Sleep – A Q&A Interview with Tracy Hogg
June, 2002
© Tracy Hogg, all rights reserved
Q: Hello everyone! This is a Q&A session with Tracy for Baby Whisperer readers on common sleep questions, including the A-Z of the pick up/put down method, as well as extending naps. We’ve tried to gather many of the questions that readers have commonly posted to the message board, so that we can put it all together. Thank you, Tracy, for taking the time to do this -- I just know that this is going to help so many parents!
T: I’m very pleased to do it – this is going to be a great way to get it all down, and really go through all the scenarios!
Q: And let me just say, before we start, that most of these questions assume that people reading this have read at least Tracy’s first book, and will be familiar with the basic terminology and principles of E.A.S.Y. Where you see “Q:” that’s me asking the questions, and “T:” of course is for Tracy’s responses. Let’s get started!
Q: One of the most common questions that comes up for people after reading the book to ask is: Can you give me a detailed description of the pick up/put down (“pu/pd”) method?
T: Let’s start with age. So, the examples in the first book – one is based on a 3 month old perspective, and one on a child of 8 months. We did that because the technique is a bit different for the different ages. With a 3-month old, they usually don’t have a lot of motion in the process, so you can calm them to the right point in your arms and then put them down, whereas with an 8-month old you pick them up, and if you lay them straight back down, they can usually settle a lot quicker out of your arms. Generally if people are saying, well he gets more upset when I pick him up, you’re talking about a child who’s probably in that 5-8 month range. Because then they start doing some thrusting with their bodies and burrowing with their heads that we’ll talk about a bit more later.
First, the reason why we do pick up/put down is to completely reassure the child of our presence – and it’s usually needed in the beginning as a result of accidental parenting, and sometimes, either in the beginning or later because of missed cues. These are the reasons why we need to “resort” to this method. And the principle behind it is that we don’t leave the child to figure it out – there’s no “crying it out”.
How to identify when to use it is the main thing that parents need to figure out. If your child is fitful or you’re finding that you need to do “accidental parenting”-- which are things like feeding on the bottle to sleep, feeding on the breast to sleep, rocking/swinging the child to sleep -- as they get older and these habits start to establish, you can get to the extreme of driving in the car to get the child to nap or sleep at night. Now what happens is, then the child can only fall asleep with the “prop” that he associates with sleep. So when you start to take those things away from him, then you start to get opposition from him – he starts to get upset, and really what he’s saying is ‘what are you doing mum, we don’t do it this way’, and that’s where you hear sometimes the frustration of that from him. And that’s where the pick up/put down method comes in.
Now, how to go about it: You would always start with a routine. So your routine could be, for instance, at nap time, drawing the curtains, sitting in the rocking chair for a couple of minutes, and then proceed to take the child to the crib.
Q: Is this time in the chair spent rocking? Singing? Any kind of low-key wind-down activity, or just quiet and still?
T: These last couple of minutes should just be quiet and still. Any other things that are preparation would come before, as the wind-down from the activity time. Some mums can just walk in, close the curtains, lay them down and they’ll babble and what have you and go off to sleep. But it’s been my experience that just before they go down, and when I do it, 5 minutes of just sitting and being quiet, and saying “now you’re going to have your nap, I’ll see you when you get up.” And then put them in. Very low-key. The most important thing with routine is that it’s the same every time, so they know what to expect – it acts like a cue, “now it’s time to go to sleep.” But it should be no longer than 5 minutes. It’s just to separate activity from just popping them straight into the crib.
Now, if you’re a mum reading this who is doing something different and don’t have any problems, don’t change it! If it’s not broken, don’t fix it.
Q: Okay, so you’ve completed the wind-down, and you’re ready to make the transition into the crib.
T: Now, when you’re starting out and this is a change for them, when you lay them down they’re going to cry, because they’re used to the old “prop”, which would be the bottle, the boob, rocking or jiggling or walking – whatever it has been. So you’re going to get resistance straightaway, because they don’t comprehend what you’re doing. So in that instance what you do is, you go ahead and you pick them up.
Before the age of 6 months, you pick them up and you calm them completely down before you lay them back down. And you’ll start to see that they’ll cry again – you pick them up, and you reassure them. Up to the age of 3 months, you would use the patting on the back, and the shh-shh, because a child under 3 months cannot hold 3 thoughts in their mind.
Q: That’s interesting to know about that age. So this starts to distract them from crying?
T: Yes, they can’t continue to concentrate on the crying whilst being patted and shushed, they’re incapable of focusing on all three at once, so they’ll start to focus on the shush and the pat, and eventually they’ll stop crying, it’ll calm them down.
The other thing to remember is that under the age of 3 months, they have no control over their arms or legs. So the other thing to do is to swaddle. I would suggest doing that prior to laying them down.
Q: So as part of the routine of winding down to the nap?
T: Yes, even prior to sitting with them before going to the crib. So, when you lay them down, continue to pat them. So what you’re going to do is, lay them down slightly on their side so that you can have access to their back. Continue to pat them and see if they start up again -- then you would pick them up and calm them down.
Q: Just so people can get a really good mental picture, can you describe in a bit more detail how to hold and position, and how to pat and shush?
A: Okay, you bring them into a vertical position, into your shoulder. And remember at this age it’s best if they’re already swaddled before first being laid down in the crib. So you’re holding them into your shoulder, and it’s also best with a young baby if you’ve got their face tucked into your neck or shoulder to block out the visual stimulation. Your mouth is near their ear, but you make sure the shh-ing goes past their ear, and not into it, because you don’t want to perforate their eardrums.
The patting needs to be quite firm, and you want to be in the center of the back, not on one side or the other, and certainly not as far down as their little bottom – because too far down you’re going go be whacking their kidneys. And bear in mind it’s more or less the center of the back.
And then, it needs to be in a rhythm of a clock. So it’s tick-tock, tick-tock.
Q: I’ve seen some people post that they find it difficult to pat on the back while the baby is lying down, and they will pat the shoulder or, very gently, the chest once the baby is in the crib – because of course they should sleep on their backs.
T: You can do that, but it’s not as effective. Once they’re down, and if you’re not picking them up again but calming in the crib, you can roll them gently to their side (if they’re swaddled this is fairly easy, and you can also use one of the wedgies) – and pat on the back. If you’re using a wedgie, it would be on their tummy, and I like to put my other hand on the chest, and then pat on the back. Because then you can go down to their ear and do the shh-ing without picking them up.
Q: And the volume of the shh-ing?
T: The volume needs to be quite loud.
Q: I’ve seen a post from someone who saw you do this, and compared it to a faucet on at full force, would this be about right?
T: Yes, perfect. You’re giving a feeling of comfort to the child, a “hey, I know what I’m doing here,” so it’s important not to be too timid and soft with the pat or the sound. You’re not thumping them and you’re not yelling, you’re just being confident with it.
And I usually say this – once I’m committed to the crib, I use the skills of patting and shh-ing to keep them in the crib. And I pat probably 7-10 minutes after they’ve calmed. As soon as they’re quiet I don’t stop, I keep it going until they’ve got that complete focus on it, and then I start to slow it down and slow it down and stop the shush.
Q: So maybe early on in teaching sleep, some people are stopping too soon.
T: Yes, because then what happens is they come back to consciousness. They go through that second stage, and jolt, and you have to start over again. And remember, once you have to start again, it’s a full 20-minute process. So it’s best to take the time, and know “I’m going to be in there for 20 minutes” rather than, “I’m in and out for an hour and a half, because every time I leave and think I’ve got it, he starts up again.” And they haven’t -- if you just make sure you have in your mind that you’re going to spend that full 20 minutes, then you can get that Y time, because you don’t have to keep going back in and out, in and out, which is more frustrating than just staying there. And if you’re there, you can see your child visibly go through the stages, which gives you another skill.
Q: Does this relate to the trust issue also, where you say, when you’re teaching sleep, never to leave your child for a minute?
T: Yes. Trust is broken when we leave our child, who is not fully capable of knowing where you have gone and you leave them alone to cry, even if it is for 5 minutes as suggested by some sleep books. And parents need to realize that all of this helps lay a foundation for the later months, say around 8 months when they start to experience separation anxiety.
Until around 12-18 months, a child does not have the mental capacity to realize that you will return. At around 8 months, they start to have enough memory recall to comprehend and trust that when you leave, you do return. So what you’re doing with pu/pd and being there to comfort your baby is building that trust, so when those later months come and you start to introduce words, saying “I’m going to the kitchen, you are safe, I will return,” and you keep your word, you can build on that trust.
Q: So, I think we’ve got the early months covered pretty well, for the basics of pu/pd.
T: Now from 3 to 6 months what we’ll find is, you’ll see that your child will start to display the following behavior if you’re trying to correct accidental parenting or you’ve missed the cues. They’ll start to arch themselves backwards, or push down with their feet.
What you do at that point is you lay them down; you don’t want to fight with them. They’ll often push away and kind of bury their heads kind of forward and down, and push away with their feet and their arms. At that point, say okay, let me lay you down. You lay them down because you don’t want to fight, but then you pick them immediately back up. If they do it again and start to fight with you, put them in the crib and see if they can start to settle themselves.
And what you’ll find is that there will be three very definite crescendos -- the cry starts, and it gets louder and louder and more frantic and more frantic, and then all of a sudden it reaches a peak, and then it starts to come down the other side. Now expect that to happen about 3 or 4 times, with a child between the age of 3 and 6 months.
Q: And what are you doing in the meantime, are you just standing there?
T: Yes, and you’re maintaining physical contact. Which means, you’re either patting them very gently, or you’re making your physical presence known by talking and reassuring them, saying “hey, hey, hey” and remember to keep the mood up and elevated, because a child will pick up on and get into his parent’s emotional state.
Also bear in mind why you’re doing this. And this is part and parcel of teaching them how to go to sleep independently. With any change comes a resistance. The main thing to remember is that you’re not leaving them on their own. The cry of a baby who you’re with is very different from the cry of a baby who is left to cry it out. A baby who is left to cry it out is crying a fear and almost primal cry, to call the parent back, and the other is more frustration. So if you keep a positive thought in mind, why am I doing this, or why did I start the process, and you go back to your original thought of “I need to change this habit” -- or I need to teach my baby how to fall asleep on her own, or help her settle because even though she knows how to put herself to sleep, she’s had a rough day or I’ve missed the window and she can’t seem to settle herself -- then that should give you the strength to go forward.
Q: I’ve seen some questions from parents about swaddling babies beyond the age of 3 months – whether to do it.
T: And a lot of babies need it, because they haven’t quite found their fingers. You know, some babies up to 7 or 8 months like to be wrapped. Even as adults – my husband cannot bear the bedclothes tucked in, and I have to be in a cocoon. It’s individual.
First of all, if you’ve been swaddling and now want to try stopping, you’ve got to do it gradually, first one arm and then the other. The process is to go gradually. Some like to have one arm down by their side and the other up by the face, so they can find their fingers. But if you find they’re not settling being unswaddled, even if you’ve tried to do it gradually, then swaddle them – and keep trying the gradual approach every now and again. But keep swaddling until they can settle.
Q: I’ve seen where some people say their doctor has instructed to stop swaddling, that it could slow motor development.
T: I don’t agree – unless you’ve got your baby swaddled all the time, 24/7? I suggest parents ask, can you give me the reason behind that. Some babies like to be snuggled up tight, others like to be open. The reason some parents think they’re resisting is because when we go to put an arm down, they do have a natural resistance. The reason we start to unswaddle at around 3 months is because that’s when they start to find their fingers – but that’s trying to put a baby in a “book”. Some babies don’t find their fingers until 5 months, or even later!
Q: For any of this that you’ve described, is the method going to be any different if I’ve got a Touchy or Grumpy or Spirited baby?
T: No, not in its basics. Just be prepared to do it a little longer. And the quieter the activity time is, the better. Also, you can’t take them straight from the gymini and put them down. You’ve got to realize you’ll need at least 15-20 minutes wind-down time. And the darkening of the room and the blocking of visual stimulation is going to be especially important for these babies. Some, especially Touchies, can’t seem to keep their eyes shut -- and then they start processing the environment, and can’t switch off. And that’s why you’ll get a baby who is crying the world out. They go to that to “switch off” the world. The patting and the shh-ing will take the focus from the crying to the physical touch and the audio.
Q: So it’s important, if you’re having sleep problems, not to just focus on what’s going on right before sleep time, but to look at the activity time, and look at the whole.
T: Yes, you have to look at the whole day. Using the principles of the book, you have to tone their whole day down, from the very first awake time. Remember that infants can’t get out of the way of things hanging over their head. Often during activity time, parents will hear that first fussy cry and think, “Oh, she’s bored” and jiggle something in her face. Whenever you hear your child do any kind of first fuss, it’s an indication. And if you’re on the E.A.S.Y. routine, then it’s easier to tell – if she’s been up an hour and 10, I’d put money on it that’s she’s getting tired. Sometimes that first cry is enough. Or the first yawn – get them out of there.
You want to limit your activity to 15-20 minutes; this is a long time for an infant to be looking at anything, even your face. Parents will find that it’s around 3-4 months that they start getting enjoyment out of these types of toys, the gymini and such, because they can move their head from side to side purposefully. Up to that point you want to use your pastels, or a simple face drawn on an index card, the types of things I talk about in the first book.
It’s hard because there are so many gadgets and so much pressure to use them. The swings, and the seats that jiggle, it seems like there has to be something going off all the time. But less is more with a baby. The calmer you can keep them, the better they’ll be at sleeping, and the more neurological growth they can achieve.
Q: I’ve noticed that when a baby gets a bit older, they might not yawn as much, so the yawn might not be the first cue, it might be the fuss.
T: Yawning is a way of getting oxygen to the brain. So with a baby who is sleeping well in general and is well rested, you won’t see as many yawns. Certainly with a newborn, up to about 3 months, you have the definite cues. And my hope is, that by about 6 months, we certainly know our babies. At 6 months, if they’re fussing, and you change the venue and still have fussing, then you know he’s tired.
Q: Now, let’s take a scenario of a 6 month old who generally can go off to sleep on his own very well, but where the window has been missed and the baby can’t settle – this baby is probably no longer swaddled, but wrapping a blanket tightly around everything but one arm, and putting him in the crib and holding him firmly but gently (maybe putting the weight of the forearms along his body) seems to help him settle. Is this common for this age?
T: Yes, very common. You still have to help them control their arms and legs. Once they start flailing around, they have no skills to calm themselves down. That’s why they depend on us to do that.
Then once they start to calm, what you’ll see is some self-soothing. The cry might be more of a “mantra” cry, and start reaching that peak. Leave them alone, but be a soothing presence.
Now, 6-9 months, you’re going to start to see a child that has more mobility. Some children at around 8 or 9 months can even start to stand up. This is where parents get confused. If they’re able to get to an upright position on their own, you wait until they do that. And then you reach out your arms to them, and you say, “Here, let me pick you up”. Then you physically turn them, put your arm underneath their knees, with your other arm around their back, and then you lay them back down on the mattress. And wait until they get all the way back up before you lay them back down again.
Also, at this age, you need to have introduced a blankie, or a security object, something that they’ve gravitated to. It’s usually a blankie, or a soft toy, or something that they can start to use as their comfort.
Now, the same applies from 9 mos. to a year. The only thing is, you start to use your voice more now; you say, “Hey, hey, hey, it’s okay, you’re just going to sleep. I’m not leaving you, I know you’re frustrated” – you start to bring in and start to name their emotions. That continues on, through to about 18 months.
Now if you are just starting the process at about 15 – 18 months, and up to then your child has slept in your bed, there isn’t much point in putting them straight into the crib. At that point, you start the process with sleeping with them on a blow-up mattress on the floor in their room – there is a detailed example of this in the Toddler Book – and then you go gradually to them being independently sleeping in their own bed.
Q: Now, all of these, for any of these age groups, when you’re doing it at night for night wakings, are you going to use your voice, or are you going to just rely on the physical reassurances
T: Just rely on the physical. Of course, you know it’s mum’s judgment, if they feel they need to intervene, by saying “hey, hey, hey”, like cutting the cry, sometimes mum’s voice will do that, then it is an option. But the less eye contact and use of your voice in the night, the better.
Q: What about doing pu/pd with an infant when you’ve also got a toddler – maybe even in the same room?
T: This is where you have to bring in help – where there’s a will, there’s a way. If you’ve got a friend, or a partner and you want to really go at it over a weekend – or, maybe you’ve got nobody. Then you can use the “no-no” toys that I talk about in the second book, for distraction. Everything is planning. You say to the toddler, outside the room, “Here’s your no-no toy. And I’ll put another one outside the bedroom door, so when you’re done with this one, you can come and get that.”
Now, depending on your child, if you’ve got what I call “Irish twins” that were both born within a 12-month period, then what do you do? Well, hopefully, you’ve got one on a good routine. If not, then you’re going to have to engage someone else to help, otherwise it’s impossible. But if you say, “I’ve got no one,” well, then maybe you’ll have to put one in their crib in another room and run back and forth. But I know if you really need to change this, we’ll find somebody – even if it’s finding another mum who lives in your area and will come around.
I’ve got a mum right now, and her husband just doesn’t want to participate. She’s got a friend with a 5-month old who sleeps through the night and is going to come ‘round and help this other mum get this baby to sleep through the night. So there is a way.
Q: Another question we see a lot is people who say, “When I pick my baby up, it seems to make her more upset.” Or they have a hard time getting them to settle – they “never” calm down.
T: Right. Now what you have to do is to be patient and see it through to the end. It’s really important, because they will eventually stop. It’s then when you have to use your, well, your survival, and the survival techniques are – and not to say that this is means to ignore the child – if you’ve got ear plugs to use when you’re in the room with the child, or a partner, or a best friend, who you can team up with to do this, that child will eventually calm down.
I can’t stress this enough, and I’m saying this in bold – If you are as consistent with the new method as you are with the old, it will change.
Q: So, even if I’ve got my baby in my arms, and she’s not calming down, I continue to hold her, or calm her in the crib, based on the techniques for the age ranges you described?
T: And use your voice. Because if you go back to the old habits, say putting them on the boob, you’ve then made that child cry for that amount of time and then ended up doing what you used to do and haven’t seen it through. And that’s cruel, and very confusing for the child. Because if you feel that you’re going to give in -- that’s why to have someone who is willing and able to help you see it through – having that person with you would be a good thing. If you know your own temperament, and you say you know, there’s going to be a point where I’m won’t be able to stand it. If you feel that, you’ve got to think this through before starting. You can’t go into this kind of blasé, because the child is obviously having a difficult time adjusting to the new way. So if you think you’re going to cave in – you’ve got to look at your child’s overall well being. What will the situation be if I cave in? If the child has been crying for 40 minutes and you take them back to the old habits, then you’ve made that child cry for 40 minutes for nothing! And that is cruel.
Q: I wanted to talk a bit about the difference between “caving in” and feeding because there is a clear hunger cue, or it’s now time for a feed.
T: When I say, “don’t cave in”, I’m not telling you to ignore your child’s cues. The premise of the whole thing is to read the cues! It’s when your baby isn’t getting enough sleep and is overtired, that the cries can all start to sound the same.
Q: So if you’re doing pu/pd, and you’re hearing the overtired cry, but either it changes to that distinctive hunger cry you describe, or you’re clearly in the zone of the next feed time, then feeding is not caving in.
T: That’s absolutely correct. And this is important for parents to realize, there’s nothing in E.A.S.Y. that says to ignore a cry of hunger, just to use common sense and separate the eating from the sleeping early on so that your baby continues to use his different cries to let you know what he needs.
Q: Let’s also take people who have been using E.A.S.Y. from the beginning – the baby has never fallen asleep on the breast, or depended on props, but still has periods or episodes where he gets worked up and won’t settle. And even if pu/pd has worked in the past, it doesn’t seem to be working this time. But sometimes leaving the room with him seems to calm him right down. Is this okay?
T: Yes, if you need to and other calming hasn’t worked, you can take him out of the room for twenty minutes, and then back in.
Q: And sometimes, when the baby is in my arms crying, I’ll just sense that he’ll calm more quickly if I go ahead and put him into the crib and work on calming him there. Is this okay too?
T: You know, sometimes they cry because that’s why – the pushing away and burrowing down is a way of trying to settle themselves. Sometimes when we’ve got a lot of props, we miss the essence. We don’t recognize what a frustrated cry sounds like, because we’ve always fallen back on the other methods. And trust me, it’s not because parents aren’t observant; it’s just getting into habits that work for the short-term. But what we’re trying to do is develop habits and teach them ways to go to sleep that will work for the long term.
And because we’re going to have some nights – and days – where it seems like it’s regressed.
Q: Let’s talk about that. You’ve started, it seems to be getting better, and then boom – it’s seems just as bad or worse than before.
T: I can give you all the scenarios that happen when parents are doing it. And bear in mind that when I do it, I do this all the time, so I know the facial expressions, or the way they throw their arms out, or the way they slam their legs on the mattress – I know what’s self-soothing and what needs intervening, because I’ve been in every possible situation. So I tell parents don’t beat yourself up if it takes you a bit longer.
And actually, the older the child, up to a certain point, the quicker it is to “fix”. Like with an 8 month old, if you really go at it for 3 days and 3 nights, you’ll change it. We can talk through all the different scenarios.
Q: Let’s start with infants – what is a typical scenario?
T: Sometimes what happens with an infant is this:
You try the first night, or the first day, and it only takes you half a dozen times to pick them up and put them down, and they go to sleep, and you think, wow -- that was fast! So that night comes and they just wake up once, and the following day it starts to go smoothly but that night, all of a sudden, they’re up eight times. And you think, “what the ens has happened?” Sometimes what parents do is they think, this isn’t working. And of course then the next day they’re both going to be tired, and often the child then in the day is up and down, up and down, because they haven’t had a good night’s sleep and are overtired. The more relaxed a child is to go to sleep, the better they’ll sleep. An overtired child isn’t going to easily go to sleep.
Then, what parents will do is say, okay, let’s get through today, we’ll see this through. Then that night, the child may sleep through. The following day seems to go okay. And you get to the 5th day, and it seems to go all the way back to the beginning. What we have to look at is what activities we’re doing during the day. What a lot of parents do is too much activity during the day thinking that if they tire the child out, it will make him sleep better. But it doesn’t work that way at all. It works the opposite. If a child is overtired, they have to cry the world out. And then they don’t go through the three stages of sleep in a very gradual way. What you’ll see is a lot of jerking, and lots of crying and lots of fussing, and then they’ll stay asleep maybe 15-20 minutes and then they’re up again.
And you know, you’ve got to make sure you’re consistent, and not give in. If you’re going to attempt this, give it at least a week. I sometimes see parents posting on the website that say this is my 8th or 10th day doing this. When I’ve spoken to them, it turns out they’ve skipped it a couple of times, because they’re tired. And you can’t do that, because it throws you all the way back to the beginning.
Having worked with so many parents, either via the telephone, or in homes, I know that they’re doing something different, because I know this technique too well, for it to be going 10 or 15 days.
A classic example came up recently with a mum on the website. When I called her, she had a week off and really wanted to tackle some ongoing problems with getting her baby to go down. I talked her through this method, and I told her all the pitfalls, and what was going to happen – and when to intervene and when to hold back. And within about a week, she’d got it. I spoke with her again recently and she said it was great, it was on track. Sometimes we need to tweak it, based on getting the full picture from the parents, or we talk it through like we’re doing now, it really helps.
Q: When parents are trying to start teaching sleep, is it better to start with, say, one nap time a day, or if they think they have the stamina, do it for all sleep times?
T: The thing is this, whatever you’re doing, being consistent means that you have to be doing it all the time. It’s like I say in the books – start as you mean to go on. It’s like being on a diet, so this morning, I’ll have a banana and a yogurt, but then I’ll have a steak and kidney pie at lunchtime. Then I have a salad for dinner. But then I decide to have porridge with lots of sugar for breakfast, and a bacon buffet. I’m never going to lose the weight like that. I have to be consistent.
Parents have to remember that with any change comes resistance, and comes frustration – even in adult life. Because that’s a human trait. And babies don’t just have skills, they have to learn skills. Once habits are established, what you put in is what you get out. And it’s never the baby that gets fed up with it.
And in all of this, it’s important to say that even though I’ve got a million scenarios and I’m so successful talking one on one, this book was designed to be general. And to put all of these scenarios in the book, well the editors wouldn’t let me – couldn’t really, think how long the book would be. So I had controls and constraints I had to work within. And that was frustrating for me, because I know all of these idiosyncrasies that happen with all babies. And I know the frustration level of parents! I work with them every day. I had a mum write to me the other day, who was clearly frustrated, and had a go at me, and that was sort of okay. Because I could see where she was coming from. And having spoken to her – that was Tuesday and we’re now Sunday, and when I spoke to her last night she said she’d had two of the best days she can remember in this child’s life, and he’s now 5 months old. And that’s sad! But you see how you cannot put every single scenario in. What we’re trying to do and achieve here with this Q&A is to guide you as much as possible by giving you this extra information that can help you to move forward.
Q: And going back to what I was asking earlier, if someone says, okay with pu/pd, my baby calms more quickly if I put him down – to say, well okay then, put him down.
T: Yes! Remember the most important aim of my books is to know your child, to learn about your particular child, because each one is an individual.
Q: And the point is, as you say, there’s no book that’s going to cover every possible, conceivable situation.
T: No. Because also, you’ve got to take into consideration two peoples’ personalities – in fact, three if dad’s participating too – mum, dad, and the baby! And the tolerance level for crying, for hearing your baby cry. Some people have very, very low tolerance. I have some mums who get very angry, because they just want the baby to stop crying. And in no cir!@!stance is this to say you’re a bad mum, it’s just to say that you’ll need help. Because if this is frustrating you, and you’re turning from empathy to the other way which is anger, then you need to be mature and say, “I can’t do this alone, I need someone to help me, in order to help my child.”
Q: Great – let me just run through a few of these that I know we see all the time on the website, that might be kind of general.
T: Perfect.
Q: One is, if I’m doing pu/pd for the start of a nap, how long should I continue it – is there a point where I should just give it up for that sleep cycle?
T: 40 minutes. This is the amount of time that they usually stay asleep if you’re dealing with short naps. Then, what you do is you don’t go back to the old habits. You take them out of the room for 10-15 minutes, depending on how they’re calming, and then you go back to it.
Q: And so if you’ve done that, presumably you would try not to feed them until close to their normal feed time.
T: Yes.
Q: And would you then have activity time, during that 10-15 minutes -- would you be playing with them?
T: No, you’d keep it very low-key and calm. Because it’s supposed to be their sleep time.
Q: And then you’d take them back in and try again to get them to go to sleep?
T: Yes, and that will take you probably up until the next feed.
Q: And what do you do at that point?
T: Right, now you’re going to feed them, and if they’re falling to sleep, you only need a window of about 10 minutes after the breast or bottle is done for you to start again. But that means, you really do have to work hard at changing the diaper, and keeping them up. So as you see them falling asleep on the breast or bottle, don’t wait until they fall asleep, take it out, and sit them upright. Because a child sat upright will come immediately to consciousness.
Q: That’s good information; I think that’s going to help a lot of people.
T: So then you only need to change the diaper, and they may be a bit fussy, but you can go ahead and put them down.
Q: Another question is, I’ve picked the baby up, and she’s calmed down. I go to put her back down, and she starts crying on the way down, before I’ve even gotten to the mattress. What do I do?
T: You lay them down – you lay them all the way down, and take away the physical contact, then say “I’m going to pick you up again.” Or else you’re teaching them that when you lift them, to cry. So you’ve got to see it all the way through, laying them down, but then go ahead and pick them back up. And that is usually around the 5-month range, where you see that kind of pattern.
Q: Where they’re aware that they’re about to be put down, and start crying?
T: Yes. And sometimes, what I’ll do after the second day, if it’s still really going, I’ll lay them on the mattress – actually sometimes this is where I’ll even climb in the crib – but I’ll lay them on the mattress (and I have a stool, otherwise my boobs will kind of catch on the bar) put the bar all the way down and I’ll physically go in, with my whole body into the crib and lay my cheek next to theirs. I don’t pick them up. So let’s say if you’ve done this for 2 days and you see it just isn’t changing, then lay them down but go to them, instead of them coming up to you. And I can tell you, it’s around 5, 6, 7 months.
Q: Now let’s say you try that, and it seems to tick them off, make them even more upset.
T: Well, what she’s saying is, “Get out of my space! I’m trying to settle, now just back off.” And it’s respecting that.
Q: A lot of people ask: At what point do I leave the room?
T: When you start to see that they’re settling themselves. We call it “heartsluffed” in England. It’s just a name that we give to someone who’s going off – I don’t know what they call it here. Let’s say when you see that their breathing starts to become calm and regular.
Q: So they may not be asleep yet? But their eyes may be drooping?
T: They may not be fast asleep, but their eyes are going, and you see a lowering of consciousness, and they’ll start to take kind of a shuddery breath, shuddering breathing.
Q: I know when they find their thumb, that might be the cue, they’ll turn their head and stick their thumb in their mouth, and even if the eyes are still open but starting in the distance, you know you’re okay. What about for young babies, are they doing the snuffling?
T: Right. What you’ll find for a newborn is that they don’t do that, because they’re nasal breathers. What you’ll see for a newborn is that they’ll shut off very quickly. And you think, there, I’ve done it, he’s asleep. But a couple of minutes later, they’ll start up again.
Let’s talk about newborns: It takes a newborn 20 minutes to go from consciousness to being deeply asleep. A lot of moms, when still teaching sleep, that is when they’ll leave the room at 10 minutes, and then the baby starts to fuss and wake up and then they’ll have to go back in and spend another 20 minutes getting them to go to sleep again. The essence there is to stay the whole 20 minutes, because then you’ll get a baby who’s going to sleep a whole hour and a half to two hours. Really, this is by you just standing there 20 minutes.
Now, eventually, over 3 or 4 days you won’t have to stand there that length of time because they’ll start to learn the skill of going to sleep – but in the beginning it’s well worth that 20 minutes of your time to watch your baby go through those three definite stages. It’s usually after about 10 minutes that they drop into the second stage, and that’s when they’ll wake themselves up.
Q: Now this is assuming that you’re putting them down at stage 1, basically, that you’ve made it to that point.
T: Right. Usually an infant up to 3 months – well actually, if you like, 8 weeks, doesn’t generally cry because they’re being put down, it’s because they’re overtired. And also it could be because they’ve got a little bit of heartburn. That’s why I ask parents, always from day one, have a slight elevation on your mattress. Because their digestive system is very immature, and they tend to get heartburn, which if it’s not – I always go with prevention rather than cure, that’s why I elevate all mattresses for all newborns, full stop – but if it starts to get really bad, with putting a newborn down you really have to see if this is the problem. I was just talking the other day with a dad who said we’ve been resorting to accidental parenting because we can’t put him down, and clearly with all the signs he gave me, the baby’s got esophageal reflux. They took him to the doctor, who sent them to a gastroenterologist, and the baby’s got very severe reflux.
Q: Can we list here what those signs are?
T: Some of the signs are: Explosive poops. Fussing and bobbing on and off the breast, and crying. And the cry is clearly uncomfortable, and on and off all day. They’ll make a wincing noise when they swallow. They clearly bring the legs up, but it’s more things like bobbing on and off – they don’t necessarily have to spit up. That’s a common misunderstanding; sometimes people think it has to be as extensive as projectile vomiting. But that’s not the case. Heartburn, you know yourself if you’ve got heartburn you don’t spit up. If it comes into the upper part of the esophagus, then you’ll see spitting up. But normally, it’s the lower part, just above the sphincter to the stomach where they’ll feel the burning sensation.
Now these babies like to feed a lot, because when they’re swallowing, it eases the pain. So they tend to want to feed regularly ever hour or hour and a half, and then they fall asleep. This is how parents get confused, because they’re giving the appearance of hunger, and then fighting on the breast after a couple of sips, or even with a bottle, they’ll fight, because they can’t swallow fast enough. That’s why I’ll use the Haberman feeder, because conventional bottles flow too quickly.
Q: And this was the case with the baby you just mentioned, where the dad called you?
T: Yes. But they thought this was a baby who was trying to control them because he didn’t like to be put down, and he screamed when he was laid down. So you have to remember, especially with infants who scream when they’re laid down flat and not when they’re put into a motionless (we’re not talking here about the case where the baby has become addicted to motion to get to sleep) swing or car seat or other device on an incline, that it’s not because they’re trying to “control” you – it could be because they’re in discomfort. And the cry is very different. When they’re laid down flat it puts pressure on the stomach sphincter and opens up to heartburn and causes a lot of pain. So again, elevating the mattress is very important.
Q: I would think that especially at that age, they don’t have the ability to manipulate – crying when being put down is not an attempt to control you.
T: No, they don’t have that ability until much later. And we as humans learn to manipulate – when people say “he makes me do” when they try to change to a new habit and it doesn’t work right away, that frustrates me a little, because the child doesn’t make you do, you’re just not doing what you used to do, which he’s learned. Do you see the difference?
Q: So you’ve got two kinds of car seat sleepers, one where it’s because of accidental parenting and they’ve gotten used to it, and the other where it’s a brand new baby, and they’re not in the car, not moving, but as soon as you put them in the car seat they fall asleep.
T: Exactly.
Q: One question I see a lot from parents of newborns is that they’ll be sleepy, very sleepy, up until the moment they’re put down. Not asleep – not a case where they were asleep and being put down woke them, but you’ve sat them up, you’ve changed the diaper, and done everything to get them to wake up and eat more, but nothing works. And then you put them down and either right away or in a few minutes, they’re awake and crying.
T: When you’re being carried, you feel a sense of weightlessness, and being put down can make you feel the weight. And also, with breastfeeding some of that could be the oxytocin. It’s making sure that feeds are feeds, and they’re not just taking off the front of the milk. That’s why I’ll say to mums, if it’s been 5 minutes, and they’re dropping off to sleep and you can’t wake them, lay them down and 10 minutes later they’ll strike back up. The oxytocin has gone through their system. And usually after that first oxytocin level works through their body, it’s at that second phase they’ll eat more efficiently.
Q: And if they have eaten a full feed, or are on formula, and this still happens, that might go back to the heartburn issue you were talking about earlier?
T: Yes, exactly.
Q: Here’s a question we also see a lot – “I can’t seem to find that perfect time to start heading for the nap.” They’ve tried acting on the first cue or even earlier, or waiting longer, keeping them up.
T: Always, for young babies, keeping them up longer does not help them sleep better. Never does. It’s most definitely related to the activity period, especially as you get to the afternoon. As the day progresses, they get more and more tired – physically, emotionally, and neurologically. And that’s why I stress that an afternoon activity for a baby – even up to a year – should be low-key. So if you have your errands, to them in the morning. If you’re doing a playgroup, do it in the morning or no later than up to 2:00 in the afternoon.
If a young baby is consistently having a hard time going down for a nap, and it’s not heartburn, then it’s probably overtiredness.
Q: Okay, another one: You’ll sometimes see questions from parents with babies that are probably a bit older, who ask, “My child has learned how to fall asleep on her own, either using pu/pd or otherwise, but how do I get out of the room – she cries if I don’t stay until she falls completely asleep.”
T: And the way to handle that is to leave, and have a minute out of the room and then come back. Because she knows you’re physically present, because you’ve gone through the pick up and put down, but you just haven’t left the room at the right time, way back when you first taught sleep. And now you are the prop in the room-- not the physical prop – and that’s when you leave and come back and leave and come back, for a minute at a time. Now that is a lot older, usually you’ll see that at 10, 11, 12 months, when they “make” you stay in the chair, because the minute the chair creaks, or the door, they pop their head up above the bumper. Because they haven’t really learned how to go to sleep, not safe, secure, and confident – there are some anxieties attached to it. And that’s because you probably didn’t leave before they were fully asleep when they were younger.
Q: Now, naps. If a baby wakes early from a nap, or you never got them to sleep in the first place for a nap?
T: Give them the feed, if you’ve gotten to the point where it is time to feed, then keep them up for 10 minutes, and then go for the nap. Don’t look at the clock.
Q: Now sometimes a baby, after he’s eaten, even if he’s skipped a nap, won’t seem sleepy. Do you still just wait about 10 minutes and then start trying, or do you wait until they show tired cues?
T: Right, you have two scenarios: One is where they’re falling asleep on the bottle or the breast, and the other is the wide-awake. If they’re falling asleep, wake them up for 10 minutes, and if they’re wide-awake, go ahead and give them half an hour – 45 minutes, and then start the process. Otherwise you’re going to have an overtired baby.
Now what you might see, is after 45 minutes of sleep they’ll wake up again, and that’s when you do the pu/pd to put them back to sleep – but if it takes you 40 minutes to get them back to sleep, do you let them sleep the other hour? No, you let them sleep just until the feed time again. You don’t overcompensate.
Q: So let’s say I’ve spent a lot of time doing pu/pd, and I’ve finally gotten him to sleep, but it’s only 10 or 15 minutes until the next feed time, do I go ahead and wake him back up?
T: Yes, you get him up.
Q: Because I know how some moms must feel, I’ve spent an hour and a half to get him to sleep, and I’m only going to let him sleep 10 minutes.
T: Yep, and that’s what you do, you get them up. But that activity time – you’re going to feed him, and then the activity time is going to be very short. That’s where you’re going to compensate.
Q: So let’s talk this all they way through in the form of a scenario: You have a baby who is on a 3 ½ to 4-hour schedule, who has woken at 7am, and gone down for a nap at 9am. Say he wakes after 45 minutes, at 9:45am, and it’s not a growth-spurt or hunger that’s driving the waking. The next time he’s supposed to eat is, say 10:30am on the early end. So from 9:45 to 10:30 is only 45 minutes. Are you going to then do pu/pd until it’s time to feed?
T: Yes. And then you might find that he’s dropping off to sleep as he’s eating, so you’d do what we mentioned earlier, keep him up for 10 minutes after eating, and then go for the nap. Now, if he isn’t dropping off but is awake, then only give him a half-hour or so awake time. Because he’s going to be extremely tired, and then you’re never going to get him down because he’s overtired.
Q: So let’s carry that through – you go ahead and feed him at 10:30am, then keep him up for half an hour after he finishes eating, so let’s say he goes down at 11:15am, whereas normally he would have gone down at 12:30 or 1pm. Now how long would you expect him to sleep?
T: He should sleep for 1 ½ or 2 hours. This is where you don’t watch the clock; you’re applying the principle of robbing Peter to pay Paul. Now when he wakes up, it might be an hour before his next feed, but that’s fine – as long as you’ve gotten a good nap, you’ll have an hour of activity time before feed, and then he might have a shorter activity time after the feed, but his total up time is normal length. The point is this: We’re trying to get him used to sleeping a long time, a good-length nap of 1 ½ - 2 hours.
Q: So if they have a good nap, but wake far in advance of the next feed, that would be activity time.
T: Yes. And this is where people sometimes get confused – and so as I said, you don’t look at the clock, if they’re up a little while before the feed, that’s fine, because you’re still going to have at least another –this is another thing, because he’s had that hour up time, and then a feed, remember if he’s had a good 1 ½ -2 hr. nap he might go the distance, because he’s has that good nap, even if the routine got skewed a bit early. So he might go another hour after his feed.
Q: Now if he doesn’t nap that long, but again wakes up after 45 minutes, you start the pu/pd?
T: Yes, you’d do the pu/pd, same as before. Being consistent for all nap and sleep times, until you’ve worked it through.
And realize that it is frustrating. It’s not easy, it’s never easy. Well, that’s not true, because for a younger baby it is. The hardest stage is between 3 and 6 months, because they’re having a lot of physical changes as well.
Q: In that age range, there seem to be two categories of short nappers: You have the baby who has never napped longer than 45 minutes, and you’ll have the babies who used to nap very well, and now have regressed. Let’s start with the regressions.
T: Great! Because we’ve covered this at times on the site, but I really want to make it a special topic here. Once it’s time to start to move your feeding schedule from a 3 hour schedule to a 4 hour, and it’s around 3-4 months that you’ll start to move in that direction, what you’re seeing is a baby who can stay up longer, but because they’re still eating on a 3-hour schedule, the eating will cut into what should be a 2-hour nap. So then they start to do the 45-minute naps even if they’ve been napping well up to this point. Now this will happen very gradually, and if you’re watching for it, you can see it as it starts. You don’t need to let it get established.
What you need to do is respond to it, because this is where it’s going, to revert to the 45-minute nap. Because they can physically stay up longer, but they’re only having 45-minute naps, they then revert to only being able to stay up and hour and 15 minutes. Okay? But because they’re older, and can store energy better, they only need 45 minutes, because they’ve only been up an hour and a half, or an hour and 15. When really, at about 4 months or so they can start to hold their own for at least 2 hours, earlier for some babies and later for others.
So this is when you get into that vicious cycle of, because I’ve only had 45 minutes I can only be up for an hour and a quarter, and because I’ve only been up an hour and a quarter, I only need 45 minutes!
Q: And I think for a lot of people who have read the first book, and are working so hard on trying to follow cues, it’s that transition that’s tricky, when you’re not just going to follow the sleepy cues right away.
T: Exactly.
Q: Especially if you have licked the 45-minute naps, and then they reappear. It might not be intuitive to say, “Now we’re going to delay when we see the sleepy cues and keep her up a little bit longer.
T: Right. The other thing that parents will make the mistake of doing is trying on the first day to go straight to keeping them up 2 hours. And then all hell breaks loose, and then they’re not relaxed enough to go sleep, so they still only sleep for 40 minutes, and it’s a mess. Sometimes, they’ll sleep less, they’ll go to a 20 minute nap or a half hour – we see this all the time on the website. “We started to keep them up for 2 hours, but then they’re overtired, and wouldn’t sleep at all.”
Q: So it’s important to lengthen the awake time gradually?
T: Yes. Start with adding 15 minutes, and do that for several days. And then if you need to add more to get it up closer to 2 hours, add 15 more for several days. And so on. And keep at it for at least a week, and you will start to see results. But it’s striking that balance, not keeping them up so long they’re overtired but keeping them awake long enough.
Q: Is it important to say here that if your baby is, say, 4 months or even 5, and is napping very well but only awake for 1 ½ hrs at a time, then you don’t need to “push” them to stay awake longer? That the baby will give you the cue because his naps are consistently getting shorter?
T: Exactly.
Q: Taking the other category: If you have a baby who has never taken good naps, how do you know when it’s time to stretch their awake times?
T: I’ll often get babies who are 5, 6, 7, 8 months old, who have always taken 45-minute naps and are taking maybe 4 a day – what you try to do is consolidate. To at least two 1 ½ hour naps. You only achieve that by lengthening their up time by 15 minute increments.
Q: Now, at that age is 2 hours what you would consider the maximum awake time?
T: It depends; it could be 2 or 3 hours, depending on the baby. Some babies can stay up 2-3 hours and then go down for a good 2 hours.
Q: If you’ve got a baby who’s staying up 3 hours at a time, and is taking 2-hour naps, what is their feed schedule – they’re not on a 5-hour schedule, are they?
T: No, usually what you have is a baby who on some of their cycles will be up an hour, feed, be up another 2 hours, and then go down for two – so that would be a four hour cycle. They may not always be feeding at the same spot in every awake cycle, and might sometimes be taking more than one feed in there.
Q: So there are a lot of things changing in this age range.
T: Yes. And sometimes you’ll have something else that’s very common – “My baby has been sleeping through the night, and now she’s started waking again.” I guarantee that probably started at a growth spurt, and they didn’t recognize it, so they didn’t up the calories during the day.
And the other thing is, parents will say is “He’s four months old, and he’s started waking, and he’s drooling a lot – has he started teething?” No, he’s not teething, except in very rare cases, his saliva glands have just matured. Because drooling has nothing to do with teething.
Q: I remember that our pediatrician told us the same thing, but we just have so many people who insist, “Oh, she’s drooling, she’s teething.”
T: No, it’s the saliva glands.
Q: What our pediatrician told us is that the body knows the age they’re going to start bringing everything to their mouths, developmentally, and it’s a lubricating and germ-fighting mechanism.
T: Exactly! People always associate it with teething, and it’s not. But it’s also important to note that if you want to start sleep training, and you’ve got a suspicion that your child’s got a cold, or an ear infection, or something else is off, then you don’t do it yet. And the other thing to remember is, when a child is ill, you go to them, they don’t come to you.
Q: That’s advice I’ve seen you give often. But it always seems there’s one parent who is more in favor of bringing the baby into their bed than the other – and the other parent is afraid of starting or reintroducing habits that will be harder to undo now that the child is a bit older.
T: Yes. But go to them, set up the mattress on the floor for yourself so it’s not so tempting.
Q: So if night wakings are starting again, and it’s clearly hunger, you would feed him that night, but the very next day start trying to increase the calories?
T: Yes, get the extra calories in wherever you can. Don’t even think about the clock. So if they get up at 7 and feed, you give them a couple more ounces at, say, 9. Whatever you fed them in the night you’ve got to make up the next day – let’s say he woke up at 2am and gulped down 8 ounces. Then you’ve got to get 8 extra ounces in the next day. It doesn’t mean in one bottle or feed. It may mean you’ve got to add an ounce to every bottle/feed they’re having in the day. Say they’re having 4 feeds/bottles, that’s an extra 4 ounces. Then, say after an hour that they’ve fed, you give them an ounce. And then another hour later, you give them another ounce. And then it’s not until about the third day that they’ll start to adjust during the day so they can take all the extra they need at regular feed times. But if they’ve been sleeping through the night, and suddenly they start waking, I could put money on it that it’s hunger, and it’s calories.
Q: Let’s say they’re already taking 8 oz. per feed, would that be an indication that it may be time to start solids? Or increase them if they’ve already started?
T: Yes, and you’d speak with your pediatrician. I always refer parents to their pediatricians, and I like to see them try to get to that 6-month mark, or as near as they can. With formula-fed babies, they’ve already had the artificial iron and such introduced to their bodies, so sometimes they won’t react as much to the iron in the cereals, but in any case, I like to wait if possible – and always check with the doctor before starting solids.
Remember that with breast milk, they actually get more calories in the same number of ounces as they get older, because the breast milk changes, the mother’s fat storage will start to come up. Formula-fed babies get the exact same number of calories per ounce every time. And that’s why you’ll see them maxing out and perhaps needing to move to solids a bit sooner.
Q: Let’s take another example, where they’re waking at night and only taking 2 ounces, would you say that hunger is driving that waking?
T: No. If they’re regularly taking between 5 and 8 ounces per feed during the day, on a regular basis, and they’re not snacking, then if they wake up and take 2, then they’re not hungry. A hungry baby will take at least close to a full feed, and will gulp it down. And what tends to happen is that these babies have woken up, probably coming out of REM sleep, and the parents are so quick in wanting them to get back to sleep that they’ll rush in too soon. And then the habit starts. Leave them be for a bit, they’ll probably settle themselves.
Q: So if I think he’s waking early because of hunger – sometimes they’ll wake early, even from a nap, and it’s clearly hunger –and you feed and then it happens again the next day, a little light bulb should go on to say you need to do something, because if it goes on the next day, that’s three days and it can start to “lock in”?
T: Yes, anything more than three days is starting to be a habit, because their recall is about 3 days – less for a newborn, but for a 3-month old it’s about 3 days. So if it goes on that long it’s more than just a
