In The Moment ... May 16, 2018 Show 338 Hour 1
SDPB brings NPR's #HowToRaiseAHuman conversations home to South Dakota. Where better to start than with the sometimes maddening topic, of babies and sleep?
Bleary eyed parents ... wake up. Help is on the way. Joining us for the conversation is Sanford pediatrician Dr. Laura Whittington. This conversation has been edited for web use, to listen to it in its entirety click here.
Lori Walsh:
Welcome to In the Moment. I'm Lori Walsh. Does raising kids have to be stressful? Is it really dangerous for babies to sleep with mom? Do chores have to be a fight? Over the next month, NPR travels around the world for ideas to make parenting easier. Weekend edition looks at the way modern American parenting can serve to put Mom in a box, culturally, that is. Hidden Brain looks at the language of babies from decoding a temper tantrum to research that shows grooving to music with babies somehow makes them more helpful. Tune in to Monday's Morning Edition where a quick tour of sleeping babies around the world reveals something strange about the US, infants alone in cribs. For the first time in human history, parents are explicitly told not to sleep with their babies, that co-sleeping could kill the baby. Why? NPR's Michaeleen Doucleff reports, and that's just the beginning of the NPR coverage that continues into June. Well, South Dakota Public Broadcasting wants to bring those conversations home to South Dakota. Where better to start than with the sometimes maddening topic of babies and sleep? So, bleary-eyed parents, wake up. Help is on the way. Joining us for the conversation is Sanford pediatrician, Dr. Laura Whittington. Dr. Whittington, thanks for being here. We appreciate your time.
Laura W.:
Hi, yes, thanks for having me.
Lori Walsh:
How many myths are there about how babies should sleep in the first place? Let's start with some of those unreasonable expectations or that you hear parents ask about all the time.
Laura W.:
Yeah, so there are numerous myths that we hear in the clinic. Of course, the biggest ones are how much sleep should their baby be getting, and when will they sleep through the night. So, of course, as any newborn, babies are going to sleep a lot, so they're going to sleep 16 to 20 hours a day. Most of the time they're just awake to feed. As they get older, of course, they're going to sleep less and less, but still, I mean between four to 12 months of age they're still going to sleep 12 to 16 hours a day.
Lori Walsh:
Yeah, that's not all at once, though, so when parents are almost desperate to have the baby sleep through the night, what exactly is sleeping through the night? How many hours do you count as a victory?
Laura W.:
So, of course, that is going to vary by parents' expectations, but even sleeping five to six hours through the night we would consider, for a baby, sleeping through the night, and then we don't expect them to technically sleep through the night until they're around six months or older.
Lori Walsh:
Right. Is there a difference between babies who are breastfed versus formula-fed babies as far as their sleep patterns, or is it just dependent on the baby?
Laura W.:
We have seen that formula-fed babies can go a little bit longer. So usually we tell parents that are formula feeding every three to four hours, especially as a newborn they should be waking up, whereas breastfed babies is two to three hours waking up and being fed. So usually formula-fed babies do sleep a little longer, especially initially, but as they get older, it doesn't tend to matter whether they're breastfed or formula fed.
Lori Walsh:
Right. I put some questions on Facebook about it and said that you were coming to the show, we were going to talk about babies and sleep, and as you can imagine, a lot of parents chipped in with comments from throwing up their arms and screaming and saying, "Yeah, this is a very stressful thing for me," to people saying, "I can get the baby to sleep, but getting them to stay asleep is the real problem." Then a lot of awareness of how parents are judged based on the expectations of parenting. So when we talk about sleep, we're talking about more than sleep in some ways.
Laura W.:
Of course, you want to talk about sleep hygiene, things that you're doing before your baby or infant is falling asleep. You don't want to be having the TV on because that's going to stimulate, even as a baby, it's going to stimulate their brain and make them not want to sleep as well, and having those cues, keeping the room dark, having the same routine, whether it's having a bath every single night, and if they're older, of course, if they're brushing their teeth every night, that they get into a habit where they're like, "Oh, this is actually what I'm supposed to do right before I go to bed," and it gets their body ready to go to sleep.
Lori Walsh:
Then the notion of keeping them to sleep. Talk about the room itself. Are there things that you can do to, once you get the baby down, to let them stay sleeping? What's happening there? They're waking up or waking themselves up and then not being able to go back. What's happening there?
Laura W.:
So at night definitely want to keep the room fairly dark. Even if they are waking at night to feed, you want those feeds to be very short and straight and to the point. You don't want to be turning lights on and stimulating them and not talking to them as well, just keep it quiet, and then when they're done feeding, putting them back to sleep. For older infants, kind of the same thing. Keeping the room dark. Some babies do like to have a little bit of background noise or white noise. So they do make white noises machines that you can buy just to have that going in the background. Then, kids older than six months of age, you can actually just let them cry it out. That also depends on the parents' comfort level with that.
Lori Walsh:
What exactly does that mean? So how much crying is letting them cry it out? How do you balance that? How do you do it? How do you encourage it? It's not just leaving them alone and letting them cry, right? I mean there's a technique to that?
Laura W.:
So there is. You have to get to know your child and get to know their different cries. Most of the time parents can recognize if their child is hurt, that different cry, and of course, if there's something going on that you're concerned about, you definitely want to go in and check on them, but if they're whining and crying a little bit, it is okay to stay in your bedroom or stand outside the door and just let them cry. Then of course it does depend on parent comfort level as to how long. No baby has ever cried themselves to death or gotten injured by crying, and after six months of age, there's not a correct timeframe. It just depends on parents' comfort level.
Lori Walsh:
How about the opposite, if there's a parent who says, "That's just not for me, and when they cry, I'm going to pick them up and soothe them"? Is that necessarily working against the child in any way? Is that just a different style of parenting where this is how I want to handle it?
Laura W.:
It definitely makes it so that that infant is not developing maybe coping mechanisms that we would like them to develop. They will get there. It just might take that parent longer for their child to sleep through the night.
Lori Walsh:
All right, so let's talk a little bit about when you have people coming in, parents coming in, there's a lot going on. Maybe they're new parents. Maybe they are sleep-deprived at this point. Are you seeing them making a bigger connection to where they feel as if, "If my kid doesn't sleep through the night, then I'm not a good mom," or are they making a broader statement about that? Do you find yourself talking parents through larger cultural issues in the clinic?
Laura W.:
We definitely talk about every child is different. Children will sleep through the night at different stages, and just because their friend's child is sleeping through the night at six months of age, that doesn't necessarily mean that their child is going to sleep through the night at six months of age. We talk about what they're doing and ways that they can try to get their child to sleep through the night but also recognizing, "Yeah, you probably are not doing anything wrong." Reassuring them that they have to make it work for their family as well, and they can't judge themselves based on what other people's children are doing.
Lori Walsh:
Could there be something wrong with the baby though? I remember my daughter, she's a teenager now, but thinking back to her as an infant, I mean that kid cried all night long. I mean it was a constant. I was one of those parents, I picked her up, I held her, I lost a lot of sleep. Now, when I look back, I think, "Could she have had a food allergy? Could there have been something else going on that I should have talked to the doctor about that I didn't?" Now that I've survived and I've had a good night's sleep, I'm starting to think about these things. Is it possible that something's wrong with the baby?
Laura W.:
So there definitely is that possibility, and so bringing your children in for those routine well visits and just talking with your doctor about their sleep habits, about what they're doing, about how they're developing, bringing up any concerns that you have at those visits, which will help your child's physician determine if we need to look any further to see if there's something else going on.
Lori Walsh:
Let's talk about co-sleeping. As I have not heard what NPR is going to do next week about co-sleeping. Looking around the world and finding out different methods of doing it, but it's certainly, we've talked about the Back to Sleep program on this show and statistics about infant deaths. It's pretty scary and stark. Should we be talking about co-sleeping, or is that something that has become taboo in American culture?
Laura W.:
So the American Academy of Pediatrics, we recommend co-rooming and not co-sleeping. So co-rooming, having your baby sleep in the same room that you are sleeping in but not sharing the same bed. So looking at putting the crib or bassinet, pack-and-play, in the parents' room, having the baby sleep in that same room so you can keep a closer eye on them, but we do not recommend having them sleep in bed with you. If you look at statistics, I mean in the US, kind of along with immunizations and medical care, the highest cause now of infant death, one of the higher causes, is SIDS, and one of the ways to prevent that is to not share a bed with your baby.
Lori Walsh:
So, Dr. Whittington, go over the basics then. What's best for babies to sleep in then for safety?
Laura W.:
So the best thing for baby is to sleep alone by themselves on their back. Things that are approved for infants to sleep in include cribs, pack-and-plays, and bassinets. We don't recommend having them sleep in the little chairs or rock-and-plays that have them a little bit elevated. They should be flat on their back. Then we don't recommend having anything with them. So no blankets, no stuffed animals, keeping their sleep environment actually pretty boring.
Lori Walsh:
Are there things that you can do during the day? Does daytime behavior somehow help the separation and the transition into sleep?
Laura W.:
During the day, if you can get their naps to be in that crib or pack-and-play, whatever you have for them to sleep in, rather than letting them lay on you while they're sleeping or be in a rock-and-play when they're sleeping, if you can transition those nap times to a crib, it will help them sleep better at night and go to bed easier at night.
Lori Walsh:
Okay, I didn't do that, I'll tell you. You're so tired, I just remember conking out with the baby in the rocking chair, in the sling, on the couch. Not safe behavior. I'm not advocating it. So you have to pay attention when you are sleep-deprived at the choices that you make as well. There's a message in there for parents, I'm sure.
Laura W.:
It is definitely easier, as a parent, when you are sleep-deprived just to sit with your baby and take a little nap or lay down on the couch with them and take a nap. However, it is not the safest things to be doing with your baby.
Lori Walsh:
So I'm looking at these Facebook comments again. There's one question about night terrors going on into those early childhood years. What exactly is a night terror?
Laura W.:
A night terror is similar to a nightmare. However, a night terror, toddlers and children, they will not wake up during this night terror. What usually happens is it's around the same time every night, this child will ... It seems like they're waking up, but they'll just start screaming. Sometimes they're flailing their arms, kicking their legs, and you will go in their room and there is no calming them down. They're not truly awake, and so you cannot truly comfort them because they don't really know that you're there. That's what makes it hard is that there's nothing that you can really do as far as the night terror other than trying to give them some time and make sure they're safe, and then once that night terror is over, usually they lay right back down and they're back asleep, and they do not remember anything the next morning.
Lori Walsh:
What causes that? Do we know?
Laura W.:
That is a wonderful question.
Lori Walsh:
Okay. Well, do they go away on their own, or are there things that you have to do?
Laura W.:
Usually by the time, six to eight years old, night terrors are just going away on their own. If children are having them every single night and if you can say, "Oh, at midnight, every single night, they're going to have a night terror," sometimes going into their room and gently patting their back or rubbing their legs a little bit, you don't want to fully wake them up, but if you interrupt that sleep cycle, sometimes that will actually prevent them from getting the night terror.
Lori Walsh:
All right. Let's go over some of the takeaways for today before we let you go. So, baby to sleep on their back in a crib, same room, is okay, but same bed is statistically proven to be dangerous, so don't do that. Nothing in the crib with them. Good sleep hygiene, which is similar to really for us for all ages, but keep that in mind for babies too, which is funny because I remember a baby class where they told us, "Just vacuum or do whatever so your baby will be used to the noise," but maybe not at 10:00 at night. You're not vacuuming anyway.
Laura W.:
Correct. During the day, yes. Certainly by all means do that.
Lori Walsh:
Try to keep things quiet at night. Then just give yourself a break and not worry so much about this idea of having this done perfectly, and talk to your doctor. What else? What'd I miss?
Laura W.:
Exactly. No, that sounds right.
Lori Walsh:
It's a good beginning. Dr. Laura Whittington, thank you so much. We appreciate your time.
Laura W.:
Thank you.