It is common for our littlest clients to have day/night reversals. When babies are born, they have not yet developed an internal clock, known as their circadian rhythm. Waking is driven by hunger and because their stomachs are so tiny, they need to eat often. Think about how much growth a newborn goes through in those first few months, both physically and cognitively. A newborn infant looks vastly different than their four month old counterpart, both in size and their cognitive function. There is an amazing amount of development that happens in those short months.
One of the developments that happens after those first few months, around the third to fourth month of life is the development of a circadian rhythm, mediated by secretion of hormones from a part of their brain called the pineal gland.
Before this, the sleep wake cycle is a constant repetition of a little bit of awake time (45 minutes at a time for newborns) that will include all care giving, feeding, and socializing and then back to sleep again. Parents often find themselves with a baby that is more alert at night as opposed to daytime and this can be difficult as our circadian rhythms are telling us that it is time for some shut-eye at midnight, not party time!
Here are some things to consider and implement to switch back to a day/night rhythm that works for everyone:
1. Notice if your baby is getting over stimulated during the day and prefers to “wake up” at night during the quieter hours. If so, dial back the visitors and outings during the day to allow them to have a calmer more peaceful daytime environment to take in.
2. At night and during the day, keep your baby’s sleep environment quiet and calm.
3. Encourage regular and frequent feeding during the day, especially in the early evening when it’s common to see “cluster feeding” occur.
4. Do your best to achieve some awake time during the day, working on keeping your baby awake during feeding to both achieve that awake time and also promote active feeding where milk is being efficiently taken.
5. During the night, do your best to keep the feeding very calm and quiet. Keep the lights low and the interactions to a minimum. Even eye contact can signal a baby to alert and wake up promoting more wakefulness at night.
6. Get outside during the day and expose your baby to daylight. While they may not be producing melatonin just yet, it’s a good practice to establish and fresh air is good for everyone (including parents!).
Persist with these changes for a few days to a week to help your baby differentiate day time and night time.
Our jobs as parents are not only to nurture our children but also to teach them the skills that they’ll need to grow and mature as individuals. As a “newborn” parent, this seems like a far off concept when you’re holding a warm little body on your chest. You have in your arms a little person who is wholly dependent on you for their existence. Every need must be met including helping them to regulate their awake and sleep time by providing them with help to get off to sleep. Feeding is a need that is met on demand and often can be unpredictable in its patterns or schedule. Movements of tiny newborns are mediated by reflexes more than volition or intentional movement. But after those first precious and wonder-filled few months, infants move through an important stage where their newborn reflexes begin to integrate, meaning they are no longer obligatory and they gain more control over their movements. Their sleeping patterns also mature around this age, too. There is a lot neurologically happening in and around the 4 month mark.
One newborn reflex that begins to fade away (integrate) at this age is the ATNR reflex. This is the reflex that is commonly referred to as the “fencing” reflex as babies look as if they are about to joust. When their head is turned to the side, the limbs (arms and legs) on the side that they are looking go into extension or straightened out. The limbs behind their head flex up. This means that your newborn has difficulty getting their own hand into their mouth or up to their face on purpose much of the time.
This is important as the skill of getting both hands to their face or into their mouth is a self calming skill.
As your baby approaches 4 months (and even before), you can encourage this skill by doing the following:
Play games that encourage your baby to bring his/her hands to midline (in front of his/her body, together and to his/her face and mouth) such as Pat-a-Cake, practicing blowing kisses with hand over hand help, putting a toy near his/her chest for him/her to reach for. When socializing with your baby when he/she is lying on your lap, gently bring his/her hands together and rub them and bring them up to his/her face and cheeks and gently rub them skin to skin.
All of these games will help your baby gain awareness of the touch and proprioceptive inputs associated with volitionally moving their hands toward midline and touching their hands together and to their face. These are the first steps in learning how to do this independently.
One of the typical developmental stages that we see with the families we work with is the stage of separation anxiety. Separation anxiety is a common and completely normal phase of development that can have a negative effect on sleep. It usually emerges between 7-10m of age and can persist into toddlerhood.
Below are some ideas for playtime that can help your child work through this stage. To deal with normal age-appropriate separation anxiety, you need to make your baby feel secure with separations. Consistency is key to make sure your baby becomes secure that you are still there and you will return! When you separate from your child, always let him know you are going (to another room, out, etc.) in a matter-of-fact manner and when you reunite, come back with a big cheerful greeting.
You can play these games to help your child develop object permanence and show him that separations are met with cheerful reunions:
Peek-a-Boo: Playing Peek-A-Boo can help with the separation anxiety that is disrupting sleep. Use a cloth or scarf to very briefly hide your face or your child’s face and then revealing yourself to him can help him realize that you exist even though he can't see you.
Find-the-toy: Place an interesting toy under a cloth and ask your child "where's ______?" Lift up the blanket to show him. Once he starts uncovering the toy, you'll know he's getting the idea of object permanence.
Hide-and-seek: Introduce your child to "Hide-and-Seek". While you're likely not quite at the stage of counting to 20 and yelling "ready or not, here I come", you can start by hiding yourself around the corner or behind the couch and then call to your child. If he responds by looking toward your voice or crawling to you (if able), respond really positively with a big smile and laugh. This will teach him that separation okay, that you are still there when he can't see you and that happy reunions always happen after separations.
Separation anxiety can be a tough stage for your child and for you but working towards building the skill of object permanence and practicing with short separations will go a long way in helping you and your child sail through this stage.
On the West Coast we’d hardly know it with all this sunshine, but the leaves are turning, the nights are cooler and the warmer clothing is starting to get unpacked into kids’ drawers. Before you know it, the end of Daylight Savings Time will be upon us. On the first Sunday in November, clocks go back an hour. Before you to bed on Saturday November 1st, turn your clocks back one hour. So on Sunday November 2nd (at 2am precisely), your clocks will read the correct time.
This next sentence is important for those of you that have early risers. On Sunday November 2nd, when your early riser wakes at 5am or 5:30am, this will now be 4am or 4:30am. Yikes!
To more gently ease into this and have a smoother transition, here are some tips. Mark them on your calendar and watch on Facebook as we’ll have some tips coming up as we approach this time change.
Think about your schedule for the day including wake up times, snack and meal times, nap times and to bed times. On a regular basis this schedule shouldn’t vary much for kids, particularly the waking up time and bed time, even on weekends.
The week prior to the time change, starting on Wednesday start the shift. Shift everything by 15 minutes. This includes wake up time, eating, naps and bedtime. If you’d like to go slower, start on Monday.
By the time you’ve reached the weekend, your child is ideally shifted an hour forward. So if they normally woke up at 7, you’ve transitioned them to 8. This one is the most difficult shift.
Once Saturday night rolls around and you head to bed at 10pm and switch your clock back an hour to 9pm, you’ll be set. Your child will be on track!
Don’t be tempted to stay up an extra hour, remember the morning will come earlier on Sunday. Get your rest!
To help your baby wake a little later, try to hold off on “morning” time by soothing them and keeping them in their “night” environment until you want to wake them. When it’s time to wake up at the new time, welcome them to the new day with light and cuddles and offer them a feeding a few minutes after they wake (if that is your typical pattern of eating with them).