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Posted by on in News
SleepTraining-325As a pediatrician, one of the most frequently asked questions I hear is, "How can I get my baby to sleep through the night?" Let me give you my best advice by first sharing my own experiences as a mother.

My oldest child, Jack, was a truly terrible sleeper. Awful. For months, he woke every hour or two to nurse. Finally, when he was four months old, and when I'd reached the end of my sleep-deprived rope, I made a deal with my husband, Paul, to let Jack cry it out.

The first night, our son cried for six hours (while I also cried the entire time). The next night was worse. By the third night of endless screaming, I had a Momma Bear moment, threw up the white flag and headed for the nursery to comfort my hysterical baby, but my husband convinced me to wait it out. Finally, Jack stopped crying. When I peeked in on him, he was blissfully asleep. Jack never cried himself to sleep again. Seventeen years later, he can still sleep through anything without waking up.

Our second baby, Liesl, was another terrible sleeper. But the process of sleep-training Jack was so painful for me, I couldn't bear to sleep-train my daughter. So, we let her call the shots, taking her own sweet time feeding and keeping us awake until she ultimately decided to sleep for longer stretches—which took years. She is now 15 and still a terrible sleeper. I often wonder if she would have been a better sleeper if only we had tried sleep-training her like we did Jack. Life as a parent is full of second-guessing.

So, what is my advice for sleep deprived parents? I believe that, developmentally, babies younger than 4 months old should be attended to when they cry for more than a few minutes, in order to feed and reassure them. Once a baby passes the 4-month mark, they are medically able to go 10 or more hours without feeding. This is an appropriate age to do some form of sleep-training IF parents wish to do so.

When you sleep-train, my overarching principle is to remove as many rewards for your baby waking up as your parental heart can tolerate. In other words, think about what you do that encourages a baby to wake up. Common examples include:

  • Going to your baby's side
  • Picking her up
  • Feeding her
  • Rocking her back to sleep
  • Bringing her back to your bed

Decide which of those rewards you can remove. What we did with my son, Jack, what I call "Dr. B's Sleep Boot Camp," was to take all of those away at once. It's the fastest, but hardest way to sleep-train. More moderate approaches are to remove some of the rewards in a more gradual fashion, determined by what the parents can tolerate emotionally.

There have been a large number of books written on the subject of getting your baby to sleep. That proves:

  1. Sleep problems are common in babies.
  2. There is no one right answer.
  3. Nobody is really THE expert.

Take my advice, think about it and make it work for you. And talk with us at Eugene Pediatric Associates if you need help managing your baby's sleep patterns.
Tagged in: Parenting Sleep

Posted by on in News

140701 EPABlogImageThrive1A traditional pediatric practice helps lots of kids, but I am convinced it barely scratches the surface of what many children need. The physical health of a child is only a portion of wellness. The other key aspect is mental and behavioral/developmental health.

Eugene-Springfield has many wonderful mental and behavioral health caregivers and agencies for kids, but coordinating care with pediatricians is always a challenge. After nearly 15 years in practice here, I became frustrated with the limitations in my traditional practice to meet the needs of the children we serve.

So, one sunny autumn afternoon last year, I asked my favorite child psychologist, Dr. Jenny Mauro, to have coffee and talk about the exciting possibilities of pediatricians working side by side with child psychologists, developmental pediatricians and child psychiatrists.

If that happened, I could step out of my exam room and grab a specialist in child mental health and development to get a “curbside consult.” My families could meet a behavioral health care provider for a momentary “hello” and know whom they would meet during an upcoming visit. And scheduling the behavioral health visit at the same location would be a breeze.

Coordination of care would be so easy and even fun. Brown bag lunches with my doctors sitting around the same table with psychologists and other behavioral specialists would make it easy to discuss children in need of our team approach.

...

The AAP recently published a policy statement that significantly strengthens its recommendations for a safe infant sleeping environment.  Among its recommendations:

  • •  Always place your baby on her back on a firm sleep surface, particularly a crib or playpen that conforms to current safety standards.  Adult’s mattresses, couches, and recliners are not recommended.
  • •  SIDS may be decreased by as much as 50% by having infants sleep in the same room as their parents, but NOT in the same bed with parents.  The AAP policy states that infants may be brought into bed for feeding but should be returned to their bassinet or crib as soon as feeding is done.  This arrangement markedly decreases the chance that baby will be accidentally harmed during sleep.  Particularly risky for cosleeping are infants whose parents are smokers, excessively tired, or medicated with alcohol, street drugs, or prescription drugs that cause fatigue.
  • •  The crib should be bare.  No bumpers, blankets, sheets or stuffed animals should be in an infant’s crib during sleep.
  • •  Commercial devices to position a baby (including wedges, nursing pillows, sleep nests) should not be used.
  • •  Carseats should not be used for sleeping due to the possibility of the baby’s head falling forward and obstructing the airway.
  • •  Tummy time of 30-60 minutes per day with an adult supervising is recommended to facilitate development and minimize positional flattening of the skull.
    •  Home heart and breathing monitors to prevent SIDS are not effective and should not be used.

Dr B has long taken a relaxed stance on cosleeping, as she coslept with her babies when they were young.  However, given the mounting evidence that infant safety can be greatly enhanced by increased vigilance about returning babies to their own beds after nighttime feeding, Dr B agrees with the newer recommendations to help keep babies safer.

Tagged in: AAP Sleep