Bedtime best practice

How to set the scene for quality sleep – for you and baby
By Philippa Selfe

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How your child sleeps can be directly proportionate to how you cope as a new parent. As someone whose children didn’t sleep consistently through the night until the age of two, I basically fell apart. If we had a third child, I’d probably do things differently. For starters, I definitely wouldn’t wait 12 months before seeking professional help like I did with the first two.
 
As sleep trainer, Una van Staden, points out, “Many families question the necessity of paying for sleep advice. Interesting when you think that babies spend more time sleeping than doing anything else – and they develop their brain during sleep. An important investment!”
 
Of course disrupted nights should be expected when your baby is very new, but van Staden recommends introducing a flexible routine at around four to six weeks. Consistency can help baby identify the cues of sleep, sending a message of security and reassurance.
 
Create a calm zone
You can help set the scene for fuss-free naps by paying attention to the sleep environment as well as following a calm sequence to help baby wind down.
 
“The nursery should be decorated in muted colours with minimal visual stimulation. Mobiles and toys in the cot signal a play zone when in fact it is a sleep zone,” says van Staden.
 
Bath time could be followed by a quiet massage for baby, which soothes and encourages bonding. Gentle touch stimulates the central nervous system, making the brain produce more serotonin and less cortisol (the stress hormone).
 
After feeding, Una recommends placing babies into their cot drowsy but awake. “Most babies prefer to be put down on their side and will roll onto their back at some stage, which is the safest position. Tummy sleeping is not recommended,” advises van Staden.
 
At night she advises total darkness for babies, but allow some form of natural light into the room during the day to prevent a baby from developing day-night reversal.
 
The fourth trimester
While not crucial, starting off in a small crib or Moses basket can help the transition to the outside world. “Newborns sleep much better in a contained, elevated position,” explains van Staden.
 
According to Dr Natalie Arkin, a Joburg-based chiropractor, babies tend to hold their foetal position for the first weeks of life. “That's why they often like to be swaddled or curl their legs up," she says.
 
The position of the arms is key when swaddling. Traditionally swaddles keep arms by the baby’s side or across their chest, but some allow for the natural arms-up position, which enables movement of the hands to the mouth to truly self-soothe.
 
You can simulate the womb further with sleep aids that play heartbeat sounds and white noise, which is different frequencies of sound combined together at one level to create a shushing sound similar to what babies here in utero. “White noise helps a baby transition from light sleep to deep sleep much quicker. It is particularly beneficial for reflux babies, but it is crucial that it plays for at least one hour, so that the baby completes one sleep cycle,” says van Staden
 
Comfort is key
The ideal nursery temperature is 21–22°C. A good heart rate monitor will display the room temperature and is also an essential piece of equipment for monitoring breathing.
 
For babies who struggle to settle even when fed, burped and changed, consider consulting a paediatric chiropractor who will use gentle adjustments to correct misalignments to the spine and nervous system. It also helps stimulate the digestive system, which is why chiropractic works so well on colicky babies.
 
Arkin explains: “Sometimes the limited space in utero forces babies into an uncomfortable position and they can have a torticollis (or "wry neck"). The birth itself can cause issues too. In a natural delivery, forceps and suctions can cause trauma. With caesareans, the sudden change in pressure affects the cranial bones of the skull and there is a tremendous amount of pressure placed on a child's neck to pull him out,” she says.
 
If you hold your baby up under their arms and their legs don't hang straight down but like a banana, it's a good indication that they are not comfortable and are in need of a chiropractor. “Of all the research on paediatric chiropractic, the one thing that comes out consistently is that chiropractically treated babies sleep better,” says Arkin.
 
Tips for parents
Van Staden suggests parents alternate carrying out the bedtime routine to avoid a situation where baby cannot go down if one particular parent is not present. “The most important principle here is that everyone is on the same page regarding the sleep routine,” she advises.
 
She recommends moving baby out of your room at roughly 3.5 – 4 months. “The baby and adult sleep cycles don't always coincide and this could be the reason for frequent night waking in babies.”
 
Partners can help by taking over one or two night feeds of expressed breastmilk or formula. At this time, it makes sense for mom to sleep in a separate room where she won’t be disturbed, even if just for two or three hours. If your baby won’t take a bottle, let your partner handle burping and nappy changes so you can get back to bed immediately after a feed.
 
It isn’t always possible to nap when baby naps when there are bottles to be sterilised and laundry to be done. Relinquishing as many of these tasks to your partner or a nanny will free up some rest time.
 
The good news is that the extreme tiredness doesn’t last forever. My four- and two-year-old now wake up and make their own bottles without even disturbing us!
 
A note on SIDS
The exact cause of Sudden Infant Death Syndrome (SIDS) is unknown, but the following guidelines are recommended to reduce the risk.
  • Always place a baby on its back for every sleep.
  • Use a firm mattress covered by a fitted sheet. If there is a history of allergies or asthma in your family, consider a hypoallergenic mattress.
  • Have the baby share your room, not your bed. If you bring the baby to the bed to feed, put him back in the cot afterwards.
  • Keep soft objects, such as pillows and loose bedding out of your baby’s sleep area. An infant sleeping bag is a good option in winter as it prevents baby’s head from slipping under the covers.
  • Do not expose your baby to cigarette smoke.
  • Research shows that a dummy reduces the risk of SIDS. Do not attach the dummy to anything that carries a risk for suffocation, choking or strangulation.
  • Don’t dress baby too warmly. Caregivers should watch for signs of overheating, such as sweating or baby's chest feeling hot to the touch.
 
For a list of sleep trainers, paediatricians and chiropractors in your area, go to childmag.co.za/resources/healthcare-practitioners

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