Wednesday, February 15, 2012

On scheduling and sleep, or: What do I do with my baby all day?

A few weeks ago, I wrote a long and rambling post about infant sleep but decided not to post it. It was too disorganized, and I couldn't figure out what my point was. 

So, here's my second attempt, and I will clarify my point up front: I'd like to share what I know about infant sleep so that if you have a new little one or if you have one on the way (or for whatever reason, you are interested in infant sleeping patterns), you won't make the same mistakes that we made.

I'll start off by offering the following guideline: Think of each day as a math equation that consists of sleeping parts and awake parts. Your goal in the first four months of your baby's life is to create a day that consists of the following parts:
  • Awake for the day.
  • Nap 1.
  • Awake.
  • Nap 2.
  • Awake.
  • Nap 3.
  • Awake.
  • Asleep for the night.
Some babies fall into the 3-naps-per-day schedule early on, while others prefer taking many catnaps throughout the day. However, by four months, most catnappers have lengthened their naps and can have 3 naps per day.

The trickiest part of this math equation is determining how long the awake periods should be. For most babies, the first awake period of the day is very short, particularly for newborns. Most babies can handle being awake for only an hour before needing to go back to sleep for what might be a lengthy nap.

E, who is one of the sleepiest babies I have ever heard of and who continues to sleep 15 or 16 hours every day, could handle being awake for only an hour until he was 5 or 6 months old, maybe older. (It's a bit hazy.)

The second awake period is usually longer, though again, with very sleepy babies, you might be looking at an awake period of only an hour in the first few months. Until just a month or two ago, E couldn't go much longer than an hour and 45 minutes without turning into a gremlin.

The length of the third nap varies, but it's frequently the shortest and is the first to be dropped, at some point by 9 months. After the third nap is typically a baby's longest awake period of the day, so it's a good time to try out solid foods (if you're there) or run an errand.

During the awake periods, you feed your baby, change his diaper (typically at wakeup and before going down), and play with him. You might feed your baby upon wake-up or right before putting him to sleep. Newborns typically fall asleep while feeding, so there isn't much opportunity for play, but with an older baby, the awake period is a good time for kicking on a play mat, practicing tummy time, playing peekaboo, or watching Mom or Dad do household chores.

Your job as a parent is to learn your child's sleepy cues so you can figure out the ideal awake periods for your baby. Signs of sleepiness include a dazed look on the face, yawning, and rubbing eyes. If you see either of the last two signs, put that baby to sleep immediately because he's in danger of getting overtired, and if he gets overtired, he will be very difficult to put to sleep. If he gets overtired and is very difficult to soothe and settle, note how long he was awake, and put him to sleep after a shorter wake-up period the next day.

Every baby is different, but I'll give a sample schedule of how a day might go for a four-month old:
  • Wake-up: 7:00 AM
  • Nap 1: 8:00 - 10:00
  • Nap 2: 11:30 - 12:30 PM 
  • Nap 3: 2:30 - 3:30
  • Bed: 6:00
  • Nighttime wake-ups: Ideally, no more than 2 for feedings, usually around midnight and 3 or 4 AM.
You might think that a 6 PM bedtime is very early. For some babies, it is. But most babies should go to bed between 6 PM and 8 PM (though some go to bed later in the first month or two). Don't make the mistake of thinking that your baby will sleep better at night if you keep him up. In fact, the opposite is true. A baby sleeps better at night if he sleeps well during the day, isn't allowed to get overtired, and goes to bed at the right time for him.

E's bedtime is even earlier than 6 PM most nights. He has gone to bed as early as 4:15 and slept through the night. On daycare days, he usually goes to bed around 5 PM.

Here is a typical (non-daycare day) for E these days:
  • Wakeup: 6:45 AM
  • Nap 1: 9 - 10:30 AM
  • Nap 2: 1:00 - 2:30
  • Bed: 5:30 PM
Again, this comes back to the math equation. I know that E can be awake for a little more than 2 hours after waking up, and I know that he can be awake for 2-3 hours after his first nap. He consistently goes to bed for the night 3 hours after waking from his second nap.

You'll note that E is down to only 2 naps. By 9 months, babies' naps get longer in duration and they drop their third nap. Almost overnight around 8 months, E went from 45 minute naps to hour-and-a-half naps (an amazing transformation). Now I sometimes have to wake him from his first nap in order to keep his naps on schedule. (A note about waking a sleeping baby - don't do it, unless his sleeping will prevent him from taking his next nap on schedule. That doesn't happen until you're down to 2 naps per day and have a regular sleeping schedule.)

You might be thinking that this schedule is rigid and doesn't leave a lot of flexibility for leaving the house. You are correct. I believe I have blogged about my house arrest status. However, life is full of choices, and we have made the choice to put Eli's sleep first. He's been sleeping through the night since 7 1/2 weeks, so I believe that we are making the right choice.

And if you're wondering when babies drop their morning naps: That usually happens between 12 and 21 months.

If you want to learn more, check out Healthy Sleep Habits, Happy Child by Marc Weissbluth. Its organization is shockingly bad, but the content is great. (That said, prepare yourself for needing to read it multiple times to figure out the most important parts.)

Monday, February 13, 2012

So sick

I have been known to make fate-tempting declarations, including "I've never had a cavity!" and "I'm one of the healthiest people I know!" The former is still true (so far). The latter, sadly, is no longer true.

I've been sicker this winter than I've ever been in my life. I'll take it even further: I think I've been sicker this winter than the average person. Sicker than average! Nobody wants to be average (right?), but even less desirable is worse than average.

But so it is, and E, our huggable, lovable little mucus factory, is almost entirely to blame. That little boy's nose hasn't stopped running since mid-November, with the exception of a 3-day stretch in which he battled the norovirus and nearly had to go to the ER for dehydration.

The norovirus was the tipping point for me, when my winter went from unpleasant (two cases of mastitis, a cold, and a couple of sequences of bad sleep for E) to downright horrible. E caught the bug first, naturally. B and I spent the weekend holding him and spoon feeding him Pedialyte, praying for wet diapers and no more vomit.

B caught the bug next and had a milder case. A few days passed, and I thought I had escaped without succumbing, but in the end, the stomach bug bell tolled for me, too, just days after I caught another cold.

The stomach bug went away. I started feeling better. And then a week and a half ago, I got a sinus infection. I suffered through a weekend of headaches, sinus aches, and toothaches, and then I went to the doctor on a Monday. She recommended waiting to take antibiotics in case the infection cleared on its own and prescribed Afrin and Motrin in the meanwhile.

This occasion was the third in my life in which I waited to take antiobiotics. The first time, when a doctor diagnosed bronchitis, I made the right decision, and the illness went away on its own. The second time, when I had mastitis, waiting was the wrong decision and just made the illness worse. And in this case, I suspect that waiting was again the wrong decision, though there's no way of knowing whether time or the drugs helped with my symptoms.

When the Motrin was no longer doing anything for my pain, I filled the amox prescription and then had to wait another 2 days before I felt any improvement. Now on day 5 of the antiobiotics, I can almost start chewing on the left side of my mouth again.

My inability to chew on the left side of my mouth for over a week combined with a stomach virus and the generally poor appetite that accompanies illnesses has left me at my pre-college weight. Is this Mother Nature's way of helping me drop any remaining baby pounds because if so, she has achieved her goal and then some.

So, here is my warning to all soon-to-be and future parents: If your child goes to daycare, your first winter is going to be hell. There will never be a day when all of you are healthy. And you'll never know whether this coughing illness or that vomiting illness will leave your child unable to sleep through the night for days at a go.

According to our pediatrician, the first winter is the worst. Please let it be so.