The Baby Sleep Book: How to help your baby to sleep and have a restful night - Martha Sears

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passages and awaken baby. Common household examples are cigarette smoke, baby powder, paint fumes, hair spray, animal dander (keep animals out of an allergic child’s bedroom), plants, clothing (especially wool), stuffed animals, dust from a bed canopy, feather pillows, blankets, and fuzzy toys that collect lint and dust. If your baby consistently awakens with a stuffy nose, suspect irritants or allergens in the bedroom.

       Make your baby’s bedroom as dust-free as possible. Besides dusting regularly, remove fuzzy blankets, down comforters, dust-collecting fuzzy toys, etc. If your baby is particularly allergy-prone, a HEPA-type air filter will help. As an added nighttime perk, the “white noise” from the hum of the air filter may help baby stay asleep longer.

       Relieve teething pain. Teething discomfort may start as early as three months and continue off and on all the way through the two-year molars. A wet bed sheet under baby’s head, a drool rash on the cheeks and chin, swollen and tender gums, and a slight fever are telltale clues that teething is what’s disturbing your baby’s slumber. If the teething pain seems really bad, with your doctor’s advice, give appropriate doses of paracetemol just before parenting your baby to sleep and again in four hours if baby awakens. (See “Teething”).

       Change wet or soiled nappies. Wet nappies bother some babies at night. Most are not. If your baby sleeps through wet nappies, there is no need to awaken her for a change – unless you’re trying to get rid of a persistent nappy rash. Nighttime bowel movements necessitate a change. Here’s a nighttime changing tip: if possible, change the nappy just before a feed, as baby is likely to fall asleep during or after feeding. Some breastfed babies, however, have a bowel movement during or immediately after a feeding and will need changing again. If you are using cloth nappies, putting two or three nappies on your baby before bedtime will decrease the sensation of wetness. Also, if baby is prone to nappy rash, slather on a hefty layer of barrier cream to protect baby’s sensitive skin from the sensation and irritation of wetness. Cold nappy wipes are sure to startle baby awake. Run wipes under warm water (a great job for Dad!).

       Remove irritating sleepwear. Many infants cannot settle in synthetic sleepwear (some adults, too!). A mother in our practice went through our whole checklist of night waking causes until she discovered her baby was sensitive to polyester sleep suits. Once she changed to 100 per cent cotton clothing, her baby slept better. Besides being restless, some babies show skin allergies to new clothing, detergents and fabric softeners by breaking out in a rash. (See “Sleepwear – How to Dress Your Baby Safely and Comfortably for Sleep”.)

      Fill tiny tummies. The tinier the tummy, the more frequently babies need to be fed – both day and night. Babies have tiny tummies – about the size of their fist – which is why babies under six months of age need one or two night feedings. Some babies (especially breastfed) continue to need night feedings even in the second six months of life. You can maximize the amount of time baby will sleep after a feeding by being sure that baby fills his tummy as he feeds off to sleep and again when you feed him in the middle of the night. (See “Night Feedings”, pages for how to comfortably fill tiny tummies for longer sleep.)

      Swaddle your baby. Swaddling recreates the womb environment. In the early months, many babies like to “sleep tight”, securely swaddled in a cotton baby blanket. Older infants like to sleep “loose”, and may sleep longer stretches with loose coverings that allow them more freedom of movement. Often, dressing a baby loosely during the day, but swaddling him at night, conditions the baby to associate sleep with swaddling. Make sure baby doesn’t get too warm.

       Once I started swaddling her, she slept through the night. At about three months she got too strong to swaddle in the traditional way. She would get her arms out and rub her face and startle herself awake. I took a larger thin blanket and wrapped the sides individually over each arm and under her back so she couldn’t get loose. It may sound cruel, but she smiles as I do it and nods off peacefully all night long.

      Babies usually start squirming out of the swaddling wraps by six months. Another possible problem with swaddling is that once babies get used to it, they have a hard time sleeping without being swaddled. The movement of their arms and legs wakes them up.

       caution about over swaddling

      Dr Robert Salter, Professor of Orthopedics at the largest children’s hospital in the world, the Hospital for Sick Children in Toronto, Canada, literally wrote the book on infant hip development. He wrote me a long letter after the publication of the first edition of The Baby Book, in which we extolled the merits of swaddling and showed parents how to swaddle a baby. He believes leaving babies swaddled too long, especially in the early months, can interfere with the development of the ball-and-socket hip joint. For this reason, we recommend parents only swaddle babies during sleep time. Give baby plenty of time to “let loose” when awake.

      You are learning where baby sleeps, when baby sleeps, and how to create a comfortable sleepy environment, and now we come to the next step in our plan: helping you work out what bedtime rituals work best for your baby. As you use these same routines night after night (or alternate through several routines consistently) baby will learn to fall asleep easily and stay asleep longer.

       Creating healthy and relaxing sleep associations

      A sleep “association” is not a naptime playgroup or a group of sleepy parents who gather to yawn and complain about their baby’s sleep habits. A sleep association refers to a connection in baby’s mind between falling asleep and the various activities, places, experiences, and feelings that precede his nodding off into slumber. The wiring in baby’s brain is full of patterns of association. For example, if you usually feed and sing your baby to sleep in a rocking chair, this setting will become programmed into your baby’s mind as a sleep-inducing routine. He will remember the calm and drowsy feelings he gets from rocking and feeding, and this will help him fall asleep.

      What kind of sleep associations do you want to teach your baby? Do you want to create attachment-based sleep associations or independence-based sleep associations?

       Attachment-based sleep associations. Many parents like to “parent” their babies to sleep; rocking, feeding, or snuggling while baby drifts off to sleep. Baby learns to associate falling asleep with a parent’s presence. The advantage? Closer bond between parent and baby. The disadvantage? Mum or Dad must be involved with baby falling asleep for months or years. Depending on your own instinctive parenting style, you may actually view this as an advantage; certainly your baby would.

       Independence-based sleep associations. Other parents strive to help baby learn a more independent way of falling asleep, without the need for parent involvement. The most popular method for learning to fall asleep independently is the cry it out method. The disadvantage? You don’t teach baby to fall asleep, you force him to. Medical research has shown that excessive crying creates stress for a baby. So a baby learns to associate falling asleep with fear, stress, and worry. This is not healthy in the long run.

      (We will discuss sleep anxiety more on page and the harmful effects of

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