Sleep & Nap Issues: I Need Help Transitioning My Toddler From A Bed To A Crib

At first, Attachment Parenting sounds really good. Responding to the baby's needs, keeping her close for skin-to-skin contact, letting her learn independence at HER pace. I get it. I live on Maui, people -- this is Attachment Parenting Central.

Or maybe you just accidentally fell into having baby sleep in your bed. Lots of babies don't sleep well in the first year, and we're so tired that we're willing to do anything to get a little rest. Plus, it really can be dee-lish to snooze with that little sweetie right there.

But eventually, your little baby grows -- into a toddler. And realizes that she can 1) keep herself awake on demand, 2) insist on nursing constantly through the night, and 3) crawl, climb and play all over Mom and Dad, who are trying (in vain) to sleep.

So I get a lot of desperate emails from readers like Amy who are re-thinking the Attachment Parenting thing. Maybe not the WHOLE thing, but the "not getting any sleep at night after umpteen months" thing. Is it possible to transition a toddler OUT of your bed, and INTO her own crib? (Or is a toddler bed in your room better?)

This is such a complicated situation that I'm devoting an entire chapter in my book to it. But until that's available, here are some things to consider:

  • Toddlers don't associate cribs with "jails" or "cages", as some might suggest. That's an adult projection. Toddlers feel relieved to have a safe, cozy, predictable place of their own to retreat to, after a long day toddling, climbing, and falling.
  • Letting a toddler have free access to your room (or the whole house) at night while co-sleeping (or sleeping in a toddler bed in your room) is enough to cause most parents to sleep with "one eye open". Too much freedom, not enough sleep -- and maybe not safe, I say.
  • Parents who aren't getting much sleep after many, many months risk SERIOUS health consequences (think: life and death), plus the obvious negative impact on the relationship. Parents need some sleep to stay healthy and sane -- plus their own time -- together -- to be "on the same page" and have a strong relationship. Even babies and toddlers can absorb -- and accept -- this message.

But how to do it? This depends on your family's needs, the setup of your home, and your kiddo's temperament. If you're struggling with this, let me know. We can problem-solve in the comments section.

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert Sign up for my Newsletter and Follow Me:

Sleep & Nap Issues: Nighttime Crying & Proof That Crying It Out Is OK

Don't flame the messenger, but here's more proof that SOME nighttime crying won't harm your baby -- and actually may help the whole family by boosting mom's mental health. A big shout-out to mom's health advocate Katherine Stone for being on-record about this hot-button issue. She risks the backlash that I've experienced here, but she does it for the health and well-being of families and babies. Kudos to you, Katherine!

The bottom line is this: Neglect, hostility, and abuse DO hurt babies. Blowing off some steam to settle down for a better night's sleep DOESN'T. Of course, individual personalities and circumstances make a difference: Pick up and comfort your baby if she's sick, super-scared, or if she has an unusually sensitive temperament (or, if you have a crying/barfer, like one of my kiddos. Who wants to be up all night AND clean a barfy crib?) If you want to argue, argue with the respected journal that published the research today, Pediatrics.

Judging parents for their reasonable decisions about their own children is NOT good for families and babies. So hurray for more proof that this controversial parenting decision doesn't deserve the attacks it often gets. Parents and children who get more sleep are happier AND healthier. That's nothing to cry about.

Aloha,

Dr. Heather

The BabyShrink Mom of Four, Parenting Expert

Dr. Heather's First Live TV Appearance

Despite awakening at 4 am with bloodshot eyes from an allergy attack (perfect for HDTV, right?) -- I was psyched to head down to KITV yesterday morning to talk story with the gang about parenting. So mahalo to Jill Kuramoto for inviting me, and a big aloha to Mahealani Richardson, Moanike'ala Nabarro, and Yasmin Dar for making me feel so at home in the studio. Looking forward to seeing you all again next month!

Here's the link: Dr. Heather on KITV -- January 17, 2012

Aloha,

Dr. Heather The BabyShrink

"Crying It Out": Acceptable -- or Abuse?

One of the most primitive, innate reactions any mom has is to comfort her crying child. But as we've talked about here before, many babies can tolerate -- and thrive -- with some crying, when their parents thoughtfully decide why and when that might be necessary.

That's why articles like this leave me mystified -- especially when they come from one of my shrink colleagues.  Her bottom line is that CIO is dangerous. She trots out all the old arguments, hailing the Dr. Sears "science" behind her claims, and providing one of the most common misinterpretations of infant research. She makes the mistake that clinical research findings about abused and maltreated babies -- babies who were pervasively denied their needs over the long-term -- should be applied to NORMAL babies in NORMAL families.

The fact is, there is no evidence whatsoever that occasional CIO in typically developing babies causes any damage. PERIOD.

More importantly, there IS evidence that severely sleep-deprived mothers are at much higher risk of developing an already common --and dangerous -- condition: postpartum depression. And PPD certainly CAN lead to long-term damage to both baby -- and the entire family. CIO is a method that, when implemented thoughtfully, can often lead to improved sleep (and health and happiness) for everyone.

Firebombs like those thrown in the Psychology Today article only make the burden heavier on moms. What a shame.

Aloha as always,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

PS: Wow, what a response! After commenting here, please also see the comments developing over at the Fussy Baby Site.

BabyGeek: Infant Sleep "Rules" Don't Work

I've been sleep deprived since April 2001, when our oldest was born. Since then, I've tried every "trick" in the parenting book. And nothing seems effective at "making" my

kids sleep better. They've all evolved into being better sleepers over time.

That's why I'm so interested in the line of research discussed in this study. Penn State scientists found -- despite common parenting advice -- that parents' EMOTIONAL response to their children at bedtime was much more successful than any specific behavioral "trick" in getting children to sleep.

As a shrink, I tell parents that babies absorb their emotional messages. Parents are often surprised when I tell them that even the youngest babies sense their emotions -- but it's true.

In the shrinking world, we've been struggling internally for years over the predominant theoretical orientation -- Behaviorism, and its spin-offs -- and the power it holds over the way we do our work. Those of us who work with very young children understand that simple behavioral and operant conditioning simply doesn't apply with the little ones. That's why "Ferberizing" and related approaches are often ineffective.  FIRST, babies need to feel emotionally (and physically) safe. Other learning can proceed from there. But sleep is an inherently scary proposition, and often triggers resistance and regression in children. It's a weird and scary thing to transition into a sleep state.

So the fundamental message of this research at Penn State is both obvious to me -- and very reassuring -- as an Early Childhood specialist. I'm eager to see what else they discover in this line of inquiry, and I'll be sure to share it with you.

Here's a link to some of my "getting to sleep" advice. What's yours?

 

Aloha,

Dr. Heather The BabyShrink

Sleep, Toddlers, and Mental Health (Hopefully, Not Mutually Exclusive)

Mental Health Blog Party Badge I'm blogging for mental health today -- but not in way you might expect. Mental health isn't just some esoteric list of psychiatric diagnoses. It starts with simple -- but critically important -- things. These include the support of loved ones, meaningful work and relationships, and enough resources to have a little fun. On the top of that list, though, is getting adequate SLEEP. Having young children is the quickest way to ruin in the sleep department (and I speak from vast experience). Here's a quick tip on tackling the sleep issue for toddlers (and by extension, YOU):

Dear Dr. Heather,

 

My 2 year old started climbing out of the crib a few weeks ago. We transitioned her to a toddler bed and she continues to wake up around 2 am to play! And doesn't go back to bed until after 4 am. I've tried cutting her nap, which resulted in a miserable little girl in the afternoon and still waking in the middle night. I know allow her to nap for an hour and she's still up and playing at 2 am. Her bed time is around 8:30pm every night. Help!

Holly

Dear Holly,

It's very common for toddlers to start waking in the middle of the night after transitioning to a bed. That's why I always recommend WAITING to give up the crib as long as possible. But don't worry: Your late-night party-girl will remember how to sleep through the night -- with your help.

During the day, remind her that it's her job to sleep when it's dark outside -- plus, Mommy and Daddy get grouchy when she wakes them up at night. Everyone needs their sleep to be healthy.

Adopt the "broken record" approach -- she needs to stay in bed. Lights out. Time to sleep. If she gets up or makes a ruckus, calmly guide her back to bed and repeat the rules. Don't get emotional, don't turn on the lights, don't talk much, and certainly don't offer any food, drinks, or TV.

It may take a zillion or so reminders (or just a few, depending on her personality), but eventually her internal clock will win out and she'll start to sleep again -- as long as YOU'RE consistent in your approach. And when she DOES sleep through the night again, congratulate her for a job well done in the morning, and tell her how great YOU feel after having a good night's sleep!

Aloha,

Dr. Heather The BabyShrink

 

Sleep & Nap Issues: When Your Toddler Looks Tired -- But Won't Nap

It was 2 pm, and my toddler STILL hadn't gone down for her nap. Routines were followed, milk was drunk, and the house was quiet (no small feat around here, I assure you). She was rubbing her eyes, complaining -- but plowing ahead. Throwing her little arms in the air, she was chanting, "Up! Up!"

Some of you are pretty mellow about your toddler's nap schedule. But I'm the type who has to have "mellow" beaten into me with the stick of experience. "Toddlers are supposed to nap. Go to sleep, toddler of mine."

Not always that easy, is it? Turns out, none of my 4 babies ever read the Weissbluth or Ferber books, and they totally failed the "How Many Hours Per Day Babies Need To Sleep" test. They didn't follow those rules, and I was left fretting that something was wrong (and trying to soothe an overtired baby).

But guess what? I'm up at 3 am writing this post. Why? I can't sleep. I did my nighty-night routine, but my BabyShrink work beckoned me from bed. Your baby has important work to do, too. Sometimes, it's more important than sleep.

But what does a poor parent do with an obviously sleepy (but not napping) toddler?

Here on my 4th baby, I've discovered some important truths about nap schedules:

* The best-followed routine doesn't always work. Sometimes a nap simply isn't in the cards.

* Yes, an over-tired toddler sometimes means a cranky and difficult afternoon. But often, your toddler can rally and make the most out of the day.

* Toddlers are notoriously wacky about following nap schedules -- some more than others. Focus on nighttime sleep, and an earlier bedtime when there's no nap.

* Some parents attempt to hang on to that second nap for too long. If she used to be a good napper and now isn't, experiment with dropping the nap.

* Yes, I know: Sleep is important to a baby's brain. But as with food, parents need to focus on the overall amount, over time. A bad day ( or week) of sleep isn't going to do any lasting damage (except to us).

Now it's off to bed for me. If you're still awake, go and read more about your toddler's sleep challenges here.

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Toddler Behavior: My Toddler Won't Sleep

Reader Allie emailed me a couple of questions about her 15-month-old Jack*.

He was an otherwise healthy boy who simply stopped sleeping a few weeks ago. After getting through a nice, regular sleep-time routine -- a routine that used to work beautifully -- Jack would fuss, play, and scream. Anything to avoid going down to sleep. This would escalate over the course of the night with Jack snoozing briefly here and there -- but only with Allie holding him. The moment she carried him to his crib, he'd pop up, wide awake. Although she wasn't a co-sleeper "type", she tried it in desperation -- and it only made matters worse. Mommy's bed was treated like a big playground by Jack.

And Jack's Dad wasn't so hip on it either. He was of the belief that "tough love" was in order (as was Jack's pediatrician), and again in desperation, Allie tried it with Jack. After three hours of crying (and barfing all over himself and his crib), Allie had enough. No "CIO" for this baby.

After weeks of this, poor Allie was totally blotto from the accumulated sleep deprivation. My emailed suggestions didn't seem to get to the heart of the problem, and so I asked for more information. Turns out that Mom and Dad were having relationship difficulties on top of everything, and they just couldn't agree on how to handle the nighttime sleep issue. They had just started couple's therapy, and although the therapist was helpful to them, there was no time to focus on the problems with Jack. Plus, the therapist wasn't a specialist in babies and young children.

I suggested a Parent Coaching session, so that I could see Allie for myself, get to know her a bit, and have some time to get into the nitty gritty of Jack's situation. We spent an hour on Skype, going over Jack's temperament and personality, as well as options Allie hadn't thought of yet. I gave her detailed information on what is "normal", sleep-wise, as well as developmentally, for a child Jack's age. This helped decrease her fear that something was really "wrong" with Jack. Also, Allie was upset that Dad wasn't seeing things exactly the same as she was. I carefully side-stepped the relationship issues, focusing on helping Allie to understand that different parental attitudes CAN WORK with children. We created a plan that both parents could agree on, with the goal of helping EVERYONE get better sleep.

The "nuts and bolts" of the plan weren't anything fancy or unusual. But the fact that we had the time to really put our heads together to make a plan -- a plan that would work for Mom, Dad, AND Jack -- made it simple, but powerfully effective. And although I'm not necessarily against CIO in every case, I knew it was off the table for this family -- so we worked out a different plan. I was excited to receive an emailed update from Allie this weekend, letting me know that Jack was back to his old good-sleeping self (and more importantly, so was SHE).

If you can relate just a little too well to Allie, you've come to the right place. I'm including a link to one of my most popular Sleep posts here, to get you started. If my sleep posts aren't enough, shoot me an email (BabyShrink@gmail.com) or hit the "Parent Coaching Packages" button up on the top of the page to complete the form. I'll be happy to chat or Skype with you, too, to help you FINALLY get some sleep!

Aloha,

Dr. Heather The BabyShrink

*Allie asked me to keep her name, and that of her child, private -- these aren't their real names. But their experiences are real.

Sleep & Nap Issues: Tips For Your Child To Sleep Successfully

It's hard to believe, but 6 weeks ago I was in agony, being awakened 6 or 7 times a night by a 7-month-old baby who seemed desperate to nurse each and every hour over night. I was at DefCon 7, or 8, or 47, or whatever the highest possible number might be for Maternal Sleep Deprivation. Worse, this is our 4th baby. My fantasies of finally getting a baby who was a good sleeper were shot to hell, and I was MAD. YES!!!

Going the "babywearing" route -- responding to every need -- wasn't working -- it was making things worse. So I undertook the most rigorous "Sleep Training" program I've tried yet. And it worked.

Now, I'm not advocating that you try Sleep Training -- and by that, I mean some variation on the "Let Them Cry Longer Than You Normally Would" theme. No, please don't take this as something I'm necessarily advising you to do. Just hear me out for a minute:

Some babies do very well with "babywearing" and co-sleeping. Mine don't. They either get all aggravated with the extra body contact -- they want to be "free" -- or think sleeping with Mommy and Daddy means fun playtime all night long. It seems they want to sleep in their cribs, because they're wonderfully well-adjusted (and much more well-rested when they finally "get it"), but they need help in "getting it".

So I used my Shrink's Crystal Ball and devised a perfect sleep plan just for her that worked immediately. Hah! I wish. No, seriously, I thought about her specific age (7 months), her temperament (loud and excitable, but resilient and forgiving), and our family's needs (3 older kids who need to have a reasonably quiet house at night plus 2 working parents), and went from there. It was 6-ish weeks, with 2 or 3 of them being fairly challenging, but I am happy to say that the plan has worked fabulously well. Miss Nighttime Partier is now sleeping 10-11 hours at night.

This combination: Your baby's age, temperament, plus your family's needs, all get put into my formula for improving any parenting problem with your baby -- not just sleep. It's a personalized approach that goes way beyond a checklist that you might find in a parenting magazine. It's developed for you and your family. That's the basis for my Parent Coaching service that I'm preparing to offer online, and I'm really excited to be able to help families far beyond my little island home out here in the Pacific.

So stay tuned for more details on BabyShrink Parent Coaching, and in the meantime, comment or email me for more specifics on your little nighttime partier.

Aloha,

Dr. Heather The BabyShrink

Child Development: Why Your 9-Month-Old Baby Is So Difficult All Of A Sudden

I had an amazing conversation with one of the world's foremost infant researchers last week, Dr. Joseph Campos. He's at Berkeley, where he's churned out tons of scientifically rigorous studies about the developmental changes in infancy. He's come up with some transformative ideas about babies, the upshot of one being that crawling causes your baby to become your little social partner, for the first time. No longer just a passive lump in the social world, now she's able to start to understand some of what's going on inside your mind. She understands how important you are to her, and seeks your emotional support, presence and encouragement as she starts to scoot out into the world under her own power. She now gets reassurance from your presence and your emotions -- your facial expressions and body language -- not just from physically holding her. Super Cute, and Super Challenging

The flip side of this is that it also causes clinginess, fussiness, and sleep problems -- some of the major complaints of parents at this stage. Turns out, crawling out into the wide world is fascinating -- and terrifying. Your little adventurer gets it now -- that as much as she wants to venture out on her own, she desperately needs you, and is panicked that she'll lose you somewhere along the way. As Dr. Campos said to me, the baby's drive for independence is equally matched by her fear of it.

So to you fellow parents of 9 to 12-month-old babies out there: I know it can be a challenging, difficult stage. Your little bug seems content to scramble around the house one minute, then wails in panic the next. What used to be stable sleep habits are now in a shambles. Feeding --and nursing -- has become an unpredictable struggle -- and separations are exceptionally difficult. And forget diaper changes! What a wrestling match! Immmobility is the enemy to her now -- being restrained in any way is bound to be a fight. High chairs, strollers and car seats are demon baby torture devices. They keep her from exploring her brave new world.

What to do? Re-think your daily tasks with this knowledge in mind. Everything will take a little longer, as your baby goes through this unpredictable (but temporary) stage. Some days she may need you constantly. But don't worry -- when you've finally reached the end of your rope with your little Clingon, she'll start to feel "refueled", and venture out again -- allowing you to catch up on that laundry and email. And make sure you get some help with nighttime wakenings -- you'll need extra rest too, since you're up again with a fussy baby -- but don't forget to reinforce the sleep routines that have worked well in the past. She'll eventually remember what her job is, at night -- and now that her memory is better, she can hold on to her internal image of you a bit longer, giving her some comfort, despite being away from you to sleep. Feel some reassurance knowing that the earlier -- and stronger -- your baby shows separation anxiety, the sooner it resolves. Lots of parental support and understanding help her get through this challenging -- but remarkable -- stage.

Dr. Campos was generous and encouraging in my BabyShrink book-writing project, and I had a blast geeking out with him, picking his brain about the amazing new developmental capacities in normal 9-month-old babies. What a great experience! Now, please excuse me -- I've got a 9-month-old baby clinging to my leg.

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

"Sleep Training": Some Theoretical Background for Parents

It's so hard to walk away from that face! Reader JD was asking me for some specifics on sleep training, and I fought off the urge to give you another list of "How-To's". Your baby is much more complicated than a quick "Baby's Sleep Checklist", so here are some thoughts to ponder while you are up with your little screamer tonight, courtesy of one of my faves, Selma Fraiberg:

Regarding 9-12 month old babies:

We understand that the older infant finds it painful to be separated from beloved persons. We grant him the right to protest. At the same time this pain, this discomfort, is something he can learn to tolerate if it is not excessive. We need to help him manage small amounts of discomfort and frustration. If we are too quick to offer our reassuring presence, he doesn't need to develop his own tolerance. How do we know how much he can tolerate? By testing a bit of the limits of his tolerance as they become known to us. The point at which protesting and complaining crying turn into an urgent or terrified summons is the point where most of us would feel he needs us and we would go to him. This is real anxiety and he needs our reassurance. But we need not regard all crying of the older infant and young child as being of the same order. At this age, in contrast to the period of early infancy, the baby can manage small amounts of anxiety or discomforts by himself....As far as possible we should try to reassure the child in his own bed. Picking him up, rocking him, is usually not necessary and seems indicated only when the baby is unusually distressed by anxiety or illness.

From The Magic Years, pages 74-75.

If you like Selma, Click on "The Quotable Parent" down and to the right for more juicy tidbits, or just buy the paperback -- I promise it will end up heavily read, re-read, mashed and dog-eared, like mine. I'm clinging tightly to Selma these days (and nights), as Baby #4 has proved to be exceptionally gifted in protesting loudly, and waking up her siblings. But we are making progress, and so will you. Hang in there!

Aloha,

Dr. Heather The BabyShrink

Sleep & Nap Issues: How To Cope While Sleep Training Your Baby

We're doing our own version of Sleep Training around here, since baby #4 has proven to be immensely resistant -- and LOUD -- in our efforts to help her sleep through even a decent portion of the night. Adorable as she is, she's the most rotten sleeper I've yet produced. Tough Love is in order. Sure, she sleeps OK in the stroller.

But Tough Love is rough on me -- and on the family. A fussing (or screaming) baby feels like a constant reminder of some kind of parental inadequacy, and is really grating on the nerves. Not to mention the fact that it often happens at ridiculous hours of the night when most other babies are surely sleeping soundly. And forget sleep for poor mom. I'm a zombie.

But persist I must. I won't give in to an 18-pound 8-month old, no matter how cute she is (in the daytime, at least). It will be worth it in the end.

Here are my tips for getting through this rough time, if you're going through Sleep Training:

Make sure you and your partner are on the same page. There's nothing worse than arguing about sleep training techniques at 2 am, standing outside the door of a screaming baby. Agree ahead of time -- or don't attempt it.

Prepare the older kids for nighttime noise. I tell my lightest sleeper that he may hear the baby fussing at night. "But you're a big boy and can roll over and go to sleep. Soon we'll all get better sleep."

Use a little reverse psychology on yourself. (You're so sleep deprived it just might work!) Instead of preparing for a night of sleep, prepare for a night of watching "guilty pleasure" TV, listening to great music from your (childless) past, or even folding laundry. Fooling yourself into thinking you don't really need to sleep somehow makes it less painful to be up at weird hours.

Take a deep breath, have a zen moment, do some mindfulness meditation, yoga, or pray -- pick your version of expressing gratitude and relaxation. Having a non-sleeping, screaming baby at 2 am is really hard. But in the scope of things, not really that big of a deal. A few moments recalling the years when we feared we couldn't get pregnant, or thinking of friends who have a baby who's quite ill, and others who have God forbid lost a child, and I'm ready to get through another tough night of sleep training. Having a healthy, happy, non-sleeping baby is a high-class problem we're blessed to have, quite honestly.

I've written other posts about getting through the sleep deprivation aspect of this, but let me also mention our friend caffeine here. Don't overdo it. At my peak, I have a mug of java in the morning, some iced tea at lunch, and another cup of coffee around 2. That's 3 servings a day. Any more and I get frazzled and nutty -- and no more awake than if I had stayed with the 3 servings. Studies say that some coffee is fine for most of us, but too much will definitely make you feel worse.

Sleep Training eventually works -- I'm writing this now as the baby sleeps nicely in her crib. Get through the rough nights and I promise things will improve!

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Toddler Behavior: Fabulous Fraiberg #6: Why Won't My Toddler Sleep?

zzzzzz.......Excuse me, I was just dozing off. I haven't been able to get much sleep over the past, say, 10 years or so (I keep having babies, what can I say) -- and the pursuit of sleep, because of unwilling babies and toddlers, has become an obsession for me. Unfortunately, there's no holy grail, but at least there's a good explanation for it. As usual, I turn to the Fabulous Fraiberg for a little support over my sleepless children. I always get goosebumps when I reach the end of this section:

We began with a baby in the first month of life....His world was a chaos of undifferentiated sensation from which he slipped gratefully into the nothingness of sleep...

At 18 months this baby is traveling extensively and has acquired a small but useful vocabulary (just enough to get a meal and bargain with the natives). He has encountered some of the fundamental problems of the human race -- the nature of reality, of subjective and objective experience, causality, the vicissitudes of love, and has made promising studies in each of these areas. We could easily forgive him if these first encounters with our world should create a desire to go back to sleep twenty hours a day. But this fellow upsets all notions about human inertia by forging ahead like a locomotive right into the densities of human activity. Sleep?...Let us try to take it away from him and put him back into the darkness. Sleep? But look, he can't keep his eyes open! He's drunk with fatigue. He howls with indignation at the extended hands, rouses himself with a mighty exertion from near collapse to protest these villains who take away his bright and beautiful world. From his crib, in the darkened room he denounces these monster parents, then pleads for commutation of sentence in eloquent noises. he fights valiantly, begins to fail -- then succumbs to his enemy, Sleep.

Sleep -- at last

From Selma Fraiberg, The Magic Years, pages 63-64

Don't blame the toddler for resisting sleep. But notice, Fraiberg doesn't suggest we take him out of the crib and let him keep up his explorations -- no, Fraiberg asks us to understand the toddler's dilemmas, to empathize with him, but to put him to bed nonetheless, when he needs it. A toddler can be "pushed" to go to sleep. A 6-month-old baby shouldn't (yet). It's this major disparity in the developmental needs of young children -- 3 months, vs. 6 months, vs. 9 months, vs. 12 and 18 and 24 months -- that confuses us, as parents. But the more we understand the unique needs of the specific age of our child, the better we will be at negotiating their needs.

And now, off to get a cup of coffee -- the baby needs me :)

Aloha,

Dr. Heather The BabyShrink

Sleep & Nap Issues: A Noisy House = A Sleeping Baby?

When our first was born, I was determined to eliminate any possible source of noise inside (and outside) the house in hopes of bettering my baby's sleep. I neurotically tiptoed around, turned off the phones, waited on chores that made noise, and considered complaining to the County for allowing leaf-blowers in my neighborhood. Guess what? Nothing worked. The baby slept as she was going to sleep (not very well) no matter what. As I kept having babies, the ability to even try to maintain a quiet home was beaten out of me. It simply wasn't possible. And guess what? The babies still slept as they were going to sleep (still, mostly not very well). But slowly, it dawned on me that the normal, medium-noise level of the house not only didn't seem to worsen the baby's sleep...it improved it. Turns out, babies are used to a ton of noise in-utero. The mother's body -- and the typical household -- make it fairly raucous in there. So don't worry about a little noise -- in fact, noise machines, fans, and radios turned down low have all been found to encourage a good snooze.

I have found that a sudden CHANGE in the noise level of the house can disturb sleep; for instance, a generally noisy house turned quiet all of a sudden is just as likely to wake the baby as is the big roar of the garbage truck outside her window. But all in all, the baby will get used to the noise level in your house, and eventually allow you to sleep (a bit) too. So don't make yourself nuts trying to shush the other kids (and your entire neighborhood). Just breathe deeply, and try to grab a nap!

Aloha,

Dr. Heather The BabyShrink

Sleep & Nap Issues: A Toddler's Sleep Dilemma Solved

Hi Dr. Heather, I have a sleep question regarding my 11-month-old. Since he was 5 months, he successfully fell asleep in his crib after our nightly routine, and woke 2 or fewer times to nurse. Similarly with naps. We do not use any type of music or white noise when putting him to sleep.

We have always had a music box in his crib. We usually turn this on when we put him in the crib for "safe keeping" while we wash our hands after a diaper change. We do not use it for sleep.

In the last 2 weeks or so, we have noticed he frequently uses the music box. Now when we put him down, he will get up less than a minute later and turn on the music box. Sometimes he will play with it for a few minutes (turning it off and on) - but eventually he will usually lay down and fall asleep. We have noticed him using it in the middle of the night as well - sometimes letting it play out then turning it back on again. (Usually this is after I have gone in due to his crying and put him back down again).

Putting him down for naps has been a struggle this past 6 weeks or so, and the last 2 weeks he has been playing with the music box during naps, sometimes falling asleep, sometimes crying after he is done playing and defiantly not going to fall asleep anytime soon. (about 60/40).

Okay, so all that to ask: Is this okay? I do not want my baby dependent on a lighted music box to fall asleep, and I do not want him playing in the middle of the night. But, if this is how he "self-soothes" . . . Will this become a dependency problem or will he grow to not need the music box? Should we let this continue as he chooses or should we turn off the music box or do we need to remove it from his crib? What do you think?

Thank You, Angie

Dear Angie,

Thanks for your question! You're not the only one to wonder about this; our 3rd baby used to do the same thing, with a very similar music box. We'd be asleep late at night, then all of a sudden we'd hear that familiar tune coming from his room. What the heck? We'd wonder. Our little guy was in there, happily rolling around, very pleased that he'd turned on the music all by himself.

At first we worried that we'd have to take out the music box, since we didn't want him to be up and playing, late at night. Then I realized...Hey, instead of crying for me at midnight, he's entertaining himself. This is a good thing, right? I left him alone in there and sure enough, he'd fall asleep on his own after awhile.

Because the overall drift of our parenting goals is to support them in being independent, as soon as they are ready. And babies and toddlers DO normally still frequently waken at night, it's just an issue for us when we have to get up too to help them get back to sleep. But if they're handling it on their own? That's a good thing. I also recall that the late-night-music-party was a short phase. The excitement ran out after awhile and then we were on to the next dilemma.

And now that your little guy is approaching toddlerhood, you're going to get a lot more testing along these lines. The nap issue is always going to be there, in one form or another, through toddlerhood. The music-box thing is only his first effort to avoid naps. Most toddlers go through phases where they're really good at napping, and then take a stab at trying to stay awake. Let your expectations be known, urge him to nap, but don't get too worked up about it. He'll make up for any lost sleep at night, or when he's done testing you with that particular phase.

But I also hear that you're concerned about being consistent as a parent, and not wanting to send him mixed messages. Listen: Don't worry. It sounds to me as if you're trying to be very consistent, and all you can really do is send a general message of what you expect from him. There is a lot of parenting advice out there that says you need to be consistent to a fault. I don't agree with that. These are people we're talking about! And rigidity is never a good approach in dealing with people, large or small. We have to be flexible as well as consistent, as our kids think up all sorts of new wrinkles to throw at us.

I, too, used to over-worry about the importance of being perfectly consistent, until my mentor suggested that I lighten up. "A habit isn't a habit until it IS a habit," she told me. In other words, you're trying to be consistent in order to instill a sense of structure, predictability, and behavioral expectations. But you can do that by being generally consistent; it doesn't have to be a 100% effort. I promise: You're allowed to be flexible -- I even strongly SUGGEST that you're flexible. It offers a good model to our kids that we can consider new situations and not be rigid about them. Consider every new situation afresh, THEN make your decision.

So next time you hear that familiar music drifting out of your son's room late at night, try to let the music calm YOU back to sleep too. Your baby is getting bigger, and soon he'll be getting into bis "big boy bed", and then you'll have reason to worry about new things...wandering in the night, monsters, and everything that goes along with THAT phase. So enjoy this time when he's still captive in his crib!

Aloha,

Dr. Heather The BabyShrink

Sleep & Nap Issues: Got a New Baby? How to Manage The Sleep Deprivation

Boy, am I tired. You'd think I'd get used to the lack of sleep by now -- this is our fourth child, after all. But the crushing effects of sleep deprivation continue to be the hardest part of parenting, for me. I could change diapers and nurse and even chase toddlers all day long, if I could just GET SOME SLEEP. But this baby is just like her siblings, and she sleeps sporadically at best. At 4 months of age, she sometimes awakens once or twice at night -- but more often three or four times -- to nurse and be comforted. I've got 3 other kids, a day job, and you, dear reader, to keep me more than busy. I'm tired. IMG00341

When I had our first child, I had secret visions of the wonderful sleep-inducer that I'd be. "Babies need sleep, and so do parents. I'll get the baby to sleep." Somehow, I thought I could use my super-shrink powers to calm, soothe, or hypnotize her to sleep.

I was wrong. Our first didn't sleep reliably through the night until she was four. FOUR!

Since psych grad school, oddly, is completely unhelpful in the preparation for parenthood, I sought out and read every single "Baby Sleep" book out there. All the major titles. I tried everything, religiously. Didn't work.

And in the process, I got more and more sleep deprived myself.

There's not much recognition out there that parents' sleep deprivation often goes on for a really long time, and despite how difficult that is, it's actually quite normal and typical for a baby to be up a lot at night for several months, and even beyond. I was doing some research for this post and I found something really annoying -- most articles only address the FIRST MONTH of how to survive with a newborn. The implication is that things really improve in the sleep department after that first month of your baby's life. AS IF! In the first month, you're getting by on adrenaline, grandma's help, and that extra sympathy and interest everyone still has in the new baby. It actually gets WORSE after that first month; you lose most of those extra perks, the baby STILL doesn't sleep very well, and you're slowly but surely losing your mind from the accumulated lack of sleep.

And of course there ARE some babies who sleep beautifully from very early on. (But parents of THOSE babies aren't reading this post, are they?) It makes those of us with crummy sleepers feel there must be something wrong with my baby; or, there must be something wrong with my parenting. The urge to compare our babies to other babies is just too tempting. Not recommended, but hard to avoid.

When Your Baby Starts to Sleep Better...and then Regresses It's also easy to worry that "something is wrong" when your baby seems to be sleeping better....then all of a sudden is back to waking several times a night. Please know that regression is normal in many developmental areas, especially in early childhood. Sleep is no exception. My second-born slept a good NINE hour stretch from the age of 9 weeks until the age of five months. Then he started trying to roll over, and he roused himself several times a night with his new-found pursuit. After prematurely congratulating myself that we finally had a decent little sleeper, I just about lost it when he regressed back to waking several times each night again. Just as you get used to being up all night with a newborn, you also quickly get used to regular sleep again. And when your baby regresses and you have to go BACK AGAIN to being up and down all night, it somehow feels WORSE than when you were used to it before. "Of Course, MY Baby Sleeps Through the Night!" Another thing that happens is that we compare our experiences to other parents'. That's a mistake, because PARENTS LIE. Not all parents, but enough of them DO get caught up in the game of comparing kids that you end up getting some pretty skewed information. And for some reason, the misinformation also comes from other parenting "resources", which are often misleading. Even most pediatricians have little sympathy for our sleep deprivation. After all, most of these doctors take overnight call and had to be awake for their residency training for a couple of days at a time for years, so sleep deprivation is a relative term for them. And when your pediatrician says you can expect your baby to "sleep through the night" at 12 weeks of age, guess what she means? Sleeping a 6-hour stretch (sometimes, at least), is considered "normal". But in my book, that's not sleeping through the night, especially when most babies that age want to go down for the night at around 7 or 8 pm. By the time YOU get to bed, the nighttime rounds are just beginning.

The WORST advice you get is to "sleep when the baby sleeps". Well, DUH. But it's not that easy, is it? Babies' sleep cycles can sometimes be so unpredictable that they have their best stretch of sleep smack in the middle of the day, when you need to shop, cook, do stuff with your other kids, and otherwise live your life. Waking up every hour or two in the middle of the night is often more the reality for many young babies.

And I don't know about you, but it's impossible for me to sleep "on command". OK, baby's asleep now, ready, get set...SLEEP! It doesn't happen that way, does it? There are biochemical reasons for that. Once we're awake for far too long, or we're awakened one too many times at night, our bodies start to produce hormones to keep us awake. That's when you get that hyper, wired, "I-know-I-should-be-sleepy-but-I'm-wide-awake!" feeling at 3 am.

You might think that I'm going to give you some fabulous secrets for getting your baby to sleep. Sorry, folks -- sleep is one of the things you can't "make" your child do -- along with other bodily functions like eating and pooping. And if I had found the holy grail of making a baby sleep through the night, I would be a very rich Baby Shrink indeed. The truth is, nobody's done that. But I have come up with some tips, over the years, from both my experience as a shrink and as a mom, for how to SURVIVE the sleep deprivation that most of us experience with babies:

How to Survive Baby-Induced Sleep-Deprivation In order to be safe behind the wheel of a car and to keep your body (and mind) relatively healthy, you MUST get at least adequate sleep a couple of times a week. Consider this a Doctor's Order: GET HELP so that you can at least 1) sleep in at least 2 mornings a week, complete with eye shade and ear plugs so that you don't feel like you're "listening" for the baby, and 2) get at least a 90 minute break most afternoons when you can lie down and rest (and hopefully sleep). If you're a first-timer, it might not be easy to trust anybody to care for your Babe, even if you're eyes are crossing from lack of sleep. But you MUST force yourself allow a trusted person to help you. Not easy to arrange? I know. Essential for your health and well-being? YES.

Get some exercise -- preferably outside -- for at least a few minutes each day. I know it feels impossible when you're wiped out, but there really is a magical effect in taking even a few minutes' brisk walk. Getting outside in the sun will also help to re-set your circadian rhythms, which are being hammered by your 24/7 schedule. I promise, you'll feel better. You might also be able to sleep better when you get an opportunity later on.

Learn meditation and breathing techniques to calm the stress hormones that keep you awake when you should be sleeping. Any "mindfulness", prayer, yoga, or other meditative technique that focuses on breathing will work. If you feel hyper and over-tired, even TEN SECONDS of mindful breathing will help you slow down and feel better. But do strive for 15 minutes a day in order to get your stress hormones under control. This will help you to sleep better when you DO have a chance.

Don't obsess over how little sleep you're getting. Believe me, I've been there -- staring at the digital numbers on my bedside clock, getting madder by the minute about yet another night of lousy sleep, up and down with the baby. The less sleep you get, the more upset you become, and a vicious cycle begins. Don't obsess about it. Let it go. Tell yourself: Oh well, another late night. This is something I can look back on later in life and laugh about. I know I feel beyond exhausted right now, but this too will pass. And if you can't sleep, then read or watch TV. Just give yourself a break about it.

Don't compare the amount of sleep you're getting now to how much sleep you USED to get or need. I know you used to sleep in until noon, and you couldn't function with less than 8 hours before this, yadda yadda. But your body has changed -- you're a parent now, and things ARE different. Yes, your body needs sleep, but you're also pretty good at adapting to less sleep -- at least for the short term. It feels impossible to "roll with it", but that's what you've got to do.

Don't be afraid of the "Cry It Out" method for your baby -- once she's old enough. I think you can safely start that at about 9 months of age for most babies -- after they have sufficiently developed the memory skills to remember that you'll be coming back eventually, despite being left to cry (and sleep). Before then, you can (of course, with your pediatrician's blessing), allow baby to fuss, grunt and make noise before rushing to get her; many babies are NOISY sleepers (another reason for them to sleep in their own rooms), and don't actually need to be picked up. Try to learn the difference between "grunty-noisy-baby-sleep" noises and actual "come feed or comfort me" noises.

And finally, try to adopt a bit of a Zen attitude about all of this. Because your crushing sense of exhaustion will quickly dissipate one day, sooner or later, as your baby naturally develops a better capacity to sleep at night. Then you'll be on to the next parenting challenge. So pace yourself. Our oldest is almost 9 and I still almost cry in relief as I check in on her, in a deep sleep, late at night. How can they grow this fast? (Cue the music to "Sunrise, Sunset".) Is this the baby that so challenged my sense of order in the world, simply because she wasn't a great sleeper for the first few years of her life? And here she is, a beautiful, intelligent, happy third grader, reliably sleeping from 8 pm to 7 am every day. Development is a magical thing, people. We parents can only provide love, structure, safety, support and guidance to shape these fabulous creatures that are our children, while the amazing processes of "growing up" happen before our (sleep deprived) eyes. We can't "make" them sleep, but we can't "make" them roll over, sit, stand, speak, and run, either. So step back for a minute to bask in the miraculous glow of your child's growth and development. It's a beautiful thing! I hope this helped. And now, please excuse me while I try to get some sleep!

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Here's another post on babies and the normal range of their sleep patterns.

More on Potty Training: When Your Preschooler Poops in Her Sleep

Dear Dr. Heather, I have a question for you regarding my daughter, who turned 3 in October. She has been potty trained (pee at least) since August. Here is the problem….she poops in her sleep. She also poops on the potty if she has to go while she is awake. But mostly, she is pooping in her pull-up during naptime. She also has pooped twice at nighttime. I don’t know if she is holding it to do it while she has a pull-up on, or if she is sleeping so soundly that she doesn’t realize she is doing it. Since she also poops on the potty, I don’t know what to think. Is it possible to influence the time of day she poops? She will be starting preschool soon and I am concerned that she will poop in her underwear at school during naptime. When she does poop in her pull-up, she apologizes profusely. I used to say that she needs to poop in the potty, not in her pull-up, but I don’t want to turn her into a neurotic kid, so I just clean her up and say nothing. Any suggestions?

Thanks for your help.

Marcia

Hi Marcia,

It sounds like you are being sensitive to your daughter regarding her poopy-timing. I'm glad you're not pressuring her about the issue. And the fact that she apologizes profusely shows you that she knows what she is supposed to do, but isn't there yet. You're right; lecturing her about it won't help. And I wouldn't suggest doing anything to somehow manipulate her potty schedule; this would likely be felt as intrusive by her.

It also seems that it wouldn't concern you as much if it weren't for the preschool issue. Many preschools have rules that state the child must be "toilet independent" before starting school. The pressure to be "completely" potty trained before starting preschool MAKES ME CRAZY! It's really unrealistic for many kids, and parents feel compelled to get their kids trained before they're ready. This can cause problems later on.

That said, many schools WILL work with you, if you approach them directly. Believe me, this isn't the first time they've dealt with this! They can support your daughter on her way to being fully potty trained. If her school won't work with you on this -- look elsewhere. You want a place that understands the developmental issues of preschoolers.

In the meantime, continue to praise her efforts, and be neutrally supportive when she has an accident. I wouldn't dwell on it much with her; it sounds as if she KNOWS what is expected, and that's what matters. It sounds like she's well on her way to having full control over her potty needs, and I'll bet that soon, she'll be making good progress.

Good luck and let us know how it goes!

Aloha,

Dr. Heather The BabyShrink

Toddler Behavior: What to do When Your Toddler Won't Nap Anymore

It happens to the best of us. We work so hard to establish nice, regular nap schedules for our babies. Finally, we've gotten used to a more predictable nap schedule for our toddler. And boy, do we need it: Running around after a toddler all day is HARD WORK. We need that couple of hours to clean up, get stuff done, pay attention to a neglected sibling, and sometimes -- gasp! JUST RELAX! Then, it happens. One day, your toddler decides that, hey, why not just STAY AWAKE, instead of go to sleep? There's so much to do, let's just keep the party going ALL DAY LONG! And the frustrating thing is that, usually, she'll nap perfectly well at daycare. This makes us feel like WE'RE doing something wrong.

UGH. A non-napping toddler triggers desperate measures. We lie down with the offending 2 (or 3)-year old, we pretend WE are sleeping (and sometimes, we don't have to pretend!). We bribe. We cajole. We threaten. Sometimes it works -- and sometimes it doesn't. And on the days it doesn't work, our toddler is a fussy, tantrumming mess by dinner time. Or worse: she falls asleep in the car at 4pm, meaning she'll then stay up till 10 or 11 pm! Yikes!

Nap schedule? What schedule?

Reader Ilima worries that her 2-year-old still needs a nap, but has starting refusing to sleep. What to do, she asks?

Dear Dr. Heather,

I have a napping question. My daughter still takes naps at day care, but we can't get her to nap at home. At home she gets out of her bed and won't stay in. If I leave her alone she just gets out and plays in her room. If I stay and supervise, she does whatever she can think of to provoke me and get a reaction, and it becomes a game that gets her stirred up. If I lie down with her, she just wants to talk and play with me. She's 2 and a half now. She still seems tired, and I know naps are important for her brain development. Any thoughts?

Ilima

Dear Ilima,

I've been there. All morning long, you're talking yourself through the frustrations of dealing with a toddler by planning what you'll finally be able to do, once she goes down for her nap. If I can just make it until 12:30, I can eat a nice, peaceful lunch, straighten up this mess, and catch up with a friend on the phone. But your toddler's got other plans.

What Not To Do You can't force anyone to sleep, especially a toddler. It's similar to feeding and potty-training issues. Trying to force a toddler to eat, poop, or sleep is a setup for disaster. You don't want to trigger a power struggle -- one that you'll lose -- by trying to MAKE her follow her nap routine.

You also can't allow yourself to get desperate and miserable about this new turn of events. I know it's really easy to get comfortable with a nap routine, and it feels impossible to get through the day without it. But don't panic. Here's why: Your Baby is Growing Up! Babies NEED to sleep during the day. Their brains can't handle all that stimulation without shutting down after a few hours. But your toddler's brain is growing past that stage -- and isn't that an amazing thing? She can handle more now. And despite what other "experts" may say, most children automatically get the amount of sleep they need, more or less. They require your direction and support, but they don't need you to closely control their need for sleep. As my mentor (an infant development expert) said, while scolding me for putting too much emphasis on my own toddler's nap schedule, "If she's tired, eventually, she'll sleep! You don't need to make a federal case out of it!"

But She Still Seems Tired! I know. this development thing isn't perfect. She'll still have crabby, tired days as she transitions from daily napping to no naps. Some days, she'll absolutely NEED to nap. And on those days, feel free to insist that she does. But on days that she resists -- let her stay up. If she falls asleep on the couch or in the car later, wake her so that she doesn't stay up to an ungodly hour. Eventually, her boody will adjust, and she'll sleep in later in the mornings, or allow you to put her down at night a bit earlier, or nap once in awhile.

Then Why Does She Nap at Daycare? Take it as a compliment -- daycare isn't as fun as home. Your toddler would MUCH rather be up and having fun with her family. Unfortunately, she also saves her worst toddler moments for you as well. That's why this "Dr. Jeckyll/Mr. Hyde" sort of dual-personality thing is so common at this age. All her very best -- and very worst -- moments are reserved for you!

Tricks for the Toddler in the Napping Gray Zone If you know she needs a nap but she's been resistant, use these tips that I learned from our kids' expert babysitter. Say, "Today, you don't nap. But you need to lie down in your bed with your book for 30 minutes. But whatever you do, DON'T GO TO SLEEP!" Often, your oppositional toddler will resist your suggestion to NOT SLEEP -- by sleeping. (Hey, I never said they were RATIONAL as toddlers, just OPPOSITIONAL!)

Decide in advance that she won't nap on a certain day, and make a big deal out of it. Say, "Hey! Today is a NON-NAP DAY! You get to be a big kid and NOT NAP! And on non-nap days, bedtime later is at 6:30, because you're SUCH A BIG GIRL!"

Plan your life differently. From now on, you won't be able to count on mid-day time for yourself. But you CAN plan for more evening time. You can also plan your toddler's day accordingly. Set aside "quiet time", "free play time", and other set blocks of time when you encourage her to entertain herself. Reward her with praise or little rewards for playing nicely and quietly for increasingly longer blocks of time. As she gets older, you'll be able to count on her more and more, so that you get little "mini-breaks" throughout the day, instead of one long nap period.

Remember, your toddler is becoming a KID, and kids don't need daily naps. Kids go to school, go to sleepovers with their friends, and in general gain more independence every day. (Sigh! I know it's a cliche, but now that our oldest is 8, I see how truly fast they do grow up!) This is just another phase in the amazing process that guides the development of your child. Hang in there!

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Sleep & Nap Issues: Understanding Your Baby's Sleep And Wake Cycle: A Recipe For Sanity

Having a new baby throws all semblance of a household schedule into chaos. Your little interloper has demands around the clock, and as YOUR ability to sleep decreases, your feelings of insanity increase! Sleep deprivation is really one of the most difficult parts of being a new parent. You can't really blame the baby; he's obeying his internal needs and commands, which don't yet follow a nice, predictable pattern. Or do they? Believe it or not, you CAN make some sense of your baby's sleep/wake/activity cycle. Most babies generally cycle through the following phases:

1) Sleep 2) Hunger/awakening 3) Feeding 4) Alertness 5) Fussiness 6) Sleep

Very young babies may be in each phase for only a few minutes each, gradually lengthening the time spent in each phase as they get older. And of course there are variations on the above cycle; for instance, some babies like to feed again, for comfort, before they go to sleep. But most babies WILL have even some very basic, cyclical pattern that they follow around the clock, even from the earliest age. And as your baby gets older, his tendency to develop a more predictable pattern will become more obvious to you (as long as you look carefully for clues to his own unique cycle). Become a parental detective, and you'll learn a lot about your new little one.

It helps to know where your baby is in the cycle at any given time, so that you can know what to expect from him now, and in the near future. For instance, if your baby is at the tail end of a nap, it might not be a good idea to plunk him in his carseat for a long ride; he'll likely awaken with a powerful hunger, and you won't be able to feed him easily. It makes more sense to let him awaken and then feed him before you leave. Understanding where he is in the cycle also helps you know when you can expect to interact with him most productively (and have the most fun with him!) I know our new baby will awaken from her longest stretch of sleep in the morning, feeling good and ready to "play". I try to schedule my day so that I can linger with her while she coos and smiles at me from her favorite perch; the changing table, in the morning. We have fun, sweet little "conversations" that are both fun AND important to the development of her little brain. But at the tail end of her period of alertness always comes the fussiness, and I know we can wind down our playtime, as I start to rotate among her favorite soothing techniques. (At 7 weeks of age, it's anyone's guess what will soothe her at any particular moment; sometimes it's her Daddy's "Heismann Hold", sometimes it's her binky and bouncy seat, her swing, or a ride in the stroller).

Getting to know your child starts at even this very earliest of ages. You'll find, over time, that the general patterns you observe about her sleep/wake cycle eventually extend into her personality tendencies and temperament. This will help you over time to meet your child's unique parenting needs. Have fun -- and try to get some sleep!

Aloha, Dr. Heather The BabyShrink

Developmental Issues: Did Swine Flu Cause Autism In My Son?

There's a lot of confusion out there about illness, the flu, vaccines, medications, and autism. This poor Mom is terrified that her son may have contracted Autism from a bout of Swine Flu. Here's her email to me: Dear Dr. Heather,

Please help. I saw your article on autism, and I am very intrigued and impressed by your knowledge and insight.

I don’t know what to do. I have two beautiful, 91/2 month old identical twin boys who were always very social, smiley, interactive, looking directly into the face, etc. The one I am most concerned about would turn his head and smile at his brother in their crib, smile at everybody, I would play the ‘up’ game with him and he would gaze into my eyes, smile, and giggle… and they both almost always responded by looking when I said their names.

Then one of them got sick with Swine Flu on August 6th. His brother got sick on August 8th. I will never forgive myself as the last time I remember him (the baby who got sick on the 8th) acting distinctly like himself was the 6th when I went to pick up his sick brother at daycare… he looked right up into my eyes, threw up his arms, smiled, and said ‘Mommmmm’…. And I barely paid attention to him, I rushed to his sick brother… I should’ve thrown my arms around him and hugged him and praised him…. I have such guilt and keep worrying/wondering what if that is the last time he ever does that?

They were both put on Tamiflu due to being high-risk (they have asthma symptoms). The baby I am most concerned about didn’t get as high a fever, but the virus infected his eye, and we think he also got a bacterial infection, so he got eye-drops and Amoxycillin as well. He was miserable and cranky for days. I know he can hear (by testing by loud noises, etc.) and he doesn’t have an ear infection, as he’s seen a doctor.

Now he is not himself. I first noticed this as he got better. He is not responding when I say his name, hardly ever. If he does he just looks for a second. He will make eye contact, but only for a second or two. He looks away when I try to play the ‘up’ game with him. He is still babbling, but not as much. He did this weird whisper-babbling this morning and smacked his lips. He is still playing with his toys, but is also playing with non-toy objects like straps and blinds.

The doctor has an ear test set up for him, but I have to wait two weeks just for a call to make the appointment.

Can a virus or antibiotics trigger autism? Does a flu ever attack the ears, eyes, or brain which might cause sudden symptoms? What are the other possibilities might be going on if he doesn’t have an ear infection? This is a very, very abrupt change.

What tests should I push for to find out what is wrong as soon as possible? What are the possibilities?

So far his brother is acting normally, but I am terrified as I'm worried about it affecting both twins eventually.

Please, I would love a response. We have (mega-large HMO) and it is hard to get tests/things done. I am eagerly awaiting your response and guidance.

Very, very sincerely, Concerned Mom

Obviously, this mom is in a state of desperation, so I responded immediately:

Dear Concerned Mom,

Of course I cannot evaluate your son myself and as such, I can only provide some educational information for you. But I did want to respond right away because you sound so very upset and worried.

First of all, please know that autism is thought most likely to be a genetically-related developmental issue, and I have seen no convincing information that it can be caused by a simple flu or other virus in a child, nor by antibiotics or antivirals. Additionally, the timeframe you mention of the abrupt changes in your son do not sound like the onset of autism. After all, it's been barely 2 weeks since the onset of his flu symptoms.

A (temporary) step backwards in response to illness However, it is VERY common to see temporary developmental regression in response to illness. This means that your child can take several steps BACKWARD developmentally -- in response to illness and/or stress -- and then "bounce back" days or weeks later. It's all part of the normal developmental process,which is full of starts, stops, and reversals -- the old "one step forward, two steps back" thing. Young children don't understand that the course of illness is temporary; that they will get better. They simply know they feel lousy. They are not up to showing off all their "best" developmental skills. They commonly regress to earlier stages of development, temporarily, until they feel better. And often times, symptoms of illness can linger for WEEKS in children -- especially for something as yucky as a flu. If he is showing regression in response to illness, the regression itself can linger for weeks as well, past the time that he gets better. This may vary from child to child and from illness to illness, so his brother may be fine (at least this time). Personalities vary in response to illness and stress I don't know about your husband, but when mine gets sick, he just wants everyone to GO AWAY. (is this a guy thing?) He's crabby and won't talk to me and is just a completely different personality than when he's feeling well. Everyone is different, and your boys also will have different responses to stress and illness. The point is that there are very reasonable possible explanations as to why your son is acting so differently than his usual self, for this relatively short timeframe.

It's important that you respond in a positive and supportive way, and not convey to him that you're so worried. He's able to pick up your anxieties, and internalize the message that "something must be wrong with him". He needs reassurance that he WILL get better, and WILL feel better, but for now he still feels lousy and needs to be babied -- and that's OK.

As I said, however, I cannot evaluate your child from afar, so it's important you get your doctors' advice, as it sounds like you are doing. But since you have to wait for appointments, I would take this time to hang out with your boys in a relaxed way, giving them the chance to fully recover.

Please let us know how you're all doing in a few weeks' time.

Aloha,

Dr. Heather The BabyShrink