What is sleeping through the night?

Following on from last week's blog post we have been talking about babies "sleeping through the night," sometimes seen as the holy grail of early parenting! The question is, what does sleeping through the night actually mean?

Some doctors and experts consider sleeping through to be an unbroken stretch of sleep from midnight to 5am, only five hours. Most new parents are glad of that much sleep but wouldn't call it sleeping through!

Some sleep experts and books call sleeping through, either generally or in babies under a certain age, unbroken sleep from a late evening "dream feed" until morning. Usually eight or nine hours, which gives a tired mama the chance of a reasonable night's sleep.

Other people don't think a baby (or toddler) is really sleeping through until they can go from their bedtime all the way to morning without waking - eleven or twelve hours. That's long enough for mum and dad to have a child free evening and a good night's sleep.

So, do all these different definitions matter? Ultimately, no. Whatever you call it your baby will develop the ability to sleep for longer stretches gradually and in their own time so it doesn't really matter what label you use!

The problem is, parents do like to compare their babies. If someone tells you their baby slept through at just a few days old, they might be talking about a five hour stretch. Meanwhile you're still waiting for your baby to go twelve hours and feeling like you're falling behind! What if your baby sleeps for eight hours every night but instead of 11pm to 7am (through the night) she likes to sleep from 7pm to 3am. It's still eight hours, just less convenient for the adults.

All babies are different, they all grow at their own rate and they develop the ability to sleep for longer stretches when they are ready (if you need help with that, do ask me!) Being able to tick off a milestone is always fun, but when you chat to other mums remember that you might well be comparing apples and oranges. And if you're talking to a doctor, health visitor or other medical professional, always question exactly what they mean by "sleeping through."

Surviving on no sleep

We all know that newborn babies don't exactly sleep well, even those who love to sleep will need regular feeds and some struggle to settle, or have reflux, or just don't sleep for any number of reasons.

 

There are lots of things you can do to gently guide your newborn towards better sleep, and eventually sleeping through the night, but in the meantime night wakings are going to be a part of your life. The question is, how do you function during the day?

 

Emergency Sleep

If you have had less than four hours sleep in the last 24 hours then you are in desperate need of rest. The same can apply after very disrupted sleep for weeks or months. In that situation you are not safe to drive, not safe to share a bed with your baby, and can't function properly - although you might think you can. Life really is a struggle at that point, both physically and emotionally, and you are in desperate need of some emergency sleep.

This is the time when you need to rope in someone else, your partner, your mother, an understanding friend or a nanny. It doesn't have to be overnight, if they can only manage daytime, you are tired enough to sleep no matter what. First of all, if you are breastfeeding, express as much milk as you can. Then go to sleep while your helper cares for the baby somewhere where they wont disturb you. Have the breast pump set up near your bed so that if you wake with sore breasts you can just express quickly and go straight back to sleep. Don't get out of bed until you can't sleep any more. I heard of one mum who slept for a full 24 hours!

The world will seem like a whole new place in the morning.

Prioritise Rest

Make rest one of your most important priorities, right after making sure both you and the baby get fed. Yes, it's that old saying "sleep when the baby sleeps." I know it's tempting to use nap time to run round and get jobs done but housework really can take a back seat for a while. Clean laundry wont mean much if you are hallucinating through exhaustion. At least once a day either settle your baby for a nap or take them to bed with you (make your bed safe first) and rest, just lying down makes a big difference and if you fall asleep so much the better.

Use your Mornings

Mornings tend to be the easiest time, babies often nap well or are in their sunniest moods and you are as well rested as you are going to get. So make use of them! Do everything you possibly can first thing, from putting on the laundry and emptying the dishwasher to chopping the veg for dinner or even sticking it in the slowcooker. Later on in the day when you are really exhausted and the baby is grumpy you'll be thankful that you don't have to worry about cooking dinner. Plus you can get some rest in the evening, or even an early night, instead of staying up late to wash the dishes.

Get Things Done When Baby is Awake

Again, you want to be able to put your feet up when baby sleeps, and that means getting things done when she's awake. Get to know the things your baby likes best and build them into your routine. Does she love the sound of running water? Then she may well be happy in her bouncy chair while you have a shower or do the washing up. If he likes motion then try popping him in a sling while you dust and hoover. This approach kills two birds with one stone, you get things done and entertain your baby at the same time!

Singing through the day

Singing through the day

Earlier today I was cutting a two year old's toe nails. I managed to do about four nails before he started squirming around so I made up a silly song. It made no sense, the lyrics were awful and they had the wrong rhythm for the tune (plus it was about cutting nails) but it kept him happy and still while I got the job done! Even if you think you have a terrible voice children love to hear you sing, and a few songs can be a wonderful tool to get you through the day.

If you use specific songs at certain times of day, and avoid singing them at other times, your child will very quickly learn what the songs mean. I know several children who will automatically start to tidy up when they hear the "tidy up song", without being asked. I even know some toddlers who will sing the song to themselves and start tidying up - entirely unprompted! Using a song can take a boring chore and turn it into a game.

Songs also have a limited length and let a child know that something won't last forever. Few toddlers enjoy having their face washed after a meal but singing "rub-a-dub" helps them to understand that the face washing will be over when the song is done. I have even known a child who hated having his face washed remind me to do it, because we had to sing the next part of the song!

When you are singing you are engaging with your child, not just doing something to them. With all the stress of parenthood it can be easy to think of things like face washing and nappy changing as tasks to get done as quickly as possible and you can almost forget that you are caring for a small person! Singing  reminds you to interact with your child and introduces a bit of fun, so you're not just restraining them while you clean up the mess.

Finally, in order to sing you have to breathe. Singing can really help you to cope with a stressful situation, such as a crying baby. It may even calm the baby! Any song will do, a lullaby if you know one or just something you have heard on the radio. Making up your own songs can be fun as well, adapt words to suit and think up variations. Anything to distract both yourself and your baby. When you get into the habit of making up songs you will find you do so as you go round the supermarket or in the car, any situation where you need to distract or calm a child but can't pick them up and don't have toys to hand!

Here are some songs I like to use:

For hand and face washing before or after meals:

Wash your dirty hands,
Wash your dirty hands,
Rub-a-dub and scrub-a-dub,
And wash your dirty hands

(repeat for face)

To calm children down and get them sitting still:

I have 10 wriggly fingers and they all belong to me,
I can make them do things,
Would you like to see?
I can shut them up tight, and open them wide,
I can put them all together, or make them all hide,
I can jump them up high,
I can jump them down low,
I can fold them quietly,
And sit just so

Nappy changing:

Oh, dear what can the matter be?
We have to change your nappy,
That will make you happy,
Now that you're nice and clean.

Doing up a baby grow after nappy changes!

1 little, 2 little, 3 little poppers
4 little, 5 little, 6 little poppers
7 little, 8 little, 9 little poppers
10 little poppers, let's do them all up

Pop, pop, pop those poppers
Pop, pop, pop those poppers
Pop, pop, pop those poppers
10 little poppers, are all done up.

Tidy up time:

Tidy up time, tidy up time
Tidy up the toys, tidy up the toys
Let's all be helpers, let's all be helpers
Girls and boys, girls and boys

Silly songs

Here is an example of a song adapted one day when comforting baby triplets who were upset following their immunisations, their mum and I enjoyed taking turns to come up with new verses and the children enjoyed the singing.

What shall we do with a grumpy baby?
What shall we do with a grumpy baby?
What shall we do with a grumpy baby?
In the afternoon?

Give her a kiss and a cuddle too...

Pat her on the back and see if she burps...

If she's hungry give her some milk...

Take her out for a walk in her pram...

Give her something fun to look at...

Dance around the room and sing a song...

Put her in bed so she'll have a sleep...

Ten Essential Baby Buys

If you are expecting your first baby it can be very difficult to know what you need to buy, and what you don't! Here are the ten things I think you really do need.

 

Don’t forget that there is nothing wrong with second hand items, provided you check for cleanliness, wear and tear.  The exceptions to this are your car seat and mattress, both of which must be new. If at all possible all of your baby’s sheets, blankets and clothes should be 100% cotton, with some woollen hats and cardigans in winter. Natural fibres are more comfortable than synthetic, and cotton can be washed at high temperatures if necessary.

1) A newborn car seat.

This is something you will want to have well in advance since you can't leave hospital without it. Ask the shop staff to make sure it fits your car and show you how to fit it yourself. You might like to practice that one, it's rather embarrassing if your homecoming is delayed because you can't strap the baby into the car!

2) A Moses basket, crib, co-sleeper or cot.

You can use a cot from day one, but most people like to use a basket as well.  Don't forget that you will need sheets and blankets too, go for cotton jersey fitted sheets and waffle weave blankets. If you plan to have baby in your bed at night do consider whether you will want somewhere for them to have daytime naps (bouncy chairs and swings are not safe for sleeping), and make sure you prepare your bed for safe bedsharing.

3) Swaddles

Get proper swaddles, shaped jersey wraps that do up with velcro. They are much easier to use and are also much safer than a large muslin or simple blanket.  Jersey (t-shirt fabric) may look thin but it is the best thing to use since you can always put a blanket over the top when it's chilly, and then take the blanket off if the baby gets too warm. Newborn babies really do sleep far better if they are swaddled, and you will want him to sleep well between feeds!

4) Muslins.

No matter how many you get, you will still manage to run out at some point. Muslins are great for so many things, catching dribbles during feeds, protecting your clothes from vomit, spreading over a changing mat, making an impromptu sun shade, the sky's the limit!

5) A dim light

You will need one for your baby’s room, and another for the room your baby will have night feeds in, if that's different. It could be a dimmer switch on the main light, a dim bulb in the lamp or a night light. You want to avoid bright lights at bedtime and for night feeds.

6) Nappies.

You will be needing a lot of nappies (washable or disposable), and cotton wool, nappy sacks, a changing mat and possibly a nappy bin. If you want to use baby wipes with a newborn I recommend waterwipes as they are the closest thing to water (you can get them from Amazon or Ocado.)

7) Clothes

Your baby will need something to wear but clothes are often given as gifts so stick with the basics to start with or you may end up with far too many. I would get short sleeved vests, babygrows, and two or three cardigans. You may also want some hats and mittens but do remember that your baby shouldn't be wearing a hat indoors. You will need some socks or booties if the babygrows don't have feet.

8) Transport

If you want to wear your baby then I suggest you go to your nearest sling library, where you will get lots of friendly advice and the chance to try out different types of sling before you decide to buy.

If you want to use a pram look for one which allows the baby to lie completely flat on a mattress. I like the old fashioned style since you can see the baby but any pram where they lie flat on a firm mattress is fine. Avoid using a car seat or other shaped surface on a pram base, except very briefly. Do get the sun shade and rain cover now, you will need them both eventually!

9) A soft play mat with hanging toys

The kind that include a variety of toys such as mirrors, bells etc. are the most interesting. Even a very young baby will enjoy watching the toys swinging and it gives you a safe place to put them down when you need your hands for another job.

10) Some quick and easy adult food.

Make your life as easy as possible and stock up on things you can cook almost without thinking. You may want to have some nice biscuits on hand to offer visitors as well, but don't feel you have to play hostess. This is one time you really can point guests towards the kitchen and ask them to put the kettle on!

Can I breastfeed if I'm ill?

Breastfeeding mums often ask me what will happen if they get ill, might breastmilk make the baby poorly? Would it be "good enough" if mum is run down? Would breastfeeding slow mum's recovery? The short answer is that for the majority of people, it is perfectly safe to continue feeding during most illnesses, with only a very few exceptions.

The most common situation is where a mum has a minor illness, a bad cold perhaps, and doesn't want to pass it on to a tiny baby. It is worth remembering that, by the time you are showing symptoms, the baby has already been exposed so switching to formula would not prevent that. In fact, your breastmilk contains the exact antibodies the baby needs to fight off the disease and continuing to breastfeed is likely to be the best protection you can offer your baby. It is also worth bearing in mind the fact that if you stop feeding suddenly you may have problems with engorgement, mastitis and other issues which would make you feel even worse. After a week or so of bottle feeding it can also be difficult to go back to the breast, many mothers find that what was meant to be a short break becomes a permanent change.

It might surprise you to hear that often illnesses are not present in breastmilk, and even if they are they may pose very little risk. For example, Hepatitis A is found in milk but infection in babies is rare and unlikely to be serious so it is generally thought that there is no need to stop breastfeeding. There are only a few exceptions, such as HIV, where it is best to switch to formula in most cases.

Many diseases are passed on through skin to skin contact or via droplets (coughs and sneezes) which means the only way to prevent infection would be to separate mother and baby. Most of the time, where mum has something like flu, this would be very extreme and is unnecessary. Taking sensible precautions is more than good enough. However with a few serious conditions, like tuberculosis, the baby does need to be kept away. That doesn't mean they can't have breastmilk though and it is often safe for mum to express milk, which someone else can give to the baby.

Any mum who is feeling unwell, and anybody else who comes into contact with the baby, can take some simple precautions to reduce the baby's exposure to disease. Washing hands well and as often as possible may seem obvious but can easily be forgotten at home. Any coughs or sneezes should be "caught" in a clean disposable tissue which is immediately thrown away, not kept for re-use. If anyone has a rash, spots or lesions those should be well covered with a bandage. Finally, it is helpful to avoid the baby touching your mouth or nose. Unfortunately that means no kisses for a few days.

Unless a mother is very ill, breastfeeding is unlikely to put her recovery in any danger. Even mums who are admitted to hospital can sometimes continue breastfeeding if they have the right support. Despite that, breastfeeding while ill is not a particularly pleasant experience and it is important to look after yourself. If at all possible delegate household tasks, including childcare, to other people so that you can go to bed and rest in between feeds. Make sure you are eating well, drinking enough and follow any other advice you are given by the doctor. Many medications are perfectly safe while breastfeeding, so if your doctor knows you are nursing and tells you to take something, take it! You might normally put on a brave face and battle through but now you have to look after yourself, if you don't you won't be able to look after your family.

Why does "sleep beget sleep"?

You have probably heard the phrase "sleep begets sleep," perhaps from an older relative or an experienced mum at playgroup. It's a confusing one, partly because it's so counter intuitive. After all, surely a baby will sleep better if they are tired!

In a way you are right, nobody can sleep all the time and there is certainly a point at which you can't sleep at night if you slept all day! Having said that, most babies and toddlers are running short on sleep so if you are having difficulties at night it is highly unlikely that cutting down on naps will be the answer.

Our bodies are complex things and there are many influences on them, but there are two main reasons why being well rested makes it easier to fall asleep and stay asleep. Both are to do with hormones. This is a very brief summary since it's not intended for scientists, and I'm not one either! But on a practical level it can help to have a basic understanding.

First, levels of the "sleep hormone" melatonin go up when you are asleep. In an adult they go up in the evening and fall again in the morning, staying very low all day. When a child has lots of naps the level hasn't so much time to drop at each waking and stays a bit higher. Melatonin is so effective in helping your child to fall asleep that it is sometimes prescribed to people with sleep problems, so might as well make use of it when it occurs naturally! If your little one hasn't had a nap in a while their melatonin level will be lower, making falling asleep harder.

To add to that, levels of the "stress hormone" cortisol drop during sleep. So a well rested child is likely to feel calmer and more relaxed, exactly the state you need to fall back to sleep at bedtime. It is important to know that cortisol is entirely normal, and even essential. The levels we are talking about here are part of normal daily fluctuations and not high enough to cause brain damage or other problems (those are usually reserved for really traumatic situations, like war). Even so, a slightly high cortisol level can make falling asleep tricky!

So, there it is in a nutshell. Sleep begets sleep because the hormone changes during sleep make it easier to fall asleep, and stay that way. Which is why I sometimes suggest an earlier bedtime, or longer nap, for a little one who struggles at night.

Getting rid of a dummy

Dummies (or pacifiers for those on the other side of the ocean) are a controversial topic. Sleep experts and breastfeeding advocates frequently advise against them, many people hate the look of them and swear they will never use one. Yet their use has been shown to slightly reduce the risk of SIDS (sudden infant death syndrome, or cot death) and lots of parents will end up using a dummy, whatever their intention was! It can be a useful tool, but what do you do when it's time to let them go?

Babies

Sometimes a baby can be so disturbed by a dummy falling out that they wake and cry frequently through the night. If they don't yet have the mobility or motor skills to get the dummy for themselves this can be extremely difficult for the parents. I have worked with little ones who woke as often as 20 times a night, so this can be a really tough problem!

You can lessen your baby's dependence on the dummy by allowing them very limited access. You let the baby suck for a short time, perhaps 20 or 30 seconds to begin with, then remove it. When they begin to fuss you give another short burst. The idea is that the child still gets some comfort but breaks the habit of constant use, falls asleep without the dummy and over time you reduce the time allowed. It does sometimes take a while for this to work so you need to be persistent, consistent and very determined!

Unfortunately this method doesn't always lead to giving up the dummy altogether, and some children don't like it at all. In that case you are going to have to go cold turkey. There are plenty of things you can do to support your child and make the experience as gentle as possible, but it is going to be tough for a few days. The alternative is to continue putting the dummy back in until they are old enough to find it for themselves. Avoid any sort of tie, cuddly toy attached to the dummy or other way of keeping them in, as those are potentially risky for a young baby.

Toddlers

If your toddler has a dummy you face a slightly different challenge. They may sleep quite happily through the night now but your concerns are for tooth development, speech patterns and the fact that you toddler can't have one all day when they start school! Your approach here will depend on how attached they are to the dummy.

Reducing dummy dependence

If you are currently taking a dummy with you everywhere you go it is probably a good idea to reduce that dependence as much as possible before taking them away altogether. I do this by gradually allowing the dummy less and less, using boundaries that a toddler can understand. You will need to be firm at first when you move on to a new step, your toddler will protest at the change in the rules! But stick to your word and they will soon get used to it. Some steps I have used are:

1. Dummy can be used at home and on journeys, but stays in the car/my bag when we get to playgroups and classes.
2. Dummy stays at home, and can wait on the sofa or somewhere near the door for us to come back.
3. Dummy use is reduced at home. Whenever the child isn't using the dummy it is put out of sight so they are less likely to request it. I also "don't understand" anything said with a dummy in, even a single word. Generally they get so tired of taking it in and out that they give up!
4. Dummies are only allowed in bed.
5. Any preferred dummy might be "lost" or "broken", leaving those the child likes less.

This will take a few weeks, perhaps even a couple of months, but it makes the whole process much more gentle. I would also start to encourage an attachment to a cuddly toy (who stays in bed) if they don't already have a favourite as that will help in the first few dummy-free nights.

The last dummy

There are lots of different things you can do to try to make giving up dummies a little easier for your toddler. Most of them involve a little ceremony or ritual that helps your child to understand that the dummies are gone now (and may also put the blame on some outside agent instead of the parent!) You know your child best so choose whichever you think will work for them.

• "Breaking" the dummies. If you make a small hole in the sucking part of a dummy it no longer makes a seal and the child sucks air (like a straw) instead of the satisfying suck they are used to. Some children will then be happy to give them up and put them in the bin.
• The dummy fairy. Leave your dummies out and the fairy will take them away. She takes them to give to tiny babies who need them more than a big toddler does, and is so grateful that she leaves a gift to say thankful. This is especially good for any child with a strong sense of empathy, since they like the idea of helping little babies.
• Santa. Much like the dummy fairy, Father Christmas has been known to take dummies hung on a Christmas tree and replace them with a special bauble or gift.
• Teddy bear. You can take the child on a special outing to Build a Bear and let them make a teddy. Along with the heart and sound machine put a dummy inside. That way the child still has a dummy, but now it's for holding and cuddling instead of sucking.
• Family ritual. Why not come up with your own little ritual to mark the occasion? You could have a special meal with a cake, plant the dummies in a pot with a houseplant (not in the garden as they wont decompose) or hang a big piece of paper over a door for your child to burst through from babyhood to childhood, leaving the dummy behind. Whatever you choose, keep it positive as you move on to the next adventure!

Whichever approach you choose to take, however elaborate or simple it is, be prepared for reality to hit. Ultimately there is likely to come a moment when your little one climbs into bed without a dummy for the first time and isn't sure how to soothe themselves to sleep. Reassure them, give hugs, make sure they have their favourite teddy or use a sleep coaching method but whatever you do, don't give the dummies back. The first night is by far the hardest in the majority of cases (sometimes night one is easy but it hits on night two or three) Just get through it, celebrate in the morning and you will never look back!