Книга - Help Your Baby to Sleep

Help Your Baby to Sleep
Penney Hames


Sleep is something all new parents want, both for themselves and their babies. This book offers background information and practical steps to help you establish a routine with your baby that will look after his or her needs – and yours, too.New parents are given all sorts of conflicting advice on how best to get their baby to sleep through the night. For example, should he/she sleep in your bed, in your room beside your bed or in another room altogether? Should you leave your baby when he/she wakes or cries?Penney Hames tackles every issue, including cot death, and talks about each technique. She examines the need for routine, a comfortable sleep environment and a baby’s sleep patterns at different ages and stages. She also explores research into how a child’s sleep pattern might reflect its character, well-being, health, and even intelligence, thereby debunking myths and extracting the truth. Two-colour with black and white pictures.The main message Penney Hames gives is that parents should make their own minds up and she offers advice on where to get help with addresses of sleep clinics and other support agencies.
















Help Your Baby to Sleep

Penney Hames










Copyright (#ulink_6a8572e0-bb2c-59d7-9b2a-2b5b52af5266)


Thorsons/National Childbirth Trust Publishing

Thorsons is an imprint of HarperCollinsPublishers Ltd. 1 London Bridge Street London SE1 9GF

www.harpercollins.co.uk (http://www.harpercollins.co.uk/)

First published in collaboration with National Childbirth Trust Publishing 1998

© NCT Publishing 1998, 2002

Original photography: Anne Green-Armytage, © 2002 NCT Publishing Additional photography: Michael Bassett here (#litres_trial_promo) and here (#litres_trial_promo).

Penney Hames asserts the moral right to be identified as the author of this work

A catalogue record of this book is available from the British Library

All rights reserved under International and Pan-American Copyright Conventions. By payment of the required fees, you have been granted the nonexclusive, nontransferable right to access and read the text of this ebook on-screen. No part of this text may be reproduced, transmitted, downloaded, decompiled, reverse engineered, or stored in or introduced into any information storage and retrieval system, in any form or by any means, whether electronic or mechanical, now known or hereinafter invented, without the express written permission of HarperCollins ebooks

HarperCollinsPublishers has made every reasonable effort to ensure that any picture content and written content in this ebook has been included or removed in accordance with the contractual and technological constraints in operation at the time of publication

Source ISBN: 9780722536087

Ebook Edition © AUGUST 2016 ISBN 9780007405008

Version: 2016-09-09




Dedication (#u72949ace-4374-573b-97d9-f1d17b3b37dc)


For Richard. Beany and Richard (Junior), with love




Contents


Cover (#u2525a2f3-7301-5eb5-8bf6-b2da666eb1d4)

Title Page (#uc33ae671-90b4-5e6b-bb1c-3adc1d0794c4)

Copyright (#u87dcbbb7-308c-544b-8edf-d0d9987f0fe4)

Dedication (#ubb52380d-65e5-5ec1-8874-dd2034de148e)

Introduction (#ubee39a3e-0070-5617-8fbb-6e30b01dff00)

1 What do we Know About Sleep? (#u8c8737ed-5471-5c16-8c74-772faf5f9a9c)

2 But What do You Want? (#u3b839961-dfe9-59c3-aadf-af43b86ca1bc)

3 What does your Baby need for a Good Night’s Sleep? (#ucfd14ea0-46c9-54cb-835f-e31cd0e3911b)

4 Where Should my Baby Sleep? (#u4b7b2457-7377-5862-994f-25d11af7cf48)

5 Feeding and Sleeping (#litres_trial_promo)

6 Who Wakes at Night? (#litres_trial_promo)

7 Crying and Sleeping (#litres_trial_promo)

8 Practical Tips (#litres_trial_promo)

9 Coping with Feelings, Gaining Support (#litres_trial_promo)

10 Alternative Help (#litres_trial_promo)

11 Behaviour Management (#litres_trial_promo)

12 Sleeping at the Wrong Time (#litres_trial_promo)

13 Beyond Babies (#litres_trial_promo)

14 Afterthought (#litres_trial_promo)

Resources (#litres_trial_promo)

Further Reading (#litres_trial_promo)

About the National Childbirth Trust (#litres_trial_promo)

Index (#litres_trial_promo)

Acknowledgements (#litres_trial_promo)

About the Author (#litres_trial_promo)

Other titles in this series (#litres_trial_promo)

About the Publisher (#litres_trial_promo)




Introduction (#ulink_57865709-adf7-5e28-b321-d2599d5d1722)


Sleepless babies are all too common. One small paragraph in New Generation, the Journal of the National Childbirth Trust, which asked for parents’ experiences for this book elicited dozens of replies. Then, talking to an astonishing array of professionals and researchers who have devised, through their widely differing disciplines, effective approaches or remedies for the sleeplessness of babies led me on to dozens more women. And women who had heard about the book on the grapevine of my local National Childbirth Trust branch, also called. Find me a parent and I’ll show you someone with an opinion about babies’ sleep.

The problem with any subject worth its salt is that right-minded, sensitive people can believe any number of threateningly different things. I believe that an author ought to listen to all these different opinions, try to see the value in each, and while rejecting none, chart a clear course for each reader, irrespective of how that reader prefers to travel.

So much for the theory. I’m sure that my own persuasions are written large in between the lines of this book. Nevertheless I hope that Help Your Baby to Sleep has accomplished three things: first, to acknowledge that no one approach is right for everybody; second, to accept that complex emotional ties may make the supposedly simple act of leaving your baby to sleep heart-wrenchingly difficult, and that is not simply something to overcome, but an awareness that may suggest a different approach; and third, to express the ambivalence and complexity of a vast range of attitudes, through the words of parents.

I hope you find in it something that speaks to you.



Penney Hames










1 What do we Know About Sleep? (#ulink_f4879754-3f57-55a2-8fa9-42ff26775a00)


Oh sleep! It is a gentle thing, beloved from pole to pole



Coleridge, ‘The Ancient Mariner’




Why does my Baby Sleep so Much?


Babies have a lot to learn, and quickly. But it’s hard to reflect on anything when there’s a lot going on. This is one of the reasons that babies sleep so much. Putting the world into some sort of order takes a bit of peace and quiet. While he is asleep your baby’s brain can organize the vast array of experiences he has when he’s awake. At the same time, chemicals in the brain and body are renewing themselves ready for more activity. As new parents we also have a lot to learn, and we also need our sleep to help us do it. Without sufficient sleep everyone suffers.




How Much Sleep does a Baby Need?


Most of us come to parenthood better prepared for the birth than for life with our baby. Charlie felt unsure and desperate for sleep when Elisa was tiny:

‘Elisa’s two weeks and three days and she doesn’t have a routine yet. Her best night was when she slept for three hours and then fed for one-and-a-half hours. I’d really like her to feed and then sleep for four hours.’

It can be a fraught time. You don’t know what to expect, everyone else seems to have it sussed, and you are just so tired … Sometimes it’s helpful if you know about the average baby so that you stop expecting your baby to sleep for longer or more regularly than most babies manage. When Charlie found out that Elisa’s little-and-often-never-at-the-same-time-twice approach to sleep was the standard new baby format, she began to relax.

Naturally, sleep researchers have discovered average sleep needs for babies of different ages (see below). But treat them with care. There are wide variations between one baby’s need for sleep and another’s. lust because your baby doesn’t sleep as much as the average doesn’t mean that there is something wrong. After all, any average figure means that half will be below and half above. And don’t worry that your baby’s erratic sleep is harming him. In his first few months a healthy baby will take as much sleep as he needs; he won’t be able to help himself.

Some new-born babies sleep 21 out of 24 hours. Others, with less feeling for their parents, need as little as eight hours; the average at birth is about 16 (about two-thirds of the 24-hour day), and gradually falls to about 14 hours by one year.




Average Number of Hours of Sleep Needed





It doesn’t matter whether your child is hitting these averages – some children sleep for longer and some for less. The acid test is whether your baby wakes happy and alert. If he does, you know he’s had enough sleep; if he seems irritable or tired, he may need to sleep longer.

‘Our oldest son, Robert, has the sleep requirements of Mrs Thatcher. If you hand our youngest, Jonathan, a nappy at 6.30–7pm he will take himself to bed.’’

Cathy and Adam

‘Jessica only needs ten hours’ sleep a day. I remember asking at her six-week check-up whether ten hours sleep a day was enough. If she has a two-hour nap she goes to bed with me for eight hours. If she goes to bed at 7pm she will wake up at 3am and be ready to start the day, so it is easier if she keeps the same hours as me.’

Yvonne




A Sense of Rhythm


Most adults and older children have a diurnal pattern of sleeping and waking – we sleep at night and wake in the day. Your new-born baby has no such pattern. He is missing two things: the physiological maturity to be able to do it and your guidance. Once he has developed the first, he can make use of the second.

By the end of the first month most babies start to fit in with the adult pattern. But a thorough going awake-most-of-the-day-sleep-all-night rhythm doesn’t usually appear until three or four months when your baby’s physiology is mature enough.






Breathing in Sleep


Babies often pause in their breathing for anything up to a few seconds at a time while they sleep. This is quite normal and your baby will spontaneously begin to breathe again. Often your baby of less than four months will wake as his breathing pauses, and this kick-starts his breathing into action again. As he matures, your baby begins to breathe more regularly, without pausing, and at the same time he wakes less frequently.

Babies are very adaptable, and amazingly competent, but at birth they still need a lot of physical, close and loving support from their parents to help them adjust to an independent life. Researchers have found that touching, stroking and holding your baby has a marvellous effect on his ability to regulate his breathing and his temperature – and that this is as true at night as it is in the day. (See Chapter 4 for a fuller discussion of this point.)




When will He Sleep Through the Night?


Maybe not ever. But waking at night and waking you at night are different things. Your baby probably wakes more often than you think. Most people, children and adults alike, come to consciousness several times a night, but some are able to soothe themselves back to sleep while others lie awake tossing and turning, missing that certain something that will allow them to drift off again. Babies in this second group soon realize how to get hold of that certain something. They cry and in comes mum or dad. It’s not waking up that’s the problem, it’s not being able to go back to sleep again.

In the beginning almost every baby wakes and cries about five times a night, and almost every parent expects that they will. But by the time they reach nine months the average baby wakes only once or twice a night (Anders, 1978), and he may no longer call out.




How Common are Sleep Problems?


Very common. Somewhere between a fifth and a third of all families say they have a sleeping problem during the pre-school years (Messer and Richards, 1993). Of course it’s not always the same children waking all the time. For example, only 5% of children have a sleeping problem which lasts from their first to their second birthday.

‘At 14 months Erica just suddenly got it and slept … well, like a baby at last. I don’t know what we did but I’m definitely going to do the same thing with the next one.’

Karen

The fact is that some sleep problems last for months, some for years and some come and go but, roughly speaking, sleeping problems fade away as your child gets older.

‘With your first baby you go in with the expectation that the baby will sleep for four hours at a time, and you believe that you can be your own person in that time. When your baby isn’t that sleepy you think it’s you, or that your baby is weird, or that there’s something wrong. At toddler group last week we looked around and everyone looked tired and we said how many of you have been up all night? I think it was about 80% of the mothers who put their hands up. You could see the other mothers, the other 20%, looking round and thinking: “What’s wrong with my baby, why does he sleep?’

Teresa, mother of three, who tried ‘everything’ with her first

Although many children with sleep problems improve without specific treatment, many improve a lot more quickly with a little help.

‘Some babies just do it, and I kept thinking: “He’ll just do it.” People kept saying “He’ll do it when …” and I kept living for those milestones.’

Karen, mother of David




Deep and Light Sleep

REM Sleep


• body twitches

• eyes flicker

• smiles and frowns

• 50% of all sleep at birth

• 20% of all sleep for adults

• older children and adults may dream

• occurs mostly in the later part of the night for adults

• learning is organized and stored

• irregular heartbeat and breathing in tiny babies

• inability to regulate temperature in tiny babies

• adults woken from this sleep may be disorientated




NREM Sleep


• more peaceful sleep

• 50% of all sleep at birth

• 80% of all sleep for adults

• no dreaming

• slow and regular heartbeat and breathing

• harder to wake from

• occurs mostly in the early part of the night for adults

• the immune system is boosted

• physical growth occurs

If you watch your child sleeping, you may notice that there are times when, eyes closed, he seems to be watching some particularly frenetic cartoon. Beneath his eyelids his eyes may flick from side to side and he may frown or smile and wiggle his fingers and toes. If your baby could watch you he’d see the same thing happening from time to time, though not so often. This is REM sleep, which stands for Rapid Eye Movement. This sleep state is also called active sleep. Adults and older children dream during REM sleep but it’s difficult getting a straight answer out of a baby, so there is no way of knowing whether babies do or not.

New-born babies spend about half their sleep time in REM sleep, and babies born before 30 weeks’ gestation initially spend a massive 90% of their sleep time in REM sleep; whereas for you and I, REM sleep only accounts for 20% of our sleep. The point about this is that most of the arousals your baby makes from sleep are from REM sleep. Which explains why premature babies wake more often than term babies and all babies wake more often than adults. However, don’t lose heart if your baby was born prematurely because premature babies are often better than term babies at soothing themselves back to sleep.

As they get older, babies have less REM sleep and therefore wake less often.

When he’s not in REM sleep your baby will, perhaps obviously, be in non-REM sleep or NREM sleep. This sleep state is also called deep sleep or quiet sleep. NREM sleep can be divided into four stages. Stages 1 and 2 are lighter, and stages 3 and 4 deeper and harder to wake from. You are more likely to wake up during stage 2 sleep than in any other part of NREM sleep. In NREM sleep things are more peaceful – no eye movements, with slower, more regular heartbeat and breathing. There is a theory that NREM sleep is the time when bodily processes are restored, when the immune system gets boosted and physical growth can occur.




Sleep Gates/Windows


• Just as active (REM) sleep is followed by quiet (NREM) sleep, so we have active and drowsy periods during the day as well.

• Look out for signs that your baby is tired and put him down to sleep then – it will be easier for him to fall asleep at this time.

• Start to get him ready for sleep when he is still in an active phase so that he can enjoy his bath and be dried and dressed just in time to feel drowsy.

• If you miss one drowsy period you may have to wait an hour or so for another, as the whole cycle takes about this long to complete.




Cycling Through Sleep


NREM and REM sleep alternate through the night in both adults and babies. Babies cycle between the different types of sleep faster than adults. At birth it takes your baby about 50–60 minutes to complete a cycle, whereas it takes you about 90–100 minutes. The reason that this matters is that as you come out of REM sleep, ready to drop back down into NREM sleep, you arouse briefly. Your baby does the same. These brief arousals may or may not become complete awakenings depending on what you or your baby make of being awake alone.

Naturally, as your baby moves through the REM/NREM sleep cycle once every 50–60 minutes there’s a chance that he could wake you every 50–60 minutes. What’s more, these arousals happen with greater frequency towards dawn (Carskadon and Dement, 1989), just when you are having most of your REM sleep, the sort that helps you cope mentally with the day.




REM Sleep


• Pessimistic?

• Lacking in energy?

• Upset over trivialities?

• Can’t see the wood for the trees?

Maybe you’re not getting enough REM sleep. When you have a baby you may need more REM sleep than usual to help your brain ‘organize’ your thoughts and feelings, and file away yesterday’s business.

People who are deprived of REM sleep for a long time become depressed and disorganized. They are unable to focus on what is important because they haven’t been able to deal with the debris of the previous day before they start the next. Try to arrange things so that you can get a block of REM sleep at least every other night – you’ll feel more energetic, optimistic and self-confident the next day. Try the following:

• Go to bed earlier than usual, so that you get to your REM sleep before your baby gets to you.

• Ask your partner to be responsible for the early morning shift from 4am onwards – at least once in a while.

• If you’re breastfeeding ask your partner to listen out for the baby and to bring him to you in the early hours.

Researchers have found that when adults are woken while in light sleep it makes little or no difference to their day; when woken from deep sleep they tend to be a little tired; but when woken from dream sleep they find it extremely difficult to cope with their tasks the next day (Ferber, 1985, and Rotenberg, 1992).

Babies cope with frequent night-time wakings better than their parents because they set the pace.










2 But What do You Want? (#ulink_ce3dfb45-8382-5ade-bfd3-0e5035d6c5d8)


‘If you have a baby who sleeps, you are considered lucky, but if you have a baby who doesn’t, you are considered to be doing something wrong.’



Harriet and Will, parents of Emily, ten-and-a-half months

‘You can think that you’ve cracked it and that you know yourself and then you find that you haven’t and you don’t.’

Buff, mother of four, who has an ‘appalling’ sleeper after two ‘good’ ones

It doesn’t matter which of the suggestions you take away from this book. The important element in whatever you choose is that you have chosen it and made it fit with your way of parenting. Solutions need to fit relationships. There are no universal panaceas.

What matters to your baby is that you have confidence in yourself and in him. But in the beginning, and especially with the first baby, many parents find it hard to decide how they want things to be, and what will work for their baby. Sometimes it can be hard just finding out who you are, now that you’re a parent. Be patient with yourself – it will come. Confidence emerges when you know your baby and yourself well and are able to be loving and predictable. Most new parents find that when they relax and just do what comes naturally they become predictable. Loving, predictable and relaxed – it’s a confident combination.




That Certain Something


Some people know how they want to handle their baby’s sleep from the beginning. Melissa, mother of Jessie, read a book and was convinced:

‘About three weeks before Jessie was born I read a book called The Continuum Concept which convinced me that the best way to sleep was together. It’s been no problem at all since she was born. Sometimes Jessie’s a bit restless and John has to lie on his front to protect his sensitive parts, but putting her in another room just seemed such hard work. After a couple of weeks she never really woke at night, she just goes around looking for milk. She sleeps through to eight or nine and sleeps really deeply. We have a 5ft 3in bed which is a great family bed. We built a big sleeping platform with rails at one side and the wall at the other. Possibly we are more relaxed because we don’t have to think “Shall we let her cry?” I think our relationship (John’s and mine) was improved because we both slept well.’

Jane, mother of Thomas, Esther and Isaac knows what works for her:

‘It was important for us to have an evening so we wanted the baby upstairs on his own, in his own space. Simon felt very stressed having the baby around him and I was very worried that I’d spoil the baby by not having a routine. I was happy for a little baby to lead me, but there came a time when I needed some time and I needed to instil some routine. So, from ten weeks once he had his bath in the evening, he didn’t come downstairs. It was bath, feed, bed. It felt like we were back to normal.’

Others know that they want to make a decision with their baby:

‘My itinerary is totally unaffected by Alistair’s need to sleep. He sleeps anywhere and everywhere as soon as he’s tired, and at night he sleeps with me in my bed. Even strongly disapproving grandparents have to admit that he is a charming, pleasant, well mannered and very independent little boy. Child-led parenting isn’t a panacea, but it works well for a significant number of families. Too often “experts” seem to be trying to persuade us that our babies are tyrants needing strict regimes and hard-hearted discipline.’

Monica

What all these families have in common is a sense of certainty. The parents believe in what they are doing, and in their baby’s ability to fit in with it. It seems that babies who feel a sense of their parents’ certainty sleep well.

Every time a new baby is born he brings with him an infinite range of possible relationships. For both of you it is a time of enormous change, and some of the changes may seem awkward and not ‘you’. But by listening to your baby as well as to your inner voice, it is possible to smooth out most conflicts and to become confident of your ability to deal with any problems.




Listening to Your Baby


Take some time to get to know your baby and yourself. Do whatever feels right – gaze into your baby’s eyes, massage his tiny body (more about this in Chapter 8), sing songs, tickle, talk about life, the washing up and the cat, but especially listen and respond to what your baby has to say. Once you and your baby know each other well he can feel how much you love him, and he will be quicker to respond to you. And you can relax, because you know that, whatever happens, he can cope and that you will be there to support him while he does.

‘I really don’t think I was in tune with Laura as a baby. I don’t remember knowing when she wanted feeding, when she wanted sleep. I think I relied on mum more for interpreting her cries. It got worse as I got more fatigued. I had a honeymoon period between three and five months, but then I got postnatal depression.’

Sally, mother of Laura and Annie




Listening to Yourself


If you feel ambivalent about your baby’s sleeping patterns it may be because you haven’t acknowledged what your own needs are.

‘It would be funny if I wasn’t so tired. The other day I was watching him through closed eyes so he couldn’t see that I was awake. He was sitting in bed in between us and just playing and then he looked around and realized that we were both asleep, or so he thought, and he reached over and hit Mike on the back. Mike turned over and mumbled something to him and then fell back asleep. So, Jonathan turned towards me and whacked me until I “woke up”. I thought “Who’s running the show here?” I don’t know. I’d like to have our bed back but Jonathan really seems to need to be with us.’



Sarah, mother of Jonathan, aged seven months

Sometimes practical problems cloud the issue further:

‘I tried to put her in her cot but she didn’t sleep for long. I just didn’t leave her for long. I couldn’t get a routine because I had the other children, and sometimes I was doing different things. She ended up being in our bed and I think I wanted her there. I kept giving her targets. I said: “By the time I get to six weeks she’ll be on her own.” So I felt under pressure a lot of the time. I felt I was letting Pete down. He’s not pushy at all, but every so often he jokes about it.’

Kim, mother of Camlo, five, Evie, two, and Eden, nine months

And sometimes the way we live our lives stops us doing what we want even when we are sure what is for the best.

‘When Bernard was seven weeks old my step-daughter came to live with us. As we only have two bedrooms and our lodger had the second, my step-daughter slept in the sitting-room. This meant I couldn’t bring Bernard downstairs if he woke up. So, because my partner works long hours I would put him to me immediately so he didn’t disturb my partner’s rest. Now our lodger has moved out, my step-daughter is in the second bedroom and I can again use the sitting room at night.’

Clare




You and Your Baby’s Needs


Part of the job of becoming a family is to discover what you all need. Some parents meet their own needs vicariously by letting their baby’s needs come first. This is how Pauline and leremy, parents of Hannah, Joshua and Martha, like things,

‘Martha has three or four stories and then one of us sits beside her bed until she is asleep, or outside her room, depending on her wishes.’

And Caroline, mother of four, says:

‘I didn’t have my children to ignore them. The health visitor just didn’t understand that. She kept saying “What about you, what about you?” Well, I’m sorry, but my children come first.’

Other mothers recognize that they need to meet their own needs first. Ruth, mother of less, four, and Alice, two, knew she needed her sleep:

‘I knew I had to work so they had to sleep. My going to work is not negotiable and I cannot function if I haven’t slept. Both of my children have slept through the night from four to six weeks. From very early on I’ve put them down awake – from five, six, seven weeks. You could always rely on feeding them to sleep, but I decided I wasn’t going to do that any more. I take them upstairs and I’m down in 15 seconds. A kiss and in the cot. I don’t believe that any child needs to be fed and comforted every hour-and-a-half, and I’d be very unaccepting of a child like that. I believe there’s a range of needs, but I don’t believe that a baby has needs in the middle of the night. I think the lack of ambiguity is crucial – if they feel that they can stay awake then they will.’

If you know you can’t manage on five hours interrupted sleep a night, and want to do something about it, you shouldn’t feel guilty. On the other hand, if your own needs are met by being available for your baby through the night then there is no reason that you should feel that those who choose a different method are doing a better job.

Certainly your baby needs to feel secure before he can sleep. But his security comes in part from your loving, relaxed predictability – not just from your presence. You don’t have to be there when he goes to sleep and you don’t have to leave him either.

What is essential is that you communicate your needs clearly, negotiate ground rules and stick to them. Don’t try to be nice or to please. If you have to grin and bear it, something’s wrong.




Discovering Boundaries


In the early days many mothers find that they love the enveloping closeness of their relationship with their baby.

‘When I fed Rachel and she sucked and slept a little and then sucked some more I didn’t ever want it to end I just felt so complete – like we were still a part of each other and that Rob was some protective giant.’

Kate

For others, unclear boundaries are more difficult.

‘The first months with Bryana were shattering and confusing. I’d waited so long to have her, but somehow it didn’t feel right. I couldn’t connect with what I felt I should be feeling as a mother. All the time I was sitting and “calmly” feeding in my mind I was frantically thinking how to be off doing something else.’

Rose

After the first few weeks or months many mothers feel ready to put a little more space between themselves and their baby and many fathers are equally ready to develop an increasing sense of their place in the relationship. Many babies move from sleeping in their parents’ room to sleeping alone at this time. Yet sometimes, and especially when you haven’t found becoming a parent a smooth ride, it’s hard to find comfortable new boundaries between you, your partner and your baby. Sometimes it can feel almost impossible either to put your baby in his cot and leave him to sleep or to have him in your bed without feeling guilty.

Saying goodnight to your baby can stir up ambivalent and powerful feelings, which may be difficult to face.




Sleep Problems May Occur When…


• You feel anxious

• You feel isolated

• You have postnatal depression

• You hadn’t planned this baby

• You don’t love this baby

• You feel as though you are abandoning your baby

• You haven’t been able to grieve for a loss, maybe even a loss that is unconnected to the baby

• Your baby seems to need you to be there

• You have marital problems, or there is a lot of tension in your home

• Something from your childhood still bothers you

• You have been sexually abused

• You work outside the house during the day and feel that your baby is missing some important closeness which makes night-time separations harder to bear

• You feel that you ought to pick up your baby every time he cries, though sometimes you don’t feel like it

• Every time you leave him he cries, and you can’t bear to hear him cry

Most sleeping problems do not hide deeper problems, but where they do, a little bit of soul-searching and a lot of honest and open discussion may help. Talk to someone you trust. And be kind to yourself; ambiguity and confusion are often part of the journey to the most rewarding of relationships.

Some parents find that talking with a child psychotherapist helps. Child psychotherapists understand that relationships can affect sleep and that sleep disturbances can sometimes arise from unreconciled losses in the parents’ lives. Sleep is a form of separation – a temporary loss – and can be a powerful reminder of other losses or separations which still affect us. Such reminders can hamper your ability to let your baby go. (If you would like to find out more about brief psychotherapeutic therapy for sleep problems see the resources section on page 149 (#litres_trial_promo).) You neither need to hang on to your baby nor push him away. Sleep becomes an example of how you can love him and let him go.




Loving and Letting Go


If you would like your baby to go to sleep alone but find it hard to get out of his room, you may find that listening and talking to yourself and your baby in a certain way helps.




Why Should I Talk Out Loud to my Baby?


• Because sometimes you and your baby both need to hear how you’re both feeling

• It helps you clarify what you want to say

• Things said out loud seem more real

• It can stop the same old thoughts going round and round in your head

On putting him down to sleep, try tuning in to how you are feeling and acknowledge that out loud. It’ll sound funny the first time you do it but if you talk directly to your baby it may seem less crazy. If you want to laugh – go right ahead, it could be part of the medicine.




Describe How it Feels


To begin, think about how you feel as you are ready for him to sleep. You may feel confused, scared, angry, exhausted, or a hundred other emotions. Put a name to it. Tell your baby. Start your sentence with ‘I feel…’ rather than ‘I feel like…‘. So, ‘I feel … tired and scared’ rather than ‘I feel like … I could sleep standing up and I feel like … a failure.’ Some people find that when they finally say how they are feeling, they start to cry. It’s OK. Let it happen. Who’s to know? If you start to cry, your baby may join in too. Give him a hug.

Once you’ve identified your own emotions it may become easier to listen to your baby’s protest. Is it sad, angry, tired? Whatever it is acknowledge that that is how he feels and that you understand that this is a big, important feeling for him. You could say something like: ‘You sound sad/cross/confused. It can be really hard to cope with big feelings like that.’ You may feel strong and capable when you can hear your baby’s sadness in this way. And he will be able to hear two important messages from the way that you say it: that it’s OK for him to feel like this and that you will support him while he copes.




Explain the Deal


Next, try saying that it’s time for sleep and that you have confidence in his ability to go it alone. True, you may not feel particularly confident that he can do it when you start, but just as you encourage him to feel he can do things during the day, so do the same here. In the day time you encourage him because you know he will do it in the end and you want him to feel good about himself. Going to sleep is also something he will do in the end and feel good about.

Finally, tell him when you’re coming back. Be specific. He may not understand the difference between ‘I’ll be back in a bit’ and ‘I’ll be back in two minutes’ but you do and it will make you feel more in control when you say out loud exactly what you’re going to do. Your baby will pick up a lot of clues from the way that you talk. But if you don’t like the clock-watching approach, a good alternative is to say: ‘I’ll be here when you need me.’ This is specific, because his ‘needs’ define when you come and go, and you’ve already shown that you are tuned into his ‘needs’ by listening to his cry. You are making a commitment to go on listening to him. Now start the behavioural routine you’ve chosen (see Chapter 11 for a range of options), coming and going as appropriate.

In this way you won’t be abandoning him, but loving and letting go: a subtle but powerful difference, which will allow you and your baby to move on in your relationship. You will have really listened to yourself and your baby, acknowledged what you are both feeling and been clear about what has to happen now. It won’t stop the crying immediately, but it may make you more able to deal with the tears. For more on listening to your baby cry, see Chapter 7.




What can I say to my Baby when he goes to Sleep?


• Tell him how you feel. For example: ‘I feel tired/sad/angry.’

• Listen to his cry. Describe it to him. For example: ‘You sound tired/sad/angry.’

• Let him know you care for him. For example: ‘That sounds like it’s a real problem for you.’

• Let him know what you want him to do. For example: ‘I want you to sleep now.’

• Let him feel your confidence in him. For example: ‘This is tough but I know you can do it.’

• Tell him when you’re coming back. For example: ‘I’ll be back in one minute/in the morning/when you need me.’

Choose your own words if these do not feel right to you. Of course, talking to a baby like this may feel ridiculous. This technique isn’t for everyone. You decide whether it’s for you.





3 What does your Baby need for a Good Night’s Sleep? (#ulink_3bf351b1-0276-5fcc-88c4-5ac2c59e2b1b)


‘Esme was born when our boy was five years old. Things had changed since he was born. We were much more relaxed as parents, and confident. We were also more aware of our responsibility and ability to encourage patterns of behaviour in our children.’

Brenda and Dave, parents of Mark and Esme

It’s a complex business. Your new born baby will need to be safe (see page 33 (#u48a0537c-49c1-48cc-b9cb-341e167e4b50) on safe sleeping), sleepy and comfortable – fed, clean and dry, warm and free of pain. But from about three months many babies are a little bit more astute and are ready to respond to a more definite timetable. There’s a lot you can do to help your baby learn.

Babies like to understand, but they are not clever enough to grasp a lot of complications – they like things clear and they like repetition. So, to get your baby to understand the idea of going to sleep, you’ll need to have a few clear steps and to go about it in the same way every time (see pages 28–32 (#uef6c7e27-57ae-4bf7-8b70-7a5cf9b3627b) for some tips about the end of the day, bedtime routines and sleep associations).




Organizing the Day


Strange as it may seem, having a regular breakfast time has a lot to do with getting a good night’s sleep. Babies don’t fit naturally into the daily pattern of sleeping and waking that we adults take for granted, so if you have a laissez-faire attitude to the day, with moveable feasts and naps when needed, your child might develop the same attitude to bedtimes and night wakings.

‘I really don’t know why Sophie slept through the night from very early – luck maybe! However, I do feel a bedtime routine is essential and even some kind of routine during the day.’

Diane, mother of Sophie, aged 15 months

Many parents find that thinking about the patterns they create during the day as well as at night helps their baby to develop a more regular routine. You may find that a structured day with meals and naps at fairly regular times, give or take ten minutes, gives your child a better chance of a regular bedtime with continuous sleep. If your baby is bathed, fed and sleepy by 6pm, it’s best not to keep him awake waiting for daddy to come home for a cuddle, especially if that could be any time up to 9pm. This doesn’t mean being ruled by the clock. Some days are bound not to fit your pattern. But knowing what your goal is, allows you to respond to your child’s needs while recognizing that flexible routines can provide a reassuring anchor.

‘My first child was a nightmare for nine months, and needed hospitalisation to check there was no underlying problem, he was that bad. I was a single parent at the time and I feel that that contributed to the problem. However, I really believe that developing a good daytime nap routine was the most important thing I did. Within one week of establishing two daytime naps Sam went from screaming every two hours to sleeping through the night. I also used this for number two – it works!’

Fiona

However, some parents feel that routines can get in the way of meeting their own and their children’s needs, and stop them responding to their child as an individual. Many of these parents prefer their children to eat and sleep wherever and whenever they like.

‘By the time he was five months old Thomas occasionally slept through the night. But reading The Continuum Concept made me realize I did feel odd about the hours of separation from him. I decided to continue to sit up and feed him and gently put him in his cot in the evening. When he woke in the night I’d follow how I felt or how he seemed to feel and either take him in with me or to the guest-room double bed for a feed and sleep or just sit up to feed him to sleep again and pop him back in the cot. The sleeping through stopped immediately. But I feel it worked because I gave myself to him 101 % instead of getting annoyed. When he’d perk up after an hour’s feed from 8pm to 9pm and I’d felt he was just dropping off, I’d laugh and say, “Well we’d better go downstairs and see what daddy’s doing.” The key was to be really and truly willing to share his joy of life.’

Sarah




The Choice is Yours


Psychologists have discovered that when adults live in a laboratory for a few days without a watch or clock or any other way of discovering the time, they tend to sleep longer and stay awake longer so that they quickly become out of sync with the outside world. In fact, adults’ biological clocks are set to run on a 25-hour clock and not the 24 into which we squeeze ourselves. This is why we find it easier to stay up late at night than to go to bed earlier than usual.

Your baby’s internal clock is set to the same rhythm. If you let him he could gradually work his way round to an increasingly late bedtime and late morning wakening.




Bedtime Routines


If you want your baby to go to sleep at a regular time, the best way to complete a well-organized day is with a bedtime routine. When you look into your baby’s eyes around the time of the six-week check-up there finally seems to be someone home – or almost. So this is a good time to introduce a bedtime routine if you haven’t already done so. In fact, many babies begin to sleep a lot better from this point without much prompting and many have developed a definite pattern of their own making by the time they are three or four months old.

A bedtime routine will probably include some or all of the following: bath, feed, story or quiet play, cuddle and a kiss. And it will end with your baby in his place for sleep on his own or with you. A bedtime routine can be as long or as short as you like. Many people find saying goodbye difficult. A bedtime routine can be a good way of preparing you and your baby for the separation of sleep.

‘It took me a couple of weeks to get myself organized and then we decided to organize Thomas. Lots of people had given us advice. So we decided to have a set bedtime to have the evening to ourselves. We started with a bath, and then into the bedroom with a very dim light so that we could just see, for his last feed. He slept through the night at six weeks.’



Sue, mother of Thomas, aged two

The main points to consider when developing a routine are:

• Is it peaceful? Waiting for a partner to come home from work for half an hour of rough-and-tumble play can be counterproductive. Save it for the weekend.

• Do all the elements always come in the same order? Babies feel more relaxed when they can predict what’s coming next.

• Is it practical? Sometimes a family will develop a routine that is useful at times and difficult at others – such as letting the baby fall asleep in front of the television or while driving round in the car. It is worth persevering with a more practical alternative if you can find one.

• Is it possible to do all these things within the time you’ve set? Starting a lengthy routine at 6.30pm for a bedtime of 7pm is doomed to failure. Experts now recommend a daily 20-minute dose of book sharing even with the youngest of babies, so it may be worth winding things down a little earlier than you had planned.

• Is anything else going to interfere with the routine? This should be a relaxing and close time for both of you. So, record that soap opera for later and ask your mum to call after your baby is asleep. You and your baby both need to give and receive full attention, so that you can both feel secure enough to say goodnight.

• Is there an end to the routine? Cycling through the last couple of elements again and again can be exhausting and frustrating for you and suggests that your baby has not made the association between the end of the routine and sleep. Many parents find that whenever they put their child down to sleep he cries out, so they sing another song, or give another cuddle or drink only to find that the baby cries again when he is put down. A good routine ends with the baby falling asleep without you performing any encores.

Sally, mother of Emily, four, and lack, 18 months, remembers that Jack used to be afraid when the lights were suddenly turned off. Now she ends their routine by getting lack to ‘blow’ the light out himself with a little help from his bedtime friends, Piglet and Pooh.

Inevitably, there will be times when your routine has to go by the board – holidays, illness, visitors staying overnight. But the sooner you can reinstate the familiar routine, the more easily you will both rediscover your pattern of sleep. Alternatively, some parents find that where sleeping problems have already developed, a break in the usual routine can mean a chance to create a new pattern.

Kathy, mother of Lily, six, Robert, four, and Alice, two, delayed going away because Alice woke nightly and would only accept her:

‘A friend was getting married 200 miles away and we’d said we would go but I really didn’t want to because I was concerned about Alice not settling with my mother-in-law. I went looking for sympathy from my neighbour, but I got none. She just said that I should remember that life isn’t just about children but about husbands as well. So I was really upset, but I went. When I rang up the next morning my mother-in-law told me that Alice hadn’t woken in the night as usual. She’d slept better than usual so I needn’t have worried.’




Sleep Associations


As the name suggests, ‘sleep associations’ are the things your baby associates with going to sleep. The fact is that, whatever your baby is used to when he falls asleep in the evening, he may need again to get himself back to sleep if he wakes in the night.

Babies are incredibly adaptable – if you always sheared sheep in your baby’s bedroom whenever you wanted him to sleep, he would still sleep – he would just learn to associate sleep with the sound of bleating and sheep clippers. And you’d have to be ready to fleece another from your flock each time he woke at night. Most parents find that a teddy and a goodnight kiss work just as well.

After the first few months of life, a baby who routinely falls asleep on his own in a room that is fairly dark and quiet will recognize the same conditions when he wakes for the average five times a night – and so be able to return himself to sleep without needing you. Some parents start a routine earlier than others:

‘James and Richard have both slept well from the beginning. I put it down to some advice I had at the start. The first night home with James I didn’t get a bit of sleep, and then there was a knock at the door and it was the midwife. “Stick him on,” she said. “Hmm, he’s just using you as a dummy. Put him down. Go and play some music that you like.” We were a bit hesitant but did as we were told. It was the best advice I’ve ever had. He cried for ten minutes and then went to sleep. The midwife said, “When he’s fed and you know he’s satisfied, put him down.” He slept through the night by the time he was six weeks old. It was the same with Richard.’

Frances and Stuart

On the other hand, a baby who routinely falls asleep in your arms or at your breast will need to find a nipple and someone to hold him at night to do the same. Many parents who prefer this way of saying goodnight to their baby are also happy to share their beds with them, so that they can easily recreate the evening’s sleeping conditions:

‘In the evening I undress Sophie, sometimes she has a shower or a bath and then we lie down in bed, read a story and then she holds my breast and falls asleep. I’ve had her in bed with me since birth. I did the same with Sam and Rosie when they were smaller too.’

Clare, mother of Sam, eight, Rosie, five, and Sophie, two-and-a-half

But if you like your bed to yourself, it’s counterproductive to lull your baby to sleep in the evening with a feed or a cuddle – because you’ll probably spend a lot of the night in his bedroom doing the same thing again. If you want to spend your nights in your own bed with only adult company, sooner or later you’ll have to get your baby to go into his cot awake and alone in the evening.

Sleep associations can take a while to learn. Especially in the early days, it may be difficult to identify a strategy that works. Sometimes, putting him in his cot and leaving him to it makes him nod off and at other times he can remain determinedly awake through all 25 verses of ‘Oh my darling, Clementine’. Still, it is worth persisting with a structured bedtime formula that you like because eventually your baby will find the predictability of the formula reassuring and relaxing.




Safe Sleeping


The possibility of cot death worries many of us. But there are things that research has shown help to prevent it. Making sure we follow the recommended advice may help to put our minds at rest.

Many parents buy a baby monitor so that they can hear when their baby cries. These are a good idea, especially when your baby sleeps out of ear-shot. But there’s another sort of device called a ‘breathing monitor’ which is designed to sound only when your baby stops breathing. The Foundation for the Study of Infant Deaths recommends that you only buy one of these breathing monitors if your baby has problems breathing. Talk to your doctor or health visitor before buying this type of monitor. In tests, parents found that breathing monitors tended to sound when there was no problem with the baby – making them more anxious rather than less. Parents also tend to check their baby less often when there is an alarm in the room, which means that they may not pick up the other predictor of cot death – that their baby is too hot.

Babies of less than four months old are less able to adapt to swings in temperature than the rest of us and need help to keep a steady temperature. Overheating can lead to cot death. So don’t use any bedclothes that make it difficult to regulate your baby’s body heat. Duvets and lambswool fleeces are out, but sheets and blankets are in. Babies regulate their temperature by losing heat from their heads so don’t dress him in a hat to sleep. Your baby can also wriggle his head under a cot bumper, soft toy or pillow, so it’s best not to put any of these into the cot until he is one year old.

‘We worried about having the duvet on our bed and that she would overheat but we’d move the pillow out of the bed and there would be an air space between us.’

Sally, mother of Laura and Annie

Other co-sleeping parents regulate their babies’ temperature by swopping their duvets for sheets and blankets and dressing their baby in fewer clothes.



The Foundation for the Study of Infant Deaths recommends:

• Laying your baby on his back to sleep (he is not more likely to choke).

• Don’t allow anyone to smoke near your baby or in the house.

• Keep your baby’s room at about 18°C/64°F.

• Cover him with a sheet and cellular blankets, rather than a duvet. (A folded blanket counts as two.)

• Don’t assume that, because it’s cold outside, your baby will be cold; judge it by feeling him.

• Check your baby by putting your hand inside his babygro and feeling his stomach. If he’s warm, that’s fine. Too cold and add another blanket, too hot and you need to remove one. (Don’t worry if his hands and feet are cold – this is normal.)

• Lie your baby with his feet at the end of the cot so he can’t wriggle down under the covers.

• If your baby seems unwell, seek medical advice early and quickly.

• Have your baby in a cot beside your own bed for the first six months.

If you are a smoker, have taken drugs or are drunk, you should not sleep with your baby in your bed because this increases the risk of cot death.

Cot death is rare, so don’t let it spoil those special first few months with your baby.





4 Where Should my Baby Sleep? (#ulink_70dad97a-977d-5709-9da3-baf5d88958b7)


‘I think that children are supposed to sleep with their parents. Many of the sleep problems are to do with sleeping alone.’

Margaret and Phil, parents of James, aged 20 months

‘Thomas went into his own bedroom pretty early on. I think he lasted about two days in our bedroom – we couldn’t sleep. The health visitor had said something ridiculous like six months, but we couldn’t keep to that.’

Sue and Michael, parents of Thomas, two

For 95% of evolution, babies have slept with their mothers. Independent sleep is a relatively recent idea. So which is best – co-sleeping or independent sleep? As yet there’s no clear answer but there is mounting evidence that our bodies are designed for close proximity or contact with our babies throughout the day and night until at least six months. It may be that solitary sleeping in the first few months of life makes too many demands on your baby’s body, and that sleeping and waking within sight and sound of you helps him to adapt to life more smoothly.




Bed-sharing Benefits


The process works like this: it’s not unusual for babies, and especially premature babies, to have breathing pauses, which last anything up to 20 seconds. It’s quite normal. The breathing system is not fully mature at birth. If they happen in sleep, these breathing pauses lead the baby to wake and start to breathe again. Researchers have now discovered that babies who sleep close to mum and dad tune into their parents’ breathing following a breathing pause and join in again at the same pace (McKenna et al., 1994). There is also a suggestion that mothers who sleep with their babies tend to sleep up close, facing their baby most of the time and that this closeness stimulates their baby’s breathing in another way – through the increased level of carbon dioxide they emit (Mosko et al





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