Questions for Dorothy Waide

Hi Dorothy
thanks for the talk yesterday, was excellent and I learnt heaps :)
I have a question about formula and constipation... my baby is 15 weeks old and is now fully formula fed, she suffers terribly from constipation. My GP has told me to use brown sugar and water, which i did for a few days and she came right, then stopped and now is very constipated again, wont go for days and days and when she does they are like golf balls which are very hard and I have to help her pass them (sorry too much information)... the dr gave me enemas which i used but dont want to have to resort to these again... is there anything else you can suggest, or another type of formula she should be using? she is currently on S26... I can use the brown sugar but feel this cant be good for her, any advice would be wonderful - thank you so much :)

Hi Dorothy. My little man (16 weeks) has started to fuss sometimes when feeding. He will pull off after just a minute or so, and grizzle. I offer the other side which he takes greedily, before repeating the whole thing over, sometimes switching sides 3 or 4 times in a feed. Should I be letting him do this? Do you know what might be causing it and what I could do about it? I don't know if it is related, but he has been a lot more grizzly in general lately. Is it possible he could be teething, he has been chewing on his fist a lot, and dribbling more than usual.

Hi Dorothy.

My boy is 15 weeks old and a terrible catnapper. He currently sleeps in his cot for naps, but to get him to take naps I have to feed him to sleep, or my partner swaddles, walks and pats until he is really drowsy, and then puts him in the cot where sometimes he will fall asleep, other times we need to give him our little finger (he doesn't take a dummy and hasn't found his thumb). And sometimes he won't have a bar of it and refuses to sleep unless my partner walks him again.

Every naptime feels like a battle, as though we are forcing him to sleep, even though we watch very closely for his tired signs. Then there is another battle to try and get him to resettle to sleep longer than 45 mins.

He goes to bed at around 8:45pm (after another battle), sleeps until 2ish, then feeds (BF), wakes at 5ish, another feed, then wakes anywhere from 6:30–8am. Takes his first nap after being up for about 1hour 30mins, this nap is the most welcomed by him, but still only lasts 45mins. All naps after that are taken after 1hour 45mins to 2hours of being awake. He is quite a grizzly and easily frustrated baby, which I put down to the difficulty of napping. I have already excluded dairy, reflux and "windy baby" foods from my diet.

My questions are: How can we get him to sleep, without it being a battle every time? How can we get him to sleep longer than 45mins, and how long will we need to do this before he can do it on his own?

Also, he hates car rides, fine for about 5–10mins, but then screams the rest of the ride, even when he has someone in the back with him… He has only fallen asleep in the car a couple of times. It's to the point where I don't leave the house until absolutely necessary… Any tips on getting him to like being in the car, or do I just have to wait for this "phase" to pass?

Thanks!

Also one further question, you mentioned putting baby to sleep in own room, and pulling curtains during the day so they know that it's sleep time.

I had been sleeping my 6 week old in his bassinet in our lounge around noise, on the advice of our antenatal educator who suggested it was good to get baby used to day to day noise and so that they would sleep 'anywhere'. Do you have any thoughts on this?

Cheers

Guest_63873 wrote: Hi Dorothy, I'm concerned with my 15 month old whom seems to be always hitting his head on things on purpose both with frustration and anger. Ive tried ignoring him but he just continues doing it. Is this something I should be getting seen too or is this normal behavior? Every mother I have spoken too doesn't seem to come across this weird behavior with there own kids which makes me think its more serious than just a tantrum. Please help

Rest assured that it is normal and up to 20 percent of healthy children are head-bangers for a time (Journal of the American Academy of Child Psychiatry, Jul 1983)**.
.
These are things that I would be looking at :-

His routine - you have not mentioned how well he sleeps at night, how he naps during the day and also his meal times.

You also have not mentioned how you deal with his head banging - one of my favourite expressions is to reward the good and ignore the inappropriate.

Try and have lots of one to to one during the day with lots of cuddles, reassurance and just being there for him will go a long way.
   
Also look at your use of language and be conscious of the meaning of the words we use.   Words I try and not use are ÒnaughtyÓ, ÒbadÓ, and ÒhorribleÓ and the constant use of ÒnoÓ. I do a lot of distraction when necessary and of course ignoring what I donÕt want to draw attention to.

I also donÕt agree with time out and if using this method I would suggest you do some research into it as basically you are sending the child to coventry.

Bedtime routine should be calm and run to a good routine and again lots of one to one and positivity before going to bed for the night. Try and have a very consistent bedtime routine as this helps to keep the household calm at this time of the day.   

Ignore and Distract
It is important to remember that he will grow out of this habit and to remember that the more reaction he gets from you the more likely he will continue with this habit. Try and be matter of fact when dealing with him during the night Ð again nurturing and reassuring but keeping him in his cot to try and get him to resettle.   You may need to do a little patting and ssh sshing or just staying in the room and keeping a hand on him to distract him from head banging.

There are various reasons why toddlers head bang and probably the one that concerns most parents is whether it is a developmental or behavioral problem. If you are concerned that it could be a development issue then it is best to seek medical advice and rule out it out.

Dorothy



**http://www.drgreene.com/qa/head-banging-children

jaxx1234 wrote: Hi Dorothy, Thankyou for the talk yesterday, it was very helpful. I have a question about goats milk formula. You mentioned that the HA formulas are more quickly digested than normal formula. My nearly 5 month old has just changed from Karicare HA (which helped but she still had bad stomach problems) onto goats milk in the last 2 weeks, her stomach is much more settled, and I noticed within a week she went from drinking an average of 650ml a day to well over 800ml, and her catnapping is worse, I can't resettle her after a half hour nap back into another nap and I think it might be because she is hungry, today for example she has had 200mls almost 2.5 hourly with top ups all over the place, by 1:30pm today she has had 750mls! Is it maybe that she is catching up now she is on something that agrees with her and is drinking what she should be on for her age (and should I increase the amount I offer her each feed now?), or maybe a growth spurt, or comfort feeding to resettle, or is goats milk just super quick to digest? Thanks!

You have not mentioned whether your baby has started solids and I wonder whether she is hungry due to needing more calories rather than then change of formula.

WIth regard to her cat napping you need to do some resettling here and I wonder how well she goes down for her naps.

If you think she is really hungry then you could offer a full feed when she gets up and then before going down for a nap offer a top up and then you know when she wakes after the 45 minute mark that she is not hungry.

I would offer her a bottle of say approx. 240mls per feed and the top ups before going back to bed. If she is still hungry after that then you would need to look at introducing solids.

Guest_58605 wrote: Hi Dorothy. My boy is 15 weeks old and a terrible catnapper. He currently sleeps in his cot for naps, but to get him to take naps I have to feed him to sleep, or my partner swaddles, walks and pats until he is really drowsy, and then puts him in the cot where sometimes he will fall asleep, other times we need to give him our little finger (he doesn't take a dummy and hasn't found his thumb). And sometimes he won't have a bar of it and refuses to sleep unless my partner walks him again. Every naptime feels like a battle, as though we are forcing him to sleep, even though we watch very closely for his tired signs. Then there is another battle to try and get him to resettle to sleep longer than 45 mins. He goes to bed at around 8:45pm (after another battle), sleeps until 2ish, then feeds (BF), wakes at 5ish, another feed, then wakes anywhere from 6:30–8am. Takes his first nap after being up for about 1hour 30mins, this nap is the most welcomed by him, but still only lasts 45mins. All naps after that are taken after 1hour 45mins to 2hours of being awake. He is quite a grizzly and easily frustrated baby, which I put down to the difficulty of napping. I have already excluded dairy, reflux and "windy baby" foods from my diet. My questions are: How can we get him to sleep, without it being a battle every time? How can we get him to sleep longer than 45mins, and how long will we need to do this before he can do it on his own? Also, he hates car rides, fine for about 5–10mins, but then screams the rest of the ride, even when he has someone in the back with him… He has only fallen asleep in the car a couple of times. It's to the point where I don't leave the house until absolutely necessary… Any tips on getting him to like being in the car, or do I just have to wait for this "phase" to pass? Thanks!

Hi, first off you need to stop movement to get him to sleep and you need to give him the ability to self settle himself. That means he goes into the cot wide awake and learns to settle in his cot.   At the moment you and your partner are doing the settling and not allowing him the right to try and self settle on his own with support from you if he can not quiet get there on his own.
eI also re feed in particular my breast feed babies before they go for their naps so I know that they are going to bed on a full tummy. I do this about 15 minutes before they are ready to go to bed.   To avoid them falling asleep on the breast I always swaddle or put them in their sleeping bags after the feed.

You need to re think your word terminology - you are not forcing your baby to sleep, however you are teaching him to sleep. SLeep is a learned behaviour and the earlier you do this the easier it is. At 15 weeks his up time will be between 1 1/2 hours to 2 hours for each awake time cycle

To teach him to sleep you need TACT - time, acceptance, consistency and tranquility.


Sleep Cycles and Patterns
It takes a minimum of ten days to see changes and the circadian sleep cycle change takes at least three weeks of consistency.

Sleeping routines
Sleeping is a learned behavior and this applies to resettling during the night.

Teaching good sleep habits requires TIME, ACCEPTANCE, CONSISTENCY and TRANQUILITY (TACT).

Settling
I believe one of the most important skill that parents can teach babies is that of self-settling. It teaches babies how to gain control over their emotional state and this in turn leads to them developing their emotional backbone as they grow. It does not happen overnight and needs to be taught in a nurturing way.

Basically when you go to bed you read a book, mediate, watch TV, or chat to your partner Ð a baby can only do one thing and that is cry. It is actually healthy for a baby to cry before going to sleep. ItÕs difficult to listen to and as long as they are happy and contented it is part of life. Remember you are not leaving him/her there to cry it out you are leaving him/her there to give him/her the ability to find his/her own sleep. You will not get anywhere by leaving him/her to cry for hours, you will succeed quicker by giving him/her space and then helping him/her find his sleep.

Settling Cycle
Below is the ideal settling cycle that I suggest you use, however as long as you do 1 lots of up to 5 minutes to begin with then that is okay. I work on the principle that it takes most babies/toddlers 20 minutes to wind down before going to sleep and adjust this for each individual as well.

Bed ÐÒDump and runÓ i.e., put in cot and walk away and Òdo not hover like a helicopter.Ó Walk out of the room and shut the door. Remember a dark room creates calmness and also signals time to go to sleep. Light is for playtime and dark is for sleeping.

1st Stage
Cry up to 5 minutes STOP THINK and ACT (the act will be probably to leave him/her for another 5)
Cry up to 5 minutes STOP THINK and ACT
Comfort ssh and pat off to sleep Ð

Then the next stage will be
Cry up to 10
Comfort - ssh and pat Ð this is to reassure and not to stop crying and should be shorter than the crying time
Cry up to 10
Comfort - ssh and pat and off to sleep

Then the next stage will be
Cry up to 15
Comfort - ssh and pat Ð this is to reassure and not to stop crying and should be shorter than the crying time
Cry up to 15
Comfort - ssh and pat and off to sleep Ð

Then the next stage will be
Cry up to 20 STOP THINK and ACT
Comfort - ssh pat and off to sleep Ð

Then the next stage will be
Cry up to 20   STOP THINK and ACT
Comfort ssh and pat Ð this is to reassure and not to stop crying and should be shorter than the crying time
Cry up to 20 STOP THINK and ACT
Comfort Ð ssh and pat off to sleep

The last stage you will find that he/she will be asleep by the end of the 20 minutes wind down.

Also the crying isnÕt to be crying at the top of his/her lungs for this length of time. The baby will start of loud and slowly reduce and also stop and start. If its constant at one level and goes for a long time then you need to reassure and see what is happening.

The crying time can and will be built up to 20 to 30 minutes especially on the first cry and then intervene.   Also the time frame does depend on the cry and also how you are feeling - nothing is set in stone but you do have to push the boundaries to get results.

Do this settling up to ten days Ð if its not working then you need to address what you are doing.

Always try and settle in his/her cot. Its harder to resettle if you take him/her out of the cot, but trust me there will be times that you will do this.

Try not to use movement as a calming tool or to put the baby to sleep Ð this is the hardest habit to break.

The crying time does depend on the cry but try not to go in under the time frame that you are working with. You need to work within your comfort zone and also the babyÕsÕs comfort zone. It is not about leaving him/her alone to cry until he/she is exhausted and goes to sleep, but it is about giving The baby space to find his sleep.

When comforting do not talk or give the baby eye contact Ð both of these stimulate Ð you can use the ssh ssh noise and let your body talk to him/her. Also try and stand to the bottom end of the cot when comforting. If you do talk to him/her keep the verbalization to a limit so in other words try not and have a full conversation with him/her.

You need to take small stepping stones so dependent on how you feel you can do the full cycle above or start with doing two lots of crying and at the end of the second pat off to sleep.

Do this settling up to ten days Ð if its not working then you need to re look at what you are doing.

Comfort
When you go in and comfort The baby try and do something that works for you both. So when you go in if he/she is annoyed you are there then step back and leave him/her and then re try settling him/her. In the beginning you can stay in the room to do this. I would suggest sitting in the chair or lying on the bed. Babies/toddlers mimic us so my suggestion is to lie on the bed and pretend to go to sleep Ð he will follow your steps.

Cuddly Toy
ItÕs a good ideal to give the baby a cuddly toy or blanket (snuggly) so that he/she can find comfort with it.

Patting
I put one hand on the babyÕsÕs chest and with the other hand pat his/her bottom. Two types of patting Ð normal pat, which you try first and then if that doesnÕt work, do the second one.   The second one when patting gives him/her very slight movement rather like jiggling and also you can use the ssh ssh noise.   Or you can sing to him/her but whatever you do make it consistent.    The patting should be in rhythm with their heartbeat.

If itÕs the time you are patting the baby to sleep then once he/she is asleep remove your hand from his/her chest, then it he/she doesnÕt wake then pat lighter until you think you can stop and then leave the room. If the baby wakes again you need to redo the whole cycle.

Getting Up
When you go to pick the baby up from his/her cot whether it is after a nap or in the mornings, open up his/her room before picking him/her up.   This encourages the baby to play or lie in his/her cot and also he/she will learn that when you walk into the room you are not going to pick him/her up straight away. I always chat to my babies when I go into the room and while opening up the room. I also use this time to put away clothes etc.

Resettling Suggested Cycle
This is not an easy one to write as I know that you need to do it during the night - SO most importantly we need to resettle in his/her room and not intervene too early or too late. The time frames are guidelines only and you need to do something that you can work with and not give up because it becomes too hard. Yes, you can leave him/her to cry it out for Òx Òamount of hours for ÒxÓ amount of days but I donÕt believe in this. My approach will take longer or maybe not, but its to be done with nurturing and working within everyoneÕs boundaries.

Wakes during the night Ð STOP, LISTEN AND ACT
The act will be probably to leave him/her for an appropriate time 5 to 30 minutes (the longer time will be something that you extend to as time goes by)
Then again STOP, LISTEN and ACT
If the crying is off and on then you may leave him/her longer, if the crying is full pitch and he/she hasnÕt stopped to take a breath then you will go in and comfort.
Comfort two ways of doing this, you stay in there until he/she goes into a deep sleep and then you leave OR you can attempt to calm him/her down and leave and then give him/her an appropriate time to see if he/she will resettle. IF he/she doesnÕt go back to sleep then you go in and stay with him/her until he/she goes into a deep sleep.

The time frame that you leave the baby is something that you all need to be comfortable with and work together.   

Always try and settle in his/her cot. Its harder to resettle if you take them out of the cot, but trust me there will be times that you do this.

Try not to use movement as a calming tool or to put him/her to sleep Ð this is the hardest habit to break.

You canÕt spoil a baby at this age; they need lots of nurturing and reassurance.

The crying time does depend on the cry but eventually try not to go in under 20 minutes and it also depends on you. You need to work within your comfort zone and also the babyÕsÕs comfort zone. It is not about leaving him/her alone to cry until he/she is exhausted and goes to sleep, but it is about giving him/her space to find his/her sleep.

When comforting donÕt talk or give the baby eye contact Ð both of these stimulate Ð you can use the ssh ssh noise and let your body talk to him/her. Also try and stand to the bottom end of the cot when comforting.

L4Lisa wrote: Also one further question, you mentioned putting baby to sleep in own room, and pulling curtains during the day so they know that it's sleep time. I had been sleeping my 6 week old in his bassinet in our lounge around noise, on the advice of our antenatal educator who suggested it was good to get baby used to day to day noise and so that they would sleep 'anywhere'. Do you have any thoughts on this? Cheers

My answer to this is if you sleep in the lounge then by all means let your baby sleep in the lounge. Bedrooms are for sleeping and lounges are for playtime.   Your baby will get used to the household noises from their room. I teach all my babies to sleep in dark rooms and away from busy rooms and I have never had a problem with sleep issues. In fact they are normally the best nappers and night sleepers all around.

It is important not to creep around the house but give your baby the same consideration as you would want for yourself when sleeping.

L4Lisa wrote: Hi Dorothy, i have a 6 week old baby that sleeps through the night from about 9pm til 6 - 7am (which is awesome! :)). He is breast feed and I feed on demand. He doesn't seem to have much of a routine during the day however- and doesn't sleep for long periods - is this just the trade off from his long night sleep? I was wondering if it's possible to get him into a routine, so that I can time outings etc. Typically he wakes from his sleeps relatively content, and we have some play time while we change then we feed and maybe have some more play time before trying to put him down. But his sleeps don't last for long, and he's awake again. Any suggestions would be great.

You may just be one of the lucky ones that has a good night sleeper with out regard to his daytime routine. However, is he sleeping through the night because he is exhausted from not having good day naps.

With regard to a routine for a 6 week old baby is that when they wake, you respond, you feed, you change and burp, you finish feeding and then swaddle and back to bed.   

Young babies feed better when they first wake as they are full of energy, the longer they wait for a feed, the more tired they get and therefore will not suck as well as when they first wake.

The routine you would be looking at is that your baby will be up approx. 45 minutes to an hour and then napping for approx. 1 1/2 hours. This means you will be feeding approx. every 2 1/2 hour stretching over time to 3 hourly feeding.

I save my changing of the nappy until either 1/2 way through the feed, or at the end as it is a good tool to help with burping a baby.

At this stage you would not have a routine that was set to certain hours of the day as your day begins when your baby wakes and while they are night feeding the times changes all the time.

Guest_68639 wrote: Hi Dorothy, My daughter is 3 months old and each night she wakes at different times sometimes once a night and sometimes twice. I put her to bed at 6.30pm every night and one night she might wake at 1.30am & 5.30am and another night it could be 3am & 6.30am. No 2 nights seem to be the same, I never know what the night will bring. A couple of times she has gone from 6.30pm to 4am. She is exclusively breastfed and was 4.7kg 2 weeks ago. During the day she sleeps ok. Usually 1.5 hours in the morning and if we are at home the rest of her day sleeps are around 45mins, but if we are out walking she can sleep for 2 hours times. Is there anything I can do to make the night feeds more consistent or routine? Thanks

The first thing I would look at is how do you put her to sleep during the day and also in the evening.
Then you would need to spend some time resettling her during the day when she wakes up after her 45 minute sleep cycle.

Night time routine is dependant on your daytime routine and once you learn to resettle her during the day, then you will be able to try resettling when she wakes in the night.   This ensures that when you do a night feed that you are feeding for hunger and not comfort.

Do you offer her a top u feed before she goes back to bed for her naps. You also do not mention her evening routine which should be that you feed her, bath her, top her up and then put her to bed for the night.