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So You Want to Swaddle Your Baby?

by babysleepexpert

For newborn babies up to 14 weeks of age swaddling can provide a tool for parents to calm and soothe their baby.

If you are considering swaddling your baby it is important to weigh up the pros and cons, particularly with relevance to your unique family situation. In general swaddling is more beneficial for those families who do not bedshare and babywear.

Pros of Swaddling.

Swaddling can help promote new sleep cycles, meaning less waking requiring parental input.
Swaddling can help prevent prolonged crying and can give parents a technique to calm their baby and thus time to calm themselves
Some parents feel that swaddling can help breastfeeding when a baby has flailing hands making latch difficult (however see point no.2 below).
Swaddling can help a baby to not accidentally scratch his or her face
Swaddling can stop loose blankets going on top of the babies face
Swaddling can prevent a baby from rolling onto his or her tummy during sleep.
Swaddling can help a baby feel ‘held’ and perhaps as if still in utero.

Cons of Swaddling

Swaddling can lead parents to miss baby’s early hunger cues
Swaddling can inhibit breastfeeding, particularly in the early days
Swaddled babies cannot suckle on their own hands to soothe themselves, as they may have done in utero
There is an increased risk of SIDs shown in studies when babies are placed to sleep on their stomach swaddled
Swaddling can cause hip dysplasia if babies are swaddled too tightly over hips
Swaddling can cause respiratory compression if babies are swaddled too tightly over their chest
Swaddling has been linked to less arousability, if the swaddling was not started until 3months of age, which has been linked to SIDS.

Swaddling Safety

1. Never swaddle over a baby’s head or near their face

2. Never swaddle a baby who is ill and/or has a fever

3. Make sure the baby does not overheat, only swaddle with a thin breathable fabric such as 100% cotton or bamboo.

4. Only swaddle until a baby can roll onto their tummy or by the time they are 14 weeks old, whichever is sooner.

5. Always place a swaddled baby to sleep on their back

6. Do not swaddle tightly across the baby’s ches

7. Do not swaddle tightly around the hips or legs. Baby’s legs should be free to “froggy up” with free movement of the hips.

8. Begin swaddling well before 3 months of age. If you are breastfeeding only begin once feeding is established and never in the first few hours postpartum when skin to skin contact is essential.

For a summary of current swaddling research see this article from the Lullaby Trust.

Sleep Environment & Props

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Is Bedsharing and Cosleeping Safe?

by babysleepexpert

The following are Bedsharing Myths:

1. Bedsharing is Always Dangerous

Bedsharing can be very dangerous, so can most things in life. Sleeping with a baby on a sofa, sharing a bed with a baby if you formula feed, smoke (or smoked during pregnancy), if you have drunk alcohol, if you have taken prescription medication or recreational drugs can all be incredibly dangerous.

Sharing a bed with your baby following some simple rules (see our article here) has not been shown to be dangerous in any research. Sadly there have been no studies done to date that include all of the variable contained in sensible bedsharing advice. The research is always missing important variables.

2. Two Thirds of all SIDS Cases Occur When the Baby Was Sleeping With a Parent.

As mentioned above research that categorically states that bedsharing is far more risky than a baby sleeping alone is sadly deeply flawed. It misses so many important variables and while these studies have provided a good opportunity for scientists to clear up the issue of bedsharing safety sadly all they have done to date is confused the issue. It is naive at best and deceiving at worse to use these studies to tell parents not to sleep with their babies. Many are concerned that anti-bedsharing research may actually put some babies at more risk as their parents may fall asleep with them in bed accidentally, having not been made aware of what the risks are or how to reduce them.

3. It’s Not Good for the Baby, They Need to Learn Independence

Before independence first comes dependence. When a baby is born they need us, they cannot survive without us, indeed they do not even realise they are a separate entity to us until they are 3mths old. So much research speaks about the importance of infant attachment, baby-carer bond, and how if an infant is allowed to be as attached to their parent as they need then we can help to create a confident toddler, child and adult. Separating an infant from it’s parent before he or she is ready to separate does not make him autonomous or independent, it deprives him of a basic need.

4. Bedsharing Kills Marriages

Stress & exhaustion with a non sleeping crying baby is more likely to affect a marriage than a small person in the bed. In fact most marriages break down because of a lack of communication or simply growing apart. Babies are small for such a short time, if parents agree on a parenting strategy and communicate well with each other this clearly isn’t an issue.

What about sex? is really the undercurrent here though, for most new mothers sex is the furthest thing from their minds. After the birth hormones are haywire, bodies are sore and tender, where the baby sleeps is almost irrelevant in this respect. This also presumes that it is only possible to have sex in bed at night, which is clearly not true.

The following are Bedsharing Truths:

1. Bedsharing Can be Safe

In many countries bedsharing is the cultural norm. During the 1990s, in Japan the SIDs rate was only one tenth of that of the West and in Hong Kong, it was only 3%. Interestingly bedsharing is normal, and very common, in Japan and Hong Kong. All around the world parents sleep with their infants in their beds, bedsharing rates are as high as 60-70% in some societies, the SIDS rates do not correlate with this.

To quote William Sears, MD:

“Until a legitimate survey is done to determine how many babies sleep with their parents, and this is factored into the rate of SIDS in a bed versus a crib, it is unwarranted to state that sleeping in a crib is safer than a bed. If the incidence of SIDS is dramatically higher in crib versus a parent’s bed, and because the cases of accidental smothering and entrapment are only 1.5% of the total SIDS cases, then sleeping with a baby in your bed would be far safer than putting baby in a crib. The answer is not to tell parents they shouldn’t sleep with their baby, but rather to educate them on how to sleep with their infants safely.”

2. Bedsharing May Save Lives

There are many reasons where it may be safer for a baby to be in close proximity to its parent(s) including the concept of limbic regulation and gaseous exchange, decreased levels of infant apnoea, and the increased arousability in breastfeeding mums (resulting in heightened awareness to their infants). Research has found infant apnoea decreased by up to 60% in studies when babies are near to someone else breathing whilst sleeping.

3. Bedsharing Can Mean More Sleep For Everyone.

Many parents spend hours fighting their babies, returning them to their cribs and moses baskets as soon as they fall asleep, where they awaken and cry. Conversely many comment that their babies will snooze for hours in their arms. Babies are likely to wake more regularly and feed more regularly during the night when in their parent’s bed, however the awakenings are shorter and often parents aren’t fully aware of all of them.

4. Bedsharing Helps Breastfeeding & Milk Supply

Bedsharing and breastfeeding go hand in hand, indeed we know the research says it is only breastfeeding mothers who should co-sleep with their babies (due to their heightened states of arousal to their infant), we know that the close physical contact – oftentimes skin to skin – that comes with bedsharing can make the breastfeeding experience easier. We also know that breastfeeding alone candecrease SIDs risk – imagine what a powerful combination we have in terms of decreasing SIDs risks when we combine safe bedsharing and breastfeeding.

Bedsharing & Cosleeping

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Safer Bedsharing Guidelines for Cosleeping Families

by babysleepexpert

If you would like to share a bed with your baby always make sure that it is an informed decision and one that has been fully discussed and planned with all members of the household. The following is a list of guidelines that should always be followed to minimise any risks to your baby:

1. The mother should be breastfeeding. If the baby is formula fed it is not safe to bedshare with them, they should have their own sleep surface, such as a cosleeper crib.

2. Both parents should be non-smokers and the mother should not have smoked during her pregnancy either.

3. Neither parents should have consumed alcohol.
4. Neither parents should have consumed recreational or prescription drugs, including post-birth painkillers.
5. Neither parents should be ‘excessively tired’ (some experts believe this to be less then 5 hours sleep in last
24hrs, while others say this should be left to the parent to decide based upon their own instinct).
6. The mother should always sleep between her partner (and any older siblings) and the baby. The baby should never be in the middle of the bed, only the mother possesses a special ability to easily arouse to her infant and not roll onto them.

7. Always ensure that the sleeping surface is firm. Never fall asleep with a baby on a sofa, bean bag or waterbed. Avoid memory foam mattresses too.
8. Prevent the baby from rolling onto the floor, if possible sleep on a mattress on the floor, or a futon style bed.

9. Keep all pillows well away from the baby. The baby should always sleep at the same level as the mother’s breasts, not her head.
10. The mother should lie on her side and form a protective frame around baby with her body.
11. Keep duvets and blankets well away from the baby to prevent the risk of smothering. Many mothers sleep in onesies or dressing gowns to keep themselves warm.
12. Ensure the baby does not overheat, dress in appropriate clothing, such as a babygro and a sleeping bag.
13. Make sure both parents tie any long hair back and do not wear nightclothes with loose ties or belts.
14. Consider a separate sleeping surface if the baby is small for age or is premature.
15. Consider a separate sleeping surface if the mother is significantly overweight.

Bedsharing & Cosleeping

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Is Controlled Crying Safe and Effective?

by babysleepexpert

Leaving babies to cry for a predetermined period of time in order to teach themselves to fall asleep (or “self settle”) was introduced by Dr Emmett Holt in his 1895 book ‘The Care and Feeding of Children’, this idea was then popularised by Dr Richard Ferber (which gave rise to the term “Ferberisation”) in his 1985 book ‘Solve Your Child’s Sleep Problems’. Since then many baby care authors have picked up on the trend of leaving babies to cry for an increasing period in order to encourage them to get themselves to sleep and not wake in the night.

Does controlled crying work?

The answer to this is not simple, whilst many parents report more unbroken sleep at night after three or four nights of sleep training, research has not found any long lasting positive effects. Indeed many parents report significant sleep regressions several months after trying the technique and experiencing initial positive effects.

More importantly however is how we define ‘does it work?’ Controlled crying, and similar techniques, can initially make babies quiet throughout the night, which can often lead to better sleep for the parents for a limited period of time. When it comes to the baby though it is unlikely sleep has changed at all. It is highly likely that the baby is still waking just as much as before, just no longer alerting his or her parents to the fact they have awoken. This may initially appear appealing, however it does throw up several alarming thoughts, in particular – what if the baby is in physical distress and does not alert the parent? For instance if they have vomited or have a blanket over their face, this has potential to be a SIDS risk. In addition, is how parents really feel about the idea that their baby is awake and potentially hungry, lonely or scared yet has been trained to know that there is no point in crying because their parent will not come to them.

As a parent it is important to consider your long term parenting goals as well as those in the short term. A short term goal may be ‘to get a little more sleep to be able to enjoy my baby more’ and a long term goal may be ‘for my child to know that I am always here for them and that they can always come to me with their problems’. If we think about how controlled crying fits with these goals we can see that while it may help in the short term, in the long term it is often completely at odds with what we want for our children and in particular the type of relationship we would like with them. Most parents would like their children to know that they can rely on them to always be there, however what are we teaching a baby when we practice controlled crying on them?
The Research Findings.

Of more concern is the long lasting psychological and physiological consequence of controlled crying. Sadly here there is no definitive research either way and much work to be done before we can make any firm conclusions. What we do have though is a couple of studies we can work with. In 2012 researchers found that babies who have been trained to not cry out through use of controlled crying were not calm or ‘self soothed’, their stress hormone levels actually remain just as elevated as the days previously when they cried a lot. Why if they were so distressed did they stop crying for their parent? The obvious assumption here is not because they had now learnt the advanced skill of ‘self soothing’, but that they had learnt it was futile to continue crying.

Further research in the same year attempted to put to rest any assumption that controlled crying was ‘bad’ for infants and confidently published findings which stated that it caused no long lasting ill effects. The research however was full of significant flaws, such as failing to check if those in the experimental group had actually done controlled crying and failing to check if those in the control group (who were not meant to sleep train) actually did. It is highly likely the research was not actually measuring what it said it was. In addition the only attempts to investigate whether the controlled crying had caused any ill effects was to ask the parents their thoughts and to check stress hormone levels in the child’s saliva five year post sleep training, both of which are dubious measures at best. What research needs to look at is brain imaging – particularly of areas such as the hippocampus which is known to be affected by long term stress and to check other markers such as attachment style and cognitive ability. Sadly this research has not been done and until it is we are not able to say one way or the other that controlled crying is either safe or damaging to infants.

The last issue with controlled crying is the gross misunderstanding those who advocate it have of a young baby’s brain and neurological development. Controlled crying presumes babies think logically and rationally and have the skills of emotional self regulation (which is what is really meant by ‘self soothing’). These skills however are far too complex for a small baby and even toddler. They are not skills that can be taught, they are developmental milestones, just like walking and talking. Sleep training a baby in order to teach them to ‘self soothe’ is as ludicrous as trying to teach a three month old to walk when we think of it in neurological terms. It just isn’t possible.

When a baby is born their brain is incomplete, not only is it smaller than an adults, the vast majority of its 100 billion neurons are not yet connected into networks. Babies simply don’t think like we do – the neocortex – the home of logical thinking – does not really spring into life until 3yrs plus, before that a baby’s brain is very primal – focussed on survival and basic emotions. That said early experiences can and do have a big impact on the wiring of an infant’s brain, a baby’s brain has twice as many synapses (connections) as the child will eventually need. If these synapses are used repeatedly they are reinforced. If they are not used repeatedly, they are eliminated – therefore we can cause permanent changes in the brain structure of our children, both good and bad. Depriving a baby of the love and contact they need in infancy alters the neuroplasticity of the brain, changing the wiring in the relationship part of the brain which affects the individual’s experience of relationships long into adulthood. Research on the impact of early attachments confirms that warm, responsive care giving is essential to healthy brain development and ironically those babies who were allowed to be attached as a baby are the ones that can truly self settle as older children and adults.

In Conclusion

This is one topic that science cannot definitively give us an answer for, however it is important to remember that at this stage having ‘no evidence of harm’ is not the same as having ‘evidence of no harm’. The best guidance for parents considering controlled crying, and other forms of sleep training, is to trust their instinct. How do they feel about leaving their child to cry for several hours per night for several nights? How does the technique fit with their long term parenting goals? Would they like to be treated in the same way by somebody else? In the end we usually find our best answers this way.

Sleep Training

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The Four Month Sleep Regression

by babysleepexpert

Many parents experience a regression in their baby’s sleeping habits at around four to five months. After they have emerged from the fog of the fourth trimester their baby’s physiology develops enough for them to begin to know the difference between night and day meaning that more and more sleep is taken at night. Around the three month mark babies may be beginning to settle into some kind of predictable pattern in their feeding and sleep, both day and night. By three months babies may even be sleeping in stretches of four hours at night.

Life begins to regain a small sense of normality, albeit a new one and many parents begin to gain in confidence after the fourth trimester is complete. Parents begin to look forward to their days being calmer and nights becoming easier as their baby gets older. It comes as a harsh shock then when their baby begins to wake as often as they did as a newborn. To add to this any colic experienced in the first few months has possibly begun to fade, which makes it seem so cruel when the short weeks of having a happy baby give way to having a cranky baby who is hard to settle and grouchy and bored in the daytime.

To add insult to injury by the time your baby reaches four months of age the support network you had around you in the early weeks has often begun to dissipate. The emails, phone calls and visits asking how you are, bringing you chocolate and meals are increasingly rare. Discharged from the midwive’s support and now in the hands of the local health visiting clinic things are very different than they were at the beginning. It’s no wonder parents question what they did wrong, did they allow their baby to be too reliant on them? Should they have listened to those who told them not to spoil the baby with too many hugs? Is it all their fault? The answer is definitely no to all and many more questions asked. This is a normal developmental stage that will pass.

Developmentally much happens between four and five months of age. Babies are so much more alert and aware of their surroundings, yet their bodies are not capable of movements that they would probably so like. Can you imagine how difficult it must be to be four or five months old and to deal with that frustration on a daily basis?

As a baby approaches four and five months they become stronger, especially their core strength. They begin to develop a grasping ability, though this is still immature and often they get frustrated that they cannot pick up a certain object or move it where they would like, more frustrating is the knowledge that they cannot purposefully let go of the object. The baby’s senses heighten at this age as their sensory processing matures. One of the most sensory areas of a baby’s body is their mouth – which is why they put everything they can in their mouth. This is often mistaken as teething or a need to introduce solids, but it is likely due to neither.

As well as strength and sensory processing, four to five month old babies become much more aware of their surroundings, their vision improves and they begin to recognise familiar – and non familiar objects and people. This is also the stage that babies may begin to babble or make purposeful noises.

With all of this rapid development imagine how exhausting and confusing this period must be for a baby. It would be like everything in your world changing all at once, almost with no warning. It makes sense therefore to keep everything else in your baby’s life as constant as possible, so as not to introduce any more change into their life. Many parents are tempted to wean onto solids, move the baby into their cot or room or even sleep train at this stage, however all of these introduce even more change and are therefore quite likely to make things worse and not better. It may feel as if this stage will last forever, that your baby will never sleep again, but it will pass and relatively quickly. It may be a month or two until your baby’s sleep naturally improves and they become easier in the daytime, so the key is to look after yourself in the interim. Making sure you sleep when you can, accepting and asking for help and taking any opportunity to relax will help you to cope with this normal developmental phase, that will pass.

Sleep by Age

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8 Tips for a Baby Who Won’t Sleep

by babysleepexpert

1) Always try to think in the long term. Yes it is exhausting looking after a young baby who wakes regularly and responding to their needs every night, but why are you doing this? What sort of relationship do you hope to have with your baby in the future? What sort of person do you hope they will be? Thinking more long term can really help. One day your baby will sleep and it will all be worth it!

2) Trust your baby, not an expert who has never met either of you. The people who write the baby sleep books and give advice on television have never met you or your baby. Guidelines for the amount of sleep a baby should have either at night, or napping during the day really are just guidelines with no evidence to back them. There is a huge array of normality when it comes to baby sleep. Some need far less, some need more, they are not all the same!

3) Help to build positive sleep expectations in your baby by starting a positive bedtime rhythm – such as “massage, story, feed, sleep”. Research shows the importance of a good consistent bedtime routine and it is never too early to start!

4) Use environmental triggers such as sound and smell to help calm your baby and form good sleep associations. For young babies white noise works well, for older babies relaxing alpha music can be better. Try using scent, such as lavender or chamomile to calm and soothe too. Build up a good association to these by using them in baby massage and similar.

5) Does your baby have a special comfort object, such as a muslin or teddy bear? If not try to introduce one, only 60% of babies will take a comforter, but if they do take to one it can help your baby to feel as if they have a part of you with them which can help sleep.

6) Make the sleep space a positive place – play, sing and massage in the sleep room to help your baby to form happy associations with their sleep space. Don’t be afraid to bedshare if it works for you; just ensure you follow safer bedsharing guidelines.

7) Night feeds are normal throughout the first year of life, however if your baby is approaching toddler hood (and definitely over 6 months) you may want to consider feeding to calm and not to sleep, this means allowing your baby to feed whenever they want but removing the bottle/breast when they are calm but not asleep.

8) Try to stay calm yourself & really nurture yourself as much as possible. Research shows parents moods have an effect on infant sleep. How will you stay calm yourself and fulfil your own needs today?

Baby and Toddler Sleep Tips

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The Baby Sleep Expert

The UK's Most Popular Gentle Baby and Toddler Sleep Expert

So You Want to Swaddle Your Baby?

Is Controlled Crying Safe and Effective?

The Four Month Sleep Regression

8 Tips for a Baby Who Won’t Sleep

Baby and Toddler Sleep Articles