Continued from this post...
3. Healthy Sleep Habits, Happy Child, by Marc Weissbluth, M.D.
There was a good deal I liked and found useful about this book. However, in my opinion the most fundamental thing about this book -- the recommended "extinction" crying method is overly harsh and unnecessary for most babies.
But let's start with what I did like, most of all the maxim that sleep begets sleep. Here, I have found that Weissbluth is right and Ferber is wrong. Almost always, an earlier bedtime, not a later one, is better for Mari's sleep. She sleeps more and better than when I've tried to keep her up longer or later. Of course, there is a limit, though Weissbluth sometimes seems to imply otherwise. Mari cannot and will not sleep for more than 14 hours in a day at the most, and she averages about 13 hours, though if I recall correctly, Weissbluth recommends 14-15.
Another thing I liked is the emphasis Weissbluth places on baby temperament and his acknowledgment, missing in many other books, that some babies just aren't going to be as good of sleepers as others, and that what works for most babies may not work for a certain percentage -- especially those who were very fussy as younger babies, which Mari certainly was. It was reassuring to me to know that just because some techniques work with other babies and don't seem to work with Mari, it's not necessarily because I'm doing something wrong -- it's because Mari is a different baby.
For the above reasons, I am prepared to believe that there are some babies for whom the extinction crying method Weissbluth advocates may be the only thing that works. However, I also believe that it's highly stressful for babies. It's plain that babies don't like to cry. Their faces turn red, their temperature goes up, they give every indication of being in extreme distress. Babies cry to communicate. Whether it's because they're in pain or because they just want their mothers, for the baby, something is wrong. I believe those needs should be responded to promptly (though not necessarily immediately), unless there's a damn good reason to delay response. In my opinion, a parent should consistently and patiently try every other method possible before resorting to the extinction method.
It's true that babies need to learn to fall asleep and stay asleep on their own. It may be true that for some babies, a certain amount of crying is necessary before they learn. However, just plain ignoring the baby's cries, no matter how long it takes, ignores the possibility the baby may be in pain or discomfort, which if fixed could get him or her to sleep.
I did find Weissbluth makes good points about why it's so important for children to be well-rested. However, I thought he overstated the case. I found myself worrying as I read it that I had already caused Mari irreparable damage by letting her stay up too long in the past. I even wondered if that was the cause of her not doing things such as crawling as fast as some babies (though she is still very much within the normal range). With a little more distance, I found the book was making me worrying too much. More guilt is something parents don't need.
Another issue I have with the book is that it is overly long, repetitive and written in a convoluted manner. However, that may be the editor in me talking.
4. The Baby Sleep Book, by William, Robert, James and Martha Sears
I like Dr. Sears a lot. I find what he says about attachment parenting (I have the book by that name and love it) makes a lot of sense. Though I no longer follow it to the letter (I allow some limited crying alone, I no longer "wear" Mari much at home, we no longer co-sleep), I believe in the philosophy of maintaining a strong bond between parent and baby. I believe the amount of time I spent in earlier months wearing or carrying Mari, co-sleeping, responding immediately to her cries, bonding with her immediately upon birth, and breastfeeding (still going strong there) laid the foundation for us knowing her well and her trusting us. I also found The Birth Book, also by Dr. Sears, to be the best, most balanced resource I read about birth. So certainly I have nothing against Dr. Sears.
However, I did not find The Baby Sleep Book to be terribly helpful. When I tried to follow his suggestion of waiting until Mari had been asleep for 20 minutes before putting her down, I found she was more lightly asleep than when she had been asleep only about 5 minutes. It also delayed my going to sleep myself -- but then, generally, I found the book didn't give enough weight to parents' needs.
Really, I found the whole concept of actively putting her to sleep each and every time problematic. I do believe Ferber's assertion that babies develop sleep associations. If Mari is rocked or nursed to sleep, then put down once deeply asleep, she does indeed tend to wake up when her sleep cycle becomes shallow, probably because she's alarmed that the conditions she associated with going to sleep (rocking, nursing) are no longer present. It was only when I started working to break those sleep associations that Mari started sleeping better.
Basically, the message I took away from The Baby Sleep Book was that if I didn't like Mari waking up constantly, I should just be very, very patient and she would eventually, by the time she was a toddler or preschooler, learn to sleep better and more independently. In the meaning, Jon or I should always carry her until she fell asleep and then sleep with her, even if it meant a more disrupted sleep for everybody. I found this unacceptable.
To be fair, there are bits about other ways of doing things, and a good chapter about night weaning, but I generally found the book to be simplistic, not that informed about sleep and not very respectful of the need to teach a baby to fall asleep and stay asleep on her own. Though just as gentle, I found the No-Cry Sleep Solution to be better about all that.
Next up: The No-Cry Nap Solution, The Baby Whisperer
Showing posts with label temperament. Show all posts
Showing posts with label temperament. Show all posts
Thursday, April 22, 2010
Friday, February 26, 2010
Day 38: Imposing a schedule, of sorts
I've been trying to respond promptly to Mari's cues and keeping track of when she sleeps for quite awhile now in hopes a pattern would emerge. Unfortunately, the only conclusion I've come to is that Mari is highly unpredictable and has little or no internal rhythm of her own.
She wakes up wide awake and ready to play anytime between 2:30 AM and 8 AM, though of course with the earlier times I try really hard to get her back to sleep, though it often takes up to an hour and a half. Her nap number ranges from two to five, though three is most normal. She has gone to bed as early as 5:30 PM and not until nearly 9 PM. Her morning nap has started as early as 7:40 and as late as 10:10. Her nap lengths vary from 20 minutes to three hours.
Having learned a little more about temperament, I can conclude that Mari is a highly irregular baby and will not put herself on a schedule no matter how long I wait and keep track of what she does. So I've decided I have to impose one.
No, Jon, I'm not going to be inflexible about this. Because I'm going to try to balance establishing a schedule with making sure Mari gets enough rest and isn't overtired, it may take a long time for her to get the idea. Nonetheless, I'm going to try. Someone has to set her circadian clock.
The key is going to be establishing quiet times and active times. Ideally she will sleep during the quiet times and play during the active times, but if not, she will play quietly during the quiet times and nap in a brighter, noisier environment during the active times.
The ideal schedule will be as follows:
7:30 AM - Up, active play
8:15 - Naptime routine (feed, potty, story, lullaby and rocking, down)
9:00 - Nap/quiet time
11:00 - Active play
12:15 PM - Naptime routine
1:00 - Nap/quiet time
2:30 - Active play
3:45 - Naptime routine
4:30 - Nap/quiet time
5:30 - Active play/suppertime
6:30 - Bedtime routine (feed, potty, bath, massage, 2 stories, lullaby and rocking, down)
7:30 - Sleep
Of course, Mari won't follow the ideal schedule exactly. So I have the following contingency guidelines:
- If Mari wakes up from a nap while it's still naptime, I will try my hardest to get her back down. If after 20 minutes of rocking and soothing, she won't go back down and it's still naptime, I will let her play quietly in her crib for up to 20 minutes or until she shows tired signs. Then I will try again, until she goes down or until it's active time.
- If Mari wakes up while it's still naptime and I'm able to get her back down, but she wakes up again I'll try a second time to get her back down -- and this time I'll rock her all the way to sleep. At all other times I will endeavour to rock her only until she's drowsy and put her down still awake. If she wakes up a third time while it's still naptime I'll let her play quietly in her crib until it's active time.
- If Mari shows signs of fatigue during active time, I will immediately stop what I'm doing and put her to bed. I won't do the whole naptime routine -- no feed, no potty, no story. Just lullaby and rocking.
- For naps during active time, I will not try super-hard to be quiet. I will walk around, flush the toilet, etc, though I won't actively try to disrupt her sleep. I will close only the blind over her crib, not the one over the roof, unless it's very sunny, in which case I'll close the bamboo part of the blind only, not the blackout fabric. For naps during quiet time, I will close both blinds and I will try to be as quiet as possible.
- If Mari wakes up from a short nap during active time I won't try to put her back to sleep unless she's very fussy and obviously tired and continues to be for more than a few minutes.
- For most naps, even if they go into the next scheduled time, I will not wake her up or disturb her. However, if the last nap of the day goes beyond 6:30 PM, I will go into the room, walk around, open the blinds, turn off the white noise machine. If that doesn't wake her up I'll try again in another 10 minutes. By 6:45 at the latest, I will actively wake her up by picking her up.
- During active time, Mari will play downstairs, not in her crib. I will try to play actively with her as much as possible, though I don't promise to do so all the time.
- If Mari is happily playing in her crib during quiet time, I will either leave her alone in her room or sit in the chair and read, interacting with her only minimally, if at all -- looks and smiles, no talking.
- If Mari is playing in her crib during quiet time, I will provide only her lovey and perhaps one other toy at my discretion, and she will be facing the direction she faces to sleep, unless there's less than 15 minutes remaining in her quiet time, in which case she can play with whatever she wants, facing whichever direction, as long as she stays in her crib.
- If Mari starts to fuss when I've left her alone to play in her crib during quiet time, I'll take this as a sign she's tired and will try again to put her down for a nap.
- If Mari naps during active time, I will nonetheless try to put her down for her next nap on schedule, unless she has woken up less than half an hour before the naptime routine is supposed to begin. If the latter is the case, I'll let her play actively for 30 minutes before beginning the naptime routine. If she seems wide awake even then, I will use the time normally allotted for the naptime routine as a transitional time. I will feed her if she'll eat, read her stories, play with her very quietly until she starts to lose steam or until the actual nap is supposed to start. Then I will try more aggressively to get her to fall asleep.
- The bedtime routine starts at 6:30 PM even if she's just woken up, because she's tired at that time of day anyway and because the bath and massage will provide some activity before bed.
- While I will try to feed her at the beginning of every naptime/bedtime routine, it's not a big deal if she's hungry earlier or refuses to feed because she's not hungry -- I will feed her on demand. If I end up having to nurse her at the end of the naptime/bedtime routine I will pull her off before she falls asleep completely. I will try not to make a habit of nursing her immediately before bed.
- I will try to potty her toward the beginning of the naptime/bedtime routine. If she doesn't go, I won't take her again unless she clearly needs to poo (not pee). If she does, I will use the bowl in her room; I won't take her to the (brighter) bathroom.
- If she wakes up before 7:30 AM, I will try hard to get her back down. But if she's wide awake between 7:00 and 7:30 and seems unlikely to go back down, I will let her play quietly in her crib until 7:30. In this case I will potty her if need be.
- If she seems very tired at night, I will shorten the bedtime routine and concentrate on getting her down, even if it's earlier than 7:30 PM.
- I hope that eventually, if she's sleeping better during the day and waking up less at night, I can move the bedtime up to 8 PM and allow her to get up at 7 AM, since she probably only needs about 11 hours of night sleep.
Today: Last night we were back to the bad old days -- four night wakings. She was up from about 2:15 to 3:30 AM and wouldn't fall back asleep. I don't know what's up because yesterday was a fairly average day. Maybe it's the developmental leaps of Wonder Week 26 making her fussy for up to five weeks. Sigh. As for the new schedule, yesterday was the first day I tried to follow it, and we were fairly successful. However, today, Mari screwed it up by napping only for about 45 minutes in the morning and refusing to back down. She ended up having four short naps today, one of them during an active time. I really, really wish I could get her to nap longer.
She wakes up wide awake and ready to play anytime between 2:30 AM and 8 AM, though of course with the earlier times I try really hard to get her back to sleep, though it often takes up to an hour and a half. Her nap number ranges from two to five, though three is most normal. She has gone to bed as early as 5:30 PM and not until nearly 9 PM. Her morning nap has started as early as 7:40 and as late as 10:10. Her nap lengths vary from 20 minutes to three hours.
Having learned a little more about temperament, I can conclude that Mari is a highly irregular baby and will not put herself on a schedule no matter how long I wait and keep track of what she does. So I've decided I have to impose one.
No, Jon, I'm not going to be inflexible about this. Because I'm going to try to balance establishing a schedule with making sure Mari gets enough rest and isn't overtired, it may take a long time for her to get the idea. Nonetheless, I'm going to try. Someone has to set her circadian clock.
The key is going to be establishing quiet times and active times. Ideally she will sleep during the quiet times and play during the active times, but if not, she will play quietly during the quiet times and nap in a brighter, noisier environment during the active times.
The ideal schedule will be as follows:
7:30 AM - Up, active play
8:15 - Naptime routine (feed, potty, story, lullaby and rocking, down)
9:00 - Nap/quiet time
11:00 - Active play
12:15 PM - Naptime routine
1:00 - Nap/quiet time
2:30 - Active play
3:45 - Naptime routine
4:30 - Nap/quiet time
5:30 - Active play/suppertime
6:30 - Bedtime routine (feed, potty, bath, massage, 2 stories, lullaby and rocking, down)
7:30 - Sleep
Of course, Mari won't follow the ideal schedule exactly. So I have the following contingency guidelines:
- If Mari wakes up from a nap while it's still naptime, I will try my hardest to get her back down. If after 20 minutes of rocking and soothing, she won't go back down and it's still naptime, I will let her play quietly in her crib for up to 20 minutes or until she shows tired signs. Then I will try again, until she goes down or until it's active time.
- If Mari wakes up while it's still naptime and I'm able to get her back down, but she wakes up again I'll try a second time to get her back down -- and this time I'll rock her all the way to sleep. At all other times I will endeavour to rock her only until she's drowsy and put her down still awake. If she wakes up a third time while it's still naptime I'll let her play quietly in her crib until it's active time.
- If Mari shows signs of fatigue during active time, I will immediately stop what I'm doing and put her to bed. I won't do the whole naptime routine -- no feed, no potty, no story. Just lullaby and rocking.
- For naps during active time, I will not try super-hard to be quiet. I will walk around, flush the toilet, etc, though I won't actively try to disrupt her sleep. I will close only the blind over her crib, not the one over the roof, unless it's very sunny, in which case I'll close the bamboo part of the blind only, not the blackout fabric. For naps during quiet time, I will close both blinds and I will try to be as quiet as possible.
- If Mari wakes up from a short nap during active time I won't try to put her back to sleep unless she's very fussy and obviously tired and continues to be for more than a few minutes.
- For most naps, even if they go into the next scheduled time, I will not wake her up or disturb her. However, if the last nap of the day goes beyond 6:30 PM, I will go into the room, walk around, open the blinds, turn off the white noise machine. If that doesn't wake her up I'll try again in another 10 minutes. By 6:45 at the latest, I will actively wake her up by picking her up.
- During active time, Mari will play downstairs, not in her crib. I will try to play actively with her as much as possible, though I don't promise to do so all the time.
- If Mari is happily playing in her crib during quiet time, I will either leave her alone in her room or sit in the chair and read, interacting with her only minimally, if at all -- looks and smiles, no talking.
- If Mari is playing in her crib during quiet time, I will provide only her lovey and perhaps one other toy at my discretion, and she will be facing the direction she faces to sleep, unless there's less than 15 minutes remaining in her quiet time, in which case she can play with whatever she wants, facing whichever direction, as long as she stays in her crib.
- If Mari starts to fuss when I've left her alone to play in her crib during quiet time, I'll take this as a sign she's tired and will try again to put her down for a nap.
- If Mari naps during active time, I will nonetheless try to put her down for her next nap on schedule, unless she has woken up less than half an hour before the naptime routine is supposed to begin. If the latter is the case, I'll let her play actively for 30 minutes before beginning the naptime routine. If she seems wide awake even then, I will use the time normally allotted for the naptime routine as a transitional time. I will feed her if she'll eat, read her stories, play with her very quietly until she starts to lose steam or until the actual nap is supposed to start. Then I will try more aggressively to get her to fall asleep.
- The bedtime routine starts at 6:30 PM even if she's just woken up, because she's tired at that time of day anyway and because the bath and massage will provide some activity before bed.
- While I will try to feed her at the beginning of every naptime/bedtime routine, it's not a big deal if she's hungry earlier or refuses to feed because she's not hungry -- I will feed her on demand. If I end up having to nurse her at the end of the naptime/bedtime routine I will pull her off before she falls asleep completely. I will try not to make a habit of nursing her immediately before bed.
- I will try to potty her toward the beginning of the naptime/bedtime routine. If she doesn't go, I won't take her again unless she clearly needs to poo (not pee). If she does, I will use the bowl in her room; I won't take her to the (brighter) bathroom.
- If she wakes up before 7:30 AM, I will try hard to get her back down. But if she's wide awake between 7:00 and 7:30 and seems unlikely to go back down, I will let her play quietly in her crib until 7:30. In this case I will potty her if need be.
- If she seems very tired at night, I will shorten the bedtime routine and concentrate on getting her down, even if it's earlier than 7:30 PM.
- I hope that eventually, if she's sleeping better during the day and waking up less at night, I can move the bedtime up to 8 PM and allow her to get up at 7 AM, since she probably only needs about 11 hours of night sleep.
Today: Last night we were back to the bad old days -- four night wakings. She was up from about 2:15 to 3:30 AM and wouldn't fall back asleep. I don't know what's up because yesterday was a fairly average day. Maybe it's the developmental leaps of Wonder Week 26 making her fussy for up to five weeks. Sigh. As for the new schedule, yesterday was the first day I tried to follow it, and we were fairly successful. However, today, Mari screwed it up by napping only for about 45 minutes in the morning and refusing to back down. She ended up having four short naps today, one of them during an active time. I really, really wish I could get her to nap longer.
Tuesday, February 23, 2010
Day 36: Temperament and sleep
I'm still not done reading Healthy Sleep Habits, Happy Child by Dr. Marc Weissbluth, but the book's discussion of infant temperament made me wonder how much Mari's temperament affects her sleep.
The widely accepted measures of infant temperament are as follows (more details at http://en.wikipedia.org/wiki/Temperament#Nine_Temperament_Characteristics_of_Thomas_and_Chess):
Activity (General motion and energy): Mari is pretty squirmy, always has been. Even when she's on her back she's always kicking and flailing in a jerky way. Though she's not yet creeping or crawling, I would put her activity level at fairly high.
Rhythmicity (Regularity of bodily functions): Mari is definitely not regular or predictable. Today was a fairly good day -- she napped regularly and was pretty happy and energetic. But I swear, I didn't do anything differently than I did yesterday, when she hardly napped at all. I can never predict when she'll nap or for how long, when she'll poo, how much she'll eat, etc.
Approach/Withdrawal (first reaction): Hmm, I'm not sure on this one. Mari has some pretty fierce stranger aversion, so she's definitely withdrawing when it comes to people. But she's not necessarily fearful of new places, experiences or tastes, as long as we're with her.
Intensity: Mari is very intense. When she's happy she's ecstatic. When she's unhappy she screams like a dying jet engine. She can careen between the two in less than a second.
Mood: Not sure I get this one. Mari's moods vary a lot, but don't most babies' moods vary? When she's well-rested she's generally cheerful. When she's not she's fussy. So I suppose she's somewhere in the middle of the scale.
Persistence: Mari is very persistent, for better and for worse. When she was learning to roll over or to sit up it was all she wanted to do for days. She can also be extremely persistent in crying and resisting sleep even when she's tired.
Distractibility: Mari is quite distractible, though she's not on the extreme end of the scale. She's very easily distracted by unusual or new sights, noises, and toys. Picking her up can distract her from fussing quickly, but it doesn't last. Same goes for novel soothing techniques -- they seem to work quickly at first, but she goes back to fussing quickly.
Threshold (sensitivity): Mari is very sensitive, especially to noises. She's easily startled by even not-so-loud noises such as a wooden block falling into a small box. Truly loud noises such as the sound of the vacuum make her howl. When she's sleeping she's very easily awakened even by tiny sounds such as the rustle of paper or the crinkle of plastic.
According to the book, intense babies also tend to be slowly adaptable, negative in mood and withdrawn. These traits make for a "difficult" temperament. Well, I'd say Mari is very intense but in the middle on the other supposedly related measures. So I suppose she has an "intermediate" temperament by the book's classification system. But Weissbluth also notes babies who are highly active and highly sensitive are also at risk of sleep problems, especially when routines are disrupted. This is obviously true for Mari. So despite her natural lack of regularity she really needs me to try my best to impose a routine and a schedule. Too bad it's so hard.
There are other ways of measuring temperament. According to The Baby Whisperer, Mari is "spirited" -- a baby who knows what she wants and doesn't want and doesn't hesitate to let people know, and loudly. (An abbreviated version of the quiz in the book is available here: http://quiz.ivillage.com/parenting/tests/knowyourbaby.htm)
Mari is also a "high needs" baby according to Dr. William Sears, the guru of attachment parenting. She fits all 12 of the characteristics listed here <http://www.askdrsears.com/html/5/T050400.asp> to a tee.
All this adds up to Mari not being hard-wired to sleep well. Dr. Sears has a good article about it here: http://www.askdrsears.com/html/5/T050900.asp. So I suppose sleep will always be somewhat of a struggle. Still, the changes I've made so far have made a world of difference, though I clearly still need to do more work on trying to get her to fall asleep on her own, especially for naps, since I'm still having difficulty putting her down before the very-nearly-asleep stage.
The widely accepted measures of infant temperament are as follows (more details at http://en.wikipedia.org/wiki/Temperament#Nine_Temperament_Characteristics_of_Thomas_and_Chess):
Activity (General motion and energy): Mari is pretty squirmy, always has been. Even when she's on her back she's always kicking and flailing in a jerky way. Though she's not yet creeping or crawling, I would put her activity level at fairly high.
Rhythmicity (Regularity of bodily functions): Mari is definitely not regular or predictable. Today was a fairly good day -- she napped regularly and was pretty happy and energetic. But I swear, I didn't do anything differently than I did yesterday, when she hardly napped at all. I can never predict when she'll nap or for how long, when she'll poo, how much she'll eat, etc.
Approach/Withdrawal (first reaction): Hmm, I'm not sure on this one. Mari has some pretty fierce stranger aversion, so she's definitely withdrawing when it comes to people. But she's not necessarily fearful of new places, experiences or tastes, as long as we're with her.
Intensity: Mari is very intense. When she's happy she's ecstatic. When she's unhappy she screams like a dying jet engine. She can careen between the two in less than a second.
Mood: Not sure I get this one. Mari's moods vary a lot, but don't most babies' moods vary? When she's well-rested she's generally cheerful. When she's not she's fussy. So I suppose she's somewhere in the middle of the scale.
Persistence: Mari is very persistent, for better and for worse. When she was learning to roll over or to sit up it was all she wanted to do for days. She can also be extremely persistent in crying and resisting sleep even when she's tired.
Distractibility: Mari is quite distractible, though she's not on the extreme end of the scale. She's very easily distracted by unusual or new sights, noises, and toys. Picking her up can distract her from fussing quickly, but it doesn't last. Same goes for novel soothing techniques -- they seem to work quickly at first, but she goes back to fussing quickly.
Threshold (sensitivity): Mari is very sensitive, especially to noises. She's easily startled by even not-so-loud noises such as a wooden block falling into a small box. Truly loud noises such as the sound of the vacuum make her howl. When she's sleeping she's very easily awakened even by tiny sounds such as the rustle of paper or the crinkle of plastic.
According to the book, intense babies also tend to be slowly adaptable, negative in mood and withdrawn. These traits make for a "difficult" temperament. Well, I'd say Mari is very intense but in the middle on the other supposedly related measures. So I suppose she has an "intermediate" temperament by the book's classification system. But Weissbluth also notes babies who are highly active and highly sensitive are also at risk of sleep problems, especially when routines are disrupted. This is obviously true for Mari. So despite her natural lack of regularity she really needs me to try my best to impose a routine and a schedule. Too bad it's so hard.
There are other ways of measuring temperament. According to The Baby Whisperer, Mari is "spirited" -- a baby who knows what she wants and doesn't want and doesn't hesitate to let people know, and loudly. (An abbreviated version of the quiz in the book is available here: http://quiz.ivillage.com/parenting/tests/knowyourbaby.htm)
Mari is also a "high needs" baby according to Dr. William Sears, the guru of attachment parenting. She fits all 12 of the characteristics listed here <http://www.askdrsears.com/html/5/T050400.asp> to a tee.
All this adds up to Mari not being hard-wired to sleep well. Dr. Sears has a good article about it here: http://www.askdrsears.com/html/5/T050900.asp. So I suppose sleep will always be somewhat of a struggle. Still, the changes I've made so far have made a world of difference, though I clearly still need to do more work on trying to get her to fall asleep on her own, especially for naps, since I'm still having difficulty putting her down before the very-nearly-asleep stage.
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