Sleep Training Methods for Children

Transcription:

Melanie Cole, MS (Host): Are you tired? Are you not sure how to help your kids sleep through the night? Well my guest is here to give you some sleep training tools and methods to help both tired parents and babies get better sleep. My guest is Dr. Tina Smith. She’s a pediatrician with the Marietta Memorial Hospital department of pediatrics, part of Memorial Health system. Dr. Smith, before we start with the advice, tell us a little bit about yourself and how you came to memorial health system.

Tina Smith, MD (Guest): Hi. I'm Tina Smith and I'm a pediatrician and a mom of three young children. They are ten, seven, and five. We moved to Marietta for this position in pediatrics here. I'm originally from Ohio and I've been living in different areas of the country, mostly in the Midwest, but it was time to come back home and be closer to family.

Host: Tell us how you got into the field. Why pediatrics?

Dr. Smith: I've just always loved children and working with children. I originally wasn’t really sure about medicine, but I knew I wanted to work with children specifically. Once I chose to go into the medical field, then it was just natural to choose pediatrics. I love getting to see kids every day and helping them with the development and illnesses as well. It’s just a joy to see all of the kids.

Host: Tell us a little bit about what you do for fun. Something about you that patients and their families just might not know.

Dr. Smith: Well I love to do lots of stuff with my kids. We ski together and we hike. I guess stuff for myself. I like to read. I do like to garden a little bit. Pretty much I’ll try anything a few times and give it a go.

Host: Well it’s great to have you as part of the system. Now we’re talking about sleep training, Dr. Smith. Yikes. Every parent, new parents especially, that seems to be one of the biggest problems is getting baby to sleep through the night. So what age can you start sleep training a child?

Dr. Smith: You know, you really can start good sleep habits at any age. But what people typically think of as sleep training, I wouldn’t start until usually around after two to three months of age. Good sleep habits can start even in infancy, just trying to help that baby get in the good cycle of trying to do more frequent feedings in the day, of less frequent feedings at night. Being able to sleep in the crib or bassinet on his own and not having to always be held. Those are things we can start even early.

Host: Are there some recommendations, before we discuss some of the methods out there, about what you want—You just mentioned a little bit of good sleep hygiene and the importance of routine, but what things would you like parents to know are really important that you do not want them doing?

Dr. Smith: The most important thing for me is that babies are in a safe sleep environment. By safe sleep I mean an environment where the baby is alone in his or her own sleep space with nothing else in the crib or bassinet besides the baby wrapped up in a tight-wrapped blanket or a swaddling Velcro sleep sack. Something of that nature. It is important that baby be sleeping alone. Certainly, sleeping in parent’s arms is a safe place when the parents are alert and awake, but once they start getting sleepy, it’s not longer a safe space and that baby needs to be put down to sleep on a nice, flat surface. Always sleeping on his or her back as well. Babies who sleep on their sides or bellies before they're able to roll themselves onto their sides or bellies are at increased risk for unexplained death.

Host: So what kind of training options are out there? When we get to actually start sleep training, whatever age that is that you're going to tell us, there are so many different methods out there, Dr. Smith. People are not sure whether they're allowed to let their kids cry it out, whether they should camp out and sit there and then eek their way out of the room as I did. What do we do?

Dr. Smith: You're right. There are a ton of options. I read a lot of different things. I have three kids of my own, so I have tried lots of different things. Generally, the way I’d advise families to do it is a combination of multiple different options. Sometimes starting with one and if it’s not working out for your family, feeling free to switch to a different one. So generally speaking, I do encourage right from the get-go with newborns to keep babies eating every two to three hours in the daytime. Don’t let those long naps happen in the middle of the afternoon. You know we shouldn’t have a newborn sleeping four hours in the middle of the afternoon. If they want to sleep that long, it should be at night when everybody is sleeping. So just kind of trying to keep that routine for them. That they're eating more often in the day. Sleeping longer at night is a great place to start. Like I mentioned before, making sure that baby’s also always having the option to sleep in the crib or bassinet and not always in a parent’s arms so that they can get used to that.

Having the routine of just picking up a couple of things that you can do right before bedtime. You know you turn the lights off, you maybe sing quietly to your baby while they’re bottle-feeding or nursing before bed. Those things can kind of set the stage for baby to start to feel sleepy and get into a routine where they’ll fall asleep easily. From there, I like to make sure that when we first teach our babies how to fall asleep, the first time’s at night. We don’t worry about the middle of the night awakenings for a while. So once the baby has learned that initial skill of falling asleep at night, often times the middle of the night awakening completely fall away and we never have to sleep train in the middle of the night.

So initially I recommend that you make sure it’s evening, it’s around the time your baby usually goes to bed. If you're ready to sleep train, you're going to change the baby’s diaper, do the last feeding of the night, rock and hold your baby and sing to her. When her eyelids are getting nice and heavy, that’s when you're going to lay her down in her crib. We don’t want her to fall asleep completely in the parent’s arms. We want her just to be super tired. Ready to fall asleep but doing that last little bit of work herself where she falls asleep in her crib on her own.

Sometimes when you lay them down, they’ll wake back up being completely alert, cry for you. But we know that that baby is tired and was almost asleep in our arms. At that point where I recommend backing away from your baby and giving him five to ten minutes to himself. Just letting him go ahead and hash it out. He may cry for a bit, he may be quiet, he might not fall asleep immediately, but you're giving him that time to himself to fall asleep. If after those five to ten minutes he’s still crying, I really recommend checking on him, but not picking up. Because then you’ll be starting this all over again. So really, just making sure he’s safe. His arm is not stuck in the side of the crib or anything like that, and then giving him, again, another five to ten minutes on his own and checking on him.

So, this sounds like cry it out, but I worry about the cry it out being done in the middle of the night when people have never taught their babies how to fall asleep on their own to begin with. So, this is when I recommend doing it. It’s when they really are sleepy right then and there. They need to learn how to fall asleep in the bed, outside of the parent’s arms.

Host: One of the scariest things is once you're done swaddling a baby and you can do this little bit of length of crying it out, parents worry their kid’s going to throw up while they're crying and they're on their back. I mean I know so many parents that were afraid of that. Can we sneak in? Do you recommend those cameras that point in on there so that we can watch them cry and then maybe stick our fingers in our ears? What do you recommend for the fears that we have when they’re crying?

Dr. Smith: I recommend just understanding that most babies do not get so upset that they vomit. There are a few that do, and once that has happened, then you kind of know that that’s what your child does, and you may to get a camera to keep an eye on him. You may just want to peek in more frequently. Again, try not to let the baby see you peeking in, but just double checking.

Now babies turn their heads side to side and we’re not immobilizing that ability at all. So, if a baby were to vomit, there’s really not a danger of that hurting the baby. You certainly want to know it happened so that you can go in and clean up, but you're not going to really worry about the baby harming themselves by getting so upset that he or she vomits. So, I personally recommend going and washing the dishes. Doing something that takes your mind off the baby for that five to ten-minute period. It also creates a little bit of noise and distraction so that you don’t have to just sit there and listen. Two minutes of crying sounds like an eternity when you are just sitting there waiting for it to stop and feeling like if you just walked in, they would immediately stop. Which is probably the case, but not going to help your baby fall asleep on his or her own.

Especially with a baby who maybe vomits, they may do more of the camping out method that you mentioned earlier where they just stand at the baby’s bedside and just kind of soothingly sing to her or rub her head while she is trying to fall asleep. Most of the time that baby’s still going to cry because you're not picking them up like they expect, and I think that that could be a little bit more agonizing for parents.

Host: So, you’ve done all the right things, baby’s sleeping through the night or going to bed perfectly on their own. Isn’t that wonderful? Then all of a sudden like a year old or something, they start again, and it’s like all that sleep training down the tubes. What do we do if there’s a relapse? While we don’t have a ton of time in these podcasts, what about as they get a little older and then they can start to sort of vocalize don’t leave the room? Or they can really scream because they know it works or please sit there next to my bed until I'm 10. What do we do if there’s relapses and then it starts to sort of carry on from there?

Dr. Smith: It does depend on the age of the kiddo and you definitely see relapses with illnesses and different things that kind of wake the baby up in the middle of the night or the older child. So, with someone around one or two years of age, I’d recommend going back to that original just make sure they have learned and relearned how to fall asleep on their own at night. In the middle of the night if they wake up, you can go to them and say, “everything’s okay. Mommy’s going back to sleep, goodnight.” You know just something very sweet and simple and just that you’ve checked on them, you’ve told, “I see you, you are okay. I'm going to sleep because it’s nighttime.” I do not recommend getting that baby up and trying to do a middle of the night feeding. Around that age, there shouldn’t be any need for middle of the night feedings. If they're sick, that’s a whole different story where you're going in to check on them for that. When they're older, definitely check in on them. Tell them everything’s okay.

Once they're old enough to be out of a crib and they’re wandering around, they may come in your room, they may climb in your bed, and you won't even notice. There's really nothing you can do about it if they're stealthy ninja getting in your bed in the middle of the night. You just ignore it to be honest. I mean you can say what happened, why’d you come to my bed? But if you're not awake enough to walk them back to their room, you're really not going to be able to make an impact on getting them back to sleep. Because in order to re-sleep train them at the wandering ages, you truly do have to walk them back to their bedroom night after night after night and just tell them that’s where they sleep. Some parents will set up a little makeshift bed on the floor for their child who wanders in just to keep them out of their bed. That’s fine too. Whatever works for your family there.

Host: I did that, I must admit. Then it was the bed made up on the floor next to my son’s bed because that’s where my daughter felt comfortable. Wrap it up for us Dr. Smith. It’s really great advice. Such important information for parents to hear. What you really want them to know about sleep training their children, all of the things that go along with that as a pediatrician.

Dr. Smith: I think it’s most important to recognize that one method doesn’t work for everybody. You may start with something and tweak it a little bit, but don’t give up on it entirely. Your baby is capable of sleeping well through the night. By through the night, those number of hours depend on the age. A two-month-old or a three-month-old, we might only be looking at a six hour window calling it sleeping through the night, but that’s the goal. Then as they get older, you a 10 to 12-hour stretch is really quite reasonable and expected as they're older and that they would maintain that. So, finding ways that work with your family, that are the approach that works for your specific child is imperative. And working directly with your pediatrician to work out all those details can be very helpful.

Host: Thank you so much, Dr. Smith, for joining us today. It’s really important information. You're listening to Memorial Health Radio with Memorial Health System. For more information, please visit mhsystem.org. That’s mhsystem.org. This is Melanie Cole. Thanks so much for tuning in.