Help! My breastfed baby wakes me up every few hours all night long.

Dear readers and parents,

A common concern breastfeeding mothers report is that although their child is at the age to be physically able to sleep through the night (around 3-4 months)they keep mommy up by waking up 3-4 times a night to nurse. What is going on?

When babies are first born they need to eat every 2-3 hours throughout the day and night in order to get enough calories. At birth, most infants stomachs are only the size of a quarter. This means they need less milk to fill them up but they burn through the milk quickly thus needing to eat more often. When your baby reaches the age of 3 or 4 months they have probably developed some sort of routine and are understanding the difference between nighttime and daytime sleeping. They can also go for longer stretches without eating. At this age the goal is to fill up their day time tummies so their longest stretch will be in the middle of the night.

Sometimes a breastfed baby begins to sleep longer stretches around 3 months which is very exciting for parents. However, at some point around 4-6 months they begin to wake up more often (every 2 hours) and stop sleeping long stretches in the middle of the night. Today's question is Why?

What may be happening...

As a breastfeeding infant, your baby's primary goal is to begin developing a secure relationship with their caregiver which means they learn to trust that you as their parent will meet their needs when they need something. To an infant they are just beginning to understand this world and how to survive. So the goal for parents is to be attentive and loving to their infants during the first 3 months of life so their baby learns that they are safe. After the first 3 months your baby has probably learned that they are safe and well taken care of but now they are beginning to have preferences and are learning how to get what they "want" not necessarily what they "need". As parents your job now is to try to meet your babies needs by giving them what they want but also begin introducing boundaries and teaching them self soothing skills. Now it is time to make parenting decisions. Your breastfed infant has now learned that they love breastfeeding and they love their mommy. What is probably going on in the middle of the night is that they "want" you. They "want" to snuggle, they "want" to pacify on the breast, they may wake up and "want" you to put them back to sleep. Often they are not waking up to eat.

Now that you know what may be going on for your baby, now what do you do about it? Before we begin any changes in the nighttime feeding arrangement, we must first look at your babies routine during the day. Babies need structure and routine. It helps them understand what is coming next and what is expected of them.

Step #1: Routine

Review or establish a routine for your baby. Your routine can be flexible but should have some structure. Begin by purchasing a notebook and start recording what time your infant wakes up in the morning, times they eat, and designated bedtime. If you do not have a routine start by writing out your ideal routine that would work with your family's schedule.

Things to look for when reviewing your baby's routine...
1. How often do they eat? How long at each feeding? How long of stretch imbetween feedings.
2. When are your babies naps during the day? How long? How does your baby fall asleep? Where are her naps? Is their a routine at bedtime so she knows it is time to sleep?

It is common if you are reading this that you realize that your baby does not have a routine. That is okay, however it is time to establish one and begin following it daily. A baby's daytime routine is directly related to sleeping through the night. Creating a routine for your breastfed baby is the first step to increase stretches of sleep at night.

Step #2 Baby Checklist

Now that you have a set routine (check former blog post for more info), lets look for possible night waking causes.
Ask yourself...
Questions:

1. Is my child eating enough during the day?
2. Is my child getting at least 2-4 hours (2-3 naps daily) of sleep during the day?
3. Is my child sleeping more than 4 hours during the day?
4. Does my child no how to fall asleep without the breast?

These questions will point you to the possible solution...
Answers:

1.If your baby eats every 2 hours throughout the day, this is not a long enough stretch for your baby's body to adjust to going longer stretches at night. At five months, your baby should be able to go at least 3 hours between each feeding. The way to correct this is to start at the beginning of the day and only offer the breast after 3 hours. During the first stretch your baby will more than likely get hungry at their normal 2 hours but you need to distract them and hold them off to 3 hours. This will retrain them to eat more at each feeding thus increasing the amount of food they eat throughout the day.

2. If your baby is not getting at least 2 hours of sleep during the day, then your child is overtired and is having difficulty staying asleep. The solution is to develop a daily sleep routine and help your child get longer naps. Naps should be in the crib (or your families designated sleep area). It should be dark and calm in the room with a form of white noise to drown out daytime noises and to help keep baby sleeping. Pick a designated time for bedtime and try to stick with it. Again focus on developing routine. Create bedtime routine that may consist of a bath and books or just pj's and sometime in the rocking chair.

3. If your child is sleep more than 4 hours during the day, I would suggest keeping it to a 4 hour maximum. The best way to do this is to have a set routine with two 2 hour long naps which are at the same time everyday. Wake your baby up buy turning on the lights and turning off the white noise at about 2 hours.

4. More than likely your baby does not know how to go to sleep without the breast so they wake up often and need you to soothe them or they are waking up because they miss you and just "want" you to put them back to sleep. If this sounds familiar, it may be time to start crib training. Another helpful thing is to have dad go in the room and put her back to sleep with a bottle if it is time to eat. This will show your baby that it is not always mom and this usually encourages them to stay asleep.

Step #3 Make Changes

Now that you have an idea of what may be causing the night wakings, try one of my suggested solutions. If you need additional support or if you think it may be time for crib training, you can contact myself or your local postpartum doula for support.

Postpartum Doulas

www.honestfamilyservices.com
www.cappa.net
www.coloradodoulaassoication.com

Best of Luck,

Michelle

Michelle Chrastil, MA CPD NCC
Honest Family Services, LLC.
www.honestfamilyservics.com

How do I teach my baby to go to sleep on their own?

Dear parents and readers,

Teaching our infants to sleep through the night can be tiresome and frustrating, however it is very important. There are different ways that experts suggest on how to teach an infant to self soothe or fall asleep on their own. Recently a concerned parent asked me if there is a way to teach self soothing without letting your infant "cry it out". My answer to that is "yes, but" there are ways to teach your infant how to soothe themselves through opportunities and practice, however there is no way to guarantee that tears will not be shed.

Most families are working towards a goal of being able to put their child down for bed or nap while they are awake and being confident that their child can fall asleep on their own. Now this may not happen until a child is 2 or 3 years old or as early as 4 or 5 months, however it depends on the parents expectations and determination.

Before I provide suggestion on how to teach self soothing without "crying it out",
Lets talk a little about crying. Infant crying is the most important way babies have of communicating their needs. Babies don't have spoken words to tell us what they need or like or feel. Instead, they have a language all their own. Feet-kicking, hand-waving, head-turning, and different kinds of cries are the "words." Understanding crying is important for parents so they can learn to distinguish which need their infant is expressing based on the sound of their cry. In regards to teaching infants to self soothe, just remember if your child is safe, fed, dry, and securely attached then they will be completely okay crying for a few minutes without you reassuring them. With every transition there is likely to be a few tears since it is your babies way of communicating and they have learned how to get what they want.

Here are a few tips on how to teach your baby how to fall asleep on their own...

First off, developmentally an infant is capable of developing a regular sleep routine and self soothing techniques around the age of 4months. Prior to the 4 month mark, infants are still needing to eat every few hours throughout the night and most importantly, are learning that they can trust their caregivers to meet their needs.

The first thing to distinguish before you start teaching your child self soothing, is to decide whether or not your child feels safe. This means that you want to think about how your infant has been treated over the last few months. Questions to ask yourself include, When my baby cries has she been tended to? Has her environment been consistent? Has she been exposed to any violence or stress within the home? When I pick her up to soothe her does she calm down quickly? Does she know that her needs will be met when she needs something?
If your answers point to the fact that she has been given every opportunity to bond to a caregiver and she now knows that her needs will be met, this means that she has more than likely developed a "secure relationship". This means she knows she is safe and she trusts you. Now you can begin to challenge her by teaching her self soothing which is a valuable lifelong skill.

Teaching Self Soothing

1. Develop a regular sleep and feeding routine. (See Post on Sleeping Through the Night)

2. Routine should include a calm dark room with consistent white noise. It should also include a tight swaddle or a sleep sac for larger babies. This routine may also include a bottle and up to 10 minutes of rocking.

3. First goal is to be consistent with sleep routine for at least 2 weeks. Once baby is used to sleeping in crib at certain times, then we can begin to wean her from needing to be rocked/swayed to sleep.

4. Introduce opportunities to self soothe. The way to do this is to follow your normal sleep routine, which probably includes rocking, but start by laying your infant down in crib before they fall completely asleep. Walk away for 5 minutes. If they did not fall asleep, pick them up and rock them again. Try to lay them down again before they are completely asleep and repeat process. This allows opportunities for them to learn to self soothe. It may not work on day one so I suggest trying 2 or 3 times on the first day then go ahead and let them fall completely asleep so they get their nap. Repeat this everyday. They will eventually get more used to the idea and will eventually fall asleep during the 5 minutes where you walk away and they are left alone.

Some infants cry when they are put down before completely asleep. The first step is to lay them down and walk away for 5 minutes. When babies are really tired, they may fall asleep on their own after about 5-10 minutes of fussing or they will get mad and begin to cry hard. The goal is to pick them up and try again before they get really mad because it will be difficult for them to fall back asleep.

5. Be consistent. This is the closest option I know for not letting your child "cry it out" because it is only allowing a short 5 minute window for infants to try to put themselves to sleep or cry. "Cry it out" method includes increased periods of time where the infants are left alone to cry themselves asleep, thus eventually learning that they Can fall asleep without mom. The crying will subsequently decrease during each nap until they go down peacefully.

Remember, your child knows that they are safe and they know that you have not abandoned them. You are making the important parenting decision to teach you child a new life long skill. Sometimes parenting decisions are difficult although they are very important. You can do this. It is in the best interest of your entire family. Just be consistent and give yourself breaks. You can expect to see progress after at least 1 week of consistency. Good luck!

Sincerely,

Michelle

Michelle Chrastil, MA NCC CPD
Honest Family Services, LLC.
www.honestfamilyservices.com

How do I get my baby to sleep through the night?

Hello readers and parents,

How do I get my baby to sleep through my night? is a very common question in my line of work. I have worked with many families on how to incorporate a scheduled daily routine for their babies which is the number one thing I recommend to increase the length of time your baby sleeps between each stretch at night. Although this was a routine designed individually for a specific family, it can be a useful tool to new parents. If you are interested in having me create a routine that is tailored to your families individual needs, you may contact me through my website.

When creating a routine for your infant there are two things that are important to remember...

1. Between the ages of 3-6month your infant should be moving to a regular eating schedule where they eat every 3-4 hours during the day. They should also be sleeping at least one 5 hour stretch in the middle of the night.

2. These babies also should be put down for a set nap every 2 hours. This means you check the clock after they wake up from their last nap and around 1 1/2 hours later offer them sleep again. I recommend a dim room,some form of white noise, and your baby should be swaddled. Being consistent is key in teaching your child healthy sleep habits.


Honest Family Services, LLC.
Brenna’s Feeding and Sleeping Routine

Feeding #1: Rise and Shine! 4:30-5:30 am Feed warm bottle of 4oz.

Early Morning nap: Between 6:30-8am.

Feeding #2: Between 8am-9am. Bottle made for 6oz.

Morning nap: Between 9:45-10am (wake up between 10:45-11:45). Put to
sleep in crib and let sleep up to 2 hours.

Feeding #3: Between 11:30am-12:30pm. Bottle made for 6oz.

Afternoon nap Between 12:45- 1:45. Put to sleep in crib. Can sleep up to 2 hours.

Feeding #4: Between 3:00pm-4pm. Bottle made for 6 oz.

Bedtime routine starts: Between 5:30-6:00pm
• Bath time and Lotion
• Pajamas and fresh diaper

Feeding #5: Between 6:00- 6:30pm Mom or Dad Feeds bottle with 6 oz in her room, dim lights, white noise, swaddled. (If asleep place in crib after being held slightly up right for 10min) or….

• Place in crib while swaddled snugly or need baby sleep sac to keep warm. Babies need to feel warm and comfortable. Consistency is the most important thing.

Feeding #6: Between 11:30pm-12:30pm bottle feed with 4oz-6oz of formula.
This is the feeding we want to be pushed back hour by hour until it becomes the Rise and Shine Feeding.

Rise and Shine Feeding #1: Between 4:30-5:30pm for Rise and Shine Feeding.


Again, this is an example of what a typical routine would look like.

Rules of thumb for introducing a new routine....

1. Be consistent for at least 1-2 weeks so you and your infant can both get used to the new way of doing things.

2. Make sure the whole family is on board. It is important to have both partners involved in making routine decisions so that they can make a team effort while they attempt to teach their baby a new and more healthy way of doing things.It is also good to involve the older siblings so they know the time that mommy or daddy may be unavailable due to the babies routine.

3. The routine should work for the whole family.

4. Allow yourself flexibility however staying consistent is the most important thing. Follow the above guidelines for the routine and stick with it consistently to allow opportunity for change.

Sincerely,

Michelle

Michelle Chrastil, MA CPD NCC
Honest Family Services, LLC.
www.honestfamilyservices.com

Help Me! My 21 month old will not stay asleep in her crib.

Honest Family Services, LLC.

Sienna’s Report

Name: Sienna

Age: 21 months

Identified Problem: Mother reported that Sienna has recently begun fighting sleep. Over the last week Sienna has begun fighting sleep by crying when parents lie her down for naps or bedtime. Sienna had no previous problems with going to sleep and staying asleep in her crib prior to the last few weeks. Parents also have observed new behaviors in Sienna that seem to be tantrums related to parents saying “no”.

Sleep Related Suggestions:

#1 Make sure that Sienna’s behaviors are not related to an illness, teething, or pain before trying a behavioral modification technique.

#2 When putting Sienna down for bedtime, make sure she is comfortable. Put lotion on eczema and make sure she cannot scratch herself. Follow a routine every night so she knows what to expect.

#3 Give Motrin before bed when trying to tell if the sleep problems are pain related.

#4 If Motrin makes no difference and you know that she is healthy then it is time to re-teach her to stay in her crib. (The information below regarding discipline will be a good place to start. We can talk about more specific techniques related to sleep once Sienna is well again)

Developmentally Based Suggestions for Discipline:

Sienna is approaching the age where parents need to start thinking about their personal discipline style and exploring which discipline techniques they plan on introducing to Sienna and continuing to use throughout toddlerhood and preschool years.

It seems Sienna’s behavioral changes may be related to her understanding that she is the “boss” of her household and of her parents. This is normal but needs to change. She needs to learn that it is her parent’s job to keep her safe and to teach her good behaviors. Sienna needs to know that her parents are in charge.

Developmentally children need to have their limits or boundaries taught to them by their parents. They need their parents to be able to teach them what is expected from them regarding behavior. The way to do this is to begin with laying out the household rules. This may seem advanced for a 1 ½ year old but she will understand. The concept will evolve with age.

Introduction to Discipline

#1 Begin with appropriate Household Rules for Sienna

1. No Hitting

2. No Biting

3. No Screaming when mom or dad tells you “no”.

These rules are sufficient and should cover most of your basis for behavioral problems at this age.

#2 Choose Sienna’s Consequence to breaking a rule.

This should include picking a safe space for Sienna to calm down while throwing a tantrum or breaking a rule. This place can be a designated chair, pillow on the floor, a room, a stair, or a spot of the floor that is marked. (When I started with laven at 19 months it was a “naughty pillow” on the floor and it evolved to the first stair as she got older)

Once you choose the spot be consistent and choose a name for the spot. It could be anything that fits with your parenting beliefs…. “Time out”, “Naughty Spot”, “Reflection Room”, “Down Time”, “Chill out Chair”, or anything else that works for you.

#3 Implementing the Consequence (we will refer to the spot for now as “naughty spot”)

To begin, “Naughty spot” is used when Sienna breaks a rule. The way you use this technique is you match the time Sienna spends on the spot with her age. For now Sienna is one year old so she will serve 1 minute when she breaks a rule.

Sienna must stay on the spot for the entire 1 minute but she is allowed to cry at this age.

To teach her how to use the “naughty spot” you will start with showing her the spot and telling her that if she screams or throws a fit then she will have to sit there for 1 minute. She won’t completely understand until her first offenceJ

Steps for 1^st offence…

Parent Dialog:

#1 Give a warning. “If you don’t stop crying like that then you will go to the naughty spot for 1 min.”

#2 Sit Sienna on the spot. If she gets off the spot, pick her up and set her back on the spot. In a very firm voice, “Sienna you have to stay.”(Stay calm in your actions and in your voice). Continue with putting her back on the spot until she stays. She will probably fight with you and cry the whole time for the first time. Stay close by but don’t engage her by looking at her or talking to her while on the spot. Start the time when she figures out she needs to stay on the spot. Time 1 minute.

#3 After 1 minute is up, walk over to Sienna and get on her level eye to eye. “Mommy put you on the Naughty spot because you were screaming. That is not ok. We don’t scream when I say no. I love you.” Give her some loveJ through hugs or a kiss.

Yea you have done it!

#4 When Sienna is older you will ask for an apology but not until she can more fully understand and communicate.

Great job! You will probably feel a well deserved sense of accomplishment once you have been able to do this technique because it will be a reminder that you as her parent are in control.

This discipline tool will work for Sienna until the age of 9 most likely. Typically once children understand the rules and the consequences the need for using the “naughty spot” will slowly disappear but once it is in your tool bag you can use it whenever you need to. For example, my daughter used to have time out once a day or more but now it is rare. She has learned what is expected of her.

In regards to the validity to this technique, I can tell you that every therapist, behavioral specialist, parenting coach, Supernanny, Nanny911 all use the same technique. It works. It is safe, and children understand it. It works much more effectively then spanking or yelling.

It is important for parents to remember that their expectations for their children are known through household rules and there is a consistent consequence. I know you are both great parents and I believe with this tool you can continue to teach your beautiful daughter what is right and what is wrong. Give Sienna lots of words regarding her behavior “we don’t hit because it is not kind” and also give her words for her feelings “I can see that you are angry right now” or “I can see that you are sad, that is ok, but it is not ok to hit mommy.”

Remember children need boundaries and need their parents to teach them the consequences of unacceptable behavior. You will do great I am sure.

Good Luck and remember to value your time with your daughter and focus on having moments of joyful one on one time to foster a close relationship between the two of you.

Sincerely,

Michelle

Michelle Chrastil, MA NCC CPD

Honest Family Services, LLC.

www.honestfamilyservices.com