Baby & Child Health

Your baby or child’s health often impacts their sleep! Joan addresses popular topics in health as related to sleep.

Understanding Baby and Child Sleep Cycles

Joan Becker Friedman Baby & Child Health , ,

Variety is the spice of life, but that’s not true when we talk about baby sleep!

As new parents, we want our babies to have predictable sleep patterns. It’s frustrating and exhausting when they don’t. Unfortunately, it’s also normal for newborn sleep to be inconsistent. The best chance you have of catching as many Z’s as possible is to understand baby and child sleep cycles!

Newborn Sleep Cycles

New babies have two stages of sleep. There’s rapid eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. REM sleep is also known as active sleep, while non-REM is considered quiet sleep. A complete newborn sleep cycle includes both REM and non-REM sleep. During each sleep cycle, newborns spend an equal amount of time in each stage. During active sleep, baby’s eyelids may flutter, their mouth might move, they might twitch and their breathing might speed up. During quiet sleep, your baby remains still. 

Sleep Cycles Change With Your Baby

Between three and six months, babies develop a predictable circadian rhythm. This is when their sleep cycles lengthen to about 45 minutes. By six months, each cycle may be 60 – 75 minutes or longer. During this time, non-REM sleep develops into three stages.

  • Phase I – Very light sleep The eyes are closed. Your baby is relaxed but not quite asleep.
  • Phase II – The heart rate slows down; body temperature decreases and muscles relax.
  • Phase III – Deep sleep

During Phase I and Phase II, baby can wake up easily. During Phase III, or deep sleep, it is harder to wake a baby (or grown up, for that matter!)

Baby and Child Sleep Cycles- They Grow Up So Fast

Throughout childhood, sleep cycles progress to looking more like adult sleep cycles. By the time we reach adulthood, sleep cycles lengthen to 90 – 120 minutes. Adults spend approximately 20% of sleep time in REM sleep, whereas newborns spend 50% of their sleep time in REM sleep.

Using Baby and Child Sleep Knowledge to Get More Sleep

Newborn parents often check on their babies*, see them moving or hear them making noises and think baby is awake! We naturally want to jump in and help soothe baby to sleep. Plus, newborn parents are exhausted and want more sleep- whatever it takes!  

All of that said, the best way to help your baby sleep is understanding that movements and noise in REM sleep are normal. If you can wait to intervene until baby lets out a true cry, your baby has a chance to embark on the next sleep stage independently.

At the end of a sleep cycle, a baby (or an adult) either wakes up or just goes on to the next sleep cycle. Babies who sleep through the night, transition easily from one sleep cycle to the next without waking. Or, they may wake briefly (without you even noticing) and self-soothe back to sleep. This is where sleep associations come into play. If your baby associates falling asleep with holding, rocking, bouncing or feeding, they’ll want your help moving between each sleep cycle. If you’re exhausted, helping your baby learn to connect those sleep cycles gives both of you the gift of more sleep!

*If you find yourself checking your baby’s sleep so much that you can’t sleep when they sleep or it interferes with your functioning, please reach out to your medical team. This may be a sign of a perinatal mental health condition requiring additional support and/or treatment.

Understanding the AAP’s New Safe-Sleep Guidelines

Joan Becker Friedman Baby & Child Health, Baby Sleep, Parenting

Here at Peapod Sleep Consultants we’ve been working hard to digest the American Academy of Pediatrics’ (AAP) new safe-sleep guidelines and recommendations. It’s the first time in SIX years they’ve updated this information, so these new recommendations and clarifications are based on research that’s happened since then and will hopefully help prevent Sudden Infant Death Syndrome (SIDS).

At the end of the day, the lead author of the new policy says keep sleep simple. 

“Simple is best. Babies should always sleep alone in a crib or bassinet, on their back, without soft toys, pillows, blankets or other bedding,“ said Dr. Rachel Moon. 

While you may have read the new safe-sleep guidelines, you also might have walked away wondering “what’s new here?” Mostly, these updated suggestions provide more specific guidance to clarify earlier recommendations.

What’s new in the new safe-sleep guidelines?

They’re more specific and they’re meant to clarify the earlier recommendations. Here’s the summary:

  • Try to share your room- NOT your bed- with baby for six months. While some parents may find bed sharing preferable, according to Dr. Rebecca Carline, co-author of the AAP report, said the evidence is clear that bed sharing increases the risk of a baby’s injury or death.
  • Inclined sleepers of any kind are not acceptable for sleep (and the Consumer Product Safety Commission agrees with their new rule banning certain types of inclined sleepers)
  • Swaddling is fine for sleep but should be discontinued with the first signs of rolling over.
  • Avoid weighted blankets, weighted swaddles or weighted sleep sacks.
  • Keep pillows, bumper pads, stuffed animals, blankets or any other types of soft bedding out of baby’s bed.
  • Try not to use car seats, bouncers, strollers, carriers, swings and slings for naps or night sleep. If a baby falls asleep in a car seat, they should be transferred to a crib or bassinet as soon as possible. During the first few months of life, a baby doesn’t necessarily have head or neck strength to keep their airway open in one of these products. 
  • Heart rate monitors and pulse oximeters you can buy in your average baby store are not recommended. The concern is false alarms and that they may provide parents with a false sense of security.

About That Six Month Rooming-In Suggestion

Yes, the guidelines suggest that you keep baby in your room for six months. But, there may be circumstances where it makes sense for your family to move baby to their room sooner. We say this with the knowledge that the greatest risk for SIDS is between one and four months. If you’re so sleep deprived at night that you’re bringing baby into your bed to catch up on sleep, it may be less risky to move baby into their own room than to keep them with you. Before you make any decisions, consult with your pediatrician. 

Returning Safe-Sleep Recommendations

The following safe-sleep guidelines remain part of the AAP’s recommendations:

  • Place your child on their back to sleep for all naps and night sleep.
  • Avoid overheating (68-72 degrees is the sweet spot)
  • Breastfeed or provide expressed human milk for six months or more. Editorial note: Fed is best! Please don’t feel any guilt if breastmilk is not a good choice for your family.
  • Offer your baby a pacifier at sleep times.
  • Avoid smoke exposure, alcohol and illicit drug use.
  • Try to work your baby up to 15 to 30 minutes of daily tummy time each day by seven weeks.

If you’re ever in doubt about a particular product, consult the Consumer Product Safety Commission https://www.cpsc.gov/ or the Juvenile Products Manufacturers Association https://www.jpma.org/. If you have questions about any part of the newly revised guidelines, it’s best to consult with your child’s pediatrician.

Bedtime Changes For Sleep Anxiety

Joan Becker Friedman Baby & Child Health, Common Sleep Challenges, Nighttime Sleep, Toddler Sleep , ,
mother laying with child

“Mommy, lay with me.” 

“Can you hold my hand until I fall asleep?”

“One more hug.”

They’re the sweet bedtime murmurs of your little- or the exhausting demands of a child struggling with sleep anxiety. 

When children show sleep anxiety at bedtime (and they don’t express it during daytime hours) these manifestations- clinginess, procrastination, “one more…”- may be a sign that your child hasn’t mastered the ability to fall asleep independently. These kiddos don’t want you to leave their room because they can’t fall asleep without you. Your child stays on “high alert” each time you try to go. 

Inside your scared sleeper’s body their fears are getting in the way of their sleepiness. 

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Popular Baby Sleep Products Banned by New Regulation

Joan Becker Friedman Baby & Child Health, Baby Sleep

On Wednesday, June 2, 2021, the Consumer Products Safety Commission (CPSC) approved a new infant safety regulation. All products intended for infant sleep will be tested to make sure the angle is less than 10 degrees AND they must meet current standards for cribs and bassinets. Neither of these is required of inclined sleepers and similar baby sleep products today.

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When Your Baby’s Head-Banging- And not the Rock & Roll Kind

Joan Becker Friedman Baby & Child Health, Baby Sleep

Thump, thump, thump. You check the monitor. You see your baby bumping his or her head against the crib. Yikes! It’s understandably upsetting and worrisome. Here’s the good news; this baby head-banging, where babies or young children repeatedly hit their head against a crib, mattress, wall or pillow, looks painful, but in a healthy child, it is a form of self-comfort. 

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Reflux & Your Baby

Joan Becker Friedman Baby & Child Health, Baby Sleep, Common Sleep Challenges , , ,

Reflux can cause baby sleep challenges but not all baby sleep challenges are due to reflux. When it comes to reflux, there can be a bit of confusion regarding symptoms, causes and treatment. Let’s get the facts straight!

What is reflux?

There are two types of reflux. There’s GER or Gastroesophageal Reflux, also known as just reflux and then, there’s GERD or Gastroesophageal Reflux Disease. 

Reflux can start as early as a few weeks of age but, usually, starts between two and four months. This is generally the time that infants start consuming larger amounts of breastmilk or formula.

GER is quite common. With GER your baby’s milk & other stomach contents back up into the esophagus. Sometimes, you might see it come out through the mouth or nose. GER starts to ease up at six months and usually resolves by nine to 12 months. GER diminishes at this time for a few reasons: 1) the muscle between the esophagus and stomach (the esophageal sphincter) tightens up; 2) most babies start sitting up and 3) most babies begin eating solid foods. All of these factors make it harder for baby’s food to work against gravity to come back up.

While GER is common, GERD is not so much. It is similar to GER in the fact that it causes baby’s food to come back up. The difference is that GERD results in complications. GERD causes inflammation of the esophagus and/or oropharynx. If GERD is not managed , it can lead to more serious complications such as airway problems (wheezing, gagging or difficulty breathing), poor feeding and inadequate weight gain.

Due to the acidity of stomach contents, both GER and GERD can cause discomfort.

How do you know if your baby has GER?

Common symptoms of GER include the following:

  • Spitting up or vomiting after feedings
  • Fussiness, irritability
  • Back arching, head thrusting
  • Difficulty self-soothing and falling asleep

Some babies have “silent reflux”.  With silent reflux, a baby won’t necessarily spit up or vomit but this type of reflux can result in inflammation of the esophagus and an uncomfortable baby.

If you notice these symptoms, check with your pediatrician. Your pediatrician will also be able to figure out if your baby has reflux or an allergy to milk or formula, which is another possibility with the same symptoms.

Many parents get concerned if they see their baby spitting up regularly. But, that’s normal! If they aren’t bothered by it, your little one is probably just a “happy spitter”!

How can you help your baby’s discomfort?

  • Feed your baby smaller amounts more often.
  • Burp you baby frequently while feeding.
  • Hold baby upright for 15 – 30 minutes after every feeding.
  • If your baby is bottle feeding, make sure that the size of the bottle’s nipple hole is appropriate for your baby.
    • If the hole is too small, your baby will swallow too much air.
    • If the hole is too large, your baby can take in too much fluid.

Could reflux be the reason your baby isn’t sleeping well?

If your baby falls asleep while feeding, rocking, swinging or bouncing, and wakes up regularly, those wake-ups are likely due to a sleep association. If you’re putting baby down calm, but still awake, an occasional wake up might be due to reflux.

While many parents used to think wedges or inclined sleepers helped babies with reflux, wedges and inclined sleepers are not safe. The American Academy of Pediatrics does not recommend inclined sleepers for reflux. The use of these products has resulted in death.

Can medication or diet help?

“The good news about reflux”, says Dr. Tim Marsho from Tosa Pediatrics, “is that it almost always gets better without any intervention at all.”

If you do need to make changes, your pediatrician can guide you.

With all the different formula options out there, they might recommend trying a different option. If you’re nursing, your doctor may suggest tracking your diet and limiting anything that seems problematic.

According to Dr. Marsho, reflux medication is used much less frequently than years ago. “There is growing evidence that medication does not help as much as we once thought it did. In fact, there are safety concerns with long-term use of medications. If we have to resort to medication, it’s only for a very short period of time.”

While reflux can be a nuisance for babies and very stressful for parents, it is normal. Dr. Marsho reassures parents that “it is not a medical problem”. In most cases, it resolves by nine to 12 months. You and your pediatrician will figure out the best way to address this temporary nuisance. If your baby’s intake is inadequate, weight gain is insufficient or there are compromising respiratory issues, your pediatrician may recommend further diagnostic testing. Fortunately, this is a much less common scenario. 

Everything You Need to Know About Teething

Joan Becker Friedman Baby & Child Health, Baby Sleep, Common Sleep Challenges, Nighttime Sleep , , , , , ,

Everything Gets Blamed on Teething!

Teething gets a bad rap! Teething takes the blame for just about everything, including disrupted sleep. A lot of parents say their child has been teething FOREVER. And, many parents feel that teething is surely the reason their little one isn’t sleeping well. We’ve broken down just about everything you need to know about teething- including separating teething facts from teething fiction.

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