Marc Weissbluth's Blog, page 7

Cool video on the effects of media on attention span

Dimitri Christakis is one of the thought leaders in the field of media and child development. Here is a ~15 min. TED Talk that I found to be really interesting about how fast moving imagery (like in the Baby Einstein videos) can entrain shorter attention spans and inhibit learning. Although they are animal studies, they are elegant experiments and his discussion is engaging.

Enjoy!

-Daniel Weissbluth, MD

Filed under: Media Topics

Nap Facts 4-6 Months

Some babies have predictable mid-morning and mid-day naps. Each nap is 1-2 hours. Other babies still have brief naps or a mixture of long and brief naps. Post-colic babies and others who have not yet learned self-soothing skills are more likely to have brief naps. Don't compare napping patterns in babies and be patient.

Some babies have a brief late afternoon 3rd nap and two major naps (mid-morning and mid-day). Perhaps these babies are able to have a later bedtime than those who sleep less during the day. Don't compare bedtimes.

The variability between babies is often frustrating when parents compare their baby to other babies. Accept the fact that babies are different and stay on course to ensure good quality night sleep (especially a bedtime at night that is in synch with emerging drowsy signs). In general, practice soothing your baby when drowsy signs are first emerging but sometimes (especially if the wake-up time is very early) also try to stretch your baby towards mid-morning and mid-day to have the naps occur in synch with nap rhythms.

Marc

Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App.

Filed under: Nap Facts

Nap Facts: Birth to 3 months

Naps are irregular and brief. Help your baby learn self-soothing skills as soon as you come home from the hospital: put your baby down drowsy but awake, keep the intervals of wakefulness short to avoid a second wind, and get dad (or anyone else) on board to do nap duty when available. Swaddling and pacifiers might help and will not harm your baby. For those with colic, do whatever works to maximize sleep and minimize crying: swings, strollers, cars, sleep at mom's breast or on dad's chest.

Focus on night sleep and after 6 weeks of age, counting from the due date, move the bedtime earlier. Watch for drowsy signs at night and catch the wave.

Some brief naps might be extended by re-swaddling, a quick feeding, or replacing a pacifier.

Marc Healthy Sleep Habits, Happy Child

Weissbluth Method Infant Nap App.

Filed under: Nap Facts

Toliet Learning- Behavioral Book Review #9

Bowel and bladder training has become the most obviously disturbing item of child training in wide circles of our society. -Erik Erikson,

Recently, a colleague recommended to me a book called, "Toilet Learning" by Alison Mack. Anytime a parent or doctor recommends a book, I try to read it first and then I "field test" it by recommending it to other families and having them report their reviews back to me. "Toilet Learning" was very popular among the families that read it and I liked it a lot too.

The book is divided into two parts: Part one is for the parents and gives a nice analysis of the history of toilet training. There is a thoughtful discussion of current methods and misconceptions. She writes well about the different stages and the potential pitfalls at each stage. Mack says there are three stages in preparation of toilet training: "has wet," "is wetting," and "will wet." When the child can let the parent know in advance of a bowel movement, then the parent can begin toilet training (what is represented in part 2 of the book).

Part two of the book is illustrated and meant for the parents to narrate with their child. Reflecting the book's 1978 copyright, the illustrated mothers and fathers have bell-bottoms, afros, and lots and lots of mustaches. To me, it was hilarious! I think this book is currently out of print but can be found online.

I would recommend this book to any family with a ~2-3 year old child who has questions regarding toilet training. I personally have taken a few lines out of the book for my own discussion with families and found the information very helpful.

What books on this subject have you liked?

-Dan

Six Sleep Problems and Solutions

Infant Nap App for iPhone/iPad

Filed under: Behavior

Sleep Smarts #1

1. The single most important fact to remember is that the time when sleep occurs is more important than the duration of the sleep period. You can't fight circadian rhythms! We all have internal clocks that are genetically controlled. These clocks create an internal timing mechanism for sleep. These clocks evolved from dark (night)/light (day) cues. This signal is very primitive because it is based on the rotation of the earth on its axis. Sleeping in synch with circadian rhythms is more restorative, of better quality, than sleeping out of synch with circadian rhythms. Jet-lag syndrome is an example of sleep not in synch with circadian rhythms.

Additionally, a bout of sleep that is continuous (consolidated) is much more restorative than a bout of sleep that in interrupted (fragmented).

Marc

Six Sleep Problems and Solutions

Infant Nap App for iPhone/iPad

Filed under: Healthy Sleep

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Filed under: Announcement

Swing Sleep and Motion Sleep

Swing Sleep & Motion Sleep

Clarification: A baby rocking asleep in a swing at home in a dark and quiet room probably has more restorative daytime sleep than a baby sleeping in your arms or stroller in a light and noisy mall. Both are sleep in motion but I suspect that those babies who are able to sleep in a light and noisy environment are more likely to be babies who are somewhat sleep deprived in general due to late bedtimes, fragmented night sleep, or naps that are sometimes not synchronized with biological periods of daytime drowsiness. It is also possible that the naps in light and noisy environments are themselves less restorative because of lighter sleep or shorter duration. So when I encourage stationary sleep in the crib or bed over sleep in motion, I am thinking more about discouraging sleeping outside than swings at home. I believe that thinking about naps at home helps organize parents' plans about sleep in general: teaching self-soothing, early bedtimes, consolidated night sleep, and naps is synch with biological rhythms.

Question: How long do I use a swing to get good naps?

Answers: Why was the swing used in the first place?

A. Habit. "My child is well rested without sleep problems and he can be put in the swing and crib at night drowsy but awake but I just got in the habit of using a swing for naps." He is well rested and has self-soothing skills.

If he is under 4 months of age." Experiment with first turning off the swing after he is in a deep sleep for his nap and if he continues to sleep, after a week or two, transition him to a crib for naps. If this involves some low level crying for several minutes in the crib for the naps, consider sticking with the plan for 4-5 days to see if the crying decreases and naps increase before going back to the swing. During this transition from swing to crib, an earlier bedtime might be needed. Also, if your child is younger than 3-4 months, shorter intervals of wakefulness might be needed during this transition.

At any age, when you stop the swing, if he cries or awakens immediately, he probably was not in a deep sleep so allow him to sleep a little longer while swinging before you turn off the swing. If this still occurs after a longer duration of swinging, consider the possibility that he needs an earlier bedtime or a shorter interval of wakefulness between naps.

If your child is 4 months or older, similarly, experiment with turning off the swing after he is in a deep sleep for his nap and if he continues to sleep, after a week or two, transition him to a crib for nap attempt. If this involves some crying for up to one hour for the naps in the crib stick with the plan for 1-2 weeks and time the naps in the crib at his best mid-morning and mid-day nap time independent of intervals of wakefulness because biological nap rhythms are developing. If you are not successful, go back to using the swing to restore any accumulated sleep debt and try again with an earlier bedtime in place and shorter intervals of wakefulness before the nap attempts. Naps lengthen between 4-6 months of age so it is possible that when you make the transition from swing to crib, you may wind up with shorter total nap duration and the bedtime now has to be earlier. This earlier bedtime might be temporary as the naps lengthen between 4-6 months of age.

If your child is 6 months of age or older, first experiment with turning off the swing after he is in a deep sleep for his nap and if he continues to sleep, after a week or two, transition him to a crib for nap attempt. If this involves some crying for up to one hour in the crib for the naps stick with the plan and do not look back. Initially, you may wind up with shorter total nap duration and the bedtime now has to be earlier. This earlier bedtime might be temporary or permanent.

B. Only way to get a nap. "I use the swing because my child has difficulty falling asleep unassisted. I soothe him to a drowsy but awake state but when I attempt to put him down in his crib, he either cries or fusses loudly then or shortly thereafter. I discovered that the only way to get naps was to use the swing. Usually he has to be in a deep sleep before I can put him down in the swing." He might not be well rested and does not have self-soothing skills.

If your child is under 6 weeks of age, practice putting your baby down in the crib drowsy but awake after only one hour of wakefulness in the morning and maybe accept some low level crying for several minutes in the crib, focus on brief intervals of wakefulness, a dark and quiet room, get Dad on board, and use the swing for sleep at all other times. You are allowing your baby to begin to learn some self-soothing for the morning "nap."

If your child is 6 weeks of age or older, continue to do the above but now include a focus on an early enough bedtime to avoid a fussy period near the end of the day. Consider allowing your baby to learn some self soothing at bedtime by putting him down drowsy but awake and allow several minutes of low level crying.

If your baby is 4 months of age or older, continue to do the above but now include a focus on best times for a mid-morning and a mid-day nap.

Whenever you think your baby has acquired more self-soothing skills, then experiment with first turning off the swing after he is in a deep sleep for his nap and if he continues to sleep, after a week or two, transition him to a crib for naps.

At any age, when you stop the swing, if he cries or awakens immediately, he probably was not in a deep sleep so allow him to sleep a little longer while swinging before you turn off the swing. If this still occurs after a longer duration of swinging, consider the possibility that he needs an earlier bedtime or a shorter interval of wakefulness between naps.

Acquiring self-soothing skills is a prerequisite for success in transitioning from swing to crib. But this acquisition of self-soothing skills might not be an all or none event and there might be a messy month during which he gets better at self-soothing and accepts the crib without protest. The failure to develop self-soothing skills usually occurs when the bedtime is too late, there is fragmented sleep, or naps are not in synch with biological nap rhythms.

Tip: At any age, it might be a good idea to use the swing for a longer period of time, for example, a month or so to help repay a major sleep debt or help a colic or post-colic child first learn self-soothing at night onset, or in the middle of the night, or for the first morning nap (either after one hour of wakefulness in children under 3-4 months or at the best mid-morning nap time for older children) before attempting to transitioning to a crib. Accept that this entire process will involve some trial and error and there will be a trend towards success punctuated with frustrating setbacks. But if you stick to the age appropriate plan and consider all sleep elements (bedtime, consolidated night sleep, and timing of naps) you will succeed.

C. Other Children or Twins: "With other children, I had to use the swing because I was unable to do as much soothing as my baby needed." Make a judgment call whether your child is well rested and proceed with A. above or maybe not well rested and proceed with B. above.

Marc

Filed under: Uncategorized

NO NAP=NO DIP IN CORTISOL AND LOW SLEEP TANK IN AFTERNOON

New Research Publicaton

Toddlers grow up grumpy without an afternoon nap

Toddlers who are denied regular afternoon naps grow up into grumpier and moodier adults, a study indiates.

Researchers say missing naps 'taxes the way toddlers express different feelings'

Tired young children are unhappier, more stressed and at greater risk of lifelong mental health problems, the research claims.

Findings reveal that toddlers who miss just one daytime nap become more anxious and less interested in the world around them. They were also less excited by happy events and the slightest stress makes them crankier.

US researchers say this is because missing naps 'taxes the way toddlers express different feelings.' And long-term sleep deprivation could even lead to 'lifelong, mood-related problems,' they warn.

The team, from the University of Colorado Boulder measured the sleep patterns of toddlers aged two to three. Kids wore a special device which measured how much they slept, with their parents also keeping a sleep log.

Study author Professor Monique LeBourgeois filmed the toddlers' facial expressions as they completed two jigsaws on one day where they'd had their usual nap, and on another when they'd been deprived of it.

Results, published in the Journal of Sleep Research, showed that tired toddlers who successfully completed the first puzzle were a third [34 per cent] less positive in their emotional responses than when they'd been well-rested.

And on being given another deliberately unsolveable puzzle the team noticed tired toddlers were a third [31 per cent] more stressed by it than when they'd enjoyed their usual nap.

Toddlers who had missed out on a nap were also more than a third [39 per cent] less curious about the unsolveable puzzle than when they were well rested. Prof LeBourgeois warned that 'Confusion is not bad,' adding that it was necessary to help kids learn from their mistakes.

Prof LeBourgeois added: "Many young children today are not getting enough sleep, and for toddlers, daytime naps are one way of making sure their 'sleep tanks' are set to full each day. [HE LIKES MY METAPHOR 'SLEEP TANK', MARC]

"This study shows insufficient sleep in the form of missing a nap taxes the way toddlers express different feelings, and, over time, may shape their developing emotional brains and put them at risk for lifelong, mood-related problems."

"Just like good nutrition, adequate sleep is a basic need that gives children the best chance of getting what is most important from the people and things they experience each day."

Discussing the wider implications, she added: "When well-slept toddlers experience confusion, they are more likely to elicit help from others, which is a positive, adaptive response indicating they are cognitively engaged with their world."

"The non-adaptive emotional effects we saw in toddlers who missed a single nap make us wonder how young kids who consistently don't get enough sleep deal with their complicated social worlds.

"A sleepy child in a classroom or nursery environment may not be able to engage with others and benefit from positive interactions.

"Their coping skills decrease and they may be more prone to tantrums or frustration, which would affect how other children and adults interact with them.

"This study shows that missing even a single nap causes them to be less positive, more negative and have decreased cognitive engagement."

Filed under: Behavior, Nap Facts

Colic and SIDS

DO NOT WORRY IF YOUR BABY HAS COLIC! THERE IS

NO

PROVEN LINK BETWEEN COLIC AND SIDS

I want to discuss a question that occurred to me more than 30 years ago. The reason that I did not want to discuss this in the past is because there is embedded in the question some frightening implications. But now I think that parents on this blog might clarify or answer the question based on their experiences and those of their friends.

The question is: Does colic or infant fussiness/crying/wakefulness prevent SIDS?

Both colic and SIDS spare the first several days of life. Both occur mostly in the evening/night hours. And both are largely gone by a few months of age. When the individual bouts of colicky behavior end, the baby falls asleep and SIDS is thought to usually occur during a sleep phase. But the medical literature suggests that a more "easy" temperament might be associated with SIDS and the colicky baby has the opposite ("difficult") temperament.

The frightening implication, which I want to emphaisize is not based on solid research, is: Is it possible that an "easy" temperament baby is at an increased risk for SIDS or a colicky baby, when the colic abruptly ends, is at an increased risk for SIDS?

In a paper (Medical Hypothesis 7(9):1193-9, 1981), I wrote that "Four (27%) of the 15 SIDS victims had colic [more than 3 hours/day of irritability, fussiness, or crying occurring more than 3 days/week, and lasting more than 3 weeks], but the spells had disappeared before their deaths." A few parents described how happy they had been to see there child suddenly stop crying/fussing and sleep better only to be devastated days later with SIDS. In other words, in this very small sample, when colic was present, SIDS did not occur. I wondered then if colicky crying represented a wakeful drive to breathe (arousals from sleep) and thus had a protective function. But I could not celebrate the presence of colic as a good thing because of the fear that this was a marker for or a risk factor for the subsequent development of SIDS. Additionally, I recognized the possibility that there might be multiple causes of colic and SIDS so it would be inappropriate to think that all colic was associated with preventing SIDS or all colic might be a risk factor for SIDS when the colic ends . I was a full-time academic pediatrician then working with neonatologists doing research on arousals from sleep and SIDS. I tried to talk to more mothers outside of the published research group who had just recently lost their babies to SIDS about their infant's sleeping and crying behavior prior to SIDS to help decide how to gather data and do further research. But these mothers became so upset during the interviews I did not pursue further research with parents. Perhaps some of you have observations that you can share.

Subsequently, I authored two papers (Journal of Pediatrics 101:307-10, 1982 and 106: 688-90, 1985), about the association between breathing during sleep, infant temperament, and sleep duration that seemed to support a possible association. Although "low parental ratings for the three temperamental features intensity, activity, or threshold were associated with less physical activity during sleep, fewer night wakings, and increased respiratory dysrhythmia during sleep…it should not be concluded that less sensitive infants are necessarily at increased risk for SIDS."

Finally, in 1992, my wife, Linda, and I proposed that elevated serotonin levels are associated with colic and subsequent published research by others showed this to be correct. More recently, in 2010, published data linked low serotonin levels with SIDS. "Serotonin is a hormonal neurotransmitter closely linked to many of the body's vital functions, including the sleeping cycle." So we are back to the subject of sleep!

What are your thoughts? Do any of you know of a clearly colicky child who was still having colicky crying/fussing and then died of SIDS when the colic was still present or did the colic disappear before the SIDS.

Another disturbing thought that I would like your opinions and observations on is whether SIDS, which is more likely to occur in the evening/night hours, is more likely in those infants who are extremely sleep deprived, especially during the day. I want to empnasize that I am not thinking about the normal daytime sleep issues that all of you have experienced but I am thinking of much more extreme nap deprivation that I encountered before I wrote my book. No one on this blog has negleted day time sleep but I have, in the past, encountered parents who never thought of putting forth effort to nap their child. Could SIDS be the final common pathway of such extreme daytime sleep deprivation so that the baby is so totally exhausted by evening or night he cannot make a wakeful drive to breathe?

Marc

Filed under: Colic

Happy New Year From The Weissbluth Method!

Welcoming 2012- he already has more hair than both of the Drs. Weissbluth!

Thanks for being a part of our blog and we hope you enjoy it in 2012.

-Marc and Dan

Filed under: Announcement