Category Archives: Readers’ Questions

Some strategies for dealing with the dreaded temper tantrums

18-22 months, 2.5 - 3 years, Discipline, Readers' Questions

Periodically, I've received emails about temper tantrums and how impossible they are to deal with. Tantrums usually escalate in frequency from about 18 months to about 2.5 years old. Most kids don't full-out tantrum anymore by the time they are 4 or 5. But apart from waiting these hellish episodes out, what else can we do? Here's just one example of an email that I think summarizes most parents' concerns:

This is an email of desperation.  O is going through another series of wicked temper tantrums – tantrum every morning when we change his diaper (doesn’t want it changed), tantrum getting dressed, tantrum when dinner isn’t ready right away every night, tantrum putting on his mittens, tantrum last night because I called “may” by its proper name “milk” AND dared to put it in a yellow cup.  Often these tantrums are accompanied by the classic face-down on the floor fist beating etc. 
 
So, we wait them out.  He escalates to the point of hyperventilation and my heart starts to break and I fear that I am being the worst mother ever, sitting passively by while my child gets more and more worked up.  We tell him, “O, I’m not going to do XX while you are screaming at me.  You have to stop whining/crying/ask nicely etc.” After a while (15-20 minutes), he’ll stop, he’ll say, “I’m done now.”  I try distraction but, often, he’s too worked up to be distracted.

This is SO classic and, indeed, distraction and ignoring are often the most commonly suggested ways of dealing with full-out temper tantrums. But there are a few additional strategies to consider. Part of the problem with the (approximately) 2-year old stage is that their verbal skills can’t catch up to their thinking skills, so they get easily frustrated. And also? 18 – 22 month-olds are ALWAYS frustrated. So are 2.5 year olds. It's just part of the major developmental transitions that they're plodding through.

Here are some thoughts and suggestions to manage those temper tantrums when they pop up:

1. The idea of ignoring the temper tantrum when it occurs and not giving into the tantrum-ee's demands is straight out of any behavioural modification program of reinforcement (It's part of the "coercive cycle" we've talked about before). Those are still good ideas. The only thing I’d add is to walk away from the child and go to another room when he’s tantruming — but remain in earshot so that he doesn't feel totally abandoned. Having you present, even though you’re not giving in, can be amping up his frustration (you are the evil being who is blocking his goal DAMMIT!). It’s not that he’s intentionally freaking out (in other words he’s not manipulating in any sophisticated way — he doesn’t have the cognitive capacity), but you ARE the object of his wrath and his hysterics are simply communicating that, as well as expelling his anger/frustration.

(Although you can see why many parents feel like they ARE being manipulated by these temper tantrums. Check out this video.) 

2. Forget the mommy guilt. Crying isn’t a terrible, bad thing that we should try to avoid in our kids at all costs. The only way our children learn to regulate their emotions is to express them first. As parents, we can try to take what we all feel, and the original poster expressed so well: “my heart starts to break and I fear that I am being the worst mother ever, sitting passively by while my child gets more and more worked up.” And reframe it with this: "Kids cry. Kids get pissed off.  Crying and raging aren’t in and of themselves bad (many kids just need to emote… A lot, especially when they can’t reason or talk it out). And I'm not a bad mom for simply witnessing his distress." You are doing everything possible not to escalate, you are not punishing him for his emotions, you are just there to witness them and therefore you’re inadvertently teaching him that emotions CAN be expressed (doesn’t mean he’s getting what he wants, but he can wail all he wants and you won’t hate him).

3. Try this set of responses, from the fabulous book, How to Talk so Kids Will Listen and Listen so Kids will Talk (works for some, not others). Give words to his feelings, mirror those emotions, repeat the rule you're trying to enforce, fantasize with him about his wishes. The steps are as follows: (1)  When he’s starting to whine/complain (but is NOT tantruming yet), give him words to express what he feels (e.g., O, you’re feeling so mad that mama won’t let you watch TV! Mad, Mad, MAD!), (2) Scrunch up your face and look mad, so he gets that that’s what he looks like and YOU get that that’s what he’s feeling, (3) Repeat your rule, accepting his feelings, but not his behaviour ("You can only watch TV after dinner; You can be mad at mommy but you can’t throw things/scream, whatever"), (4) Fantasize with him: "You know, I ALSO wish it was TV-watching time. I LOVE watching TV with you O! I wish mommy didn’t have to work, but I can’t WAIT until after dinner when we can watch together." Seriously… sometimes this set of steps work MIRACLES. The trick is to REMEMBER the steps in the heat of our frustration and anxiety.

4. Provide him with lots of opportunities throughout the day where he has the illusion of control (if not the reality). He’s being told what to do all day long: with parents in the morning, with child-care providers or at daycare, during mealtime, and so on. Children sometimes need to feel like they have some say in the way their day unfolds. Most of you have heard this stuff many times and have mentioned this in the comments sections. Provide choices: Do you want the blue or the red pants today? Do you want to take off your diaper now or after breakfast? Do you want to have cereal or toast?. Also, I'd suggest being very attuned to his behaviour so that you can catch him being strong, good, powerful, brave. And then praise the hell out of him (he needs to feel his power and control and that you recognize those things, not just put him down for it).

5. Look for reasons for escalation of tantrums: Sleep changes? Nap dropping? Missed snacks? Missed meals? Too much sugar/preservatives? Too little sleep at night? Sick? Teething? Too many transitions? Working on new skills (e.g., verbal)? This doesn't help us deal with the tantrums in the moment, but it does help us understand them better and it may help us to avoid them sometimes as well.

What are your favourite ways of dealing with temper tantrums? If you're past this stage with your child, what was the best advice you received?

Reader’s Question: Sleep training during the (8 – 11 month) developmental transition

8-11 months, Advice For Parents, Readers' Questions

Let's start this week off with a reader's question about something we haven't talked about for a while… sleep!  Yes, we can still address this thorny, ever-morphing issue even though the blog is no longer fully focused on the topic. The question comes from a mother of a 9-month old, but I think we can consider it more broadly to cover any developmental transition period:

My son was sleeping in his crib with very few interruptions until
he came down with a bad cold a few weeks back.  I'd trained him using
the sleep doula method when he was seven months old.  This involved
sleeping on a matress on his bedroom floor for a week and shhh-patting
him whenever he awoke during the night.  Anyhow, once he got sick I
began to take him out of his crib in the night and take him into my
husband's and my bed to sleep.  Now he won't sleep in his crib
anymore.  I'd like to try the sleep doula training method again but
I've now entered the 9-11 month blackout period.  I'd still be in the
room so he'd know I hadn't abandoned him, but I'm worried that it might
be damaging to him to see me right there, standing in his room but not
responding to his requests to be picked up.

Do you think it would be okay to try this method at this time or should I wait?

So, first off, although the reader is asking about her 9-month old in particular, I think the question can be considered more broadly to cover ANY of the developmental transitions we've talked about on this site. I could have picked from another 4 emails that asked almost the same question (although the particular sleep training methods differed), but were about their 18-month old or 2.5 year old child. So I wanted to mention and review some GENERAL points about transition periods and their impact on sleep training and then get into the specifics of this question.

There are a few, very predictable, developmental transition periods that I've mentioned can be quite problematic for sleep training children. Each of these periods have their own specific character, but what they have in common is that they are developmental transitions during which there are massive reorganizations/changes occurring in multiple domains (cognitive, emotional, social and oftentimes physical). Our approach has been to discourage parents from sleep training during these periods because, no matter what sleep training technique you use, they are less likely to work if the child is adjusting to these huge changes. So, no matter if the child is acquiring object permanence and getting his first real taste of separation anxiety at 8 – 11 months, or is experiencing a burst of language development and understanding social roles at 18 – 21 months, or feeling her first stabs of jealousy at 2.5 years old, or really groc-ing how different people's perceptions can be and feeling the resultant first stings of shame at around 3.5 years old… each of these new stages brings with it a whole lot of upheaval, much of which is related to the social connectedness we have with the ones we love most. Sleep training can be a hard enough battle to win, without stacking the deck against you with all of these new psychological acquisitions added to the mix. So, if there's a way to avoid sleep training during these stages, I've always recommended doing so.

HOWEVER, as we all know, we can have the best-laid plans and then things just don't go our way. Sometimes, like this reader's question typifies, sh*& happens and we find ourselves smack dab in the middle of one of these transitions with little recourse but to forge ahead and try to teach or re-teach our children better sleeping habits. In these cases, my best advice would be: Go for it, try whatever technique you feel will work best for your family, and keep an open mind. The worst that can happen is the child will NOT learn better sleep habits. That sucks, but at LEAST you can feel rest assured that it is NOT your fault. It's not that you didn't learn the most magical, bestest, coolest technique out there to help your kid sleep; it's not that you let her CIO or DIDN'T let her CIO or nursed too much or not enough or that you used the wrong blinds, the wrong music, the wrong pacifier. It's just a sucky developmental period to make these kinds of lessons stick. So I would caution this reader and anyone else trying to forge ahead and sleep train during a sensitive period: it will be hard, possibly harder than if you would have done it earlier or later. And it may not work. BUT! BUT!  Are you all paying attention here? BUT! You are NOT screwing up your child for life if you give it a try. If you feel you must sleep train during a sensitive period, for your sanity, your child's health, whatever, do it and feel no guilt. If it works (after perhaps more work and more time at it) yippee for everyone. If it doesn't work, you have a likely causal explanation and your next plan of action is to wait until this phase runs its course and you can implement the sleep-training method of your choice at that time.

Getting back to the reader's specific concerns about the 9 – 11 month stage, I don't think you will "damage" your child with this sleep training method. Is it ok to try, sure, at least for a couple of days. But because this new stage is all about the child acquiring a more sophisticated understanding of your presence in the world, the same technique that worked at 7 months (before your child really GOT your "permanence" in the world) may simply not work at this stage. The sight of you near, but unattainable, may be too frustrating at this sensitive stage. Sleep training with this "doula" method may just flood your child with too much anxiety, making it difficult to learn any new sleeping skills. But again, I firmly believe you won't damage your child for life if you attempt this method for a few days, even if a few tears are indeed shed (perhaps on both your parts). 

Anyone out there have some supportive words for the original poster of the question? Anyone have great success stories to share from this age? Or how about some words of commiseration… this is a tough age to muddle through (for the whole family).

I’m leaving on a jet plane, my kids will never be the same again…

Advice For Parents, Devevelopment in general, Fear and anxiety, Readers' Questions, Separation anxiety

 I'm out of the country this week so I've got a few posts that will go up automatically for the next few days. As you'll see, it seems like I couldn't get my head around only one theme this week — probably has a lot to do with how completely out of control my life feels right now. It's all good: I'm LOVING being with my kids these days (they'll be 4 in March and there's just something about this age that seems to groove with my parenting style), I'm crazy-busy at work with some great projects, and I'm traveling overseas to work with fabulous people. Each one of these things seems great on its own, it's the combination / balance that I'm having a problem with. Yes, I know this isn't a personal blog, apparently I just need to get those excuses out. And it sets up the premise for today's post and tomorrow's follow-up…

I thought I'd post some thoughts about longer separations from our children. I don't mean leaving your child for a few hours or for the evening. I'm talking for a couple of days or longer. We've had two readers send questions about this issue, the gist of which boiled down to two main concerns: (1)  Are there better and worst ages to leave your child for a few days/weeks? and (2) What can I do to make the separation more bearable for my child?

Since my kids turned one and I returned to work full time, I've thought (and freaked the freak out) about these questions a lot. I've had to leave my kids for 2-6 days at one time about twice per year for business trips. Leading up to these trips, I invariably get very anxious about how my boys will cope. I try to remind myself that they're with their father, that he is an equal partner in this parenting gig, that they love him equally and need him equally. But who am I kidding? There's no doubt about the equal love, but the attachment is different and when they get tired, hungry, hurt, frustrated, or challenged in other ways, they want mommy (and I fully recognize this isn't the case for all family situations). But we do what we have to do — some of us have little choice but to leave our kids for a few days and many of us actually think it's healthy to go away for a weekend or so without the kids (count me in both groups). 

So… are there better and worst ages to leave your kids for a while? For those of you who have been following this blog for longer than a couple of weeks, you'll probably have a good guess at my answer. Yes, I DO think there are certain stages that will be harder than others for your children to deal with separations. Those stages happen to correspond to the sensitive windows in development that I spent 6 months talking about in terms of sleep training children. The same stages that are particularly difficult for sleep training are also generally difficult for ANY transition, especially those that have to do with separations. Before the age of about 8 months or so, I actually think these separations are not too bad for babies (I suspect they're much harder on moms). They haven't yet reached the big 8 – 11 month transition that will usher in a sudden burst in working memory and allow the child to understand that "out of sight is NOT out of mind." Even when mom is not in the room, she's "out there" somewhere… As I've written at length, this ability to keep mom in mind even when she's not present results in the onset of full-blown separation anxiety — NOT a time when you first want to take off on your child for days on end. Another stage you may want to avoid leaving for extended trips is the 18-21 month period. This is a DOOZY (and, of course, it happens to be one of the ages when I DID have to leave my boys… I remember the weeping phone calls to this day). I won't get into all the MANY, MANY reasons why this stage is considered the most dramatic transition period in early childhood… you can read about all the gory details here.  Suffice it to say that children are really GETTING social interactions in a way that they weren't able to before — "real" language takes off, they understand simple rules and family members' roles and they get the idea that they are expected to follow rules and respect those family roles. Most parents report this stage as the most intense emotional period in their child's life, fraught with buckets of neediness, moodiness, tantrums, meltdowns, and general crazed vulnerability (there's lots of research to back this up, reviewed in our book). Leaving your children for extended periods during this phase may heighten their sense of vulnerability and neediness and it may take a while before you child "forgives" you for leaving, once you are back. 

The other stages to watch out for are the 2.5 to 3 year old period and the 3.5 to 4 year old stage. Different developmental issues are at play at each of these various sensitive periods, but the general rationale for avoiding long-term separations during these phases are the same: these are developmental transitions during which children are more emotionally vulnerable, more attuned to separations and their meaning, and they're in need of more reassurance and support than at other more stable periods.

Ruby's jetplaneA couple of extra considerations: (1) Kids will likely be more vulnerable at the beginning of these sensitive periods, when new cognitive acquisitions are just emerging and they're coping with this novelty; the more into the stage they are, the more likely it is that they've started to learn to cope with their new sense of the world (and the accompanying new skills). Or at least that's what I'm telling myself, as my kids round the corner of a sensitive stage (3.5 – 4 years old) and I'm gallivanting in Europe. (2) If you gotta go, you gotta go. Sometimes we have no choice but to take off during one of these sensitive periods. In those cases, the mere recognition that it might be tough on our kids might be important. We can try to put in place some plans that might help ease children's distress like scheduling more phone calls (or less, depending on how your child responds to these brief connections from afar) and/or taking some extra time off when we return.

But that's the topic for the next post: What CAN we do to make separations from our children less stressful? (Hint: See this pic of one of my boys? That's just one of WAY too many guilt presents he got after I returned from my last overseas trip <sigh>)

Tell us: Have you left your child during one of these sensitive periods or during more stable ages? How did it go? Do you think it's easier to leave younger or older children? How have your children coped with your times away? How have you coped? Do you think it's generally a good or bad idea to leave your children (with a partner or grandparents or other trusted caregivers)
for a few days?

(I haven't said this in a while, so I wanted to remind readers: ALL opinions are very welcome, whether they conflict or are consistent with mine. We want to know what YOU think. What YOUR experiences have been. And I'd like to hear from those of you who DON'T think it's wise to leave kids just as much as I'd like to hear from those who do. Really. Let's talk…)

Reader’s question: What can we do to maintain good sleep habits during transitions?

8-11 months, Readers' Questions

Here's an interesting set of questions that resonates with several that I've received. The crux of the concerns revolve around what happens when previously great sleep habits start falling apart during developmental transitions. If the idea is to try to AVOID sleep training during these transitions, what do you do when everything that USED to work doesn't work anymore? There's no magic bullet here, but I'm going to try to address this question in parts so we can think about it more clearly.

Now our Little "J-Bird" is nearly 10 months old.  All the things I read
about are happening & are affecting her sleep:  she definitely
understands object permanence, she's cutting a 3rd tooth, pulls to
stand everywhere & is just about to cruise. And her good sleep
habits are starting to fall apart, one by one. 

Here are my questions:
1) 
If about 8-11 months is a sleep training "blackout": period, what do I
do to MAINTAIN the good habits she's already got?  For example, she
consistently wakes to feed once during the night, typically after 7 or
even 9 hours of sleep.  She nurses for nearly a full feed, then I rock
her for 2 mins TOPS, then it's back into the crib & right to
sleep.  This week, though, she has been demanding that I rock her for
longer & longer.  A few nights ago, the entire production took
1:40, where it would normally take about 20 mins.  How do I not do any
NEW sleep training but avoid letting what good I do have slip away?? 
Needless to say, I was a WRECK after that 1:40 starting at 2 am &
shudder to imagine what will happen if this is a new pattern I must
live with for 2 more months.

Unfortunately, I think what most of us do to maintain good habits is keep up the routine we have going, that was working, to the extent that we can. So, same book, songs, bathtime, whatever every night. But as your case easily demonstrates, the same sleep routines can start meaning vastly different things to kids during developmental transitions and so they may stop "working." Recall what I outlined were the main features of this transition: separation distress peaks, object permanence comes on line, and the baby is all about social referencing. So, it's no wonder that your 2 min rocking session has become this protracted experience and you are NOT the only one this has happened to. For so many of us, we would have loved to rock our babies to sleep for years (I would happily do it even now if my 3.5 year olds would let me), but when that peaceful 5 min rocking session turns into a 2-hour battle of wills in the middle of the night… not so much. MANY, many parents report co-sleeping beautifully before this transition and then suddenly, it stops working (Of course, many families co-sleep without any problems for years and years, I'm just referring to those that start having difficulties, and often these difficulties fall around the 9-month mark). And that's because in both the rocking or the co-sleeping case, the baby has some new-found obsessions: to keep you NEAR her (to avoid separations), to LOOK for you constantly (because you being out of sight no longer means you're out of her mind) and to "reference" or check with you that everything is ok, that all is well with the world. So, you may HATE to hear this (and I don't blame you), but there IS no way to maintain EXACTLY the same routine you've establish and NOT sleep train again. Because all that sleep training really entails is CHANGING habits/associations that are linked to sleep. And if rocking now entails lots and lots of pleas to remain with your baby, then it's not working for you anymore (and probably not for her too, because she's probably not happy during those protests).

From my perspective, you are in the middle of this transition and riding it out is one of the only options. It WILL get better, probably in a month at most. Until then, you can do what you've already figured out yourself: (a) resign yourself to rocking for over an hour or more (maybe putting on a good podcast or some good music on for yourself will just help ease the crazies a little for you), (b) try your favourite sleep-training method for 3 days and if you don't see any improvement, go back to (a), or (c) try some gentle night-weaning techniques that may be less aversive to you than outright sleep training. The problem might just go away if she's not waking up to be fed anymore.

2)  What do you think about the
idea of scheduled awakenings to eliminate night feedings?  Some of the
descriptions of the practice include progressively reducing the amount
of time or amount the baby feeds during the night, others do not. 
There's even a 1988 study in Pediatrics that (according to the PubMed
abstract) found the method to be as effective as controlled crying. 
The practice is alluring to me, since any kind of CIO does not work for
our family.  However, it seems to be rarely suggested in any sleep
books (I think I've read ALL of the "biggies").  The only one that
includes it is The SleepEasy Solution, but that's in conjunction with a
CIO.

My answer to ALMOST any of these sleep training technique questions is: sure, give it a try. Really. If it feels right to you, if you think you can give it a go for a few days without it driving you or your partner nuts, and if you are at your wits end, then give it a try. Be consistent with it for at least 3 days (outside of transitions, I'd give it a week) and if there's no measurable improvement, you haven't lost much. But I have to interject the final caution: it may not work NOT because it's the wrong technique for your family, but because of the timing. If you DO try it and it DOESN'T work, I'd recommend you give it another go when you're out of the worst of this developmental phase (around 11 or 12 months).

The bottom line is that the end of this blackout period
seems really far away to me.  Not only am I terrified that I'll lose
the good practices we created when the last sleep window was open, but
I also dread continuing the night nursing for at least 2 more months. 
I thought I could live with the fractured sleep when I had a 7
month-old, but it now seems to be destroying me.  So, might scheduled
awakenings be worth a try?  If so, how do you suggest we implement it? 
If not, is there ANYTHING else I can do during this time to get more
continuous sleep?  (BTW, J-Bird is breastfed, won't take a bottle &
barely takes a sippy cup; I tried dream feeds at about 5 months but
they seemed to stimulate her & she fed MORE during the nights I
dream fed.)

It ALWAYS seems so far away, doesn't it, the end of these transition periods? I'm in the middle of one now and I'm FREAKING OUT that OMG I have to wait MONTHS for this to taper off (because, dear me, this CANNOT be my boy's new personality. CAN'T. BE.). But it DOES end. That's really all I can tell you. That and try the above suggestions if you're dying and if they don't work, then don't, don't, DON'T give up entirely. Re-try after the transition period. I think this is one of the things that's had the biggest impact on me when I read emails and hear other parents' stories. So many of them tried so very, very hard to implement a sleep-training technique and it didn't work for them so they gave up entirely for the rest of their son or daughter's early childhood. In so many of these cases, I think that if the same  techniques were tried again during a stable developmental window, things COULD HAVE work out.

Of course, I can coulda-shoulda all I want. These kinds of data DON'T exist. So tell me, readers, is there anyone out there who tried sleep training during a transition period, found it difficult or even completely useless, then re-tried during a stable window with success? Can we give this reader at least some rays of hope that her child's hard-won, previously-established sleep habits may return after this phase, even without much sleep training?

Reader’s Question: My child is taking FOREVER to fall asleep?

Readers' Questions
I've received three emails in the last month about the same issue, so I'm going to summarize them all here. The crux of the problem that some parents are having goes something like this:

My baby sleeps well once she/he is finally asleep. But for either or both naps and bedtime, it's taking him/her FOREVER to fall asleep. There's nothing I can do to make the process go faster. She/he goes into the crib/bed and then just lies there awake for 30 min [or 1 hour or whatever seems unbearably long]. Usually my child babbles, talks, or just plays with her toys in her bed. How can I get my child to fall asleep faster?

I don't have any data for this one. Just lots and lots of anecdotal evidence and, of course, my personal sample size of 2 (one of my boys falls asleep in 2 min flat, the other takes almost 45 min to go to sleep EVERY. SINGLE. NIGHT). In all of these emails, the parent doesn't mention any distress on the child's part when she or he is trying to fall asleep for naptimes or bedtime. And this is the key for me. The child is FINE, just not asleep yet. We often think that it's a terrible thing to leave a child in her crib
or bed alone if she doesn't immediately fall asleep. The poor thing!  All alone!  Nothing to do, no one to play with, lonely and scared… But maybe not. Why do we assume that if a child's not asleep when we think she should be that there must be something bad about how she's feeling
(bored, restless, frustrated)? If she was crying, whining, fussing, then yes, you'd want
to try to figure out what's going on to ease her distress. But if not,
she may just be one of those kids that takes a while to wind down before falling asleep. If your child is babbling, talking, singing, or just rolling around on her own without calling out for you, it's likely she is giving you the message that she enjoys daydreaming and playing
alone.

We hear so much about "attachment parenting" and the imperitive of holding your baby as much as possible, carrying him/her, co-sleeping, and so on. But I suspect that that level of contact isn't always right for ALL children. Some kids NEED alone time. Some kids feel overwhelmed with constant interaction. And some kids have revved up physiological systems that take a while to wind down. Sometimes that means they need your help with that calming-down phase (and you'll know that from their cries of distress), but sometimes they're doing fine all on their own, with no help needed from you AND THAT'S JUST FINE.

If you have a baby or toddler that seems to take FOREVER to fall asleep, here's a few things you might want to consider: 

  • Once your child DOES fall asleep, does he sleep for a healthy period of time? If so, then there may not be a big problem for you to fix. If your child ends up sleeping in later than you'd like, then consider putting him down even earlier so that he has time to wind himself down and actually falls asleep at the time you'd hope he would.
  • Going back to the temperament discussion, if you and/or your husband are introverts, could it be that your child might likewise share that trait and that the period before sleep is a time when she gets those "alone time" needs met?
  • Are there too many distractions in your child's crib or bed that may be promoting more play and less sleep? If you have lots of toys, especially ones that buzz and blink and play music, then these things may be too stimulating for the child to disengage from when it's time for sleep. One or two stuffed toys, a blankie, soother, lovey, that sort of thing might be enough to provide a soothing atmosphere.

Reader’s Question: Developmental timing when babies were born premature

Readers' Questions

Here's a quickie, but an important question. Quickie because I can actually answer this in a few sentences and also because I have been smacked with a cold that I caught from my kids and my head is snotty. (On a total side-note: Does anyone know if this whole thing about people with colds/viruses only being contagious for the first 24 hours from when they caught the cold is true? Because I caught this a whole week after my kids and I haven't been around anyone sick. So CLEARLY this means that any scientific evidence out there about incubation and contagion periods is wrong. ALL WRONG. Because I'm SIIIIIIICK. Anyone know anything about this? <sniff>)

On to the REAL question of the day:

I have a 13 week old but he was born 4 weeks early so if we count from his due date he would have been 9 weeks old instead of the 13.  Anyway, since you say… that it's not about the how but the when, do I look at him at his chronological age or his adjusted age when referring to sleep issues and training?  Right now, he has a hard time falling asleep and/or staying asleep for longer than 30 minutes on his own but when he's in my arms or in my wrap, he sleeps for hours at a time.  I've been working at getting him to fall asleep on his own by establishing a naptime routine and putting him down drowsy but awake, sometimes it works and sometimes it doesn't, sometimes he cries, sometimes he doesn't.  I don't let him cry it out but sometimes I do let him fuss it out.  I don't want to cause my baby any harm by doing this if he's just not ready due to him being a preemie.  He's about 12lbs, and is healthy except for a bit of reflux (currently trying to control it without meds but will be reevaluating that in a couple of weeks if necessary).  He coos, laughs, smiles in response to mine and spontaneously just like my 3 year old did at this age except that my 3 year old did it earlier than this one.  So what's your take on 4 week preemies and sleep?

My take is that you adjust for the number of weeks the baby was premature. ESPECIALLY in the first year, but the rule of thumb is up to the 2nd year. So, if you've read about the oncoming 4-month transition, you should really be thinking about it around the 5-month mark. And remember, our age spans are still approximations. I usually advise parents to start becoming wary of any big changes they're making, including sleep training, about a month prior to the stage transitions we delineate here and in the book (because some kids DO hit them early and others a little later, we're just talking averages here). So, it's TOTALLY normal for a 9-week old (adjusted) to have trouble napping anywhere else except near or ON your body and it's very, VERY common for naps to last only 30-45 min at this age. They'll lengthen significantly AROUND 6 months for most kids. Until then, I'd suggest using any gentle approach you feel good about and doing whatever works for you and your baby to get as much sleep as consistently as possible. 

BTW, the same adjustments aren't usually made the other way around, if your baby was born PAST his or her due date. There's a few reasons for that, including that we're sometimes pretty bad at figuring out exactly when conception occurred so due dates are notoriously "approximate" and also because cognition and perception doesn't develop in the same ways in the womb as it does outside of it. Make sense?

If you had a premature baby (or babies, as in my case), has your child hit the sensitive developmental windows or cognitive milestones at his adjusted or "actual" age? Both my boys hit their stage transitions about a month later than average (they were born at 36 weeks). But by 2, there were no difference with their same-age peers in terms of general timing.

Reader’s question: Teething and sleeping… not so much

Readers' Questions, Sleep Setbacks

Several of you have written to me about teething and how it can mess with any hopes of sleep training (or how teething has disrupted already healthy established sleep patterns). Here's one example of the emails about this topic:

We have a 6month old daughter whose reflux is now on the wane, and who
seems to have had either a stomach bug, colds, or teething pain since
she was about 2.5months old. One just melted into the other and we have
come to the point where she has to be rocked to sleep, and now that we
are going through the second round of teething, she's been waking up
sometimes every 1 – 1.5 through the night.

My main question is how to deal with teething / colds. The little I
have found on the subject of teething/sleeping online says that a)
teething disrupts sleep, b) wait for teething to pass. But because our
little one always seems to have something going on, I fear that if we
wait for this round of teething to pass, something else will come up
and then we'll be in the no-no time zone and even worse off than we are
now. I also go back to work in three months and am dreading those
nights already.

Do you have any suggestions about teething / sleep training?

Before I had kids of my own, I was convinced that one the most serious design flaws ever to emerge from our evolutionary history was being born without teeth. Why on earth would babies be born with sweet, gummy mouths and then have to painstakingly grow each and every tooth, one by one, in excruciating anguish?! Why don't infants just pop out with a full set of pearly whites? Then I started nursing my twin boys and it all became soooooooooo clear. Actually, my "aha" moment came when my peacefully-nursing 8-month old clamped down on my boob so hard that he left some serious marks. Yeah. I get it now.

Teething is a funny thing when you start talking to parents about it. There is no doubt that it's one of the most common reasons for sleep setbacks and disruptions and it certainly can mess with any sleep- training plans. There is a fascinating amount of variation among babies in terms of how much pain they actually experience during teething episodes. You talk to some parents and teething is the #1 most under-appreciated parenting (and infant) challenge they have ever experienced. They talk about watching their children's pain with such horror and pain themselves. Other parents? They can't see what the big deal is; they didn't even notice when Johnny got his last 10 or so teeth. Although I'm no physician and this is most definitely not my area of expertise (I'm happy to hear from anyone that knows more about this), I haven't come across any good research on what might cause this huge difference among children's teething experiences. Some pediatricians have had the gall to suggest to me that teething doesn’t actually cause pain, it just “seems” like that to us; some tell us that often parents attribute "bad moods" to teething in general (I can't tell you how hard I wanted to deck my ped when he offered this nugget of insight while my 4-month old was gnawing on his fist, sobbing and screeching all the while. And I can't tell you how righteous I felt when the poor boy cut his first tooth 2 days later, "way before kids get their first teeth"). Most parents, however, have had the heartbreaking feeling of watching a young infant or child wail through a teething episode, rubbing their gums like mad and biting on anything that passes their way. 

Teething can disrupt sleep for the obvious reason: pain is difficult to sleep through. But teething is also often accompanied by a runny nose, fever, congestion, coughing from all the drool that gets stuck in the back of the throat, and rashes around the mouth or anal area; all very difficult symptoms to fall asleep and stay asleep with!  Teething episodes can last as short as one day to as long as many weeks.  Diagnosing the problem can be critical for your sanity and, importantly, for helping your child through this difficult period by providing pain relief and emotional support.

But you all probably know that. How can you sleep-train through these episodes? Should you? Is it better to wait it out with the potential of getting into a dicey stage transition after the teething subsides? All I can offer are some of my thoughts, no real answers here:

  • Sometimes, children with well-established sleep habits can and do put themselves to sleep right after bursts of pain. From my experience and other moms I know, teething often happens in
    bursts, so the pain doesn't last for hours at one time (although the
    bouts may come one after another for hours).The skill to put oneself to sleep can be a blessing for these kids, because they escape the post-pain anxiety that often comes AFTER the pain recedes. In other words, sometimes kids continue to cry even after the major bout of pain has subsided because they're afraid of the impact of the next bout. If they can put themselves to sleep quickly, they might be able to avoid this extra distress.
  • If you do want to sleep-train during a teething period because EVERY month is a teething period or the child has a cold or you're traveling or… SOMETHING, then you might want to avoid any sleep-training method that requires prolonged stretches of letting the child cry. Gentle sleep-training methods that encourage you to help the child fall asleep gradually on her own without crying will help you read your child's signals better. In contrast, if you use a cry-it-out method, it will be very difficult for you to distinguish between when the child needs you to help him deal with intense physical pain vs when she is simply crying because she wants you present and/or she doesn't want to go to sleep.
  • Obviously, pain medication can be a huge help if you ARE sleep training during teething episodes.
  • If you're in a good developmental window for sleep training and the only obstacle you're facing is teething, there is no harm in trying to implement your favourite sleep-training method and just see how it goes. If after 3 or so days nothing is improving and you're finding it confusing to read your child's signals of distress, quit and try again next week. Teething bouts ebb and flow and some weeks they are less intense than others (at least for some children; some others never seem to feel relief until all their teeth have come in).

This is a really, really common problem and I hate when I can't give straightforward advice based on data. But I thought it might be good to just put this issue out there since so many of you are dealing with it and perhaps others can help with some suggestions that have worked for them. Alternatively, remember that development IS like a pendulum and if you miss the next opportune window for sleep-training, another one is coming eventually (little comfort, I know, for a desperately sleep-deprived parent RIGHT NOW).

Words of wisdom or commisseration?

Context Matters Part III: Reader’s question about physical milestones and their impact on sleep

Readers' Questions, Sleep Setbacks

Another very common change in "context" that is oftentimes overlooked is the onset of new motor skills, most notably rolling over, crawling, and walking. All these fabulous physical milestones change the way your baby sees the world in fundamental ways. Here's one of many similar questions I've received:

I just received your book and found out that we are now entering a good
sleep training phase since my son turns 1 this coming Friday.  I want to get
him to start falling asleep on his own, but if I try to put him in his crib
while he's only half asleep, he just stands right up like he's on automatic
pilot.  If I then leave him he starts to cry and I don't want to use any of
the CIO methods. Besides, that doesn't work with him because it just
escalates into a frenzy. I still have his crib in our room and want to get
him into a firm sleep habit before trying to move him into his own room. I
can't figure out how to get him to relax though….

This is a classic age when SOME kids have a hard time falling asleep. And it has a lot to do with the new motor skills they're learning and practicing — namely walking. About the 12th month mark is when many kids start learning to walk and all hell can break loose with their sleep habits because their little minds and bodies are furiously practicing. By the way, children can start walking as early as 8 months (oh… I pity the parents that have to deal with those little daredevils) and as late as 18 months with no long-term benefits or problems. When we watch people do things, even if we are currently not doing them ourselves, a fascinating thing happens in our brains. The same pattern of neurons fire whether we're watching someone move their arm , for example, or if we ourselves are moving that arm. This  fascinating discovery is considered by some to be the most important one made by neoroscientists for decades –  "mirror neurons." So it may be that when children are watching others walking and when they are put in their cribs alone, what they are doing is not only moving their feet, poppinp up and down holding the bars of the cribs, cycling their little legs, and so on. They are also probably imagining the act of walking — both when they're awake and asleep, dreaming. This may be why many kids' sleep is disrupted as they're at the cusp of mastering physical skills. There are no direct studies that have mapped the neuronal activities of babies asleep in their cribs when they're just starting to walk, but that would be my strong hunch of what's going on.

The same holds true of the other major physical milestones — they too have the potential to disrupt sleep. So, rolling over (around 5-6 months), crawling (around 8-10 months) and walking (around 12-14 months) may be difficult times for sleep training also (Again, please keep in mind that these age-spans are approximate. My kids didn't hit any of these milestones "on time" if that matters to anyone). And remember the title of this post was supposed to be the continuation of Part I and Part II about how context can have an impact on sleep-training or can disrupt already well-established sleep habits. The reason this post is also about context is that when children learn new motor skills their WHOLE WORLD is blown apart. So many of the most important parts of their contexts undergo radical changes. The baby that can suddenly roll over begins to feel the wonder of intentionally changing their body posture, their view, their physical feeling of how the exist in the world. The baby who can finally crawl finally feels the incredible miracle of being able to reach and chase stuff that's so far been out of his reach. The baby who previously had to point or squak to get you to get her some toy across the room can now DO IT HERSELF!  YIPPEEEEE! Now mulitply that miracle by 100 when walking begins. Oh how fast he can now move to the desired object! How much fun it is to hurl yourself onto couches and into grass and to push, push, push chairs and tables and plastic lawn mowers and so, so much more. The world around these babies is indeed changing dramatically and, as we talked about before, these shifts in contexts can have a major impact on sleep (as well as moods and thinking styles… but that's another post).

Reader’s question: Sleep considerations when travelling

Readers' Questions, Sleep Setbacks

Um, yeah, remember I said that I had a bunch of posts in the hopper waiting to be automatically uploaded at regular intervals? Well that didn't work as well as I had planned, did it? I have no idea what happened, but it seems that nothing has yet been posted. Sorry… and onward.

I am currently travelling with our two lovely but CRAZY three-year olds. Crazy in that they are completely unpredictable. We flew overseas and of course I was sure they'd eventually SLEEP overnight. You know, on that OVERNIGHT flight?! They did not sleep ONE WINK. How does that happen? They were up until 2 am and they seemed permanently set on party mode. I was convinced that the rest of our trip would be fraught with sleep HELL. I certainly was prepared to be up ten bajillion times per night as they adjusted to being jet lagged. And yet, for the first 3 nights of our trip they've slept 14 hours straight through the night, 13 hours and 12 hours, respectively. Go figure… I don't know why any of you listen to me. I have NO IDEA what's up with this sleep stuff. But enough about me let's move on to the reader's question:

I started 'sleep training' over a week ago with a 'gentle'
approach by sitting by his crib and soothing him.  Each night I moved
further away until I was out the door.  When I was out the door, we did
the Ferber method.  Generally speaking, it's worked pretty well.  The
most he ever cried so far was 40 minutes.  He's gone to bed the past
few nights without any crying and when he wakes in the night, he
typically puts himself to sleep in under 5 minutes.  I still feed him
once in the night, but will work on that in a few weeks.  I plan to
work on naps next since he typically nurses through the duration of his
nap and is always held.  So, after all of that long-winded background
information, here are my questions:

  1. Does the timing in your book apply to naps as well?  Do I need to
    be 'all done' with sleep training my son for naps before he is 7.5
    months old?
  2. I've heard and read that it may be necessary to 'sleep train' your
    child multiple times.  For example, after illness or after traveling. 
    If we travel after our son is 7.5 months old, do you recommend we hold
    off on 're-training' him until after 12 months?!  Or, does your timing
    generally only apply to the first time you 'sleep train' your child? 
    We have quite a bit of travel coming up during the 7.5-12 month
    timeframe and I'm concerned about the impact to our son and us.

Great questions. Let's start with question #1: The short answer is, yes. Timing ANY big transition is best done outside of the sensitive developmental windows. As you may have figured out by now, I think that the developmental transition periods are periods of vulnerability during which children are sensitive in general and changing any established habits — including, but not limited to naptimes and bedtimes — are more difficult during these stages. Extending this idea, I actually think that events such as potty-training, entering a new daycare, changing caregivers, and weaning could best be done (IOW, more easily and with less distress) outside of these sensitive developmental stages. But returning to the specific question, being "all done" would be ideal, but of course circumstances in our lives usually don't align themselves perfectly with optimal developmental timing. All we can do is to try to time things as far away from these ongoing sensitive periods; but remember, these ages are approximate and you've got a little leway on both sides of the ages spans we talk about here (and in the book).

In terms of the second question, yes, the dirty little secret that very few people talk about is that MOST of us have to sleep-train our children more than once. Illness, travelling, a new sibling, moving houses, and parents going back to work (or changing hours) may all be reasons why hard-won sleep habits can disintegrate and sleep-training efforts will need to be renewed. From our experience with our own children and hearing many stories from countless parents, I DO believe that the subsequent sleep-training efforts are usually more easily implemented and cause generally less distress for the whole family. BUT THIS IS NOT BASED ON ANY RESEARCH EVIDENCE. I need to be clear about what I have a strong feeling about, based on experience and anecdotal evidence, and what is backed up by empirical evidence. Also, we may have to use different methods at different
developmental stages. For example, I think straightforward Ferberizing
can work quite well for some children around 6 months or so, but 3
year-olds are not going to be easily "Ferberized." So not only do we often have to sleep-train a few times, but we may need to be flexible with the methods that will be most effective over these repeated efforts.

So back to the second part of question #2, I think that sometimes, if kids have already learned to put themselves back to sleep at one time, when those habits get shaken up (by illness or travel, for example), you can "remind" kids how to do it, even during developmental transition periods. This is because these "booster" sleep-training sessions may not trigger the same sorts of fears of loss, anxiety about the "unknown"; basically, they may not be loaded with the same intense emotions the second, third or fourth time. So, if I were you, I would TRY to re-train as soon as you get back from all your travelling. Implement your preferred sleep-training method for a few days and if after 3 days or so things don't start improving, then you may indeed want to wait for a couple more months. But you may be surprised by how easily your baby "remembers" the skills she learned so well a few months ago. 

Enjoy your time away, good luck with the "re-training" and keep us posted with how it goes. Because there are no systematic studies on this exact topic, I am genuinely interested in whether this advice is sound. Anyone else have any datapoints a la Moxie? Any other parents have experience with sleep-training multiple times? Was it easier each consecutive time? Did it depend on what age you were "retraining"? I'd love to conduct a study on this…

Reader’s question: Seperation anxiety and marital conflict

12-17 months, Readers' Questions

Here's a set of intertwined questions and circumstances that many of us can relate to.  B is feeling stressed and confused about this situation. I'm going to take her email in parts. Please feel free to pitch in with your comments and support, as usual:

I'm not sure what to do, and my husband and I are kind of at an impasse
about this.  Our daughter just turned 1, and on occasion has nights where she is wide awake for 2
hrs – nothing seems to be wrong, but nothing seems to solve it. We
usually just rock her and eventually she falls back asleep.

To
help
hasten the sleep process, we've tried giving her pain meds (in
case of teething), a half bottle of milk, a sippy of water, cosleeping,
etc.
Nothing seems to work except time. We keep it quiet so she doesn't
think it's play time. But if we don't go into to get her, she cries
until picked up, so she isn't content to just play on her own in the
crib.

I've
always kind of chalked it up to
teething pains – she is a very slow teether and usually a few weeks
after these  episodes a tooth would appear.  We went through this with
the 9 month sleep regression too though. Right now she just has 2
bottom teeth, and those came in just in late May. I'd expect more are
on their way.

The
problem – lately she's been
female clingy lately, and quite the mama's girl.  Last night / this
morning she screamed – and I mean hysterical screaming at the top of
her lungs – for 45 mins when my husband came in to relieve me after an
hour.  (The hour she was with me, she just laid in my arms awake and
calm). I
went back into her room after the 45 mins of scream to take her back
from my husband, and he pitched
a fit.  He feels that I'm rewarding her with what she wants (me).  I
don't see it that way at all – I feel that it's our job to comfort her
and if she feels she needs me, damn it I am going to her.  I think it's
really unfair to let her scream for 45 mins to "teach her a lesson". It
would be different if it was 5 or 10 minutes, but it isn't. That has
happened on occasion too, but she surrenders much more quickly.  I
guess I draw the line at over 10 minutes.

So, first off, your baby is likely at a good age to start to make some changes in her sleeping habits if you're not keen on how they're going. In another part of her email, B. asked how separation anxiety affects sleep. We've talked about what could be going through a child's mind starting just before 1 years old and why those changes are likely to keep a child awake at night. But the peak of separation anxiety will likely have subsided by now. That doesn't mean the baby's not sensitive to separations  — now that she's passed through the "object permanence" gates of the 8-11 month period, your disappearances will always be somewhat fraught with meaning. But she should be settling down with the understanding that mommy doesn't disappear forever. So, if you want to apply your favourite, non-CIO sleep-training method (because you say you don't want to use CIO), I'd say go for it. It sounds like these long periods of wakefulness are tiring out your baby and certainly tiring for you and your husband.

I
don't know who's right, and I don't know how I'm supposed to tell the
difference. I ovbiously don't want to give in to any tantrums and spoil
her, but I really think something going on.  She is usually a pretty good sleeper at night. But testerday she didn't nap at
daycare (an in home provider) – she just wanted the to be held.  She was exhausted and so I know
she isn't really staying awake this morning for fun. She's tired, so if
she is up, something is going on.

Oh yes… I so feel for you. NO ONE is right or wrong in this situation. You both are just tired, frustrated, and you both desperately need a break. If you DO decide to use a systematic approach to sleep-training, I
think it's CRITICAL for you and your husband to get on board with a
plan TOGETHER. It is probably the only way you can maintain any consistency in your sleep-training approach.
If SOMETIMES you hold the baby for an hour and SOMETIMES your husband
goes in and attends to the baby and SOMETIMES he stays there and
SOMETIMES you can't take it and get the baby from him, it's going to be
very difficult for your baby to learn new sleep habits. So… my
suggestion would be for you to sit down one night after the baby IS
asleep and pour a glass of wine for the two of you (if you're into that
sort of thing… I find it a delightful way to begin a marital
discourse on any given parenting issue ;-) Then work out a plan
that BOTH of you feel good about following. If you don't think you can
allow your husband to do the soothing part of the sleep training, then
you make the commitment to always be the one doing it. This is a
perfectly reasonable strategy if your baby is going through a MOMMY
ONLY stage. Most babies do go through this. It's exhausting and often
infuriating and it can feel awfully rejecting to the parent who is
being… rejected. But I can assure you from a developmental perspective that your baby is not being manipulative (she doesn't have the cognitive capacity for that yet), nor will you spoil her to give her more mommy than daddy time; her behaviour is simply
evolutionarily adaptive. And VERY likely, she'll so get over you sooner or later and it'll be all about Daddy and how COOL he is and what a DRAG
you are. But until then, the mommy game may be the only game in town. That doesn't mean you can't sleep-train her; again, I won't tell you what method to use, but whatever you choose, it's likely to work a whole let better now than at 17/18 months. So, if you DO decide that you want to sleep-train and you want to be the one to take
on the major part of the soothing, that's fine; that's what feels right for you. But then I urge you to also give your husband responsibilities
during this sleep-training phase. Not only because you need some help, but also because he IS a valuable part of your family "team" and he needs to feel that his efforts are valued. Those efforts, at this stage, may not be best aimed at soothing the baby when she wakes because the baby has a clear goal of mommy. But he CAN do things to help. He can take the baby off your hands when she's less needy, for example, in the day or on the weekend and let you take a nap; he can rub your
feet while you go in and out of the baby's room at night, make you dinner, and
generally be a kick-ass cheerleader for you. You get the idea here… You guys are in this together and have the same goal: to raise a happy, healthy little girl.

Her screaming kills me emotionally. I feel so guilty when I give her to DH, like I instantly regret
it. I can't sleep when she is screaming like that, so I end up questioning why I didn't just
keep her so my husband can sleep, my daughter is calmer, and the neighbors don't think
we're murdering our child? 

It used to drive me BATTY to see my husband try to soothe the babies when he was unable to do it. I just wanted him to do it better or at least let me take over when he wasn't being effective. It is so hard for us mothers to remember that the father is, and should be, a large part of this child's world and even if our partners are not as good at soothing the baby as we are, they may need to give it a try, over and over, until they figure something out that works for them. 

I'll even go further… And please don't take what I'm about to say
as callous in any way. I have felt EXACTLY how you're feeling. But if
none of the sleep-training that you personally do works to minimize how
long your girl is awake at night, and you are really at your wit's end,
then try what I did the first time my boys were sleep-trained:
Let your husband take over the sleep-training, walk to your closest
restaurant, order a glass of wine (notice a theme here?) and a
main course. This latter part is crucial. Order a full meal so that
you are forced to stay away for an hour. (I remember that I actually had auditory hallucinations in the restaurant — I believed I could hear the cries all the way down the street). Repeat for three days. For
some, this may be disastrous. For others, like our family, after the
third day, I entered a quiet home, with children sleeping and a
husband who thought he was the most kick-ass Papa in town.

I think one of the crucial parts of B's email touches on the incredible stress
that a new baby puts on a marital relationship. There's a whole lot of
research on this "and baby makes three" phenomenon. Here's a review chapter
that you can actually read in its entirety, by one of the top scholars
in this field. This line of research has established that dealing with
the new challenges of infancy can put incredible, sometimes
irreparable, damage on a marital relationship. Did I need to tell most
of you this? Did you need tens of psychologists conducting 100s of
studies to prove this to you? My hunch: not so much. So many of us have
hissed at our partners to GET OUT NOW over our wailing baby's heads.
Countless mothers have felt the competing
desires to take a blessed break from our demanding child by handing him
off to our partner while at the same time wanting to grab the baby back
because YOU JUST AREN'T DOING IT RIGHT. So many of us have bit our tongues, sat on our hands, hid behind doors, willing ourselves to give our partner just 5 more min, just 2 more min, before we can't take the baby's cries for one second longer. It is so, so hard. For BOTH partners. But it DOES get easier, if the couple is willing to talk it out and even to have repeated conflicts that have the chance to repair. Withdrawing from one another, on the other hand, is often much more dangerous for the relationship in the long run. So if you can manage it — even in the middle of potentially the most stressful time in your marriage — keep the communication channels open. The whole family will be better for it.