Sleep Training for 6-12 Months (That Won’t Be As Hard As You Think It Will Be) By Brooks Hagee, MD So your six to twelve month old baby is still not sleeping through the night? This is a common parenting issue that I probably discuss at least once or twice a day with tired parents. And it’s an issue that, as we discovered with our first child, you can fix, and it won’t be as hard to fix as you think it’s going to be. You just have to be dedicated and determined. When our son was six months old I had been back at work for several months. I was getting up to nurse him several times a night and then going to work every day. I call this my “Walking Dead” period of motherhood. Finally, one of my colleagues took me aside (probably because I literally looked like the walking dead) and encouraged me to start working with him to sleep through the night. And since it was either try that or run with the circus I started doing some research. I reviewed several books on sleep training and I but I really liked the approach in “Healthy Sleep Habits, Happy Child,” by Dr. Weissbluth (Amazon, $13.60) so this is what my husband and I used to help sleep train our children. When I talk with parents about sleep and sleep training I first educate them regarding how much sleep babies need. A newborn will typically sleep 15-18 hours a day and a six month old needs about 12-15 hours. Many times a parent will tell me that they kept their baby up later so that they would be more tired and sleep better. No! With babies the opposite is true; the more tired they are the less easily and shorter will they sleep. I ask parents, “Have you ever been so tired you can’t fall asleep?” Because I know I have and with babies this is especially true. The more tired they are, the more difficulty they have falling asleep and staying asleep. In his book, Dr. Weissbluth discusses the importance of early, consistent bedtimes and protecting daytime naps. When I tell parents that their six month old should typically be put down between 6 and 8 pm at night I am frequently met with shocked looks. “But that seems so early!” “I don’t get home from work until then!” But yes, they actually need that early bedtime so they can get that 11-12 hour stretch at night. If they don’t start getting the proper sleep amount you will have an overtired baby. And overtired babies are fussier. One common hindrance to sleep training is when a baby is still sleeping in their parent’s room. I am aware that the AAP is currently advocating “Room Sharing” during infancy. However, a study in the July 2017 issue of Pediatrics found that room-sharing with infants ages four months and nine months was associated with less nighttime sleep, shorter sleep stretches, and unsafe sleep practices. Obviously, more research is needed on this subject but what I have found in my own experience with our two children is that no one sleeps well when parents share a room with babies! When we brought our newborn son home from the hospital he made so much noise with his little baby grunts and squeaks that he only lasted two weeks in the darling family heirloom bassinet next to our bed before we moved him to his own crib in his own room (with us watching via video monitor.) Obviously, some families are limited in their sleep arrangements so a baby has to sleep in the parent’s room. And that is okay, with parenting sometimes we just do the best we can. And it is true that it is easier to nurse a baby when you just have to reach over and get them out of the bassinet. But nursing in bed is not without risks. I have seen serious injuries to babies when they have fallen out of their mother’s arms after she fell asleep nursing. Not to mention the risks of SIDS (Sudden Infant Death Syndrome) associated with this. So back to that day when my colleague encouraged me to start sleep training my six month old. For his middle of the night wakings, we followed Dr. Weissbluth’s “Extinction Method.” The Extinction Method is where you don’t go to them when they are crying. At all. I know, it sounds cruel but we were very tired and willing to try anything at this point. The first night he woke up for his 2:00 am feeding and when I was a no-show he cried for an hour and forty-five minutes! Of course I felt like the worst mother ever. But we watched him from the video monitor and could see that he was fine. The following night he only cried for an hour. And then the following night he cried for 30 minutes. By the end of the week he had completely stopped waking up in the middle of the night. He went to bed between 6:00 and 6:30 pm and woke up between 5:30 and 6:00 am. The best part was that he was happier baby and I felt like a different person. And it wasn’t as hard as we thought it was going to be! What about when they protest when you first put them to bed? For that we followed Dr. Weissbluth’s “Graduated Extinction Method.” This is the where you put them to bed (don’t forget to keep it early and consistent) and you give them five minutes to cry before you go into them. You don’t pick them up, rock them, feed them, etc. You merely pat them and smile and tell them you haven’t fled the country (that last part was my own addition). Then you leave and shut the door if you can. Of course he will immediately start crying again because why in the world did you just leave him alone again? So then you give him ten minutes before you go back in and repeat above procedure. The next block of time before you go back in is 15 minutes and honestly if a baby can cry this long you got to give it to them. But don’t pick them up! At first, our son could cry for the five, ten, and then maybe two 15 minute stretches before he would fall asleep. But soon it became only the five and the ten minute blocks. And before we knew it, we laid him down and gave him a kiss and he would roll over and close his eyes and go to sleep. It was almost magical!
Times have changed, bedtime should not. Sleep is more important now that ever. Coping skills are more effective when a child’s body is rested and their schedule is consistent. A cranky, over active child or teenager suggests a lack of sleep. Keeping the families’ school time routine intact during the current stay at home mandate will make your days less frantic and thereby more productive. The stress emanating from a multitude eof lifestyle changes is best handled by both parent and child after a good night’s sleep. Elementary school age children require 9 to 11 hours of sleep each night. Expect 15 to 30 minutes of restlessness until your child falls asleep. Begin preparing for bed soon after dinner. Cut off electronic games, computer use and TV one hour prior to bedtime. Minimize exercise, outdoor play and/or dance in the evenings as they trigger an adrenaline surge which interrupts falling asleep. Stop caffeine drinks at least five hours before bedtime. Once in bed, allow one excuse to leave the bed whether to give a parent a kiss, run to the bathroom or get a drink. Afterwards, do not respond to pleas to get out of bed. Parents cannot make a child go to sleep but you can make them stay in bed. Calming activities like reading or use of a meditation APP for soothing sounds or music can set the mood for restful sleep. Time for bed should stay the same even while homeschooling. Children will have less trouble going to sleep and waking in the morning if the bedtime routine stays the same. Adolescents need the same limits on electronics, exercise and caffeine as younger children in order to maintain good sleep patterns. By their teenage years, sleep needs decrease slightly to 9 hours. Of course, teens have more control over bedtime. It may take 20 to 30 minutes for teens to fall asleep. Their sleep-wake cycle is altered during puberty. Teens will stay up late and sleep later resulting in grumpy, moody students with poor attention and memory. Encourage your teen to make it a routine to go to bed around the same time and rise at the same time. They will still sleep until noon on the weekend. That may never change. Sleep is integral to keeping your body healthy. It’s one line of defense that you as a parent can build for your child. Bedtime is fundamental to insuring sound sleep.
Recommended hours of sleep by age:
Newborns (0-3 months): 14-17 hours
Infants (4-11 months): 12-15 hours
Toddlers (1-2 years): 11-14 hours
Preschoolers (3-5 years): 10-13 hours
School-aged Children (6-13 years): 9-11 hours
Teenagers (14-17 years): 8-10 hours The AAP recommends that all babies are placed on their back to go to sleep to prevent SIDS.
Teaching Children Life Lessons is a CHORE Newborns enter the world without clothes, without judgement, without self-control and without a care in the world. It is not in their best interest to forgo maturation and never develop the skills needed to traverse life successfully. Parenting with intention is critical to producing productive, civic minded, well- educated young adults. Teaching and modeling responsibility, delayed gratification, impulse control and life skills is not for the faint of heart. It is taxing to demand and monitor chores for children. Do not be tempted to think your child is too young or too busy to complete chores. Resist the urge to allow your child to skip out on chores. Research by Marty Rossman confirms that involving children in household tasks at an early age can have a positive impact later in life. According to Mr. Rossman, “the best predictor of young adults’ success in their mid-20’s was that they participated in household tasks when they were three or four.” When children contribute to the family, they or more likely to feel more capable, more responsible and better prepared to function independently in the world. The new term, “Adulting” speaks to the ability to competently take on adult responsibility. That ability begins with participating in household chores throughout childhood. Chores should be done regularly, and done well with limited prompting. Over time, a well-trained child will be able to initiate and complete assigned tasks without nagging and cajoling. Children are responsible for completing the work. Parents should communicate what consequences will occur if the work is not done or not done to predetermined specifications. Assign chores based on the best fit for your child’s age and add some that are meaningful to the running of the house. Include chores that encompass life skills that a child should be proficient in before leaving home. Allow your child to join in the discussion when revising or adding chores to encourage buy-in and decrease resistance. Household tasks must be completed regardless of school work load, sports obligations or other extracurricular activities. There is no “Get of jail free card!” for completing assigned duties. Parents must send the message that the house runs smoothly when everyone completes their job without excuse. Children will also learn that caring for the home is as important as school and athletic skills. Chores represent lessons that will serve your child well later in life. Check out the links below for age-appropriate chores and chart.
"5 Myths About Vaccines” I am a firm believer in the ideal of individual freedoms. Freedom of speech, press, and religion are the cornerstones of what it means to be an American. Yet, as with any freedom, it is implicit those freedoms be exercised with responsibility. I also respect individual’s rights to question the status quo, especially in the scientific community. Nevertheless, questioning should entertain at least a shred of valid substantive evidence, responsibility in research, or logical thought. So, please view the following comments in that light. Over the last twenty years I have watched the anti-vaccine groups grow in intensity and purpose. I have watched conspiracy theory videos, read multiple antivaccine articles, viewed seemingly endless links to self-proclaimed vaccine experts, and have listened to hundreds of frightened parents quote a litany of erroneous data from research that has never actually been done or poorly done. I originally thought that these groups would tire of spreading their fear inspiring doctrine, yet they seem to be capturing more and more media and social media time with their horrifying stories of conspiracy and fear. As a result, more and more people are either not vaccinating their children or trying “alternative” schedules, leaving their children at a higher risk of serious disease. Truly the vaccination rates all over the country are decreasing. All of this, out of a fear that vaccines will cause autism, overwhelm their immune system, or cause them to become infertile are among the few myths about our vaccines that prove to scare the uniformed. Vaccinations have been perceived as “unnatural” yet they are actually the most “natural” forms of prevention of illness. In vaccinating, small amounts of proteins from the would-be offending agent along with an immune stimulator are injected into the muscle. This triggers the immune system to produce antibodies which protect against the actual bacteria or viruses that would cause inexplicable harm if caught from the environment. The alternative is injecting large quantities of antibiotics and antivirals (chemicals) into the bloodstream to hopefully thwart the illness and save a life after the disease has taken its toll. So, I will cover a few myths about vaccines: Myth #1: Vaccines cause autism. While the exact cause of Autism is unknown, vast amounts of scientific research and data tells us that there is a strong genetic predisposition that causes the disorder. While there may be some suggestion that factors in the environment may contribute to the unmasking of the disorder, there is no one cause identified. What we do know with absolute certainty is that vaccinations DO NOT cause autism. Multiple well-done studies in past and recent years from around the world, involving over 750,000 children have proven this. Actually, a recent study of over 600,000 children in Denmark, showed that the children who received vaccinations had a reduced incidence of autism. Myth #2: Vaccines contain Thimerosal and other harmful chemicals. Actually, all vaccines with the exception of certain influenza vaccinations, have not contained thimerosal in the United States for over 10 years. Thimerosal is an ethyl mercury preservative that keeps multi dose vials sterile and over 95% of thimerosal is eliminated from the body within hours of injection. Thimerosal has never been implicated in any adverse medical conditions. It was discontinued largely due to public fear and misconception. Thimerosal was the chemical that people ignorantly blamed the MMR vaccine for causing autism. Factually, the MMR vaccine hasnever contained thimerosal. Other chemicals that may be found in vaccines are from the manufacturing process and are in quantities less than if one poured a teaspoon of salt in a swimming pool (parts per billion). Chemicals that may be found in vaccines are in far less concentrations than can be found in many foods like fish (mercury and lead), rice (arsenic), and apple juice (cyanide). Myth#3:Vaccines overwhelm the immune system. Antigens are proteins that the immune system recognize and process for protection through antibody production. Vaccines take advantage of these antigens and couple them with other proteins to make them more effective. Furthermore, in recent years, our technology has made these processes more effective. As a result, we need fewer antigens in order to accomplish the same result. It has been postulated there are more antigens in the old small pox vaccine than the entire first year vaccines. Nevertheless, our immune system is designed to recognize and destroy would be offenders. On a daily basis our immune system battles against countless invaders with their antigen proteins fulfilling its purpose. No study has ever shown that that small numbers of antigens that are introduced into the body have ever depressed or overwhelmed the immune system. Myth#4: Aborted fetuses are used in the manufacturing of vaccinations. The fact is in the early 1960’s the WI-38 fibroblast cell line was isolated from the lung tissue of 2 therapeutically aborted fetuses and have been used to safely create vaccines against measles, mumps, rubella, varicella, polio, and hepatitis A. Unfortunately, in the 1960’s the use of fetal tissue was relatively unregulated, and the WI-38 cell line was used for scientific research. However, it has since been largely the only cell line used in vaccine development. On the other hand, there are only a handful of vaccines that are currently produced from an over 40-year-old cell line. While many of us may disagree with the ethics of abortion, we cannot argue with the overwhelming numbers of lives that have been saved. “Billions of people are alive today who would otherwise have either died in childhood or who would have been crippled or disabled by vaccine preventable diseases. The World Health Organization estimates that all immunizations now available avert about 2.5 million deaths among children every year, but many more lives could still be saved if vaccines were universally available. In fact, it is ironic that the rubella vaccine (which is produced in theWI-38 cell strain that originated from an aborted human fetus) is vigorously opposed by anti-choice advocates, even though this vaccine prevented over 633,000 miscarriages in the U.S. alone, and countless more across the globe, and it has prevented tens of millions of clinical health issues in children (e.g., encephalitis, autism, deafness, diabetes, etc.) linked to congenital rubella syndrome.” Since the introduction of the rubella vaccine alone <10 cases per year of rubella have been reported and in 2015 rubella has been nearly eliminated in the United States. No other aborted fetuses have been used in the current production of vaccines. Myth#5: My child is protected because others are vaccinated…these diseases are not around any longer. The fact is that the only vaccine preventable disease that is completely been eliminated worldwide is Smallpox. Completely eliminated due to a worldwide vaccination program. It was responsible for millions of deaths for centuries…eliminated by vaccination. While many other of the major vaccine preventable diseases are virtually eliminated in the United States, they are not worldwide. We saw just how vulnerable we still are with recent outbreaks of measles in California and New York among unvaccinated populations exposed to travelers from Europe. Nearly 1500 cases of measles were reported in New York, and 21cases were reported in Texas this last year. Furthermore, Diseases like pertussis responsible for severe respiratory illness are on the rise again primarily due to the decreased vaccination rates in vulnerable ages. Ultimately, we are not out of the woods yet in protecting our children. Finally, it is irresponsible to put the health of your child in the hands of someone else. Honestly, nothing in this life is without risk. Drinking water, walking across the street, and driving a car all carry significant risks. It is up to the parent to make sound decisions about the care of their own children based on facts and a good relationship with their own doctor. Yet the facts are that vaccines have been studied time and time again with hundreds of thousands of children and have proven to be safe, effective, and protective against a host of horrible and devastating illnesses. Think about it…the chances of dying in a car accident is 1 in 520 while the chances of death from a severe vaccine side effect is less than 1 in 1 million. References: AIMS Public Health, 4 (2): 127-138, CDC website. 5 Myths about Vaccines, By Ike Pauli Jr. M.D.