The Partisan Parenting Politics of Sleep
October 9, 2009 · Posted in Infant Development, Parenting, Sleep · Permalink · Comments (3)

red_vs_blueIt seems when it comes to babies and sleep the discussion is as heated as the Democrats vs. the Republicans.  Your baby’s sleep should not be a pawn in partisan parenting politics! There doesn’t need to be two camps –the “cry it out” party vs. the “never let my baby cry” party.  Let’s calm down the rhetoric and just look at some very simple and gentle ways to help your baby get the sleep she needs.

Parents have been following Soho Parenting’s sleep advice for over twenty years and we have helped thousands of babies become and remain great sleepers!

Birth – Three Months:

Practice putting your baby down on her back whenever she is in a quiet, alert state, anytime from birth on.  If she falls asleep after being fed and rocked, lay her on her back swaddled up tight. The goal of putting the baby down when she is awake or asleep and comfortable is to build connections between lying down and contentedness. Experience adds up over time and becomes meaningful even in a tiny baby.

The next thing on the path to great sleep is to differentiate day from night. From about eight weeks on you can start to think of your baby’s bedtime somewhere between 6 pm and 8 pm.  This is “bedtime” even if your baby will eat or awaken many times between “bedtime” and “morning time”.  Treat every wake up after “bedtime” as a night waking.  Handle these wakings with the least amount of intervention: dim or no lights, whispering, changing diapers only when you hear or feel that it is a necessity, and keeping the goal of getting her back to sleep in the front of your mind. You and your partner need to be on board to avoid those middle of the night arguments that come hand in hand with sleep deprivation. Just concentrate on getting that baby back to sleep.  Sadly, this means not watching the Daily Show or Friends reruns at eleven with the baby after those first few months. Not feeling overstimulated by nighttime hoopla, your baby will adjust to a day/night cycle

Now it is time to establish your bedtime routine. Bath, boob or bottle and books is a typical one, but you can get creative! Put the baby down when she is drowsy and work on helping her fall asleep while she is laying in the bassinet or crib – this takes more work but will pay off in the end.  Of course some babies just can’t settle on their own or with only minimal help so do what you need to soothe your baby in these early months.

Babies often surprise us.  We have seen countless mothers in groups and individually who swear that if her baby is put down she will immediately freak out.  When put to the test – lo and behold, with a bit of patting or jiggling, the baby quiets and stays that way for a period of time. Therefore, we encourage you to keep experimenting. If your baby is crying and uncomfortable by all means do what ever it takes to calm her. Remember that in these early months the physical connection between you and your baby is primal and necessary but helping your baby feel comfortable in her own skin, with you nearby, is important as well. Finding the midpoint between closeness and helping to regulate her biological need for sleep will help your baby thrive.

Three to Six Months

Once your baby gets used to falling asleep at approximately the same time every day, the next point of focus is slowly weaning out nighttime feedings. After your baby is over 12 weeks and 12 pounds you can BEGIN to move towards the goal of not feeding during the night.

Very important medical reasons support this move — one of course being your sanity — but for a baby, night feedings after they are nutritionally necessary become too much work for her body.  Think of your baby as being see through or clear.  If you could watch the bodily processes of sucking, swallowing, digestion, peeing, pooping and getting rid of gas you would realize that what appears to be a simple activity is actually revving up the metabolism. Your goal should be to quiet the baby so the brain can cycle through the different levels of sleep.  We now have much research to prove that these deeper levels of sleep are critical to both her bodily needs and also the intellectual processing.  Begin to consider nighttime as your baby’s opportunity to digest information, not milk.

Many babies will drop one or two feedings on their own as they approach three to four months, and these techniques will help move your infant even further in that direction.  Slowly reduce the number of ounces given. For instance, if your baby takes a six ounce bottle twice a night at one and four o’clock,  start with just one feeding and reduce the amount by one ounce or minute every few days. If you are nursing you can either reduce the number of minutes or just feed on one side at the first feeding and the second side at the next waking. The baby’s stomach will adjust to having less and less milk. This is a slow and gentle way to help your baby comfortably give up a feeding. Once you reach the point where your baby is only receiving one or two ounces/minutes, you can feel certain that she is no longer waking because of a NEED for food. The night you decide not to feed – and if your baby awakens and is crying – first offer a pacifier, water or soothingly pat her back to sleep. If the baby becomes more upset, then leaving the room and letting her figure it out might result in some tears but also in her finding her own special way to soothe herself back to sleep. No doubt, this process will feel much more difficult than just feeding the baby, but it is worth the effort as the ultimate goal is her sleeping for longer stretches of time.

Remember, your job is to help guide the baby’s body toward not requiring a late night feeding. If you have followed this, your baby should be getting her last feed of the day in the 6:30 pm range, one feeding in the middle of the night, and her next eating in the morning – anytime after six. The next step will be to cut out the one remaining feeding in the same way.

Day Time Sleep

Here are some additional things to be done during the day that will assist you in reaching your goal of eleven to twelve hours of nighttime sleep and at least three hours of daytime sleep. Notice that your baby will want to go back to sleep soon after she wakes up in the morning. This can be taken as another reminder of how much sleep she needs to fuel herself while growing in leaps and bounds. A pattern will begin to develop – she will become cranky about one to two hours after waking.  Capitalize on this natural pattern and as your baby moves into her fourth month of life decide on a specific time within that range, for example 8:15 or 8:30 am.  Once designated, begin to think of this as “nap time”. Stop following patterns and use the clock to establish a daytime schedule.  Do a very abbreviated routine–change into “day clothes” sing a little song and become dedicated to putting the baby down at the same time every day.

Another tip to help the process — the more you put the baby down in the exact same way, same place and same time, the easier it is for her to count on these routines.  Your baby is quickly learning to associate and remember things in her brain and body.  Repetition is both respectful and crucial because it communicates what is to come next to your baby.  Soon, you will be able depend on this morning nap. The two remaining naps will fall into place a bit later. A typical schedule is 8:30 am, 12:30 pm and 3 :30 pm. One nap will drop out between 5 and 8 months and the two nap schedule can last well into the second year.

Prepare yourself — this transition will come with fits and starts.  There will be days that seem haywire — and days that feel smooth and wonderful. This is to be expected and is truly the essence of taking care of children. You are looking to establish a routine that you count on — most of the time — creating structure to the day. Do not fret if it all seems to have gone down the tubes after one hard day.  Instead, think of any mishap as a glitch, a ripple and stay your course.

As for crying, an issue strong enough to birth a parenting divide, it is a part of human life. A communication, a release, a sign of discomfort when we go through big transitions. Some crying is inevitable as your baby learns to soothe herself but if you follow these guidelines she will cry the least amount of time possible. Just enough to learn something very important and fundamental.

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Soho Parenting’s Sleep Philosophy
August 24, 2009 · Posted in Discipline, Infant Development, Parenting, Sleep · Permalink · Comments (4)

sleepingbaby-main_FullFor over twenty years we have been counseling families on a wide variety of parenting issues, such as discipline, sibling rivalry, and toilet training. The vast majority of parents, however, seek us out for help with their children’s sleep problems. These parents, tense and bleary-eyed from their own lack of sleep, are in need of guidance, yet understandably wary of subscribing to a method that may be emotionally detrimental to their child now or in the future. Parents’ worries are often magnified by the controversy and misinformation about sleep circulating today. We would like to take this opportunity to clarify our ideas about children and sleep in the context of our Responsive Parenting philosophy.

We are often asked, “Do you believe in letting babies cry?” or “Are you ‘family bed’ advocates?” Although we do not ascribe to any one method of “sleep training” for all families to follow, we do hold strongly to some basic tenets about the importance of sleep.

•    Sleep is one of a child’s most basic needs. Parents should consider it primary fuel, as important as milk.

•    It is a parent’s responsibility, not a child’s, to ensure that a child gets the correct amount of sleep.

•    All children of the same age bracket require approximately the same amount of sleep.

•    Children vary significantly in how easy or difficult it is to get them the sleep they need.

•    Without the right amount of sleep, children are compromised in obvious and subtle ways that can be detrimental to their overall growth and development.

Keeping these important ideas in the forefront, how do we help parents to get their children the sleep they need? At Soho Parenting, counseling sessions are customized to each individual family’s needs. We take into account the child’s age, living situation, parents’ work schedules, child’s medical history, as well as recent events that may effect our discussion of how to proceed, such as the birth of a sibling or a recent move.  We then set up a step-by-step plan of how to implement appropriate routines and structures that will insure that the child will get the right amount of sleep and develop the ability to fall asleep with a sense of security and comfort. Parents can then be in touch by phone or by email as they proceed, to get support, report progress and make any necessary changes in the plan.

One of the biggest stumbling blocks for parents is the fear of having their child cry. Crying is a very difficult issue for many parents and we often hear statements like:

“I can’t stand having my baby cry. She’ll think we’ve abandoned her.”
“He’ll stop trusting us and be insecure.”
“She’ll be afraid and all alone.”

It is understandable how this intense worry about crying has developed in parents. But in helping a child to achieve regulated sleep patterns some crying is often necessary. Crying is a natural part of the human repertoire; a certain amount of crying in the service of learning something very important will not harm children. There is even ample evidence that crying in a controlled way to learn to sleep as an infant helps with later sleep problems and reduces maternal depression.

We would like to put this worry into a historical and societal context. Parent-child relationships have been enriched immeasurably by strides made in the 1980’s and 1990’s in understanding children’s emotional lives. But there has been an unfortunate negative outcome as well − pervasive worry about emotionally damaging babies and children. Parenting advice from the previous generation was deemed old-fashioned and unsympathetic to children’s psychological needs. A mixture of popular psychology and influential childrearing advice has strongly advocated an almost constant gratification of children’s needs in order to promote “healthy self-esteem.” This has inadvertently put tremendous pressure on parents who then feel selfish and remiss if they frustrate and upset their child.

These ideas have had a tremendous impact on the arena of children’s sleep. Rather than allowing their child to be uncomfortable and unhappy or frustrated even for brief periods, parents sometimes opt instead for months, and even years, of sleepless or interrupted nights. This can deprive a child of a basic need, as well as compromising the entire family’s functioning.

At Soho Parenting we advocate responsive parenting, which we believe is a more balanced approach to childrearing. It takes into account the importance of connection and comfort, as well as the structure and limits that are essential for children’s psychological growth. Responsive parenting means that sometimes you will respond with comfort, sometimes with distraction, sometimes with explanation. Often though, it will be holding back from responding that will be the most appropriate action. Holding back can leave enough room for your child to develop a new skill of her own. Making thoughtful decisions about when to respond by comforting a child and when to respond by setting a limit is a critically important part of being a responsive and responsible parent.

We know from our own experience as parents and from the many hundreds of families we have worked with that regulated sleep habits for children makes the whole endeavor of parenting easier and provides an important structure that can carry through all of the school years. Helping a child learn the fine art of sleep is a huge gift to him and his entire family for now and years to come.

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A Letter to all Fathers
June 18, 2009 · Posted in Fatherhood, Infant Development, Marriage, Parenting · Permalink · Comments (8)

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Dear Mothers,

Please show this to all the men in your lives. In it they will find the simple secret of what all children want from their fathers.

Dear Father,

Here is what I need from you.  When I am a baby, take care of me. Bathe me, feed me, and diaper me. We will have fun while you are doing those things. You might not do things perfectly but I really don’t care about that, I just want to be with you and I will hold on to the memory of a masculine caregiver, the early touch of a strong, solid, but gentle man.

When I am a toddler, play, play, and play some more. Rough and tumble me and make me laugh. Let me explore. Encourage me to find my own abilities. Let me try and fall and try again. If I am a boy don’t tell me it’s nothing when I cry, don’t belittle me for needing my mom, or being scared or even being angry when I can’t get my way.  These are my natural emotions and the more I can express them out loud with you the safer I will feel.  This will help me be more sure of my feelings and I will not be ashamed to be vulnerable. If I am a girl look at me with adoring eyes and delight. Encourage my physicality and playfulness and my assertiveness. Scoop me up when I am sad and hold me close and stroke my hair.

When I am a little older, take me to school sometimes. I will feel so proud to show off my dad. Talk to my teachers, get to know my friends. They are important to me even though I am a little kid. Take me out on your own. We don’t always need to have mom with us. Let’s have our own adventures, our own special things we do. Teach me to do all the things you can do, but if I like to do something else better, come and learn about that. I feel important when you are interested in the things I like.

You can go to work and love your job, but don’t stay there when you really could be with me. Don’t talk on the phone or stay on your blackberry when you come home from work.  If you always work or you are always distracted I will come to feel unworthy. Play puzzles with me, build with legos , read to me, watch me swim in the tub.  When I am not listening tell me what is right. Try not to yell. Put me in my room, or take  something away but don’t hold  my wrong doing against me. All kids misbehave. That is what we are supposed to do while we are learning about the world. Don’t push me to the best at everything even though you will want me to be the best that I can be. It makes me feel loved if you accept that sometimes I’m just OK or even not so good at something.

The most important thing, Dad, is that you be brave enough to be honest with yourself. What ever has hurt you in life will become a part of our relationship. Pay attention to that. If you have been neglected don’t neglect me or smother me, if you have been hurt physically, don’t hurt me or be so afraid of your anger that you withdraw. Tell me about your growing up so I can understand you. Let me know your story.
Control your anger, be kind and respectful to my mother and give her love. Listen to her, spend time with her, show me how to treat women or what I deserve from other men. I love to see you two having your own private love affair. Show me how to love and be loved. Give me space and freedom and confidence and teach me respect and kindness, and that all people matter.

Never leave me, ever. I know you can’t imagine that now, but some dads do. More than you think. Never stop rooting for me, having faith in me, believing in my abilities and telling me that you love me and are proud. Care about the details in my life not just the generalities. Put me to sleep, snuggle me, kiss me on my neck and belly, and I will feel like I am the biggest gift in the world to you.

Don’t worry dad, you’re going to be great! Have a Happy Father’s Day!

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Early Psychotherapy Intervention – an Investment in the Future
June 9, 2009 · Posted in Infant Development, Mental Health, Parenting, Therapy · Permalink · Comments (1)

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A recent article in The New York Times features a mother-infant psychotherapy program for low income mothers at high-risk for attachment difficulties with their babies. It highlighted the long-term powerfully beneficial effects of this intervention both psychologically for the mother/baby pair and the financial fall out from waiting to intervene.

It is in this type of program that Jean and I met, oh so may years ago, at Bellevue Hospital.  These intimate and powerful experiences with families fighting poverty, histories of abuse and neglect are the core of our ideas about Soho Parenting.  We’d like to think these serious issues are reserved for the poor, but we all know this in not true. Post-partum depression, alcoholism in the family of origin, sexual, physical abuse and neglect occur in well to do families as well. Education, success at work and financial comfort may seem like a protective immunity–but the deeper issues that get triggered in family life are blind to these accomplishments.  What these resources do give you is the opportunity to privately work on some of these problems early on in life as a parent.

Some of the most rewarding work we do at Soho Parenting is to provide that same kind of infant/parent support in our mother infant groups and in psychotherapy with a mom and baby together in individual sessions. We always tell mothers–you are the CEO and Secretary of Mental Health of your family. If you have a nagging sense that the connection with your baby seems particularly fraught, or you have a history of high conflict divorce, alcoholism or any kind of abuse in your family of origin get support now. The brains of new mothers and babies are so open for new connection and change–it is the perfect time to get a little support–it goes a long way.  And kudos to the practitioners at parents at the Montefiore program. Our future depends on the work we do today.


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Is it “The Case Against Breastfeeding” or a Case Against Dr. Sears?
May 28, 2009 · Posted in Breastfeeding, Feeding, Infant Development, Parenting · Permalink · Comments (6)

izs002157The Case Against Breast Feeding by Hanna Rosin appears in the April issue of The Atlantic. The title is sensationalistic. The content of the article addresses inconsistent findings in medical literature about the superiority of breast feeding, the snobbery of the 21st century perfectionistic supermom, and the possibility that the pressure to nurse is a new form of prison for women.  All  interesting.  In our previous post on breast feeding we addressed some of these same issues. Judith Warner, of the New York Times reacts to this article with admiration and the anticipation of reprisal. While she applauds Rosin’s challenge to present day pressure on women to exclusively breast feeding, she fears the backlash. “I am sure that … the Dr. William Sears-inspired attachment parenting crowd will soon assail her in the blogosphere.”

We are struck that both Rosin and Warner still look to Dr. Sears and his disciples for affirmation.  We were hoping we were about done with Dr. Sears and “attachment parenting”.  I can’t count  the number of mothers who have come to Soho Parenting with Post Sears Traumatic Disorder. Here are the symptoms: debilitating guilt, exhaustion, crying outbursts, marital conflict and a baby who cannot sit or play independently for more than two minutes. Of course, that could describe any new mother, but the followers of Sears have a special brand of this overwhelmed state.  They have drunk the Sears Kool-Aid that 24/7 nursing, holding, “bonding” with your baby is the only way to secure the mother baby attachment. They come for guidance when their babies are 6, 9, 12 months, feeling like complete failures. They just can’t manage what Martha Sears has purportedly done with her 11 children.

The detox program we offer is simple. Feed your baby during the day when she should be eating. Have them sleep from a nice early bedtime until morning.  Honor your babies need for comfort, connection and love as well as for solitude and their capacity to use and develop their own resources.

http://www.theatlantic.com/doc/200904/case-against-breastfeeding/3

http://warner.blogs.nytimes.com/2009/04/02/why-i-dumped-the-pump/#more-291

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