What to Expect the First Year (60 page)
Read What to Expect the First Year Online
Authors: Heidi Murkoff
Your parent pals may be lucky, but they're not typical. Though some babies no longer need night feedings by the third month (and sometimes sooner), most 2- or 3-month-old babies, particularly breastfed ones, still need to fill their tummies once or twice during the night.
Three or four (or more) middle-of-the-night chow-downs, on the other hand, are typically too much of a good thing at this pointâand for most babies, definitely not a necessary thing. Gradually reducing the number of late-show feedings baby's getting won't only help you get more rest now, it's an important first step in preparing him to sleep food-free through the night later on. Here's how:
⢠Increase the size of the bedtime feeding. Many sleepy babies nod off before they've totally filled their tanks for the night. Try restarting yours with a burp or a jiggle or a little socializing, and continue feeding until you feel he's really had enough. Don't be tempted to add solids to baby's diet (or put cereal in your baby's bottle) before he's developmentally ready in hopes of buying extra hours of sleep. Not only will it not work (there's no more nutritionally dense food for a baby this age than breast milk or formula), giving solids usually isn't recommended until 6 months.
⢠Top off before you turn in. Rousing your baby for a late-evening meal (aka a dream feed) may fill him up enough to last him through your own 6 or 8 hours
of shut-eye. Even if he's too sleepy to take a full meal, he may take enough to hold him an hour or two longer than he would have gone without a snack. Of course, if your baby begins waking more often once you've started this strategy, discontinue it. It could be that being woken up by you makes him more prone to waking himself.
⢠Make sure baby's getting enough to eat all day long. If he isn't, he may be using those night feedings to catch up on caloriesâafter all, he's busy growing up a storm. If you think this might be the case, consider nursing more frequently during the day to stimulate milk production (also check the tips
here
). If your baby's on the bottle, increase the amount of formula you give at each feeding. But never force-feed. And be aware that for some babies, feeding every couple of hours during the day sets
up a pattern they continue around the clock. If your baby seems to have fallen into such a schedule, you might want to go for longer, less frequent feedings instead, assuming he's growing well.
⢠Wait a little longer between feedings. If he's waking and demanding food every 2 to 3 hours (necessary for a newborn, but not usually for a thriving 3-month-old), try to stretch the time between feedings, adding half an hour each night or every other night. Instead of jumping to get him at the first whimper, give him a chance to try to fall asleep again by himselfâhe may surprise you. If he doesn't, and fussing turns to crying, try to soothe him without feeding himâpat or rub him, sing a soft, monotonous lullaby, or turn on a musical crib toy or white noise app. If the crying doesn't stop after a reasonable time (for however long you feel comfortable letting him fuss), pick him up and try soothing him in your arms by rocking, swaying, cuddling, or singing. If you're breastfeeding, the soothing tactics have a better chance of success if dad's on duty, since a breastfeeding infant who sees, hears, or smells his source of food is not easily distracted from eating. Keep the room dark, and avoid a lot of conversation or stimulation.
If baby doesn't fall back to sleep and still demands feeding, feed himâbut by now you've probably stretched the interval between feedings by at least half an hour from the previous plateau. The hope is that baby will reach a new plateau within the next few nights and sleep half an hour longer between feedings. Gradually try to extend the time between meals until baby is down to one nighttime feeding, which he may continue to need for another few months, especially if he's breastfed or growth is on the slow side.
⢠Cut down the amounts at the nighttime feedings you want to eliminate. Gradually reduce the number of minutes he spends nursing or the ounces in his bottle. Continue cutting back a little more each night or every other night.
⢠Increase the amount offered at the night feeding you are most likely to continue (for now). If your baby is getting up at midnight, 2 a.m., and 4 a.m., for example, you may want to cut out the first and last of these feedings. This will be easier to do if you increase the amount your baby takes at the middle one, either from breast or bottle. A nip from the breast or a couple of ounces from the bottle is not likely to knock him out for long. See the tips for keeping a sleepy baby awake for feeding
here
.
⢠Don't change your baby's diaper during the night unless it's poopy or uncomfortably sopping.
⢠Listen before you leap. Room sharing provides safer sleep, but probably not sounder sleep. Parents tend to pick up their babies more when they're close by, leaping to feed when there's really no need. Keep your baby in your room for safety's sake, but try to remember that a fussy baby isn't always a hungry baby.
Metabolically speaking, babies can usually get through the night without a feeding once they've reached about 11 pounds, yet far from all actually doâespecially those who've tipped that scale at an early age. But by 4 months, you can rest assured (and hopefully rest more at night) that your little one doesn't need any middle-of-the-night feedings at all. If the night-waking habit
continues into the fifth or sixth month, you can begin to suspect that your baby is waking not because he needs to eat during the night, but because he's become used to eating during the night.
Click here
for tips on getting an older baby to sleep through the night.
Though it's the major cause of infant death, the risk of SIDS is actually very small for the average baby (about 1 in almost 2,000). And thanks to preventive steps that more and more parents are taking (see below), that risk is getting smaller still.
SIDS most often occurs in babies between 1 and 4 months, with the vast majority of deaths occurring before 6 months. Though it was once believed that victims were “healthy” babies randomly stricken, researchers are now convinced that SIDS babies only appear healthy and actually have some underlying defect or defects that predisposes them to sudden death. One hypothesis is that the control in the brain that is usually alerted when breathing conditions are dangerous is underdeveloped in these babies. Another theory: SIDS may be caused by a defect in the heart or a faulty gene involved in managing breathing and heart rate. What is known for sure is that SIDS isn't caused by vomiting, choking, or illnesses. Nor is it caused by immunizations.
There is a somewhat higher SIDS risk for preterm or low-birthweight babies, as well as for babies of women who had poor prenatal care and those who smoked during pregnancy. But many risk factors for SIDS are also related to a susceptible baby's environment. They include tummy sleeping, sleeping on soft or loose bedding or with pillows or toys, being overheated during sleep, or exposure to tobacco smoke. The good news is that these risks can be avoided. In fact, there has been a 50 percent decrease in the number of SIDS deaths since the AAP and other organizations initiated the “Back to Sleep” campaign in 1994.
You can reduce the SIDS risk significantly for your baby with these measures:
⢠Use a firm mattress and tightly fitting bottom sheet for baby's crib ⦠and nothing else. No loose bedding, pillows, blankets, bumpers, fluffy quilts, sheepskins, or soft toys. Don't use devices designed to maintain sleep position (such as wedges) or to reduce the risk of rebreathing airâmany have not been sufficiently tested for their safety, and none has been shown to be effective at reducing the risk of SIDS.
⢠Put baby to sleep on his or her backâevery single time. Make sure all of baby's providers, including babysitters, daycare workers, and grandparents, are instructed to do this, too.
⢠If your baby falls asleep in a car seat, stroller, swing, carrier, or sling, move him or her to a firm sleep surface as soon as possible.
⢠Never allow your baby to get overheated. Don't dress baby too warmly for bedâno hats or extra clothing or blankets (use a temperature-appropriate sleep sack or swaddle instead)âand don't keep the room too warm. To check for overheating, touch the nape of baby's neck or the tummyâit shouldn't feel hot (hands and feet normally feel cooler to the touch, so they're not a reliable gauge).
⢠Consider running a fan in baby's room. Circulating air may reduce the risk of SIDS.
⢠Offer a pacifier at sleep times, even if baby doesn't use it during the day. (Don't worry if baby spits it out during the night or refuses to take it.)
⢠Don't allow anyone to smoke in your home or near your baby.
⢠Continue to breastfeed your babyâresearchers report a lowered risk of SIDS among breastfed babies.
⢠Consider sharing a room with your baby. Studies show a lowered risk of SIDS among babies who sleep in the same room as their parents. Babies who share a bed with their parents, however, are at greater risk of SIDS and suffocation and entrapment death, so if you do choose to co-sleep with your baby, you'll need to be sure that sleeping conditions in your bed are as safe as possible,
click here
.
⢠Be sure your baby is up-to-date with all vaccines. There is evidence that suggests that immunization reduces the risk of SIDS by 50 percent.
If, even after taking all these preventive measures, you're still nervous about the risk of SIDS, you may feel more secure if you learn infant rescue techniques and CPR. Also make sure that babysitters, grandparents, and anyone else who spends time alone with your baby knows these lifesaving techniques. That way, if your baby ever does stop breathing, for any reason, resuscitation can be attempted immediately (
click here
).
“My premature baby had occasional periods of apnea for the first few weeks of her life, and I'm worried about it possibly putting her at risk of SIDS.”
Breathing lapses are very common in premature babiesâin fact, about 50 percent of those born before 32 weeks gestation experience them (
click here
). But this “apnea of prematurity,” when it occurs before the baby's original due date, is totally unrelated to SIDS, and it doesn't increase the risk of SIDS or of apnea, itself, later. So unless your baby has serious episodes of apnea after her original due date, there's no cause for concern, monitoring, or follow-up. Even in full-term babies, brief lapses in breathing without any blueness, limpness, distress, or need for resuscitation are normal. They're not believed by most experts to be a predictor of SIDS risk.
“Yesterday afternoon I went in to check on my baby, who seemed to be taking a very long nap. He was lying in the crib absolutely still and blue. I grabbed him and he started breathing againâbut I'm terrified it'll happen again.”
Your baby experienced what's called an “apparent life-threatening event,” but as frightening as that sounds (and as understandably terrifying as the experience was for you), it doesn't mean that his life is in danger. While a single episode of prolonged apnea (when breathing stops for more than 20 seconds) does put an infant at slightly increased risk for SIDS, there's a 99 percent chance that the risk will never become reality.
Still, be sure to call your baby's doctor to report what happened. It's
likely the doctor will want to evaluate, test, and monitor your baby in the hospital. The evaluation often uncovers a specific treatable cause for such an eventâan infection, a seizure disorder, GERD (gastroesophageal reflux disease), or an airway obstructionâthat can be treated, eliminating the risk of future problems, and hopefully putting your mind greatly at ease.
If the cause is undetermined, or if there seems to be an underlying heart or lung problem, the doctor may recommend putting your baby on a device that monitors breathing and/or heartbeat at home. The monitor is usually attached to the baby with electrodes or is embedded in his crib, play yard, or bassinet mattress. You, and anyone else who cares for your baby, will be trained in connecting the monitor as well as in responding to an emergency with CPR. While the monitor won't give your baby absolute protection against a recurrence, it may help your doctor learn more about his condition and help you feel less helpless.
Though very brief (under 20 seconds) periods of breathing lapse can be normal, longer periodsâor short periods in which a baby turns pale or blue or limp and has a very slowed heartbeatârequire medical attention. If you have to take steps to revive your baby, call the doctor or 911 immediately. If you can't revive your baby by gentle shaking, try rescue techniques (
click here
), and call or have someone else call 911. Try to note the following to report to the doctor:
⢠Did the breathing lapse occur when baby was asleep or awake?
⢠Was baby sleeping, feeding, crying, spitting, gagging, or coughing when the event occurred?
⢠Did baby experience any color changes, turning pale, blue, or red in the face?
⢠Did baby need resuscitation? How did you revive him or her, and how long did it take?
⢠Were there any changes in baby's crying (higher pitch, for example) before the breathing lapse?
⢠Did baby seem limp or stiff, or was he or she moving normally?
⢠Does your baby often have noisy breathing? Does he or she snore?
“I've heard a lot about the benefits of co-sleeping. And with all the night waking our baby does, it seems like sharing a bed would mean more sleep for her and us.”
For some families, a family bed (aka co-sleeping) is an unequivocal and cuddly joy. For others, it's just a convenience (whatever gets you through the night, right?). For still others, it's a total nonstarter (babies sleep in cribs, grown-ups sleep in bed ⦠end of bedtime story).
