By Rachelle Gershkovich
What does it mean to help support a baby with sleep? Throughout the first few years of a baby’s life, there are developmental stages of sleep that play a big role in sleep support. These natural progressions of sleep can be supported by parents, caregivers or sleep specialists, if they are able to recognize and understand each progression. As long as a baby’s caloric needs are being met and they are being held to developmentally appropriate sleep expectations, providing sleep support for little ones is a safe process.
Before I describe the unique methods I’ve developed, I want to share a little bit of my background and experience that led me to these conclusions. I started my career as a night nanny in 2002, which is when I realized that I wanted to offer specialized support to families. I was taking nursing courses, and it was during this process that I discovered the undeniable, universal value of nutrition. I went on to earn my B.S. in Human Nutrition and Dietetics. In 2009 I founded my own night nanny agency and since then have been training other nannies on my sleep techniques. Throughout these last 14 years, I have combined and applied my knowledge of nutrition and sleep. Through that, I have helped hundreds of families get the sleep they need by using a gentle, nutrition based method.
Natural progression of sleep
Let’s talk about a baby’s natural progression with sleep. For the first few weeks a baby will sleep constantly and eat around the clock. By week three they typically wake up a bit more and show more interaction with their environment. At around 8-12 weeks a baby starts the journey of differentiating day and night. This is regulated by their circadian rhythms, which helps the brain distinguish day from night using light verses dark and melatonin, which in turn helps regulate the hormones of sleep (and is typically given to a baby throughout pregnancy and then through breast milk) (2). Between the ages of 12 weeks and 18 months the developmental changes in relation to sleeping will be minimal. However, during this time period, a baby will change how they split up their total time of sleep in a 24-hour period. Sleep cycles are usually around 45-60 minutes, which is why naps in the first six months are typically very short, usually 20-60 minutes long. After six months, the naps begin consolidating creating 60-90minutes stints and there will be less throughout the day. This will happen again around 1 year dropping down to 2 naps a day and around 18 months down to 1 nap a day. The total nap time will not change much still around 3 hours.
How growth spurts affect caloric needs
Now let’s consider the growth spurts of babies both calorically and developmentally. In the first month of life, calories change quickly due to rapid growth, followed by continuous growth spurts throughout the first year. Each one of these growth spurts will affect a baby during this period, yet they only last five to seven days. The growth spurt with the most impact is between four and six months. This growth spurt typically creates an increased need of 150 calories a day. Since the baby is still not eating solids, it means the mother must be able to produce an increase in breast milk from 24 ounces to 28-32 ounces. This is followed by another 150-300 increase in needed calories a day when another growth spurt occurs between nine to twelve months but will be supported with calories from solids foods and not just milk. During these times, it helps to remind parents that during growth spurts, the baby will have more frequent feeds in order to increase the amount of breast milk being supplied. Also during growth spurts the baby may need night feeds to help with the increase in caloric needs. With that said, it is only the duration of five to seven nights that night feeds would be needed and then longer stretches of sleep will resume again as long as this is encouraged by the parents. As the growth spurt comes to an end, it should be easy to phase out the night feeds and soothe them back to sleep, rather than feeding them.
Expectations
Now that we have a bit more information on an infant’s sleep and their caloric needs, the expectations we put on them can be more realistic. Instead of thinking of it as a baby needing to be “taught” or “trained” to sleep, the focus can be put on the systems we can best support. Our method assumes that a baby cannot be taught to self soothe. In addition, their nervous systems and emotions are not yet developed, understood by them, or mastered, so they are not capable of manipulating their parents through crying (3). A baby does not have the ability to control or reset their own nervous system (4). This will not be a mastered skill until adulthood and even then, takes a life time to master. So their nervous system and cortisol levels need to be supported by using a steady touch and deep breathing from a parent, or care provider. Another way to reset a child’s nervous system is to take them outside. The stimulation from the environment with light and sounds help to reset a nervous system. A baby will begin understanding their emotions and be able to calm their own nervous system around the time they are three years old (4).
So instead of an extinction method, what we do is help guide a baby to sleep through the night by supporting their digestive system, which is their most developed system at this age. We focus on their metabolism and caloric intake, which results in healthy sleep habits to create a restful night for both parents and their baby. To do this we concentrate on helping babies get necessary calories during the day time hours. Shifting calories from the night time to the day time allows babies to get healthy sleep at night. We also pay attention to a baby’s circadian rhythms, which come into play between eight and 12 weeks.
Make positive associations
I believe it is very important to create positive associations with both sleep and food. Once negative associations have been formed, it can be increasingly more difficult to help a baby sleep through the night. For example, withholding food for certain duration of time, especially if the baby is crying can create negative associations. If the baby is rewarded with food after crying, this makes the baby think they need to work hard for their food, thus creating a negative association. Instead of working with underdeveloped systems, such as behavioral training, we believe that we can support positive and healthy associations to sleep by using the digestive system and circadian rhythms. These healthy associations will promote longer stretches of sleep at night.
To protect their sensitive circadian rhythms, and create a positive sleep space, we encourage parents to create a calm sleep space including minimal light, or better yet, no light. It’s important to make sure that the entire bedtime routine is calming from start to finish, including keeping a positive and soothing tone while speaking. A baby learns the most by watching us, therefore the parent or caregiver should be “sleepy” while putting baby to bed. This can be physically shown by taking long deep breaths, keeping eyes closed, and speaking in a quiet and soothing tone, while leaving the lights off. (This should also be portrayed any time the baby wakes up throughout the night.) This can be difficult, as it’s natural to feel panic or stress when a baby is crying, however it is extremely important to remain calm. If the adult is stressed, the baby will also feel stressed. Cortisol allows us to reset our own nervous system, but babies aren’t able to do this yet and rely on adults to help calm their nervous system. In addition, the bedtime routine should always be consistent and punctual. A baby clearly cannot read the clock, parents and caregivers need to be the enforcer of this bedtime. Positive associations can also be created by nursing or feeding to sleep, which will keep a baby relaxed and encouraged into sleep.
Using the digestive system
After positive sleep associations have been made, we begin to work with a baby’s digestive system. It’s important to remember as you’re supporting babies through this process, that they are on a 24-hour schedule and all sleep and calories need to be calculated based on this time frame. Sleep will need to be allocated throughout day and night, which is why we typically reserve 8-10 hours for night time sleep and allot 2-4 hours a day for naps.
To start, we ask parents to work on one longer stretch at night without feeding, to give the digestive system a break. We tell parents to start with four hours at night and gradually extend this time period (using the soothing methods discussed below). As long as the baby is getting enough calories during the day, they should not need additional caloric intake at night. In our experience we have found that the reason they continue to wake is due to the habit of eating every two hours. Eventually, with gentle support, the baby will no longer wake during the night and will begin to sleep longer and longer stretches.
As parents work on the first transition at night time, it’s important to discuss that babies will need three to five days to allow their metabolism to adjust to the transfer of the calories from the night time to the day time (1). From there, they continue to transfer nighttime calories to the daytime, which will allow for longer and longer stretches of sleep. In order to ensure this is done safely, it’s important to make sure a baby is at an appropriate weight AND age. Between 8-12 weeks a baby’s circadian rhythms begin to come in to play, this is why we must wait until at least 8 weeks to start to provide sleep support. We believe that a baby who is eight pounds can sleep four hours and still maintain the proper weight gain necessary to develop at a healthy rate. A baby weighing 10 pounds can sleep six hours, 12 pounds can sleep eight hours and 15 pounds can sleep 10 hours. This of course will fluctuate with each child, but they are good general guidelines.
The transition
Below is my preferred method for this transfer:
Day One
Begin new day time feeding schedule, which will offer increased day feeds (feeds every two hours for breast feeding, and three to four ounce feeds for bottle feeding, with a total of 28 to 32 ounces). At this time, it is important to communicate with the baby about changes that are coming.
Day Two
Continue increased calories during the day. Also encourage four to six hours a day of floor time activity to make sure they are developing as much as possible. Continue to communicate about their night time changing.
Day Three
Continue days with the new schedule and add in the first night stretch. This will consist of a bedtime routine and putting the baby to sleep in the designated sleep space. With the first wake of the night the parent or caregiver will soothe the baby to sleep instead of feeding. The soothing will entail any form of support via holding, rocking, cuddling, etc. At this time, support the baby until they go back to sleep, no matter how long it takes. Make sure to encourage the parent stay patient and calm, this will help soothe the baby most effectively. This transition will continue through day seven. From your designated bed time through the first 4 hours of the night you will soothe not feed. Once your baby has surpassed 4 hours resume night feeds, which should occur every 2-3 hours in correlation to the triggers of the metabolism.
Often after getting a baby to the first four-hour stretch, the next transitions happen very smoothly and require very little effort for an even longer stretch. As the baby grows, and their weight permits, we increase the total amount of time they can go without night feeds. As long as the total calories they need (which is 500-650 for a baby between four to six months and 650-800 for a baby six to nine months) are being met during the daytime hours (1). They will be capable of sleeping well at night, and parents will get the much deserved rest they need.
We have found that the best way to approach night sleep is to first have realistic expectations for the baby and secondly allow the baby to lead the process. When a baby is ready they will show signs of readiness, and will typically start with a growth spurt of increased eating followed by an increase in sleep or spontaneously sleeping a long night. This first stretch will usually occur shortly after the circadian rhythms come in to play around 12 weeks.
This method, what we call Baby Created Sleep, is a fully nutritional and instinctual based sleep support for babies and parents. By paying attending to their caloric and developmental needs, babies get the support they need, parents can be comfortable with the tools they’re using to meet the needs of their babies, and everyone gets healthy sleep!
Bio
Rachelle’s passion for new mothers and babies set her career in motion as a night nanny in 2002. Through nursing courses, she discovered the undeniable, universal value of nutrition, and earned her BS in Human Nutrition and Dietetics, later becoming a Certified Sleep Development Specialist. Merging her passion for new mothers, babies and nannying with her love of clinical nutrition, Rachelle founded Maternal Instincts, LLC / Denver Night Nannies in 2009. After 13 years of providing sleep support to families, she published her book, Creating Sweet Dreams. She has also recently launched the Infant Sleep Institute.
Works cited
- “Basal Metabolism of Infants.” Basal Metabolism of Infants. Accessed March 10, 2016. http://archive.unu.edu/unupress/food2/UID09E/UID09E0E.HTM.
- “Circadian Rhythm Fact Sheet.” National Institute of General Medical Sciences. November 2012. Accessed March 10, 2016. nigms.nih.gov.
Gershkovich, Rachelle M. Creating Sweet Dreams. Amazon, 2016.
- Stiles, Joan, and Terry L. Jernigan. “The Basics of Brain Development.” Neuropsychology Review. Accessed March 10, 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989000/.
- “SUPPORT US.” ZERO TO THREE. Accessed March 10, 2016. http://main.zerotothree.org/site/PageServer?pagename=ter_key_brainFAQ.
