Category Archives: newborns

Safe Sleep Guidelines Don’t Give Parents Enough Support

I just downloaded the entire American Academy of Pediatrics’ Technical Report-SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment.   It was a large file to read, but the bottom line for me was this:  they must not have any sense what it is like to be a new parent, and maybe not what it is like for practicing pediatricians.  In other words, they say what to do and what not to do to prevent SIDS, but don’t mention how to accomplish any of it in the world of actual babies and parents, where crying and sleeping is real, not theory.  No wonder parents don’t follow the guidelines.  Without useful strategies and simple explanations, most parents wouldn’t be willing to follow their recommendations for very long.  In my opinion, the most difficult guidelines for parents are the instructions to only place newborns on their backs to sleep, and not to have a baby sleep in the bed on on the parent.  Babies should be in the room, but not in the bed, with an adult.  Simple, right?  Not.

Sleep-deprived new parents are struggling to comprehend all the things they should and shouldn’t do.  Defensive driver classes say that lack of sleep makes you drive like you are drunk.  Why should we expect the parents of newborns who get 5 hours of sleep a day to think clearly?  Because they aren’t behind the wheel?  An exhausted parent isn’t just tired.  They are less capable of judging what is safe and how to follow their pediatrician’s general recommendations.    They are going to let a 4 week-old sleep in the car seat for over 30 minutes because he slept poorly last night, pick him up from his “tummy time” right away when he cries because they are so frazzled, and use a positioning wedge in the crib.  They will be afraid to use a pacifier at 5 weeks, and will abandon swaddling when they can’t get it snug.   I can’t blame them one bit.  Babies aren’t simple.  Their crying when they are put down rips a parent apart.  No one knows how to deal with newborns without some help.

Not letting your baby sleep on you or next to you, and only placing a baby to sleep on his back means that a parent needs to be shown other good sleep strategies that leave both parties comforted and calm.  Pediatricians know that back sleepers show initial delays in motor control that disappear by 18 months on average, but generally offer no other suggestions than to “do some tummy time.” There are some great methods to make Safe to Sleep successful, but the AAP doesn’t share any specific baby management secrets (if they have them.)

The New York Times ran a story in 2005 that made me stop in my tracks before I finished reading it.  They reported on the increase in parents placing their babies on their backs to sleep after hearing about the Safe to Sleep protocol from professionals.  Turns out, their newborns had a hard time sleeping in this position.  It is well known that many babies don’t sleep as deeply or as long in this position, and for some simple reasons.  Their random arm movements wake them, they turn their heads and motor reflexes wake them, and they traded the firm support of the womb for the feeling of floating in space on a bassinet mattress.  Who could sleep well like that?

The NYT author quoted a parent that suggested that her NICU nurses encouraged stomach sleeping on discharge, even though they had to tell her officially not to do so.  A Manhattan newborn care instructor was quoted saying that “the role of a professional is to say these are the recommendations and this is why.  The role of the parent is to think critically and apply those recommendations in a way that makes their life manageable.”

I see things differently.  Professionals should anticipate the need to provide practical strategies when they teach their lifesaving guidelines.  Expecting exhausted parents to “think critically and apply these recommendations” is asking much too much from well-meaning but tired and vulnerable people.  It just seems very unfair for pediatricians to know full well how hard those first few months are, and yet not be more practically helpful.

Then again, they may not have any direct experience or even know what to do with a baby after a checkup or a treatment.  After all, they treat medical problems.  SIDS is a medical problem. Sleeping, calming and caring for babies isn’t really a medical problem.

If doctors or other professionals are not able to provide real-life instruction in ways to make the Safe to Sleep program successful in the real world, they should have resources to offer to parents. As a Happiest Baby educator and a pediatric occupational therapist, I wish that every parent had the ability to learn how to use Dr. Karp’s amazing baby calming and sleep techniques from me, and how to carry and hold their babies to develop good head control.  I wish I could show every parent how to make “tummy time” fun and easy.  I write this blog in order to reach out to parents with love and support.  They don’t have as many resources as they deserve.

 

Preschoolers Can Welcome a New Baby With Help

Preschoolers look so grown up sometimes.  When a new baby comes home, all that can change.  They can have very strong responses to becoming an older sister or brother, and not all of their reactions are easy to decipher or deal with.  Here are a few explanations for their responses and some suggestions to make things easier on everyone.

First of all, seeing the situation through their eyes will help explain some of the behaviors.  Even though a preschooler can tell you that “There is a baby in Mommy’s tummy”, she really can’t imagine what it will be like for her to live with a newborn in the family.  Older siblings can do that, but she was the baby the last time!  Preschoolers aren’t expecting that Mommy will be less available for a cuddle while she is nursing, or that people will flock around the new baby when they come over instead of her.  She is going to realize that she isn’t the focus of adult attention when the new baby comes home.  And she did nothing wrong to lose that spot.  Being the baby of the family has it’s down sides, but it is a recognizable position that a preschooler has held for years.  With the addition of a new baby, a preschooler has to recognize that things have changed, and then figure out just where she belongs in this new family.

You heard me, new family.  It took me years of professional work and studying to really understand something simple.  When a family gains or loses a member, the entire dynamic shifts.  In reality, the family is much different after each change.  It is a new family, not just the-old-family-plus-one.  Parents change and children change.  I really saw this happen when my oldest friend had another baby after her youngest of 3 was six.   The oldest became practically a statesman for the children as a group, and the youngest lost his “baby” title.  The middle daughter became a junior mommy, which she enjoyed.  New roles for everyone.

Back to preschoolers and welcoming a baby home. As in my earlier post on toddlers and new siblings:  imagine that your spouse or partner brings home a new husband or wife, and tells you that they still love you.  You just have someone younger and cuter to compete with and you will love helping that person!  If you complain, you are behaving badly.  Toddlers actually get off the hook a bit easier because everyone expects toddlers to react strongly to everything.  Preschoolers can be expected to act like 7 year-olds, even when they are not.

Here are my suggestions for a smoother ride:

  • try not to emphasize what a wonderful thing this new role of big brother really is, since your preschooler might be less willing to talk about his feelings if he thinks that you only want to hear about how happy he is.
  • Acknowledge the change, even the negative emotions.  You might have to put words out there.  Preschoolers are still learning how to name feelings, and you can help.  Saying that he can have emotions like anger, jealousy and resentment ( or simpler explanations that explain emotions) makes it OK to feel what he feels.  Having feelings isn’t bad, acting them out aggressively is a problem.
  • Schedule one-on-one time, but prepare to be refused or rebuffed.  You may even need to ask your preschooler what he thinks would be good “me time” and when it should occur.  Remember, gaining control in some things can make a person in the middle of a sudden life change feel better.
  • offer cuddle time and even time to pretend that he is the baby again.  Make it clear that you are pretending and the this is a time limited offer, just like the store bargains.  But being able to sit on your lap and cuddle, even reminisce about the time when he was your baby, is really nice for both of you.

 

Are Babies Addicted to White Noise? Yes….and No

White noise helps colicky newborns calm and sleep.  It can help newborns develop essential self-calming skills in the first 3 months of life.  It can help older babies tolerate teething and their first colds.  It can even help babies transition to a shared bedroom with a toddler sibling.  The magic of white noise is not lost on Happiest Baby on the Block educators.  Every time I am asked if using white noise will create an addiction, I think to myself “Deeper, longer sleep patterns are an addiction most of us should have!”  Here is why parents should add white noise to their bedtime plan, and how to calm their fears of creating a “white noise addict”.

White noise is part of the 5 S’s: the five steps in The Happiest Baby on the Block plan to quickly calm a newborn and one of the 4 that you can use for sleep.  You cannot use the side/stomach positioning for sleep.  It is only for calming.

When you use white noise at the right volume and at the right frequency, it creates a barrier to the noise a child makes when he cries and to the household sounds of doors closing and siblings talking.  Newborn hearing isn’t as developed as the hearing skills of an older baby, so the standard white noise machines are often giving you less harsh and higher frequency sounds than newborns need.  This is not as effective.

What I see when a parent has been using another white noise source is that the child is not falling asleep quickly and is not fully in deep sleep.  Some parents tell me that they think he wakes more often because he needs to nurse frequently, but this pattern often makes me suspect that he is child who isn’t sleeping deeply enough so when he wakes he wants to suck to pull himself back to sleep.  The clue?  He only nurses for a tiny,super-short time and conks out.  That, my friends, is not a hungry newborn.  The hungry ones really get into it (nursing) and fill up. Take a look at Accidental Parenting at 4 Months: Out Of The Swaddle And Into The Frying Pan to see what can happen if a good routine with a plan for aging out of the 5 S’s is forgotten.

Take a listen to the “shower” or “hairdryer” sounds on Dr. Karp’s Happiest Baby tracks on iTunes to get a sense of what really works for newborns.  Older babies and children can calm down with the standard white noise machine offerings.

White noise is the one “S” from THBOTB that you never have to remove.  You can load it on a phone and use it whenever and wherever.  If you are worried about creating a child than cannot sleep without it, then take a look at your entire sleep plan.  Babies that are inadvertently taught that they have to be held to go to sleep, or they should fall asleep nursing,  will cling to that white noise more because they have not yet developed age-appropriate self-calming skills.  Yes, you start this before 12 months old!  Try to build those self-calming skills and diminish a baby’s sense that good sleep requires another human.  I know, it sounds nice to be so needed and it seems so loving, but the most loving thing we do is help children build the skills so that they have the choice to connect or be independent.  If a child has no ability to calm themselves, then he is not making the choice to cuddle.  He is desperate for the only way he knows to feel better. Without it, he is lost, frightened and struggling.

“Wings and roots” from the very beginning means teaching self-calming skills.  This does not diminish a child’s love for a parent.  It is the other way around.  Parents are the people who show a child how to be powerful and cheer their independence at every turn.  That creates a bond that is strong and flexible at the same time.  It only grows stronger and is less likely to fray during the toddler and teen struggles.

To decrease a child’s use of white noise, all you have to do now is lower the volume a little at a time, or start out sleep with white noise then turn it off.  After a few days, don’t start the bedtime routine with white noise, and see how things go.  A word of advice:  never shift a bedtime routine when other routines are also shifting.  Those shifts include:  parents returning to work, siblings returning to school, holidays, toddler roommate toilet training, etc.  Changing so much in their world at the same time is asking a lot of a baby.

Want more information or answers to your questions?  Visit my website tranquil babiesand purchase an in-home session (in the NY Metro area) or a phone/video consultation.  You will get a chance to discuss your unique situation and receive new ideas you can try tonight!

 

Another Baby Lost to Crying

There was a news story here in NY about another newborn allegedly choked to death by a father that couldn’t take all the crying.  This is a recurring story that has to end.  If that family knew how easily The Happiest Baby on the Block techniques could have calmed down their baby, he would still be here, ready to have his first Christmas Day.

Jose Feliciano has been arrested for murder after the baby’s mother took an overdose and told someone in the facility caring for her what had happened.  I have sympathy for their entire situation.  If you do not have children, or if your newborns were almost silent, you do not know the frustration and pain of constant screaming.  THB techniques are capable of more than just giving babies better sleep.  They can prevent the slide into exhaustion and depression that parents often do not admit to.   Calm babies nurse/bottle feed better and parents feel more competent.  Everyone wins.  This time in the Bronx, everyone lost.

Most fathers do not commit murder, no matter how frustrated they are.  Perhaps we will hear about additional issues that made this dad take the ultimate action.  If only the mom had learned THB when she gave birth, or at a prenatal class, or at a well-baby visit.

I made some brief inquiries into teaching The Happiest Baby class to men about to be released from the prison system this fall.  Perhaps one of my resolutions for 2016 should be to teach that class for free somewhere in the Bronx, to some group of parents at risk.  This is a blog post I don’t ever want to write again.

For more information about The Happiest Baby on the Block, please visit my website: tranquilbabies.com

The Safest Crib Bumper Might Be Deeper Sleep

Most pediatricians will tell you to avoid all crib bumpers.  The American Academy of Pediatrics feels that no bumper is 100% safe. They discourage parents from using even the most breathable mesh fabric, tied onto your child’s crib.  I totally believe parent reports that a baby that isn’t swaddled can get a limb caught over the bumper edge or, worse yet, under a poorly designed bumper.  Babies move in their sleep.  What is the answer?

I wish there was a perfect solution that works for everyone.  Some babies sleep well in a sleep sack, but they can still theoretically get an arm stuck under a bumper.  Most sacks don’t restrict arm movement as much as the legs and feet.  Babies move more when they are in the lighter phases of a sleep cycle, or when they awaken from sleep.  Some “breathable” crib bumpers are not well constructed, with longer or fewer ties, leading to entanglement or the risk of strangulation.  A mesh bumper that crushes might still allow a child to get a limb under or over it.  Bumpers that don’t tuck under the mattress are even more likely to allow a little leg to poke under the bumper.

One potential answer?  Keep them in deeper sleep longer by using the Happiest Baby on the Block techniques.  Going beyond the swaddle delivers far more than just faster calming.  You are using layers of calming input that keep babies from spending too much time awake or in the light sleep phase.  Happiest Baby educators like myself are amazed that parents think Dr. Karp’s program is just about swaddling.  Doing a good swaddle is great, but it is only one of 5 essential tools in The Happiest Baby on the Block.  Knowing how to use all these techniques effectively for safe sleep is a huge reason why parents request personal consultations with me instead of just running out for a swaddle blanket.

White noise, sucking and swaddling are your Happiest Baby moves to help babies to stay in that deep-sleep phase (the one where you really can change a diaper and they don’t move a muscle) and jump back into it faster if they do wake after a diaper change or a feeding.  The longer and more frequently your baby is in deep sleep, the less she will move when in the crib.  Older babies that are rolling can do the step-down swaddle without arms inside, or use the sleep sacks that have velcro trunk compression for cozy deep pressure.  It is this 4 to 18 month-old phase of development when the “shush” of white noise and sucking help so much to send babies back into deep sleep, and prevent them from coming out of sleep with household noises or their own curiosities.

Toddlers can usually get themselves unstuck without your help, so by 24 months your concerns will shift to whether or not he can climb out of the crib by himself!

 

The Difference Between “The Hold” and The Happiest Baby on the Block? Sleep!!!

I love it when baby calming is in the news!  This week “the hold”, pediatrician Dr. Robert Hamilton’s method for calming newborns, received a lot of attention.  I watched the video, just like a few million parents and professionals.  Then I thought about how this fits in with The Happiest Baby techniques that I am certified to teach.  The biggest difference I see is that The Happiest Baby techniques provide parents with more tools to support fussy newborns all day and all night.

I think “the hold” probably works very well with the 50% of babies that are relatively easy to calm.  It has the right moves to give calming vestibular input, inhibit the startle reflex, and uses the prone (stomach) positioning to soothe a newborn quickly.  The Happiest Baby on the Block adds the lasting calming and neutral warmth of the swaddle, the suck, and the “shush” to layer on the love for better feeding and sleeping, and keeps it going over time.  That is where this technique, in my opinion, gives parents more helpful tools than “the hold”.

The Happiest Baby on the Block isn’t just for calming fussiness.  It gets newborns nice and calm, and keeps them there for longer sleep.  Sleep for everyone, parents included.  Calming a baby super-fast, but not helping her to get to sleep quickly and to stay asleep through multiple sleep cycles/noises, isn’t going to make the life-changing difference that the 5 S’s can make for newborns.  Especially for the fussiest babies that really need all 5 moves (swaddle, swing, suck, shush and stomach/side positioning) to get calm and stay there.

I know; saying that this is life-changing is pretty dramatic.  If you are a sleep-deprived and frantic new parent, sleep is what you desperately want, not just calming.  Getting a newborn to sleep an extra hour or so at a time is not magic, it is The Happiest Baby On The Block at it’s best!

I forgot to mention how heavy a 9-pound screaming child could feel when you do “the hold”.  Raising a newborn up in the air with just your hands  isn’t as easy as it looks for some women.   Hormonal changes in pregnancy will loosen our ligaments in our pelvis, our wrists and our hands as well.  I have a suspicion that dads will be the ones doing “the hold” more often than moms if a baby needs calming a few times a day!

Prepare Your Toddler Before Bringing a New Baby Home

Look at it as if your spouse announced that a new, younger, and more vulnerable wife was joining your family: ” She will need a lot of my close attention at first.  That doesn’t mean I don’t love you just as much, sweetie, but I won’t be as available to you as I used to be. She will sleep with me every night, but we will still have a few minutes together when she is resting.  I am so proud that you don’t need me as much as you used to!”.

How does that sound to you?  Not too wonderful, and yet you would realize that protesting got you criticized, and acting out got you punished.  Maybe there is another way to add a new member to the family?

If you ever had a reason to use The Happiest Toddler methods to build your toddler’s patience and develop his ability to deal with defiance and whining, now would be the time to take out that book again.  Read the chapter on the Fast Food Rule to deal with outbursts.  Then go on to the time-in section. Dr. Karp recommends the magic breathing stress reduction technique, as well as time-ins such as gossiping (about him to the baby in your belly) and “playing the boob” in which you set up situations in which your toddler is the one with the right answer, the more effective puzzle assembly skill, etc.  You are trying to shore up his self-confidence and self-calming to prepare him for the inevitable issues of jealousy and waiting longer for attention.

Toddlers love praise, but this is the time for focused, understated praise as well as chances to revert to being the baby for short periods.  It sounds silly unless you know that without being invited to cuddle like a baby for a few minutes, your toddler may insist on being a baby at exactly the moment that makes it impossible for you to comply.  As in the middle of a messy newborn diaper change.  You choose the moment, and you will get a better outcome.

Think this is the moment to move him out of the crib or take away the pacifier?  Those things are a part of his sense of security.  If you want to make these changes, you might do them well in advance of the birth or well after.  You would not want your toddler to resent the baby by associating these “losses” with your newborn.  Toddler anger and sense of betrayal is not going to last forever, but it can result in a loss of new skills such as daytime toilet training and even a willingness to walk instead of being carried.

I have heard of families obtaining a toy that the newborn can “give” to a toddler when you bring your new baby home, and I think this strategy can work for some children.  Some families like to have the toddler give a toy to the new baby as well.  Giving away anything when you are in a vulnerable state is harder than usual.  Your toddler might decide that he needs that rattle more.  If that happens, try not to criticize him for being selfish.  It is just a vulnerable toddler trying to shore up his strength in the face of changes he did not authorize and he realizes he cannot reverse.

Toddlers have a tendency to suddenly want to revert to infancy when they see you cuddling a tiny baby.  It can get ugly if that happens in the grocery store and he refuses to walk.  Instead of waiting until your toddler throws himself on the floor or insists on using only “baby talk, why not invite him to be your little baby for a short time?  By offering him the chance to pretend to be a baby, maybe hold him like a baby or babble to him, you are taking the reigns of when and how this happens.  The bonus?  Just like the magic of the Fast Food Rule, Dr. Karp’s signature plan for toddler communication, your stressed toddler sees you as someone who perceives what is on his mind with love and compassion.  Everyone wins.

Finally, practicing being helpful with the new baby, such as bringing over a clean diaper and shushing the baby, can be fun and paired with other good times such as special toddler snacks that the baby won’t be “allowed” to eat!

When to Stop Using the Infant Swing with Your Newborn

Weaning the swing can happen earlier than weaning swaddling.  Somewhere about 2.5 months old (adjust for prematurity if needed), many newborns no longer get more peaceful while swinging.  There will always be babies that prefer to be jiggled on your shoulder or in your lap from the beginning. There will also be babies a bit over 3 months old that only calm when snugly swaddled and swinging, firmly buckled in and fully reclined, of course.  If you are not talented in the blanket swaddling area, this is the time when you might want to try a swaddle garment.  It is unsafe to loosely swaddle a child when they are old enough to partially roll inside a swing.  If your child is so strong that he can undo a swaddle garment or a firm blanket swaddle, then swaddling in a swing is not for you.  You will just have to double-down on the shush/white noise, sucking and side/stomach calming.  I would also recommend the dream feed (my most popular blog post ever from January 2015) and be very careful not to put off naps until your child is over-tired.  More on that topic later this month.

When your baby is ready to wean swinging it may be as easy as shutting it off and putting him in the bassinet or a co-sleeper.  Wean a movement-loving baby by slowing the swing down for sleep for a few nights and then seeing if he can sleep in a non-moving swing.  If his sleep is still as long and as deep, then it could be time to put the swing on Craigslist or in the garage.

Don’t forget that the other S’s, especially shushing/white noise, may be even more important now for general calming and signaling bedtime.  This is not the time to dismantle your previously perfect newborn sleep routine.  Abandon all the signs and sounds that tell him things are quiet, safe and cozy at your own risk.  You may even add some more mature routines that can continue throughout childhood, like infant massage and story time.  Babies love to hear your rhythmic voice as you read “Goodnight Moon”.  I hope you like it too, since you will be reading it over and over…and over!

Beyond Tummy Time: The Magic of Side Lying Play for Balance and Vision

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Tummy time is terrific, but your baby cannot stay in that position forever, no matter how entertaining you make it, nor how hard he works to lift his head.

Side lying is another great position for a young infant, one that is well-known by occupational therapists to give babies unique opportunities for head control, eye-hand coordination and visual coordination in those early months of life. Yes, vision!  The connection between vision and balance is so strong in fact that every young infant should have side lying in their daily play time.

Of course, side lying is terrific for arm and head control as well as balance.  Even though your child isn’t lifting his head, he is refining movements of his head, shoulders and arms while he is looking and reaching.  That “top arm”, the one that is more free to reach, is being pulled down by gravity.  This means that he is strengthening his shoulder every time he reaches up and out.  When that happens, his body rotates just a bit and he has to coordinate that movement of the hand, the shoulder, and the ribcage.  He will be practicing the fine control needed to roll over, and might develop that skill a little sooner as well.  But the special skill that side lying supports is not rolling or reaching.

The unique benefit is that in side lying your baby can more easily bring both hands together, bring eyes and hands together, and coordinate both eyes without the normal movement reflexes interfering as much.  You know, those reflexes that swing his head and arms back or to the side just as he is reaching out.  He can independently control his head and arms to examine his hands using touch and vision, learning about these wonderful things at the ends of his arms.  And he can tilt his head just a bit to look at his hands as he plays.  Side lying supports but also stabilizes that wobbly little head, allowing him to bring both eyes into focus and helps him isolate eye movement from head movement at this early age.  Guess what?  Better eye control is known to help develop balance, and when you pick him up and he lifts his head, you will see better balancing of his head on his shoulders, and better sitting balance sooner!  The gift that keeps on giving!!

Safety concerns:  Never leave your newborn alone in side lying. He will not have the ability to clear his airway if he slides into an awkward position.  This is not a sleeping position, it is a supervised play position.  Side lying is most effective if you fold up a soft receiving blanket into a thickness that is approximately the width from his shoulder to his neck, and slide it under his head and cheek.  Leave the area near his mouth and chin unsupported.  You have reached success when you can draw a straight horizontal line from the center of his chest through the center of his chin, nose and forehead.  Everything is aligned in the center of his body.  Some active babies need a towel roll behind their whole head and back to feel stable, as they can feel that rolling movement when they reach or turn their head.  Some also need a little towel roll under that “top leg”, to keep them from rolling forward.  Again, supervised play is safest.

I should mention that placing your baby in positions like side lying and prone on his tummy relieve pressure on the back of his head, reducing the chance that he will develop a flattened skull, also known as “positional plagiocephaly”.     My post was intended to explain the visual development that side lying supports, but as you can see, this position is great for so many reasons!

Read more about infant development here:  Why Parents Used The Fisher-Price Rock and Play Sleeper: Desperation and Confusion and Kids With Low Muscle Tone: The Hidden Problems With Strollers.

Will Swaddling Make it Harder to See Baby’s Hunger Cues?

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This question is the one I have heard repeatedly from parents and birth educators.  Here are the facts as I know them:  Hunger is natural, hunger is strong in most infants, and hunger is more powerful than the swaddle. In fact, a great way to know if your fussy newborn is hungry or just fussy is to swaddle her and do all the rest of the 5 S’s from Happiest Baby on the Block.  If she calms for a short period of time and then really cries for you, she is probably hungry.   I am assuming you checked her diaper first.   Dr. Karp recently posted a short video and suggested that you see if the rooting reflex is super-powerful (you know, touch the corner of her mouth and she searches for the nipple?)  A baby that roots and still cries is probably fussy, not hungry.  OK, with that out of the way, there are some details about newborns to examine.

A very small number of babies, preemies and otherwise, do not have strong hunger cues.  That is not the fault of swaddling, but it is an issue that must be addressed by your pediatrician, doula, or lactation consultant.  Problems with avoiding feedings or lack of interest in feeding are important to deal with as early as possible.  Children that have developmental issues or neurological issues such as very low muscle tone often struggle to maintain a level of alertness for feeding, and also work very hard physically to suck.

For these children, keeping them alert is important, but an alert-and-fussy state takes whatever energy they had away from them.  Swaddling correctly can help get them in that beautiful calm-alert state in which they can nurse or feed longer.  They will not be flailing their arms and scratching their face, or crying when they set off the Moro (startle) reflex by their random movements.

Doing a good, safe swaddle isn’t always easy.  Read The Happiest Baby on the Block or contact a certified HB educator (like myself) if you are all thumbs with those blankets and swaddle garments.  Don’t blame yourself or think that your child either hates it or cannot tolerate it.  Check out  Why Some Newborns Look Like They Hate To Be Swaddled to understand why more crying doesn’t equal swaddle fear.  You might just need a little demonstration and practical advice.  Doing a good swaddle is that important.  Here is a new post that explains why you need more than a good swaddle to calm them down:  Swaddling Success: Layers of Calmness

Babies that have difficulty swallowing can decide that the feeling of choking or reflux is so difficult that they really only cry for food when they are desperately hungry.   Again, swaddling isn’t going to dampen down the hunger that will come to them eventually.  Swaddling will help them calm and focus, especially if they are fearful.  Swaddling supports their arms and trunk, making it easier for you to hold them in the position that reduces their distress.  If your baby is finding the suck/swallow breathe pattern harder to synchronize, getting her into a calm but alert state is key.

Babies that are struggling for any reason to develop a calm state are known to develop a pattern of “snacking” because they are using sucking alone to calm down. Read  Baby Nursing For Only a Few Minutes Then Fussy? Use the 5 S’s to Settle And Focus your Newborn To Feed, Not Just to Sleep  for more information on this problem.  Don’t let your newborn fall into the snacking trap, and allow her fail to nurse fully and well during her regular feedings.  It is often the first step down the road to flipping days for nights, and sleeping only short periods of time (for her respective age).  In this situation, she is never really rested and never really full.. Imagine being always a little tired and a little hungry.  How miserable.

Using THBOTB techniques will help you help her.  Did you buy a SNOO?  You still need to learn how to calm your baby:  Why You Still Need the 5S’s, Even If You Bought a SNOO.

The secret to knowing whether she needs to soothe by sucking or if she is really hungry is to watch her behavior.  Is the rooting reflex strongly sending her into “search for the nipple” mode?  Is she actually swallowing?  Is she showing you HER best latch-on skills, and really going for it eagerly?  Does she seem to fall into a dreamy sleepy state after nursing/feeding?  Or is she taking a few random sucks and then playing with her hands or your shirt?  Watching a baby will give you their hunger/satisfaction pattern over time, and knowing when something is wrong is often as easy as seeing a change in the pattern that doesn’t match the next developmental stage.  Your support team can help you determine what that stage looks like.  It could be your family, your pediatrician, your therapists, or your lactation consultant.

If you have fallen into the common trap of “accidental parenting”, which is possible as early as 4 weeks but more frequently seen after 12 weeks, take a look at my post Accidental Parenting at 4 Months: Out Of The Swaddle And Into The Frying Pan for some guidelines to get you back on track.  Jumping from one solution to another and creating unhelpful habits to solve short term problems isn’t a sign that you are a terrible parent; it means that you don’t have a solid plan or a way to evaluate what a good plan looks like.

Using swaddling can really help your baby feed more calmly and feed fully.  Swaddling correctly supports successful nursing and bottle feeding.  Hunger cues are easier to separate from fussiness and fatigue.  Effective swaddling makes it easier to see what your little one really needs from one moment to the next.

For more information on The Happiest Baby on the Block, to request a consultation or a phone support session, please visit my website:  tranquil babies

Ten Problems That Cause Parents to Abandon Happiest Baby on the Block

Learning to use The Happiest Baby on the Block 5 S’s can be tricky.  In addition to teaching group classes, I also teach parents privately to help them get the techniques down correctly and answer all of their questions on the spot.  I meet parents who have watched the DVD or read the book but still struggle to get the amazing results they see/read about.  Here are the biggest problems/mistakes that parents encounter when they try to use THBOTB:

  1. The Loose Swaddle.  New parents can be hesitant to use a firm swaddle, thinking that since their baby is still crying, he is crying because he hates being restrained. Why Some Newborns Look Like They Hate To Be Swaddled This is usually not the case, as newborns generally love deep pressure that simulates the womb, and parents that I work with are far more likely to do a too-loose swaddle than a too-tight swaddle.  In fact, I have never yet seen a parent that I have personally trained do a swaddle so tight that I had to gently intervene.  A loose swaddle is an asphyxiation risk when it comes undone and the fabric covers the nose and mouth.  It also allows a baby’s arms to fly up and startle a newborn, leading to more screaming.  Preemies are swaddled with their arms up to increase calm alertness and they are monitored 24/7.  Huge difference.
  2. The Too-Hot Swaddle.   Using the fleece swaddle garment in a warm apartment will sedate your child.  It looks like it works perfectly.  But newborns cannot sweat away excess heat, and if a baby is sweating, their ears and neck are warm and damp, then they need to be swaddled in something cooler.  Being overheated is a risk factor for SIDS, so if you have no A/C and your baby is too hot even with a muslin swaddle, you need to remove it.  A hot baby is a baby at risk.
  3.  Too Slow and Too Gentle Swinging.  The magic of the Swinging “S” is in the small but faster head movements that stimulate a baby’s vestibular (balance) system.  Completely different from shaken baby syndrome, this jiggling movement is calming.  Slow swing is not going to be able to stimulate a newborn’s balance system correctly.  Parents are often afraid that they will harm their baby, but if they are taught well, that little neck and brain are completely safe.
  4. Stomach/Side Positioning Errors.  This “S” is another way to dampen down the startle reflex,  so correct positioning is key.  The little secret of this move?  Every baby’s balance sense is  a little different, and yours may prefer stomach instead of side positioning to calm them, or she might need a little more of a side turn to feel “just right”.
  5. Pacifier Abandonment Out of Fear.  Many new parents are anxious that their child not become addicted to pacifiers like toddlers they see walking around town.  They are also worried that it will deform their teeth.  Well, newborns have no teeth to deform, and addiction to pacifiers is created when older children have no other ways of calming themselves down.  Parents that make a conscious plan to wean pacifier use after 6 months, well before growing cognitive skills and long-term use create a habitual need, should be OK.  Teaching a newborn to use a pacifier is easy when you get the one that fits their mouth shape and you use THBOTB training technique.  The 5 S’s can be done without a pacifier, but rejecting it out of fear is different than using different techniques for sucking.  For more information, see Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic
  6. Ignoring the Layer Cake Concept of the 5 S’s.  There are some babies that calm with just a swaddle and a shush.  But most need the full-on 5 S’s.  I meet more of those because parents call me when they are frantic for sleep and have tried maybe 2 or 3 of the S’s and given up.  Needing all 5 moves is not a sign of a problem.  The problem is likely that your baby is normal, has a sensitive or spirited temperament, and is right in the stage for maximal newborn crying (2-10 weeks).  Ignore this at your (sleep’s) peril.
  7. The Too-Quiet Shush.  Babies quickly calm to the right volume and pitch of shushing, but parents sometimes think that the loud shushing needed to calm them initially will harm their hearing.  Loud shush is used for a brief period when they need help to pull themselves together, and then the correct shush is the loudness of a bathroom shower.  Avoiding the loud shush is ignoring the needs of a newborn brain as it seeks organization and calm.
  8. Forgetting the Basics.  I was reminded of this when I taught my first class.  The host, a breastfeeding consultant, asked if I would mention checking whether a baby needed a feeding or a diaper change before starting the 5 S’s.  I will confess that it had never occurred to me that I would have to say that. It seemed so obvious.   I will say it here:  Before you use THBOTB to calm your crying newborn, check to see if he is hungry, soiled or wet.  First things first.  A baby that is healthy, full, and clean should be easily calmed with THBOTB.  A baby that needs those other things will not stay calm for long, regardless of your technique.
  9. Using Small Garments/Blankets for Swaddling.  The swaddle garment industry has exploded, and you can find all styles.  Blankets are often big enough for the first 2 months at least.  The biggest issue with garments, other than matching the fabric to the room temperature, is that once they are too small, they are a danger.  Outgrowing a swaddle garment means that the velcro isn’t correctly placed for a solid hold and can come undone, and the baby’s legs cannot move freely.  Legs that are stuck in an extended (straight) position are a risk factor for hip dysplasia, a condition in which the joint is not correctly formed.   If you are buying garments, better to have at least one in the next size up sitting and waiting for use.
  10. Waiting Too Late to Try HBOTB.  Some of the 5 S’s, such as white noise shushing and sucking, will help babies over 3 months calm down and sleep, but the real magic is in starting life with peace and good sleeping habits.  Parents who take a wait-and-see approach risk the development of poor sleep habits or feeding issues related to crying/poor sleeping.  Their own lack of sleep and sense of failure is a risk factor in postpartum depression.  Worst of all, they do not have the full joy of those precious first months because  they are exhausted and frustrated, struggling to calm their newborn or get just another hour of sleep each night.

Teaching Your Baby to Sleep Through the Night

No baby sleeps all night.  Not one.  Neither do adults.  Surprised? A normal sleep cycle bring us into a foggy awake stage and only then do we return to sleep.  This happens many times throughout the night, but good sleepers send themselves right back into a deeper sleep without being held, an extra feeding (excluding that magic dream feed), or a midnight sandwich run.  Developing the ability to send yourself back to sleep is learned, not acquired with time.   Babies that have learned this skill appear to stay asleep all night long.  They are actually settling themselves down repeatedly in the middle of the night, just like there rest of the family.  How babies learn to send themselves back to sleep depends on the mindset of the adults doing the teaching.

I believe that good sleep skills after those first few months of life depend on the parent’s perceived role as sleep coach.  Gradually sleeping through the night after the first 6 months is a skill, not an innate instinct.  Here is what you need to know to build those skills in the littlest learners. New parents aren’t often aware that children all the way to about age 4 have shorter sleep cycles than adults (60 minutes versus 90 for adults) and can begin to be able to shift to a day-and-night awareness late in the second month of life.  Yes, that early.  Good sleep for the smallest babies up to 12 weeks is largely a matter of respecting their need to have the womb experience replicated.  All of the 5 S’s in Happiest Baby on the Block do that really well, which is why I teach classes and provide personal consultations.  Providing the physical experiences that newborns need is essentially your job in those first couple of months.  Being able to fall asleep quickly and without hours of crying right from the start sets babies up to have good sleep habits.  It also gives parents a confidence boost and a sense that healthy sleep patterns are possible.  Teething, growth spurts, runny noses and all manner of things will happen in that first year to derail good sleep and shake that confidence.

After about 12 weeks babies’ brains are more mature, and need the social support of a routine and an adult that can “read” them well.  Sleep becomes more of a dance between habits, needs, and expectations.  You use the white noise, transition objects and shush-pat to help a baby quiet themselves down, put tired babies to sleep before they get too tired, and treat your sleep routine just like a dietary guideline for good health.  It is.  Communicating your confidence in their ability to calm and being aware of accidentally creating bad sleep habits is key.  “The Baby Whisperer” is my favorite reference for turning around bad sleep habits in a kind but firm way.  No one else does as good a job of advocating for children to be independent sleepers who do not feel abandoned.

In the terrific book “Bringing Up Bebe”, the characteristic French approach that is described is not cold and callous, but rather respectful, as parents wait to see if a whimpering baby can self-calm, and allow the baby to settle herself down much of the time.  Assistance is brief and while warm, it is understood that the baby is being taught to “do her nights”, as they say.  It certainly helps that maternity leave and good daycare in France is generous, so that parents are less stressed and fatigued.  But it is more than that.  Their culture also values developing independence in very young children throughout the day, not just around sleep training.  If your belief is that your job as a parent over time is to teach your child to NOT need you for sleeping, for feeding themselves, and for entertaining themselves, then this will seem like second nature. You will start with fostering them to settle themselves, and quickly move along with holding a spoon, playing alone, and even cooking dinner at 10.   If you believe that your job is to protect your child from every frustration that you can, then it will seem like cruelty not to go to her when she gently whimpers.  It all depends on how you see your role. For parents that decide to take this approach, they may have two hurdles here in America.  Friends and family that do not agree will erode your confidence, and our overall culture doesn’t support this attitude right now.  My family had this more traditional European approach to parenting, and many of our friends were also from this culture.  You may have to work to find a like-minded community if you want face-to-face support.  The internet can support parents who do not have direct encouragement.

One of the first considerations when thinking about how you will address infant sleep issues is to determine how you see your role, and what you believe is possible for your child.  Then you can see your path to a good nights sleep more clearly.

Prevent Pacifier Addiction With A Focus on Building Self-Calming Without Plastic

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Parents of newborns are concerned that pacifier use will lead to pacifier “addiction” in later infancy and toddlerhood.  It doesn’t have to be that way.  Pacifier addicts are made, not born.  Parents should not feel guilty about the difficulty they encounter with pacifier weaning, since no one explains what pacifiers do for babies and how to prevent accidental addiction in an older infant.  It starts out as a natural way to soothe a newborn.  No one intends for things to get out of hand. Happiest Baby on the Block even includes sucking as one of the 5 techniques that make up the calming reflex response for newborns.  Pacifiers can be a way to incorporate the calming action of sucking, but then as a child gets older, he should be developing more mature coping methods as well.  Here is what you need to know:

Why pacifiers work so well for younger babies:

  • the need to suck is something your baby was born with.  Fetal ultrasounds show them sucking their thumbs.  Developmental reflexes support sucking at birth.  The shape of the newborn jaw and tongue make it easier for newborns to get a secure and strong seal.  A newborn has more ability to interpret sensory information from the mouth than the eyes or hands, but no ability to keep their fingers in their mouth to suck until 2-3 months of age.
  • this biological need to suck helps them learn to nurse right away, and can calm them quickly in the first 6 months of life.  The ability to self-calm is a learned skill, and develops over the first years.  Babies begin learning to calm themselves down in the first 12 months of life.  If we teach them.

The slide down the slippery slope to pacifier addiction can be prevented:

  • after 6 months, babies still using pacifiers have no biological need to suck, but have the ability to remember their routine.  It can now be a habitual need, not a physical one.
  • some babies aren’t so easy to calm after swaddling and swinging have ended.   Using white noise, a blanket swaddle with the arms out/swaddle garments that have the arms free, and plenty of opportunities for cuddling, rocking, nursing or bottle feeding help the transition for sleep.
  • building early communication skills and responding quickly and effectively to frustration and fatigue in older infants can minimize or prevent the use of pacifiers to calm them during the day.  Start Patience Stretching and the Fast Food Rule (from The Happiest Toddler on the Block) as soon as possible.  See my blog posts on these techniques How To Get Your Toddler To Wait For Anything (Hint: They hear “Wait” as “No”)Taming Toddler Tantrums Using Sympathetic Reframing.
  • families that haven’t established effective sleep routines can run for the pacifier to end bedtime fussiness, rather than taking a wide-angle look at the way they manage naps and bedtime.  Creating a firm but flexible sleep routine isn’t easy.  Step 1 is accepting that building calmness throughout the day (by crafting a daily eating and playing schedule that supports good sleep) is like investing money in the bank for retirement.  It seems a long, long way off until the time arrives when you need the cash.  This may mean that the working parent plays energetically with the baby in the morning or only plays quietly at night.
  • all caregivers, including daycare and nannies, have to be on-board with your exact routines.  No routine at all can be better for a baby than one routine with parents, one with the daycare, and one when grandma watches him on Saturdays.  Imagine if you went to sleep with music playing on Mondays, left Jimmy Fallon on for Thursdays, and had it quiet but the lights are on for Fridays.  Very disorganizing.  This is not easy to coordinate, and many families default to the pacifier to tie it all together.
  • changing the attachment from a pacifier to a “lovey”, which is a transition object that the child can hold and cuddle, is often very helpful.   Switching to thumb-sucking has been shown to be a potential issue for dental malformation. Holding a lovey has not.  This lovey could be a small toy, a tiny blanket, etc.
  • the American Academy of Pediatrics recommends pacifier use until 12 months to prevent SIDS.  If you follow that plan, you need a strong plan to get rid of the pacifier from an older, stronger willed and wiser baby.  It makes complete sense for safety, but parents need to know that it will take longer and be harder to eliminate the pacifier as the child gets older.
  • children who have spirited temperaments, and families that have difficulty creating and establishing routines, often struggle to successfully change any familiar pattern of behavior.  The pacifier can seem like the only sure fix for a child that gets upset easily or has to deal with a lot of unpredictability in their day.  Read  How To Respond to Your Toddler’s Aggressive or Defiant Acts  for some strategies to handle aggressive behavior before you decide that the paci is the answer.  The problem with running to the next idea too quickly is that some children are going to need a few days or even a week for any strategy to become familiar enough to tolerate.  Until then, you can’t clearly see what is going to work or not work.  My favorite book that gives practical advice on creating sleep routines for the strongest-willed babies  is “The Baby Whisperer Solves All Your Problems”.  If you have an older child with a pacifier addiction, check out  Weaning the Pacifier From An Older Child for ideas targeted to getting rid of a pacifier once an addiction has set in.

The most important life skill your baby will learn in the first few years may not be walking or talking.  It may be the ability to calm himself down in times of change and frustration.  Thoughtful planning and execution of a plan can avoid pacifier addiction but also build a skill he will use for the rest of his life.

How To Calm Crying If You Don’t Swaddle

Yesterday I taught a Happiest Baby on the Block class, and one mother was adamant that she would not swaddle her 3-week-old daughter.  She thought it would be too restrictive for her.  Although I taught the correct safety principles, how it mimics life in the womb, and the effective techniques for a good swaddle, this mom wasn’t convinced that it was for her.  My action of choice?  Emphasize the techniques she could embrace.  She learned the technique correctly, but she gets to choose what is right for her and her child.

I do not teach a “swaddle class”, I teach THB.  It is so much more than an opportunity to learn how to swaddle.  The class teaches the neurological and behavioral underpinnings for newborn sleep and calming, and that is powerful information for parents.  Understanding what is happening, why it is happening, and how THB capitalizes on the science of development is empowering on it’s own.

There are four other techniques with their own power to soothe and organize a tiny little being.  Using a safe and firm swaddle is considered the foundation of calming in THB, but the other techniques can be effective when used together, especially with a baby that isn’t exceptionally fussy and is easier to calm.  The correct shushing, swing/jiggle movements, sucking, and side/stomach calming positions can be enough for those babies, and she was lucky enough to have a pretty calm infant (for now – plenty of time for a colicky period to erupt).

Swaddling your baby is the bottom layer of calming, and should extend periods of sleep and create a “calming barrier” of deep sleep to prevent noises in the environment, first infant stuffy noses, and other distractions from waking her up.  If you have struggled with the swaddle technique, watch Dr. Karp’s DVD, use my phone consult sessions or trainings, or try a swaddle garment.  Used correctly, they are a quicker way to an easy “A” in swaddling.

We practiced the effective distance and volume for the shush, the different forms of the jiggle/swing in her arms, discussed sucking as a natural soothing approach, and why just turning a baby onto their side or stomach to calm (never for sleep) is like clicking a sleep switch with a newborn.  And her daughter slept through just about all of it.

Safer With a Swaddle Blanket or Swaddle Garment? Research Says You are Asking the Wrong Question

As a certified Happiest Baby on the Block educator, I am often asked which choice new parents should make.  Swaddling with a blanket is cheaper (babies don’t grow too large for most blankets for months) and blankets can be repurposed after swaddling is finished.  Garments are easier to master; not everyone is willing to learn how to do a firm swaddle.  Parents with physical limitations, and parents of super-wriggly or very strong babies get a more secure swaddle with a garment.  But which is safer? There has been research on this topic.  A Journal of Pediatrics article in January 2014 found that ensuring a wide range of safe sleep practices was more important than method choice for safety.  The question parents should be asking is:  What should we do to make swaddling safe?  Safe swaddling has not been directly connected to very many documented injuries or deaths.  When unsafe sleeping practices are removed from the equation, using swaddling before a child can roll by themselves has a low level of risk.    Here are guidelines to help you make swaddling successful and safer:

  • Many preemies are allowed to sleep on their stomach while in the hospital.  Placing a baby on their stomach without the monitoring and supervision of  a NICU is dangerous.  Safe-to-Sleep recommends only back sleeping at home, swaddled or not.
  • Loose swaddling, soft bedding, rolling over on your child while co-sleeping, or engaging in the use of alcohol or drugs while co-sleeping are huge risks.  Using a co-sleeper next to your bed is much safer than having your baby in your bed.  Avoid having your baby sleep on you in a recliner chair or on the couch.
  • Swaddling your child too warmly is a risk, so learn to “summer swaddle” with muslin or a light cotton swaddle garment, or turn on the A/C.  Child still too warm?  Remove the swaddle until the room is cooler.
  • Not getting a larger swaddle garment once your child has grown is a risk for safety (velcro will not securely attach) and puts him at risk for hip injury if his legs aren’t able to move freely.
  • Once your baby can roll independently, swaddling is riskier. The American Academy of Pediatrics recommends that swaddling should stop when a child is beginning to roll independently.  If you are doing all the other Happiest Baby techniques for the older newborn, then you should have established great sleeping habits without swaddling by the time your baby starts to roll.

Massage With Your Special Needs Child

When parents hear that I am a licensed massage therapist as well as an OTR, they often ask how massage can help their child.  They seem to assume that I would recommend massage only to calm a child on the spectrum, or help a child sleep.  Actually, massage can be great preparation for getting a child moving as well, and supports focused thinking and communicating.  Massage doesn’t just have to be about relaxation.

Massage techniques range from sedating to invigorating.  Children with low muscle tone are especially helped by quick strokes and moving vibration.  They need more information about where they are in space, and where their muscles are around their joints.

Children with spasticity certainly benefit from stretching and relaxing tight tissue, but the best results are when they get up and move purposely.  Their brains note the changes in posture and range of motion, and build new neural connections for easier and efficient movement. Combining massage techniques with movement is like adding one and one and getting three!

Massage with children on the spectrum can range from quiet to more stimulating, based on their current state.  These children get extra support to learn that touch can be acceptable and enjoyable. Reducing a fear response to approaching touch from another person is a worthwhile goal.

Massage is so many things to children, and can support all the other therapies they receive.  Find a great therapist, and learn how to use massage on your own child to help them grow!

Why Stomach Sleeping For Newborns Isn’t the Answer to a Good Night’s Sleep

Why would parents place a newborn on her stomach to sleep, even though their pediatrician clearly advised against this position due to the increased risk of SIDS?  Simple: many babies fall asleep faster and stay deeply asleep this way.  Many, many babies struggle to fall asleep easily or stay asleep  when they sleep on their backs.  This leaves parents torn between safety and sanity. It does not have to be this way!

Parents have good reasons to be afraid of SIDS; the death of an infant is an almost unimaginable tragedy.  One of my best friends said that she could imagine surviving the death of her husband but she couldn’t imagine the pain of losing one of her children.  Back sleeping is one of the simple recommendations to lower the risk of SIDS that has a proven record of efficacy.  Simply put:  placing your baby on her back to sleep could save her life.

One reason that babies sleep so well on their stomachs is that it positions them so that the Moro reflex isn’t triggered when they move their head or limbs.  It also gives them a lot of nice soothing deep pressure as the weight of their body is pulled by gravity into the firm bassinet mattress.  This is also the reason it isn’t safe.  This position makes it harder for a tiny baby in that deeper newborn sleep to clear her airway to breathe, since she doesn’t have the strength to turn her head while barely awake that older babies have.

Getting a newborn to sleep isn’t easy, but it is made so much easier with The Happiest Baby on the Block techniques.  I am a certified HBOTB educator, and I find the greatest error parents have made when they call me for a consultation is that they haven’t layered all the techniques.  They bought a swaddle blanket or garment, they have a white noise playlist on their iPhone, and they got a swing as a baby shower gift.  They use a pacifier, and they know about calming in side lying.  Then they behave as if they are ordering appetizers at Cheesecake Factory: they pick the strategies that they think will be good tonight.

Very young or very fussy babies just don’t sleep as well if you don’t give them all of the 5 S’s.  The sequence is solidly based on the unique neurology and biology of newborns, and you ignore the details at your peril.  Each component gives some support for calming a baby, but most babies need more than one, and most of the consultations I have done are for very fussy babies that clearly needed all 5 right from the start.

Find a consultant if you just cannot get the swaddling or the jiggle down, and practice, practice, practice.  Buy a swaddle garment if you are all thumbs with the origami-like blanket swaddle.  But don’t think that since it works “a little” with just a garment and a pacifier, you are going to get the long, deep sleep that all 5 techniques together can allow.   Always use the side lying or stomach position to calm your baby, but not to sleep.  Don’t cave and put her on her stomach, thinking that most likely nothing will happen.  You do not have to make that kind of gamble with your baby’s life just to get a good night’s sleep!

The Newborn Exercise Your Baby Really Needs…And Why He Isn’t Getting It

Last year I wrote a post on the Bumbo chair, but this time I feel it is time to write a post about the early days of baby positioning, before anyone would put a baby in a bouncing saucer.  I recently published an article locally on why tummy time is now fussy time.  This is news to most great-grandmothers, because their babies weren’t known for throwing fits when placed stomach-down.  Human development takes a very long time to change biologically, so what would cause babies to wail so frantically now?

Today’s babies are sleeping on their backs, which is the safe choice to prevent SIDS.  Pediatricians hardly ever mention that doing so means that parents and nannies will have to make early and intentional efforts to use “tummy time” to get their newborn to 3 month-old familiar with this position for head control and crawling.  I have even met parents that thought the prohibition on this position for sleep meant that it shouldn’t be used for newborns when awake.  Oops!

The American Academy of Pediatrics has a short instruction piece at the end of their very good “Back To Sleep” publication, and it even mentions the [eventually reversible] delays in motor development noted with babies that do not get tummy time.  They do not explain why car seat carriers and other passive positioning devices aren’t recommended for long periods.  And they do not mention the developmental benefits of well-fitting and well-monitored baby wearing for those first months.

Many American babies under 3 months will spend large parts of their day in a car seat/sling seat/vertical carrier.  They are designed to be so comfortable and so entertaining that babies and parents both like them.  Taking a peaceful baby out of a seat/carrier seems cruel.  But so is depriving them of the opportunity to develop neck, shoulder and eye muscle control.  Spending the short periods of time they are awake in a seat prevents the opportunity to move, look and balance.  A baby cannot turn his head freely or sometimes at all in a sling seat.  He can’t use his emerging vision fully when lying on his back at an angle.  Most of the action is not near the ceiling.  He cannot build a sense of balance because he is in one position until an adult moves him.   When these babies get the chance to try tummy time, they fuss a bit.  Or a lot.  A parent who is wondering if tummy time while awake is safe, or who cannot distinguish between complaining while developing a skill and being in pain, might scoop up a baby before he really got the hang of it.  Imagine if you lifted a weight at the gym and groaned, and someone took it away from you?  It would take you a very long time to get stronger.

Just like at the gym, having good company, something fun to watch, and taking breaks can really make a difference.  And cross-training by being carried on someone’s shoulder, playing tummy down on an adult’s chest or lap, etc. is great.  Safely done baby-wearing can be very stimulating and handy for a parent on the go.  The biggest issue is getting to “the gym”.   A baby can’t drive there.  We have to bring the gym to them.

Swaddle at Night, but Get Moving During the Day

A correctly swaddled baby that is also using white noise and all the other Happiest Baby strategies can sleep amazingly long periods at night.  But as your baby goes from a 2 week-old to a 2-month-old, they are up and awake for longer periods of the the day.  Nobody wants to swaddle them all day, and nobody should. Parents now have to think about “positioning” a baby who is not yet rolling over by herself, and not sitting independently.  A baby’s daily exposure to sensory input during the day can have a huge effect on their development.  The American Academy of Pediatrics warns of skull flattening if a baby is left in a carrier or on her back most of the day.  Here are some thoughts from a HBOTB educator who is also a pediatric occupational therapist.

*  Babies that get lots of opportunities to look and move at the same time are developing their balance even though they are not even old enough to roll.  And vision is one component of balance. One secret to great visual development is having the opportunity to develop close and distance vision as early as possible, as well as looking at things from different angles and speeds as she is moved around.  Carrying and holding her in your arms or using a wrap/carrier can provide that input.

*  If you use an infant seat or car carrier, use it for brief periods and not for sleep.  if your baby seems to love the enclosure of a carrier, then you might have someone who would be a good swaddle candidate.  Swaddling with a blanket is a skill you can learn, or you can try the swaddle garments.

*  Wearing your baby in a front-facing carrier or a wrap/sling is terrific as long as your baby’s head is supported to keep that airway open, and you move carefully to avoid falls, bumps or burns.  Wrapping babies who cannot hold their head steady or even turn their head to get more air is trickier than carrying a 6 month old.  I have heard stories of people who stand at the stove while wearing their baby.  Take as few chances as you can.   Always bend at the knees when reaching down, and check your baby’s head and neck position as they can slide a bit due to gravity.  Every time you turn and bend your baby will get valuable balance stimulation, as long as she is secure and safe.

*  Young infants can learn to love tummy time, but start early and make it fun.  Temperamentally cautious babies and babies who resist novelty by complaining may need a gradual introduction and some creative approaches.  The reward is that play on her stomach can help the development of head, arm and trunk control for sitting and crawling.  Plus less time with the back of her head pressing into a carrier or mattress.

*  THBOTB uses side lying as a calming position, but when supervised it is a great play position.  Never leave a young baby unsupervised in a position in which the could roll on their stomach and be unable to breathe.  Use rolled towels to support your baby’s back and the leg that is on top, and maybe a folded receiving blanket under her head so that it isn’t tipped downward.  Placing their backside against the firm back couch cushions can work too.  Then put a few toys in front of her to reach for and look at.  Best part:  both hands can work together easily.

Move Your Baby Into a Shared Bedroom Using The Happiest Baby on the Block

One question I usually hear when teaching The Happiest Baby on the Block (THB) classes is “Can this help me when I want to move her into her sister’s room?”.  The answer is: absolutely!  Strategies that keep your newborn calm and sleeping more deeply will smooth the transition to shared bedrooms later on.

Most parents use either a co-sleeper or a bassinet for the first few months after birth. They can hear and see the baby more clearly, and the frequent feedings and diaper changes are less disruptive to everyone’s sleep.   Unless they use the “family bed” concept, they often plan to move their newborn to a separate room after 4 and 6 months.  I think every family should decide for themselves when and where they want their babies to sleep.  But if you want two children to share a room, you need to have a plan.  Twins can be a bit easier, but it is not a guarantee that they will have identical sleeping and feeding schedules.  When you have an older child already sleeping in a bedroom, moving your infant in with them is even more complicated.  Parents are generally worried about waking the infant when the toddler goes to bed later, or worried that the infant will wake for a feeding and then wake up the toddler.  They envision nights with one or the other crying, and nobody getting a decent night’s sleep.  It doesn’t have to be that way.  And it can be done without anyone crying.

My favorite saying about sleep issues in infants is that a good night’s sleep starts in the morning.  Using THB, you have strategies to calm your baby all day long, through naps and stressors like noise that other children make.  A baby that has spent the day being quickly calmed, had deep refreshing naps, and knows that their caregivers can calm them quickly is much easier to put to bed at night.  Parents who are no longer swaddling have asked me what they can use.  Well, swaddling isn’t the only THB technique.  In fact, it is only one of 5.  Parents can use sucking without risk of dental deformation or habitual dependence through month 6, and white noise is great for the whole first year.  Some children will use the adjustable swaddle garments to get the firm chest/abdomen swaddle input after they start rolling.

It helps if you use techniques like the dream feed to extend and deepen sleep at night (see my post on the magic of dream feeds).  THB techniques can be done by dads and nannies, so moms aren’t the only ones who have to get up at night.  Sometimes babies need to nurse, and sometimes they aren’t hungry but have a stuffy nose or need a diaper change.  Getting them back to sleep quickly is very important to preserve the concepts of day and night difference.  Recent research in the UK indicates that the circadian rhythm of naturally seeking sleep at night is developed in the second and third months of life, and is not entirely biological.  Their research suggests there is an interplay of brain development and the way babies are supported to sleep that promotes that circadian pattern.  It can be disrupted; ask any insomniac.  Give your baby the best chance at solid sleep patterns right from the start!

Babies that have grown accustomed to always nursing or bottle-feeding to get back to sleep, or expect to play a bit before going back to sleep are going to be the most difficult to blend into room sharing.   A baby that is quickly calmed by THB techniques at the earliest age is practically asleep by the time you put them down.  They can save the fun for the times when the sun is shining.  They are so sleepy when you use THB that they will not develop habits that work against getting their precious nighttime sleep, even in a shared room.