Thursday, August 12, 2010

Infant Sleep: Receptiveness more important than Routine.

Research showing that a caregiver's responsiveness to a child is more important than routine in getting a good nights sleep.

For infant sleep, receptiveness more important than routine

Parents understand the challenge of getting infants to sleep through the night, and now Penn State researchers show that being emotionally receptive can reduce sleep disruptions and help infants and toddlers sleep better.

"Bed time can be a very emotional time. It heralds the longest separation of the day for most infants," said Douglas Teti, professor of human development and family studies. "It struck me that going to sleep, and sleeping well, is much easier for some young children than others, and I wanted to assess what factored into this, and what parents and children contribute to sleep patterns."

In the study, which examined mothers' behaviors during infants' bedtimes, parents had the most success with their children's sleep when they responded appropriately to their children's cues. These include showing disinterest in an activity or simply glancing inquisitively at a parent. For example, one mother in the study talked quietly and gently to her 6-month-old infant while breastfeeding.

"She continuously gazed at the infant's face and, whenever the infant vocalized, she responded promptly (e.g., 'It's OK.')," the authors report in a recent issue of the Journal of Family Psychology.

In contrast, a different mother in the study "used stern directives with her 24-month-old during book-reading whenever the child got up out of bed," and "continually attempted to engage the child in the book despite clear signs that the child was losing interest (e.g., child was fidgety and continually turned his attention elsewhere)," the authors note. The result: "the child got up and left the room four times before he eventually fell asleep."

When parents provide reassurance through emotional communication, Teti and his colleagues believe that it lets children know they are in a safe environment.

"Emotions are the most basic form of communication between babies and parents," Teti said.

His findings pose new challenges to parents because they suggest that being emotionally available -- paying attention to cues and responding to children appropriately -- is more effective than a specific bedtime behavior in promoting better sleep.

The researchers found no significant relation between sleep disruptions and the amount of time parents spent in close contact with infants or involved in quiet activities before bedtime. This contradicts past research, which had suggested that prolonged close physical contact with a parent undermines babies' ability to sleep on their own.

This study was one of the first to use direct observation of infant sleep patterns, and is the first to use multiple video cameras in the infants' and parents' bedrooms to capture parent-infant interactions at night.

"Sleep is a context about which we know little," said Teti. "It can be a very emotionally charged period for parents and babies. Looking at parent-child interactions in this context could be more telling for childhood outcomes than what you see in a more structured daytime play session." Many existing studies of parenting have focused on controlled play environments, in which researchers have studied parent-child interactions and emotions.

Teti's study, SIESTA I (Study of Infants' Emergent Sleep TrAjectories) looked at data from 35 families, and he sees very similar results in an ongoing longitudinal study, SIESTA II, which is a more in-depth analysis of factors promoting infant sleep as infants age, from 1 to 24 months. SIESTA II is funded by the National Institute of Child Health and Human Development.

One of the next steps will be to examine links between infants' temperamental styles, parenting at bedtime and during the night, sleep disruptions, and development, according to Teti.


Other authors on the paper include Bo-Ram Kim, Gail Mayer and Molly Countermine, all Human Development and Family Studies graduate students at Penn State at the time of the research.

Nursing Noah: A Love Story.

Noah Christopher was born at 6:31 pm on December 3rd after a long hard labor. I put him to the breast right away. He was a little disinterested whether from the epidural or from the pure shock of entering the world. He did attempt to latch a couple of times but I couldn't tell if he was actually latched on. I was still high on the "this is MY baby and he just came OUT of me" emotions.
We tried to nurse through out that night but mostly, we slept, tucked in together safely by the most wonderful night nurse on maternity. The next day proved difficult and we made good use of the hospital lactation consultant. He wasn't latching well (now I know due to a flat nipple on one side and probably the fact that well, I was very large chested postpartum and he has a small jaw). I was given a nipple shield and on we went.

I stressed about using the nipple shield but it saved us. I didn't have any side effects from it like lack of supply from less stimulation, or nipple confusion,etc. We went on to use it for 3 months when he self-weaned himself from it in a couple of days..he just was suddenly able to latch normally! Woohoo...!

He nursed every two-three hours for the majority of the first year. I also nursed him to sleep until he was at least 16 months old for most of his naps and bedtime. Some of my fondest memories are of the late night/early morning feedings when he was still tiny... it was just me and him snuggling in bed and the bonding that happened was incredible. His little dark blue eyes looking up at me until they closed in blissful milk-drunk sleep.

There were tears of exhaustion some nights when he was teething and wouldn't stop nursing but I was thankful that I had a way to soothe him. We struggled with nursing in public due to his distractedness and often had to find a quiet place to successfully nurse. Sometimes I would feel desperate looking around for a place to nurse, in say, the grocery store, where truly, none exist. The car would end up being the go-to place even though uncomfortable. We battled thrush from time to time When I returned to work for a short while, pumping was a savior for my supply and a good way to stay connected to Noah throughout the day. Turns out, he much preferred mommy and had a hard time sleeping/eating while I was gone. Happily, I stayed home.

We found ways to work around the stresses that go with nursing a baby. When I was exhausted nursing him to sleep, daddy would take over and rock. If he was too distracted to eat in public, I popped him in a sling or ergo carrier and nursed him there, sometimes with a cover to get him to sleep. I continued pumping after I came home from working so I could go out once in a while.

I worked nights for a short time and daddy had to take over soothing Noah at night. Since we cosleep he was still night nursing and got the majority of his milk that way. He slowly transitioned to a bottle a night of soy or almond milk and started sleeping better. He still nursed about 3 or 4 times a day.

I became pregnant and almost instantly he noticed a difference in the taste of my milk. He started nursing less and less. My milk supply was gone by 13 weeks. He's no longer nursing during the day and asks maybe once a night to nurse before deciding it's not worth the effort. We rock and snuggle to sleep with his lamb and blankie. At first, I cried a lot mourning the loss of our nursing relationship. Especially when he told me that I had "ew milk". haha. Now, I'm enjoying the evolution of our bonding experience and love rocking and holding him to sleep. It's hard to accept that he is growing up and becoming a little boy instead of a baby. I think it will make the transition to having another baby easier to have only one nursling.

Although, difficult at times, I had such a blissful experience nursing him and am so thankful that I was able to. We've bonded incredibly and I only wish that I could provide him with milk longer than I am able to. At 20 months, he is almost completely self-weaned. I didn't imagine it would be this easy. I think that because I trusted my instinct nursing him on demand as well as in general during his weaning process, he was able to self-wean easily. It's a bittersweet time for both of us and as he talks about the new baby in mommy's tummy, I have a feeling that it will be this way for a while. It's hard to believe he is growing up...and as every mother says, he'll always be my baby.