Isaac's sleeping habits

My last several entries have been about James and his kidney cancer. I plan to write another update about him soon since today we celebrated his last day of radiation, but instead of writing about him today, I want to write an entry about my little Isaac. Isaac is a very sweet and happy baby. He has a great temperament and while its been challenging waking up with him and James's feeding tube each night, I feel like I couldn't have asked for a better baby to join my family. Isaac is now 5 months old and he's been a lot of fun and has given us a lot of laughs. I really enjoy data and metrics, so here is his sleep chart, which I'll describe a bit below:

On the left axis you see the time of day and then from left to right is time from when he was born in May through now 5 months later in mid October. The dark spots are when Isaac is sleeping. You can see Isaac typically goes to bed around 21:00 (9:00pm) and then wakes up around 7:00am. There are little white gaps at night that show when he's awake having a bottle at night. This chart shows that Isaac sleeps more at night and you can see his gradual progression to better stretches at night. One reason why there's a lot of blank space during the day in the first few months isn't because he's awake all day, but because we liked to do a lot of contact naps with him that aren't recorded (plus he napped a lot on the car rides to Seattle Children's Hospital to visit James).

One book that really helped me understand and make a plan for baby sleep is called "Your Child's Health" by Barton D. Schmitt (full title: Your Child's Health: The Parents' One-Stop Reference Guide to: Symptoms, Emergencies, Common Illnesses, Behavior Problems, and Healthy Development). I got the book recommendation from my pediatrician. I really struggled to get enough sleep with my oldest son Neil because no one told me about all the little things you can do over time to help encourage your baby to learn how to sleep. So, here is older and slightly wiser me sharing what has worked for our family. Skip to the bottom for more photos, and of course feel free to comment with what worked best for your family if you want to share.

Below is the "Prevention of Sleep Problems" section of the book:

Prevention of Sleep Problems: Birth to 6 Months

Parents want their children to sleep through the night, giving the parent 7 or 8 hours of uninterrupted sleep. Newborns, however, are not born able to sleep through. They have a limit to how many hours they can go without a nighttime feeding, usually 4 or 5. By 2 months of age, some 50 percent of bottle-fed infants can sleep through the night. By 4 months, most bottle-fed infants can sleep through the night. By 4 months, most bottle-fed infants have acquired this capacity. Most breast-fed babies can sleep through the night by 5 or 6 months of age. Good sleep habits may not develop, however, unless you have a plan.

Consider the following guidelines if you want to teach your baby that night time is a special time for sleeping, that her crib is where she stays at night, and that she can put herself back to sleep following normal awakenings that don’t relate to hunger. It is far easier to prevent sleep problems before age 6 months of age than it is to treat them later.

Newborns

Help your baby fall asleep using any technique that works-- During the first month of life, survival is the main agenda. If your baby falls asleep at the breast or bottle, so be it. If he needs skin-to-skin contact to fall asleep, fine, we can fix that later. But if your baby is on the brink of falling asleep and calm, try to put him in his crib and try to introduce self-initiation of sleep into his repertoire. (Note: The safe sleep position for healthy babies in on the back.)

Swaddle your baby in a blanket-- Snug swaddling reduces awakenings caused by the startle reflex and increases the length of sleep. Swaddling also helps babies fall asleep. Swaddling should be done before your baby is put down in the crib. To swaddle your baby use the 3-step "burrito-wrap" technique. Start with your baby lying on the blanket and the arms at the sides. Then (1) pull the left side of the blanket over the body and tuck it in, (2) pull the bottom up, and (3) pull the right side over and tuck. It is a useful technique from birth to 4 or 6 months of age. For more details, consult Dr. Harvey Karp's book The Happiest Baby on the Block.

Try different techniques to calm your baby-- If your baby is tired but irritable, try holding and gentle rocking to calm her. If that doesn't work, try swaddling her, which is comparable to being hugged. Try humming, singling lullabies, or white noise. Try massage or patting. Even try a pacifier. Different babies respond to different calming techniques.

Do not use a pacifier to help your baby fall asleep-- While it's okay to use a pacifier to calm a crying infant if holding does not work, don't use a pacifier when your child is drowsy. Your infant will not be able to locate and reinsert the pacifier until at least 10 months of age. Therefore, don't let it become part of the falling-to-sleep- process. If you do, you will need to be present following all normal awakenings.

Keep daytime feeding intervals to at least 2 hours for newborns-- More frequent daytime feedings (such as hourly) lead to frequent awakenings for small feedings at night. (Exception: the first week, when breast milk is still coming in.) Demand feedings are appropriate, but only if your baby is hungry. Crying is the only form of communication newborns have. Crying does not always mean your baby is hungry. He may be tired, bored, lonely, or too hot. Hold your baby at these times or put him down to sleep. Don't let feeding become a pacifier (called comfort nursing). For every time you nurse your baby, there should be 4 or 5 times that you snuggle your baby without nursing. Don't let him get into the bad habit of nursing every time you hold him (called grazing).

Give the last feeding at your bedtime (10 or 11 pm)-- The reason for this advice is even when your baby is 4 months old, he will only be able to fast for 7 or 8 hours (i.e. until 5 or 6 am). Try to keep your baby awake for the 2 hours before this last feeding. Going to bed at the same time every night helps your baby develop good sleeping habits. look after your sleep needs by sleeping when your baby sleeps.

Do not let your baby sleep more than 3 consecutive hours during the day-- Try to awaken him gently and entertain him. In this way, the time when your infant sleeps the longest will occur during the night. (Note: Many newborns can sleep 5 consecutive hours once during the 24-hour clock, and you can teach them to sleep for this longer period at night.)

Don’t let your baby sleep in your bed-- Once your baby is used to sleeping with you, a move to his own bed will be extremely difficult. In addition, the risk of SIDS during the first 8 months is 20 times higher sleeping in an adult bed than in a crib. So teach your child to prefer his crib. For the first 2 or 3 months, you can keep your baby in a crib or bassinet next to your bed.

1-month-old babies

Learn to recognize the signs of drowsiness-- These include droopy eyelids, tired eyes not interested in the surroundings, yawning, decreased body movement, decreased facial expression, and quietness. When these occur, put your baby in the crib. If you miss these signs and your baby becomes overtired, he may become irritable and harder to put down. Therefore, if your child has been awake longer than 2 hours, assume he needs some sleep.

Place your baby in the crib when he is drowsy but partially awake-- This step is very important. Without it, the other preventive measures will fail. Your baby's last waking memory should be of the crib, not of being held or of being fed. He must learn to put himself to sleep without you. Don't expect him to go to sleep as soon as you lay him down. It often takes 10 to 20 minutes of restlessness and fussiness for a baby to go to sleep. If he is crying, hold him to try to calm him. But when he settles down, try to place him in the crib before he falls asleep. Handle naps in the same way. This is how your child will learn to put himself back to sleep after normal awakenings during the night. Don't help your infant when he doesn't need any help.

Comfort your baby for all crying, but not for normal fussiness-- All new babies cry some during the day and night. Always respond to a crying baby. Babies can't be spoiled during the first 6 months of life. But by 1 month of age, hold your baby just for crying, not for normal fussiness. Soothe him until he's calm, not until he's asleep. (Note: Even colicky babies have a few times each day when they are drowsy and not crying. On these occasions, place your child in the crib and let him learn to comfort himself and put himself to sleep.)

Make middle-of-the-night feedings brief and boring-- You want your baby to think of nighttime as a special time for sleeping. When he awakens at night for feedings, don't turn on the lights, talk to him, or rock him. Feed him quickly and quietly in the dark. Provide extra rocking and playtime during the day. This approach will lead to longer periods of sleep at night. By contrast, during the day don't try to make his bedroom too quiet or too dark. Normal levels of background noise may keep him from oversleeping during the day.

2-month-old babies

Move Your Baby's Crib to a Separate Room-- By 3 months of age, your baby should be sleeping in a separate room. This will help parents who are light sleepers sleep better. Also, your baby may forget that her parents are available if she can't see them when she awakens. Also close the bedroom door so your child becomes accustomed to sleeping that way. If separate rooms are impractical, at least put up a screen or cover the crib railing with a blanket so that your baby cannot see your bed.

Try to stretch daytime feeding intervals to 3 hours-- Over the next 2 months, gradually lengthen the interval between daytime feedings. The ability to fast for 3 hours during the day increases your infant's potential for sleeping through the night. Going beyond the 3-hour mark during the day is not important. In fact, it may build up a caloric deficit that will leave your child more hungry during the night. Therefore, if 4 hours passes during the day and your infant doesn't give any signals for being hungry, offer a feeding anyway.

Try to delay middle-of-night feedings-- By now, your baby should be down to 1 feeding during the night (2 for some breastfed babies.) Before preparing a bottle, try holding your baby briefly to see if that will satisfy her. Never awaken your baby at night for a feeding except at your bedtime.

4-month-old babies

Try to discontinue the 2 am feeding before it becomes a habit-- By 4 months of age, your bottle-fed baby does not need to be fed formula more than four times a day. Breast-fed babies do not need more than 5 or 6 nursing sessions a day. If you do not eliminate the night feedings by 6 months of age, they will become more difficult to stop as your child gets older. Remember to give the last feeding at 10 or 11 pm. Include extra baby food with this feeding. If your child cries during the night, try to comfort him with a back rum and some soothing words instead of with a feeding.

Don’t allow your baby to hold his bottle or take it to bed with him-- Babies should think that the bottle belongs to the parents. A bottle in bed leads to middle-of-the-night crying for refills because your baby will inevitably reach for the bottle and find it empty or on the floor.

Make any middle-of-the-night contacts brief and boring-- All children have 4 or 5 partial awakenings each night. They need to learn how to go back to sleep on their own at these times. If your baby cries for more than a few minutes, visit him but don't turn on the light, play with him, or take him out of his crib. Comfort him with a few soothing words and stay for less than 1 minute. If the crying continues for more than 10 minutes, calm him and stay in the room until he goes to sleep. (Exceptions: You feel your baby is sick, hungry, or afraid.)