Marc Weissbluth's Blog, page 12

Extinction At About 6 Weeks of Age.

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24.228.130.172 Submitted on 2011/07/11 at 10:39 pm

Dr. W – I'm wondering it I'm on the right path starting much earlier than most of these commenters, so I'm hoping you can reassure me or advise me. My 7 week old is colicky and until the end of last week needed to be held for all day sleep and a lot of night sleep. We noticed she was starting to have increasing difficulty sleeping on people and around the noises of our 18 month old son and started putting her down in her crib for night sleep. That has been going generally well. She often goes down after about 10 min of crying around 6:15 (the earliest I can do since my so goes down at 5:50/6), and wakes anywhere from 5-45 min later with lots of crying and can then take up to 3 hours to get back down for the night (at which point she starts giving us 3-4 hour stretches until 6am). We do graduated extinction at this point. Naps are a complete disaster. She always goes to sleep after about 10 min of crying, but has yet to sleep more than 10 min before waking and crying. After an hour of back and forth with graduated extinction (or less by the end of the day, because the screaming gets more frantic as the day wears on and I am less able to deal with it), I end up taking her out and trying to lay down with her or otherwise soother her to no avail when it comes to getting sleep. Today it seemed like the entire day was spent trying to get her to sleep, and she probably slept under 2 hours total. Am I doing the right thing? Should I just go to extinction already with a 7 week old? After the train wreck today was I'm feeling very unsure. Right now she went to sleep after 10 min or crying for the night but then woke after 8 and is completely frantic. I plan to give her 12 min to resettle but it's killing me listening to the breath-holding cry…

I think that there may be circumstances when a trial of extinction or extinction with a cap is warranted at night, after about 6 weeks of age (counting from the due date) because night sleep is becoming organized around this time. I hesitate to list the exact circumstances because my list could not cover all the possible variables that might go into making this decision. Briefly, when the parent is extremely stressed, sleep in the child is worsening or not improving despite parent's heroic efforts, and graduated extinction or check and console is not working or is considered by the parents to be unlikely to help, I think a 5 night trial of extinction or extinction with a cap may be considered for some families in dire straits. Ideally, you try to maximize day sleep and minimize day time crying by whatever soothing method that works and you start the night sleep before the baby gets a second wind (6-8PM or earlier if needed). Practically, this might be started on a Saturday when both parents are available to work together as a team. Feed your baby at night whenever you think she is hungry. If after the fifth night there is no clear improvement in night sleep, I would give it up, take a break, do whatever works to maximize night sleep and consider trying it again in a couple of weeks. Discuss your situation with your pediatrician and be comfortable with the knowledge that your child is healthy.

I know that this will help some babies sleep better at night. I do not know when this fails whether the lack of success resides in issues involving the baby, the parents, or parent-child interactions

Marc

Filed under: Colic

Shoot the Monitor!

Audio and visual monitors for your baby might be useful in very few situations. For example, you are in your yard and you want to hear when your baby awakens from a nap. Or your home is multilevel and you think that you really will not be able to hear your baby awaken or cry. But the truth is that monitors are rarely needed. The sleeping brain of the mother is acutely sensitive and discriminating to her baby's cry. Even a quiet cry is like an alarm bell going off in her head. A louder but distant siren will usually not awaken the mother because the brain recognizes that there is no close danger.

Audio monitors robs mother of deep long sleep because it amplifies very quiet sounds that do not need to be attended to. The visual monitor can make a parent compulsively watch their baby when there is no real need for watching. Monitor companies prey on the natural fears of new parents.

Shoot the monitor!

Marc

Here's a nice related article on this topic -Daniel Weissbluth

Filed under: Barriers to Sleep Solutions

Friday Parenting Myth #3

This is a new feature-Please write it in any myths that you would like us to write about! Have a nice weekend

-Dan

Myth: Teething causes Fever

Teething has a long history in medicine. Fever, diarrhea, infection and death have all been attributed to teething. There was a point in history where lancing the gums was considered a treatment for this "ailment!" After looking at parents' reports of symptoms, measurements of fever, and having a pediatric dentist look for signs of tooth eruption, no causality was discovered. So why do parents believe this myth? I think it is because tooth eruption occurs over months and years when many other childhood illnesses and developments occur.

Teething may change an infant's food preferences for bottle or solids. Additionally, putting various objects in the mouth to relieve the teething pain may expose the infant to more viruses that may cause a runny nose or diarrhea. However, the tooth eruption, itself, is not responsible for diarrhea or congestion. When molars come in, some children complain of ear pain and this may be due to swelling in and around the Eustachian tube.

References:

Macknin, Michael L. et al. "Symptoms Associated with Infant Teething: A Prospective Study" Pediatrics 105.4 (2000): 747-752.

Wake, Melissa et al. "Teething and Tooth Eruption in Infants: A Cohort Study" Pediatrics 106.6 (2000): 1374-1379.

Filed under: Common Myths

Questions and Comments 6-9 Months Old

Due to the difficulties of our readers in asking and answering each other's comments, we are going to create posts which separate sleep forums by age. Because there are so many questions, we ask that the reader states these items prior to each question:

1. Age of child (corrected age if born before due date)

2. Self-soothing skills: Yes or No?

3. Colic: yes or no?

4. Bedtime and nap time

5. Time required to soothe for bedtime and naps.

After answering these items, please try to create a brief narrative (~300 words max) that describes your problem- the long questions make the forums difficult to load and access by not only us but also the other readers. We believe that these changes will benefit all of the readers on the blog. We also added a category called "Questions and comments" on the sidebar.

Thanks, Marc and Dan Weissbluth

Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App 0-12mos.for iPhones/iPod/iPad

Weissbluth Method Toddler Bedtime App 12-36 mos.

Filed under: Questions and Comments

Colic

My first book, Crybabies, published in 1985 was the first book ever written on colic and subsequently it was updated and revised as Sweetbabies and now Your Fussy Baby. My interest in sleep in children led me to the fact that many sleep issues started with colic. That's why Crybabies was published two years before Healthy Sleep Habits, Happy Child, in 1987. Colic has different definitions but all definitions describe a lot of fussiness and crying and I highlighted, wakefulness. Some colicky babies are more consolable than others. Some parents of colicky babies have more resources and skills to soothe colicky babies than others. So what follows are general ideas that may or may not apply to your own colicky baby.

Do your best to survive colic and know that it will end. Get help to take breaks. If you wish or if you are at your wits end,try check and console or graduated extinction at night at any age (even at or before 6 weeks of age) early in the evening before a second wind develops for 3-5 nights. Then stop and determine whehter it did or did not help. If it did not help, not to worry, try it again in a few weeks.

Has anyone tried this?

What are your thoughts?

Marc

Filed under: Colic

Two Year Anniversary of The Weissbluth Method

Hello everyone,

Two years ago, dad and I decided to start this blog- we had no idea it would be interesting to so many people and that it would grow to this size! In the last year, the blog has:

1. Increased the average number of views per day to 3x the first year and 2x last year!

2. Translations in Czech and Bulgarian (by our readers) and Vietnamese (by who knows)

3. Started series on "Sleep consults", "Behavioral Book Reviews", "Parenting Myths".

4. Created the Weissbluth Method Toddler Bedtime App for 12-36 mos

We have a lot of interesting content for this next year including "sleep smarts" more "sleep consults", hopefully more video and hopefully another App:). Of course, we will keep you posted (if you have not already done so, please subscribe!)

Thank you,

Daniel Weissbluth, MD

To celebrate, we put our Weissbluth Method Infant Nap App on sale for 99 cents!!!:

Weissbluth Method Infant Nap App 0-12 mos.

If you like the App, please give it a good rating/review!

Filed under: Announcement, Introduction

Friday Parenting Myth #2

Myth: Flu vaccines cause children to "get the flu"

This is a particularly dangerous myth because influenza kills many children all over the world every year. There are currently two vaccines available in the United States: the first is a "dead" virus that is injected-at the site of injection, there may be redness, swelling, or aches. This vaccine can also cause a fever. However, this "dead" virus cannot cause disease. The second type of flu vaccine is a "live", attenuated vaccine- this is a genetically modified flu virus that also cannot cause flu in its recipients. There are no known cases of this genetically modified "live" vaccine reverting to the original influenza virus and causing disease. There are certain children who should not get the influenza vaccine and parents need to discuss their child's health with their pediatrician prior to getting the vaccine.

So why does this myth persist? There is a Latin saying: "post hoc ergo propter hoc" which translates to "after this, therefore, because of this." This fallacy in logic refers to the belief that because A precedes B in time, that A causes B. Many people believe this myth because when they get the flu vaccine, they are also contracting other viruses that are making them sick. Whether this is due to the time of year when the vaccine is administered (winter=more viral complaints) or where the vaccine is administered (health care providers are where many sick people congregate), it is hard to tell. Feeling sick after receiving the flu vaccine is oftentimes a coincidence. That's why pediatricians recommend routine influenza vaccines for infants over 6 months of age, toddlers, children, and adolescents.

I hope all of our readers have a great 4th of July weekend!

-Daniel Weissbluth

References:

Tosh, P.K., T.G Boyce, and G.A Poland. 2008 Flu Myths: dispelling the myths associated with a live attenuated influenza vaccine. Mayo Clinic Proceedings 83 (1): 77-84

CDC, "Key facts about Influenza and Flu Vaccine" http://www.cdc.gov/flu/keyfacts.htm (Accessed June 2011)

Toddler Bedtime App 12-36 mos.

Infant Nap App 0-12 mos.

Filed under: Common Myths

SLEEP CONSULT: CHILD #3

4/20: Parents: "My biggest question is what do I do in the morning when he is calling out for me before 6?"

MW: Go to him if he becomes upset after about 5:30am but not before. The reason is that if you go to him substantially earlier, he will learn to fight his early morning sleep and start the day too early. This will make it impossible to get to 12-1pm for a good quality nap.

At night, if he is up talking or crying but you do not think he is ill, do not go to him at all. If you are not sure and want to do a quick check, than it is essential that father dart in and out to check for fever, vomiting, or difficulty breathing. If he is not ill, exit immediately without talking (very important), soothing, or any social interaction.

NIGHT #1, 4/19: A lot of crying at sleep onset (about 90-120minutes).

NIGHT #2, 4/20: Substantially less crying at sleep onset (about 30 minutes or less). The good news is instead of him finally falling asleep at 9 like he did two nights ago, last night he finally fell asleep around 8 and I think he slept until about 5-5:15am with one brief waking."

NIGHT #3, 4/21: No crying at sleep onset.

4/21: MW: "On NIGHT #1, the first night, you put him to bed at 5:30pm. After about 2 hours of crying, he remained awake in his crib for 30 minutes and fell asleep around 8pm. The previous two nights, he was put to sleep later and stayed awake in his crib until 10-10:30pm. On NIGHT #1, he actually fell asleep earlier. He did awaken as expected around 4am but he did not cry. On previous early morning wake-ups (3-4am) he cried for about half an hour.

On NIGHT #2, he cried much less, about 30 minutes, slept about 30 minutes, awoke without crying for about 30 minutes, and then fell asleep at 7pm.

Let's try to tweak his schedule to shift all times (the morning wake-up, the nap, and the bedtime) to a slightly later time.

Let's try to put him down for his nap around 1pm. Either slowly push it to the later hour or do it abruptly. To accomplish this, he might need extra distraction, comforting, entertainment so he doesn't get too out of sorts. The timing of the nap is more important than its duration. My expectation is that a later nap will be more restorative and thus it might naturally shorten in duration. For now, no matter when the nap starts, wake him after two hours. We do not want a late 2.5 to 3 hour nap because it would interfere with an early bed time. Our hope is that in the future, he will nap a solid 1-2 hours, and the nap will start somewhere between 12noon and 2pm.

Because we are pushing his nap later, let's move his bedtime to 6pm starting tomorrow night. Our hope is that in the future, there will no night awakenings and he will sleep in until 5:30-6:30am.

4/23: Mother: Last night (NIGHT #4) he talked softly to himself until about 7:30 and slept until about 5 so we know he still needs some more sleep but we feel/hope we are on the right path. He fell asleep yesterday around 12:15 for his nap and woke up on his own at 2:30. We are very happy with the positive effect of his earlier bedtime!

MW: As mentioned on 4/21, try to keep him up for a nap until 1pm and do not let him nap for longer than 2 hours. Wake him then even though he will be out of sorts for several minutes ("sleep inertia"). The reason why you "had bouts of good sleeping and then suddenly with no discernable change in the routine it ends and we have several days of disastrous results" is because the bedtime was usually a little too late.

4/25: Mother: He is definitely starting to get back to sleeping through the night and getting more quality rest overall. As each night progresses he's talking and playing for less amount of time in his crib before falling asleep. He's eating better too! He's also been a little less moody. When he's happier, we're happier! The quality of our sleep has improved as the quality of his sleep has improved. I'm able to enjoy time with him more b/c I'm not as completely exhausted and just going through the motions. Our happiness as a family ultimately revolves around the happiness of our children. When he sleeps better, we all sleep better and hence we all feel better.

5/13: Mother: To summarize, we had been seeing small but steady improvement with an earlier bedtime but the vacation really threw off the sleeping through the night. We were very consistent throughout though with an early bedtime and it does seem to work for him. As soon as we got back, we stuck with it and he's been sleeping through the night since our return on Saturday no problem. [This illustrates how consistent schedules will dampen the disruptive effects of colds or vacations] I definitely see an improvement in him–he's happier and eating better, which of course makes me happier. I see fewer temper tantrums.

Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App.

Filed under: Sleep Consult

SLEEP CONSULT: CHILD #3

Here is our sleep solution:

1. Temporarily, we will bathe, feed, and soothe him and put him down, drowsy but awake, at 5:30pm. (see child #1)

2. Extinction. Do not go to him until about 6am. The night awakenings will disappear first in several days followed by the early morning wake ups. Several days later, he will be more comfortable taking a nap that starts around 1pm or so.

3. When he has more consolidated night sleep and a later nap, than he will look and behave substantially better between 4-6pm. When this occurs, we will allow him to stay up later. In the future, we will always watch him between 4-6pm and make a judgment call to put him down for bed between 6-6:30pm: earlier if his sleep tank is going dry between 4-6pm and later if he had a late and/or long nap. I expect this entire process to take a few weeks.

4. If you initially see improvement in consolidated sleep but he starts to get up too early to start the day, than this super early bedtime might be backfiring. If so, we would allow him to have a bedtime between 6-6:30pm. 7pm is too late. There will be some trial and error to find the sweet spot for his best bedtime.

5. In the future when he is well rested, ignore everything I've taught you and ignore naps and/or early bedtimes about 1-2 times per month. Well rested kids can handle occasional disruptions.

6. If he accumulates a bigger sleep debt (illness, family vacation, crossing time zones), than on one night only do the "reset' of a 5:30 bedtime to repay his sleep debt and ignore all protest crying .

7. A "response burst' will occur when he has better night sleep and then out of character starts crying out again at night. This is to be expected. He is just trying to get back to old style to see if mom and dad might come and give him some attention. Check to make sure there is no fever, vomiting, or appearing ill and if he is well, walk away without soothing.

8. A common scenario is that because both of you now are highly motivated, you will see success fairly quickly. But because of long Spring/Summer days you allow him in the future to stay up a little later. Initially, he looks well and appears to tolerate this later bedtime. Then, all of a sudden (cumulative sleepiness) he's back to night wakings. A slightly too late bedtime causes children to cycle in and out of healthy sleep and this frustrates parents because nothing seems to stick. Now that you have a young baby, it's even more important to keep reasonably early bedtimes in place-for both children. So this Summer, I suggest that when you are socializing, each of you take turns going home early with the kids so the other can stay longer with friends and enjoy adult company.

9. Sleep need is positively correlated with intelligence. If he is unusually bright, he might always take great naps and thrive on an early bedtime. Don't compare his sleep needs with other children his age. Always watch him more than watch the clock.

Filed under: Sleep Consult

SLEEP CONSULT: CHILD #3

4/19: MW: Here is a synopsis of his sleep issues. He is currently sleep deprived because he is allowed to fall asleep too late at night. Because his bedtime is too late, he wakes up in the morning too tired which causes him to have difficulty or inability to nap in synch with his biological nap rhythm which starts between 12-2pm. Instead, he tires earlier and falls asleep for his nap before 12 noon. The power of restoration that a nap gives depends more on when it occurs than on how long it lasts. This out of synch nap does not hold him so that "He usually is clingy and ready to come home from wherever he is by 4pm" and when you add in the factor of fragmented night sleep, "he's definitely whiny, clingy, demanding, irritable, requiring more attention" between 4-6pm.

The consequences of not napping well means that by the end of the day he is in an even higher state of arousal so it might become more difficult for him to easily fall asleep at night at an age-appropriate earlier bedtime. The higher state of neurological arousal certainly directly causes him to have difficulty returning to sleep unassisted in the middle of the night or stay asleep during the light sleep phase at 4-5am.

"Cumulative Sleepiness" explains why "for seemingly no particular reason, the night wakings have started again." "I do see the effects of cumulative sleepiness with him when he has a bout of night wakings, he'll start off with one waking, then the next night it will be two or three until we are on a terrible cycle of exhausted boy (& parents), poor quality naps and tantrum-prone or clingy. Usually we end up trying to put him down super-early after a few days of this and trying for a "reset". Sometimes it works, sometimes not."

Be optimistic because both of you agree that he needs help and will work together as a team and you have enjoyed great success with your baby's sleep.

What would you suggest?

Marc

Filed under: Sleep Consult