Holistic Baby Sleep Workshop

Life in the first 6 months of being a parent! Feeding methods and parental factors.

In this series of mini blogs we look at life in the first 6 months of your baby’s life. Week 2 discusses how feeding methods and parental factors affect baby sleep.

Does feeding method make a difference to baby sleep?

There is evidence to show that exclusively breastfeeding mothers get the most sleep in these early months and that mixed feeding mothers get the least! This is not meant to discourage a mother from mixed feeding her baby, as any amount of breastmilk is highly beneficial. It is merely meant to demonstrate what effect parental behaviour can have on baby sleep. Let me elaborate!

Breastfeeding – not compatible with sleep?

Breastfeeding mothers who co-sleep with their babies – whether this is in the family bed or in an adjacent baby sleep space get the most sleep of all mothers despite their babies waking more frequently. This is because the baby is in close proximity and because breastfeeding induces melatonin in the mother and passes to the baby. Therefore, despite more waking, mum and baby settle quickly back to sleep, and often mum is unaware of how many times her baby may have fed in the night.  Why is baby waking more frequently? Most likely due to the need for a breastfeed to induce sleep – i.e. baby associates breastfeeding with how they get to sleep so every time they stir and move through a sleep cycle, they need a quick feed to resettle them. This is only a problem if mum deems it so and has been the biological norm throughout human history.

So, what is a bottle-feeding mum doing differently?

Firstly, bottle feeding babies are not as safe in the parental bed as a breastfeeding baby – this is due to baby being in a deeper sleep and baby not associating the breast with night-time comfort. This means baby is more likely to be closer to mum’s face rather and therefore nearer pillows. Breastfeeding mums also assume a curved side lying sleep position automatically, which bottle-feeding mummies do not seem to do.

Secondly, getting up to prepare a bottle (regardless of prep method or whether it is expressed breast milk) is generally much more disruptive to maternal (or paternal!) sleep than offering a quick breastfeed. Therefore, bottle feeding mums will often offer an alternative source of comfort and settling. This reduces baby’s dependence on one method of settling only, in addition it takes time to get up and prepare a bottle thus baby is naturally having to wait before comfort and/or milk arrives.

Whether this is beneficial or not depends on your point of view – sometimes baby will be very cross about the wait and therefore take into more air, feed more vigorously and take longer to settle after a feed – obviously not ideal at 3am! Sometimes however, baby will stir, shuffle about, whinge a little and then drift off back to sleep. If mummy has to get up to make a feed, she is likely to wait to see if baby is really going to shout for this feed before leaving the warmth of her bed – therefore she gives her baby a chance to resettle themselves, and they start to learn this skill.

Breastfeeding mummies know that if they offer the breast quickly at first sign of baby stirring then baby will drift off to sleep after that feed without a fuss. There really is no right or wrong between these 2 scenarios.

So how does the poor mixed feeding mummy end up with less sleep?

Interesting Kendall-Tackett et al (2011) report no statistical difference in maternal physical health and self-reported energy levels between mixed and fully formula feeding mums. Although these mums did report increased tiredness over formula feeding mums. In a large Chinese study, however, it appeared that partially breastfed infants woke more frequently than exclusive breastfed babies and formula fed infants (Huang et al, 2016). Increased night waking among partially breast-fed infants in the above study may be explained by more frequent infant feeding among partially breast-fed infants compared to exclusively formula-fed infants. It may be that the exclusively breastfeeding mums did not realise how often their babies were feeding?

So, what about regressions and leaps?

Are these a ‘thing’? We have seen in part 1 that a baby’s sleep changes dramatically at around 4-5 months – is this really a regression or a huge development?

Leaps is a term coined by Frans Plooij and his wife in their popular ‘Wonder weeks’ book and app – they describe weeks during a baby’s first 20 months which are particularly disruptive to sleep. The research behind this book has not been able to be replicated and it was based on a very small sample size. Regardless of the debate of the validity of the research, there is no doubt that as a baby makes physical and cognitive developments, their new perspective of their world will understandably lead to disruptions in sleep.

What parental factors do we need to think about?

Family dynamics – some of the factors which influence how a family feels about their sleep situation are listed below. Often a parent feels that improving a child’s sleep will improve their sleep and therefore their daytime functioning. While this is true in some cases, often there are lots of variables in each family’s situation.

Factors such as; parenting without support, the influence of surrounding community or culture and whether grandparents/partner and/or friends are supportive, can have a huge influence on how a parent feels about sleep.

Herman et al (2012) found less parenting stress was related to more positive parenting perceptions. As parental stress will affect child behaviour and stress levels (Barsade, 2002) supporting a parent with a holistic approach may improve family sleep by itself.

Emotional health of the parents is not the only factor in influencing family sleep, physical health made worse by lack of sleep is often an issue (Walker, 2017). This also makes it very hard for the parent to have the resilience or ability to make changes. Financial and work situation is often a motivator for parents to make changes as they are concerned about how they will manage work on a lack of sleep. This might result in a situation where the child’s sleep is developmentally normal, but the parent cannot manage their daily tasks on top of poor sleep (Meltzer and Mindell, 2007).

Sometimes the family’s antenatal experience has led to unresolved issues, such as a child not being planned, or health issues of the unborn baby, mother or any other siblings. There is evidence that in-utero environment for babies of mothers with anxiety or depression affects that child’s sleep once born (O’Connor et al, 2007).

Parental biological chronotype –morningness or eveningness (known as chronotype) is determined mainly by genetics and refers to whether a person is naturally more alert in the early morning or evening. 40% of the population are morning types, 30% are evening types and the rest are in between (Walker, 2017). There is some evidence to suggest that morning types report more positivity than evening types (Biss and Hasher, 2015). It may be fair to say though that if a morning-type adult has a child who takes a long time to settle for bed, they will struggle with this. Likewise, an evening-type adult may find early rising in their child particularly hard to deal with. Thus, it is prudent to discuss these aspects with parents and factor them into any suggestions made to improve sleep.

Personality – La Vigouroux et al (2017) looked at the personality types of parents who experience burnout. They found that parents who have difficulty maintaining affectionate relationships with their children, those that struggled to respond to their children’s needs and those who found implementing boundaries hard – were at the most risk of parental burnout. In addition to the above, considering whether parent and child are more extroverts or introverts will also help resolve sleep problems. An introverted parent may find a high-need wired lively child exhausting. Conversely an introverted baby or child may find some parental social occasions or being passed around much more stressful. Both situations will impact upon sleep or perception of sleep problems. Siblings may also factor into this – for example if the new baby or younger child is a different personality type to older sibling(s) the parent may need to use different techniques with each child.

Blog will continue in part 3 where we look at day-time rhythms, naps and family diet.

Rachel Greaves is a midwife, public health nurse and accredited sleep coach. She volunteers at local breastfeeding support groups and works privately at Goodnight Solutions 

References

Huang, X, Wang. H, Chang. J, Wang. L, Liu. X, Jiang. J, and  An. L (2016) Feeding methods, sleep arrangement, and infant sleep patterns: a Chinese population-based study. World Journal of Paediatrics. 12(1) pp 66-75 Accessed at: http://www.wjpch.com/UploadFile/010%20%2013-201.pdf

Kendall-Tackett. K, Cong. Z and Hale. T (2011) The Effect of Feeding Method on Sleep Duration, Maternal Well-being, and Postpartum Depression. Clinical Lactation. 2(2) pp22-26 http://breastfeedingmadesimple.homestead.com/kendall-tackett_CL_2-2.pdf

Herman. M, Mowder. B, Yasik. A and Shamah R.  (2012) Parenting Beliefs, Parental Stress, and Social Support Relationships. Journal of Child and Family Studies.21(2) pp190-198

Walker. M (2017) Why we sleep. Chapter 2 Caffeine, jet lag and melatonin. pp13-37 Allen Lane. London.

O’Connor. T Caprariello. P, Robertson Blackmore. E, Gregory. A, Glover. V and Fleming. P and the ALSPAC Study Team. (2007) Prenatal Mood Disturbance Predicts Sleep Problems in Infancy and Toddlerhood  Early Human Development 83(7) Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853892/

Biss, K and Hasher, L. (2012). Happy as a lark: Morning-type younger and older adults are higher in positive affect. Emotion, 12(3), pp437-441. Accessed at: http://dx.doi.org/10.1037/a0027071

Le Vigouroux. S, Scorla. C, Raes. M, Mikolajczak. M and Roskam. I (2017) The big five personality traits and parental burnout: Protective and risk factors. Personality and Individual Differences 119, pp216-219 Accessed at: https://www.sciencedirect.com/science/article/abs/pii/S0191886917304658

Life in the first 6 months of being a parent!

In this series of mini blogs we look at life in the first 6 months of your baby’s life. Week one discusses what normal baby sleep looks like.

What is normal young baby behaviour?

Our society and cultural expectations have changed over the years, as have our experiences and expectations as parents. However, our babies’ innate behaviour and needs have not!

I’m not an expert but mammals appear to be divided into caching species (i.e. hiding their young when mum goes off to hunt for food) and carrying species, whereby mum carries her infant and feeds it frequently. Dr Blurton Jones in 1972 concluded from several anatomical, behavioral and physiological comparisons, including the composition of the milk, that humans are a carrying species, which breast feed their young frequently. In addition, to this Dr Emmy Werner (again 1972 – busy year!) studied groups of infants in ‘traditionally’ reared rural communities’ verses ‘Westernised’ urban infants across 5 continents. Dr Werner found that traditionally reared infants had greater motor development than the urban infants. These traditionally reared infants, regardless of the continent, lived within an extended family system with many caretakers, breastfed on demand, day and night, had constant tactile stimulation with the body of the adult caretaker who carried the infant on her back or side, and slept with him. As these infants were with an adult continually, they participated in all adult activities, with frequent sensorimotor stimulation and had no set routines for feeding or sleeping. Interestingly, many parents in our Western society often comment their baby appears most settled when ‘out and about’ or when surrounded by the normal daily rhythm of adult life.

Baby brain development!

Due to evolution and the development of the large human brain, babies must be born at a stage of maturity when other mammals would remain safely in the uterus. For these large heads to fit through their mother’s pelvis babies are born gestationally very immature. This is also seen in marsupials, such as kangaroos and koalas, but they have the convenience of a pouch supplied with a nipple! Normal human baby behaviour includes frequent breastfeeding and sleeping for short periods in bodily contact with a parent. In the first 3 months feeding and sleeping are very closely linked – conveniently feeding releases gut-induced melatonin and promotes sleep.

As human babies have lots of brain development to do, human milk is high in sugars to facilitate this. This means that our babies must feed frequently. Compare this to the young of a sea-based mammal, for example, who have milk with very high fat content to allow their young to be left for several days while their mothers hunt for food in the ocean.

Due to this human baby immaturity mother-infant attachment is needed from birth, long before the baby develops true infant-to-mother attachment. During this time babies like to be held and carried, for their own security, as a baby can do little to overcome a potentially dangerous separation except cry to ensure they are picked up again. In the early weeks and months, this close carrying and care tends to be provided by the mother or primary care giver. As the first year progresses into the second, infants may have several attachment figures, usually including father, siblings and grandparents, depending on who has cared for them. In non-parental childcare they develop attachments to care-givers if the care is sensitive and favourable.

Robin Grille writes a reassuring article about parental guilt and postnatal depression, in which he makes the point that parenting was not supposed to be done in isolation. In the past raising small children was done as a group – long before the mother became exhausted, she was supported by other adults caring for the child. Yes, the mother breastfed and slept with her child, but she also had help and support during the days and nights.

Where does that leave us as new parents?

Unfortunately, our society has moved on and values babies who are content being placed down. This is compounded by the workload most parents face. Even whilst on maternity leave – most new mothers often have emails, social media, health appointments, expectations to be at groups and must look after either older siblings or do household chores.

Add into this mix parental exhaustion (either from pregnancy, workload, birth or the early days of baby’s life) and underlying anxieties about parenthood or a pre-existing mental health problem. It is therefore, not surprising that a young baby who can be placed down is desirable or necessary!

Babies pick up on their parents’ emotions very quickly. From a survival perspective a baby needs to be near his carer, they have no other way of protecting themselves. A baby is designed to read body language, therefore a parent who is depressed, frustrated, anxious or cross is going to induce those emotions in their baby. The baby will not know why their parent is upset; they are using an innate survival mechanism which the primitive brain is assuming is an immediate threat to the baby – i.e. an imminent attack by a sabre tooth tiger! In this situation, baby does not want to be left behind if the parents run, so by crying the baby is ensuring that they are noticed by the parent and therefore picked up and stay safe.

There are not many situations where the above scenario is true these days – however this has not altered baby behaviour. This does not mean to say that parents cannot experience or show these emotions but is does explain why baby may react as they do. When parents do feel like this – taking some time out to stop and breath, cuddle your baby and reconnect can make everyone feel better.

For many new parents their tiny babies sleep well in the first few weeks at home, and then they wake up about week 4 and decide that they will not be put down again ever! This can either go 2 ways – parents wondering what on earth they have done wrong or parents accepting this as the norm and carrying and co-sleeping with their baby. The next scenario is a parent who is happy to do this for a few weeks but then starts to become really exhausted with the relentlessness of the carrying. Some parents surrender to this and happily carry their babies’ long term, others would like to do the same, but logistics prevent them and for other parents this scenario is just not either physically, logistically or emotionally practical.

What can we do to support new parents and their babies in this situation?

Firstly, look at feeding – is the baby’s reluctance to be put down a symptom of tummy ache – does baby need to be in an upright position to be comfortable? Is frequent waking caused by either under or over feeding? This is not meant to be a piece on breast or formula feeding – but feeding and sleep cannot be separated in the first 2-3 months.

Let’s assume that baby is being fed responsively when he/she asks for it – either for nutrition or comfort. Let’s also assume that there are no breastfeeding, supply or anatomical problems which may affect feeding. Let’s assume that if bottle feeding (either formula or expressed breast milk) that baby is being fed by a paced technique where they can regulate their intake and take breaks as needed. Let’s further assume that there are no cow’s milk protein allergies or reflux in the picture. If any of the above are suspected, then a feeding assessment and/or medical review is recommended.

What does normal young baby sleep look like?

Again, this piece is not an academic essay and I will use some more accessible terminology when describing sleep cycles.  Simply put – light sleep is a term for rapid eye movement sleep (REM or more commonly known as dreaming sleep) and quiet (or deep) sleep is known as non-REM sleep. As babies mature this sleep changes and incorporates REM sleep, light sleep – stages 1 and 2 and non-REM sleep stages 3 and 4.

In the first few months babies spend the majority of their sleep time in light REM sleep. This is thought to be due to the huge amount of brain development taking place – in REM sleep there is almost double the blood flow to the brain than in quite/deep sleep. This light, rousable sleep is also thought to be protective against SIDS.

A young baby’s sleep consists of cycles of around 30-40 minutes, baby enters light sleep first then shifts to deep sleep and back to light sleep etc. As this sleep shifts are relatively simple babies find this easy to achieve. Disruption to these sleep cycles is likely when babies are in pain – for example reflux or CMPA – this is often seen as a baby who only sleeps for 20 minutes or so when placed down.

Babies do not produce their own melatonin until about 3-4 months of age, up until then the precursor of melatonin, tryptophan, is available in breastmilk. The first circadian rhythm (i.e our body rhythms over the 24-hour period) to develop in a new-born is the body temperature fluctuation which appears at 1 week of age. By 3-4 months the baby’s light/dark circadian rhythm is established. There is evidence to suggest that a baby who is exposed to 12 hours of dark, quiet and reduced stimulation and 12 hours of light, noise and daytime activities, over the 24-hour period will develop this circadian rhythm sooner than a baby who is not shown these differences.

How does this sleep change?

As babies develop over these early weeks and months, they are gradually able to spend more time awake in between sleeps. Especially around the 3-4-month period parents often feel their baby is so alert and distractible that they are unable to settle to sleep and often struggle to achieve much day-time sleep. At this stage overtiredness is often a factor as babies may not show obvious signs of being tired. In fact, an overtired baby can appear livelier as they produce adrenaline and cortisol to keep themselves going. Frustratingly overtiredness often results in more fractured and disrupted night-time sleep, therefore it is essential to consider daytime sleep when addressing night-time sleep.

Often this combination of being awake longer, being less able to calm or settle, being more distractible and being overtired, leads to a fractious fussy baby who resists being put down.

Somewhere between 3 and 6 months the baby’s sleep cycle matures into a ‘sleep architecture’ that lasts all their lives! This change in sleep pattern is extensive and often results in worse sleep for several weeks. Instead of a simple light/deep cycle, the baby’s brain is now moving in between 2 stages of deep sleep (NREM 3and 4), 2 stages of light sleep (NREM 1 and 2) and REM sleep. Each sleep cycle therefore ‘looks’ something like this; NREM1-NREM2-NREM3/4-NREM2- NREM1-REM.

The biggest change to this is the fact that babies are now going straight into deep sleep rather than drifting from light to deep sleep as they did as newborns.  These many stages can cause frequent waking as the baby is not used to this pattern and at each transition, they may wake – this is much more likely if they are overtired. When a baby is overtired, they ‘crash’ straight into the NREM3/4 and do not get to practice the changes in sleep state. Therefore, over the night period every time their brain moves into a different sleep state they wake up. When this change in sleep architecture is combined with a sleep association provided by the parent (for example feeding, rocking, cuddling etc) then every time the baby’s brain changes sleep state the parent is needed to help baby settle again.

Blog will continue in part 2 which will look at whether feeding method affects sleep, and the influence of parental factors on baby sleep.

Rachel Greaves is a midwife, public health nurse and accredited sleep coach. She volunteers at local breastfeeding support groups and works privately at Goodnight Solutions 

References

Cook. P (1997) The Species-Normal Experience for Human Infants: A Biological and Cross-Cultural Perspective. Early Child Care: Infants and Nations at Risk Melbourne: News Weekly Books. Accessed at; https://www.naturalchild.org/articles/peter_cook/ecc_ch1.html

Grille. R (2019) Parent Guilt – A Silent Epidemic. Accessed at: https://www.naturalchild.org/articles/robin_grille/parent_guilt.html

Grille. R (2019) Post Natal Depression – Mental Illness or Natural Reaction? Accessed at; https://www.naturalchild.org/articles/robin_grille/post_natal_depression.html

Everything a new parent needs to know about baby colic! What it is, how to relieve and treat it and what works and what might work!

This blog is written from my professional experience of working with hundreds of new parents as a midwife and health visitor in combination with on-going learning and up to date evidence from the Holistic sleep coaching programme. This includes in-put from lactation consultant Shel Banks  and health educator Maureen Minchin.

The definition of colic was updated in 2017 and is included in the functional gastrointestinal disorders category of the Rome IV diagnostic criteria. Why is this important? Because it acknowledges what many parents have always attested to – that it is a tummy pain! The term “colic” refers to unexplained and acute abdominal pain. The Rome definition states ‘Infant colic can be considered as a behavioral phenomenon in infants aged 1 to 4 months ( sometimes now from birth) and involves long periods of inconsolable crying and hard-to-calm behavior.’ OR Inconsolable, unexplained and incessant crying in healthy infants lasting for more than 3 hours a day.

The crying occurs for no apparent cause and this is one of the main reasons it is distressing and worrisome for parents. For those who like the science the full criteria can be found HERE.

The key point to note is that colic is a symptom and not a cause – i.e. the crying is due to something which is distressing the baby therefore addressing the cause of the distress will relieve the symptoms namely ‘colic’.

What is the cause of your baby’s distress?

Firstly 5% of babies will have an underlying disorder – that’s a small number but enough to warrant a trip to the GP to rule out any medical causes of your baby’s distress.

Secondly address any non-tummy related causes which can be causing your baby some discomfort or anxiety. These include but are not limited to:

  • Uncomfy clothing – ie tight/big label/seams/can’t stretch feet out etc
  • Under stimulated baby– ie wanting to be held and touched
  • Over stimulated baby– more common – for example trying to get baby to repeat a cute new skill for other family members or not noticing baby’s ‘tired cues’
  • Smell – key sense in babies and strong perfumes or room air fresheners can be overwhelming – try gentle relaxing essential oils in a burner or diffuser instead
  • Smoking – smoking during pregnancy increases the likelihood and severity of colic, it is suggested infants may be allergic to exhaled cigarette smoke.
  • Maternal stress – during pregnancy and after birth appears to make babies more likely to suffer from colic. Try some mediation or mindfulness whilst feeding which can also help with baby sleep. See this link Breast feeding relaxation therapy helps babies eat more.
  • Behavioural factors – perhaps baby is just tired – or doesn’t like the way they may be handled

 Colic is tummy related so read on!

Tummy related causes of colic could be;

  • Trapped gas – is very common and caused by swallowing air whilst feeding and/or a reaction in the tummy
  • Hunger – sometimes but more often pain is related to over-feeding
  • Over-feeding – babies suck when in pain and it is very easy to over feed on a bottle – gradually our tummies stretch, and we want more food.
  • Bottle feeding a baby in a lying down position or sub-optimal position and attachment at the breast and/or oversupply. For a good explanation of paced bottle feeding click HERE
  • Cows Milk Protein Allergy (CMPA) –  allergy to the protein in cows milk is becoming more common. CMPA causes tummy distention, cramping, vomiting, skin reactions and diarrhoea ( sometimes constipation also). If there is a family history of allergy or your baby has the above signs please see your GP. See below.
  • Temporary lactose intolerance – this is a due to a lack of the enzyme lactase, which can be due to a tummy virus. Your baby will show tummy symptoms such as continual diarrhoea and difficulty passing gas. It can also be as a result of an inflammed gut when CMPA is present. Again see your GP. Congenital lactose intolerance ( ie from birth) is very rare and serious.
  • Gut bacteria out of balance – this is where the bad bacteria outnumber the good bacteria! The gut microbiome might be altered by birth practices and antibiotic use, read more from Maureen Minchin if you are interested in this fascinating subject!  Altering the bacteria in the gut causes fermentation (ie gas), cramping and bloating.  This can also be caused by incorrect making up of bottle feeds ie with water which is not over 70C. Your baby may not show signs of illness but may be very windy and in discomfort.
  • Please note in young babies straining and going red when passing a stool is common as long as the stool is a normal colour (yellow/brown) and of toothpasty/watery consistency. This is known as infant dyschezia. There is no need for laxatives at this point. A useful pdf guide is HERE.

Please note;

CMPA is getting more common and parents should see their GP if they suspect it or have a history of allergy themselves. Signs are faltering growth, vomiting, rashes, incessant crying, diarrhoea. It takes 6 weeks to clear in mum and baby if present, although improvements will be seen in 2-3 days. Sometimes a lactose intolerance will be present in CMPA due to inflammation of the gut due to allergy.

What about reflux?  40-50% of babies under 3 months will posset some of their feed – non-forceful regurgitation normal physiological process very common as babies spend most of their time on their backs. It is often seen as recurrent hiccups, frequent coughing, irritability or crying and frequent night waking. The techniques below should help with physiological posseting.

Gastro-oesophageal reflux disease (GORD) is more serious however and is covered under NICE guidance. This needs treating as the stomach acid in the oesophagus (food pipe) can lead to longer term damage. Babies with GORD often have difficulty gaining weight with frequent forceful vomiting, possible old black blood in stool or in vomit.

What works and what doesn’t!

There are several products marketed at parents which suggest they can help resolve colic symptoms in a baby. Simeticone and dimeticone (brand names Infacol and Dentinox) are no longer recommenced by NICE due to not enough evidence of effectiveness. It is suggested they work by reducing the surface tension of gas bubbles in the stomach thus making many small bubbles into one bigger bubble. This will only help if the bubble is underneath the sphincter (ie tummy opening) at the time the baby is burped! However both of these products contain sugars (artificial or real) – sugar is well known as a pain relief for babies. Therefore mild pain reliving effects may be seen.

Lactase enzyme (brand name Colief) is also not advised by NICE. Primarily because if a baby has a congenital lactose deficiency then medical advice will be needed. The suggested way of use of the product is also fiddly for both breast and formula fed babies – but it contains sweeteners so a pain relieving effect may be seen. However in a baby/toddler who has had a diarrhoea and vomiting virus there may be a temporay lactose intolerance due to damage to the gut wall – a lactose free formula or lactase enzyme preparation may be suitable for use in these circumstances.

It is important to note that I am not recommending giving a baby any kind of sugar preparation for pain relieving effects. Both breast and formula milk contain enough sugars and carbohydrates – preventing the cause of pain is the most effective way of helping a colicky baby. Gripe water contains dil oil, water and sodium bicarbonate (sodium hydrogen carbonate). BUT sodium bicarbonate added to stomach acid will produce hydrogen gas thus baby produces a nice big burp therefore it looks like its worked!

So what about the many infant milks for ‘special medical purposes’ which can be found on the supermarket shelves? There are many marketed milks and a lot of them are thickened, meaning they have to be made up at a lower temperature. This will increase the risk of bacteria overload as the powder has not been sterilised. Bad bacteria may accumulate in baby’s gut and produce extra gas and discomfort. In combination with a bottle making machine, which uses cold water to fill the bottles, this may be enough to produce a very windy and uncomfortable baby.

NICE also does not recommend manipulative strategies such as cranial osteopathy for colic due to lack of evidence of effectiveness for tummy pain. However in a baby with a tight jaw, neck or some kind of head or shoulder pain they may not be able to work their jaws as effectively. This means they not be able to form a ‘bolus’ of milk to swallow properly. This can lead to more air than necessary being swallowed with the feed. As there is no evidence of harm of these strategies  these treatments are worth investigating.

OK so what does work?

Firstly fix any of the above situations if they apply to your baby. Seek advice from your GP and breastfeeding group/or health visitor regarding feeding. Discuss under or oversupply with a knowledge breastfeeding adviser or peer supporter and attend your local well baby clinic.

Keep your baby upright after a feed, making sure they are winded properly before laying them down, therefore preventing the gas going into the intestine. When winding your baby try having them upright, leaning forward and slightly to their left – this give bubbles the best chance of escaping upwards! Lots of tummy time, massage and warm baths also help!

If formula (or bottle feeding with expressed milk) try the following;

  • Smaller, more frequent feeds.
  • Reduce pressure on baby’s abdomen – tight waist bands and nappies etc
  • Frequent burping and paced bottle feeding.
  • Avoid shaking formula to mix it – use a sterile spoon instead to avoid micro bubbles and froth.
  • Ensure formula feeds are made up correctly with water over 70 C and not left to stand for too long.
  • Feed babies at their early feeding cues – not when distressed on or a strict schedule
  • Try a vented bottle to reduce air intake
  • Don’t coax baby to finish the bottle – if this is hard to do try placing a sock over the bottle and follow your baby’s cues
  • Pay attention to sterilizing bottles and dummies – a build-up of pathogenic bacteria will lead to fermentation, cramping and discomfort.

If breast feeding try the following;

  • Avoid allergens in maternal diet if breastfeeding – see note below.
  • Burping after a few minutes if a mother has a fast let-down.
  • Improve position and attachment.
  • Keep babies upright after feeds and wind as above

The NICE clinical knowledge summary on infant colic and www.nhs.uk  give the same advice when it comes to helping your baby with colic. However both state changing maternal diet when breastfeeding is not indicated due to lack of evidence. It is not in my role to go against this advice. However I suggest that if you or your partner (baby’s father) have family histories of food allergy then identifying any foods which either of you avoid/dislike due to causing you digestive discomfort is a good idea. As mild as the discomfort may be to either parent, due to epigenetics these foods may be causing your baby more discomfort. Avoiding these foods you have identified may provide relief from the colic.

What is definitely needed?

A colicky baby is very hard to deal with so extra help and support can make all the difference to parents. If there is no physical help available from family or friends then parents can access supportive online groups or find a local supportive group. Considering which other aspects of daily life are causing stress and finding a solution to those is also a possibility. This could be a cleaner, extra childcare for older children, reduced working hours for a partner, or hiring some extra baby help for example.

If the above are not financially viable then parents can contact their health visitor or children’s centre to ask what local support is available.

Self-help measures a parent could try are;

  • Identify a supportive online group
  • Explore mindfulness – headspace has a lot of positive reviews
  • Exercise with your baby – there are many local classes designed for parents and babies
  • Look at your diet – alcohol and caffeine increase anxiety and dehydration worsens anxiety. Complex carbohydrates and protein will stabilise and boost mood.
  • Activites which boost oxytocin such as touch and massage or a calming smell
  • Spend time outdoors in bright light to boost melatonin.
  • A positive mindset and mental dialogue – this colicky phase WILL pass.
  • Foods (or supplements) rich in DHA, EPA and Omega-3. These have been shown to reduce inflammation which is a key influence of anxiety and stress.
  • Essential oils can also help – lavender, clary sage, frankincense, and vetiver are a few which may help.
  • A decent nights sleep is not possible or practical with a new and/or colicky baby and will affect milk supply if breastfeeding. However evidence has shown that a 4-5 hour stretch is protective of parental mental health and may be achievable with some help. This does not have to be overnight if help is only available in the day. After 2-3 days of a 4-5 hour stretch of sleep (plus additional hours here and there in the 24 hour period) parents can consider the above suggestions. Sleep first!

This blog has been written by Rachel Greaves of Goodnight Solutions – and information from Lyndsey Hookway’s Holistic Sleep Programme is acknowledged.

Please visit my website for additional support or to contact me.

 

For the next 4 months I’m privileged to be training with Lyndsey Hookway (BSc; RNC; HV; IBCLC) on her holistic sleep coaching course. Check out Lyndsey’s site here.

So what is holistic sleep coaching and how can it support you?

The key is in the title – ‘holistic’ ! This is a gentle exploration of all factors within a family and their circumstances. It should result in a family feeling reassured and supported.

Sleep ‘ problems’ do not happen in isolation and what one family can cope with another may not be able to. The Cambridge dictionary defines ‘ holistic’ as ‘ relating to the whole of something or to the total system instead of just to its parts‘. Family sleep is just that- a combination of other siblings, wider family support (or unhelpful suggests perhaps), finances, work circumstances and possible health problems. Sometimes trying to conform to what society deems is normal baby sleep can also be a worry.

Babies and children’s sleep can vary enormously in what is ‘normal’ for that child. It can vary enormously over the first 2 years without there necessary being a problem which needs ‘fixing’.

What factors affect sleep?

Age, developmental milestones, overtiredness, boredom, anxiety, feeding issues, allergies, sleep hygiene and environment. Circadian rhythms, excercise, naps and meal times, holidays and illness all affect everyone’s sleep!

Looking at this – it is no wonder that our babies struggle at times! On top of that, as young babies and children’s brains develop – sleep changes again!

The concept of a ‘ parenting village’ is also popular at the moment. In effect meaning that in many cultures babies are cared for by several adults – not just one or 2. Social support is a big factor in parenting and sleep, and can really benefit parents assuming they find a like-minded community.

What factors affect me as a parent?

When looking for support with a sleep issue there is so much information available online, via social media, magazines and books! How much of this is evidenced and research based and how much is based on ‘personal experience’ and anecdotal or out-dated methods? And how do you know!

Has children’s sleep changed from previous generations? Or has the world around us and our lives as parents become so much more busy and complicated? Parents are well aware of the need for attachment, love and responsive care. They are also aware of the need to keep their jobs, home and lives secure for their families. There can be a conflict and a compromise between the too! They are also in need of a rest at times – parenting is hard work!

So is the ‘sleep issue’ really problematic and abnormal sleep or is it normal baby sleep in the context of a logistically tricky environment? Does it matter though? If sleep is an issue within the household then parents need support. This is where ‘holistic’ support is necessary – by optimising some simple aspects of a child’s routine, feeding, and settling method we can prevent larger problems. A ‘knee jerk’ reaction to a temporary sleep disruption can cause more unsettledness. In addition, a solution or plan which does not feel a ‘good fit’ for a parent will be unsustainable and therefore,  unsuccessful longer term.

So some quick wins whilst pondering the need for sleep support!

Maximize your family’s sleep hygiene – remember a cool and dark bedroom and if it’s noisy consider pink or white noise. A consistent short bedtime routine helps set up good sleep associations. Regular sleep and wake times also help daytime routines and mealtimes.

Optimise the timing of naps and consider an appropriate length of awake times, depending on your child’s age – overtiredness can really reduce sleep at night.

Watch for your child’s sleep cues ( some are very subtle) and offer a nap at this point. Conversely don’t obsess about this, some babies are bored rather than overstimulated – consider your child’s temperament when looking at this aspect.

Ensure 12 hours of daylight and 12 hours of dark – this will speed up the development of your baby’s circadian rhythm, outside time in later afternoon can really help a child/baby settle at bedtime.

Realistic parental expectations of what is normal feeding and night waking at your child’s stage of development can help reduce parental anxiety – a ‘solution’ to something normal may not help!

Optimise feeding – responsive breast and/or bottle feeding, effective breastfeeding and colic/wind/reflux or allergies will also affect a baby’s sleep. Switching to a bottle of formula will not necessarily improve sleep.

Get extra family or paid support for the really rough times, and remember that all things improve eventually – do whatever works to get the sleep your family needs right now and work on small steps to make the changes you may want.

For support and help contact me at Goodnight Solutions

 

Spring forward ! Bedtime back!

Resolve sleep issues with the clocks changing!

This Sunday 31st March the clocks go forward by 1 hour and British Summer Time begins! This is great news for those of us who love longer days and spring time.

Not so great for anyone working an early shift on Sunday morning and not so great for those of us hoping for an indulgent lie -in.

However it is excellent news for anyone on a night shift on Saturday 30th. And it is wonderful for those with small children!

How you ask?

If your child normally wakes at 5.30am – from Sunday morning they will be waking at 6.30am – much more acceptable!

Make sure you reinforce this sleep pattern by pushing Sunday evening bedtime routine 30 minutes later and placing them to sleep 30 minutes also. If you wish, keep shifting this back gradually until that hour is accounted for. Alternatively you may find your little one accepts this new sleep time and sleeps for a longer period of time.

Make sure that bedrooms are kept dark as the mornings become lighter – use well fitting blackout blinds. Light mornings affect our Melatonin levels and make it harder to fall back asleep in the early hours.

Small children get hungry!

So if you are delaying bedtime and hoping for a longer sleep into the morning make sure you give a ‘sleepy snack’ before bedtime. Milk, oatcakes, cherries are all good foods to provide tryptophan which converts into Melatonin. It also means a full tummy! https://www.sleepfoundation.org/articles/food-and-drink-promote-good-nights-sleep

Make wake time obvious for your little ones

Does your child know its time to get up? Make a clear difference between night time and morning time. Use timer switches on bedside lamps to signal daytime and make sure any early morning milk feeds are done out of the bedroom and that they signal wake time. A sleepy early morning feed in mum and dad’s bed is very confusing for a young child.

For help and support with your family’s sleep visit http://www.goodnightsolutions.co.uk

 

World Sleep Day 2019

World Sleep Day 2019® is designed to raise awareness of sleep as a human privilege that is often compromised by the habits of modern life (BSS, 2019).

World Sleep Day is an annual event, intended to be a celebration of sleep and a call to action on important issues related to sleep. These include medicine, education, social aspects and driving. It is organized by the World Sleep Day Committee of World Sleep Society (founded by WASM and WSF). It aims to lessen the burden of sleep problems on society through better prevention and management of sleep disorders. https://www.sleepsociety.org.uk/world-sleep-day-2019/

Habits of modern life!

The British Sleep Society (BSS) describes sleep as often compromised by the habits of modern life. Evolution has designed us to repair and renew ourselves overnight. Before the invention of modern lighting our sleep was much more in line with the ebb and flow of daylight. With mobile phone and tablet technology our ability to sleep has declined, despite updated features of light reduction on our devices.

It is not all to do with screen technology however! Have our priorities changed? Is it now more important to keep abreast with social media and communications than it is to sleep? Do our youngsters understand that late-night checking of their phones induces anxiety? Not only from what they are seeing but also because they are missing crucial sleep? Our teenagers go through a huge period of brain development and pruning and this is enhanced by REM sleep. Missing out on this REM sleep can deprive them of the social and emotional development they need to navigate their complex media worlds.

Not just youngsters!

In my work as a sleep practitioner I am seeing many adults who are struggling to sleep throughout the night. The main reason stated for this is a racing mind and worry about the day ahead. This self-perpetuates and can easily become a habit of not being able to sleep well. Our motivation to sleep is there as most adults recognise sleep as important, but perhaps our motivation to make changes to our lifestyles has not caught up?

What can we do to promote better sleep?

Make a good sleep a priority in the workplace – request more flexible hours perhaps or consider input from a sleep practitioner such as myself to improve employees sleep https://www.goodnightsolutions.co.uk/sleep-businesses/

Remember sleep hygiene  https://www.goodnightsolutions.co.uk/sleep-and-hormones/ and bedroom environment https://www.goodnightsolutions.co.uk/need-to-know-about-your-childs-sleep/

Ask for help for ongoing insomnia and techniques to help with this https://www.goodnightsolutions.co.uk/insomnia-or-sleep-deprivation-part-1/

And finally look at your motivation to improve lifestyle and sleep and what might be your barriers to change.

For more information and support contact me at https://www.goodnightsolutions.co.uk/contact/

“Sleep results from a complex cascade of hormones in the brain which initiate and maintain the state of sleep throughout the night”

One of the main hormones involved in sleep is melatonin.

Melatonin helps to regulate the timing of sleep onset but does not generate sleep by itself. Once sleep is achieved melatonin slowly decreases over the night and as sunlight enters the brain (through closed eyelids) the release of melatonin is stopped by the pineal gland.

As darkness falls at the end of the day the pineal gland no longer stops the release of melatonin and so the brain/body is primed for sleep again.

This is our circadian rhythm – the term for the body’s natural cycling of hormones – and simply put is the sleep/wake cycle. See https://www.sleepfoundation.org/articles/what-circadian-rhythm

Thus light (natural and artificial) is the biggest external control of our circadian rhythm. Other influences on our circadian rhythm are sound, meal timings, temperature and social cues – ie work/school timings.

Another important chemical involved in sleep is adenosine.

Another important chemical involved in sleep is adenosine. This builds up naturally throughout the day as a byproduct of using up our internal energy stores. For most people it creates an irresistible desire for sleep after 12-16 hours of wakefulness. This appears to be mainly related for a desire for deep sleep rather than REM sleep.

Luke Mastin (2017) describes this in much more detail in his blog https://www.howsleepworks.com/how_homeostasis.html

The combination of melatonin and adensosine creates the natural peaks and troughs of wakefulness throughout the day.

These are much more noticeable in people who are not achieving enough sleep at night. Caffeine temporarily blocks the affect of adenosine creating a boost when tired. This is useful just after lunch but not at 9 pm for example.

Temperature and sleep

Core body temperature also operates on a 24 hour rhythm. A 2 degree drop in body temperature helps initiate the sleep process. This is why vigorous exercise too close to bedtime wakes us up. It also explains why factors such as stress, which increases the ‘flight or fight’ response, therefore raising body temperature affects sleep. Likewise the temperature surges associated with the menopause has a detrimental affect on sleep.

Groggy in the mornings?

Sleep inertia which is the feeling of grogginess in the first 30 minutes after your alarm goes off in the morning. This is more likely to occur if you are wakened from the short period of deep sleep occurring after around 6 hours of sleep. See previous blog https://www.goodnightsolutions.co.uk/need-to-know-about-your-childs-sleep

Quick recap!

Regular sleep and wake times to help our circadian rhythm. Cool and dark bedrooms help the hormone cascade initiate sleep. Try to reduce worries and anxieties which can affect sleep. Prioritise as much sleep as possible to reduce sleep inertia and sleep deprivation.

Need help?

Contact me at https://www.goodnightsolutions.co.uk/contact/

What are your thoughts about sleep?

Insomnia or sleep deprivation? Part 2. In the first part of this blog we looked at some tweaks parents could make to give themselves more time in bed. We also discussed the quality of our sleep and our priorities as adults. Is there an accidental sleep deprivation or a real problem with insomnia?

The Great British Sleep Survey 2017 identified that as a whole we were following conventional sleep advice regarding screens and sleep hygiene. The survey found more people than ever were using music and mediation to help them sleep and yet the amount of hours slept was overall lower than 4 years previously.

https://sleepcouncil.org.uk/wp-content/uploads/2018/04/The-Great-British-Bedtime-Report-2017.pdf

Therefore awareness of sleep hygiene and the importance of sleep does not necessarily mean we are achieving a good nights sleep.

Why is this?

Consider how our brain works – it is designed to learn from experience, to extrapolate from previous situations and help us change our behavior to avoid repeating mistakes. Our brains are also very good at ruminating and worrying about the ‘what ifs’. As an example, if a person who generally sleeps well has a bad nights sleep – they may shrug it off as a ‘one off’ and continue as normal. If that person then has 2 or 3 bad nights sleep then their brain may well start to forecast and predict that they will ‘never sleep again’.

This may start a cascade of worrisome thoughts and feelings regarding sleep. This person is now giving much more attention and weight to this problem and will naturally try to solve it. Conventional advice regarding insomnia looks at sleep restriction, getting up after 15 minutes of sleeplessness and other techniques including lifestyle improvements and possibly CBT for Insomnia. This advice is helpful in the short term and will most likely help resolve intermittent periods of insomnia.

But I’ve tried all that you say!

Let’s look at advice previously given by Goodnight Solutions regarding children’s sleep. In past blogs I have discussed sleep environment, bedtime routine and falling asleep where you want your child to sleep all night.

This advice all relates to sleep associations i.e feeding to sleep, dummies or a parent present. It also links to the normal cascade of hormones needed for sleep initiation, i.e bedtime routine to regulate the melatonin release needed for continual sleep. Adults (and teenagers!) are no different. We also need that strong regular release of melatonin which is promoted by a short calming bedtime routine and consistent sleep and wake times. Remember we all run on a circadian rhythm.

Now consider looking at the clock every evening to see if you have been awake for 15 minutes or more knowing that perhaps you then need to get up. Is that relaxing? Think also of those worries and anxieties which pop into your brain as you lie there. It is is not an easy task to lie with troublesome thoughts and the emotions that accompany them. But these thoughts are just that – thoughts and feelings – and not actual events happening at the time.

We need to stay in bed!

To achieve better sleep we need to stay in bed, falling asleep anywhere else is a poor sleep association and will not maintain long term good sleep. We need to rid ourselves of the negative association of bedtime and our beds by accepting that we probably will lie awake! However lying awake in bed is still more restful than marching around the house and will result in a more rested next day regardless of whether we fell asleep. As a sleep practitioner I always tell parents to reward their children for lying still in bed and NOT for falling asleep as this is beyond their control. Likewise for an adult – we cannot control when we fall asleep – it is a complex hormonal cascade.

Conversely however our brains are very good at preventing us from falling asleep. The more we try to fix this the harder it becomes, as our brain is now far too active and engaged. In fact our brain is most likely activating the ‘fight or flight’ stress response as we get into bed as that is what it has become conditioned to do. It is not easy to change the way we see our insomnia. However by changing our attitude to lying in bed awake we will start to see small improvements in our nights. This allows us to make more positive changes during the day and starts us on an uphill spiral again.

For help and support with your family’s sleep or for help in the workplace please contact https://www.goodnightsolutions.co.uk/