Taking medication while pregnant: what to consider

For me, spring means allergy season: constant sneezing, itchy eyes, the works.  Basically, my sinuses go into full freak-out mode and decide that protecting me from some as-yet-unidentified pollen is more important than actually functioning.

Fortunately, medications exist that can calm down my widely overactive immune response.

However, I’m pregnant, and our culture is filled with messages about how the smallest dose of anything is dangerous and scary and really you just shouldn’t risk it.  And most meds aren’t well-studied during pregnancy, so it can be hard to figure out what’s worth worrying about.

So what’s an expectant mother to do?

1.  Talk to your doctor.

Or your nurse practitioner.  Pharmacists can also be helpful, although I’ve found their advice tends to be more generic.

When it comes to anything concerning pregnancy, this is the #1 rule: talk to a medical professional.  Call up your OB/GYN’s office, or bring it up during an appointment, or whatever is applicable for your situation.

My OB/GYN helpfully provides all her prenatal patients with a one-page list of common medications that are considered safe to take as directed during pregnancy.  Happily for me and my allergies, diphenhydramine (Benadryl) and loratadine (regular Claritin) are on her approved list.

Relatedly, you should also talk to a doctor before abruptly stopping medication during pregnancy.  Even if the drug in question is widely considered dangerous to fetal development, you might be risking worse effects by doing a sudden withdrawal instead of a controlled taper.

2.  Be skeptical of online information.

This is a universally true rule for life, but it is especially true when it comes to medical information.  Health info on the web has always been questionable, and it seems to have gotten worse in recent years with the proliferation of “healthy living” websites.

Pregnancy-related Google queries are particularly unreliable.  Most of the results you’ll get for something like “is it safe to take Benadryl while pregnant?” are mommy forums where other women have asked the same thing—and gotten a bunch of responses from women who also don’t know the answer.

I understand the desire to scour the internet, hoping that someone somewhere knows something that can give you a definitive yes or no on medication safety.  I’ll be honest, I’ve done some serious Googling on this stuff myself.  But with a lot of drugs, we just don’t have that much data about safety during pregnancy, and you’re far better off going with someone who’s qualified to interpret the data that do exist.

If you must ask the internet, go directly to a reliable source.  I’ve found these resources to be valuable:

  • The medication fact sheets at MotherToBaby, which are put together by experts in teratology (the study of birth defects).
  • The InfantRisk Forums, part of the InfantRisk Center at the Texas Tech University Health Sciences Center.  Forum questions about medication safety are answered by administrators, who are qualified medical professionals.  The InfantRisk Center also has an app, although I haven’t tried it myself.
  • The Massachusetts General Hospital Center for Women’s Mental Health has a ton of info about mental health and psychiatric medications during pregnancy, although you sometimes have to dig around a bit in their archives.

3.  Consider the risks of not taking medication.

The discourse around taking medication while pregnant (or indeed, doing anything while pregnant) revolves around minimizing risk.  There is a general tendency for people to focus on the risk of doing something, as in, “if there’s even the tiniest risk of taking this medication, I won’t do it.”  But what about the risks of not doing?

For example, imagine you’re pregnant and thinking about taking some acetaminophen (Tylenol).  Tylenol is on my OB/GYN’s “OK to take” list, and is broadly considered safe for pregnancy at appropriate doses.  But maybe you saw that study recently about there being a possible association between Tylenol during pregnancy and children’s later behavior problems, and you’re nervous.  You’re worried that you might be taking an unnecessary risk.

What are the risks of not taking that Tylenol?  It depends on your situation.

If you’re just a little sore, maybe you stretched a muscle the wrong way, or you’ve got a bit of a tension headache, there’s probably not much risk to skipping the Tylenol.

But if you’re running a fever, there are documented risks to not taking a fever-reducer like Tylenol: high fevers, particularly during the first trimester, are associated with birth defects.

If you’re in serious pain—let’s say it’s not something directly dangerous, just really uncomfortable—the risks are somewhere in the middle.  Pain stresses your body, making it pump out cortisol and other stress hormones.  Pain might make it hard for you to sleep, or to otherwise care for yourself.  We don’t know that much about how stress affects developing babies.  I wouldn’t want to imply that it has dire effects, because everyone deals with some amount of stress during pregnancy, but lessening the stress on your body is probably a good thing.

(This last one is where allergy medication falls for me: the risk of not taking it is that I will feel like absolute crap.)

With other medications, especially those that haven’t been well-studied, the risk calculation is even more complicated and specific to individual situations.  I am currently taking the antidepressant escitalopram (Lexapro), after a great deal of thought and consultation with a psychiatrist who specializes in pregnant and postpartum women.  I’m aware of what we know and don’t know about the risks of taking Lexapro during pregnancy.  I’m also aware of the risks of untreated depression in pregnant women in general, and the risks of untreated depression in me in particular.

4.  Understand how drugs are classified during pregnancy.

Whenever someone asks a med question on a mommy forum, there’s always that one person who shows up to announce that the drug in question is Category B and therefore obviously dangerous and clearly the rest of you are dolts for even considering otherwise.

That person is a pompous twit, and also wrong.

For a number of years, the U.S. Food and Drug Administration (FDA) sorted medications into five pregnancy categories, A, B, C, D, and X.  Other countries use different systems, often based on similar principles.  As of mid-2015, the FDA officially stopped using the five-category system, but it’s still widely in common use for discussing drug risks, and it’s useful to know what the categories mean.  (It’s also not clear to me that the new labeling rules, which supposedly provide more information, are actually in use yet.)

Here’s what the categories mean:

Category A:  There have been controlled human studies showing no risk to taking this drug in the first trimester, and there is no evidence of risk in other trimesters.

Very few meds are in Category A.  It’s actually pretty hard to find examples.  Folic acid (you know, the stuff in your prenatal vitamin that helps spinal development) is Category A.  Many thyroid replacement hormones are Category A.

Category B:  There have not been controlled human studies, but the existing evidence (including animal studies) indicates there are no serious risks.

Pretty much everything that’s basically fine is in Category B.  The meds on my OB/GYN’s “OK to take” list are Category B.  Tylenol is Category B, as are some antibiotics, some allergy medications, and a variety of other things.

There is, I think, a tendency for laypeople to assume that drugs end up in Category B because they’re inherently not as safe as drugs in Category A, and that isn’t true.  A lot of meds end up stuck in Category B because it’s really, really difficult—not to mention frequently ethically problematic—to run controlled trials, the kind where you assign people to treatment and non-treatment (control) groups in advance, in pregnant women.  You can ask women about their med usage and compare outcomes, as they did in the Tylenol study mentioned above, but a lot more confounding factors can creep in that way.

(Somewhat weirdly, Category B does include drugs that have had controlled human studies with good outcomes—if there are also animal studies that show possible risk.  As always, talk to your doctor for details on your particular drug.)

Category C:  There are limited data in humans, and maybe some animal data showing risk.

There are a bunch of different combinations of data (or lack thereof) that can put something in Category C.  There’s “we don’t have formal studies on this, but women have been taking it for a while and it doesn’t seem to cause anything dramatically bad.”  There’s “we can poison animals with really high doses of this, but we don’t have human data.”  There’s “we’ve seen this cause withdrawal symptoms in newborns but it doesn’t seem to have any long-term effects on their development.”  In short, Category C meds are not known to be safe, but they are also not known to be unsafe.

General pregnancy references often lump Category C meds in the “don’t take this” group, but what they mean is “don’t take this without consulting your doctor about your own personal situation.”  Any source that tries to tell you Category C drugs are absolutely unsafe should be treated with great suspicion.

Examples of Category C medications include my Lexapro and several other antidepressants, some types of antibiotics, and the antiviral Tamiflu.

Category D:  Human data show that this drug can have negative effects on developing babies, but the benefits might still outweigh the risks in certain situations.

If you’re dealing with a serious health situation—epilepsy, cancer, etc.—and less risky drugs are not available or appropriate, a doctor may consider giving you something from Category D.

Interesting fact: the common painkiller ibuprofen (Advil) is in Category D in the third trimester.

Category X:  Human data show that this drug is dangerous and should not be taken during pregnancy.

Category X includes things like thalidomide (infamously prescribed for morning sickness in the late 1950s), methotrexate (used, among other things, to treat ectopic pregnancies), and isotretinoin (the prescription acne medication Accutane).

5.  Don’t panic.

And carry a towel.  (Because if I can’t make Hitchhiker’s Guide to the Galaxy jokes on my own blog, where can I?)

Do I worry, sometimes, that taking Lexapro and allergy medications and the occasional Tylenol will hurt my growing baby?  Yes.  But I’ve talked about my worries with my doctors, and I trust them, and I trust myself.

Be thoughtful and be cautious—but take care of yourself.

There’s new advice for new parents

It’s been a busy week when it comes to telling new parents what they should and shouldn’t do.  The American Academy of Pediatrics (AAP) released several new policies, and the US Preventive Services Task Force (USPSTF) reviewed and updated their recommendations on breastfeeding support.  Even though Little Boy is well past infancy, I’m still very interested in the science of infant care (and we might decide to have another kid), so I’ve been paying attention.  Let’s take a look at each of the new policies.

Kids & screen time

The general message of the AAP’s new policy statement on media use by young children is familiar: choose age-appropriate media, talk to your kids about what they’re watching, and turn off the TV (and other devices) before bed.  But there are a few key updates worth pointing out:

  • They’ve lowered the age of “no digital media” from 2 years to 18 months: you are now allowed to introduce “high-quality programming” to your 18-month-old if you so choose.  I’m pleased with this recommendation, because it agrees with my observations of child development.  Little Boy was 17 or 18 months old when he started really caring about Sesame Street.  By age 2, he knew all the characters and could identify the letter C (is for Cookie) in other contexts.  The old ‘kids don’t get anything out of TV before age 2’ policy seemed frankly incorrect.
  • For children under 18 months, the “avoid digital media” recommendation now explicitly says video-chatting is OK.  It’s a little thing—I mean, we all kind of figured that Skyping with Grandma didn’t really count as “screen time”—but it shows that the AAP put some thought into the various uses of media in modern society.
  • I also appreciate that this statement is included: “…there are intermittent times (eg, medical procedures, airplane flights) when media is useful as a soothing strategy…”

Safe infant sleep

Again, most of the recommendations in the AAP’s new policy statement on infant sleep safety are things we’ve heard before.  Babies should sleep on their backs.  Avoid blankets and soft bedding.  Don’t smoke.  Offer a pacifier (nobody quite knows why, but pacifier use is associated with lower rates of SIDS).  In a few cases, though, the details have changed:

  • Room-sharing (baby sleeps in parents’ room but in his/her own crib or bassinet) is now explicitly encouraged for the first 6–12 months.  Popular media articles seem to be treating this as a shocking new development, but the old safe sleep policy already recommended room-sharing, just without a specific length of time.  The science around this is up for debate, though; it’s not clear if the references cited by the AAP really show strong support for room-sharing.  (Some thoughts from educated folk here and here.)
  • The AAP remains very strongly against bed-sharing; however, they now admit that parents get really fricking tired caring for new babies and sometimes falling asleep with your baby in bed is the least bad option.  While bed-sharing is most definitely not for me, I appreciate their concession to reality:

    However, the AAP acknowledges that parents frequently fall asleep while feeding the infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep.

Supporting breastfeeding

The recommendation statement by the USPSTF, accompanied by an in-depth statistical analysis, addresses whether anything hospitals and medical professionals do actually increases breastfeeding rates, and if so, what interventions are most helpful.  They conclude, “with moderate certainty,” that breastfeeding support has a “moderate net benefit.”

That’s not terribly surprising, but there are some really, really interesting specifics in the report, highlighted in a Journal of the American Medical Association editorial:

  • There is no evidence that the Baby-Friendly Hospital Initiative (BFHI) does any good.  If you’re unfamiliar with the BFHI, the idea is that hospitals can be certified if they implement a set of ten “baby-friendly” (read: breastfeeding-friendly) steps.  Some of these steps are controversial; for instance, if a new mother wants to formula-feed, the BFHI requires that hospital staff “educate her about the possible consequences to the health of her infant.”  Anyway, the USPSTF report determined that “individual-level interventions” (seeing a lactation consultant, attending a breastfeeding support group, etc.) were useful, while “system-level interventions” (the BFHI and other hospital policies) were not.
  • There is no benefit (in terms of breastfeeding duration) to completely avoiding formula during the newborn period.  Moms who supplement with formula before their milk comes in are just as successful at breastfeeding!  This is a big deal, because current breastfeeding advice tends to take an “any formula ever will ruin your breastfeeding relationship” approach.
  • Pacifiers are also OK!  Pacifier use is not associated with breastfeeding problems.  In fact, because pacifier use is associated with lower SIDS risk, the JAMA editorial goes so far as to say that

    routine counseling to avoid pacifiers may very well be ethically problematic.

Interestingly, when the USPSTF posted a draft of their recommendations back in April, there was apparently some concern about their choice to talk about the “support” of breastfeeding instead of the “promotion” of breastfeeding.  Because people are weird about this.

Trying not to scare away potential PhDs

Earlier this week, a friend drew my attention to this article on Times Higher Education, addressing the question of when to give up on an academic career.  When do you decide that the sacrifices are too much, and the chances of successfully landing a tenure-track professorship too small?

The article takes a particularly interesting tack: it imagines academia as a boyfriend who “does not want to commit himself,” insisting his partner give everything to the relationship while refusing to make any firm plans.  Basically, the kind of guy that makes advice-givers want to say, “Dump him now!

I think this analogy is really interesting, if imperfect.  Confession time: sometimes, when I’m in the car singing cheesy country break-up songs to myself, I think of them as break-up messages to grad school.  You know, stuff like “You stole my happy, you made me cry…”  (What can I say, my marriage is happy and stable, so I don’t really have any feeling-wronged emotions to express in that direction.)

As I do, I shared the article on Twitter:

(In retrospect I think this was maybe a bit glib toward people who have had to deal with real abusive partners, and for that I apologize.)

One of my followers, PB (@fuckyascience), reacted:

And I felt sort of bad, because PB is a neuroscience student who’s really interested in pursuing a PhD.  We’ve had chats about the grad school admissions process, and now here I was saying that an academic career was all kinds of awful.

I’ve been thinking for the past few days about how to respond.  I’ve written about this dilemma in various forms before, puzzling about how to talk to prospective grad students and sorting out my advice to incoming grads.  But neither of those quite captures what I want to say today, which is this:

Yes, the job market in higher education is crap.  If you want to do a PhD, you should know that.  Don’t go to grad school because you want to be a professor, go to grad school because you think something is really cool and you want to study it for 4, 5, 6+ years.

Yes, the academic employment system is pretty exploitative of early-career researchers.  You get paid very little as a grad student, and then a mediocre salary as a postdoc, and then nothing fantastic money-wise as a professor.  You should be aware of this going in.

Yes, at some point, grad school is going to suck.  There’s a reason why PhD Comics is so popular.

But I can’t in good conscience actively discourage anyone from pursuing a PhD, and I don’t want to.  Plenty of people are very happy in academia and can’t imagine themselves doing anything else.  You, dear reader, could be one of those people!

Go to grad school, with your eyes open to its problems and the difficulties that people face.  Know that at every stage, there are people who’ve been there, done that, and can offer support.  If at any point you find that the cons of academia are outweighing the pros, give yourself permission to re-evaluate your plans.

And if you ever need to, know that it’s OK to sing cheesy country break-up songs about your career.

My advice to new PhD students: do what you love

Dear new PhD students:

It’s the end of September, and you’ve been in the thick of things for about a month now.  Chances are, the graduate school experience is feeling pretty intense at this point.  You’ve got homework.  Research.  Umpteen seminars and discussions.  Maybe teaching on top of that.  Some of you are thriving on the chaos, and some of you are worried you’re about to drown.

It’s right about this time that the senior PhD students in my department traditionally host a grad-to-grad advice lunch.  I missed it this year, which is probably better for everyone.  I am cranky and bitter and bad at small talk.

However, I do have one piece of non-cranky advice that I’d like to share with you, which is the following:

Do what you love.

Find the things in grad school that make you happy, and do them.  Pursue your interests.  Follow your curiosity.

You’re going to hear a lot of advice on what you “need” to do to be successful in academia.  Ignore it.  Or maybe don’t ignore it completely, but put it away in a mental filing cabinet, to be reviewed only periodically.

Because if you spend your time in graduate school worrying about how many papers you’ve written, or how many potential reference-letter-writers you’ve cultivated, or how many lines you have on your CV, you’re going to be miserable.

The best way to write papers is to care enough about your results that you want to tell everyone about them.

The best way to develop collaborations is have ideas you think are cool and skills you want to share.

If you’re working on something you love, the rest will follow.  It might not necessarily follow easily—you might, like me, dislike writing in general, or it just might not be your strong suit.  Maybe presenting at conferences will require getting over a fear of public speaking, or maybe your interests are so far-flung that they’ll take a little wrangling to shape into a coherent thesis.  But writing and public speaking are skills that can be learned.  They’re steps to an end goal (sharing your cool research with others), not the goal itself.

Somewhere along the line, you might discover that the things you love doing are not the things that academia thinks you should love doing.  That’s OK.  That’s something you need to know about yourself.

Do what you love.

Because if you don’t, you’ll end up like me: cranky and bitter and not totally sure why you’re still here.

All the best,

Me

Handling criticism

I struggle with taking feedback, especially feedback of a critical nature (which is the only kind you ever really get in academia).  I always take it personally.  As an über-perfectionist, I hate receiving any indication that my work deviates from 100% excellence, even though I know logically that (a) no one is perfect, and (b) definitely not me.

As a result, I’ve tried to develop a series of coping techniques for responding to criticism productively and professionally.

STEP 1:  Remind yourself that feedback is good.

Repeat after me: Feedback helps me get better.  Feedback improves my work.  Feedback helps me get better.  Feedback improves me work. 

Not all pieces of feedback are good, of course – some are useless and aggravating and completely unhelpful.  But “feedback” as a concept is good.

STEP 2:  Read it (or listen to it) all at once.

Rip off the Band-Aid, so to speak.  It’s probably not as bad as you’re imagining (and if it is, at least you’ll have something concrete to get angry about).

STEP 3:  Resist the urge to get defensive.

Yesterday, one of my co-authors on the Paper From Hell sent me some feedback (as I’d requested).  Along with some general comments, she included a list of some two dozen typos.  My first instinct was to write back apologizing for my sloppiness, explaining that I hadn’t wanted to spend the time doing a final fine-tooth-comb proofread while we were still at the “ask for general comments” stage and that some of the typos existed because I’d done so much rewriting over the years.

Fortunately, I was able to remind myself that such a response was unnecessary.  I didn’t have anything to prove here.  Everybody makes typos.  That’s why copy editors exist.  Plus, she was doing exactly what I’d asked: providing me with information with which to improve the paper.

I experienced this from the other side recently while participating in WordPress’s Writing 101 mini-course.  Bloggers would write on the course discussion board, asking for feedback on their latest post.  But if I left a comment that contained any constructive criticism (think along the lines of “this is a great message but I think it might be easier to read with paragraph breaks”), they’d respond with an apology or a “well, writing is just my hobby.”  It was… awkward.  And uncomfortable.  It made me feel bad that I’d said anything.

Sometimes, when particularly self-conscious about and/or enraged by criticism I’ve received, I open a text file and type out all of my angry/worried/but-I’m-so-perfect responses.  When I’ve completed that first anxiety-inducing read-through and gotten all my emotions out, I delete the file.

STEP 4:  Take each point of criticism one at a time.

After I’ve read through, felt terrible, and calmed down again, I go back to the feedback I’ve received and start addressing it one part at a time.  Broken down into bits, things are rarely as awful as they seemed on first approach.  I ask myself:

Is this a valid criticism?

Is it worth addressing in full or in part?

Just because someone makes a suggestion doesn’t mean that suggestion is automatically right, or that it should be done in exactly the way they suggested – even if the person making the suggestion is someone whose opinion you value.  Their relative experience/knowledge/authority will carry some weight (maybe a lot of weight, if they’re your boss), but it’s still your final decision on how to address their feedback.

If it’s worth addressing, what steps do I need to take to address it?

Do I need more information?

Make a plan!  Take action!  Fix your typos, follow up on something you hadn’t thought of, or develop concrete steps to prevent similar issues in the future.

STEP 5:  Decide how to reply.

Not all criticism requires a response, and sometimes all that’s needed is a short “thanks for the feedback.”  In the case of the list of typos from my paper’s co-author, no long explanation was necessary.  After all, I corrected all of the typos, as she will see when I send around the next draft.

For more substantial feedback, it’s often important to let the criticizer know that you respect his or her opinion.  If you think their ideas have merit, give them a short summary of what you’re doing to fix the issue.  If you’ve decided not to adopt their suggestion, explain why.

 

That’s my current strategy – it’s a work in progress.  Usually my biggest hold-up is trying to avoid Step 2, on the entirely incorrect theory that avoiding something will make it go away.  Readers, I’m sure none of you are particularly fond of criticism.  What’s your approach to making it a productive experience?

The lazy mom’s guide to introducing solids

(I know dads feed their babies too.  But “The Lazy Dad’s Guide” sounded overly stereotypical, and “The Lazy Parent’s Guide” just didn’t have the right ring to it.)

STEP 1:  Start with something that can be prepared quickly, easily and in small quantities. 

(We chose iron-fortified rice cereal.)

Offer daily.

Be entertained by the fact that baby is more interested in spoon than in food.

STEP 2:  Scrounge cupboard / fridge / freezer for food that is soft or can be easily squashed / puréed with a hand blender.  Bonus points if this is yesterday’s leftovers.

Ignore all the old rules about allergies.

Be grateful that the latest research and your pediatrician recommend ignoring all the old rules about allergies.

Be highly entertained at the faces baby makes when given a spoonful of applesauce.  Seriously, who doesn’t like applesauce?

Occasionally remember to put avocados and sweet potatoes on the grocery list.

STEP 3:  Put some finger food on baby’s high chair tray.  Prepare for chaos.

Discover that Puffs get soggy and gross really quickly and replace them with Cheerios.

Be extremely impressed at the rapid improvement in baby’s pincer grasp.

Realize that your little one is growing up.

In praise of Dr. Ferber

Ferber seems to take a lot of flak on the internet these days.  I’m referring, of course, to Dr. Richard Ferber, author of Solve Your Child’s Sleep Problems and founder of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital.  His method of sleep training has become so well-known that it has its own verb: “Ferberizing.”  But spend any time on mommy forums and you’re bound to encounter science-y sounding proclamations about how terrible the so-called “cry it out” methods are for your baby.  Abandonment!  Brain damage!  Instant breastfeeding failure!

Those people are nuts.

I think when a lot of folks hear the words “sleep training,” they think of situations like the one described in this New York Times article, in which a doctor recommends leaving your 8-week-old alone for 12 hours, no matter how much he or she cries.  Don’t do that.  Don’t even think about doing that.  Seriously, that is a terrible, terrible idea.

That’s not what the Ferber method is about.

I actually read Ferber’s book, in its entirety, and it is the very opposite of ignoring your child’s needs.  His (in)famous method occupies just one chapter out of eighteen.  Most of the book deals with a variety of other sleep issues: nightmares, sleepwalking, bedwetting, circadian rhythms, etc.  It was clear to me that Dr. Ferber cares deeply about children’s well-being.  For instance, his recommendation for an older child dealing with severe anxiety is to do “whatever is necessary to help your child feel safe” – the italics are his emphasis, not mine.

My Little Boy stopped nursing himself to sleep somewhere around the 2-month mark.  Bedtime became progressively more and more of a struggle, as he grew less and less interested in being rocked or sung or swung to sleep.  By 3 months, it was taking a solid 90 minutes to put him to sleep at night, and then we’d be on tenterhooks for another 45 minutes in case he woke up at the end of that first sleep cycle.  The stress and lack of personal time was making my husband and me very unhappy.  Something was also making Little Boy very unhappy: he started crying the moment we took him out of his bath and kept it up all through his bedtime story and song.

That’s when we decided to sleep train.  Ferber’s book told us to lay him down in his crib with a kiss and leave for 3 minutes.  Go back in for more kisses and shushes and reassuring words.  5 minutes.  More reassurance.  7 minutes – wait, he’s quiet.  He’s asleep!  The next morning, Little Boy went down for his first nap with zero crying, and he cried for less than 5 minutes that next night.  Night 3 was a bit rough with 20 minutes of angry baby, but he’s been good at falling asleep ever since.

Now 7 months old, Little Boy falls asleep on his own and greets us in the morning with giant smiles.  He will sometimes grump for a few minutes when we leave him at night, but more commonly he happily babbles for a bit before getting comfy.  He sleeps well in strange places as long as he has a quiet, safe space to rest, and he’s added two teeth with extremely minimal sleep disruption.

We are happy, because nighttime is much less stressful.  Even more importantly, Little Boy is happy.  He stopped screaming during his bedtime routine, perhaps because he is confident in his ability to fall asleep.  (Ever been tired but unable to convince your mind and body to sleep?  It sucks.  It would make me scream, too.)  Sleep training has meant a lot LESS crying for Little Boy.

There are other methods of sleep training, with varying degrees of parental presence and intervention.  I liked the Ferber method’s balance of giving my baby the chance to fall asleep on his own while still allowing me to make sure he was OK.  We still check on Little Boy if he fusses for more than 5 minutes; on the rare occasion that this happens nowadays, it’s almost always because he needs a clean diaper.

Of course, you don’t need to sleep train your baby.  If you’re happily co-sleeping or just have a kid who sleeps easily and well – awesome!  Don’t fix what isn’t broken.  But if it takes hours just to put your baby to sleep at night, or if he’s waking up every 45 minutes all night long – the rest of this post is for you.

I call it “Crazy Grad Mama’s guide to (mostly) guilt-free sleep training.

Wait until your baby is old enough.  Most sources will say to hold off on sleep training until 4 months; some say to wait ’til 6 months.  The real hard-and-fast rule is to wait for the end of the “fourth trimester,” that 3-4 month period in which your baby is still adjusting to life outside the womb, his nervous system still developing to a point where it can handle the big wide world.  You can gently try to make your newborn sleep longer, but you can’t force it.

Sleep training is not the same thing as night weaning.  (In fact, they’re separate chapters in Ferber’s book.)  “Sleep training” should be about falling asleep, not specifically about sleeping through the night.  If your baby needs to nurse every hour because that’s the only way he knows to fall back asleep at the end of a sleep cycle, then yes, sleep training will mean fewer night feedings.  But you should never let your baby go hungry (duh, right?).  In our case, Little Boy had dropped to 0-1 night meals of his own accord before we sleep trained.  Since we knew that when he woke out of hunger, it was around 4-5 a.m., we decided to treat any wakings before 2 a.m. as not-hungry times.  (As it turned out, this happened only once.  I don’t remember what was bothering him, but his dad comforted him a few times, and he went back to sleep.)

Have a plan.  Consistency is key to learning any new skill or habit.  The first couple of nights of sleep training will probably suck, so it’s important to be prepared.  It’s also important to implement a legit sleep training method and not a haphazard “I’m going to let my baby cry for a while and see what happens” approach.  Read a book (or books, if you’re me) or find a non-crazy internet site for reference.  Noob Mommy has a great explanation of Ferber, and BabyCenter’s Teaching Your Baby and Toddler To Sleep board is a good resource for sleep training options (this is only time I will ever recommend a BabyCenter forum, so take note).

Commit for a week.  Again, the first few nights will be the worst, but you should see noticeable improvement after that.  It’s also not uncommon to see some improvement, then have a random worse night (like our third night).  But if you stick to it, things should be better after a week.  If they’re not, stop and reevaluate; either you, the parents, have implemented something incorrectly, or your kid needs a different approach for sleep.  (If you have Ferber’s book, you can refer to the section titled “If Things Are Not Getting Better.”)

Remember the importance of sleep.  Some people dismiss sleep training as selfish, and it undoubtedly benefits parents.  But sleep is important for growing babies, too.  Memories consolidate during sleep; the mind and body refresh and renew themselves.  Solid sleep is as important a biological need as food and human interaction.

For those about to embark on a sleep training adventure, I wish you luck!

5 tips for newborn sleep

Everyone said, “Take her for a drive, that’ll put her to sleep.”  No, then we just had a screaming baby in the car.

– My dad, describing my behavior as a newborn.

Ah, sleep.  One of the great struggles of new parents.  For all I talk about the horrors of Little Boy’s early sleeping patterns, he has been in some respects a very good sleeper.  He was giving us a good five- or six-hour stretch at night by about 9 weeks old, and was regularly sleeping up to eight hours by 12 weeks of age.  Getting him to actually go to sleep in the evening was the hard part, as were his persistently short naps.

There are some good newborn sleep tips out there, but there is also a lot of highly impractical advice.  “Put your baby down drowsy but awake” – my baby just fell asleep nursing and I’m not going to wake him up, thank you very much.  Unlike me, Little Boy would usually fall asleep in the car, but then he would wake up again the moment we brought him back inside the house.

In no particular order, then, here are the sleep tips that worked for our Little Boy as a newborn.  I hope someone out there will find these helpful; however, as I’m extrapolating from a sample size of N=1 baby, I offer no guarantees.

1.  Recognize that sleeping babies are noisy.

As a new parent, your first reaction to any sound from your baby is to think, “Oh my gosh, are they OK?  What do I do?”  But newborn babies are loud sleepers: they grunt, snuffle, wiggle, and generally make a ruckus while they are still asleep.  Just like adults turn over or adjust the blankets without really waking up, babies go through periods of light, restless sleep.

More than once, I was wakened by an escalating series of grunts from Little Boy and was sure that I was going to have to drag my tired self out of bed for another feeding.  Except I was so exhausted that it took a minute – and then I woke up two hours later.  Little Boy and I had both gone back to sleep.  The first time this happened, I felt seriously guilty, until I realized that there was nothing to be guilty about.  Little Boy was fine.  If he had needed me, he would have let me know in no uncertain terms.

Once we figured this out, my husband and I instituted a rule for night sleep: “If he’s not crying, let him be.”  I give a lot of the credit for Little Boy’s early extended nights to this rule.  We still use it now: Little Boy sometimes wakes up in the wee hours of the morning, babbles happily (but loudly) to himself for a while, and falls back asleep on his own.

2.  Encourage full meals.

A key contributor to those middle-of-the-night wakings in the early days is hunger.  Newborn stomachs are tiny, and their food digests quickly.  You can’t – and you shouldn’t – dictate how long new babies go between meals, but there are some ways to gently encourage longer stretches.

I wasn’t actually thinking about sleep when I first started using these techniques.  Rather, I was a paranoid brand-new breastfeeding mother worried about making sure her baby was getting enough of the fatty “hindmilk” that comes later in a nursing session.  In addition to letting Little Boy nurse as long as he wanted, I didn’t assume that he was finished on one side just because he needed to burp.  Instead, I’d offer him the same side again, and only switch him to the other side when he was really truly done with the first.  The downside to this approach was that each meal took a long time, usually upwards of 40-50 minutes in the early weeks.  Thank goodness for cable TV.

The other part of this strategy is this:  If your little one gets fussy and it’s been less than 90 minutes since the start of the last feeding, try other methods of comfort before offering more food.  Breast milk digests quickly, not immediately.  Your baby might be tired and need help falling asleep, or gassy, or maybe just bored.  Obviously, you should always feed a hungry baby, even if the period between meals is short.  But do consider that not all cries indicate hunger.

3.  Focus on getting calories in during the day.

A baby who gets plenty of food during the day will (hopefully) be a baby who needs less food at night.  We didn’t start focusing on this until Little Boy was closer to 3 months old, because I was having trouble figuring out how to transition from purely on-demand feedings to something resembling a predictable schedule.  If I had to do it over again, I would start sooner.

What this tip means in practice is offering food on the early side of your baby’s hungry range.  Little Boy was typically going 3-4 hours between meals during the day, so we started offering him food every 3 hours.  (Alternately, you could consider the number of feedings your baby typically wants during daylight hours.  If, for example, he usually wants to eat 5-7 times, you would then try to encourage him to eat 7 times every day.  Yes, this might mean waking a sleeping baby during the day.)

4.  Know your S’s.

The 5 S’s, that is.  As explained in Dr. Harvey Karp’s The Happiest Baby on the Block, the 5 S’s are designed to soothe your newborn by mimicking the environment of the womb.  We never used the side / stomach position during sleep because we were afraid of SIDS (and because Little Boy passionately hates being on his stomach), but the other 4 S’s came in handy.

  • We started swaddling Little Boy for sleep when he was about three weeks old.  Like many babies, he initially fought the process of actually being swaddled, but then would relax when he realized how comfortable it was.  Swaddling prevents babies from waking themselves up with their own startle reflex; it also prevented a slightly-older Little Boy from getting so worked up about how interesting his hands were that he couldn’t go back to sleep in the middle of the night.  When his swaddle-escaping skills became too much for the regular Velcro swaddle blanket, we moved to a double swaddle.
  • As adults, my husband and I still sleep with the noise of a loud fan in the background, so it made perfect sense to use white noise (“shush”) for Little Boy.  We initially used a special baby sound machine toy, but now just turn on a regular ol’ fan.  The white noise prevents outside noises from disturbing Little Boy.  Turning it on also acts as a cue that it’s time to go to sleep.
  • Little Boy liked to suck on a pacifier, but he never took to it the way some babies do.  It was helpful for getting him to relax in the early days, although it took a lot of parental effort to keep putting the pacifier back in his mouth every few minutes.  By 3 months old, he was pretty much over pacifiers.
  • The baby swing was a lifesaver.  I feel obliged to mention that the American Academy of Pediatrics recommends against letting your baby sleep in a swing for prolonged periods of time.  Nevertheless, it seemed a lot safer than letting everyone fall asleep together on the couch out of sheer exhaustion.  Little Boy slept almost exclusively in his swing for more than two months.

5.  Watch the wake times.

My sister-in-law raved about Dr. Marc Weissbluth’s book Healthy Sleep Habits, Happy Child, so I read large chunks of it in preparation for Little Boy’s arrival.  The book is honestly a bit tough to get through in places, but one of its key messages is this: a baby who is overtired is a baby who doesn’t sleep well.  And brand-new babies get overtired really quickly.

This article over at Troublesome Tots has an excellent chart of how long your baby can stay awake as a function of age.  In the beginning, your kiddo should go down for another nap just 45-60 minutes after waking from the last one.  (There was a period when Little Boy was about a month old when he literally did nothing but sleep, wake to eat, fall asleep eating, and then sleep until his next feeding.)

Readers, any other tips to add?  What worked (and didn’t work) for getting your newborn to sleep?

Talking to expectant parents and prospective graduate students

When I was pregnant, my husband and I were besieged by warnings about the apparent horrors of life post-childbirth.  Get your sleep now while you still can!  The way some of our friends and family spoke, you would think that children completely and irrevocably ruin your health, social life, and sense of self forever.

Such “advice” annoyed us to no end.  For one thing, we thought we knew it already.  We weren’t going through the pregnancy thinking, oh, it’ll be so easy once he’s born, we’ll just go back to doing everything just the same as before.  Everyone knows newborns wake up to be fed throughout the night, you didn’t need to tell us again, thanks.  We’re both quite introverted, so we already spent most of our evenings quietly at home.  We knew that parenthood would mean a temporary end to our longer vacations and had taken several long trips in the past few years with that in mind.

It wasn’t practical advice, either.  It’s not as though you can really “stock up on sleep” when pregnant and uncomfortable, or when you have long-term sleeping problems (as is the case with my husband).  The folks saying these things weren’t providing us with resources to help us through the rough spots, nor offering any real tips.  It seemed like they just enjoyed scaring us.

Our final frustration with these warnings was, Why are you telling us this now?  If life with children is really that terrible, why not give this advice to your friends before they’re pregnant?

On the other side of the newborn stage, I still believe those warnings were unhelpful, or at least delivered in an unhelpful way.  There are no words you can say to truly convey what it’s like to be up every 45 minutes, 24 hours a day.  Telling horror stories about your experience won’t make new parents any more prepared; it’s something that they just have to live for themselves.

And no matter how awful the newborn days are – and they were pretty bad for us – things don’t stay that way forever.  Nowadays, Little Boy sleeps through the night and naps regularly.  Sure, we won’t be able to sleep in past 7 a.m. for the next goodness-knows-how-many years, but the body gets used to that.  We have time to ourselves again, and time as a couple.  Having not yet put the effort into finding a babysitter, we don’t get to go out as a couple, but that will come.

Some of my friends are expecting, and I have to fight the urge to issue dire warnings about what they might face.  Instead, I try to divert that energy to more productive ways of helping them through the hardest parts.  I take note of foods they might enjoy when sleep-deprived and plan to check in regularly after the baby’s arrival.  My advice, when it slips out, includes comments about how life gets easier as they get a little older.  I want to offer hope, not scare-mongering.

Next week is the prospective graduate student visit.  In my field, applicants to a PhD program are typically flown out for department visits after admission, so the purpose of the visit is primarily to demonstrate how wonderful and productive and prestigious our department is.  We are a highly-ranked department, and most of the applicants we accept will also have offers from other well-known schools.

Every year, I am tempted to scare off the prospective students, to scream, “Avoid grad school!  SAVE YOURSELVES WHILE YOU STILL CAN!”  I, of course, do not do this.

Unlike expectant parents, prospective graduate students still have the option to back out completely.  They could still decide that this whole grad school thing is maybe not such a good idea, decline all of their offers, and go on to a real job that pays much, much more.  But they won’t.  They’ve come this far, accumulating undergraduate research experience and writing stellar personal statements; they are convinced that a PhD is the clear next step.

I know this because I was once one of them.  The horror stories of a bitter older student wouldn’t have convinced me to swear off grad school completely, just sent me to another department.  And though our department has a few peculiarities, the fundamental problems with its culture are present at all the top schools in the field.  In fact, if you are going to sacrifice your life to research, there are some pretty good reasons to do it here.

And so I behave myself around the visitors.  I stay honest but positive, and I turn my attention toward offering support to the students already here.  Chances are, those who decide to attend will be mostly happy.  Not everyone finds grad school as despair-inducing as I do, just as not all new parents will experience their child’s infancy the way my husband and I did.

This post might make it sound like I have this whole advice-giving thing figured out, but I really, really don’t.  Like almost everything I do, I’m making it up as I go.

What would you say to expectant parents, prospective grad students, and others in analogous situations?

3 things you should say to a new parent

As a follow-up to 3 things you shouldn’t say to a new parent, here are the most helpful things I heard during the exhausting early days of parenthood.  Readers, I’d love to find out what words you thought were most valuable at the beginning, too.

1.  “I’m baking muffins and would like to bring you some.  Is there a good time to stop by?”

The classic: “Would you like some food?”  It doesn’t have to be homemade, and it definitely doesn’t have to be muffins, but you really can’t go wrong with food.  (Muffins are a definitely a good choice: we had plenty of frozen meals laid by, but being able to grab a fresh banana-chocolate-chip muffin at 5 a.m. – off the platter brought over by friends the night before – was ah-maze-ing.)

It’s hard to find time to eat with a new baby, much less shop or cook.  It can also be hard to find time to make yourself and the house vaguely presentable to guests, so don’t be offended if a friendly offer of food gets a “thanks, but not tonight” response.

If you’re a really close friend, a “Can I clean / do dishes / take out the trash / do some other useful chore that you probably don’t have time for?” is also a good option.  But frankly, I’d feel weird about anyone who doesn’t live in my house cleaning my bathroom; you shouldn’t feel bad if you’d really rather not make the offer.

2.  “It gets better.”

When a 10-week-old Little Boy grumped through a family visit, interested in neither food nor sleep nor snuggles nor toys, my grandmother assured me that he would get more sociable.  “Babies become a lot more human at 3 months,” she said – and she was right.

I’ll freely admit that I have as yet no experience with the Terrible Twos or preschool or homework or the angst of teenagerhood.  I know it’s not going to be a constant upward path of getting better every day.  There will be teething and separation anxiety and illness and tantrums.  But it’s not going to be the ’round-the-clock-feeding, constantly-fussy, no-sleep-for-a-week, bone-tired exhausting ordeal of early infancy.  Little Boy is SO much more enjoyable than he was then.  He sleeps.  He laughs.  He plays with toys.  He greets me with a smile so big that I wonder how it fits on his face.

It really does get better.

3.  “You’re doing a good job.”

New parents are often filled with worry about whether they’re doing things correctly.  The internet is filled with scary articles about all the ways you could screw up your child for life.  Here you are, entirely responsible for this tiny life form, and it feels like you’re just making it up as you go.

So hearing that you’re probably doing OK can be a huge relief.  When my pediatrician said it, I could feel the anxiety leaving my body.  The first time my mother said it, I almost cried with joy.

Don’t lie, of course – if you know some new parents whom you think are doing a horrible job, keep it to yourself.  Bring them some food instead.