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Sleep!

A couple of nights ago I hunkered down with my trusty laptop and a bunch of people that I could neither see nor hear (they actually numbered around a thousand!) and chatted about sleep, or, to be precise, the lack of it. This was my 5th Mother&Baby Facebook Live and, as always, it was friendly and fun as well as, I hope, informative and reassuring.

It says something about our cultural expectations that it was the 2nd M&B Facebook Live on sleep and that this is the 3rd blog on the subject (see blogs #4 and #5 for more). We value our shut-eye and guard it closely. We check our clocks on waking to see how long we’ve slumbered and fret before our first coffee hit of the day about how we’ll cope when our precious night has been broken.

When it comes to our babies, the phrase “when will he start sleeping through?” enters our vocabulary at about the same time as our stitches heal and the visiting frenzy tails off. Books line the shelves promising to show us how we can train our babies to sleep more, to get into a routine, to self-soothe before they have even had their births registered! So we expend vast amounts of emotional energy searching for the secret to getting our babies to sleep from dusk til dawn without disturbing our beauty sleep.

Now, of course, humans have evolved over millions of years and, despite our little individual quirks and unique personalities, we’re actually all a pretty standard model – we all eat breathe, poo and sneeze in much the same way, have a head at the top end and toes at the other and hit developmental milestones along a surprisingly similar curve. How we, as humans experience and develop sleep patterns is also staggeringly similar, and understanding the fundamentals can shed some light on how we can support our babies and children to gain good sleep hygiene and social behaviour around bedtimes.

Your baby comes to you hardwired for survival and with the evolutionary “expectation” that mum will be a pretty instinct-driven cave woman. The hormones which give us our circadian rhythm and different sleep states are deregulated under about 4 months of age and the similarly deregulated autonomic nervous system (see blog #5) ensures that your little one spends many hours each day, and certainly most of the night, snuggled safely in your arms or suckling. Despite your 21st century sensibilities and the insistence of books and relatives that you should stop picking her up, your baby’s cries dig deep into your primitive soul and twist it until you respond, again and again and again.

Your newborn’s sleep is made up of lots of power naps – she suckles whilst dozing on and off, then falls deeply asleep in your arms for half an hour or so before waking up, refreshed and ready to spend more time being rocked, patted and suckled. She can sleep anywhere, as long as it is in arms!

Those parents who learn to trust evolution, relax, and spend their time honing their soothing strategies rather than attempting the impossible (and potentially risky) task of “teaching” their tiny baby to learn to be alone, find that life is far less stressful and far more conducive to a happy home life. They know that, in time, their baby will follow a human developmental curve and sort their sleep out.

From the very end of the third month the hormones and body systems which govern human sleep start to coordinate and settle and the erratic power-naps of the newborn are gradually replaced by sleep cycles. It is this emergence of cycles which puzzles parents – they expect that their teeny tiny should be starting to “sleep through” (after all, that’s what the books and your mother tell you) but nights now seem even worse: your baby wakes every hour and cannot resettle without a lot of help from her parents.

So let’s get this straight – none of us sleeps through! There, I’ve said it …

We all wake at quite frequent intervals through the night and then doze back off again. Some of us remember these wakenings (I certainly do), and some don’t. But we all have them. Each cycle is made up of different types of sleep, including deep sleep and dream sleep (R.E.M. sleep) and we need to go through the deep sleep part of the cycle in order to feel refreshed. Even those of us who feel we are plagued by insomnia actually do achieve enough sleep to survive – it is as basic as breathing.

What marks babies out as different from adults is that they need support to get back to sleep after each wakening. They can’t self-soothe. Developing the ability to self-soothe takes time and experience and, until around the six-month mark, babies are not even developmentally able to learn how to self-soothe. This is good news! You can simply stop worrying about what you should be doing to sleep-train your baby and just do whatever you know works best for him. He can’t learn good habits for sure, but this also means that he can’t learn bad habits.

Between three and six months, as the sleep cycles gradually emerge, babies also start to show distinct sleepy cues. Typically these are nose-rubbing, eye-rubbing, ear-pulling and tired noises. Parents always spot them but often don’t realise what they are.

From around six months, babies start to develop the ability to get into routines and self-soothe. But they still need help and support from their parent.

So, what CAN you do?

Well, for the first three to four months, simply soothe your baby whenever he needs it in whatever way works best. More often than not this involves rocking, patting, white noise and, of course, suckling. Certainly arms will always work in a way that a crib cannot. What you do so beautifully during these intense months is give your baby the experience of what it feels like to be distressed … and then soothed. This will set the groundwork for him to develop his own self-soothing strategies in due course. You see, the only way a baby can confidently soothe themselves is if they know how it feels to be soothed. So soothe away without the guilt and anxiety that usually pervades and poisons the parenting space.

Months four to six are about patience and watching as the changes take place. Many parents find that safe co-sleeping returns (if it ever went away!) as the only way for everyone to get any rest whilst the littlest member of the household, beset by changing systems, wakes almost every hour. Try to learn your baby’s unique sleepy cues and, as soon as you see them, start soothing your baby to sleep and continue to soothe, in whatever way works at that moment, until she has had a full cycle (this will lengthen gradually over the months from as little as half an hour, up to a couple). Some babies start to prefer a quieter, more still space to nap and sleep so try to be sensitive to these emerging needs and fulfil them as best you can.

From around six months, you should start to see distinct nap and bed times emerge. Generally the first sleepy cues of the day show about one and a half to two hours after the start of the day and then again after the same interval from the end of the first nap. Babies can often go two to three hours in the afternoon before showing sleepy cues and they often have a very late nap at around 6-7pm which parents mistake for bedtime. Bedtime itself is often around 9pm and this will move earlier as the year goes on.

At this point you get to choose: carry on providing the soothing strategies for your baby or set about giving him the opportunity to discover his own. Whatever you decide is not written in stone (you get to change your mind as often as you wish – it’s a parent’s prerogative!), and it doesn’t define you as a parent or person.

If you want to remove a soothing strategy (maybe you no longer want to offer the boob at every overnight wakening) then, until your baby can self-soothe, you need to replace it with another. That might be picking your baby up and patting him, or offering a dummy, or hauling him into your bed to snuggle down to safely co-sleep (for useful links, see below).

If you choose to give your baby the opportunity to develop self-soothing strategies, then you will need to gradually remove your support over a period of weeks or months and give your baby just enough space and time alone to find what he can do to get himself to sleep, but not so much space and time that she is overwhelmed (never a good way to learn).

In time, your highly-evolved human will learn that, in your house, people repeat the sleep needs of other people and sort themselves out at night rather than waking the whole household! This takes time and patience but she will get there. After all, she is only human …

NOTES:

  1. Chapter 10 in my book “Your Baby Skin To Skin” covers both these approaches in detail if you want to explore a little more deeply.
  2. Safe co-sleeping advice:
    CLICK THIS LINK to read the parent information leaflet on caring for babies at night from UNICEF babyfriendly.org and then …CLICK THIS LINK to read information to healthcare professionals from about the evidence behind the leaflet.
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Desperate about your young baby’s behaviour?

Sunshine follows rain, night follows day, cats sleep on newspapers and babies cry all evening. Such is life in all its glory. Every parent I see will accept that, when they announced that they were planning a family their news was met with smug grins and a threat of “just you wait for those sleepless night!” And yet, when those sleepless nights arrive before the ink is dry on the hospital birth notes, parents quickly come to the conclusion that their baby is unusual, broken, poorly or just plain naughty!

Erratic, fussy, irrational and impossible to soothe, the young baby is the same the whole world over and once you understand exactly why your little one keeps you on your toes (don’t you dare sit down) all evening, you will be more able to accept that what you need are coping strategies rather than a non-existent cure.

Colic is the name given to the particular pattern of crying and fussy behaviour seen in the Baby in the first 3-4 months of life. The pattern starts towards the end of the first week following birth and is characterised by regular, nightly crying bouts between about 5pm and midnight and then again between 2-3am and 4-5am. The baby draws up his legs and appears to be in pain. Suckling and rocking appear to help for short bursts but nothing gets the baby to sleep for long, until the end of that particular colic bout when baby falls soundly asleep.

It seems that colic has been around since the dawn of time and, from an evolutionary point of view, makes perfect sense for the survival of the species. After all, noisy babies get cared for, quiet ones get put in a corner (of a cave) and left alone …

You will hear all sorts of explanations for colic – wind, reflux, silent reflux, naughtiness, manipulation, poor milk quality, stress in the mother, but none of these make sense when looked at from a scientific, rational standpoint.

Colic simply means spasm and this is exactly what your baby is experiencing – painful gut spasm caused by high blood levels of hormones that make the smooth muscle of the gut contract. These hormones are circulating in all of us – they cause labour contractions, amongst other things. They are at their lowest between about 7am and midday, which is when your baby will be most settled and pain-free, and peak daily between 5pm and midnight and 2-5am. The evolutionary reason for a baby to be settled in the warm morning hours when the sun is up and mum is busy out hunting and gathering, and then demand to be kept very close in arms and soothed continually in the dark, cold nighttime hours are pretty obvious when you stop and think about it.

Happily, evolution has given us built-in soothing strategies – skin to skin, suckling and breastmilk, and when a baby comes to our boob all these three things happen together automatically. Suckling creates an endorphin release into baby’s bloodstream and, also, human milk contains endorphins. These natural opiates RELAX smooth muscle and therefore ease gut spasm, but they also wear off very quickly – in about 5-10 minutes. So the picture a mum typically sees is… baby in pain with gut contractions; baby gets driven through reflex behaviour to give suckling cues; baby suckles and produces endorphins at the same time as receiving a little endorphin-rich milk; baby’s gut relaxes; baby stops suckling; endorphin level drops off over about 10 minutes; gut contractions return; baby gets driven to suckle again, and so on and so forth. It is easy to see how mums think that somehow their breastmilk is actually causing the problem whereas, really, the baby is self-medicating on endorphins with each return to suckling.

People call this behaviour “cluster feeding” but in reality it is “cluster SUCKLING”. Because babies need to stay close all night to keep warm and safe, their highly-evolved, spasm-ing gut keeps them on high-suckle alert. Suckling alone produces endorphins and so babies do not actually need lots of milk during these hours – if they could get lots of milk every time they suckled overnight, they would either vomit huge amounts or you would be pushing them to school in a wheelbarrow in a few years! So, as mums correctly perceive, when a baby is at her most suckly, mum’s supply adjusts down. In the less suckly morning hours, mum’s supply adjusts up. In this way, babies can suckle as much as they need to and also get, over 24 hours, just the right amount of milk.

Now, how to deal with the problem. Firstly, it can help to know that there is no cure; only coping strategies until baby develops out of this very vulnerable state and is more able to cope for longer periods without skin to skin and suckling. This developmental stage arrives at around the 4 month mark. Next, it is useful to remember that colic is definitely not caused by wind or foods (with a couple of notable exceptions, for which, see later) seeping into the milk. In fact, all the weird and wonderful ideas you’ll hear about food really don’t bear scrutiny: human milk is made from our blood and our blood cannot become gassy, acidic or spicy and nor, therefore, can our milk. The trick is to keep endorphin levels as high as possible as this is what relaxes the painful gut. Now, as suckling raises endorphins and human milk contains endorphins, boobling will always be the most obvious solution, and you cannot put the baby to the boob too often. Baby will simply do lots of non-milk boobling and then, periodically, when a really bad spasm hits, he will draw a little endorphin-rich milk out to supplement his own suckling endorphins.

Other tricks that will stimulate your baby to produce her own endorphins are massage, skin-to-skin, rocking and jiggling, firm bottom patting, car rides, warmth (such as a bath), and stimulating her senses with certain white noises such as the hoover! Just remember that endorphins have a very short half-life, so every time you stop doing the soothing, you have about 10 minutes or so before the spasm and crying will return. Simply put, if you stop soothing your baby, your baby will stop being soothed!

Trying to cure a baby of his colic is like trying to cure him of being a baby. He will grow out of it at about 3-4 months no matter what you do (everything or nothing) when his immature nervous system stabilises. Of course, if you try different remedies, whichever one you are trying when baby is 3 months old will be hailed as a miracle cure and you will urge all your friends to try it.

Some great news about colic is that the baby who spends all evening and night soothe-suckling and in close skin to skin contact at the boob is less likely to get infections or suffer SIDS. Colic also seems to badly affect the brighter, more sociable babies – again, all that time in arms being rocked and talked to brings dividends. So much so that, even if your baby seems much calmer than your average baby, it is worth treating her as if she were really colicky and keeping her in arms as much as possible.

Colic can be more obvious in the atopic baby so, if you have eczema, asthma, hay fever or migraines on either side of the family, then your baby may be more severely affected. Many atopic people are sensitive to dairy, and cow’s milk protein is one of those rare exceptions where tiny food proteins can pass into mum’s milk and cause upset in very sensitive babies. The atopic mum might find that cutting out all dairy in her diet may possibly cut down the severity of the colic bouts. However, it is also very possible that the teeny weeny exposures to dairy proteins via breastmilk might actually help prevent dairy sensitivity when older. Remember though, the idea that the foods you eat can make your baby windy or cause your milk to be too acidic or spicy is simply not true – mums milk comes from your blood and your blood cannot be windy, acidic or spicy!

So, to sum up, your highly evolved baby survives the early, vulnerable first months by ensuring he spends long periods in arms, suckling. This arms-seeking behaviour is driven by painful hormonally-triggered gut spasms, particularly in the evening and night hours. As well as keeping him safe, this prolonged in-arms, soothing phase of life forges strong bonds and developmental leaps in language and socialisation. The mum who can just can trust her own instincts to pick up her baby up and soothe him continually helps rather than hinders this stage, and her milk carries soothing, gut-relaxing endorphins to ease the pain.

Your colicky baby will almost certainly turn into an outgoing, physically active baby (the more severe the colic, the more the baby may be likely to fit this personality type) who is an utter delight to mother (although you’ll need your wits around you as the little trouper raids every cupboard in sight!) There is light at the end of the tunnel – best to batten down the hatches for 3 months and emerge when the storm has passed and the sun is shining!

“There was never a child so lovely, but his mother was glad to get him asleep …”
Ralph Waldo Emerson

Routines

I sit here now, somewhat browner than the last time I put digit to keyboard, thinking back on my recent holiday to escape the long, UK winter. It tickles me that, even though I was many, many miles away from my home, I continued to hang onto my set routine: a cup of tea in bed before breakfast, heading for lunch at 1pm, catching up with the nightly news on TV and reading a couple of chapters of my book before turning out the light at night. New routines also quickly formed: always the same spot for my sun lounger, dragging myself away from my book for a morning session of pool volleyball and tip-toeing quickly across the scorching sand mid-afternoon to dash into the sea and float out for a quiet, bobbing moment of briny mindfulness.

Humans are creatures of habit. We love patterns and see them even when they are not really there – holding onto them like a security blanket to warm us against the cruelty of our mortality.

When our lives are rocked by the entrance into our universe of a new baby, we quickly search for any semblance of a pattern that we can latch onto to steady and reassure ourselves. Many books tap into this need and promise to help us get our newborns into a routine when they have barely drawn their first breath. After all, if humans are lovers of routines, surely babies should be a doddle to steer towards one?

There is no doubt that even very young children and babies seem to really feel reassured and more settled when each day is much like the last, and parents the world over will tell you that children thrive when they can relax, knowing that their boundaries are set and that dinner will always hit the table at 5pm. So why do all your attempts to get your teeny tiny into a regular routine fail?

If you read back over the earlier blogs you will start to see that the very young baby is hard-wired, through millions of years of evolution, to survive. She is driven to do anything it takes, for as long as necessary, to get what she needs to make it through to tomorrow. Your need for a regular bedtime or an undisturbed morning shower have no interest for your little earthling. And your opinion on what her routine should be impresses her not one iota. She has emerged into this world vulnerable and in the hands of someone who has little idea who she is and what she needs. So she had better teach that person pretty jolly quickly!

So, for the first three months of life, the human baby has a set of survival strategies that fundamentally fight the drive towards a routine. The systems that normally keep us settled and comfortable are turned to high alert and so the new baby has an irregular breathing pattern, irregular heartbeat, feisty reflexes (see those jazz hands go!) erratic temperature control, an oversensitive and spasm-ing gut and an inability to fight any bugs that come her way. On top of this, her immature system is hyper-aware of all these erratic goings on inside her skin, driving her to distraction.

Now, in order for these systems to settle and calm, the new baby needs to be in close contact with a fully working older human and guess who that might be. Every time you pick up your writhing, squalling baby, he begins to calm a wee bit and, the more you jiggle, pat, soothe and suckle him, the more his breathing, heart rate, reflexes, temperature and gut calm the heck down. Until you put him back in his crib, at which point he kicks off again …

So a baby survives the early months by doing everything it takes to stay close in arms and frequently suckled. More about this crazy picture in the next blog.

For now, simply be aware that, in the first three months of life, if your little one was able to learn a routine, he would be able to spend longer out of arms and this would work against his inbuilt survival strategies as set down by millions of years of evolution. So stop fighting evolution for a while. Your baby is a human being after all and, in time, he will enjoy a routine as much as the next Homo sapiens but for now, he needs to just do whatever it takes to stay close to you and be soothed for survival.

Over these first three months, because parents find they have no choice but to adapt to their baby, their expectations and behaviour gradually change until, by about the forth month, they automatically carry their little one everywhere and suckle her at the drop of a hat. They pass the baby around the family all evening without giving it a second thought and are so used to the long, long sucklings that the next stage completely throws them!

Between months four and five, the baby, who has now beautifully imprinted herself entirely on her doting parents, begins to settle. She no longer needs to work day and night to keep her parents protecting her – they do it automatically. This is what we call “attachment” and “bonding”. Now she can begin to look out towards the wider world. Her systems governing breathing, heartbeat, reflexes, temperature and infection all settle down and the soothing effects of long hours skin to skin at the boob are no longer necessary. Now that she is a little safer in the world, the evolutionary drive to survive can allow for learning of habits and routines. Before this, no matter what you do, a baby is simply incapable of learning a routine: survival must come first. Sure your friend tells you that her little one-month old baby has a routine, but every study that has looked into newborn behaviour tells us that your friend is simply seeing a pattern where there is none – she has thrown a dice ten times and each time she has turned up a “six”. Or she interprets her baby’s behaviour according to her world view (when her little one settles at 8pm she declares that “my routine-setting really works” and when her baby screams through 8pm and doesn’t settle until 10pm she worries that “her wind is really bad tonight. Nothing I have done has eased it and it has really thrown her usual routine!”). External observers just don’t see the pattern that the mother declares is present due to her brilliant parenting efforts!

As month four merges into month five and month five slides into month six, you will start to see patterns of wakefulness solidify and regular sleep cues for naps emerge. You will also start to see a more reliable bedtime appear. Her ability to get off to sleep without help is not innate so do not expect a settled pattern of behaviour to bring a break from rocking and soothing your baby to sleep but, should you feel it is right for you, now is the time to explore the option of helping your baby to learn self-soothing strategies. So called “sleep training” can work for most parents from the end of month five onwards but it is entirely up to you as to whether or not you do this. Some parents continue to help their baby navigate their way through a day and night-time routine and some choose to go the path of “sleep training” – neither choice defines you as a parent.

So, if your baby is three months and under, hang loose – nothing you do will help your baby to learn a routine but you might well exhaust yourself, and those who love you, by trying. If your little one is four or five months, start to watch for those tell-tale signs that he is maturing towards a more structured life – fewer evening hysterics and noticeable sleep cues such as ear-tugging and eye-rubbing. And, if your baby is six months or more, your efforts to get your life back into a more recognisable routine is likely to succeed.

I can’t promise you time to float on your back in the sea, but a quiet sit down for twenty minutes every morning with a cup of tea and a digestive biscuit is a distinct possibility!