How to Choose a Doc (Pedcast)

How would a pediatrician choose a pediatrician. Listen to my thoughts on finding a pediatric practice that will be a good fit for your child and your family.

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What Parents Need to Know about Infant Temperature Control (Pedcast)

Let’s explore how babies control their temperature and use this knowledge to discuss current recommendations about clothing, ambient temperature of the house and related topics.

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SmoNotes:

1.

Unlisted, Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position. American Academy of Pediatrics, 3 Mar. 2000. Web. 5 July 2010 .

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Straight Talk About Sleep in Infancy (Pedcast)

 

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Welcome, I am your host, Dr. Paul Smolen.  It has been my honor to practice general pediatrics for the past 27 years. I having helped an entire generation of parents with their children so  today I am going to share a little of what I have learned with some practical advice.  Before we get started, first a disclaimer: Since I am probably not your child’s doctor it goes without saying that the advice you hear regarding your child’s health is intended as a supplement to your child’s regular health supervision visits.  With that said, let’s get into today’s topic.

 

Today we are going to talk about an extremely important topic for you and your child….HOW TO GET A GOOD NIGHTS SLEEP FOR YOU AND YOUR BABY.  You remember that whole concept before you had kids– you lay down and are not disturbed for 8-12 hours.  You sleep. Bliss.  A day doesn’t go by without me talking to a family with a serious sleep problem regarding their children. Like the family I spoke with recently.  Lovely people with a gorgeous child who came in for their infant’s six month checkup.   I asked the standard questions about Johnnies sleep and I got that look.  Mom is up with him at least 3 times a night breastfeeding and rocking.  She seemed exhausted and maybe starting to get resentful of her child’s constant demands at night.   She is a working Mom and totally exhausted all the time.  Sounds like a great recipe for excellent parenting, doesn’t it?

 

So what advice did I give them?  How can we make things better for a family with a 6 and 11 year old sleeping in their parent’s bed and an infant who is up all night demanding attention?.  This is the western world and the entire family sleeping in one bed or on the floor in the same room is not necessary or healthy in my view.  I knew I had my work cut out for me. I know, I know, you “attachment parenting” fans aren’t going to like my advice about sleep but I think the advice I am about to give you is sound advice. Let’s just agree to disagree.

 

Before we get into my advice for this family lets digress and take a little detour down science lane and review a little about sleep physiology.  You must understand how we sleep in order for you to know how to make it all work for your family. We spend a third of our entire time on earth sleeping and many of us don’t have the foggiest idea of how it works. There are basically two two types of sleep–REM or rapid eye movement sleep, also known as “active sleep” and  NonREM sleep or slow brainwave sleep.  With a good night’s sleep, we cycle all night between these two types of sleep states which means that no one sleeps all night long in deep sleep without waking up periodically, even babies.  Prolonged sleep is an active process of fluctuating between deep sleep and active dreamy sleep.  Most people have at least 3 sleep cycles a night.  So, we don’t fall asleep once at night but many times.  Older infants and children must, I repeat must be able put themselves back into deep sleep repeatedly at night, without the help of their parents, in order to “sleep through the night”.

 

Babies come into the world wired for the the infant pattern of sleep–by that I mean mom holds me, I suck and get drowsy, and fall asleep.  Without mom I can’t sleep!  Between four and six months of life, Johnny needs to make the transition to the adult pattern of falling asleep–he lays down awake, gets in his own comfortable position of sleep, and falls asleep.  No mom involved.  Making the change from the infant pattern of sleep to the adult pattern of sleep is exactly what Johnnies family is having trouble doing.

 

 

Over the many years of my practice, I have found that bringing this topic up at the four month checkup is crucial to achieving good sleep habits for the long term.   Parents who  encourage their infants to learn to put themselves to sleep independently usually find the process very easy, only taking a few nights to accomplish.  I have also discovered if the first child is trained properly to be an independent sleeper, the subsequent children learn good sleep habits as they get older.

 

 

Just because your baby needed feeding and mom to go to sleep at one and two months, doesn’t mean that he or she will need that all through their childhood. Keeping them awake very late into the evening so they are exhausted and feeding them late at night as they fall asleep will certainly train your child to need you all night long, the opposite of what you want to teach them.   So here is a Doc Smo pearl for you to remember;  “Anytime your child can learn to do something for themselves, that’s a good thing!”  Training your child to be independent at night if they can be in my mind is a good thing for them as well as for the rest of the family.

 

 

 

So let’s get started.  Here is the advice I gave Johnny’s family. I explained to Johnny’s parents that no one really sleeps through the night. Most of us go through at least three awake/sleep cycles a night but we are usually unaware of our awakenings because they are so brief.  I explained that we think we slept all night but we actually don’t.  The key to our smooth nighttime sleep for your little Johnny is to teach him to go from fully awake to completely asleep without the help of his parents in the early evening.  He needs to develop his own comfortable position that does not involve mom or dad to fall asleep.  Johnny needs to be able to induce his own sleep all night without help from Mom or Dad!  But before  three months of age, most babies cannot do this.  They have almost very limited control of their bodies and are hungry all the time.  So here is the major point:  I have observed that babies who are four to six months of age, who learn to separate feeding from going to sleep by finding their own comfortable position of falling asleep, usually make a smooth transition to nighttime independence without a struggle.

 

Question: But Doc Smo, why do this training when they are so young.  Wouldn’t it be easier later?

 

An emphatic NO. Teaching them to find their own sleep ritual is easiest at four-six months.  Anyone who has spent time around infants knows that something dramatic happens to the psyche of infants around seven months… that is most develop an intense fear of separation from their parents, especially mom.  This is a good sign from a long term psychological viewpoint because it means that your infant has created a strong emotional bond with you and trusts you.  However, this feature makes sleep training almost impossible.  In my experience, seven to nine months is a particularly bad time to try and train an infant not to need their parents at bedtime.  It is also about the time that most infants start getting mobility and start having on average one sickness per month.  The combination of having intense separation anxiety with frequent disrupted sleep from sickness is a bad combo for harmonious sleep training.

 

I find that babies need to learn how to put themselves to sleep by about six months of age or rocky times are ahead.  The training sounds difficult and scary but actually is easy and good for both you and your child.

 

Remember that Doc Smo pearl I just taught you:  all through childhood….”Anytime you can get your child to do something for themselves that is a good thing.”  because the ultimate goal of childhood is to create a happy, self sufficient adult.

 

Question: So how do you do the training?

 

The idea is to get parents out of bedtime and have an infant who can put themselves into their own comfort position to fall asleep. That way they can repeat that process at anytime in the night.  Feeding needs to be gradually removed from bedtime.  This is the opposite of what you did when your baby was under 3 months of age but you need to trust me, this works.

 

Question:  But Doc Smo,  I could never do that.  He might cry!

 

 

Gradual and gentle is the word of the day. Move feeding away from bedtime by 15 minutes a night until you get the last feeding accomplished at least an hour before your child gets too tired.  Bath, play, and do active things until bedtime.  When your child shows that they are getting sleepy take them to their sleeping place.  Do not rock, feed, tell stories, stroke or in anyway do quiet things.  Put them in bed!

Leave a little light on and give your child something safe to do… a mobile or activity center tied to the crib rail perhaps as long as it is safe.  Leave for a few minutes even if Johnny cries. Go back in as often as you wish.  Pick Johnny up until he quits crying but not until he gets sleepy.

Repeat the process until he goes to sleep.  Don’t feel guilty– you are right there reassuring him every few minutes.  Learning new things can be hard but a must.  The first night may be unpleasant but I promise that within 3-5 nights your child will play in the crib and put themselves to sleep without needing you.  They will also awaken and put themselves back to sleep given a chance.

Many people try this training, starting in the middle of the night without first changing  bedtime routine–this will not work!!!!  That just intensifies your child’s fear of separation. If he doesn’t know how to fall asleep at 7pm, he certainly won’t know what to do at 2am!  Let’s get real.

 

Question: So what do we do when Johnny awakens in the middle of the night?

Good question. Assuming Johnny has mastered his comfortable position training, I recommend a 10-10-10 approach.   10-10-10 works for veggies in the garden, and it will work for your child’s nighttime as well.

After crying for 10 minutes, Johnny gets your brief attention, just long enough for him to stop crying and know you are there.  Put him back down to sleep.  If he cries another 10 minutes, repeat that process.  If he cries a third 10 minutes… do whatever he wants.  I find that most babies, over time, won’t keep it going.  Problem solved.

 

I have found that with this 10-10-10 approach, used sometime between four and six months of age, almost all children will be sleeping independent of their parents at nighttime, sleeping all night, and enjoy their own beds by six months.

The training I have outlined sounds difficult and scary but actually is very easy and natural.

Having watched an entire generation of babies grow up I am certain that creating independence at bedtime is a very good thing for both children and parents.  Parents who can enforce a reasonable bedtime are off to a excellent start.. A good night’s sleep is vital to normal growth and healthy parenting.  Let’s get started.

For additional information about sleep, check out my Safe Sleep pedcast or video on my website. Until next time.

 

Addendum:

 

It’s been about a year since I made this pod cast and things have changed… a little.  The AAP came out with new safe sleep guidelines for babies that have changed my sleep recommendations a little bit.

 

Here is what is new:

Babies should sleep in their parent’s room until 6 months of age as I read the recommendations.  That doesn’t mean that a parent needs to be in the room as an infant falls asleep and it doesn’t mean that a baby can’t learn to put themselves to sleep without a parent’s help. I still recommend that you establish the same sleep onset routine.

It is also now recommended that babies not have any toys in the crib as these might provide a choking, strangulation, or suffocation risk.

The new guidelines also encourage parents to put their children down to sleep with a pacifier that I did not address in my original podcast.  Personally, I am not a big fan of pacifiers since a parent needs to be involved in keeping it in a child’s mouth, but the experts have found a slightly lower incidence of SIDS in babies who fall asleep with so they encourage their use.

 

And finally, I have now had about a year of experience with parents listening to my original podcast with regards to sleep ritual for healthy infants older than 4 months.  Most have found it useful and easy to follow, but some missed the major point, which is to make sure we create a sleep ritual for these older infants that does not involve you, the parent, does not involve feeding, and doesn’t allow the child to get drowsy in any place other than the crib. THEREFORE, I now recommend that you listen to this podcast twice to make sure you have a clear understanding of the routine I suggest before you institute any changes. I want you to be successful the first go round!

 

 

Until my next pedcast… This is Dr Paul Smolen from beautiful Charlotte, NC wishing you and your family pleasant days and quiet nights.

 

Until next time.

Smo Notes:

1.  Charlotte Observer- safeSleepPoster.pdf (application/pdf Object)-http://www.charlotteobserver.com/images/graphics/post/safeSleepPoster.pdf

2. http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf+html

3.http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/5/1245#SEC15

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Essential Knowledge for Parents about Hepatitis B (Pedcast)

Hepatitis B is a wicked disease. Fortunately, it is almost totally preventable in the era of vaccines. Once you understand how important this newborn shot is, I hope you will choose to immunize your child immediately after birth. Let’s talk hepatitis!

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