It was an honor to be called into this Australian home by the grandmother of a charming 5-month-old baby, Julius. I had met Grandmother in the US while she was attending a conference. We had planned to make time for dinner when Jim and I traveled to her part of the world, but I was delighted to have THIS special invitation also.
She explains that her
grandson (her first) has been a "handful" since birth. His mother and
father had eagerly anticipated their child's birth and had prepared themselves
for early parenthood with education, family support, and all the necessities of
a cheerful nursery.
Though they understood that
this stage of life could be challenging, they simply cannot believe the level
of sustained exhaustion and confusion they've experienced so far.
Julius's mother has
committed to breastfeeding. Though she has adequate milk supply, this child is
constantly on the breast. That is because the breast has been the only way she
knew to comfort her son when he "got going." Lately, even the breast
will not calm him down, though. When he is obviously tired at night the parents
take turns walking him, rocking him, and singing (until hoarse) to him.
Sometimes all of these actions make NO difference. Consoling him and getting
him to sleep seem impossible.
Clearly this is a crisis.
Mom is ready to give up breastfeeding. Dad is struggling to be faithful to his
job responsibilities and to care for both his wife and their young one.
I have spent decades
hearing and responding to stories like this one, and I've developed a template
for evaluating, diagnosing, and treating families in a sleep predicament.
I begin by understanding
that children do not sleep well for one (or all) of three main reasons:
- Developmental Issues
- Child-Centered Issues
- Parent-Centered Issues
Predictable surges in a
baby's development include:
- The 2-week-old’s normal increase
in crying
- The 1-month-old's developing clear
Deep and Light sleep patterns
- The 4-month-old's increased
distractibility while nursing
- The 6-month-old's drive to eat
solids
- The 9-month-old's
separation/stranger anxiety
- The 12-month-old's learning to
walk
- The 18-month-old's second round
of separation/stranger anxiety
- The 2-year-old's negativism
Parents can be taught to
anticipate these development surges, and to appreciate them as SUCCESSES in
their child's development. However, parents also need to know how to help their
baby through these new, up-at-night activities without increasing breastfeeding
as the only way to comfort the child. Although this may sound
counter-intuitive, mothers may need to learn strategies beyond the breast—precisely
in order to keep breastfeeding!
Child-Centered Issues refer to a child's basic temperament. Initially, parents do
not recognize that some challenging behaviors are temperament-driven. Though
Thomas and Chess originally enumerated eight aspects of temperament, I find the
following characteristics most relevant to issues of a child's sleep habits:
intensity, persistence, sensitivity, and regularity. Helping parents appreciate
their child's temperament will increase their ability to make plans that take
their particular child's personality into account, rather than imaging how to
handle the hypothetical "average" baby.
I hear a brief history from
the grandmother, the mother, and the father. Clearly this was a planned
pregnancy in a stable family that is blessed with ample extended family
support. There were some challenges at birth but no significant history of
pregnancy loss, and symptoms of depression are present in neither mother nor
father.
So far I gather from this
story that one "diagnosis" is sleep
association. Since birth, this child has associated breastfeeding with
getting from Active sleep back to Deep sleep.
During this quiet time I
explain to parents how a child's temperament, as well as Active and Deep sleep
patterns, contribute to sleep issues. A sensitive child needs his parents to
respond more often and more quickly. And, a very attentive mother (as this
mother clearly is) may continue to respond so quickly that the child does not
learn to contribute to his own settling. As is often the case, this duo has
found breastfeeding to be an effective and convenient way to settle a baby, and
the baby has been taught to associate breastfeeding with going from Active to Deep
sleep.
So the diagnosis becomes
clearer:
- Developmental Issues — Emerging cognitive burst expected
around 4-5 months. Inability to get from Active to Deep sleep without
breastfeeding.
- Child-Centered Issues — Sensitive, intense, persistent
temperament traits (ALL characteristics that will bring this child GREAT
success later in life).
- Parent-Centered Issues — An extremely sensitive mother who
is increasingly (and understandably) anxious.
I conclude that the need
for this baby, at this age, is for his parents to take a loving but less robust
response to helping him settle and to helping him transition from Active to Deep
sleep.
"When you respond to
him, you now 1) talk to him, 2) look at him, 3) pat him, 4) pick him up, 5)
rock him, 6) breastfeed him. When you put him to bed now, start by dropping off
1) and 2). For a few nights go to him without speaking and glance to the side.
Then take your other loving actions as needed. When Julius becomes accustomed
to more limited consoling, drop off 6) and then 5). You will be bringing out
the best in him by helping Julius learn to contribute to his own calming. Also,
when he awakens at night, take this same approach so that he will learn to
wiggle back into Deep sleep, on his own. Teaching Julius ‘self-regulation’ will
help both him and you.”
The intensely crying Julius
immediately gives Mum a chance to practice. She turns her gaze slightly to the
side and calms him without speaking. Julius looks puzzled, but he is quickly
ready to play again. The strategy of doing more by doing less is working!
I called this mother three
days later and was delighted with the results she reported. Julius is now
sleeping from 10 PM to 4 AM, at which time he wakes up to breastfeed. The
parents hear him stir in Active sleep but leave him to find his own way back to
Deep sleep. Mum reports, "Yesterday I felt like a new woman. I made some
cookies, took the baby for a walk, and was singing when my husband got home
from work." She shares that she now hesitates a moment before responding
to her son—and sees his increased “self-regulation” capabilities as both
reassuring and exciting.
In closing the phone conversation,
I review upcoming developmental changes that are likely to impact this
remarkable little guy's sleep again, and I discuss how his parents can best
respond to the milestones ahead. The success they are all starting to
experience will provide a reliable foundation for this loving family's future
parenting successes!
© HUG Your Baby 2018
© HUG Your Baby 2018