New parents need sleep; the big question is how to get it
It's the question new parents field about as often as they change diapers: How is the baby sleeping? The follow-up query, of course, is whether Mom and Dad are getting any rest.
Possible answers to the two questions are multiple and varied, and so are the suggestions of doctors, sleep therapists, researchers and other experts on how new parents can ensure a good night's sleep for everyone in the family. And that's before grandparents, aunts, uncles, friends, neighbors and co-workers offer their advice.
``A friend of mine gave me a book on the subject,'' said Cathy Woodard, a mother of nearly 3-month-old twins in Deerfield, Ill. ``But I haven't had any time to read it.''
For now, Woodard and her husband, Greg, are not getting any more than two to three hours of sleep at any one time. The babies, Jared and Jessica, are old enough that each wants to be held rather than double-fed in a pair of car seats. Instead of one parent staying up more than an hour to feed both kids, the Woodards decided each of them could take a child so everyone's back in bed within the half-hour. On Fridays and Saturdays, they started experimenting with one parent getting a full night's sleep while handling the crying and feeding solo the other night.
``It's an important issue to keep discussing,'' said Cathy Woodard, who will be returning to her marketing and financial analyst job later this month. ``Otherwise, you can get a little short with each other.''
Establishing good habits
The Woodards are entering the time frame in which infants form sleep habits. The couple got off to a good start by following the recommendation of the twins' pediatrician, who said to put the babies in their cribs before they fall fully asleep. It helps the child learn how to drift off independently. Two to 3 months is not too young to begin the process of helping infants develop longer periods of sleep in a pattern of more wakefulness during the day and sleep at night.
``In the first six to eight weeks, no parent can possibly spoil a child or create a crying habit,'' said Dr. Marc Weissbluth, a Chicago-based pediatrician and author of two books about children and sleep, including Healthy Sleep Habits, Healthy Child (Fawcett, $12.95). ``At about 2 months, the temperament of the baby becomes a major factor.''
Weissbluth said a child with ``easy'' temperament will likely be on a regular schedule of nighttime sleep with morning and afternoon naps by 4 to 6 months old. The more difficult baby can take considerably longer, especially if parents inadvertently make themselves part of the problem.
``Some parents can make sure their kids get good, nutritious foods, but they can't distinguish between healthy sleep and junk sleep,'' Weissbluth said. ``Parents need to appreciate that their kids have two modes: awake and asleep. When they are awake during the daytime, give them hugs and attention. But during the sleep mode at night and nap time, leave them alone or else you will be causing insomnia and fitful sleep.''
Weissbluth said a common mistake among new parents is a late bedtime. That accommodates the adults who work, but it results in an upset baby, with the stress hormone cortisol being released in the body and crying unleashed on the household.
``The best thing parents can do is put a baby to bed early enough to avoid overtiredness,'' said Jodi Mindell, a therapist and researcher at the Center for Sleep Medicine in Philadelphia and author of Sleeping Through the Night (HarperPerennial, $12). ``Once children are overtired, it is significantly harder for them to fall asleep, even if you have a regular calming bedtime routine.''
A good indicator for knowing the right bedtime for your child is analyzing how she behaves in the late afternoon. If she is as cheerful then as she is in early morning, then she is getting enough sleep. If not and if she is cranky many mornings too then an earlier bedtime will likely improve her mood.
Mindell and Weissbluth agree on early bedtimes and establishing a peaceful transition time before bed (for reading, cuddling, singing, bathing, prayer and similar activities). They also share similar views on ``sleep training'' at bedtime for difficult sleepers.
In a method popularized by Dr. Richard Ferber in the mid-1980s, Mindell advises parents to put their children to bed and not pick them up if they are crying, even if the crying goes on for a half-hour to 90 minutes. What she recommends is coming back into the baby's room at regular intervals to soothe the baby with comforting talk.
Weissbluth said temperament and age are factors in deciding whether to pick up the baby for comforting or even go back into the bedroom during crying. If the child is younger than about 9 to 12 months, he said soothing the baby, even holding her, is acceptable and not counterproductive to the ultimate goal of getting a child to fall asleep on her own.
There is an even more important distinction by the 9- to 12-month mark, said Weissbluth. If going back into the bedroom helps soothe the child, it's OK to do so. But if the parent's return appears to stimulate the child to become more awake or upset or both, then he urges parents to not re-enter the room. The most effective strategy to avoid the crying and help the child become an independent sleeper is instead striving for ``perfect timing'' at deciding when a child needs to be put in bed.
Four nights to a sleeping baby
Weissbluth said some parents are distressed when he suggests crying might be necessary as the child learns how to sleep and the parents hone their ability to determine the perfect bedtime. Mindell receives similar reactions.
``I usually tell clients five minutes,'' she said. ``Some people say they can't wait that long, and others can go longer. It doesn't matter if it is 30 seconds or 20 minutes, just make it regular intervals'' rather than specific responses to the child.
If the method is successful, the difficult child should be sleeping through the night within four nights. Mindell doesn't recommend letting the baby cry longer than 90 minutes at bedtime, figuring ``something else is going on'' in that instance.
Staying strong might be a parent's biggest challenge.
``The first night the baby usually cries for about 45 minutes,'' Mindell said. ``Then the second night it can last about an hour because the baby realizes this is serious and no fluke. By the third night, the crying goes on about 15 minutes and by the fourth night, the child is happy in the crib.''
Where Mindell and Weissbluth part ways is during the rest of the night. Weissbluth and Ferber urge parents to stay with the no-cuddling method during any subsequent wakeups and disruptions, while Mindell said ``do whatever it takes to get everyone back to sleep.
``I don't recommend sleep training at nap time or 2 a.m.,'' Mindell said. ``The key is doing it at bedtime. Eighty to 90 percent of children who learn to fall asleep naturally at bedtime will then sleep through the night within the week.''
But is it good for the child?
Martha Heineman Pieper, a Chicago-based psychotherapist, is not convinced any of this sleep training called ``Ferberizing'' by some critics is healthy for children.
``The long-term meaning to the child is you want them to be unhappy,'' said Pieper, who with her child psychiatrist husband, Dr. William J. Pieper, is co-author of the book Smart Love: The Compassionate Alternative to Discipline That Will Make You a Better Parent and Your Child a Better Person (Harvard Common Press, $22.95). ``The whole idea goes against parents' best instincts.''
Pieper saves her strongest words for anyone who thinks babies can manipulate or fake unhappiness merely to get a parent to pick them up.
``Do not leave your baby to cry,'' she said. ``Always try to comfort a crying child. It helps teach them to be good to themselves, to want happiness and to be compassionate. Infants and toddlers model after their parents.''
Pieper said there are actions parents can take to avoid sleep deprivation. One is napping when your children nap. Another is to be ``boring'' at bedtime, developing a consistent routine that is soothing but not too stimulating (can include bathing, reading, storytelling and playing music on a portable tape recorder). Placing fun toys in the crib can help children not quite ready to doze off.
Yet Pieper said parents should be willing to break routine if the child seems unhappy, maybe by reading one more story or staying in the bedroom longer than planned.
``Parents lose sight of the big picture, which is creating a loving relationship with the child,'' Pieper said.
Rockin' through the night