"Ask Me Anything" about Feeding & Sleep with Dr. Monica Ordway

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  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert


    Hi @Jodie the following may be helpful:

    INFANT SLEEP SCHEDULE: Before the age of 3 months, newborns have not developed the biological rhythm (circadian rhythm) that organizes their sleep based on light and darkness. This is developed between 3-12 months, and it varies from baby to baby. Research has identified that before 3 months of age, babies have two sleep stages. After 3 months, babies begin to develop the four stages of sleep that older children and adults experience. As such, sleep training is not recommended before 4-6 months of age since they are not developmentally or biologically ready. In the meantime, you can work on developing a good bedtime routine that will set the foundation for healthy sleep hygiene.

    BEDTIME ROUTINE: The key to a bedtime routine is consistency. It is never too young to start a bedtime routine. A good bedtime routine includes 4-5 quiet activities that are done in the same order and at the same time each night. These activities should not last more than 20-30 minutes total and include an opportunity to have quality parent-child interaction. A few examples of good bedtime routine activities include: pick up toys; wash hands and face; brush teeth; put on pajamas; listen to music; sing a song (avoid energetic dancing); read a book (or two, but avoid developing a habit of ‘one more book’ and increase book reading at other times during the day instead); say prayers; share a good thing that happened during the day; hugs and kisses, etc. Early in infancy, you might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert
    edited December 2021

    Hi @Karleighw and @Shelbyruppert91 - it sounds like you are experiencing similar challenges with your 5 month old children. Please see below!

    INFANT SLEEP SCHEDULE: Before the age of 3 months, newborns have not developed the biological rhythm (circadian rhythm) that organizes their sleep based on light and darkness. This is developed between 3-12 months, and it varies from baby to baby. Research has identified that before 3 months of age, babies have two sleep stages. After 3 months, babies begin to develop the four stages of sleep that older children and adults experience. As such, sleep training is not recommended before 4-6 months of age since they are not developmentally or biologically ready. In the meantime, you can work on developing a good bedtime routine that will set the foundation for healthy sleep hygiene.

    BEDTIME ROUTINE: The key to a bedtime routine is consistency. It is never too young to start a bedtime routine. A good bedtime routine includes 4-5 quiet activities that are done in the same order and at the same time each night. These activities should not last more than 20-30 minutes total and include an opportunity to have quality parent-child interaction. A few examples of good bedtime routine activities include: pick up toys; wash hands and face; brush teeth; put on pajamas; listen to music; sing a song (avoid energetic dancing); read a book (or two, but avoid developing a habit of ‘one more book’ and increase book reading at other times during the day instead); say prayers; share a good thing that happened during the day; hugs and kisses, etc. Early in infancy, you might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room.

    When you are ready, you may consider graduated extinction as a sleep training option: Start with a bedtime routine described above that ends with saying your mantra each night before leaving the room. If/when your baby beings to cry, wait 10 minutes before going in then calmly and quietly go to their crib and repeat the mantra in the same tone and with the same calming effect. Leave the room and wait 15 minutes before returning to say your mantra with the same loving, but firm and calm tone. Repeat this process, adding 5 minutes between each time period you go to his room. Babies do not understand time, but the consistent bedtime routine that includes hearing your voice with the same words repeated can provide predictability and comfort. This process allows babies to gradually learn to fall asleep independently while at the same time feel the comfort that you are not far away.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @Kasey Please discuss this with your pediatric primary care provider. This is common especially when approaching toilet training.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @MishnaS Sleep duration recommendations at this are are 12-15 hours in 24 hours. This 3 hour difference can make it difficult to compare one child to another - even if they are twins. That said, it is not thought that sleeping 15 hours is better than 12 hours at this age, as long as your baby is growing and developing well and there are no other concerns. Sleeping 7pm-6:30am is close to the 12-hour recommendation and that makes me wonder if one twin needs more sleep than the other. That said, offering a rest period without actual sleeping can still be helpful to both baby and parent. Be firm - stronger, bigger, wiser parent (Circle of Security term) - but loving at bedtime and naptime and avoid negotiating or pleading with babies and toddlers. You might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @Sunnie The key to a bedtime routine is consistency. It is never too young to start a bedtime routine. A good bedtime routine includes 4-5 quiet activities that are done in the same order and at the same time each night. These activities should not last more than 20-30 minutes total and include an opportunity to have quality parent-child interaction. A few examples of good bedtime routine activities include: pick up toys; wash hands and face; brush teeth; put on pajamas; listen to music; sing a song (avoid energetic dancing); read a book (or two, but avoid developing a habit of ‘one more book’ and increase book reading at other times during the day instead); say prayers; share a good thing that happened during the day; hugs and kisses, etc. Early in infancy, you might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @Deena The recommended amount of 24-hour sleep for babies 4-12 months of age is 12-16 hours (including naps) . This is a wide range and parents with babies who sleep 12 hours in 24 hours understandably experience this period differently than parents with babies who sleep 16 hours in 24 hours. Calculate the number of hours your baby gets in 24 hours and if routinely less than 12 hours then seek advice from your primary care provider or a sleep specialist.

    In the meantime, developing a good bedtime routine is critical to good sleep hygiene. The key to a bedtime routine is consistency. It is never too young to start a bedtime routine. A good bedtime routine includes 4-5 quiet activities that are done in the same order and at the same time each night. These activities should not last more than 20-30 minutes total and include an opportunity to have quality parent-child interaction. A few examples of good bedtime routine activities include: pick up toys; wash hands and face; brush teeth; put on pajamas; listen to music; sing a song (avoid energetic dancing); read a book (or two, but avoid developing a habit of ‘one more book’ and increase book reading at other times during the day instead); say prayers; share a good thing that happened during the day; hugs and kisses, etc. Early in infancy, you might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @marinakyriacou1 The recommended amount of 24-hour sleep for babies 4-12 months of age is 12-16 hours (including naps) . This is a wide range and parents with babies who sleep 12 hours in 24 hours understandably experience this period differently than parents with babies who sleep 16 hours in 24 hours. With naps, it sounds like your baby is meeting the recommendations for sleep duration. Recommendations are also that it take less than 20 minutes to fall asleep at night.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @ancastan This is an extremely common concern among parents of toddlers. It is always important to work with your child's pediatric provider to be sure there are no developmental or growth concerns. Assuming all is on track, developmentally and with growth, there are a few things to understand about toddlers and how this stage can present challenges with eating. First, the growth rate during toddlerhood is much slower than that during infancy, so to parents, it can be worrisome to see a reduced interest in eating. Second (and perhaps most commonly the root of the issue), toddlers have developed the ability to walk, run, play, and explore and these newfound freedoms become their primary interest. As such, they will most commonly eat only when they are hungry. Taking time out to eat means taking time out to explore. So, if your toddler comes to you looking for something to eat and you have not yet finished preparing the next balanced meal, what do you do? Commonly, parents understandably, offer a few crackers or a fruit pouch or some other small snack without realizing that those few calories are enough to curb their appetite and allows them to go back to exploring the world. The next time they experience hunger and the desire to stop exploring will not likely line up with mealtime. Therefore, be careful to avoid the trap of offering a few empty calories and take comfort knowing that toddlers will commonly have days when they eat a lot and days when they eat less. The goal is to give them meals and snacks that support their growth and development.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @Rcondon

    Two things may be helpful:

    1. consider whether or not your baby is overtired - babies who are overtired can struggle more to fall asleep. Try moving up your baby's nap/bedtime by 15 minutes each night for a few days to see if a 15, 30, or 45 minute earlier bedtime helps.

    2. Be sure to establish a bedtime routine. The key to a bedtime routine is consistency. A good bedtime routine includes 4-5 quiet activities that are done in the same order and at the same time each night. These activities should not last more than 20-30 minutes total and include an opportunity to have quality parent-child interaction. A few examples of good bedtime routine activities include: pick up toys; wash hands and face; brush teeth; put on pajamas; listen to music; sing a song (avoid energetic dancing); read a book (or two, but avoid developing a habit of ‘one more book’ and increase book reading at other times during the day instead); say prayers; share a good thing that happened during the day; hugs and kisses, etc. Early in infancy, you might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room. If you have not tried gradual extinction, then it may be a good solution. Start with a bedtime routine that includes 4-5 bedtime routine activities that last a total of 20-30 minutes each night and are consistently performed. Develop a mantra like "good night, I love you, I will see you in the morning" and repeat that phrase each night before leaving the room. If/when he beings to cry, wait 10 minutes before going in then calmly and quietly go to his crib and repeat the mantra in the same tone and with the same calming effect. Leave the room and wait 15 minutes before returning to say your mantra with the same loving, but firm and calm tone. Repeat this process, adding 5 minutes between each time period you go to his room. Babies do not understand time, but the consistent bedtime routine that includes hearing your voice with the same words repeated can provide predictability and comfort. This process allows babies to gradually learn to fall asleep independently while at the same time feel the comfort that you are not far away. Try to avoid random time points when you go in to comfort and follow a consistent process of gradually lengthening the time between parent visits.

  • DrMonicaOrdway
    DrMonicaOrdway Member, Expert

    @Nina93 and @Hayden615 - Waking early is most likely part of his biological clock and common in early childhood. There are a number of reasons why toddlers wake frequently. First question is whether or not your toddler snores. Snoring is not something to ignore in children and should be evaluated by a sleep specialist. There are a couple of underlying reasons why young children snore that can impact the quality of their sleep and cause frequent wakings. Second, children sleep better when they fall asleep after a bedtime routine. If you are present when your toddler falls asleep (e.g. in the bed with them) then when they experience the 6-10 microarousals that are a normal part of they sleep cycles then they may wake more fully until you help them fall back to sleep in the same method they did to start the night. The key to a bedtime routine is consistency. It is never too young to start a bedtime routine. A good bedtime routine includes 4-5 quiet activities that are done in the same order and at the same time each night. These activities should not last more than 20-30 minutes total and include an opportunity to have quality parent-child interaction. A few examples of good bedtime routine activities include: pick up toys; wash hands and face; brush teeth; put on pajamas; listen to music; sing a song (avoid energetic dancing); read a book (or two, but avoid developing a habit of ‘one more book’ and increase book reading at other times during the day instead); say prayers; share a good thing that happened during the day; hugs and kisses, etc. Early in infancy, you might develop a mantra like, “good night, I (we) love you, I (we) will see you in the morning” and repeat this every night as the last thing you say to your baby/child. This type of mantra can be helpful if children go on to develop bedtime resistance. Most importantly, allow your baby the opportunity to fall asleep independently to avoid a sleep association with you present. If they fall asleep during the routine then gently wake them so they are drowsy but awake when you leave the room with the comfort of hearing you repeat the mantra as you leave the room.

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