SLEEP CONSULT: CHILD #2

#2

Marc Weissbluth, M.D., © 5/24/11

9 months

Never Learned Self-Soothing

Both Parents Work Outside the Home

Parents wants to Keep Baby Up Late so They Can Put to Sleep

3/22: (9months): Parents: I breastfed her frequently, including breastfeeding her to bed at night, and for naps. I am now still a slave to feeding her to sleep. When we are home on weekends, a nap for her requires me to lay down with her and nurse her until she eventually falls asleep. Bedtime is equally as problematic and complicated. I am the only one who is able to put her to bed as she is still exclusively breastfed and associates sleep with the breast. She has never learned to soothe herself to sleep, so she will frequently wake up within a few minutes of being gingerly placed in her crib and I'll have to go into her room, nurse her back to sleep for a few minutes, and then tip toe out again. This dance often occurs up to 5 times within the first hour of her falling asleep. There are nights when I shuttle back and forth between our bedroom and hers up to 5 or 6 times. Then, usually around 5 am I am so desperate for a few sound hours of uninterrupted sleep (that, and admittedly I like the cuddle time) that I'll bring her into our bed and allow her to nurse as she pleases as we both try to get some fractured shuteye.

4/6-18: Mother: It has become markedly worse in the past few weeks. She has now been waking up nearly every hour, and is ONLY able to fall asleep at the breast. She is unable to soothe herself to sleep. Again, we have to put her in her crib when she's sound asleep. I regret the many tears she's shed, in pain over her extreme fatigue but ultimately unable to do anything about it, having never learned how to properly put herself to sleep. As a full time working mom, I am very sleep deprived! I frequently awake upwards of six to seven times per night, going back and forth between her room and ours, to nurse her back to sleep. I've frequently fallen back asleep in the chair in her nursery, only to awake hours later with a sweaty baby attached to me and an awful kink in my neck. I sleepwalk through most of my days at work and have difficulty concentrating and finding motivation. I return home, excited to see my daughter, but oftentimes unable to summon the necessary energy to properly entertain her. Obviously this is incredibly depressing. As a parent, I am upset that I've failed in teaching my daughter this important skill, although psychologically it is of course easier to fool yourself into thinking you're doing the best for your child by responding to her every cry – even though the intellectual side knows it's really a disservice to her. As a wife, my husband and I have been unable to even go out to dinner and leave her with family or a sitter. Needless to say, after nearly 10 months, my husband and I are desperate for a few hours to ourselves. In the "Sleep Smarts" document, I found sobering – to read in no uncertain terms the ill effects of sleep disorders on all areas of mood and development. Frankly, I'm surprised that we have taken such a laid back stance on sleep, given our dedication to organic, healthful food. Nobody has had success putting her down awake but drowsy. Between 4 and 6 pm she is mostly calm but a little rough around the edges. As long as she is getting her way, and enough attention she is in pretty good spirits. Usually after 6pm is when her "witching hour" begins. At that time, she's in a great mood when we first come home from work but quickly becomes needy and irritable…requiring literal acrobatics to give us a smile or laugh. She is prone to fussiness. Mornings are great for her. However, after an hour to 90 minutes she is fussy again and very needy, ready for her first nap.

4/18; MW: Some babies have difficulty falling asleep unassisted and returning to sleep unassisted. Parents discover that the only way the baby will calm down and sleep a little is when they put forth heroic efforts to soothe their baby by holding, rocking, swinging, feeding, singing, or other calming maneuvers such as massage, lullabies, and so forth. These babies have a proclivity to fuss or cry when they do not receive all of this attention. Some babies (about 20%) have this tendency to be irritable, fussy, or cry for more than three hours per day for more than three days per week for more than three weeks. The fussiness can occur anytime but it tends to be more focused in the late afternoon or evening and it tends to peak at about six weeks of age. These babies are described as having colic but an important point that is not well appreciated is that they may not cry at all if parents/nanny put forth intense efforts to soothe and sleep. About 20% of babies are this way and at 3-4 months they can be described as parent-soothed. They were unable to learn self-soothing. Other children become parent-soothed because of habit or nanny style and never learn self soothing during the first few months of life. Obviously, this is not sustainable forever. Furthermore, because she cycles between light sleep (arousal) and deep sleep throughout the night, she is unable or less able to return to a deep sleep state after a normally occurring arousal from sleep unassisted.

She needs to learn self-soothing so she will have the benefit of uninterrupted (consolidated) sleep, so that Mom and Dad can restore their sleep deficits, and so she can be raised by well rested parents.

I would like to "rip the band aid off" and quickly fix everything. Extinction will work quickly and if you are worried about ignoring your baby's crying, look at the Posts on www.weissbluthmethod.wordpress dated 7/20-22, 7/31, and 8/10/09. If you want a slower approach, graduated extinction, that's all right too. The method check and console won't work well at her age. You will have a new family soon!

4/18: Mother: I don't believe she had colic, but we definitely always have put forth great efforts to keep her happy and calm. At the slightest whimper or protest we'd pick her up and soothe her, never letting her cry in her stroller or in her crib. We've always thought of her as a good, happy baby, but again, this could be in large part due to our soothing efforts and constant attention. For the past few months she wakes frequently, rarely sleeping beyond 3 to 4 hours at a time. Regarding the extinction method, obviously Dad and I are terrified but I do believe this is one of the only ways to fix her sleep issues. I'd probably like to try a more gradual method first.