Category Archives: Sleep and Crying

For expectant mums, new mums and those who know them.

Fantastic article from N’tima Preusser

Before I was a parent, I was the perfect one. People told me my life would change. People told me I would be tired. That parenthood would be the greatest and hardest thing I would ever do.

Yeah yeah yeah.
I know. I know.
I knew everything. “

 

Definitely worth a read.

Safe swaddling

There are lots of mixed messages about swaddling babies out there. This is a great resource on safe swaddling to reduce SUDI risk.

Sleeping and soothing your baby

I’ve been feeling a bit tired recently, and so might you be.  Sometimes it’s because your baby (or child) has had an up and down kind of night (in our family we sometimes play a game called Musical Beds “fun for all the family”!), or perhaps you’re pushing yourself a bit much.

Whatever the case, take the chance to review of posts on sleep and settling your baby…

More resources for the terminally sleep deprived

If you’re struggling with sleep it may be hard to know where to get help.

Those around you will hopefully provide support and wisdom, but we know sometimes it can seem like you are surrounded by mums whose ‘perfect’ babies sleep through the night, or friends and relatives who advocate sleep advice that doesnt suit you or your family.

So here’s a list of resources we have found helpful in our search for the elusive full nights sleep. Many of these may be available from your local library, or Parents Centre, or trying buying them secondhand or online.

Helping your baby sleep by Anni Gethin & Beth McGregor

A great practical book on sleep based on recent research.  Lots of theory but several great practical chapters on getting baby to go to sleep.

The No-Cry Sleep Solution by Elizabeth Pantley

Lots of great practical tips and tricks for getting babies to sleep.  Individual approach rather than one size fits all – helpful for identifying what is important for your family and how to adjust your babies sleeping without distress for you or them.  The name is a wee bit misleading as this is not to say your child will never cry, it just doesn’t advocate leaving them to cry themselves to sleep.

Sleeping like a baby: Simple sleep solutions for infants and toddlers by Pinky McKay

Parenting expert Pinky McKay offers a natural, intuitive approach to solving your little ones’ sleep problems and gives practical tips on how to: understand your baby’s tired cues; create a safe sleeping environment; gently settle babies and toddlers; and, feed infants to encourage sleep.

The Science of Parenting by Margo Sunderland

Fascinating factual book on how we can best parent to help our children become happy healthy individuals.  All the latest research on brain development and it’s implications for parenting.  A must read!

The happiest baby on the block by Harvey Karp

Karp focuses on calming and soothing crying infants but his five techniques are great for helping get baby to sleep as well. Especially good for newborns and babies that have lots of unexplained crying.

The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two (Revised and Updated Edition) by Dr William and Martha Sears

This is a wonderful all-purpose baby ‘manual’ that covers all those important aspects of the first years, including info on sleep. They don’t have a one size fits all approach to sleep but advocate finding what works best for all the family.

Websites

Centre for attachment website

The Centre for Attachment (CFA) is a New Zealand-based agency dedicated to providing support, education and training for families, organisations and communities on optimal child development and attachment.  Offers some useful information on sleep in their Essential Information section.

Dream Parenting

A sleep solutions company run by mum Anna Martin. They specialise in solutions which involve the use of nurturing and responsive methods, to help parents with their child’s behaviour and sleep issues.

We haven’t used Dream Parenting personally but I have heard a few good things about them. Please let us know if any of you have tried them and how you found it?

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If you have used any other books / websites / other resources that you would recommend, we’d love to hear about them!

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As you wrestle with sleep, it is helpful to remember that:

  • it is a myth that one day your baby will sleep through the night, and that will be the end of sleep troubles. Your baby will eventually mostly get the hang of a good night’s sleep but even when your children are older there will still be the odd tooth, illness, bad dream, emotional disturbance that mean the pitter patter of little feet will be heard. It is a more realistic goal to aim for your child to spend the majority of the night, most nights in their own bed. It won’t happen 100 % of the time! So don’t set yourself up for impossible expectation. There will always be nights when your little one needs you a bit more than usual.
  • It is a myth that your baby will sleep through the night by 6 weeks (unless you are one of the very lucky few and even then it will most likely be temporary!) Many babies are still  waking at least once in the night at 1 year of age.

And finally remember the parenting mantra “This too shall pass!”. A very wise woman (my mother) once reminded me that when my baby is a teenager I will no longer be trying to get him to go to sleep, but rather to wake up!

Media and midwives: More on bed sharing

The NZ College of Midwives recently wrote to Coroner Wallace Bain about his comments regarding bedsharing… read on…

Coroner Wallace Bain,
Dear Mr Bain,

We are writing to you with our concerns regarding a recent media article in which you have been quoted as saying that “parents sleeping with their babies is a form of child abuse”. We understand that as the coroner, you see some disturbing cases in which young babies have died, however, we are concerned that such remarks may be unhelpful in the education of parents.
The New Zealand College of Midwives (NZCOM) is the professional organisation for midwifery. Our members are employed and self employed and collectively represent 90% of the practising midwives in this country.

There are around 3000 midwives who hold an Annual Practising Certificate (APC). These midwives provide maternity care to on average 64,000 women and babies each year. The New Zealand model of maternity care provides the opportunity for women to receive continuity of care throughout their maternity experience. For the majority of women in New Zealand this means having the same midwife Lead Maternity Carer (LMC), or her back up, providing the majority of their care – from early pregnancy, through the labour and birth and for the first few weeks following birth. This care may be home based or provided within a variety of community settings. Midwives who work as LMC’s practice in an integrated way, working in close collaboration with other specialised services and practitioners, across primary, secondary and tertiary service environments.

The death of a baby is devastating for all involved and it is always important that any death is investigated so that contributory factors can be identified and future deaths avoided. However, it is also important that parents receive consistent evidence based information that supports safe sleeping messages. We are concerned that the focus on bed sharing as a problem causes increased confusion and guilt for parents without ensuring that parents are provided with
the important key messages that are known to support safe sleeping practices.

The cosleeping debate

There has been an ongoing unresolved debate regarding the safety/risks of bed sharing (also known as co-sleeping) for many years. To summarise:

Co-sleeping is a culturally embedded and highly prevalent practice in many societies globally, with high levels of cosleeping found in Sweden, Norway, Japan, China, Hong Kong, Bangladeshi infants in the United Kingdom and Pacific Island communities (Gantley, Davies et al. 1993; Nelson, Taylor et al. 2001; Blair, Sidebotham et al. 2009; Sobralske and Gruber 2009). The incidence of Sudden Infant Death Syndrome (SIDS) also known as Sudden Unexpected Death of an Infant (SUDI) is low in many of these countries.

Cultural beliefs and values strongly influence sleep habits and the reaction of society to co-sleeping (also known as bedsharing) (Mindell, Sadeh et al. 2010).

Research suggests that the benefits of bedsharing include; longer term breastfeeding and enhanced maternal monitoring of the baby, more frequent infant arousals and improved sleeping patterns for babies (McKenna and Mosko 1994; McKenna and Mosko 1994; Baddock, Galland et al. 2007; Blair, Heron et al. 2010) .

There is also evidence that bedsharing in particular situations increases the risk of SIDS and in response to this evidence some countries have chosen to advise against cosleeping in the first months of life.

However, a recent longitudinal case control study undertaken in the United Kingdom (UK) explored the factors associated with sudden infant death and the specific circumstances in which SIDS occurred while co-sleeping (Blair, Sidebotham et al. 2009). The authors found that it was not the bedsharing itself that was the main factor in SIDS but bedsharing along with other high risk behaviours such as smoking, alcohol and/or drug consumption (Blair, Sidebotham et al. 2009).

There was a significant correlation between SIDS, co-sleeping and the recent use of alcohol or drugs by the parents. Of particular concern the authors found that the proportion of SIDS infants found on a sofa has increased significantly since 1993-96. They expressed concern that parents are often discouraged from bedsharing but are not necessarily informed of the hazards of falling asleep with their baby on the sofa – and that this is a far more hazardous sleep location.

By focusing warnings on bedsharing rather than the specific risks, the misconceptions are perpetuated.

What are the factors that increase risk when bedsharing?

There is consistent evidence from epidemiological studies investigating the risk of SIDS/SUDI during bedsharing that the following factors increase risk (Scragg, Mitchell et al. 1993; Blair, Fleming et al. 1999; Blair, Platt et al. 2006):

  •  Co-sleeping on a sofa
  •  Maternal smoking in pregnancy
  •  Maternal alcohol and drug consumption
  •  Over tiredness
  •  Excess bedding
  •  Infants sleeping with people other than parents
  • Prematurity

While approximately half of the 50-60 SUDI deaths per year in New Zealand occur in an adult bed there is little data available on maternal smoking or alcohol/drug consumption for these cases (Child and Youth Mortality Review Committee 2009) – two factors which are identified in the literature as contributing to most of the risk associated with bedsharing.

In many Western societies parents strive to ensure separate sleeping environments for their babies, however, studies indicate that between 50 to 70% of parents bed share with their baby at some point in time (Blair and Ball 2004). Parents identify many reasons for bedsharing and these include: being an intrinsic part of their culture, part of a baby-focused parenting style, a way of facilitating breastfeeding, a response to an unsettled baby or sometimes to facilitate better maternal or infant sleep. (Ball 2002; Baddock, Galland et al. 2007; Lahr, Rosenberg et al. 2007; Ball 2009; Sobralske and Gruber 2009). Parents also identify that bedsharing may be accidental.

Therefore the argument that co-sleeping is a form of child abuse would suggest that the majority of parents in this country could be accused of child abuse at some time. As well as distracting from the actual causes of SUDI, this may trivialise the very serious nature of child abuse rather than contributing towards an improved understanding for parents of the importance of ensuring a safe sleep for every child at every sleep.

As the main health professionals involved in maternity, midwives have a key role in providing information to support parents in their early parenting practices. We are working collaboratively with other professional groups to ensure that we provide clear, concise and consistent information to parents to ensure that they are aware of what contributes to safe sleeping practices for all babies. When parents have a full understanding of what contributes to hazardous sleeping practices, they are better prepared and able to ensure that they follow safe sleeping practices in whatever environment they are in.

Assisting parents to understand the principles of safe sleeping practices means parents themselves are better placed to ensure that every sleep for their baby is a safe one.

The unequivocal evidence based messages for all those involved in reducing SIDS/SUDI are that when infants are sleeping they should be:

  •  face up
  •  face clear
  •  smokefree

We would be grateful if you and your colleagues could repeat and promote these messages as their priority.

I have enclosed a copy of the New Zealand College of Midwives consensus statement which guides midwives in these conversations and highlights the issues that need to be considered when advising parents on safe sleeping practices.

Yours sincerely
Karen Guilliland
CEO, New Zealand College of Midwives

References

Baddock, S., B. Galland, et al. (2007). Sleep Arrangements and Behaviour of Bed-Sharing Families in the Home Setting. Pediatrics. 119: e200.
Ball, H. (2009). “Airway covering during bed-sharing.” Child: Care, Health & Development 35(5): 728-737.
Ball, H. L. (2002). “Reasons to bed-share: why parents sleep with their infants.” Journal of Reproductive and Infant Psychology 20(4).
Blair, P., P. Fleming, et al. (1999). “Babies sleeping with parents: case-control study of factors influencing the risk of the suddent infant death syndrome.” BMJ 319: 1457-1462.
Blair, P., M. Platt, et al. (2006). “Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention.” Arch Dis Child 91(2): 101-6.
Blair, P., P. Sidebotham, et al. (2009) “Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England.” BMJ, 339;b3666 DOI: 10.1136/bmj.b3666.
Blair, P. S. and H. L. Ball (2004). “The prevalence and characteristics associated with parent-infant bed-sharing in England.” Arch Dis Child 89: 1106-1110.
Blair, P. S., J. Heron, et al. (2010). “Relationship between bed sharing and breastfeeding: longitudinal, population-based analysis.” Pediatrics 126(5): e1119-26.
Blair, P. S., M. W. Platt, et al. (2006). “Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention.”
Archives of Disease in Childhood 91(2): 101-6.
Child and Youth Mortality Review Committee (2009). Fifth Report to the Minister of Health: Reporting mortality 2002 – 2008. Wellington, Child and Youth Mortality Review Committee.
Gantley, M., D. P. Davies, et al. (1993). “Sudden infant death syndrome: Links with infant care practices.” British Medical Journal 306(6869): 16-20.
Lahr, M. B., K. D. Rosenberg, et al. (2007). “Maternal-infant bedsharing: risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk
reduction.” Maternal & Child Health Journal 11(3): 277-286.
McKenna, J. and S. Mosko (1994). “Sleep and arousal, synchrony and independance, among mothers and infants sleeping apart and together (same bed): an experiment in
evolutionary medicine.” Acta Paediatrica Supplement 397: 94-102.
McKenna, J. J. and S. S. Mosko (1994). “Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine.” Acta Paediatrica Supplement. 397: 94-102.
Mindell, J. A., A. Sadeh, et al. (2010). “Cross-cultural differences in infant and toddler sleep.” Sleep medicine 11: 274-280.
Nelson, E. A., B. J. Taylor, et al. (2001). ” International Child Care Practices Study: infant sleeping environment.” Early Hum Dev 62(1): 43-55.
Scragg, R., E. A. Mitchell, et al. (1993). “Bedsharing,smoking and alcohol in the sudden infant death syndrome. New Zealand Cot Death Study Group.” BMJ . 307(6915): 1312

Quote: Sleep baby sleep!

Safe Sleeping Part 4: What about having baby in bed with me?

Bed sharing or co-sleeping means sleeping in the same bed as bubs. It is one of those issues that can evoke very strong opinions – some think it’s wonderful and some think it’s terrible.

In New Zealand, parents are generally advised to sleep baby in a separate bed. However anecdotal evidence suggests that bed sharing is common practice amongst families of many different cultures in NZ. Some of this is bed sharing by choice, for others it simply happens as mother and baby fall asleep together post-feeding. It is also possible now to get devices that combine some of the benefits of bed sharing with separation of parent and child, e.g. clip on bed, box bed etc. If you choose to bed share with baby, have a look at the safety guidelines below.

“Baby shared our bed for the first three weeks. That helped with calming him down and putting him back to sleep as he needed lots of body contact. It also helped with getting to know one another.” – Isabelle

Safety when bed sharing

When babies are sleeping they should be face up, face clear, and smokefree.

  • Bed sharing is not safe if either you or anybody else living in the house smoke (even if you never smoke around baby), or if you smoked during pregnancy.
  • Bed sharing is not safe if you (or anyone else in the bed) have been drinking alcohol or taking recreational drugs, taking medications that make you sleepy, you are extremely tired, very unwell, very overweight or are a very heavy sleeper.
  • Sleeping together on a couch is not safe.
  • Bed sharing is not recommended unless your baby is breastfeeding, as breastfeeding babies and their mums tend to sleep more lightly, wake more frequently, and end up with their sleep cycles in sync.
  • Bed sharing is not recommended for babies born prematurely as their ability to rouse themselves with breathing pauses is compromised.

If you have reviewed the above recommendations and you wish to share a bed with your baby, these are the things you can do to make it safer:

  • Make sure mattress is firm not spongy or sagging or a waterbed
  • Make sure your bottom sheet is tight fitting and can’t come loose
  • Keep covers light, and room warm (but not too hot)
  • Keep baby’s head uncovered, keep pillows & duvets away from him
  • Sleep baby on her back
  • Make sure your partner knows baby is in the bed
  • Don’t allow other young children to sleep next to baby
  • Make sure baby can’t fall out of bed or get stuck between mattress and wall.
  • Don’t use electric blankets or hot water bottle as these can cause baby to get too hot
  • Don’t let pets share the bed
  • Do not sleep together on a sofa or couch
  • Some research shows that mums are very aware of their babies while sleeping and suggests that the safest bed sharing position is with baby between mum and the wall.  (Remember to make sure baby can’t get stuck between the side of the bed and the wall).  Some parents find sleeping with baby in the middle of them works better, but the non-breastfeeding partner may not be as aware of the baby.
  • If you have very long hair you may wish to tie it back.
  • Some authors identify obesity as a risk factor.


Thinking over the options

Some cons of bed sharing

  • Bed sharing appears to be associated with a slightly higher risk of SIDS (for non-smoking families and a much higher risk for smoking families). However this is largely due to recognised risk factors that can be removed or minimised. It’s worth noting that in many cultures bed sharing is the norm and this is not associated with any higher rates of SIDS. In fact in some cultures where bed sleeping is the norm rates of SIDs are so low that they don’t even have a word for it!
  • Some parents find they are too alert or anxious when baby is in bad and do not sleep well.  “I was always too scared to have my daughter in bed with me, in case I fell asleep and smothered her”. – LM

Some pros of bed sharing

  • Recent research has suggested that the close contact of bed sharing is immensely beneficial for regulating baby’s immature brain and body systems.

  • Bed sharing can help promote better sleep for parents and babies. No more getting out of bed in the middle of the night! “We co-slept with our second baby and found sleep deprivation much less – often in the morning I had only the vaguest recollection of night feeds!” – TJ

Phew, having got to the end of all that, you’re ready for a good nap!  Hopefully baby’s sleeping so you can go for it!

Safe Sleeping Part 3: Beds and bedding

Beds

Whether you are sleeping baby in a bassinet or basket or cot you will need to check it is safe.

Make sure there is nothing sharp or loose, no gaps or anything else baby could get trapped in.  Make sure it is in good condition.  Any cots should comply with the AS/NZS 2172:2003 product safety standard, which is set by the Ministry of Consumer Affairs.

We recommend extreme caution in buying a second hand cot, as you will not necessarily know if it meets this standard.

Things you need to check include general durability, depth of the cot, safety of any holes and openings and spacing between slats (so that there is nothing a child could get trapped in or between, that there are no protrusions like posts that a child could get caught on, safety of the fastening devices etc.

If you can’t afford to buy a new cot you could try to borrow one from a friend who no longer needs theirs.  They are more likely to be able to give you accurate information on how old the cot is, what it has been through, and if it complies with the safety standard.

You need to make sure that your cot mattress fits firmly in the cot with little or no gap between the edge of the mattress and the cot side.  Try to buy a new mattress even if you can’t afford a new cot.  Mattresses can harbour all manner of dust mites and germs, plus there’s a good chance that they’ve been soiled at one point or another.

Bedding

I love snuggling into bed with my feather pillow, snuggly duvet, hot water bottle, and occasionally the cat!  It’s tempting to adorn our baby’s bed with similar luxuries.  Step into any baby shop and the array of bedding and furniture is quite staggering?  Would you like a zoo animals theme?  Or perhaps fairies?  Maybe some custom made European furniture or a hand knitted quilt?  For babies’ bedding less is definitely more!  All your baby needs for her bed is a water resistant mattress protector, fitted bottom sheet, top sheet and several blankets.  Other bedding and accessories can often pose hazards.  Babies’ beds should not have:

  • cot bumpers – often sold to parents to “keep drafts away from baby” or to “stop baby banging their head” it is possible for babies to become entangled/wedged in bumpers and strangle or suffocate.
  • quilts and duvets that sit on top of covers.  All covers need to be able to be firmly tucked in.  Anything that can come loose is at danger of working over baby’s head or face.
  • pillows.  Babies don’t need pillows until they move to a big bed as they can become trapped underneath them.
  • stuffed toys that baby can wriggle under can pose a risk of suffocation.
  • too many covers.  It is better for baby to sleep in a warm room with fewer covers.  Too many covers pose a risk of over heating.

It’s worth noting that just because something is sold in a baby shop doesn’t mean it’s necessary or good.  Cot bumpers, small quilts, pillows and pillowcases, walkers and many other things that are unsafe for babies can all be found in your average baby shop.

Making baby’s bed

Beds need to be made up so that baby cannot work their way under the cover to the bottom of the bed.  So instead of making up the bed so that there is just room at the top for baby’s head (as we do with our beds), the baby’s bed need to be made so that there is only a body length of blanket.  This means baby can’t work his way under the covers.  When you put baby to bed tuck them in securely.  If your baby is especially wiggly and persists in working his way out from under the covers you may find it helpful to use a baby snuggle sack, sleeping bag, or safety sleep.

Safe Sleeping Part 2: Baby’s sleeping position

The safest position for babies to sleep in is on their backs.

Babies who sleep on their fronts are at the highest risk of dying from SIDS.  Some parents choose to sleep baby on his side using a wedge or safety sleep to stop baby rolling on to his front.  Side sleeping carries a reduced SIDS risk to front sleeping but is still not as safe as back sleeping.

 Some key points about back sleeping are:

  • Babies sleeping on their back are less likely to choke on vomit than babies sleeping on their front.
  • If your baby can roll over, start them on their back.  If you notice them on their front check that they are comfortable, their face is clear and they are breathing well. If they will be sleeping again unsupervised, gently roll them back onto their back. The early days of rolling are the highest risk time for SIDS but one of the biggest things you can do to reduce this risk is to give your baby lots of tummy time when they are awake to strengthen their neck muscles.  This gives them the strength to move their head to a comfortable position when they are on their front.
  • There are a variety of commercial sleeping devices such as wraps and wedges, which are touted to parents as reducing SIDS risk.  Many parents find these useful for a variety of reasons but please note that they have not been proven to reduce SIDS risk.
  • It is a genuine (cosmetic) concern that back sleeping gives baby a flat spot at the back of their head.  This is because babies’ skull bones are very soft and can be moulded by pressure i.e. from a baby sleeping in the same spot.  But don’t be too worried, bubs will not be teased at school for their ‘flathead’ – just alternate the direction baby’s head is turned at different times (e.g. “Right at night and during the day, the other way…”). Lots of tummy time on the floor (under supervision) or upright time against your chest can also help reduce pressure on the back of the head. If you are concerned about the shape of your baby’s head talk to your GP or to your plunket nurse.

 

Safe Sleeping Part 1: Why is it important?

Why is it important?

Unexpected accidental death refers to the death of a baby or toddler by a known cause e.g. suffocation by pillow or strangulation with a cot bumper, choking etc.  SIDS (or Sudden Infant Death Syndrome) refers to the sudden unexpected death of a baby for no known cause.  This generally occurs under 6 months (greatest time of risk is 2-4 months).

Okay this is scary stuff.  My husband was still checking my daughter’s breathing several times a night even when she was nearly 2.  Seem a little paranoid?  I think we are all just really aware of the high stakes.  Try not to let the anxiety rule your life, but here are some facts and things you can do to lower the risks.

Despite much research we still don’t know why SIDS happens but we do know that there are definite things parents can do to reduce the risks:

  • Put baby on her back to sleep
  • Sleep with face uncovered
  • Have a smoke free environment.  If mum smokes the risk of SIDS doubles, if father or partner smokes as well the risk doubles again.  The risk of SIDS is increased even if parents never smoke around the baby.  We don’t know why this is but the research shows it is true.  Also risks increase even if mum smoked in pregnancy and now doesn’t.
  • Breastfeed
  • Have baby sleep in the same room as parents