Sleep Tools-Transitioning Tips

The Baby Sleep Book : The Complete Guide to a Good Night's Rest for the Whole Family
by William Sears, M. D., Martha Sears, R. N., Robert W. Sears, M.D.

(Page 3 of 3)

In sleep psychology, this is known as "fading" (like what happens when you are listening to a dull lecture). You can't expect a baby to go from his exciting waking life right into sleep. (You don't fall asleep this way, do you?) There has to be a transition time. Here are some favorites that have worked in our families:

Fathering down. "Nursing" implies comforting, not only breastfeeding. Fathers can and should "nurse" their babies down to sleep. Place baby in the neck nestle position and "dance" or rock your baby to sleep.

One day after we explained the concept of sleep associations to a tired mother, she replied, "My baby has only one sleep association—ME!" If this sounds like you, read—with your husband—chapter 8, Twenty-three Nighttime Fathering Tips.

Nestling down. Transferring the sleeping baby from your arms to his bed can prove to be tricky. An abrupt change from being nestled next to a parent's body to lying alone on a mattress will awaken some babies. To ease your baby through this transition, try the intermediate step of lying down on your bed with your sleeping baby still in your arms. We call this the "teddy bear snuggle." Once he's sound asleep, you can ease yourself away or move him to wherever he sleeps.

Feet down. When transitioning your sleeping baby from your arms to his bed or crib, set him down so his feet touch the bed first, then his body, then his head. If baby is tipped head down first, he may startle and wake up.

Sucking down. Sucking is soothing, yet the human pacifier can wear out. Besides the breast or bottle, try your finger or teach baby to find his own hand to suck on.

Patting down. After you ease baby onto her bed, pat her chest or tummy gently and rhythmically, around sixty pats per minute (like your heartbeat). Gradually lighten and slow the patting as she succumbs to sleep. Add some verbal sleep cues.

As she was just about to sleep, I'd run my fingers across her face, over her eyes, and down her nose so that her eyes would close.

Touching down. Oh, how babies love to be touched as they fall asleep. Here are some ideas for soothing, loving touches:

• Patting. Pat baby's back or bottom gently and rhythmically while she is being held in your arms. Gentle patting on her tummy can also be used to soothe a baby who is lying in bed, especially when picking her up might be too stimulating.

• Massage. Light stroking of baby's head and back is a favorite. A gentle full-body massage before bed may also help baby relax into bedtime mode.

• Skin-to-skin. Young babies especially love the familiar feel of your skin on theirs.

• Transitional touch. If baby starts to stir as you try to slip her out of your arms or ease away from her in bed, offer the laying on of hands. Place your hand on baby's chest or tummy and leave it there until she drifts back to sleep. This extra touch is especially important in babies who have a hard time transitioning from your arms into the bassinet or crib. They need this transitional touch to stay fully asleep. It can save you a trip back to the rocking chair to soothe an awakened baby back to sleep.

Swinging down. Try a baby hammock. For most babies, motion, not stillness, signals sleep. Remember how your baby used to sleep during the day when you were pregnant but kept you awake at night when you lay down to sleep. When you were up and around, the motion of your body soothed her into sleep. When you were still, she woke up.

Wind-up swings for winding down babies are a boon to parents when their arms are wearing out. Some infants find the mechanical swing less interesting, if not downright boring, compared with being in the arms of a human being, and off to sleep they go. Yet some babies are notoriously resistant to mechanical mother substitutes and will protest anything less than the real mom. Before you actually spend money on a swing, you might want to borrow one for a week or two to see if the spell of the swing will work for your baby. You may discover that you are uncomfortable with mechanical mothering and decide that your baby is better off in your arms.

Driving down. If you've tried all of the above transitioning techniques and baby still resists falling asleep, place baby in a car seat and drive around until he falls asleep. When you return home and baby is in a deep sleep, carry the sleeping baby (car seat and all) into your bedroom and let baby remain in the car seat until the first night waking. If he is in a deep sleep, you may be able to ease him out of the car seat into his own bed.

Using props. Called transitional objects or "lovees," these are favorite toys that help children more easily transition from the familiar and interesting waking world to the world of sleep. Transitional objects should be cuddly but safe. Rolling over on plastic toys may awaken baby.

The scent of mother. Leaving in the crib a breast pad or T-shirt that mother wore all day may help baby transition from the whole mother at night.

Sounds to sleep by. A parent softly singing a lullaby is the classic sound cue for babies to go to sleep. Quiet instrumental music is another traditional favorite. Here are some creative ways you can use sound to soothe your baby to sleep:

• Mom's musical voice. The soft sounds of mom's voice, either in song or in quiet words will mesmerize baby. That's why they're called lullabies.

• Dad's deep tones. Some babies really take to dad's full, rumbly tones. Besides hearing his voice, they can feel the vibrations from the voice box when held on dad's chest.

• Rhythmic music. Music with simple repeating words and rhythms is soothing to babies. Nursery rhymes and lullabies are the classic examples. Even quiet pop music with a steady beat can get baby into the rhythm of sleep. Peaceful classical music is another favorite. Complex classical music or turbulent-sounding rap or rock, on the other hand, can be overstimulating.

• A medley of tunes. Put together a medley of easy-listening lullabies on a CD or tape and set the player for continuous play. You won't have to worry about running out of music and breaking the sleepy mood. Then tape a medley of you singing baby's favorite lullabies. Your familiar voice may help baby settle when she is being put down to sleep by someone else.

• A musical mobile. For babies in a cradle or crib, turn on a musical mobile to help baby associate the gentle movement and the sound with going to sleep. If the mobile helps to get him to sleep, restart it when he wakes to get him back to sleep.

I saved one song, our sleep song, for when it was time to go to sleep. She learned to associate that song with falling asleep.

For some suggestions from the Sears family library of music, see Appendix A.

White noise. These are monotonous sounds that block out other noises and bore a baby to sleep. Besides the continuous monotone humming or "shhhh" of a parent, here are some white-noise sounds that work:

• the hum of a fan or air conditioner

• tape recording of the vacuum cleaner or running water from a faucet or shower

• a bubbling fish tank

• a loudly ticking clock or a metronome set at sixty beats a minute (which can also be tape-recorded)

• recordings of waterfalls or ocean sounds

I wore my baby in a sling while vacuuming. The sounds lulled him to sleep and I got some cleaning done.

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Our son loves to nurse to sleep and sometimes will prolong the nursing as much as thirty to forty minutes. My husband realized one evening that our son had fallen asleep after only ten minutes while nursing and listening to a quiet mommy and daddy conversation. I decided to tape our conversation one evening. Now, when I want our son to go to sleep a little faster and my husband isn't around to talk to, I just play our mommy-and-daddy tape.

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If baby is restless and won't nurse off to sleep, my husband turns on the dishwasher for white noise and then walks baby for a time.

Motion for sleep. What baby doesn't like motion? This is why babies fall asleep in swings, rockers, cars, and while being held and walked. Here are suggestions for slings, swings, and other things you can use to lull baby to sleep:

• Rocking. Mom's or dad's arms and the steady motion of a rocking chair have been putting babies to sleep for ages.

• Cradle. Gently rock baby's cradle to lull baby to sleep or back to sleep.

• Baby swing. Many babies will drift off to sleep in a baby swing at nap time or bedtime.

• Baby slings. Wearing baby in a sling or other infant carrier while you move about simulates the womb environment and will soothe baby to sleep (see pages 19 and 20).

• Dancing. You can combine all kinds of sensory input in a dance that will envelop baby in a soothing environment. This works great for fussy babies and those who fight sleep. Snuggle baby in your arms, either in the cradle hold, up on your shoulder, or draped tummy down over your forearm. Move around gently in all directions—up, down, and back and forth—and pat baby's bottom as you hum, sing, or make other gentle sounds. All this gentle stimulation blocks out the anxious, fretful feelings coming from inside of baby and really takes baby back to the womb.

A box full of tricks. While most babies need a predictable routine to get to sleep, some enjoy novelty. And even your best transitioning tricks may not work when baby enters a new stage of development. You'll need a box full of sleep strategies to see you through the first year or two of your baby's life. Keep trying new things.

Consider winding-down routines as an opportunity to spend quality time with your child. Enjoy this peaceful time together. Don't look at your watch. Don't think about everything else you have to do. If you relax, your baby will pick up on your attitude and probably go to sleep more easily.

Figuring Out What Works for Your Baby

During the first week or two of your sleep plan, you will be trying to determine which sleep associations and tools work for your baby.

For newborns and younger babies, you will be learning one or two routines that you can depend on to get your baby off to sleep. This will likely involve some combination of feeding, rocking, or walking.

For older infants who already have a strong primary sleep association, you may be ready to make a change because it is no longer working for you. You will be trying to establish one or two new sleep associations so your baby can learn to fall asleep in other ways. Your baby will probably protest or fight this change and want you to go back to his preferred routine. Use various sleep tool ideas from the list on page 16 along with whatever new primary sleep associations you are trying to establish. Be sure to try new ideas you have never considered before—you may be pleasantly surprised at what works for your baby.

Write down your observations to help you remember what has worked:

Now that you have figured out a variety of ways to happily parent your baby to sleep, let's learn ways of helping baby enjoy sleeping longer.

Step 5. Help Baby Sleep for Longer Stretches

Babies—and parents—enjoy a more restful night if their sleep is not cut short. As you will learn in chapter 3, babies are wired to wake up during the night, and they usually need a parent's help to settle back into sleep. As babies mature, so do their sleep patterns, so that they are able to sleep for longer stretches and resettle themselves. When this blissful time happens varies greatly from baby to baby. While you can't force your baby to sleep through the night, you can provide conditions that will help your child attain sleep maturity to sleep for longer stretches.

Why do babies wake up so much? Answer: They're babies! In chapter 3 and chapter 12, we discuss the many developmental, medical, and physical reasons babies wake up. Keeping in mind that breastfeeding babies under one year typically need to nurse twice a night, and those over a year at least once, here are some ideas for lengthening the stretch of time between feeds.

Change where baby sleeps. In step 1 you chose where you wanted baby to sleep. Hopefully it is working for both of you. However, the bed that baby starts the night in may not necessarily be the same bed she wakes up in each morning. Consider this: Is your baby waking during the night because she is alone in another room and wants to be closer to you? If you think this may be the case, try moving baby closer to you at the first night waking. Or is baby already in your bed and waking up because you are right there? If so, try moving baby farther away from you when you come to bed or at the first night waking.

"Coach" baby to sleep. Repeating cue words, sounds that baby associates with going to sleep, will often help baby get back to sleep. Offer these cues as the last sound baby hears before drifting off to sleep and use these same words again when she awakens in the middle of the night (e.g., "night-night," "sleepy-sleepy," "happy nappy," or "shhhh"). Using the sleep-associations principle, baby learns to associate these sounds with both going to sleep and going back to sleep. The time-tested sound shhhh, which mothers naturally do, has a biological basis. It is similar to the sound of uterine blood flow that baby was used to while in the womb.

When he made his first peep, we quickly issued reminders, such as "Shhhh . . . sleepy-sleepy." We let him know that it wasn't time to get up yet.

Lay on hands. When baby stirs, gently lay your hands on her without picking her up. Stay with her and continue laying on a comforting hand as you say or sing your favorite sleep cues, such as "night-night" or "sleepy-sleepy." Stay with it until she settles. If she starts to wake up again right away, you can give it another try. Again lay your hands on her and give her your "sleepy-sleepy" sleep cue. If she just can't fall asleep, pick her up and walk around the bedroom for a while, holding her in a sleep-inducing position such as the neck nestle. By this time you will know whether you can get her to stretch out her sleep more or whether it's simply time to feed her.

Leave a little bit of mother behind. To help baby stay asleep when you are not there, have something nearby that smells like you. This might be a breast pad that has the odor of your milk or an item of your clothing. Your bed will naturally have your scent. You can also sleep with baby's crib or cradle sheets for a night (use them for a pillowcase) and then place them on baby's mattress. Your scent should last for a few days.

I nurse and wear my baby a lot during the day. He actually sleeps better if I take off the shirt that I have worn all day and cover him with it before I put the blanket on him at night.

Offer a thumb or a pacifier. "Pacifier" literally means peacemaker. Giving baby something to suck on will often bring peace to both baby and parents. You can actually help your baby learn to suck his hand or thumb. These are "handier" than pacifiers. They are warm, soft, and easily available. They don't fall on the floor, they are just the right size for baby's mouth, and they don't obstruct the nose or need to be clipped on with a cord. Babies feel more in control of their hands.

As you're putting baby down to sleep, ease her thumb or hand into her mouth, and do this again each time she wakes up. This way she learns to associate sucking with going to sleep—and back to sleep. If baby continues to suck but wakes up anyway, she's probably hungry and needs you, not just a milkless thumb. During checkups, when I need tiny babies to be quiet so that I can listen to their hearts, I sometimes coax their thumbs into their mouths. Sometimes I notice mothers raise their eyebrows as if they didn't realize they could do this. Babies in the womb suck their thumbs. In the early months, babies who can't quite find their thumbs will suck on their wrists or even forearms. They are born with their own natural pacifier. Take advantage of it. And don't overuse artificial pacifiers. If, when baby cries, you find yourself by reflex reaching for the binky instead of the baby, remember our advice: "Use it, don't abuse it, and quickly try to lose it."

Some parents worry that teaching baby to suck his thumb will lead to a long-term habit that will be hard to break (you can't just throw the thumb away like you can the pacifier). While this can happen, if it gets you a better night's sleep for now, it's probably worth it.

Try both the quick and the delayed response. Should you come running as soon as you hear your baby awaken in the night? Or should you hold off to see if baby goes back to sleep? Some parents find it easier if they get to baby quickly and help baby back to sleep before the cries escalate and baby gets revved up. If you wait too long, it can be much harder for both mother and baby to get back to sleep. With co-sleeping babies, a half-awake mother can simply roll over and nurse her half-awake baby, and the nursing pair can drift back to sleep without either one getting worked up.

Sometimes in the middle of the night I quickly offer her a breast or a "soothie" pacifier and she doesn't fully wake up.

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The trick is to never let him fully wake up and to never let him cry. If he cries, he's wide awake.

Other parents find that if they let their baby squirm and fuss a bit, baby is able to resettle without intervention. This is a waking-by-waking call. It helps to remember that not all noises that sleeping babies make are cries for help. If you think your baby can settle himself back to sleep, delay rushing in and picking him up. Give him a chance to work things out on his own. He will let you know if he needs help.

Keep it simple and quick. No middle-of-the-night entertainment, please. You're there as a comforter, not a playmate. Nighttime is for sleeping, not for playing. If baby needs your help to resettle, try to do it quickly, calmly, and comfortably. Even though you're tired—and perhaps frustrated—try using what we dub the "Caribbean approach"—"no problem, baby." If baby senses your anxiety and irritation, she is less likely to resettle. Try to resettle baby with a simple song or patting with your hands. If you need to pick up baby for a bit of swaying or rocking, don't make the routine too interesting. Your goal is to lull her back to sleep.

Someday your child will find the promised land of sleeping through the night. Babies do eventually wean! This high-maintenance stage of nighttime parenting will pass. Again, the time in your arms, at your breast, and in your bed is a relatively short while in the life of a child, yet the memories of love and availability will last forever.

Keep a Sleep Log

While most mothers would rather spend their free time resting than filling in charts, sleep logs can help in many ways. Charts give you a visual picture of your child's individual twenty-four-hour sleep patterns. You may be surprised to discover that he sleeps more than you thought. A sleep log can help you spot problem times and track progress to see if your sleep strategies are working. When discussing your sleep concerns with your pediatrician, show your doctor the sleep log and point out the problem areas that you've identified. In this way, you and your doctor can see at a glance your baby's sleep patterns and where certain sleep strategies may be applied. Photocopy the sample sleep log on the next page. As you try all the sleep-inducing strategies described in chapters 1 and 2, fill in the sleep log and chart your baby's progress.

Copyright © 2005 by William Sears, Martha Sears, Robert Sears, and James Sears

About the Author

William Sears, M.D., received his pediatric training at Harvard Medical School's Children's Hospital and Toronto's Hospital for Sick Children. He has practiced as a pediatrician for more than thirty years.

Martha Sears is a registered nurse, childbirth educator, and breastfeeding consultant.

Robert Sears, M.D., earned his medical degree at Georgetown University School of Medicine. Having had the privilege to help raise three active boys, "Dr. Bob", as he likes to be called by his little patients, has grown fond of the "parenting" side of pediatrics. He has appeared on the Dr. Phil show to offer advice on child behavior and parenting issues. He has also appeared on the Ellen DeGeneris show and has appeared on CNN's House Call with Dr. Sanjay Gupta to offer advice to first time fathers. Dr. Bob is a regular guest on "A Place of Our Own" on PBS, helping parents and caregivers understand a variety of child health issues.