positional Plagiocephaly, are mild and need no treatment other than positioning changes and monitoring. Learn how to prevent and treat flattening of your baby’s head, and when to speak with your pediatrician about concerns.

 What is Deformational Plagiocephaly or “Flat Head”?
Also called Positional Plagiocephaly, Deformational Plagio refers to the misshapen or asymmetric shape of the head. The flat spot is usually on the back of the baby’s head, though in some cases, for example, with torticollis, the flat area may be on one side of the skull.

What causes deformational plagiocephaly or “Flat Head”?
The most common cause of deformational plagiocephaly is positional. A newborn’s skull is soft and designed to grow quickly. When babies rest in one position for long periods of time, the skull begins to flatten from the external pressure against it. Since babies can spend a lot of time in the “passive recline position” (car seats, bouncer seats, swings, back-to-sleep position), it’s possible for a flat area to develop. Once a flattening occurs, it’s easier for the head to “resettle” there each time, allowing other parts of the skull to grow but not the flat area.

Shifting your newborn’s sleeping and resting positions is the best prevention for developing a flat spot. During diaper changes and for sleep, try alternating his “head and feet” position, reversing the way you usually lay your baby on his back. When your baby is awake and observed, use more tummy time and side-lying positions. Lots of awake tummy time with encouragement will also help by strengthening the neck, shoulder and arm muscles, which will eventually help your baby shift his own positions. Carrying, holding or “wearing” your baby without pressure on the back of his head will also encourage muscle development and prevents pressure against the flat spot.

Is a Bald Spot or stripe on the back of the head cause for concern?
No. It’s common for babies between 4 – 7 months to “wear away” an area of hair from turning their head side to side when in car seats, bouncer seats or sleeping on the back. This bald patch is normal and if not accompanied by significant skull flattening, is not a cause for worry. Bald patches tend to resolve between 9 to 12 months, as your baby will be sitting, crawling and moving more, spending less time on his back, allowing hair time to fill in again. Many fashionable babies sport a fine mullet.

Torticollis and Flat Head – 
A common cause of deformational plagiocephaly is muscular torticollis. Muscular torticollis (sometimes called “wry neck”) is a tightening of specific neck muscles, which prevent full motion and keep the baby’s head slightly tilted or turned to the side. Because torticollis causes the baby to keep his head at a specific angle, a flat spot may form as the baby’s head rests against the mattress or seat at the same position for repeated periods of time, leading to positional plagiocephaly.

Torticollis is often missed by parents and health care providers, since newborns have short necks and tend to lean or “slump” to one or another side. Make sure your baby is an “equal opportunity slumper” – sometimes leaning to the right side and other times the left, when sleeping, and check that your baby can turn his head equally to both sides. If you’re concerned about your baby’s persistent head-tilt or suspect restricted neck motion, speak to your pediatrician.

Treating Torticollis – for a baby with torticollis, treating the tightened muscles early is important to achieve full head movement as baby grows. Full motion of the head and neck helps with balance as well as the physical appearance of the head shape (and sometimes facial symmetry). Torticollis is best treated early, during your baby’s first several months of life when specific stretching and repositioning techniques are most effective. Your pediatrician may refer you to a pediatric physical therapist to learn specific stretching exercises and positioning tips for your baby’s particular needs.

What about Helmets?
Maybe you’ve seen a baby out in the store or mall wearing what seems like an infant-sized football helmet. This is a therapeutic device called a Cranial Band or Orthotic, worn to help correct a misshaped head.  In more severe Plagio, when flattening or asymmetry is significant and beginning to affect facial appearance (one eye or ear may begin to move out of line with the face), or, in situations where a baby was born very prematurely or has early closure of the skull bones, an Orthotic may be recommended. Made by a specialist, baby helmets are very lightweight, with a hard outer shell and foam lining. Very gentle pressure restricts growth in some areas while allowing the skull to “fill out” and freely grow around the flattened areas, rounding out the head. Helmet therapy typically takes 3 to 6 months with good results.  Babies generally adjust to wearing a helmet quickly – it’s harder on the parents usually due to comments from well-meaning strangers and additional appointments. But remember that mild flattening is common and usually doesn’t require treatment with a helmet.

 

Links and such

Baby Sleep, Breastfeeding, Infant Health & Safety, New Moms, Uncategorized

(This may look like a random collection of links to most. That’s ok, feel free to click and enjoy)

five babies on bolsters

History, Legacy, Feel-Good Stuff:
Great Beginnings New Mothers Groups. My Legacy. Begun in West Roxbury, 1995. Ended in 2014, after reaching 25,000 families in five states and thirteen locations. The curriculum is continued in a variety of community centers, childcare programs, birth centers and parenting programs nationally.  See the experiences of some original Isis participants. 

Magic Beans says a thoughtful Goodbye to Isis Parenting and Nancy

The Atlantic covers the MIT Program Building a Better Breastpump 

Boston Globe’s thoughts on  What Happened to Isis. (they only get it half-right, but it’s still nice)

Journal of Obstetric, GYN and Neonatal Nursing (JOGNN) free access to my publication abstract on Early Parenting and Sleep.

AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) see my  Super Cool Sleep Poster presentation on supporting parents around infant sleep.

Links Related to Topics Discussed

Go on, take a bath together! Newborn Co-Bathing is a thing if your baby hates the baby tub.

Brief Pump, Store and Feed Careplan may be useful. More on this later.

Breastfeeding Webinar Five Tips for Better Pumping with info about why I recommend pumping after breastfeeding, not mid-way between feeds.

How to Nurse Sidelying  and on both sides!  Best tweaked in person – remind me.

Soon less crying, more playing on the Changing Table! I promise!

Cradle Cap from Mayo Clinic (a trustworthy clinical source for parents IMO) – we can discuss if you want to use Head’n’Shoulders ( if pedi-approved)  and get rid of it in a week, or nothing or jojoba or coconut oil and get rid of it in 1-2 months. Either way works.

How to SAVE a Baby’s LIFE –  INFANT CPR ! Watch this 3 min. video. Also, a 2 minute choke-saving skills video review. Let’s review both of these important skills!

For S.: my favorite Infant Massage music – the original House at Pooh Corner.  We also talked about Tummy Massage for Gas.

 

Verify Credentials:  RN CPN IBCLC

RN: View my Registered Nursing License here, current and in good standing since 1989.  That’s 30 years if you are sleep deprived 😉 Check credentials.

CPN: View my Board Certification for Pediatric Nursing here, an advanced credential held for a decade and recertified every two years. View verification

IBCLC: International Board Certified Lactation Consultant – in continuous practice  since 1998. Yes, I have been a BOARD CERTIFIED feeding specialist for over 20 years, learning more each week from every mom and baby I meet. Verify IBCLC credential

Babies Don’t Keep (poem)

Baby Sleep, Breastfeeding, New Moms

Song for a Fifth Child (Babies Don’t Keep) by Ruth Hulburt Hamilton

Mother, oh mother, come shake out your cloth!
Empty the dustpan, poison the moth,
Hang out the washing and butter the bread,
Sew on a button and make up a bed.
Where is the mother whose house is so shocking?
She’s up in the nursery, blissfully rocking!

Oh, I’ve grown as shiftless as Little Boy Blue
(Lullaby, rockaby, lullaby, loo).
Dishes are waiting and bills are past due
(Pat-a-cake, darling, and peek, peekaboo).
The shopping’s not done and there’s nothing for stew
And out in the yard there’s a hullabaloo
But I’m playing Kanga and this is my Roo.
Look! Aren’t her eyes the most wonderful hue?
(Lullaby, rockaby, lullaby loo.)

Oh, cleaning and scrubbing will wait till tomorrow,
But children grow up, as I’ve learned to my sorrow.
So quiet down, cobwebs. Dust, go to sleep.
I’m rocking my baby. Babies don’t keep.

This poem first appeared in the Ladies’ Home Journal in 1958. Our chores and distractions may have changed a bit in the past 60 years, but the sentiments here have not…

Bedtime Routines: Start Early!

Baby Sleep
Bookends to the Day: helps build some predictability into your daily routine
Bookends to the Day: helps build some predictability into your daily routine

The bedtime routine: why you probably already have one even if you don’t think you do.

The bedtime routine may be one of the most important habits you can start with your baby, beginning as young as just four or six weeks of age. You may not think you even have a “bedtime routine” but you probably do. Over the coming weeks, it’s increasingly beneficial to help cue him that it’s time to sleep. As he moves into toddlerhood, a well-established bedtime routine helps limit “bedtime battles”. Your baby’s pre-sleep routine should be short and simple enough so that it’s easy to remain consistent night after night, and should ultimately serve the purpose of ending with your baby sleepy and relaxed.

Routines rather than schedules: Bookends to the Day
Aim to begin your routine around the same time most evenings. A strict “bedtime” is not necessary, but maintaining general consistency most nights means that bedtime, night feeding and morning wake up times will gradually become more predictable. Think of the “bedtime” and “morning wake up” time as the “Bookends to the Day”. Having approximate windows of time (generally within 30 minutes in either direction as your baby gets older) will lead to more predictability and will help with building routines. For example, when your baby begins to have a fairly consistent morning wake up time, you’ll find that the first nap of the day begins to happen at a more predictable time as well. Rather than thinking of these as rigid “schedules”, stay flexible and think of creating patterns and routines to guide various part of your days.

Short, Sweet and Consistent
The bedtime routine can be a pleasant, loving, soothing experience for you and your baby and will probably include a final breastfeeding or bottle, fresh diaper and pajamas. Don’t be surprised if your baby cries during part of it: not all babies love the act of being swaddled (but still do sleep better once they are), and some don’t have patience to rock and read books. Keep your routine short, sweet and consistent.

After feeding, washing, diapering and dressing for sleep, begin your pre-sleep relaxation activities.
Parts of the bedtime routine at this point might include: rocking, singing or humming, listening to soft music, bouncing on a ball, swaddling, massage, reading stories, saying prayers or saying special goodnights before bed. Your goal with the pre-sleep routine is to have your baby feel comforted, loved, sleepy and ready for bed, but awake when he goes into his crib.

What about bathing?
You may like to do an evening bath especially as your baby gets older if this is an enjoyable part of your evening routine. Parents do find that babies who enjoy their bath play and seem relaxed or tired out after bathing, so it can be a nice part of the evening routine. Or, you may feel that a daily bath is quite a big production, and is too time consuming or stressful to choose to do each day. Either way is fine.

It’s true that a baby doesn’t need a daily bath. They don’t get too dirty, and you spot clean them when they do, such as after a diaper blow-out. Places to wash morning and evening include the face, neck folds and behind the ears (where dried spit up collects) and your baby’s hands. For babies with dry skin, a daily bath with soap and shampoo can make the skin even drier. If you choose to do a daily bath, only use soap and shampoo a few times a week rather than every day. Add a few drops of jojoba, coconut or olive oil to the bath water on the days you’re not using soap and your baby’s skin will stay soft and silky.

Drowsy but Awake is hard but does work
With practice, most babies soon recognize the routine and fall asleep in the crib with little or no fussing at all. If your baby has a hard time learning to fall asleep from the drowsy state on his own, there are a variety of techniques that can be useful and that don’t include harsh “crying it out” methods.

Environment is key!  Your baby’s sleep environment should be cool, dark and quiet, especially in the early morning hours, with continuous white noise for better sleep.

Tips for holidays and travel with babies

Baby Sleep, Infant Health & Safety

It’s easy for everyday routines to be disrupted during holidays and vacations.
Travel, visitors, parties, new decorations, changes in childcare or playgroup routines, plus alterations in meals, nap and bedtime routines may result in both excitement and stress for infants, toddlers and parents.
Just a few simple steps may help keep a sense of security and routine during these busy days.

Keep mealtimes as regular as possible, or offer healthy snacks if a family meal is being held later than your child might like. Most toddlers have a short attention span in the highchair, so bring along extra diversions to keep a child content at the table a little longer, or allow him to play with quiet toys on the floor next to the table if appropriate.

When traveling overnight, bring along some favorite toys, books, music, and blankets and try to keep to your regular bedtime routine, even if it’s a little briefer than usual. If you usually bathe, read, rock, sing with your little one at bedtime, follow that pattern. Your baby will recognize the familiar rituals, even in a new environment.

Unfamiliar faces or crowded rooms at parties may take your child some time to get used to. Sometimes visitors are so eager to see the baby that they want to rush in and envelop the baby in a hug. Explain to visitors and relatives that most young children need some time to acclimate to new places and people (even grandparents, if it’s been awhile since their last visit). Hold your child and let her watch you interact with friends and relatives first. Wait until she seems more relaxed and shows a willingness to explore the environment or be held by someone new. Using a sling, baby carrier or backpack is a great way for relatives to see and interact with the baby, while parents are still able to maintain the sense of safety and security.

Stay extra-vigilant at holiday gatherings and parties when there are many adults and children present. In a full room, it’s often assumed that someone else is watching a child, when in fact the toddler may be unobserved exploring an area or object that is unsafe or mouthing a potential choke-hazard. Sometimes a well-meaning relative may give a baby or toddler a food or plaything that is unsafe or not age-appropriate. Party foods (including candy, nuts, chips and baby carrots), holiday plants and decorations, and toys for older children are all potential hazards for a crawling baby or young toddler.

Why I LOVE the NuRoo Pocket

Baby Sleep, Breastfeeding, Infant Health & Safety, New Moms

 

1. Skin to Skin for Parents and Preemies

The NüRoo Pocket is one of the only products truly designed to be completely NICU-friendly, allowing safe and uninterrupted Kangaroo Care for tiny preemies. Various secret openings allow nurses access for lines and monitors, and baby’s face is visualized the entire time.

Skin to skin care has many (many!) evidence-based benefits for baby (brain development, weight gain, heart and breathing regulation) and for mom (milk production, postpartum recovery) – these things are especially important for preemies, but are highly beneficial for every newborn or young infant. Skin to skin care is not just for premature babies, but when used in the NICU setting, the NüRoo gives a new mom a comfortable, discreet Kangaroo Care experience.

2. Truly the Perfect First Baby Carrier: Safer Babywearing from Newborn to 15 lbs

It’s quick, easy and secure and very simple to use, which helps new moms feel more confident with babywearing and soothing. Learning to use a wrap or ring sling can feel overwhelming to a new mom, and the inserts needed for soft structured carriers add a lot of bulk. Young babies need to be held, cuddled close and kept moving so much of the time! It’s important for a new mom to be able to put her baby into a carrier swiftly, easily and safely positioned. This carrier is designed specifically for tiny newborns through about 3-4 months – it’s rated to 15 lbs. Use it as a baby carrier, but at home, take advantage of the ability for true skin-to-skin babywearing, which helps with breastfeeding and milk production.

3. It feels sooooo good to wear baby in this “garment”

I’m a chronic baby-wearer and advocate, both personally and professionally. For the past 25 years, I’ve had the persistent desire to scoop up young babies and pop them in a sling. And I’ve always looked at various objects (scarves, bags, backpacks) and pieces of clothing and said “wow, I could make a baby carrier out of that!” (and, frankly, have been known to do so, with varying levels of success…)  This is exactly the shirt/system I’ve created “makeshift” numerous times in the past. Baby slipped inside a snug stretchy shirt, then safely secured by the tails of a sweater or over shirt. And, like magic, here it is.

I’m calling it a baby carrier, but it’s really a shirt (and fashionable, at that). Stretchy, lightweight fabric feels comfortable on, but once you have baby in the pocket and secure the waist-band support belt snugly, it truly feels wonderful. You can run your hands over that sweet baby bump and with your baby cuddled so close, secure and content, look down and kiss that sweet head, then go take a walk or make a sandwich in the kitchen.

4. I’ve watched it grow and develop – and now, be born!

The NüRoo Pocket is the result of several years of hard work, research and love by two Rhode Island mamas Daniela and Hope (moms, health care providers, and kangaroo care/skin to skin specialists), who asked to meet with me at Isis Parenting in 2011. I admit to being initially skeptical (Do we really need another baby carrier? Do we need a special garment to facilitate skin to skin care?), but after seeing the early prototypes, I fell in love with their vision. And over two years of development, they returned again and again to show updated prototypes, discuss features and fabrics, and bring samples for me to try and comment on. In 2013, I finally saw the end result and I was blown away. This is the perfect product for safe, easy newborn and infant babywearing, and a wonderful gift for a mom with a baby in the NICU. Available at Babies R Us and online at NüRoo Pocket.

The Gassy Baby: Such Digestive Drama

Baby Sleep, bottles, Breastfeeding, Feeding, Infant Health & Safety

“Why is my baby so GASSY?”
Is your young baby gassier than the average baby? Most newborns are both gassy, and dramatic about it, with lots of grunting, straining, arching, thrashing and tooting, and so it’s not surprising that most moms believe their new baby must be “gassier than normal”.

If your baby is gassy, it’s probably not from something in your diet, nor a sign he wasn’t burped enough after a feeding. Intestinal gas is a normal byproduct of food or milk digestion rather than from air swallowed while eating or crying. Most swallowed air will eventually come up as a burp (sometimes with milk attached) either with or without your help.

The Gastrocolic Reflex – or –  Why young babies are squirmy, grunty, gassy little people who are dramatic about their digestion

Most newborn gastrointestinal distress is caused by the sensations of motility, called the Gastrocolic Reflex, rather than gas. These peristaltic wave-like muscle contractions of the stomach and intestines propel stomach contents and stool through the small and large intestines. The gastrocolic reflex is triggered when your baby begins swallowing during a feeding and the stomach receives the milk. Inch by inch, the entire GI tract begins to wake up and contract, all the way from the stomach to the rectum. This is why babies may get squirmy or fussy 5 or 10 minutes into a feeding, and why feeding often prompts a bowel movement in a young baby.

Young babies are still getting used to the strange sensations (and products) of digestion, and aren’t shy about letting you know it. Once you see the “contents under pressure” explosion of poop some babies produce, it’s not surprising that they may react to the feeling of contents moving through their intestines at such high velocity with some distress.

Gentle Tummy Pressure can help: 

  1. Try laying your baby tummy-down across your lap, with her face turned to the side, so that her tummy is gently resting against your thigh. Pat or rub her back.
  2. Do you have a yoga/gym/physioball? Stabilize the ball and place a small receiving blanket over it, then carefully lay your baby tummy down over the ball on the blanket. Keep both hands on your baby, and rock your baby gently forward and back.
  3. The “colic hold” – drape your baby over your arm so that her face is supported by the inside of your bent elbow, and your hand is supporting her side and thigh between the legs. Her belly should be resting against your forearm. Gently press your arm, and baby, in towards your body, applying gentle tummy pressure, and either walk or sit on a physio ball and bounce.

Tummy massage for gas

  • Gently stroke your baby’s tummy from top to bottom using first one hand, then the other, like a waterwheel. Add your ‘whooshing” sounds.
  • Stroke from YOUR left to YOUR right – straight across, gentle but moderate pressure, just at or below the belly button.
  • Add the downward stroke, now moving across and down.
  • Flex baby at the hips and knees toward the tummy, gently press and hold in place, counting slowly to twenty. Repeat the entire sequence two or three times.

Many babies will pass gas during the exercise or have a BM a few minutes later – success and relief for everyone!