For most of us, becoming a parent is nothing we imagined it to be. I often meet with first time parents who come to my office with questions on how to prepare for their first child. It’s a privilege to be involved in their excitement and anticipation. They always seem nervous but eager with expectations of this new journey.
However, the reality of parenting is clearly lost and the inexperience apparent when I field questions such as “Do I need to set an alarm at night for feedings?” or “Do you think this will change our vacation we planned a couple of weeks after the delivery?”. It’s like watching someone confidently opening an umbrella as a hurricane approaches in the distance. If only there was an instruction manual. Many have tried to make one, and if you browse the listings of parenting books you can have as many differing opinions as you can stomach. All children are individuals however, and to most experienced parents this is painfully obvious from the first few weeks of life. What works for one child will fail miserably for another. They may all require some different strategies and approaches. Despite this, I do feel there are some fairly universal tips that I can give to the new parent as they deal with their first child’s opening salvo. And perhaps the experienced parent can pick up on some tips as well.
The newborn infant is a simple creature. They will sleep anywhere from 16 to 21 hours a day, most of the time they barely move at all. When they are awake they are usually either eating or going to the bathroom. As I tell most parents, if you can get these 3 things taken care of you have it made: 1. Eating 2. Sleeping 3. Pooping. Sounds simple enough. Almost diabolical in how simple it sounds. Because it isn’t easy for many. Let’s focus on the sleeping for now.
People will often tell me that their baby has “their nighttime and daytime mixed up”. I’ve never been able to ask a baby if this is true. But they do sleep a lot as I’ve already pointed out and at first there seems little rhyme or reason as to when they choose to do so. The first order of business for a new baby is to establish a proper circadian rhythm with the correct environmental cues. You have until week 3 or 4 of life to establish this or the baby will establish them for you. This may not be conducive to you getting enough sleep and being a functional human being. So, when I suggest good environmental cues, this means that the baby needs to know when it is daytime and when it is not. When you are awake at night for feedings (Yes, this will be often) it is important that it is a calm and quiet environment. Do not turn on music, television or any other portable device. The lights should be dim. This is a time to feed and simply rock back to sleep. Conversely, during the day the infant should have daylight present when they nap or feed. You may have a shade drawn, but it should be obvious that it is day. There should be a reasonable amount of noise and external stimuli present. Too often I see parents who create a dungeon for their child to sleep in, with tin foil on the windows and sound proofing. They disconnect their doorbells and shun anyone from their house during the day and if you are allowed into the home you will likely be shushed into silence. This isn’t necessary and is in fact counterproductive. If a baby awakes in the exact same environment whether it’s 1 pm or 1 am, how would they know the difference? Try this on yourself and sleep in a windowless room. It’s incredibly disorienting. Yes, the naps may not be as long during the day if there is some sunlight in the room, but they will sleep more consistently at night and for the proper amount. Avoid the temptation to put your baby down to sleep all day in order to get other chores done. You will pay for this with poor night time sleep.
Feeding at night causes a lot of consternation amongst parents. You may be one of the lucky parents who has a child that sleeps well but now you worry about them not having enough to eat. Then you must suffer those pediatric visits where they weigh your new child and the pediatrician looks at you in disgust. We’re known for our harsh treatment. As a general rule of thumb, a new baby must eat at least every 3 hours until they are back to birth weight. After this magical moment then they can stretch to longer periods of 5 to 6 hours (again, if you’re a lucky one). Most infants will fall into a habit of 1 to 2 feeds at night after a couple of months.
Now, the moment inevitably will come when you ask yourself if you will forever sleep with expectations of getting up 1 or more times a night. That is up to you in a way. It is alright to start thinking about sleep training between 4 and 6 months of age, the earlier age for those born at full term and no weight issues prior. This is, I find, a personal decision that must be made between caregivers. Everyone must be on board and agree to a course of action. No “weak links in the chain” as I always say. This is because consistency is key. This should be your moto throughout parenthood in my opinion, consistency. Any of the methods used will work if consistency is applied to the method and you don’t have a Judas Iscariot who undermines the plan without you knowing. The most common methods are: 1. Extinction method or “cry it out”. This involves giving a loving hug and kiss to your child and then closing the door at the same time every night. You do not comfort the baby no matter how much they protest. They will learn to self soothe and go to sleep. This tends to be the quickest method. Some find this too difficult to endure. 2. Gradual Extinction. This method implies that you leave you baby for longer and longer stretches. They need to go down at certain time every night. In this situation you return to the room after 3 minutes of crying without picking up the baby and gently pat the child and soothe and reassure. Then leave and don’t return until 5 minutes, repeat soothing again. You do this for longer and longer increments. Parents tend to tolerate this more, but it is difficult to do consistently and can take longer. In either situation, when applied consistently it should take no longer than 5-6 days, in some cases 1-2 weeks. If you have that turn-coat in your home you may need them to wear ear plugs, go in another room, or leave all together for a few days.
Remember that you don’t want to sacrifice long term gains for short term solutions. Those parents who start out with good sleep habits for their baby will have a child that is more well rested and they themselves will be more well rested. And a well-rested parent is ultimately a much better, more tolerant and patient parent.
By Dr. Adam Wahlstrom
Dr. Adam Wahlstrom began his post high school education at Brigham Young University where he received a Bachelors of Arts Degree in Humanities and Art History. He served a two year full time Mission for his church in the Phillipines. He then went on to Medial School at Arizona College of Medicine in Phoenix Arizona. After completing his degree in Arizona he went on to complete a Pediatric Residency with Oklahoma State University at the Children’s Hospital in Tulsa, Oklahoma. There he focused on Pediatric Nutrition and completed research on current Pediatric Obesity Guidelines as well as being actively involved in OSU’s nutrition clinic. He is the father of four children and he is currently practicing medicine as a board certified pediatrician in St. George Utah.