Tuesday, May 14, 2013

Baby Routines


Oh, I can only begin to imagine the controversy that this post will inspire! There are many people who think I'm a bad mother because of my penchant for routine. They think that I try to control every aspect of Henry's life and get him to fit within a neat little box.

But I want to write this post anyway because each of us needs to figure out what makes sense to us and our families. The more we share information with each other, the more we can expose ourselves to different ideas. We can sift and sort through them to uncover what resonates with us.

I still remember the first three weeks of life with Henry. My guess is that new babies are even harder for folks like me with more Type-A personalities. I remember reaching out desperately to two friends who had trodden the mother path before me. One of them introduced me to the book On Becoming Babywise. It revolutionized my understanding of how to structure my day with Henry: feed, engage in a little activity, sleep (repeat every 2-3 hours). That rhythm worked perfectly to meet Henry's needs. It was so much easier to meet his needs when I had a clue about what he might need at a given time. After I breastfed him, I would give him some play time, but I would watch for signs of drowsiness. Since he took so long to eat, his awake time was actually pretty limited. Then I would help him fall asleep. Without reading this book, I most likely would have reversed the sequence and breastfed him to sleep (which wouldn't have been bad, per se; it just might have made it more difficult to help him learn how to put himself to sleep later on). 

Even though establishing a routine can feel very parent-centered, I think it can actually be done in a very child-centered way. Our routine changed every couple months, based on what Henry needed as he grew. We never followed any of the books exactly because we did what worked for Henry, but the books were still very helpful to us. They functioned as a starting place for helping us decipher exactly what Henry might need at a given time and structuring our time together to meet his needs.

As we gear up to expand our family, I wanted to revisit some of the books that proved helpful to me with Henry. Of course every baby is different, but I'm eager to try out many of the same strategies again. Having a routine with Henry allowed me to take a shower every day, write an entire book, go out to eat as a family, etc. I also think it helped Henry's temperament. 

I know it's going to be even harder to implement a rhythm to the day with a second child. For example, I'll need to pick Henry up from school every day at 2:45, no matter what the baby needs at that moment. But I think the predictability will be even more important. It will allow us to more easily carve out one-on-one time with Henry, get more rest in order to be more patient as we try to juggle our expanding family, and help us feel slightly more settled and grounded amid the inherent chaos (Matt and I both feel better within a structure).

We'll see what happens! 

To refresh my memory about routines for infants, I went to four sources: advice from our pediatrician, The Baby Whisperer Solves All Your Problems, On Becoming Baby Wise, and Healthy Sleep Habits, Healthy Child. I wanted to share the bullet points with anyone who's interested. I found that it was difficult to summarize and organize the information from each book. Although there were naturally inconsistencies from book to book (which is absolutely to be expected), I also found inconsistencies within the books.

Still, I pulled out as much information as possible, so that we can reference these various approaches for ideas when we're in the trenches and trying to figure out what our baby needs:

Advice from Pediatrician
  • At two months, babies should be able to sleep 6 hours without eating in the night. At four months, they should go 8-10 hours, and at six months they should go 10-12. 
  • Don't start any sleep training before 4 months, but finish it by 6 months.
The Baby Whisperer Solves All Your Problems
Birth to Four Months
  • 7:00 = Eat
  • 8:15 = Nap
  • 10:00 = Feed
  • 11:15 = Nap
  • 1:00 = Feed
  • 2:15 = Nap
  • 4:00 = Eat
  • 5:15 = Short Nap
  • 6:00 = Eat
  • 7:30 = Short Nap
  • 8:00 = Feed and then bed
  • 10-11 = Feed
Four-Six Months
  • 7:00 = Eat
  • 9:00 = 1.5 - 2 hour nap
  • 11:00 = Eat
  • 1:00 = 1 1/2 - 2 hour nap
  • 3:00 = Eat
  • Between 5-6 = Short Nap
  • 7:00 = Eat
  • 7:30 = Bedtime
  • 11:00 = Feed (until 7 or 8 months when solid food is firmly established)

Six-Nine Months
  • 7:00 = Breastfeed
  • 9 or 9:30 = Morning Nap
  • 11:15 = Breastfeed
  • 1 = Solid food
  • 2 or 2:30 = Afternoon Nap
  • 4 = Breastfeed
  • 5:30 or 6 = Solid Food
  • 7 = Bath, breastfeed, book, bed
 After Nine Months
  • Five hours between feeds
  • Eating three meals a day
  • Two snacks 
  • Around 18 months, one afternoon nap a day 

On Becoming Baby Wise

2 weeks - 4 weeks
  • Feed every 2.5-3 hours
  • Activity
  • Sleep
  • (Average 8-10 feedings in a 24-hour period)
  • Wake baby around the 3-hour mark during the day to stabilize digestion, maintain lactation, and help the baby organize their sleep patterns
  • Early morning
  • Midmorning
  • Afternoon
  • Midafternoon
  • Late afternoon
  • Early evening
  • Late evening
  • Middle of the night

5 weeks - 8 weeks
  • Feed every 2.5-3.5
  • Set a time for the "first feeding" of the day 
  • Consider feeding closer together (~2 hours) for the last feeding of the night 
  • ~8 feedings a day (one in the middle of the night)
  • At the end of this phase, may average 7 feedings (often dropping the middle of the night feeding)

9 weeks - 15 weeks
  • Bedtime gets adjusted closer to the early-evening feeding
  • Weeks 12-15: Transition to 3-4 hour increments
  • By the end of the 13th week, baby can average 5-7 feedings a day
  • 3-5 months = 3 daytime naps (1.5-2 hours)

16 weeks - 24 weeks
  • Baby usually introduced to solid foods
  • Breastfeed 4-6 times a day
  • By 24 weeks, mealtimes usually line up with the rest of the family (i.e., solids at breakfast, lunch, and dinner)
  • Nurse first and then offer solids
  • 6-16 months = 2 naps (1.5-2 hours)

25 weeks - 52 weeks
  • Two naps (1.5-2.5 hours)
  • 4-5 nursing periods

16 months + 
  • Morning nap is dropped

Healthy Sleep Habits, Healthy Child

The First Week
  • Feed the baby whenever hungry and let sleep when s/he needs to sleep

2 weeks - 4 weeks
  • Do not expect a scheduled baby because the baby's needs for food, cuddling, and sleeping occur erratically and unpredictably

5 weeks - 6 weeks
  • Sleeps 5-6 hours through the night

6 weeks - 8 weeks
  • Sleep training may work for babies with an easy temperament

8 weeks - 16 weeks 
  • Works for babies with common fussiness/crying
3 months - 4 months
  • Morning nap starts between 9 and 10am



4 months
  • 6-8 pm = bedtime
  • Sleep training will now work for babies who had extreme fussiness/crying
  • 7am = Wake up
  • 9am = Nap
  • 1pm = Nap
  • 3rd nap varioes
  • 6-8pm = Bedtime

5 months - 8 months
  • Afternoon nap around 12-2pm
  • Late afternoon nap from 3-5pm

9 months
  • Late afternoon nap disappears




Share |

20 comments:

RebeccaK said...

A super helpful resource is following Nancy Holtxman on Twitter @nancyholtzman: great breastfeeding and parenting support at all hours. She works with Isis Parenting, and they have tons of free webinars that are incredibly helpful.

Rachel said...

Check out the 90 Minute Baby Sleep Program. It's written by sleep researcher and it helped me understand my baby's sleep patterns. It's much more pro-attachment parenting than either of the books you linked to; I think you'll like it.

http://www.amazon.com/90-Minute-Baby-Sleep-Program-Natural/dp/0761143114

I frankly didn't care for Baby Whisperer. The author's tone is so condescending. There's only so many times you can be called "ducky" by someone who's telling you not to pick up your baby.

Heather said...

At first my husband and I thought we'd just go with the flow and not use any kind of routine, but we found as soon as we started up more of a routine, all of us (including baby) were happier. We also realized that baby was more than ready to sleep through the night at 4 months. All this time we had heard from so many parents that their babies couldn't, so we assumed ours wouldn't either. I'm interested in seeing how easy it is to create a new routine once our next little one arrives.

mamarunsmiles.com said...

If I had let my 2 month old go for 6 hours without nursing, she would have starved.

I don't believe in many of the components of this post, but I am glad you figured something out that worked well for Henry.

V. Wetlaufer said...

I think the important thing is to do what's right for you and your family.

This schedule would never work for my niece and her parents, but if it works for you and your family, that's all that matters, and I think that goes for every parenting decision.

I hate how much controversy people (not you!) stir up in the whole "mommy wars" bs.

Elizabeth said...

I agree with you, Sara, that a routine is so helpful for getting a happy, well-rested baby! I read a couple of the books you did, and have found that Piper (now 11 months) has generally needed to nap about 2 hours after waking up, and then again 2-4 hours after that.

However, setting too firm a schedule can ruin a breastfeeding relationship! Your pediatrician's advice especially, seems designed to eliminate your supply and make breastfeeding next to impossible! I don't remember if you have goals of breastfeeding for the first year (or beyond) or if you had trouble breastfeeing Henry, but evidence-based breastfeeding advice sites like KellyMom.com warn against sleep training before one year, and especially so young as 2 months! Breastfeeding is unikely to be firmly established so early.

I wish you luck in navigating the hectic wonderfulness that is sure to be life with two kids!!

raisingthedough said...

I read books like this and it's like reading a calculus textbook. I know it makes sense for some people but I just can't see how it works! :) For context, my toddler is 16 months and wakes up twice a night to nurse. On the one hand I feel like we've tried everything but extinction crying to help her sleep through the night, but on the other hand I also feel like I must be missing something--all these books and parents seem so sure that these recommendations will work. It's pretty disheartening.

Sara E. Cotner said...

Thanks for the recommendations, RebeccaK and Rachel!

@ mamarunsmiles: We used our pediatrician's recommendations as a starting place. Once Henry hit the various ages, we would try to soothe him back to sleep before breastfeeding. If he couldn't be soothed back to sleep, then I would breastfeed him. I would pay attention to whether he was eating vigorously or just kind of suckling himself back to sleep. He definitely never went hungry. He's typically in the 90th percentile for weight!

Hi, Elizabeth! I didn't have any problem following my pediatrician's advice and breastfeeding Henry (all the way until I became pregnant again when Henry was 14 months-old). My pediatrician is very pro-breastfeeding. I find that the advice on KellyMom comes through the lens of attachment parenting. Continuing to breastfeed Henry through the night would not work well for our family (although I know plenty of families who do it and it works for them). I honestly believe that Matt and I are better parents for Henry because he sleeps through the night. We have time in the evening to spend time together, and we get quality sleep every night. For us, getting Henry to get his calories during the day and sleep through the night as early as possible was important. We did all of this in conjunction with our pediatrician's guidance and monitoring.

I definitely agree that different women have different issues with breastfeeding. There's no "one-size-fits-all" approach, which is why I like to look for advice from different sources. I'll keep you updated about what works for our next baby.

allisonmattingly said...

Hi Sara

You will be glad you did Babywise with baby #2. I have two kids and both were Babywise kiddos. Now 5 and 3 both are happy and healthy. Like you said in your post, you will be able to find predictable time to spend with Henry and the baby with lower stress.

I have found my friends and myself who are or have ever been teachers love Babywise but it is not for everyone. I truly believe it will work for most babies, but not for all parents just like Montessori. If you are an attachment parent it will not jive with your style.

I think it is important that all parents remember that there is no "right" way to parent. We all have the same goals of happy, healthy children and there are many ways to get there!

Aimee said...

What does attachment parenting mean? (Clearly I am not a mom, ha!)

Stacy Dohogne Lane said...

I think that people harping on you for your penchant for routine are ridiculous; it's so obvious to me that you have Henry's happiness and health at the very forefront of your lives. That video of him months ago of Henry feeding Hoss almost put in my tears it was so darling. You know what's best for you and your family.

Sara E. Cotner said...

Hi, Aimee! Here's the link to the Wikipedia definition (although the clinical definition doesn't really capture the lifestyle engendered by the philosophy):

http://en.wikipedia.org/wiki/Attachment_parenting

It typically involves extended co-sleeping, extended breastfeeding (past two years-old), extended babywearing (even when children can walk). There's lots of debate about whether or not there's overlap between the Montessori philosophy and attachment parenting philosophy.

-----------
Thanks for your kind words, Stacy!

-----------
Hi, Allison! Your comment reminded me of the one-on-one date you just had with your daughter at the art museum. So inspiring!

mamaschlick said...

Just wanted to add: Attachment parenting (AP) is not about the behaviors but the philosophy behind it. The idea is that if a child is securely attached to their primary caregivers then they gain the confidence to be secure and independent children. In many ways it is at odds with montessori, which highly focuses on cultivating independence very early (too early some would say)and separation/non reliance on a parent. Attachment parenting can involve some of the behaviors Sara mentions but many people who follow these principles baby wear but don't co sleep or co sleep but no longer breastfeed etc. It is implemented differently for each family. I follow some of these principles (and also some Montessori) and I find they have worked in the sense that my boy is secure, very attached to us yet also independent at times, curious, and always up for a challenge. He has developed wonderfully. The idea, for example, of not feeding your child at night when he cries does not usually jibe with AP. I know that many will not agree with me, but I actually think we push kids to grow up and become independent too soon, mainly because we have 2 wage earners and the need to go to work or to have many activities outside of the home/family (nothing wrong with that btw). For example, why not soothe your child by breastfeeding even if he is not hungry? Studies have shown that soothing children until they are ready to sleep through the night themselves makes for more secure and healthy kids. Same with cosleeping. It is counterintuitive--you'd think sleeping together would make babies more dependent but it actually fulfills their need for love and security so that they can approach the world later with confidence and security. We are often trying to take away from babies what they need most--what's wrong with a pacifier? What's wrong with soothing your baby? What's wrong with holding them when they are needy? Everyone told me I would be creating bad habits with my son but none it if came true. It gives me great pleasure to know that it was he himself who chose to go from 3 feedings a night to 1 then to none. We never let him cry, we held him if he needed it and co-slept. He's a great sleeper now. It took us 10 months instead of 5, but for me, it was worth it though I know it would not work for others. It was hard but I feel like he is very healthy and secure, knowing we are there for him and allowing him to explore his surroundings with confidence. It was so much fun to watch him make these choices alone without training. But we were exhausted throughout the process! Anyway, just my own experience. Good luck with baby #2!

Autumn Witt Boyd said...

I am also super Type A, and I have twins, so I think I cut myself a break about being slightly more "parent-centric" in my approach to taking care of them. Basically, my whole world was taking care of them for the first month or so! We tried keeping charts of who ate when, following the babies' leads, and nearly went crazy. My sister-in-law gave us the advice to feed them at 12, 3, 6, 9, repeat. Naps in between. It gave us our sanity back. I did wake them for feedings in the beginning because they were a little premature and needed to be encouraged to eat as much as they could. Or if they woke a little early, we'd go ahead and eat then. I wasn't super duper strict about it. Once they started to gain weight, I didn't have to wake them up for the "vampire" feedings and it became not quite so rigid, but not having to track anything, just being able to look at the clock and see if it was about time (or past time) for a feeding was hugely helpful.

Sarah said...

Thanks for this post, Sara. I started off very baby-centric with my first, which had its pros and cons. I'm expecting twins this fall, so I know we will need more of a schedule. Thanks, Autumn, for your thoughts on twin scheduling. I agree with everyone who chimed in on how it's about figuring out what works for *your* family (and not judging others who make different choices).

Sara E. Cotner said...

Thanks for the clarification, mamaschlick! I didn't mean to imply that the behaviors I listed were mandates within the Attachment Parenting philosophy or that all attachment parents implement them the same way. I simply wanted to offer some more concrete choices that a lot of AP families make, since the Wikipedia overview was kind of vague.

I'm so glad you've implemented a philosophy that works for your family and that you're seeing the kinds of results you want to see. That's the best that any of us can hope for. It's so difficult because we have to make decisions very early on and we have no idea what the outcomes of those decisions will be until months, years, or decades later.

I definitely didn't push Henry to night-wean because I was going back to work or because we had a lot of activities outside of the home. For me, I simply knew that we would be better parents for Henry if we were getting more sleep. We look at our family as a whole system and make decisions based on the needs of the system, not just the baby (since the health of the whole system ultimately benefits the baby). Our pediatrician also explained that babies are adaptable and will get their needs met regardless of whether their families guide them to sleep through the night or continue nursing them through the night. Henry definitely got (and continues to get) all the food he needs. He also got lots of soothing as an infant, as well as high-quality attention and attachment.

Thanks so much for contributing to the conversation! There are many difficult decisions to make, and it helps to hear how different people made their decisions and the outcomes that they're seeing now.

Kamilla said...

Hi Sara, I appreciate that you are sifting the advice from many sources and making decisions that will work best for your family.

I think it's worth remembering - and reminding all readers who might be looking to you for parenting advice - that the American Academy of Pediatrics has issued a warning advisory regarding the Babywise approach.

http://aapnews.aappublications.org/content/14/4/21.abstract

Babywise practices have been linked to dehydration and failure to thrive and found to contribute to early weaning. While some of the philosophy might sound appealing (scheduling and organization), there have been a number of serious outcomes from applying it.

Wishing you a wonderful birth and life with your growing family.

katharina said...

Thank you so much for this post. Our baby is 8 weeks now and we've started to think about what kind of routines would be good for her (and us) now, so its really interesting to read how you solved it for your family and what the different books say. We thought our daughter had colics until i noticed she started crying at the same time every evening. After that we started an evening routine, she stopped crying and was quite content until a few days ago- now she needs to be in the moby wrap to calm down and fall asleep (she's sleeping there right now). Lots of trial and error.
Over here in norway every baby gets regular follow up health check ups in the public health system and the mothers all get put into mother baby groups for company and support. We had our first group meeting today. Though the nurse who lead the group told me it was to early to start implementing routines at eight weeks when i asked, i realised that we all (5 of us) breastfed our babies at noon and that the babies were all asleep by 1pm. And that was following the babies needs- so there seem to be patterns i think, if one observes their own child, even though they change. So i'll definetely keep trying to establish routines, even though, as you write, we have to change them as our kids develop.
Ps. I recently went back to read your post on co sleeping. What you said about the judges- i had exactly the same thought before i read your post. But the more people i talk with the more i get the feeling that many people secretly co sleep.

Sara E. Cotner said...

Thanks for sharing that link, Kamilla!

I feel weird defending the book because I wholeheartedly disagree with lots of the author's evangelical Christian perspectives, but I still find his overarching advice helpful and still think the most recent version of the book is worth a read.

When I read the link you sent, I can't help but wonder if the article (written 15 years ago) refers to an older edition of the book. For example, the AAP statement says, "The book’s feeding schedule, called Parent Directed Feeding (PDF), consists of feeding newborns at intervals of three to three and one-half hours (described as two and one-half to three hours from the end of the last 30- minute feeding) beginning at birth."

That's simply not what the 4th Edition (the one I own) says. It says, "After ten days, a daily routine for most new mothers will be a continual repeat of a 2.5- to 3-hour cycle from the beginning of one feeding to the beginning of the next."

And throughout the book, he repeatedly says if your baby is hungry, feed him/her.

I was really nervous about using the book for guidance once I found out about all the controversy, so I was careful to run everything by Henry's pediatrician. Henry's pediatrician thought the 2.5-3 hour routine was normal, and then when Henry got older, he thought the shift to 3-4 hours was also normal.

I'm wondering if the book's content has changed a lot in recent editions?

Honestly, I think a lot of the controversy comes from the fact that the author is blatantly anti-attachment parenting.

With all of this stuff, I sift through it and separate out what resonates with me from what doesn't. I continue to find the basic premise of the book helpful, which is why I recommend reading it. I don't recommend following it--or anything else--word for word (unless everything resonates with you!).

The basic premise is that you should let your baby feed and sleep whenever for the first two weeks (but encourage your baby to take full feedings instead of just snacking and falling asleep at the breast). If you do that, the baby will naturally fall into a 2.5-3 hour cycle of eating, playing, and sleeping. That advice worked perfectly for Henry. Not only did he thrive, but it also brought us sanity as parents, which helped our family thrive.

I'll keep everyone updated about how it all works out for baby #2! There are so many unknowns.

Erin Curran said...

With some sleep advice I wonder if it's a case of the chicken or the egg - did following the advice make the baby or did the baby match the advice - does that makes sense? Hopefully you get my drift! ;-D I suppose it can be either and sometimes a little of both.

I don't dislike the book because it's anti-AP, I just don't like being around advice givers (I mean books, not you!) that are so attached to their way being THE WAY (and most sleep books come off that way to me, to some degree).

Of course, with my two boys, I took what resonated but sometimes it's hard not feeling a bit like "what's wrong with me that this advice doesn't work for me?!" or like "I *wish* this advice resonated because I'd love the promised outcome!" (a well regulated baby early on, more decompressing time!). But the reality is not all babies' nervous systems are the same. Many sleep gurus give advice as if you have direct control over nervous system development - like behaviorism always works without collateral damage. But I didn't want my son crying until he was disregulated and then falling asleep because his nervous system had actually shut down (not saying that's how it is for all - but that's how it likely would have been for him if I'd done any CIO).

My first son has always had difficulty regulating and slowing his body down. We now know that he has Sensory Processing Disorder so he needs lots of extra support regulating. I wish sleep gurus would consider these sorts of things.

There are other issues that can make Babywise-type advice difficult/inappropriate. Again, for my first son, many, many small meals (or snacks as some would call them) were necessary because I had a very small storage capacity (he was a micro-preemie, I had a very delayed start due to all the drama). Letting his eat small meals around the clock allowed me to breastfeed him for as long as he wanted, and, I believe, indirectly, helped his lungs heal because he did not get any respiratory illnesses during his first year, even ones I had.

I know my situation may seem outside of the norm but 1 in 8 or 9 babies are born premature and there are several issues related to premature birth that I think sleep experts need to consider when they make recommendations.

Just my 2 cents. ;-D

Now out of pure curiosity... I've always wondered, how do you get a baby to NOT fall asleep while nursing?! My boys were sooo sleepy in the beginning. Of course, both began breastfeeding before they were 40 weeks gestation (the first began at "36 weeks gestation" though he was 10 weeks old - we was a 26-weeker; the second was born at 37w3d and still very sleepy for a few weeks). Just curious! ;-D

Related Posts with Thumbnails