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.

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The exhaustion monster strikes again

I’m sick and tired of being, well, sick and tired.  Mostly tired.  It feels like I’m always tired, but the past few weeks have been particularly bad.  I keep crashing at school and just having to put my head on my desk and nap.  (Which I recognize is a huge privilege to be able to do, but it certainly doesn’t help me get my PhD done.)  There’s a mental fatigue, too: just thinking about what I need to do next can be overwhelmingly exhausting.

So, yeah, this is a post of complaining and self-pity.  Because I hate this state of fatigue.  Especially when it goes on and on and on and doesn’t seem to get any better and there’s no good reason for it.  It’s not my thyroid or anemia or a B12 deficiency or anything that shows up on a standard blood test.  I have a sneaking suspicion that it might be related to my antidepressants, which have a tendency to either put me to sleep or prevent me from getting rest, only I’m not quite sure which one it is this time.  And we are all still fighting the latest daycare-sourced cold.  Cold and flu season needs to hurry up and end!

Sigh.

*Wallows in self-pity for a bit longer.*

*Realizes she’s too tired to think of anything else to say.*

Got any fun stories to cheer me up?

The year in baby sleep schedules

Continuing the theme of “first year of parenting in review,” I thought I’d share how Little Boy’s sleep habits developed over that time.  As far as I can tell, the timing of his nap transitions (going from all-over-the-place naps to 4 naps to 3 to 2) were pretty normal, but his sleep needs are a little higher than average overall (e.g., he’ll nap for two hours where a typical kid might only sleep for 90 minutes).

0–2 days: Hospital

Little Boy slept about as well as can be expected for someone who has been suddenly introduced to the world.  His mother, on the other hand, woke herself up every 20 minutes to make sure that he was still breathing.  (Also, she was rather uncomfortable—did you know that C-section pain can refer up to your shoulder?—and a bajillion hospital staff kept dropping in, but that’s another story.)

2 days–2 weeks: Establishing Breastfeeding

The hospital sent us home with instructions to feed Little Boy at least every 3–4 hours, even if that meant waking him up at night.

We’d initially planned to have him sleep in a bedside “co-sleeper” bassinet, but it turns out that (a) newborns are noisy, and (b) it’s not so easy to just reach over and pick up your baby when you’re recovering from a C-section.  So we moved the bassinet out to the living room and took shifts getting a few hours of uninterrupted sleep.

2–3 weeks: Honeymoon Period

Little Boy was solidly above his birth weight at his two-week appointment, so we got our pediatrician’s blessing to let him sleep as long as he wanted at night.  Hooray!  He actually slept for a 6-hour stretch one night, which was amazing.

We knew it wouldn’t last, and it didn’t.  Little Boy’s interest in falling and staying asleep declined rapidly.

3–5 weeks: Honeymoon Period, Part 2

Swaddle and swing to the rescue!  For a roughly week-long period of time, we had it figured out again.  Little Boy’s routine looked like this: wake up, diaper change, eat, fall asleep eating, get Velcroed into a swaddle burrito, lie in baby swing, sleep.  And he’d sleep for 3 or 4 hours at a time.  I actually got kind of worried that he wasn’t eating enough, since he was only asking for food 4–5 times a day, and here were all of these baby care resources telling me that 8–12 times a day was normal.  But he’d nurse for an hour at a time when he did eat, so I guess it all evened out.

In retrospect, I should’ve maybe tried waking him up for regular meals during the day, to help him differentiate between day and night.  At the time, however, we were so grateful for any extended stretch of sleep that we took what we could get.

5–6 weeks: Hell Week(s)

The 6-week fussiness peak is notorious among parents, and Little Boy embraced it with gusto.  Life was starting to get interesting, too interesting.  There were little birds on his swing!  A Mommy and Daddy to smile at!  He was no longer in his own little world, but he couldn’t quite process the rest of the world yet.  The result was a cranky baby who did not sleep.

Baby sleep cycles are 45 minutes long at this age, so that’s how long naps lasted.  Sometimes it was because he was hungry, but usually it was because his little brain couldn’t transition to the next sleep cycle even though he was tired and wanted to keep sleeping.  My own brain practically lost the ability to fall asleep at all for a while.

If you’re a parent going through Hell Week,

1.  I’m sure you’ve tried everything already, but here are some tips that might help.

2.  Feel free to smack anyone who tells you to “enjoy every moment.”

6–9 weeks: Night Sleep Started Developing

Things started to slowly settle down after the 6-week bump.  By 8 weeks old, Little Boy was consistently falling asleep for the night around 10 or 11 p.m. and staying asleep until he got hungry around 3 or 4 a.m.  Somewhere in this time frame is when we introduced a regular bedtime routine.  Nights went roughly like this:

8:30 p.m. (ish, depending on when he last ate) — bath, PJs, nurse

10. p.m. or so — Little Boy falls asleep in his swing

3/4 a.m. — nurse

next few hours — Little Boy maybe sleeps, maybe fidgets and grunts a lot

6:30 or 7 a.m. (ish) — he wakes up for the day

Naps were still chaotic and unpredictable.  For the most part, Little Boy fell asleep nursing and would sleep for either 45 minutes or several hours, but rarely for a time period in-between.

9–13 weeks: Moved Towards a 4-Nap Routine

“Schedule” is still much too strong a word at this point.  We had noticed that Little Boy was hungry for 4 or 5 meals during the day (plus his night feeding), so we encouraged a routine that had him eating 5 times between about 7 a.m. in the morning and 8:30 p.m. or so at night.  He was no longer regularly falling asleep while nursing, so he’d wake up, eat, hang out awake for a bit, then take a nap.

In a perfect world, he would’ve slept until he got hungry again, but we were still plagued by the 45-Minute Nap Monster.  A 45-minute lap left Little Boy grouchy and still tired, but not particularly interested in eating again just yet.

We flipped his bedtime routine from bath, nurse, bed to nurse, bath, bed (and added a story and song before bed).  His longest night shift stretched until 4 or 5 a.m., which would have been great if he had gone back to sleep easily after that wee-hours feeding.  Fortunately, by 12 weeks old, he was starting to occasionally skip night feedings completely.

The worst part, however, was that he began to seriously fight bedtime.  It took increasingly-longer periods of swinging, rocking, singing, and nursing to relax him enough to fall asleep, after which we had to wait anxiously for the 45-minute mark to see if he’d stay asleep.

3–4.5 months: Long Morning Nap Developed

When Little Boy was 3 months old, we implemented two things: (1) sleep training, and (2) a consistent morning wake-up time.  The latter made the timing of our daytime routines much more predictable, and the former made all three of us much happier at bedtime.  A typical day looked something like this:

7 a.m. — wake up; nurse

8:30 a.m. — down for nap #1

10:30 a.m. or so (depending on length of nap #1) — nurse

around noon — down for nap #2

2 p.m — nurse

3:30 p.m. — down for nap #3

5 p.m. — nurse

6:30 p.m. — down for nap #4 (always only 45 minutes)

8 p.m. — nurse & start bedtime routine

Nap times were not exact—sometimes Little Boy got tired after 90 minutes of awake time, sometimes it took a bit longer.  Nap #1 settled into a solid 2+ hour nap, but naps #2–3 varied, and nap #4 was always short.

Little Boy dropped his last night feeding not long after his 3-month birthday, although he did continue waking up around 5 a.m. for a while.  He would talk loudly but pleasantly to himself for a bit, then fall back asleep.

4.5–8 months: 3-Nap Schedule

By about 4.5 months old, Little Boy could happily stay awake for about 2 hours between naps, and he was consistently making it over the 45-minute hump in nap #2.  His schedule finally became quite regular from day-to-day:

7 a.m. — wake up; nurse

9 a.m. — down for nap #1 (2 hours)

11 a.m. — wake up; nurse

1 p.m. — down for nap #2 (2 hours)

3 p.m. — wake up; nurse

5 p.m. — down for nap #3 (45 minutes)

5:45 p.m. — wake up; nurse

7 p.m. — nurse & start bedtime routine

When we introduced solid foods, those became an evening meal that eventually replaced the 5:45 p.m. nursing session.

8–12 months: 2-nap schedule

Between 7 and 8 months old, nap #3 dropped out of the picture.  Little Boy was staying up a bit longer before nap #2, and he just didn’t need the additional sleep anymore.  So for the last four months, our days have looked like this:

7 a.m. — wake up; nurse

9 a.m. — down for nap #1 (90 minutes–2 hours)

11 a.m. — wake up; nurse

noon — lunch

1:30 p.m. — down for nap #2 (90 minutes)

3 p.m. — wake up; nurse

5/5:30 p.m. — dinner

6:30 p.m. — nurse & start bedtime routine

(This is for days when he’s at home.  He naps for 30-40 minutes max total at daycare, then crashes on the car ride home.)

Right now, at 12 months, we’re starting to see signs that a transition to just 1 nap is headed our way: Little Boy has started fighting his afternoon nap on a semi-regular basis.  Of course, he’s also just learned how to pull himself to a sitting position in his crib (which is new and exciting and therefore preempts going to sleep!), and has been fighting a series of colds.  Today’s afternoon nap took place in the arms of Daddy and Mommy, because our poor little sick dude just couldn’t get comfortable on his own.

TL;DR—As soon as you think you’ve got your kid’s sleep habits figured out, they change.  Especially in the first four months. 

Parents, were your babies easy sleepers, little terrors, or something in-between?  What did you find to be the hardest age when it came to sleep?

Tired all the time

To paraphrase the Dos Equis guy, I don’t always feel tired, but when I do — no, actually, I do always feel tired.  Or, if not always, often enough that it’s my normal.

For the longest time, I hoped that there was something specific (but fixable!) wrong with me, like iron-deficiency anemia or an underactive thyroid.  Unfortunately (or maybe fortunately), blood tests through the years have ruled those things out.  We did eventually figure out that one of the medications I was taking in college was the reason I kept falling asleep in class, and changing that helped quite a bit.  But I still routinely find myself overwhelmed by the urge to lay my head on a pillow, close my eyes, and let my brain recharge with sleep.

Pregnancy and the early postpartum period made everything much worse, of course.  Now, however, I no longer wake unprompted at 5 a.m., expecting either a hungry baby or loud thuds from our ex-neighbors.  By the numbers, I’m getting enough sleep at night.  Yet I still often find myself unable to think or focus or process information by the end of the day.

And so I run through the list of possible reasons:

  • I’m hungry and have low blood sugar.
  • I just ate and am in a carbohydrate stupor.
  • I worked out today.
  • I haven’t worked out much lately.
  • I’m depressed.
  • My antidepressant makes me drowsy.
  • My antidepressant keeps me up at night.
  • I didn’t get the chance to take a nap.
  • I took a nap, but it wasn’t long enough.
  • I took a nap and it was too long.
  • I tried to do too many things today.
  • I didn’t do anything today.
  • I haven’t had any caffeine yet today.
  • I had too much caffeine today.
  • I’m bored.
  • I’m worried.
  • I’m being overdramatic… maybe this is normal and everyone feels this way.

Maybe I’ll figure it out someday.

I get my best ideas at bedtime

It’s rather annoying, actually.

On an average evening, I have a bit of time after dinner, when Little Boy is in bed and tomorrow’s lunches have been made and baby bottles washed.  But I’m tired.  My brain is tired.  It doesn’t want to write, or read interesting things to get ideas.  It wants me to veg on the couch and read mindless Facebook shares and watch TV.  Which is totally understandable after a long day of parenting and research and more research and more parenting.

However, when I start getting ready for bed – taking a shower, brushing my teeth – my brain wakes back up again.  Suddenly, it’s composing my next three blog posts.  And not just a hey, you should write about that sometime; there are whole sentences and paragraphs just running around in my head.

If I were back in college, unencumbered by normal work hours or the needs of a tiny human, I might choose to run with it.  Sit down at my computer for an hour and let the words flow.  But I’m not a college kid any more, I’m a mom who has to get up in the morning and needs a lot of sleep to function, so I have to go to bed.

Fortunately, the free-flowing sentences don’t usually prevent me from falling asleep.  In fact, they’re can be somewhat meditative.  Unfortunately, some of them are lost by the time I wake up in the morning.  I should start keeping a little notebook and pen by my bed to jot down some key points, but unless I take the time to write down everything, something’s going to be forgotten.

When do you find your best ideas brewing?

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!

Silent night

It’s about a baby.

It’s about a baby sleeping.

It’s about a baby sleeping silently.

I don’t care how many months it’s been since Christmas.  “Silent Night” is the perfect lullaby.

Also, I know all the words.

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?

Dads get PPD, too: my husband’s story

As a society, we’ve slowly become more aware and understanding of postpartum depression (PPD) and other mood disorders in new mothers.  Gone are the days when unhappiness after the birth of a child was considered a character flaw and women were expected to “suck it up” in silence.  Today, many childcare books contain a section discussing the symptoms of PPD, and doctors routinely screen for it at postpartum check-ups.  Actually accessing good help remains problematic, but we have come a long way. 

Fathers, however, remain notably missing from the conversation – and when they do appear, it’s usually in the context of how to support a depressed partner.  But men get PPD, too.  Studies report that 10% of new dads experience postpartum depression (and I wouldn’t be surprised if that number turned out to be an underestimate). 

My husband is part of that 10%.  Very little of my postpartum depression story was news to him, but he was proud of me for sharing it.  He was motivated to write up his own story and has asked that I share it with you as well. 

I want to warn you that some of what he has to say may be upsetting, especially since his story is not fully resolved.  I’ll let him take it from here (with a few notes from me in italics):

Depression runs in my family, but until the last couple of years, it seemed that I successfully evaded it.  Instead of depression, I’ve suffered from “wonderfully” enormous anxiety issues, which have grown worse with age… but never depression on the order seen in my family, the kind that could lead to someone trying to take their life.  Looking back, I probably started showing small signs of depression with my anxiety a couple of years ago, but who knows if it would have otherwise grown into such a problem as it was to become when my wife was pregnant with our son.

When my wife became pregnant, I was excited.  We had been planning for nearly two years, and I’ve wanted strongly to be a parent for a very long time.  That excitement burned out, but it was eventually replaced with anticipation of some of the great beginning milestones in pregnancy:  telling our parents, seeing the first ultrasound, making our big announcements to the world, finding out the sex of the baby, etc.

I’m not sure when things started getting worse.  The last year is a foggy mess of blurred memories.  I’ll shamefully admit that I was disappointed when the ultrasound showed we were having a boy.  When I thought of myself as a parent, I often imagined having a daddy’s girl.  I didn’t have a close or even good relationship with my father growing up, and unfortunately, I haven’t seen a lot of close father-son relationships.  Such a relationship seems to be thought of as “unmanly” in our society.  (My brother and his two-year old son are an exception.)  I wanted that really close relationship, to be completely important in someone’s life, if only for a while.  Stupid TV, movies, and books for putting that romantic notion in my head.  BUT, we were having a son, and I got over it.

During the middle part of the pregnancy, my wife started to have down episodes.  I tried, but I couldn’t help like I could in the past.  When she wanted to be held, I could do that.  But sometimes she just wanted to be left alone and I just had to wait for things to pass.  As her episodes became more frequent, I became more and more frustrated.  My frustration would border inexplicably on anger, exacerbated by three additional things happening at this time.  One, we had new neighbors move in, who eventually made me want to break something (preferably of theirs) with every stomp/thump/bang they made.  Two, my restless leg syndrome, which I have had from childhood and which runs in the family, went from an hour-a-night, 1-to-3-nights-a-month problem to something that bothered me half the night, every night.  My sleep had already been problematic, as I had started waking up completely every 60-90 minutes all night every night in early grad school. (Note: My husband has already survived grad school and has a PhD.)  Restless legs meant I would either not fall asleep for hours, or I’d wake up after 90 minutes and then not be able to go back to sleep for several more hours.  I began sleeping on the couch because my constant movement in bed and my new loud snoring (from being so tired) made sleep even more unattainable for my depressed, anxious, and already-uncomfortable wife.  The cool living room and the ability to constantly move my legs back and forth made things better for a bit… until I started getting back problems from the couch.  An air mattress fixed the back problems, but this all still meant even less close time with my wife.  And finally, three, I was traveling across the country a lot for work during the later part of the pregnancy.  So not only was I missing doctor’s appointments, but I was also constantly changing my sleep schedule.

Put all of these things together with my anxiety issues, and I started to spiral headfirst (excuse the pun) into depression.  I felt further and further away from my wife, which I alternatingly felt guilty about or just numb.  I know I haven’t been truly happy for a long time, but now I only felt just okay down to downright miserable every minute of every day.  I felt like I was just barely treading water, and that it would be easy to just stop trying and let the world drown me.  As a coping mechanism, I withdrew further and turned to superficial things to release endorphins, like food, caffeine, and the internet.

The morning my son was to be born via C-section, I was sober and resentful.  I resented that we had to do a C-section that day because I was already beyond exhausted, and all I could think about was how any possibility of sleep before the next grueling set of months with a newborn was now gone.  Fortunately, when I stepped into the operating room, adrenaline kicked in and focused me.  My thoughts were on my wife and her well-being.  When my son was born, I was also ready to do everything that I could to be a perfect dad, including doing skin-to-skin while singing to him gently for 45 minutes while mommy was being sewn up, changing nearly every diaper in the hospital and the week after, waiting hand and foot on my immobile wife, and doing generally every little thing the nurses would let me do, all while sleeping on a tiny, cramped, two-person couch (which, by the way, sucked immensely for my restless legs).  (Note: He is not exaggerating here.  I would never have made it through the C-section, much less the first week, without his help.)

From here on, things are very blurry.  The lack of sleep meant I wasn’t forming long-term memories… and by the way, that’s a bitch of a thing when it comes to work.  It’s not fun when your boss has to explain things to you 3+ times.

From the time our son was born until he was about two weeks old, there were some hints of feeling, some occasions when I would look at this little boy and think, maybe I will eventually love you.  I felt that little bit of endorphins that are released when you hold such a tiny infant.  I was also driven with a singular purpose: to take care of my son and wife like no one else could.  I liked the feeling of being needed – because I felt like I was constantly being reminded wherever I looked that mom was the most important.  After all, the baby depends on her for food and comfort, and apparently daddy doesn’t know how to do anything.

After the first couple of weeks, things started taking a turn for the worse.  When the baby would cry, I wanted to pull my hair out.  I began being consumed by extremely dark thoughts, like how relieved I would be if he didn’t wake up, or if he accidentally drowned while taking a bath.  People would feel sorry for me, but it would be over.  My wife and I would probably separate because neither one of us would be able to handle the ensuing depression, and I would probably just walk away from everything I knew and become a hermit somewhere where no one could find me.  I recognized that these were unnatural thoughts and there was no way I was going to try to make them happen – I am incapable of that.  But I did occasionally push the swing a little harder than necessary, or pick him up a little faster than I should.

My work had instituted a paid parental leave policy two months prior to my son’s birth, and I was the first person to file for it.  The only problem was, no one knew how to pay for it, and many people weren’t happy about that.  So I became the center of the controversy.  Theoretically, I could have taken up to 6 weeks of full leave, or 12 weeks of half-time leave.  I had already arranged with my boss to take two weeks of vacation, so I chose to take two weeks of full leave and 2 weeks of half, for fear of angering her and others at work.  After my leave was over, and while my wife was still on her leave, working from home was only a matter of consuming enough caffeine and sugar, playing loud music on headphones, and trying to focus on small projects that didn’t require a lot of heavy thinking.  When she went back to work at 6 weeks, half of my work day was spent watching the baby while also trying to get work done.  If he didn’t want to sleep or was crying because he was bored (which was nearly every minute), I couldn’t work.  To partially make up for not working during these times, I would file for sick leave.  But I was perpetually self-conscious, afraid that my boss was not happy with me and would find out that I wasn’t getting anything done at home or at work.  She was hiring new postdocs, so what was to stop her from letting one go and hiring one more to replace me?  (In retrospect, she never really gave me any reason for this fear.  I’m apparently not horrible enough to put the work in for replacing.)

Still more time passed, and I started yelling at the top of my lungs, until I was hoarse, to no one in particular.  Sometimes at the baby from across the room, prompted by his crying, sometimes at the neighbors for being particularly awful.  (Note: The neighbors remained oblivious.)  I was angry A LOT.  When I wasn’t angry, I was serious and numb.  I couldn’t even feel love for anyone, not my wife, not my brother (who I used to feel the closest to outside of my wife), not my parents, no one.  All of this was not good for my wife, who was also suffering from PPD.  She was getting help through support groups and a psychiatrist, but I couldn’t bring myself to find anyone for help.

Anger was also interspersed with heavy thoughts of life and death.  As an agnostic, I don’t see evidence for an afterlife.  This pervades my thoughts and frightens the shit out of me, especially late at night.  During this time in my life, this morphed into me thinking, “What the hell does it matter if I die when I’m 100 or today?  Life doesn’t mean anything.  It has no purpose.  I don’t mean anything.”  I would have thoughts while driving about hammering the throttle and driving into a pole at full speed.  I know it probably scared my wife, but I did tell her about these thoughts.  (Note: It definitely did scare me.)

Still even more time passed, and my depression head-butted into my wife’s depression, resulting in loud arguments.  One night, I snapped completely, lost it, and just started crying uncontrollably.  This may not sound like a big thing, but for someone who hadn’t been able to shed a single tear for over a decade (not even when my grandfathers died), it was definitely a big thing… I did feel a bit better after, at least for a short while.  That same night, my wife and I decided to start sleep training the screaming child who was taking us two-and-half hours every night to put to bed.  THAT was the singularly best thing we could do for my condition.  He took to it right away, leaving us with a couple of hours to decompress every night.  I could start making more complicated meals again, sit and watch TV, etc.

Since sleep training at three months, I have started getting better.  With our son also sleeping through the night on his own, we were no longer spending half our night monitoring the baby for our shift.  (Note: Little Boy was now sleeping in a crib in his own room.)  My legs continued to be a problem, meaning I was still sleeping in another room, which weighed heavily on my wife.  I don’t blame her.  She missed me.  While my sleep was still very broken, just like it had been before the baby was born, at least I was getting some sleep now.  I was also able to start exercising again after three-and-a-half months off, something that’s a big big deal for someone who hasn’t ever stopped running for longer than a few weeks in over 20 years.

So, here I am.  My episodes of extreme depression have lessened and my time doing okay has lengthened.  I can act happy when needed (though not all the time) and I even have plenty of time when I’m not miserable.  I’ve even grown to miss my son when I’m away from him for a few hours.  His crying still cuts into me really easily and deeply, driving my blood pressure concerningly high, but he’s happy quite often now.  He’s constantly talking, and he has the biggest open-mouthed smile you can imagine when I walk into the room.  He shrieks with laughter when I nom his cheek or tickle him.  I love the little dude.  My anxieties about work have lessened to a smaller degree, mainly because they were a big problem before all of this.  However, I’m able to get some of the more-complicated projects done, even if it still requires my boss to explain very simple concepts to me several times.

BUT, I still have bad episodes, even if few and far in between.  I found myself thinking recently how easy it would be to down a bunch of pills, as one of my parents did when I was younger.  Fortunately, other family were present when it happened then, so we could rush that parent to the hospital, but I could do it when no one but the kid was present.  Fear of death and a conflicting worry about what would happen to my wife afterward (conflicting because the world ends when I cease to exist, so what does anything matter, yet how could I hurt her so much) have kept me from taking those final few steps, but it’s very disturbing that I could even get that far.  My wife is helping me find professional assistance.  I don’t see someone ever being able to help me with my thoughts on life and death, but I need someone to help me not contemplate going there sooner rather than later.  I want to be able to feel happy again.  I don’t even remember what the feeling is like.

We are still searching for a psychiatrist and/or therapist that can help my husband.  (The difficulty of finding good mental health care in this country deserves its own post, I think.)  He is also taking steps to see a sleep specialist, who will evaluate the physical issues that are preventing him from getting good rest.

If you are a new dad struggling with PPD, or a new mom worried about her partner, head to PostpartumMen for support and resources.

My postpartum depression story

It’s taken me a while to write this post, and a little while longer to be sure that I wanted to share it. 

Postpartum depression is a real and serious problem faced by many mothers and fathers.  It can begin up to a year or more after the arrival of a new baby.  If you or someone you know is struggling with postpartum depression, know that you are not alone and there is help available.  Postpartum Support International and Postpartum Progress have valuable resources, including a list of support groups in the U.S. and Canada.


This morning I spent about 15 minutes dancing with my Little Boy, holding him in my arms and twirling to the country music playing on the radio.  I wasn’t thinking about anything else I had to do or worrying about finding the time to do it.  We were simply happy.

Months ago, I was afraid that I would never be able to enjoy time with my child in this way.  I was suffering from postpartum depression, often referred to by the acronym PPD.

I attend a postpartum support group, and whenever a new mom begins attending, the moderator asks a few of those who are doing a little better to tell their story.  It was enormously helpful for me to hear someone else describe going through the same extra-crazy feelings, to know that I wasn’t alone.

This is my PPD story.

I knew I was at high risk for PPD, because I’ve struggled with depression my whole life.  Several months before trying to conceive, I tapered off the antidepressants I’d been taking for years; I wanted to stop them anyway, as I was doing reasonably well and had grown tired of the major side effects.  And it was a good decision.  Things went well for a while.

Then I started having depressive episodes.  I can’t pinpoint exactly when they began, but they were bad by the start of the third trimester and getting worse.  Something small would set me off and I’d spend an hour sobbing on the bed, my brain convinced that it would feel dark and terrible forever.  Legitimately upsetting news (like learning about a last-minute office switch) would ruin three or four days.  I was stressed about getting the nursery ready on time while simultaneously struggling to find the motivation to work on it.  And on top of it all, I felt guilty because I knew I was dragging my husband down with me.

I talked to my doctor – because that’s what the pamphlets always say to do, right?  “If you think you’re experiencing … talk to your doctor.”

“Well, we don’t like to prescribe meds in the third trimester.”  No problem, what about therapy?  “I don’t know which therapists take your insurance.  I’ll have my assistant look into it and call you back.”

The assistant never called me back.  All I got was a couple of super-generic pages of information, most of which weren’t even about perinatal mood disorders.

Little Boy arrived.  By the mysterious ways of hormones, I actually felt better.  Exhausted and weepy and anxious about the welfare of this tiny new creature, but not black with despair.  My OB-GYN asked about my mood at my two-week check-up, and I remember that I said very positive things.  I thought that maybe I was going to be OK.  Maybe I’d taken the worst mental hit during pregnancy.

Nope.

The initial weepiness seemed to slowly get darker.  I was getting anxious about going back to school at the end of my six-week maternity leave, because I knew I would be expected to get some work done despite being still too groggy to read even the abstract of a paper.  And Little Boy was starting to wake more frequently (which is normal baby behavior as you approach the period of “peak fussiness” at six weeks of age).

In Little Boy’s sixth week of life, he stopped sleeping for longer than 45 minutes at a time.  My husband and I traded off several-hour shifts in an attempt to ensure that both of us got at least a few hours of unbroken sleep, but it was exhausting.  The worst part, however, was the new neighbors.  We’d lived in that apartment for four years and had at least two, maybe three, sets of upstairs tenants, none of whom had disturbed us in any particular way.  One couple had played loud bass for a few nights and then apologized profusely when we’d asked them to turn it down.

The new neighbors were LOUD.  Constantly, incessantly loud.  They apparently stomped, slammed doors, dropped heavy things, and moved furniture every day and night.  We heard them moving around at 3 a.m. when we woke to feed Little Boy, and yet they all clomped around and woke us up at 6:30 every morning.  We heard them over white noise, over the TV, and even over earplugs.

Consequently, every time I lay down to sleep, I was bound to be awakened in short order by either the sound of a hungry Little Boy or a loud BANG! from upstairs.  It got to the point where I could no longer relax enough to actually fall asleep, so wound up was I with anticipation of the next sound.  The anxious thoughts simply wouldn’t turn off.

After a few days of this, I adopted the temporary solution of not trying to sleep at all during the day, so that I might fall asleep late at night from sheer exhaustion.  If we hadn’t been caring for a small baby who needed food at night, this might have been an OK idea.  But as it was, my sleep debt just kept accumulating and I found myself running out of energy to cope long before I ran out of hours to be awake.

This is the really hard part to say.

My Little Boy is a precious gift from the universe and I love him.  I always have and always will.  But during the blackest hours of his infancy, I regretted becoming a parent.  I was afraid that we had made a terrible mistake and ruined our lives forever; I was kicking myself for how much I had wanted this child.  There were moments when I wanted to walk out the door, leave my beautiful son and his wonderful father behind, and start a completely new life somewhere else.

It took a while to process this after I wrote it.  When my son smiled at me after his nap, I felt ashamed, as though he could somehow know that I had been ruminating about this dark time.  I debated deleting the whole post, thinking, ‘That time is past and hidden away.  Why bring it up again now?”  And, “Everything’s fine today.  Are you sure you aren’t being overdramatic about this whole PPD experience?”  And yet… things definitely weren’t fine in the early months.  To pretend they were – to say that it was just a minor thing – to bury it all deep inside – that would be to do a disservice to myself and every other mother and father who has suffered. 

I got help.  I drove across town to attend the only postpartum support group that didn’t meet during working hours.  They pointed me in the direction of a good psychiatrist, and the necessary phone calls were made so that I could avoid the typical multi-week wait to be seen.  Antidepressants take a while to kick in, but eventually you notice that the bad episodes are coming less frequently, and you are no longer dreading challenges but tackling them with calm acceptance.

The neighbors upstairs continued to be total jerks, but the medication made it possible for me to sleep.  Usually.  With a loud fan parked right next to my ear and a pillow over my head.   But the universe must have been looking out for us, because an opportunity arose to rent a single-family house from a friend.  Other amazing friends helped us move, and now we have a separate office, a master bedroom that isn’t under the stairs to someone else’s apartment, and windows that are more than a foot from the sidewalk.  Oh, and a garage.  And a yard.  And natural light in every room.  It’s also closer to school.  Seriously, I love this house.  We had to pay two month’s rent to break the lease on our apartment, which I can say unequivocally was the best money I have ever, ever spent.

As this all was happening, Little Boy got older.  He began to sleep for longer stretches of the night (more on that in future posts) and eventually his naps consolidated into a regular daily routine.   He became increasingly interactive, “talking” with us in an adorable baby voice.  At 3 months, he discovered the ability to entertain himself by kicking at the toys hanging from his play gym.  LIFE-CHANGING DISCOVERY.  Now I could do the dishes while he was awake.

Little Boy is still hard work, but our lives have found their new patterns.  He is a darling, happy, curious, excited little man, and I love watching him grow.  Wonderful moments like the one I described at the beginning happen on a daily basis.

There is hope.