Ask The Doctor

Quick transition to sleeping alone?

09-12-14t:12:z

Dear Dr. Merkel,

Our son has slept with us since birth. He is almost 10 months now. Although this has worked well for us, and we have so enjoyed his time with us, it has become more of a challenge lately. We feel it is time for him to spend at least part of the night in his crib. How can we make this happen when crying it out is not an option, and we only have a few weeks to makes this happen.

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To ease the transition, you can encourage your baby to become attached to a "transitional object"-- such as a soft toy or blanket, specially used to provide comfort or solace. Your son eventually will associate the transitional object with the comforting attention of his parents. Separation is less difficult for a child who can hold on to an inanimate object, something which is carried everywhere and which the child comes to love. The transitional object is important at the time of going to sleep and as a defense against anxiety.

Attachment to the transitional object could happen quite organically when your son shows an affinity for a particular object, or it may be encouraged by you by consistently offering a particular toy or blanket at bedtime and any time that that your son does not feel safe.

If you would like to encourage a transitional object

The transitional object should be offered consistently at all times whenever the baby is:

learning to sleep alone or without breastfeeding during the night
in an unfamiliar place
is sad, lonely or hurt
is afraid, upset or stressed

Some babies maintain this attachment through the preschool years and beyond. There is no predetermined time for abandonment of a transitional object. It will be put aside when your child is ready. Most children outgrow the need, and use it less and less over time.

Attachment Parenting Question

09-09-17t:09:z

Dr Merkel,

I have a 14 month old who is still breastfeed and we co sleep. For a few months, about 4-6months of age, she was sleeping almost though the night usually waking up usually only once after being asleep 6-8 hours and then sleeping about 4 more. Since she was 6 months she started waking up throughout the night every 2-5 hours and is still doing this.

The only think that I can think of that has changed aside from teething is we moved and when she was about 7 months I and purchased a new mattress. I don't know if that has something to do with it. The one we has before was like a board and the new one is much softer.

I am not comfortable with the pediatricians suggestion to let her cry it out and I don't see how it would work anyway with us co sleeping. Do you have any suggestions on how to help her sleep through the night? Or is this just a phase she is going through, if so when do children usually sleep through the night on their own? Also the only way she will go to sleep is if I lay down with her and breast feed her. Is it bad that the only way she goes to sleep for me (throughout the night and naps included) is to breastfeed her, should she be able to self sooth herself to sleep by now. If so what are some things I can do to help her with that. Also is there a recommended age for co sleeping, if so about what age should she have her own bed? Oh also is it ok that her only source of milk is my milk and she isn't offered any soy or cow's milk, she breastfeeds about 4 times a during the day and 3 or 5 times during the night depending on how often she wakes up.

Thank you,

Sleepless
]]> Dear Sleepless,

Congratulations for being a wonderful mother who is responsive to her daughter's needs. Many advocates of the family bed are strong believers that this is the best way to give babies the security that they crave

All babies normally wale up several times during the night. It seems that your baby has never learned how to fall back to sleep on her own. Children learn to associate a certain sequence of events with falling asleep, such as being held, sung to, rocked, or nursed. Babies can become dependent on these learned routines and they can't fall asleep until they experience the accustomed sequence. If you have always held or rocked the baby until she is completely asleep, this has become a habit and she relies on that. You find yourself having to do that same thing several times at night.

In the case of a 14 month old, there is an element of separation anxiety. When she wakes up in the night, she knows that you must be nearby, so she wants to be comforted by you, to feel safe and secure..

At this age, the baby is old enough to understand your words, or at least your tone of voice.. In a firm but soothing voice you can let your baby know that you love her but that this is sleep time, that mommy is tired and that there will be no nursing but that you are together.

Breast milk is definitely the best food for your baby. At no time do infants or children need any other milk (cow or soy) as part of their diet.

Letting you baby cry it out, as you instinctively know, is not healthy. You will be teaching your baby that the world is a scary place and mother is not available to make it better.

You might want to try to encourage attachment to a transitional object, a lovey such as a soft blanket or stuffed toy, which the baby associated with being comforted by you. Eventually the security object becomes a substitute for mother and baby can calm herself.

Sincerely,

Dr. Merkel

Which vaccines are necessary?

09-09-16t:09:z

Dear Dr.Markel,

We really happy to hear your opinion regarding vaccination which it's the same as ours. Both me and my husband work in health care.

Recently we were blessed with a baby boy who is almost two months old now. He is suppose to get vaccinated soon. We have decided not to do the Hib and the PCV7 vaccine and do only th DTaP and Polio (IPV).
What is your opinion regarding these four vaccines?
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Dear Vaccine Concerns,

It is beyond the scope of this column to analyze and evaluate the story behind each vaccine. While vaccines carry a great potential for benefits, vaccination supporters and those pushing vaccination seem to over look the risks and concerns. More and more parents like you are becoming concerned about the push by government to "vaccinate your child or else". Some parents may be philosophically opposed, some may object to what seems to be a painful assault on their child, and others may believe that the benefits of immunization do not justify the risks. More and more childhood vaccines are being offered and this in itself concerns parents as it is truly an overload on such a small body.

If the hepatitis b vaccine is avoided in the hospital at birth, then it is administered during the routine two month office visit, along with five other vaccines:

    * Inactivated Poliovirus [IPV] (three serotypes)
    * Haemophilus influenzae type b conjugate vaccine [Hib]
    * Pneumococcal conjugate vaccine [PCV] seven serotypes)
    * Diphtheria and tetanus toxoids and acellular pertussis vaccine [DTaP]
    * Rotavirus vaccine [RV], (four serotypes)

That is a total of 19 vaccine antigens and multiple doses of chemicals injected on the same visit into an eight week old baby. Parents are starting to question whether it's right to inject numerous different viruses and bacteria, mixed with a multitude of different chemicals and solvents into eight week old babies' delicate, developing bodies.to "protect" them. Parents either want to delay vaccines for their child or they want to avoid vaccines altogether. They are not willing to accede to a point of view that goes against their core beliefs about health and wellness.

There are so many vaccines -most unheard of not that many years ago - but do we really need to wipe out every disease on the planet? Whether or not you decide to have your child vaccinated against any or all of these diseases, it is important to do everything that you can do keep your child healthy - to promote the strength of your child's immune system, and avoid things that can weaken it.

The best "immunization" a child will ever get is through extended breast-feeding. Continue for at least 12 months or longer if possible. The longer you breastfeed, the more your child will benefit. Breastfeeding prevents infections and the complications of childhood illness. If the government were to endorse a campaign to increase Americans' breastfeeding rate, it would prevent more childhood diseases -and deaths- than all of the current vaccination programs.

Sincerely,

Dr. Merkel

Good Night Sleep Tight

09-09-14t:09:z

Hello Dr. Markel,

My question to you is with regards to bed-sharing and my 2 and a half year old daughter.

Our daughter up until the age of 9months was sleeping with us in bed. However, around that time, once I weaned her form night time feedings, she began to sleep in her own bed/room after we implemented the techniques of "good night sleep tight". Personally, I was very exhausted, our daughter was not getting much sleep with us and we felt it was best for all of us.

She was sleeping much better up until the last several months. Our travel schedule has picked up quite a bit (every month or two). Therefore, she is usually sharing a bed with us while we are on our trips. upon our return home, she starts off the night in her own bed, but makes her way over either after a couple hours of sleep in her room, or sometimes after almost 3/4 a nights sleep.

However, now I am 5 months pregnant. Our daughter is a very very active sleeper (she takes the bed 360 several times a night:)) and both father and I are taller people (our queen size bed is starting to feel like a very small double). I'll often wake up with scratches on my face, elbow in my eye, foot in my stomach and that's after I have personally waken up 4 to 5 times throughout the night due to the activity of our daughter.

I am torn, I really am. I am sleep deprived, but at the same time, I just dont have the energy to sleep trian my daughter again according to the sleep tight rules. I dont know if this is normal, if I should just deal with it and eventually she'll grow out of it, or if we should be trying to implement some type of rule? We have tried bringing in a mattress in the bedroom and having her sleep on it, as opposed to sleeping with us in the bed, that has failed on many accounts!

I would appreciate any advice/recommendations you can give and would love to hear some words of encouragment:)

Thank you for your time,

Sincerely,
Exhausted Mommy ]]>
Dear Exhausted Mommy,

It sounds as if circumstances in your case make it imperative that the child learn to sleep without having you next to her in bed. Because she is old enough to understand what you are saying, you will have to tell her, firmly but consistently, that it is time for her to sleep in her own area.

Some other suggestions:

Give her a choice so that she feels as if she has control: Do you want to sleep here (on the floor on a mattress in Mommy's room) or here (in your own room)?
Encourage her to have a transitional object: a security blanket or stuffed animal. You must give her that lovey consistently, every time she needs comforting, and every time she goes to bed. Eventually, the security object is a substitute for the mother's presence as the child moves toward independence.

Good luck.

Co-Sleeping?

09-09-14t:09:z

Dr. Merkel,

I have been reading attachment parenting books and my husband seems to disagree with the issue of co- sleeping with my son who is 8 weeks. He says that if we get him used to our bed, we will never be able to go out in the evening again because we will be attached to the bed with our son. Do you have any suggestions to his question? ]]>

Dear Sleeper,

Co-sleeping is the norm in most of the world, and had been throughout evolution. Only recently has the modern western society's premium on independence and self-reliance forced helpless infants to fend for themselves even at the earliest stages.

It is true that infants are dependent, in the short term. This is true for all mammals, but particularly so for human infants. While your husband has a common concern that if that an infant who sleeps with parents will become too dependent and never want to leave the family bed, in the long term, babies who co-sleep develop greater trust and confidence by having their needs met in infancy. Studies show that they go on to be more independent, not less. Eventually all babies outgrow the need and the desire to sleep in the family bed.

Nursing to Sleep?

09-08-12t:08:z

Dr. Merkel,

Our family is now using a family bed and my son seems to really enjoy nursing to sleep. I love it but I am a bit concerned that I will be the only one who can parent him to sleep. Is this a major concern???

Thank You.

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Dear Nursing,

Congratulations for providing your son with the health benefits and security of having you next to him during sleep.

Despite our society's belief that children will not become independent unless we force them, babies whose early dependency needs are met are more likely to become trusting, emotionally secure, and independent when they are ready.

Human infants need constant attention and contact with other human beings because they are unable to look after themselves. For perhaps millions of years, infants as a matter of course slept next to at least one caregiver, usually the mother, in order to survive. Unlike other mammals, they cannot keep themselves warm, move about, or feed themselves until relatively late in life.

As children get older, they don't need the security of their parents' presence as much and they can gradually be weaned from the parent's bed at a time that seems right according to each family's circumstances.

Hip problems for heavier babies?

09-07-18t:07:z

Dear Dr Merkel,

We have a 18 month old, 28 pound baby boy who is in the 99 percentile (he was nearly 11 pounds when he was born). We use our Ergo carrier with him alot, but recently, a friend who is a physical therapist expressed concerned about how the Ergo caused his legs to be splayed out and said that can cause hip problems. What is your experience/recommendation for Ergo carriers and hips?

Thanks so much! ]]> The ergonomic design of the ERGObaby carrier supports a correct sitting position for the baby's hip, pelvis and spine growth.

In many parts of the world, particularly in China or Africa, hip dysplasia is largely unknown. This is, among other reasons, due to the carrying culture that exists in those countries, where people carry their children close to their body, in a position such that their legs are kept bent and spread, almost all day.

The sitting position that the baby assumes when carried in the The ERGObaby carrier disperses most of the baby's weight between the hips and thighs and helps prevent compression of the spine. The way that the baby's legs are spread corresponds exactly with the spreading and bending that is achieved by orthopedic devices to prevent or correct hip dysplasia.

When to move my baby to my back?

09-07-11t:07:z

Dear Dr. Merkel,

I have a two and a half month old who weighs more than 13 pounds and has excellent neck strength and control. Is it OK to put him on my back? His head is fine, do I need to worry about his hips at all? ]]> There is no concern about the baby's hips, because the ergonomic design of the carrier ensures that your baby is in the correct sitting position to encourage proper hip, pelvis and spine growth. It does this by distributing most of the baby's weight between his hips and thighs.

When carrying the baby in an upright position, the baby's hips should always be straddled around the wearer's body. The legs should be at least pulled up to a 90 degree angle. This agrees with the baby's anatomical make up and supports proper hip development.

According to information directly from the designers, your baby might be a bit too young to be moving to the back. Usually babies are developmentally ready around six months..."however, it is not unheard of that a 3-½ month old baby can be very happy on the back as well."

When will she nap on her own?

09-07-03t:07:z

Dear Dr. Markel,

Our baby is nearing five months and doing great. At night she sleeps with me and has been sleeping thru the night for the past two months.

My question is re: napping. At this time,
our only way to get her to nap is by nursing, holding or baby wearing her while walking around.
Am wondering when and how we can help her nap on her own. Please advise. Thanks! ]]>
Nap time,

Your baby loves the constant motion and touch when she is being held and carried. In much of the rest of the world, babies are always carried or worn in a sling all day until they can walk. Infant seats, swings, cribs, and all the other plastic baby-holding devices do not provide her with the same kind of human contact. Your daughter feels safe when her needs for food, warmth and touch are met; and when she is within close proximity to you. By meeting her emotional and physical needs while she is this young, she is likely to become more independent, not less, as she grows and develops, and eventually able to "nap on her own" I advise you to relax enjoy this precious time.

Neck support with a baby carrier

09-07-03t:07:z

Dear Dr. Markel,

I'm from Vancouver, Canada but living in St. Petersburg, Russia. My wife and I had a baby girl on May 22nd and we have begun using an Ergo Baby Carrier with the Infant Insert. Our baby likes the carrier and sleeps most of the time when we are out for a walk. Unfortunately some doctors here have told us it's bad for our baby daughter's neck and spine. Is this true? Is our daughter too young to be carried in an Ergo Baby Carrier with Infant Insert?

Our daughter was born with a small neck problem because she was tall and there wasn't enough room in my wife's womb. She has been wearing a neck brace since May 22nd and the doctor recommended that she wear it for two months. We've have also had a massage therapist come to our home for the past two weeks to give our baby ten sessions of massage.

We have a Maya Wrap sling too but it's difficult to use and we've had no success with it.

Please let us know as soon as possible because we're worried about our daughter's health.

Thank you.

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The ERGO carrier, by providing excellent support for your daughter's head and neck, will help her to develop her neck muscles properly. Rather than constraining mobility, as would be the case with plastic type carriers and seats, the ERGO carrier encourages her to look around, thus loosening up the tight muscles. In that respect, I am not sure about the value of the neck brace, although I cannot advise you on that specific issue. Passive motion exercises, where you gently stretch the muscles that are tight, is probably being done by the massage therapist, and you can do that yourself as well.

Regarding the spine, as long as she is positioned properly, babywearing encourages proper growth and development of her hip, pelvis and spine by providing excellent support for hips, legs and back. So despite what you have been told, you need not have concerns about that.

3 month old will only sleep in the Ergo during the day..

09-06-19t:06:z

Dear Dr. Markel

My 3 month old daughter will only sleep in the Ergo carrier during any of her day naps.... She sleeps from 7pm until 6am in a co sleeping arrangement and she is very settled and fine during the night, However when it comes to the daytime, not so settled..

Is it ok to wear her on me all day? My concern is that she will rely to be settled in the Ergo and sometimes now I feel she is starting to get really heavy.. Any suggestions would be of much help.

Thank you ]]> Congratulations - You have a very smart baby. She wants to be carried. She loves the constant touch and motion and she enjoys the sturdy support provided by the ERGObaby carrier. All babies need to feel close by being held securely. Even though your baby is getting heavier, the ERGO carrier is adjustable to her size; and because it is designed to ensure that all of her weight is carried by your hips and legs rather than your back and shoulders, you should remain comfortable even during long periods of carrying.

Attachment style parenting gone wrong

08-09-10t:09:z

Dear Dr. Markel,
My husband and I practice attachment style parenting from co-sleeping to baby wearing. Our son is now 8 months old. Somehow I feel we are experiencing attachment style parenting gone wrong.

I'm a full time mom and totally exhausted. Poor sleep at night is creating day time problems for all of us. Daytime naps are a production, only successful when I lay down with him. He has never slept alone and wakes up the instant I leave the bed just to use the restroom. He does not know how to fall asleep on his own or go back to sleep once he wakes up. He seems truly terrified when I leave him with daddy so I can take a shower.... I know I'm rambling here. I'm so overwhelmed and tired...It has been suggested to me to establish a nap routine with him in a crib/playpen by himself. Is this the answer? And if so, how do I go about it?

I greatly appreciate any help you can offer. Thank you for your time.
Julia

]]> It sounds like your baby is not ready to be alone. Remind yourself that this is temporary. More specifically, at around the age of eight or nine months, babies can become anxious, clinging, and easily frightened when their attachment to familiar things is disrupted. Although it might be hard to appreciate it now, predictable anxieties of this period are evidence of your son's healthy relationship with you. The intensity of his feeling can be very special and bring great joy, or, at times, you may feel suffocated by his inability to "take care of himself" separated from you.

Today, mothers are often separated from their own parents and siblings, and have fewer people to turn to when they feel tired, ill, or simply in need of a break from child tending. Because of this, a baby's legitimate needs, like being held and having cries quickly attended to, can feel emotionally and physically overwhelming. Under these circumstances, it is understandable that tired mothers wonder how to convince the baby to meet their needs. To the baby, of course, nothing has changed - his needs are the same as they have been since he was born. He needs to feel safe and secure.

I suggest that you introduce a "transitional object", also called a security object, or "lovey". This object, which is most often a soft blanket or stuffed animal, represents the security that your child feels with you and allows the transition from dependence to independence.
It is important that the transitional object be offered consistently at all times whenever the baby is learning to sleep alone, is in an unfamiliar place, or is upset for any reason.

Eventually your baby gets the comfort and security from this transitional object that was originally associated only with you and he will be able to make the transition to sleeping alone.

Plagiocephaly

08-07-29t:07:z

Dear Dr. Markel,
My son is 11 weeks and showing signs of Plagiocephaly on the side he sleeps on. He is also yet to really focus on things, could this be a cause?

]]> Dear Concerned,
Since the early 1990s, when the American Academy of Pediatrics introduced the "Back to Sleep" campaign to reduce the risk of sudden infant death syndrome, or SIDS, the incidence of "positional plagiocephaly" (flattening or asymmetry of the head) has increased markedly.

Once you notice that the back of the baby's had is becoming flat, it is important to avoid pressure on your the flattened areas. Be very aware of how much time your baby spends on his or her back in various types of "modern equipment" which can be very detrimental: car seat, swings, strollers and cribs. Once your baby is six months old, it is too late to try to change the shape of the head by repositioning.

Babywearing will help prevent plagiocephaly. Carrying your baby during the day will limit how much time baby spends with pressure on the back of the head.

My baby is 22 months now and is still breastfeeding

08-04-09t:04:z

Dear Dr. Markel,
My baby is 22 months now and is still breastfeeding. I thought he would stop on his own but he refuses to stop and doesn't really like milk and worst with soy. He also still feeds at night. He sleeps in our bed so when he wakes he wants to feed. I've tried not giving it to him but he cries and cries and I'm already sleep-deprived to I give up. Any advice?

]]> Dear Concerned,
Today, mothers are often separated from their own parents and siblings, and have fewer people to turn to when they feel tired, ill, or simply in need of a break from child tending. Probably nowhere do cultural expectations and the reality of children’s needs conflict more than in the area of sleeping behavior. Because of these factors, a baby’s needs can feel emotionally and physically overwhelming.

All babies normally wale up several times during the night. It seems that your baby has never learned how to fall back to sleep on his own. Children learn to associate a certain sequence of events with falling asleep, such as being held, sung to, rocked, or nursed. Babies can become dependent on these learned routines and they can't fall asleep until they experience the accustomed sequence. This is what is called "sleep onset association" If you have always held, nursed or rocked the baby until he is completely asleep, this has become a habit and he relies on that. You find yourself having to do that same thing several times at night.

In the case of a 22 month old, there is an element of separation anxiety. When he wakes up in the night, he knows that you must be nearby, so he wants to be comforted by you, to feel safe and secure. If you are anxious and exhausted, I suspect that these feelings are transmitted to the baby who then becomes anxious and upset.

You are obviously a concerned and loving mother. As you approach this situation with confidence, you will be less anxious yourself, and able to take control. Particularly if you keep the baby in bed with you, in a firm but soothing voice you can let you baby know that you love him but that this is sleep time, that mommy is tired and that there will be no rocking but that you are together.

In general, when evaluating a particular method, ask yourself if this advice sounds sensible. Does it fit your baby’s temperament? Does it feel right to you? I suggest that you follow your instincts rather than some stranger’s sleep training advice. You and your baby will eventually work out the right nighttime parenting style for your family.

If your current routine is not working for you, think about what changes you can make in yourself and your lifestyle that will make it easier for you to meet your baby’s needs. This is a better approach than immediately trying to change your baby. Advice that promises a sleep-through-the night convenient baby involves the risk of creating a distance between you and your baby and undermining your mutual trust. Babies are adaptable and most will eventually adjust to whatever method seems to fit your lifestyle. The most important thing is that the baby not lose the sense that his needs will be consistently met by a loving and nurturing caregiver.

My 16-month-old son is still not sleeping through the night

08-03-26t:03:z

Dear Dr. Markel,
My 16-month-old son is still not sleeping through the night. I've established a bedtime routine, which we follow each night even if it's off by a minute or two, and it's helped with bedtime, but not with his sleeping. He gets up 2-6 times each night, and while he doesn't night-nurse anymore, he still wants to be held and/or
rocked. And if that doesn't work, he wants to sleep with me. He's such a restless sleeper that I don't get any more sleep than I do when he sleeps in his crib.

I feel like I'm losing my mind because I'm so sleep-deprived, but nothing has worked. I'm dead set against the Let-them-cry method, not only because we have a common wall with our neighbors, but because that's just not the kind of parent I aspire to be. On the flip side, I'M EXHAUSTED and don't know what else to do, especially since he consistently naps for a couple hours each day.

I even tried a homeopath when my son was around 9 months old, but his remedies didn't make a difference.

Is there a such thing as a pediatric sleep specialist? Would we benefit from seeking and consulting one? I live in the San Francisco area and am open to new ideas. ]]> All babies normally wake up several times during the night. Usually they move around a bit, perhaps look about drowsily, and then fall back to sleep. If for some reason they have difficulty falling back to sleep, they may become upset and cry.

Difficulty falling back to sleep can have several causes. Sometimes the problem arises because the baby has never learned how to fall asleep on his own. Whatever you have done to help your baby fall asleep in the past, he may come to rely on that as a sleep-onset association. You find yourself having to do that same thing several times at night.

In other words, children learn to associate a certain sequence of events with falling asleep, such as being held, sung to, rocked, or nursed. Babies can become dependent on these learned routines and they can't fall asleep until they experience the accustomed sequence. When a parent always holds or rocks the baby until he is completely asleep, the baby develops a habit of having to be in a parent's arms before he can fall asleep. This is called sleep-onset association: The baby associates the feeling of being held with the process of falling to sleep. Without the holding, he simply can't fall asleep.

Part of their so-called "sleep onset association" might be being in a certain place. For example, if your son falls asleep with you in your bed he then can't fall back asleep in his crib in the middle of the night. Is there a reason that you cannot simply keep the baby in bed with you during this time? Many advocates of the family bed are strong believers that this is the best way to give babies the security that they crave and avoid sleep problems altogether.

In the case of a 16 month old, there is an element of separation anxiety. When he wakes up in the night, he knows that you must be nearby, so he wants to be comforted by you, to feel safe and secure. If you are anxious and exhausted, I suspect that these feelings are transmitted to the baby who then becomes anxious and upset.

The key to getting your baby to sleep might be to be less anxious yourself, to feel confident in your abilities as you approach the situation with firmness. Particularly if you keep the baby in bed with you, in a soothing voice you can let you baby know that you love him but that this is sleep time, that mommy is tired and that there will be no rocking but that you are together.