familybed_sm

Sleep, Changing Patterns In The Family Bed

I can only imagine a mom and dad who are as tired as anyone can be, eager to see this article on sleep, and finding that we had made it unavailable for a little while!

We had to do that because I didn’t write the article clearly enough and need to clarify some very important facts.

It would be hard to find as strong a proponent of the family bed as I am. Yet, I have received email commenting that there were sections of this “plan” which were easy to misinterpret as being just another angle on “sleep training” for young babies. It is not meant to be that. Not even close to an endorsement of the benefits of getting your baby to “soothe herself to sleep” during the first year.

Here’s what I really want to do: I want to offer an alternative to Ferber and Weisbluth and the Whisperer. I never want to see my ideas applied to a four month old or even a seven month old baby. As a matter of fact, I am not too excited about pushing any baby around at night but I know that sometimes it will be done and I’d like to offer a gentle, supported plan for after the first year.

Before I go any further, let me express my overriding concern. Babies do better when we answer all their questions as best we can and meet their needs as best we can.

Most of the families I have taken care of in my pediatric practice sleep in a family bed.

Their babies tend to breastfeed for more than one year and they don’t sleep through the night any better than most of us would if we napped and cuddled within inches of the best restaurant in town and knew it was open 24 hours a day.

This arrangement is not just adequate and tolerable, but actually feels easier to moms who can just roll over, nurse a while and fall back to sleep with their babies rather having to get out of bed to nurse or, alternatively, refuse to nurse and get their babies back to sleep some other way.

Lots of parents continue this pattern through the first year and well into the second and beyond, but some get tired of it — or just plain tired — after a while and are looking for a way to change things. Saddest of all, some moms and dads think that total weaning from breastfeeding is the best way to get more sleep. They choose not to look into nighttime weaning as a good option instead.

There are dozens of confusing books and magazine articles implying that there can be some quick and easy way to get your baby to sleep or to not nurse through the night. I have yet to read one which told parents the complete truth: It’s not easy, it’s rarely quick and it’s usually a little loud and heartbreaking for a few nights . . . or more. I have seen too many families needing help and getting offered choices they didn’t like at all.

I have a better alternative to completely weaning or to letting the baby cry it out. Babies wake up for the optimal interaction with their moms, breastfeeding back to sleep. If we offer them a little less than that for a few nights and then a little less and still less in the ensuing nights, gentle behavior modification will lead them to realize that it might not be “worth it” to knock on the door of a closed restaurant, so to speak.

I don’t recommend any forced sleep changes during the first year of life. Probably the only exception to this would be an emergency involving a nursing mom’s health. There are many suggestions in books and magazines for pushing “sleeping through the night” during a baby’s early months or during the first year. I don’t think this is the best thing to do and I am quite sure that the earlier a baby gets “non-response” from parents, the more likely he is to close down at least a little.

Don’t get me wrong. I love the family bed, child-led weaning and cuddling all through the first, second, third year or more if it’s working well and if the family is doing well. Don’t let anyone convince you that this is a harmful choice or that there will be “no way” to get him out of your bed if you don’t do it now. Don’t believe anyone who says that babies who cuddle and nurse all night long “never” learn to self soothe or become independent. This is simply nottrue but it sells books and the myths stay in our culture.

Some moms just don’t want to do this after some months or years and there should be a third choice to the dichotomy of crying it out or giving in to all-night nursing. Again, I support the family bed and frequent night nursing for a long time and even attempt to pull some parents along “just a little farther,” but I often have to switch tacks and support and help families with difficult choices.

Here’s what I recommend for older babies:

Choose the most valuable seven hours of sleep for yourselves. I personally prefer 11p.m. through 6 a.m. but you might have a slightly different idea.

Change the rules during those hours and be comfortable that a “well-built” family bed baby’s personality can withstand this rule changing and the mild inconsistency of getting everything he wants all the time . . .oops, almost all the time. That’s the word we want to show this baby. The word “almost.” If only we could explain to him that “tired moms and dads take their children to the park a little less and that children of well-rested parents get to go the zoo and for hikes a lot more than children of exhausted parents.” If that explanation only made sense to kids somewhere before the third birthday (and it doesn’t!) they would simply roll over, say, “See you in the morning,” and let us get the sleep we want.

I try to do this in three- and four-night intervals.

I’m assuming that you have a wonderfully healthy 12-, 15-, 20- or 30-month old baby who still loves to wake up every 2 to 4 hours to cuddle, eat or . . . whatever. I’m assuming that you have thought this through, decided you want to make changes and alerted the neighbors that it might be a little noisy for a week or so.

I’m assuming that both parents agree — or almost agree — that this is the best thing to do. And, most important assumption of all, you are willing to go “in a straight line” to the goal of seven straight hours of sleep.

The reason for that last statement: If your baby learns that crying, squirming and fussing (euphemisms, let’s just say “crying” . . . sorry) for an hour will get him fed you will set yourself back quite a bit. This is the best program I have seen but it’s far from easy. And now, to say it again, I really like what you’ve been doing. Cuddling, nursing, hugging through the night. Don’t change this with my program or any other if you’re happy doing what you’re doing. But . . .

The First Three Nights

At any time before 11 p.m. (including 10:58) nurse to sleep, cuddle and nurse when he wakes up and nurse him back to sleep, but stop offering nursing to sleep as the solution to waking after 11 p.m.. Instead…..

When your baby awakens at midnight or any other time after 11 p.m., hug him, nurse him for a short time but make sure he does not fall asleep on the breast and put him down awake. Rub and pat and cuddle a little until he falls asleep but don’t put him back on the breast (or give him a bottle if that’s what you’ve been doing). He must fall asleep with your comfort beside him, but not having to nurse to feel comforted enough to drift off.

Now, he will tell you that he is angry and intensely dislikes this new routine. I believe him. He will also try to tell you that he’s scared. I believe he’s angry, but a baby who’s had hundreds of nights in a row of cuddling is not scared of falling asleep with your hand on his back and your voice in his ear. Angry, yes. Scared, no, not really.

During these first three nights, repeat this pattern only after he has slept. He might sleep for fifteen minutes or he might sleep for four hours, but he has to go to sleep and reawaken to get cuddled and fed again.

These will be hard nights.

You may have decided you’re really not ready to do this. That’s OK. Stop and start over again in a few months if you like. Choosing the right time is crucial and many people choose a time suggested or pushed by friends, doctors or in-laws. This doesn’t work as well.

Is it better to do this in the family bed, a crib in the same room or using a crib in another room? I prefer to continue the family bed even though it might seem harder at first, but it has always seemed harder to me to be putting a baby in and out of a crib. However, a crib or toddler bed in your room may be what works best for you. Another option is to expand your bed’s limits by placing another mattress against your mattress. A bit more space for each family member may help to solve some of the sleep issues. My least favorite choice is a crib or bed in a separate bedroom.

Again, during these first three nights, between 11 p.m. and 6 a.m., cuddle and feed short, put him down awake, rub, pat, talk until he falls asleep and repeat this cycle only after he’s slept and reawakened. At 6:01 a.m., do whatever you have been doing as a morning routine ignoring the previous seven hours’ patterns. Many babies will roll over, nurse and cuddle back to sleep and give you an extra hour or so. Some won’t.

For me, one of the most reassuring parts of this “sleep plan” is seeing that babies wake up fine, happy and grudge-free about the change in the rules. You’ll see what I mean, even if the first few minutes of the morning are not exactly as they’ve always been.

The Second Three Nights

Again, the nursing to sleep stops at 11 p.m. When he wakes up, hug him and cuddle him for a few minutes, but do not feed him, put him down awake. Putting him down awake is a crucial part of this whole endeavor because it really does teach him to fall asleep with a little less contact and then a little less. Not feeding is the big change during these three nights. One-year-old babies can easily go for those seven hours (or more) with no calories. Theylike to get fed a little through the night, but physiologically and nutritionally, this is not a long time to go without food.

If I could wake my wife a few times each night, ask her to squeeze me a little fresh orange juice (my favorite drink) and rub my back while I drank it, I wouldn’t choose to voluntarily give up this routine. My wife might have some different ideas and get tired of the pattern quickly. Babies rarely give up their favorite patterns and things — day or night– without balking and crying.

I really don’t like listening to babies cry. I actually hate listening to babies cry. Unlike them, though, we adults can truly understand the implications of lack of sleep for a family of three, four or more people. Sleep patterns sometimes have to be changed. The incredible safety and reassurance the family bed has provided, and continues to provide, supplies the best context and location for these changes.

During these second three nights, some babies will cry and protest for ten minutes at a time and some will go for an hour or more. Your toddler is aware that you are right beside him, offering comfort and soothing. It just isn’t the mode of comfort he wants at the moment. It is hard to listen to him fuss, but it will work. I believe that a well-loved baby, after a year or more in the family bed, will be the ultimate beneficiary of his parents getting more sleep. Not coincidentally, the parents benefit “big time,” too.

“Yes, for the past many months we have enjoyed voting “1 to 2″ — non-democratically — in favor of . . . the baby. ‘Anyone want to get up all night, feed and walk the baby and be really tired all day and the next day too?’ Well, the vote is 1 to 2 in favor of the baby.”

Now, what we’re saying is, we will sometimes be voting two to one in favor of the baby’s family. This “baby’s family” concept may be abhorrent to he who considers himself the King of England, or Emperor of the Whole World, but our knowing he has that feeling of power allows us to confidently demote the dictator to a majority-respecting member of the family. His family.

By the end of the sixth night, your baby is going back to sleep without being nursed or fed. He’s going back to sleep after a nice hug, a cuddle and with your hand on his back and your words in his ear.

If, at any point this is feeling “wrong” to you, stop, wait some months and start over. Don’t go against your “gut instincts” which tell you that this is the wrong time to get longer sleep intervals from your baby. Your instincts are better than any sleep-modification program ever written.

The Next Four Nights

Nights seven, eight, nine and ten. Don’t pick him up, don’t hug him. When he awakens after 11 p.m., talk to him, touch him, talk some more, but don’t pick him up. Rub and pat only. No feeding either, obviously. He will fall back to sleep. Repeat the rubbing and talking when he reawakens. By the end of the ninth night, he will be falling back to sleep, albeit reluctantly for some babies and toddlers, with only a rub and a soothing voice.

After

After these first ten nights, continue to cuddle and feed to sleep if you like and he wants to, but do nothing when he wakes up except to touch a little and talk to him briefly. This may continue for another three or four nights but occasionally keeps going for another week or more. Then . . . it stops. He has learned that he is just as well-loved, gets virtually everything he needs and wants all day, but must give seven hours per night back to his parents and family.

What happens if you travel, he gets sick or some other circumstance demands a return to more nighttime interaction? Nothing. You do what you need to do (cuddle, nurse, walk, in the middle of the night, as many times as you need to) and then spend a night or two or three getting back to the new pattern the family has established.

By the way, pay the baby. Make sure that he really does get a lot of the benefit of your getting a good night’s sleep. Go to the park more often. Do all those things with him you said you’d do if he ever let you sleep longer. Explain it to him as you’re doing it. He’ll understand in an ever increasing way and will be OK with all this.

191 thoughts on “Sleep, Changing Patterns In The Family Bed”

  1. Hi

    Off topic slightly, but do you know any research about ivf/breastfeeding? I've been struggling to find ways to night wean my 13 month old, because I thought I needed to do this in order to have a chance of giving him a sibling (he was an ivf baby.) Both of us would like to carry on for a while, I think – he certainly would at night – but time is not on my side and I can't afford to wait till he grows out of this naturally. I know that the clinics advise against carrying on nursing while doing an ivf cycle but I wondered if you had any knowledge as to whether this was based on adequate research?

    many thanks

      1. Overall with IVF with a toddler nursing there is little significant concern for the amount that is transfered via breastmilk to the toddler, but the concern lies in what effect nursing may have on the implantation and achieving pregnancy. While we know that many moms get pregnant while still nursing, it is technically more favorable for achieving pregnancy after weaning. The decision on this is up to the parents and not one that is easy to make because you are obviously very committed to all the benefits of nursing and are torn between meeting all the needs of your toddler as well as your desire to make it optimal for pregnancy. You are the only one that can ultimately make that choice. Yes, I have known nursing moms that continued to nurse, went through IVF and achieved pregnancy and continued to nurse throughout the pregnancy. Yes, I have known moms that chose to wean and did not have a successful IVF procedure that led to pregnancy. The “what if’s” are a tricky thing to live with in life, but inevitable.

        I wish you the very best as continue on this path of parenting!

        Dr. Thomas Hale is the foremost authority on medications and breastfeeding. His book “Medications and Mothers’ Milk”, which is updated and published every two years, is in its 13th edition and THE book to turn to for information on medication for nursing moms.

        As an example of the information available in Dr. Hale’s book I have listed two of the medications used in IVF and Dr. Hale’s details on them:

        Pregnyl

        Human chorionic gonadotropin (HCG) is a large polypeptide hormone produced by the human placenta with functions similar to luteinizing hormone (LH). Its function is to stimulate the corpus luteum of the ovary to produce progesterone, thus sustaining pregnancy. During pregnancy, HCG secreted by the placenta maintains the corpus luteum, supporting estrogen and progesterone secretion and preventing menstruation. It is used for multiple purposes including pediatric cryptorchidism, male hypogonadism, and ovulatory failure. HCG has no known effect on fat mobilization, appetite, sense of hunger, or body fat distribution. HCG has NOT been found to be effective in treatment of obesity.

        Due to the large molecular weight (47,000) of HCG, it would be extremely unlikely to penetrate into human milk. Further, it would not be orally bioavailable due to destruction in the GI tract.
        Choriogonadotropin alfa (Ovidrel) is a biosynthetic form of the human chorionic gonadotropin.

        Pregnancy Risk Category: X
        Lactation Risk Category: L3
        Adult Concerns: Headache, irritability, restlessness, depression, fatigue, edema, gynecomastia, pain at injection site.
        Pediatric Concerns: None reported via milk. Absorption unlikely due to gastric digestion and poor penetration into milk.
        Adult Dose: 5000-10000 units X1
        T 1/2: 5.6 hrs
        Tmax: 6 hrs
        MW: 47,000
        Oral: 0%

        References:
        1. Drug Facts and Comparisons 1996 ed. ed. St. Louis: 1996.
        2. Pharmaceutical Manufacturer Prescribing information. 1997.

        Cyclogest

        Preogesterone is a naturally occurring steroid (progestin) that is secreted by the ovary, placenta, and adrenal gland. Oral administration is hampered by rapid and extensive intestinal and liver metabolism leading to poorly sustained serum concentrations and poor bioavailability. As progesterone is virtually unabsorbed orally, the vaginal route has become the most established way to deliver natural progesterone because it is easily administered, avoids liver first-pass metabolism, and has no systemic side-effects. Absorption through the bagina produces higher uterine levels and is called the “uterine first-pass effect”. A study by Levine suggests the area under the curve is about 38 times less with oral administration as with progesterone vaginal gel (Crinone). Thus fewer systemic effects are noted.

        With the use of progesterone in breastfeeding mothers, two principles of paramount interest. What effect does it have on milk roduction and the components of milk? Does it transfer into milk in high enough levels to affect the infant directly? In general, there is significant confusion in the literature as to the effect of progestins on milk composition, but the cmpositional changes do not appear major, volume is normal or higher, and some authors report minor changes in lipid and protein content. However, the majority of the studies are with other progestins (e.g. medroxyprogesterone). Shaaban studied the effect of an intravaginal progesterone ring (10 mg/d) in 120 women and found no changes in growth and development of the infant or breastfeeding performance of the study p0articipants. The author suggests the ring adds a measure of safety because the amount of steroid present in milk would be effectively absorbed from the infant’s gut. Another new study also suggests no impact on breastfeeding from the intravaginal progesterone ring.

        The effect of progestins on milk production is poorly studied. Early postpartum, while progestin receptors are still present in the breast, administering progestins may actually suppress milk production just as it does in the pregnant women. This has been seen occasionally in patients early postpartum. Several days to a week later, most progestin receptors disappear from the lactocyte and breast tissues become relatively immune to the effects of progestins. Thus it is advisable to wait as long as possible postpartum prior to instituting therapy with progesterone to avoid reducing the milk supply.

        The direct effect of progesterone therapy on the nursing infant is generally unknown, but it is believed minimal to none as natural progesterone is poorly bioavailable to the infant via milk. Several cases of gynecomastia in infants have been reported but are extremely rare.

        Lactation Risk Category: L3
        Adult Concerns: Bloating, cramps, pain, dizziness, headache, nausea, breast pain, constipation, diarrhea, nausea, somnolence, breast enlargement
        Pediatric Concerns: None reported, not bioavailable.
        Drug Interactions: May increase estrogen levels when co-administered with estrogen-containing tablets. Increased doxorubicin-induced neutropenia when co-administered. Ketoconazole may increase levels of progesterone.
        Adult Dose: 90 mg daily
        T 1/2: 13-18 hrs
        Tmax: 6 hrs
        MW: 314
        PB: 99%
        Oral: Low

        References: 7 studies referenced

    1. Hi! Did you get an answer to this? I just saw this, and I have the exact same question about my 16 month old (she is an ivf baby and I wil be 42 next month . . . I have no desire to wean her except that we really want to start the process for another baby). She co-sleeps and still nurses at night and I hate, for both of us, to give it up — but my dr tells me I have to in order to start IVF again. thanks!

      1. jd, you do not "have" to wean to achieve pregnancy. It's a tough decision to make when nursing a toddler and planning IVF. Your determination of your cycles and if you feel nursing is affecting your cycles is the best place to start. It is possible to chart your cycle while nursing and should be beneficial to your assessment of how your own nursing situation is affecting your cycles. This information should be helpful in your decision making process.

  2. Thanks for being able to realistically describe the method most AP parents use to put their kids to sleep! There are literally DOZENS of websites and books devoted to the selfish notion that as a parent you are "entitled" to decent sleep- actually, just writing that sounds funny. They tell you to do all of these things to make the babies "independent" from sleeping separate (an idea I believe concocted by a) furniture industries b) men who want to have sex privately without the interruption of children) to making the age limits or "minimum" placed on breast feeding. I'm not saying do it til' they are five, but generally kids over 3 are developmentally able to disconnect and sleep alone – I know this because my 13 year old sleeps just fine- has since she was about 8 or 9- she would crawl in to my bed now and again for snuggling- isn't that cool?

    I now have two babies close in age – about 17 months apart- who I chose to completely tandem nurse for the required year and the older of the two is SO devoted to nursing for emotional support I kept it up with her too. But it is quite trying and my husband cannot put them to sleep since he returned to work- After reading your article I realized that it would probably be worse for my toddlers trying to wean them in to beds, I have tried to make the older one just turn over and sleep and it has worked- though, I admit I need a consistent plan to make her more secure about the arrangement and yours sounds difficult, but I'm going to give it a go.

    More education for parents about how to creatively keep their sex lives going without sacrificing the security of their babes would be terrific- my husband and I go in to other rooms, or the shower to avoid encounters with the kids present. And even as taboo as it sounds- uh, if they are sleeping they will never know what you are up to! Of course, there is an age limit and sleep depth issue here requiring common sense. Thanks again for the article- you are right about our cultural ideas enforcing troublesome tactics for bedtime habits on to parents!

  3. Shhh . . . I did an IVF cycle (successful) while breastfeeding an older child.

    Swing by the Mothering Magazine boards, there is a lot of good info out there, mostly anecdotal. I don't think there's much research on IVF and breastfeeding, but there's lot on breastfeeding and fertility. Some women return to fertility earlier than others, more rarely, some need to completely discontinue nursing to conceive. Of course, IVF is not a typical conception cycle, so I doubt the research applies!

    Clinics are *very* protective (understandably) of their success rates, so they encourage you to do everything you can to increase the likelihood of IVF success.

    By the way, especially with a 13-mo old who is (probably) taking in solids and other fluids, medication safety to your older nursing is probably *not* the issue, but the reduction of fertility that comes from suckling. You can check out Thomas Hale's website for more on that.

    Best of luck to you on your journey!

  4. Turns out my little boy (age 2.5) has a cavity on one of his upper front teeth and the dentist is recommending an end to night nursing. I don't want to upset my child who has always had complete access to Mommy throughout the night unless it is really warranted. What are your thoughts on this? Do you know where I might find resources to support continued night nursing and dental health? Thank you.

  5. Our son is 3 years old. He has always had trouble sleeping and waking very early. As an infant and toddler he had very bad reflux, however he is fine now. Recently he has been waking up around 4. He has just started to not want to nap….somedays He will fall asleep on the couch. When he does nap he goes to sleep around 9 (no nap around 7)…on a good day he will wake up at 6ish. On a bad day he will wake up at 4 and not go back to sleep, no matter how many times I try to put him back in his bed and he is very upset during this time. I have been putting him asleep awake for a week now,(prior I would lay with him until he was almost asleep)…he has never slept in our bed besides the first 4 months of his life) sometimes it can take 10 to 20 times of him getting out of bed (and me gently putting him back) before he will actually fall asleep alone. However he still wakes up 1-2 times a night. He was sleeping pretty good between 15 months and 3 but right when we changed to the toddler bed all of these problems started. Should I just continue your approach of putting him asleep awake and maybe after 2 weeks this will get better? I am fine waking up at 5 but 4 is a problem for our family…do you have any recommendations? I know he could be reducing his overall hours of sleep but if he gets up at 4 he will fall asleep by 8 in the car or stroller. If he wakes up after 6 he is fine until his nap and his mood is much better.

    1. Let me make sure that I'm understanding correctly. If he doesn't nap he goes to bed at 7p and wakes at 4a? That's 9 hrs of sleeping. Even if he does take a nap and goes to bed at 9p if he wakes at 4a he has been asleep for 7 hrs. How long are his naps when he takes one? While most 3 yr old may be sleeping more hours in a 24 hr period than he is, there are some that don't sleep as many hours. 9-10 hrs. may be the maximum sleeping time he requires. Is he alert and happy when he's awake? Energetic? Growing well? On track developmentally?

      I don't think it matter so much whether you are putting him to bed asleep, almost asleep or awake. I think what matters is that he is learning to happily go to sleep. You are the one that knows best how he makes that transition. Whether that includes nursing to sleep, reading a book, lying quietly together and talking about dreams, or whatEVER helps your child to settle down for the night without crying or bedtime drama is what is good for both of you! The same thing applies to waking at 4a. I would concentrate not on the fact that you wish he weren't awake at 4a, but teaching him that if he DOES wake up at 4a he needs to respect that it's still night time and others want to sleep even if he doesn't, so quiet activities are all that he can do. Lying in bed reading books, whispering secrets to a stuffed animal….again whatEVER works to teach him that it's still quiet time because it's still night time and others are sleeping. It might help him to have a clock in his room so that he can see that it's still night time in addition to it being dark outside the window!

      Hope that helps.

      1. Cheryl,

        Thanks so much for your detailed answer and the suggestion to encourage a happy bedtime.. I actually went back to lying with my son until he was almost asleep and making sure our bedtime was very peaceful. I also lay with him when he does wake at 4:30 until he falls asleep and he seems to go to sleep for an hour or two more. Although, he still wakes up atleast once a night a couple times a week, is this typical for a 3.5 year old? Somedays he is napping and some days he is not. I always lie down with him for his nap around 2pm and sometimes he will sleep and sometimes he does not. When he does nap it is about 2 hours. However, at night our son will sometimes wake up in a complete rage. He will scream like crazy and hit me if I come close and then after about 5-15 min he will stop and go right to sleep. I think this is like some sorta night terror or confusional arousal, he use to sometimes act this way when he would wake up from his naps but now its just at night. At what point would you suggest involving a pediatric sleep specialist or do you think he will just grow out of all these crazy sleep patterns. As I stated before he averages 10-12 hours a sleep a day and usually wakes up around 6. He will go to bed at 7 if he does not nap and if he naps will go to sleep around 8:30. Thanks so much for your tips!

        1. This can be a tricky stage that kids go through where they are in the inbetween stage of not needing a nap every day but not quite ready to go without one every day. You are doing the right thing by being flexible. The night terror reaction to waking during the night can be as simple as the heavy sleep of a young child that keeps them from being completely awake when they seem to have wakened. I don't necessarily think it's something to be greatly concerned about at this point, but might suggest that you keep a log of the times when it happens and a few details of that day…the activities, what was eaten…just on the possibility that there may be something of consistency. You are doing a great job of teaching him when it is time for sleeping but offering him your presence to help him soothe back to sleep with your comforting near. Some children just need mom near to fall asleep peacefully for longer than others. It's certainly very normal for him to still need you near at 3.5 years of age. It's more about his personality than anything and a credit to your parenting that you are setting some boundaries but offering the comfort that he is expressing he needs.

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