Save Our Sleep

by Tizzie Hall

Try to avoid lifting your baby’s legs up while changing her nappy. Roll her onto her side instead.

I recommend you swaddle your baby until he is at least six months or you notice he is attempting to roll swaddled.

I suggest as soon as you notice your baby is trying to roll swaddled you take the swaddle off him at the next morning sleep.

However, if your baby is not in a good routine, I would recommend swaddling him until he is four months old, or when he starts to move more during his up time. This will need to be a slow transition. Because your baby will not feel as safe and secure as a baby in a routine, taking the swaddle away cold turkey could cause problems. If you are going to take the slow approach to weaning your baby off the swaddle, you need to do it well before there is a risk to your baby’s safety. If you wait until your baby is older than four months, he might become tangled in or covered by the swaddle.

In my experience, dummies are a common cause of sleep problems. Of the parents who contact me about their baby waking every two hours during the night and catnapping during the day, 60 per cent are giving their child a dummy as a getting-to-sleep aid. Another ten per cent use other sleep aids, such as rocking, patting or feeding. There are seven reasons why a baby with a dummy wakes more frequently than one without.

A baby with a dummy often finds it harder to achieve a deep sleep as their intermittent sucking will disturb their sleep pattern.

The constant sucking can trick your baby’s body into thinking there is food coming, which causes him to digest the milk feed too fast and makes him hungrier than a baby without a dummy.

Dummy use can also interfere with speech development. If you watch a contented baby lying in his cot, he will be looking around and making babbling sounds. This is the baby’s first attempts at speech. A baby with a dummy, however, will be concentrating on sucking and will not be looking around or babbling.

Comforter A comforter is what I class as a ‘good’ aid, something your baby uses to go to sleep but that he does not need your help with between sleep cycles. Every baby uses an aid of some sort to comfort himself with just before he goes to sleep but unless parents have introduced the aid themselves, they are usually unaware of just what it is (with the exception of thumb-sucking). An unintroduced comforter could be holding, rubbing or playing peekaboo with the sheets or blankets, but sometimes it can be a little more complicated. I have seen babies play with the bars in their cots just before falling asleep which can cause a problem when you ask them to fall asleep in a travel cot or anywhere away from their beloved cot bars. Another common comforter is playing with labels or tags on bedding or clothing.

Luke’s story Up until ten months old, Luke had always been a good sleeper, having been started on my routines at five weeks old. At ten weeks he started to sleep all night and had done so nearly every night since. But suddenly at ten months he was finding it hard to go to sleep and, once asleep, was waking up crying several times throughout the night. I consulted with Luke’s parents several times over the phone but we couldn’t work out what the problem was, so a house visit was the only option. After Luke was put to bed, I decided to sneak into his room on all fours and observe him. At first, things appeared okay and Luke was lying down looking ready for sleep. As I watched I noticed a funny movement of his hand. He was putting his fingers down as though trying to scratch his wrist before becoming frustrated and starting to cry. It was not the cry of a baby fighting sleep but of a tearful and genuinely upset baby. I picked him up and went to talk to his parents. After a few minutes we realised he was looking for the sleeves of his winter pyjamas but, as he was now in short sleeves for summer, he couldn’t find them anywhere. It was now obvious what Luke’s problem had been. We put Luke back in long sleeves and he started sleeping through the night again. Luke’s story was a clear case of a baby who was comforting himself to sleep using an aid that the parents were totally unaware of. It is also a good example of why it is better for parents to choose their baby’s comforter fo...

Tricks of the trade There are also a few tricks to introducing a comforter to your baby. Try starting with mum putting it down her top for a few hours (interesting look with a teddy head!) to allow her smell to infiltrate it. Then place the comforter in the cot near baby’s face so he can turn and snuggle into it; it is amazing to watch a baby take solace from their comforter.

It is my experience that babies with comforters are much happier and more secure as they progress through certain milestones in their lives. For instance, at about nine months babies often become very clingy to mum when they realise they are individuals and not a part of their mothers; a comforter seems to help with this transition. Comforters also help babies learn to sleep in different places such as the car, pram and travel cots while on holidays or at day care. And research published recently in Germany suggests that toddlers feel much more secure if they have a comforter with them for the first few visits at kinder or day care.

firmly recommend that a comforter is only given to a baby at sleep times or on occasions when some additional comfort is required, such as a visit to hospital or the doctor. In my opinion, it is not good for children or babies to be carrying their comforter around all day. My reason for this is if the comforter is carried around all the time it will no longer help a younger child recognise it as a going to bed signal and it will not help the older child with new milestones such as the first day at school because they are used to having it with them all the time.

SETTLING YOUR NEW BABY TO SLEEP One of my most important rules when it comes to babies and their sleep is to always put your baby down to sleep where you intend him to wake up, and to always put him to bed awake. Enabling a baby to settle himself is the key to successful sleep patterns. If you rock, cuddle, feed or give your baby a dummy to go to sleep, then this is what your baby will expect to have when he comes into the light stage of the sleep cycle. Instead of resettling, your baby will wake himself up looking for you or the sleep aid, and then cry out for you to put his dummy in or rock, pat or feed him back to sleep.

There are two ways I recommend you teach a new baby of up to two weeks old to self-settle and the sooner you take on the challenge, the easier it will be on everyone. The first I suggest to clients who I feel are really committed to teaching their new baby to self-settle and prepared for a bit of initial crying! Make sure your baby is well fed, winded and has a clean nappy, then swaddle him correctly and put him down in bed, with correct bedding, on his back with his comforter beside him. Go into the kitchen, empty the kettle and refill it with cold water, boil it, make yourself a cup of tea, sit down and drink it. If at the end of your cup of tea your baby is still protesting, go and see if there is a problem such as wind or poo. It is important you listen to your baby’s cries and if you think it is an emotional cry offer some milk. Most of the time, before you have even boiled the kettle your baby has gone to sleep.

Make sure your baby is well fed and winded, then swaddle him and put him in bed on his back with his comforter beside him. Allow him to shout (cry) for a minimum of two minutes (time it from when he actually starts to cry, as he may stay quiet for a few minutes at first). The longer you can stay out the better for your baby as going in is more for your sake than your baby’s, and always time the period of crying as one minute may seem like ten to a parent.

When your baby is crying, try to listen to the cries. The cry of a baby who is fighting sleep has gaps and the tone and pitch will vary. A protesting cry may sound, for example, like this: waaa, pause for a second, wa, pause, waaaaa, pause, wa, pause, waaaaa, pause, waaaaaa, pause, wa, and so on. You should hear the pauses getting longer as your baby starts to fall asleep. If you are able to watch your baby without him seeing, you will see him shut his eyes and nod off before jumping and yelling again, as though he has realised he is falling asleep.

A whinge cry.

The cry of an emotional or hungry baby is continuous with no pauses and doesn’t vary in pitch or tone, for example: waa, waa, waa, waa, waa. This cry I would never ignore. Get the baby up and look for a problem and, if there is no visible problem, I would offer some more milk.

A true baby cry.

Babies need to be listened to. It is unfair on a baby to just desperately try to stop him from crying rather than try to interpret his cries. Put yourself in your baby’s place. Imagine you are sad and trying to tell a friend how you felt but, because your friend can’t stand your tears, she just keeps saying, ‘Come on, stop crying, it will be okay.

Wind? If your baby seems stiff and when you lie him down brings both knees up to his tummy, it could be wind.

The main thing parents of older babies need to understand is the differences between a protest cry, which is like a temper tantrum, and an emotional cry, which occurs because a baby’s needs are not being met. If a baby over six months is crying an emotional cry, you will see tears and hear sobbing (I often call this a wet cry). You should comfort an emotional baby straightaway. I feel very strongly that ignoring an emotional cry could cause psychological damage and stress to a baby, which is why I disagree with controlled crying, as walking in and then out is like teasing the baby and always makes him emotional.

I believe you can ignore this protest for as long as it takes for your baby to go to sleep. The noticeable difference is your baby will stop protesting and go to sleep from a calm state, without any tears or sobbing before or after falling asleep. A baby who is protesting, as with a toddler having a temper tantrum, will not protest for long.

I have often read that babies don’t produce tears until as late as six months but I doubt the truth of this and have seen babies as young as six weeks crying with tears and emotion. Perhaps the belief came about because most babies have no reason to cry an emotional cry until six months.

Is it really all right to let my baby cry? I do not think it is all right to let a baby cry an emotional cry, however I believe you may let a baby protest (the broken cry you hear when a baby is trying to go to sleep). If you responded every time your baby protested, he would soon learn to protest whenever he wanted your attention. In fact, you would cause him to protest more. It’s not fair on a baby to be taught that someone will respond to every protest because, as your baby grows up, other people won’t like this behaviour.

Both babies and their parents gain from following my routines. The babies benefit because they don’t need to cry as much as babies not on a routine (crying being a baby’s main method of communication) and they also feel very safe and secure on a routine. Parents benefit from my routines because they find it easier to interpret their baby’s cries and can plan their days around sleep and feed times.

Some of my parents make it a habit each day to put their baby in the pram for the 9 am or 1 pm sleep and go for a walk. They walk to a café for breakfast or lunch and then walk home again for the 11 am or 3 pm feed. When the baby gets older they may walk earlier and give her a solid meal at the café. From my experience, the more fresh air and daylight babies get the better they seem to sleep at night.

Routine for a baby aged eight to ten weeks This routine is for a baby aged 56 to 69 days old. Feed times Sleep times Bedtime 7 am 8.45 am 7 pm 11 am 12.45 pm 3 pm Nap Dreamfeed 6.30 pm 4.30 10.30 pm

Routine for a baby aged ten weeks until you introduce solids This routine is for a baby aged 70 days old until you introduce solids. Feed times Sleep times Bedtime 7 am 9 am 7 pm 11 am 1 pm 3 pm Nap Dreamfeed 6.30 pm 4.30 pm 10.30 pm

I would like to start my fifteen-week-old on your routines, but she has been sleeping from 7 pm to 6.30 am every morning without the dreamfeed – should I still introduce it? If your baby has been sleeping all night without the dreamfeed then no, you shouldn’t introduce it. But if, as your baby gets older, she starts waking at night again, you will need to either introduce solids (if she’s over four months old) or give her the dreamfeed.

Most healthcare professionals recommend starting solids between four and six months as breastmilk or formula provide all your body’s nutritional needs up to six months, so any solids introduced before then serve only to get your baby used to different tastes and textures.

I recommend you start your baby on solids between 4 (or sixteen weeks) and 4.5 months.

Introducing solids before four months can damage your baby’s digestive system as it takes up to four months to develop a gut lining strong enough to cope with solids while the kidneys are still not mature enough to handle the extra waste.

Over the years I have noticed that babies introduced to a wide range of non-allergy-forming foods between the ages of four and four and a half months accepted a wider range of foods at one year than babies introduced to solids after four and a half months. Starting solids later than four and a half months can be linked to problems such as fussy eaters, food and texture refusal, catnapping and repeated night waking. I also believe that after six months a baby needs nutrition from other sources, but if at six months he has only just been introduced to solids, your baby will still only be having a ‘taste’ and not getting enough to meet all of his nutritional needs.

My routines always give the milk feed first as it is important for a baby up to one year to get his full daily milk intake.

First foods – by age From 4 months Apples: Peeled, cored, cooked and given as a purée. Carrots: Cooked and given as a purée. Pears: Cooked and given as a purée. Potatoes: Cooked and given as a purée. Pumpkin: Cooked and given as a purée (see UK pumpkin at 8 months). Rice-based infant cereal Swede: Cooked and given as a purée. Zucchini (courgette): Cooked and given as a purée. From 5 months Beans (green): Cooked and given as a purée. Sweet potato: Cooked and given as a purée. Turnip: Cooked and given as a purée. From 6 months Apricots: Stoned, cooked and given as a purée. Avocado: Mashed. Bananas: Raw as a purée (look out for constipation). Broccoli: Cooked and given as a purée. Butter: In a small amount while cooking. Cauliflower: Cooked and given as a purée. Cheese: Give in very small amounts initially and watch for a reaction. Chicken: Puréed in a casserole. Fish: Look out for a reaction. Lamb: In a casserole. Lentils Mango: Raw, mashed or puréed. Oats: In a breakfast cereal. Peaches: Cooked and given as a purée. Peas: Cooked and given as mash or purée. Watermelon: Given with pips removed or as purée. Yoghurt: Look out for a reaction.

From 5 years Nuts: I would never give whole nuts to a child earlier than this – see note below. Kiwifruit and grapefruit: can cause an allergic reaction. These foods are DANGEROUS to some young children: Honey: There is some danger of infection from botulinum spores. Tea: The tannin and other compounds in tea can affect the absorption of iron.

Whole nuts should never be given to a child under five as they can inhale them, choke on them or even stick them in their nose or ears.

Studies have shown that in the twenty years since the World Health Organization recommended parents delay starting solids until six months, food allergies have increased by 300–400 per cent but only in English-speaking countries. Every year in Australia, about 9000 children develop peanut allergy. This results in costs (such as EpiPen), inconvenience (such as food choices at home and school), and a small but significant mortality rate from anaphylaxis. In recent years, there has been increasing evidence that there is a period of oral tolerance where a baby’s gut is most capable of recognising a potentially allergenic protein as being food an...

The other problem with commercial food is that older toddlers occasionally refuse to eat anything else and won’t join in with family meals.

am If your baby wakes before 7 am, delay her milk feed until 7 am as this will encourage your baby to sleep longer. Otherwise, wake your baby at 7 am and give her a milk feed. 8 am Give your baby breakfast. Feed your baby until she turns her head away. I recommend you give your baby two courses, one savoury and one sweet. 9 am Put your baby to bed awake and allow her to self-settle. This means without the help of you or a dummy. 11 am Give your baby her milk feed. This feed will start to get smaller as your baby gets older and is eating more solids. 12 noon Feed your baby two courses of solids, one savoury and one sweet. 1 pm Put your baby to bed awake and allow her to self-settle. 3 pm Wake your baby up and give her a milk feed. 4.30 pm If your baby has not slept well, you might want to encourage a nap in the car or pram. At about 6½ months your baby no longer needs this nap. 5.20 pm Feed your baby two courses of solids, one savoury and one sweet. If your baby is now skipping the nap at 4.30 pm, try giving solids at 5 pm to allow a bigger space before the milk feed. 6 pm Bath your baby, or give top-to-toe wash. 6.20 pm Give your baby her milk feed. Your baby needs to finish this feed at least ten minutes before bedtime. 7 pm Put your baby to bed fully awake and allow her to self-settle. 10.30 pm Dreamfeed.

Note: If you are starting this routine with a baby over four months who is sleeping from 7 pm until 7 am without the dreamfeed (see page 90) you do not need to introduce it. However, if your baby starts to wake at 5 am you will need to either introduce the dreamfeed or solids. If there is no history of allergies in your family, I recommend you introduce solids rather than the dreamfeed.

Overtiredness is a very common problem in babies and it surprises me how often it goes undiagnosed. When an adult is tired she tends to slow down, but when a baby or toddler gets tired they speed up and become hyperactive.

EARLY RISING I believe that all babies are capable of sleeping in to 7 am, and there is no such thing as an ‘early riser’. If you are finding that your baby settles and sleeps well at 7 pm only to wake up at 5 am every morning ready to start the day, take a look at some of the common causes I have found for early rising. The bedtime ritual If the last milk feed or story is too close to bedtime your baby could be using this as a sleep aid and be going to bed already sleepy. Then, when your baby wakes at 5 am, she is looking for the same aid to help her back to sleep. Often just changing the bedtime ritual and making sure the last twenty minutes before bed is taken up with stimulating play will help your baby sleep until 7 am.

A big contributing factor to babies and toddlers not sleeping through the night is temperature. The baby’s room should be heated to 20°C with an oil heater or cooled to 22°C day and night when using an air-conditioning unit.

The time of your baby or toddler’s daytime sleep It might be that your baby is having her daytime sleep too early in the day. Over the years, it has been my experience that the time a baby wakes up in the morning can be affected by the time you put her down for her first sleep of the day. I have not yet worked out why this happens but, I can tell you, it does have an impact. So, if the warmth and the bedtime ritual are not issues, start to move the daytime sleep. This usually only applies to babies older than seven months. If you are following my routine and putting your baby of seven to nine months down for her first sleep of the day at 9.20 am each morning but they are waking at 6.15 am or earlier from the night sleep instead of 7 am, try moving the 9.20 am sleep to 9.40 am. If your baby is over nine months, try moving the 9.50 am sleep to 10.15 am. If you have a toddler, I suggest moving your toddler’s day sleep forward by twenty minutes every three days until you find a time that your baby is sleeping in until 7 am in the morning.

Too much daytime sleep Some babies and toddlers need less daytime sleep than others, so you can also try cutting the amount of daytime sleep to see if this helps your baby sleep in until 7 am. An average amount of daytime sleep for babies under five months old is four hours and 45 minutes; for a baby aged five to seven months, the average is four hours and twenty minutes; a baby aged seven to nine months will usually sleep for four hours; and a baby aged nine to twelve months old will sleep for an average of just three hours. Once a baby reaches twelve months old it is a little harder to give average times, but I would not let a baby of between twelve and eighteen months sleep longer than two hours and 30 minutes; a toddler of between eighteen months and two years longer than two hours and fifteen minutes; a toddler aged two years should sleep no longer than two hours; and a toddler aged three years no longer than an hour during the

Rylen’s story Nine-month-old Rylen’s parents were concerned about how restlessly he was sleeping at night and how early he was waking in the mornings. At the time, Rylen was on the sleep routine for his age and didn’t have any settling problems. Rylen would go to bed at 7 pm and get himself to sleep in a few minutes. But come midnight, he would start to move about the cot, banging his head and often getting his arms stuck between the cot bars. This unsettled sleep would go on all night until 5 am, when Rylen would wake up and be unable to get back to sleep. Rylen’s parents, Claire and John, didn’t mind starting their day at 5 am, but they were worried about his restless nights. So they asked me to come and visit to help Rylen sleep more soundly. One of the first things I did when I arrived at their home was to look at where Rylen slept and what he wore to bed. I saw that Rylen’s cot had cot bumpers on it and explained to Claire and John that cot bumpers are not recommended by SIDS researchers. There was also no bedding in Rylen’s cot or around his room. Claire and John explained that they’d been told bedding was unsafe and to use a sleep bag as a safe alternative to bedding. Since SIDS researchers suggest that the safest way for a baby to sleep is on his back, I have always advised my clients to put their babies in a safe sleep bag. However, I always recommend safe sleep bags are used with bedding, not as an alternative. Sleep bags are a great piece of clothing and help ke...