Friday, January 18, 2008

Schedule Question

UPDATE: Hey! This just up (1.31.08) quint's mom uses E.A.S.Y. !!! Check it out!! Watch for E.A.S. Eat, Activity, Sleep...


Over the last few weeks I've given advice regarding schedules for young, less than five month old, babies a couple of times. Instead of just responding to specific parents, as I have been doing, I want to post about it. Then if there are any other folks out there having similar questions but no time or gumption to ask, they'll benefit as well. 

Warning; this post will likely be long and deal directly with scheduling. Not every baby needs a schedule but many benefit from them. Do not feel that because I'm for specific schedules I'm knocking those of you who feed or sleep on demand. I'm doing things the best that I can, as I imagine you are. 


Scheduling for the young infant...
The family I'm working with now is very soft, cuddly and sweet with their babies. They really like the book, Healthy Sleep/Happy Child, she uses it with Touchpoints. Between the two she finds her balance of calm, kind mommy and intelligent, thinking ahead parent. You don't need to buy either book, your local library should have them if you think you need to read them, but I can give you the gist of what I think works (which likely comes from these books, other books, experience and successful nappers/eaters).

Many new parents feel this way, it is the response young infants tend to illicit. I'm small and sweet so just love me. Right? Who can think rationally when confronted with this? And with most single babies one can easily slip into a pattern of responsive parenting. Meaning baby cries, parent tries to fix the problem. Are they hungry? Dirty? Scared? Tired? Confused? Essentially, why are they crying and what can I do to fix it. As soon as you have one adult for two babies this ceases to work effectively and predictably. One person only has two hands, if you parent responsively, rather than proactively, inevitably both babies will desire your attention simultaneously and you'll have to make one wait or completely stress yourself out trying to accommodate both. 

Instead of getting into this place, similar to the waiting place, as described in Dr. Suess's Oh the Places You'll Go, anticipate your babies needs. You know that every day your baby will need to eat, dirty diapers, sleep, play and cuddle. No question, every day you'll do these things. 

Let's start here. Imagine you have twin four month olds, actual age, and you've entered into a place where you can't get feeding and naps in line. Start with the basics, feedings. Equally space feedings. This sounds scary, breathe, this is where you come in - how you "equally space" them is your call. 

Example:
Tabitha came home from the hospital a week before Jackson. She was small and sweet and cuddly and finally in her parents arms whenever they wanted. The nurses had sent her home eating on a schedule of every three hours. But Roger and Sara were ready to do it their way, damn the scheduling they wanted to feed her on demand. Super. One baby, two parents, Tabitha ate whenever she wanted. It happens so fast and so painlessly most parents can't see it coming.

As you can imagine, when Jackson arrived home he joined his sister in their parents new found freedom. Forget every three hours! Herein lies the problem, if given the choice, Jackson would take two bottles per day. I'm not kidding you, the boy isn't interested in eating. Tabitha on the other hand, would eat at least once per hour. Her amounts would be erratic and there'd be no length of time available for sleeping.

Because Roger and Sara are such soft, loving first time parents, 
we started their schedule as gently as possible. 

Tabitha was eating all of the time. Bottles too close together became smaller. We were preparing bottles six to seven times each day because there was no way of predicting how much and often she'd eat. 
We agreed that eating every hour was too often. 
We talked about each cycle.
One of the parenting books suggests the E.A.S.Y. cycle. 
E = Eat
A = Activity
S = Sleep
Y = You
It doesn't matter if your cycle goes eat-activity-sleep-you or eat-sleep-activity, the important part is to include each thing in every cycle. A cycle goes from one bottle to the next. If your child is eating every 1.5 hours, they have 30 minutes to eat, 30 minutes to sleep and 30 minutes to play. Obviously you need to include diapering and burping in there too. The time starts the first time you put the bottle into their mouth. some take longer to eat, some longer to burp, most don't have very long attention spans or healthy awake periods. 

We started with 1.5 hours because Roger and Sara could undoubtedly agree that Tabitha could go that long.  This may not sound like much, but when you've been responding to every cry with a bottle, it's a huge change. And including sleep in every cycle is a huge step for most parents.

Before long it was obvious to Roger and Sara that 90 minutes wasn't enough time to get everything done in and she could go longer. It was also quite a bit of work to get them to sleep during every cycle.

Sleep. Ahh, I feel strongly about sleep.
Educated sleep specialists reach out to pediatric residents and teach them the value of sleep and how to help parents reinforce the importance of sleep. Sleep is important and we as a culture don't value it, this specifically was discussed on NPR earlier this week.

From my experience (and reiterated by aforementioned sleep specialist) anything goes for the first six weeks, depending on your baby, maybe four weeks, maybe five, but six weeks at the latest, after that expectations, habits, rituals, whatever your chosen synonym, there's a change at or around six weeks. Almost every, if not every, book I've read says you cannot actually spoil babies. But maybe we shouldn't think of it as spoiling but rather expectation setting.

At any point you can begin creating the routine and expectations you'll most enjoy. If you choose something you find calming, soothing or relaxing, your baby will learn to love and expect it just as much if not more than you do. Babies are adaptable, even if they seem opinionated and determined, they can mold themselves to your expectations. Adopted babies and children are an example of how adaptable babies can be. 

Here are a few examples of nighttime routines, I start here because most families have the hardest time at the end of the day. Any routine you use for sleeping can be called a nighttime routine and should be used at all sleep times. Some choose to make the end of the day, nighttime routine a little longer than the others to differentiate it from napping. Whatever you prefer will work as long as you are consistent. 

Example 1)
Mom stays at home with twins every day of the week, she gets help two afternoons per week. Her twins are big, big babies but started as tiny preemies. she is a very petite woman and after a long day of holding, feeding, moving, loving, entertaining and caring for her two immobile children she's exhausted. Her nighttime routine must meet her needs and energy level as well as that of her robust children. Each evening she feeds her twins dinner. Then bathes them. After their bath she prepares small bottles while they play on the floor a bit. She places each one into their carseat, if someone is there with her, they each hold a baby. For her the carseat is key because they can be strapped in, had she owned two bouncy seats these would have worked just as well, because her twins were so big and active bumbo chairs and boppies weren't enough. Strapped in mom can feed both babies at the same time. Before she begins she lights a candle. She did this one night by chance and both babies were transfixed. They found the light relaxing and centering after a long day. Because it worked so well mom now does this every single night. Once they finish their bottles she burps them, puts on their sleeps sacks, cuddles for a minute, tells them she loves them, puts them into bed, turns on the white noise machine, turns off the light and closes the door. Every.single.night.

Example 2) 
Mom works three days a week, dad works five days one of which is from home and they have childcare in their home while dad is home and mom is at work. Mom has trouble with anxiety and sleep is extremely important to her thus they stress consistency. Each night mom comes home in time for happy hour, a time when the babies play on the kitchen floor. Every night, during the time they start to get fussy, her twins come to play on the kitchen floor. This is very different from the rest of their day which is why it is saved for this fussy period. So mom comes home, hears about the day, sends childcare provider home and changes from work. Dad comes home, both babies are exhausted but both mom and dad want more time with them so they get a short 20 minute catnap. While they sleep one parent prepares bottles while the other unwinds, prepares dinner, gets pjs and loveys, whatever, then they each take a baby and feed them their dinner. After they've each finished and burped, they hold them for ten to fifteen minutes. They believe this reduces their risk of reflux. Once the agreed upon time has passed, they change each babies' diaper, put on their pajamas and sleepsacks, get their loveys* and go to the sofa for stories. After two or three stories they say goodnight to the house and take the babies to bed. Once in bed they tell them about their days then say the same thing about sleep and loving them, every night, turn off the light and close the door.

The key to these sleeping is consistency. There's nothing wrong with soothing your baby. Just remember not to pick baby up again once you've put her down. Talk, sing, pat, massage her but make the choice not to pick her up again once you've put her to bed. Picking her up sends mixed signals, she's wondering, what are we doing now? What comes next? Maybe she doesn't actually think in those words but she's confused and doesn't know what to expect, except what you teach her to expect. 

You don't need to use a certain product, dress them a certain, say a specific thing, you just need to be the same. The can't tell time, your words and actions alert them to what comes next. 

There's nothing wrong with rocking your child for as long as you like, singing three songs every night or reading a shelf full of books, the problem comes in when you start to dread putting her to bed, the rocking, singing or reading routine stresses you out, getting to bed takes longer than her regular awake period or you put her to bed already asleep.

Some of these reasons are self explanatory; if you dread putting her to bed or get stressed out by all of the rocking, singing, reading, you'll avoid it. You'll push it off as long as possible. She'll get overtired, less opportunity to sleep and you'll be stressed before you even begin.

If getting to bed takes longer than her regular awake period, i.e. the amount of time she can enjoy actually being awake, then you are sure to have an overtired baby on your hand most likely to wake up at 45 minutes, sleep shorter periods or have broken sleep periods.

Finally, if you hold her until she's asleep then put her into bed, she expects to be being held when she wakes. She will wake during her sleep cycle, it's natural and normal and we all do it. Waking up in a different place than she went to sleep can be scary, disorienting and frustrating for her. Thus she wakes up and asks, through crying, to be put back in the place she fell asleep, your arms, the rocking chair, carseat, etc.

It comes down to this;

Space bottles evenly.
  • you'll know what to expect, baby will learn what to expect
  • cycles will be consistent and each include some period of sleep
Set up a sleep routine
  • regular signals that tell baby sleeptime is coming
  • consider what you think is important (reading, singing, loveys*, rocking, etc)
Be CONSISTENT
  • knowing what to expect is just as helpful to baby as it is to you
  • consistency leads to routine which will allow you wiggle room, if you always do three things before they sleep and you wait 28 minutes to put them down rather than 23, they won't notice because your signals are the same as always

*loveys = transitional object intended to soothe baby during sleep, used to transition. Examples; use with pacifier then in place of pacifier, used to signal time for sleeping, helps get them into overnight sleep, i.e. object is there when they wake in the night.




I know this was very, very long winded. I hope that it helps and gives you some more ideas, insights and options for getting your babies on a schedule that works for all of you. 
If you have more questions, please, just ask.