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    Breastfeeding and Plugged Ducts





    A plugged or blocked duct is a milk duct that has obstructed milk flow.  The obstruction could be at the nipple, or back further in your milk duct. It can be caused by something pressing on your duct (like an underwire bra or your diaper bag or even your arm when you sleep), dried/thicker milk blocking the pore/opening on your nipple (you can see this blockage on the nipple as a white spot), engorgement (from oversupply, incorrect latch, not emptying the breast completely at each feeding), infrequent feedings (from a sleepy baby, or one who is being put on a strict feeding schedule – DON’T DO THIS IT’S NOT GOOD FOR YOU OR BABY), yeast infection, or stress and not enough sleep (hello, new mommyhood!). 

     

    You can tell you have a plugged duct when you have tenderness (usually) only in one breast – in one area. In my experience, I was able to recognize a plugged duct when I’d feel a generally uncomfortable area of the breast, or an overfull/engorged feeling, that didn’t go completely away after a full nursing.  The tender area becomes more swollen, firmer – like a wedge shape – warm, and painful to the touch as time progresses, and is not fully relieved after nursing.  You may have a low fever and feel generally tired.  If you experience a high fever, or suddenly feel very ill (flu-like symptoms), it is important to call a doctor, as you may have an infection - mastitis, which can be treated with antibiotics.

     

    The good news is that plugged ducts are normal, they don’t require that you stop or even pause breastfeeding – in fact, you should nurse MORE and more often – and they can be fairly easy to clear up. Over my nearly 6 years of breastfeeding experience (my youngest son is still occasionally nursing), I’ve had several plugged ducts, and one case of mild mastitis.  I believe mine were mostly caused by oversupply (I was tandem nursing), preterm baby who didn’t like to linger at the breast, combined with adjusting to mothering two children, and returning to work. Time, taking better care of myself, and early detection and mitigation helped me through my recurrent plugged ducts.  Over time, I’ve tried pretty much everything.

     

     

     

    If you determine that you have a plugged duct (ouch!), here are my suggestions for what to do:  

     

    1) Breastfeed.  Breastfeed.  Breastfeed some more.  It is so important not to stop nursing when you have a plugged duct, even though it is uncomfortable.  Baby is the best tool to relieve the plugged duct.  Make sure baby is well-latched, is draining the breast effectively, and nursing frequently.  If baby is falling asleep while nursing, or isn’t interested in nursing as often as you need to in this time, you can pump, or hand express.

     

    2) Breastfeed in different positions. Try to point baby’s chin towards the swollen area – this may mean some creative positioning, but baby’s suction is extremely effective at loosening/dislodging the clog.  You can also try lying baby on the bed, and dangling your breast down for nursing – use the benefits of gravity to help dislodge the clog.

     

    3) Use Heat. I had a microwavable rice bag that I’d warm (not super hot – you don’t want to burn yourself, it hurts enough already!), and place directly on the swollen area while nursing. A hot shower with water directed on the area (though this can be painful as well) can help to soothe and loosen up the clog.

     

    4) Rest.  You must rest, and take care of yourself. Nap with baby while nursing in side-lying position, or, play the “sleeping game” with toddler on the floor. Ask someone to help you with the housework for a few days.  Whatever you can to take it as easy as possible to allow your body to heal, do it.

     

    5) Pump.  When baby doesn’t want to nurse, you can pump to keep the milk moving.  I found as long as my breast felt as “empty” as possible, the plugged duct was less painful.  Pumping in the shower was helpful to me as the heat was relaxing, and pain relieving. 

     

    6) Nurse a Toddler. You may not have this option, but I was lucky enough to have my toddler available and willing to nurse when baby was sleeping. A toddler may be willing (& actually think its funny) to nurse in strange positions in order to dislodge the clog.

     

    7) Pressure massage.  I found this method to be extremely painful, yet super effective. You use the heel of your hand to apply strong pressure to the swollen area to move the plug out and down. Dr. Sears very clearly illustrates just how to do this, and I’ve followed it to the letter with success, so I’m copying directly from his website:

    To do pressure massage, start at the edge of the lumpy area closest to your chest wall. Apply pressure to that area with the heel of your hand to the point just before it becomes too painful. Hold the pressure at that level until the pain eases off. Then increase the pressure again, (without moving your hand) and hold it until the pain eases. Continue to gradually increase pressure at that same site until you are pressing as hard as you can. Then pick your hand up, move it down toward your nipple about a half inch, and repeat the pressure massage in this area. Continue moving your hand a half inch and repeating the massage until you get all the way down to the nipple.

    Source: http://www.askdrsears.com/html/2/t022100.asp

    8) Use a Needle. If you actually see a white “blister” on the nipple, it can be dried milk plugging the opening on your nipple, which can block milk flow and cause a swollen duct.  Sterilize the needle, then gently insert into the blister to pop it. Follow with a pressure massage and breastfeeding and/or pumping.

     

    9) Take Soy Lecithin. Once I started taking daily lecithin, my plugged ducts stopped recurring.  The recommended dosage is 3,600 – 4,800mg/day. Soy lecithin is a fatty acid which acts as an emulsifier. There are no known contraindications to use while breastfeeding.

     

    10) Vitamins.  Up your infection-fighting vitamins & herbs, like: Vitamin C, Vitamin D, Echinacea, Garlic, Elderberry, and Probiotics.

     

    11) Pain Relief. Take an anti-inflammatory pain reliever like ibuprofen which will help with swelling and pain.

     

    11) Read up on plugged ducts:

    KellyMom.com – Plugged Ducts & Mastitis: http://www.kellymom.com/bf/concerns/mom/mastitis.html

    Dr. Sears - Plugged Milk Ducts: http://www.askdrsears.com/html/2/t022100.asp

    Dr. Jack Newman – Blocked Ducts & Mastitis: http://www.breastfeedingonline.com/22pdf.pdf

     

    Posted: Aug 24 2010, 10:25 by kelly | Comments (6) RSS comment feed |
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    The Most Peaceful Time of Day





    Crunchy mom confession: I still help my children fall asleep at night. My children are 3 years and almost 6 years old, and I lie down with them at night, after bath time, after books and quizzes with Daddy. I snuggle between them, as they drift off to sleep. When they are asleep, I disentangle myself from arms and legs, and tip toe out, lingering just a bit to see them peacefully asleep together. Now, I don’t have to do this. I know they are capable of falling asleep on their own. And they have, when I’ve asked them to – if I’m touched out for the day, or I have something to do right after bed. But most nights, I still choose to lie down with them because…

    - They still want me to, and I know they won’t always want me to. And I will sincerely miss it when they don’t.

    - They ask me the best questions after the lights go out. Like, “How far does the sky go?” and “How fast can an elephant run?”

    - Before sleep, they are always harmonious and joyful. There’s no whining, teasing, wanting. Something about the tranquility of sleep about to come, brings with it a welcome sense of peace, that I don’t often encounter during the day with two young children, and a lot of responsibilities.

    - They recount the events of the day, and we ask each other what our favorite parts of the day were – and what our least favorite parts were (this is a wonderful window into how they interpret my actions – sometimes an action that I thought was rather forgettable, like, asking my 3yo to help me sweep up a mess, turns out to be his favorite part of the day – because I was one-on-one with him on the floor, guiding him. And that expensive trip to a museum – not as fun.).

    - They tell me things that happened in school or at grandma’s house, which otherwise, with the lights on, and the events of the day swirling busily around them, they might not have mentioned – things that concerned them, things that they need help processing. I’m glad to be able to slow down for a little bit and help them through those thoughts, which might not otherwise have been communicated.

    - It’s a quiet time, to relax and just be, without expectations or schedules or places to go or things to get done.

    - They ask me to sing as I always have to them before sleep, and I love to sing, and now they love to sing too – and I marvel in hearing their little voices developing.

    - I adore the feel of their fingers, curled around mine; relaxing into sleep like they did as infants once upon a time on my shoulder. I feel blessed that almost 6 years after having my first baby; I still get a glimpse into babyhood that isn’t so far gone for my little ones.

    So for all of these reasons, I lie down with my children at night, and help them to sleep. Our days go so quickly, and they are growing so fast, I’ll enjoy this connection and this time with them now, while I can.

     

     

    Philadelphia with Children





    On Monday, I decided to be spontaneous, and take the kids for a daytrip into Philadelphia.  Typically, we’d drive in, but, because I’d be talking with the children recently about the train, I thought it would be a fun addition to an already fun trip to ride the Patco into the city.

    Children under 5 years are free, so this makes traveling into the city by train with young children very affordable.  No gas, no tolls, no parking, no emissions = eco-friendly and wallet-friendly win! Plus, it’s a train ride – which is an adventure in itself!

     

    We took the train to 8th & Market streets – right across the street from the Gallery mall.  There’s a huge food court there – if mall food is your thing – but we decided instead to walk a few blocks over to Reading Terminal Market at 11th & Filbert. 

    If you’re ever in Philadelphia – with children, or without – you really must stop by this market.  It’s been around as long as I remember – which, granted, is only thirty something years. But, their website says they’ve been there since 1893! It’s a fascinating place for children (I remember loving it myself as a child). I would avoid peak times – like lunch hour, because it can get VERY crowded. You can find fresh produce & meats, handmade soaps & jewelry, flowers, chocolates, and every type of food you can imagine. Wednesday – Saturday, the “Pennsylvania Dutch” (Amish/Mennonite) merchants are also open, which is an interesting cultural window for children.  I highly recommend the apple dumplings (with fresh cream) from Dutch Eating Place. People stand in line for these for good reason.  Wow. You’ll dream about them. Unfortunately, we arrived on a Monday, so they weren’t open.  Instead, we decided on falafel sandwiches with fresh juice.  Which turned out to be absolutely wonderful! 

    After good food & drink, we walked around the market for a while, checking out all the offerings.  The children were particularly interested in the “honey shop” a.k.a. Bee Natural, where they were able to watch bees buzzing around busily in a real honey comb.

     

    We also stopped by the candy shop for some treats before heading out on our walk around the city. They had some of the most original-shaped chocolates I’ve ever seen.

     

    After leaving the market, we headed down Arch street, through Chinatown.  It’s an interesting walk for the kids with all the bright colors, different smells, dragons at every turn, and my 6 year old in particular was interested in the Chinese writing on all the signs.

    We were on our way to the Federal Reserve Bank of Philadelphia to see the “Money In Motion” exhibit, located at 6th and Arch streets. After a thorough security scanning (think airport), in we went! We learned (as much as a 3 year old’s attention span would allow) about counterfeit bills, the latest security features on new money, the future of credit cards, the history of US currency, and other fascinating stuff – all about money! I will say the highlight of the trip was a money exchange machine that would give you a shiny new Yosemite quarter for your old quarter (or, for your newly acquired Yosemite quarter – over and over and over again).

    Once we'd had our fill of the FRB, we walked one block down to Franklin Square park. It is located at 6th and Race streets, right across from the lightning bolt sculpture and the Ben Franklin Bridge.  It is an open green park with lovely flowers (on which we happened to spy a swallowtail AND a monarch butterfly), a beautiful restored waterfountain right at the center (which is surrounded with wrought-iron fencing, so wading is prohibited – darn!), miniature golf, a multi-age playground, and a super-cool carousel. The carousel features lots of interesting animals – both fantasy and real, and costs $2 for kids, and $3 for adults.  It was well worth the expense.  The kids loved it!

    After an hour at the park, we walked up 6th, past the National Constitution Center to Arch Street and headed down past the U.S. Mint to the Quaker Meeting House on 4th Street. Along 4th, we stopped at Benjamin Franklin’s grave, and tossed a few pennies for luck.

    We continued up 4th to Market, and tucked in between 4th & 3rd street, nearly hidden, is the entry way to Franklin Court I had fond memories of this place as a child. It’s a tiny park set in the center of big buildings. It features giant metal “outlines” of Ben Franklin’s house & bookbindery.

    There are several “portals” that you can look down, below the street, to the still-existing foundation.  The remaining “privy pits” (you know, toilets) were the biggest hit with the kids. Also there is a free underground (literally) museum featuring artwork, artifacts, a glass harmonica (which we’ve seen in use on previous visits – unfortunately, we arrived very close to closing time, and no one was there to demonstrate it), a phone bank where you can call historical figures who will tell you about Ben Franklin (the kids LOVED this), and a few other more adult-oriented activities (like a film). The main drawback to this museum this time around was that the “electric” light show was turned off (due to “attracting the homeless who would come & trip out” said the attendant at the front), and there was an overall look & feel of disrepair to the museum.  I was a little bummed out, truth be told, because this place held a spot dear in my heart – and the reality just didn’t live up to my childhood memories.  My children had a grand time though, so I wouldn’t pass it up in the future.  Maybe just come a bit earlier than closing time. There are several historical buildings surrounding the museum with exhibits and demonstrations all for free – the US Postal Service Museum, an old printing press/bookbindery, and the old office of Ben Franklin’s grandson’s newspaper – all of which were closed before we got there, but there is still plenty to see & read without going inside the buildings.

    After checking out all the signs and benches and more privy pits, the kids were wearing down, so we decided to make our way back towards Chinatown for dinner.  Along the way, we discovered the (old) National Museum of American Jewish History– which is currently closed for relocation – and planning to reopen in a brand-new building in November 2010.

    The  kids explored the sculptures out front for a while before we continued on our walk. After reading about the museum, we’ll definitely plan a return visit once the new building is open (though likely without the children).

    As we made our way back to Chinatown, my 3 year old finally asked to be carried.  What a trip for a little one!  I will interject here that while I decided against bringing the umbrella stroller so I didn’t have to carry it on the train, about 6 blocks into carrying him (it was in the upper 90s outside as well), I was questioning my wisdom.

    A few more blocks walk, and we arrived at the vegetarian haven which is New Harmony.

    Their menu is amazing – larger than the typical Chinese restaurant – and everything on it is vegetarian (vegan and kosher too!).  Every last thing.  The food is delicious, the staff is helpful, and the atmosphere is casual and kid-friendly.  Highly recommended!

    After a fantastic meal, we headed back to the train station and travelled home.  In all, it was a FABULOUS day – can’t wait to go back again!  We did a lot of walking, looking around, discovering new places, visiting old ones, and just having a good time. There’s SO much to do & see in Philadelphia for kids. 

     

    Have you ever been to Philly with your children?  Tell me about it.  What did we miss?

     

    Posted: Aug 18 2010, 14:33 by kelly | Comments (4) RSS comment feed |
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    Nightwaking and Nightweaning





    Frequent night waking is absolutely normal and natural in all babies - particularly breastfed ones - as breastmilk is digested more quickly than formula, and baby will only drink as much as she needs, so her stomach may feel emptier, sooner, which may cause her to wake more frequently than her formula-fed counterpart. Night time waking is a baby’s mechanism to stay safe.  Babies aren’t physiologically intended to sleep as soundly or as long as adults (you can read more about baby sleep at the links below).

    http://www.askdrsears.com/html/7/T070200.asp

    http://www.kellymom.com/parenting/sleep/sleep.html

    http://www.llli.org/ba/Feb93.html

    http://www.drjen4kids.com/soap%20box/sleep%20stuff.htm

     

    However, perhaps because of the busy lives we lead and the lack of support mothers often have, babies have come to be expected to sleep through the night at younger and younger ages, and sleeping through the night has become a milestone with a deadline attached to it.  Strangely though, sleeping through the night seems to be the only milestone people write books about with all sorts of schedules and guarantees.  Think about it - when’s the last time you saw a baby book about “How to Teach Your Baby to Walk?”  Our culture is OBSESSED with baby sleep. But, I digress.  When baby doesn’t start sleeping according to these societal expectations, mom – and breastfeeding – often take the blame, and premature weaning and/or regimented sleep training ensues.

     

    Of course, as good and normal as waking frequently may be for baby, it can be challenging for baby’s parents.  Particularly if said parents have to get up in the morning and get older children to school and/or get themselves to work, as most people do! As the sleep deprivation sets in, fantasies of stopping breastfeeding altogether or following some "guaranteed sleep plan"  in order to get a good night’s sleep may start becoming more appealing.  However, strict sleep training plans or breastfeeding cessation doesn’t always stop night waking. And babies often need the benefits of nighttime milk and nighttime comfort beyond the time people often think baby “should be” sleeping through the night. (more about that at the links below:)

    http://www.kellymom.com/parenting/sleep/comfortnursing.html

    http://www.who.int/child_adolescent_health/topics/prevention_care/child/nutrition/breastfeeding/en/index.html

    http://www.llli.org/FAQ/bflength.html

    Babies may wake at night because they are uncomfortable, scared, in teething pain (for which breastfeeding is the ultimate natural comforter), are wet, or a host of other unknown reasons. Breastfeeding can provide baby with a wonderful source of comfort, pain reduction, and sleep-inducing chemicals. Night nursing isn’t always just about nutrition, and that’s okay.   

     

    However, if night nursing is becoming too trying, I’d encourage moms to try co-sleeping first, particularly for a young baby, before night weaning, and definitely before severing the breastfeeding relationship or sleep training.  In fact, I don't recommend sleep training with a baby at all as they are not physically capable yet of fixing whatever is waking them in the night (ever been waken by a 4 month old who has lost her pacifier but has absolutely no ability to get the pacifier back in her mouth? or a 7 month old whose ankle gets caught in the bars of the crib, but can't get it out?), and lack the ability to accurately convey the specific problem. The only way for baby to commuicate in the first year is through crying.  If you’re not coming to help, baby can become increasingly distressed as she gets more hungry or more frustrated or more in trouble. So how to help baby sleep, while helping yourself get much needed sleep? Cosleeping can be a lifesaver as often baby can learn to latch on, unlatch, and go back to sleep, from a side-lying position, and Mom doesn’t need to be fully awake (get up, get nightgown on, get baby from crib, feed, place baby back in crib, get back into bed & try to get back to sleep, in time for the cycle to start back over) in order to comfort baby back to sleep. In my experience, co-sleeping allowed me to get the rest I needed and my young babies the nighttime nutrition they needed, without ending our nursing relationship.  Co-sleeping may not work for everyone (and I remember there were times I felt my own or my baby’s motions were keeping us all up at night. Those were the times when we’d change things up & try something else – a few nights in the arms reach, or mattress on the floor, or the car seat, or the crib. Remember: babies change all. the. time.  What works one week might not work the next.  It’s really, truly okay to change things up until you find a solution that works – for the time being), but it’s worth a try, in my mind.  If you are concerned about the safety of cosleeping (there is so much negative press surrounding co sleeping) I’d encourage you to do some reading before deciding against it.  If done correctly, cosleeping can be very safe and may help everyone get a better night's sleep! (more info at the links below:)

    http://www.phdinparenting.com/2009/01/11/co-sleeping-safety/

    http://www.kellymom.com/parenting/sleep/familybed.html

     

    But what if cosleeping IS working, but baby is still waking frequently, and mom has had enough?  This doesn’t need to mean the end of the nursing or co-sleeping! Nightweaning can be the key. In my experience, night weaning can be done while co-sleeping.  And it can be done without severing the breastfeeding relationship entirely, nighttime separation, scheduled sleep training methods, or other negative sleep associations. I was able to night wean both of my children while maintaining a co-sleeping and/or family bed arrangement, and did so in a gentle way that I felt honored both my needs, and the needs of my babies at the time. Nightweaning can help mothers can find a good, happy, balanced place with breastfeeding again when night nursing is becoming too difficult, without stopping altogether.

     

     

    There are a few questions to consider before starting night weaning.

     

    Firstly (most importantly), is baby ready?

    Young babies need to nurse often.  Much of this – unfortunately for mom – is at night.  Up through the first year (and even beyond in some babies – remember everyone’s body metabolism and growth rates are different), breastfeeding at night is still a need.  Certainly, there is a lot of want in there too because babies are physiologically designed to WANT to be close to mom at night – they feel safe, mom helps regulate their breathing and temperature, they feel comforted (heck, how many of us full-grown ADULTS prefer sleeping alone to sleeping next to our partners at night?), but baby’s bodies grow more in the first year than any other time in their lives, so a night waking need for milk is a true need. I believe that if a baby is  waking in the night crying, and the crying escalates, and milk is offered and the crying stops (meaning: baby eagerly goes for the breast, willingly nurses - emptying the breast, perhaps moving to the other breast, and then goes back to sleep), then they are still waking due to nighttime hunger, and are not physically ready to night wean.   And that’s okay, in spite of what all the books say about when & how long babies are supposed to be sleeping (keep in mind unless you wrote that particular book, that book isn’t about YOUR particular baby). I believe a  baby sleeps when she’s comfortable, doesn’t when she’s not. And if she’s hungry at night, she’s not comfortable, and should be offered milk. So in general, I wouldn’t advise starting nightweaning with a baby under a year of age, and I'd never recommend an ignoring baby's cries method of getting baby to sleep at night.  Not only because of nutritional needs, but also, because I think before at least the year mark (though, closer to a year & a half even two in my experience), most babies are still in need of mom's physical proximity to help back to sleep.  If you start night weaning before baby is ready, nightweaning isn’t going to go well. 

     

    Watch and know your baby well. If she is over a year old and nurses well before sleep, but is still waking frequently in the night but isn’t readily going for the the breastmilk offered, and instead just flutter-sucking/pacifying back to sleep, (and that’s not working for you) then night weaning may be helpful for you.

     

    Secondly, are YOU ready? 

    In my experience, babies don’t particularly like nightweaning or any change in the night time routine. They like to sleep with mom (and milk) close at hand, ready at all times. When Mom decides that the all-night milk bar is closed, baby doesn’t take too well to that.

     

    I advise, for the least stress to all involved, to move very gradually with nightweaning.  It’s a slow process with ups and downs. It will mean even more sleepless nights – for a little while, and a shake up in your own routine.  It will mean giving up the easy roll over & nurse back to sleep (which, yes, isn’t that appealing or easy at 4am after doing it at 3am, 2am, and 1am, so I’m not saying its easy all the time – it just starts to look really appealing again when you’re in the midst of nightweaning, wondering if it will ever happen) in favor of doing things which will certainly bring you both into a waking state.

     

    If you’ve said yes to both questions, there’s one more thing to keep in mind.  Babies are continually changing. They go through phases of being more or less needy, during the day, and the night (though, at night, the neediness always seems worse, doesn’t it? Because, well… you’re tired.  And you’d rather be sleeping.  Not up tending to a baby. Even though it’s a baby that you love, you still wish you were sleeping). But they are PHASES. Which means they will pass.  Night weaning or no. Baby WILL eventually sleep. If your nightweaning try doesn’t go well, baby just may not be ready. Or you may not be ready.  You can ALWAYS STOP NIGHTWEANING AT ANY TIME. Go back to your regular routine for a week or two, and then try again.

     

    All babies WILL sleep through the night.  No matter what you do. Or don’t do. They aren’t going to spend forever in your bed.  They aren’t going to wake every 2 hours asking for milk when they are 6 years old.  So if you’re not ready to take on a change which will be long, and can cause some difficult nights, then remember, you don’t have to.  All babies will eventually come into a sleeping pattern more aligned with adults’ with time.

     

    Okay, so you’re ready?  Here’s what we did.

     

    [ I’m including the following prelude, to set the scene for why we approached nightweaning as follows – feel free to skip to the steps if you’d like]

    My daughter was just over 2 years old when I decided to start an alternate method of helping her to sleep.  It wasn’t intended to be night weaning, precisely, as I didn’t really mind waking to nurse at night.  Nursing to sleep released sleep hormones, and I’d mastered the “Pantley pull-off” method, so she didn’t stay latched on all night long, and I was able to easily fall back to sleep once she was full.  The reason I started altering our nighttime routine was because I was pregnant. Nursing had become more uncomfortable to me while lying down.  Also, our bedtime routine required a LOT of work each night from either my husband or myself.  I was envisioning going through this routine while 9 months pregnant, and not liking what I pictured. Before changing up our nighttime sleep associations, bedtime went something like this:

    Walk back & forth while doing deep knee bends/squats while holding 25+lb toddler in an upright position while singing for somewhere in the area of 15-20 minutes.  At approximately the 20 minute mark, as she was getting drowsy, I would ease myself down on the bouncy ball & continue the singing & up/down motion.  Once she was asleep (another 10 minutes or so), I could ease her down to her bed (at that point a mattress on the floor next to our bed), and lie down with her.  Sometimes she’d root & nurse for a bit. Sometimes, she’d just fiddle with my belly button (that was her repetitive soothing motion – many babies have this with a blanket edge, a stuffed animal, mom’s hair) until she fell asleep & I could roll away.  After becoming pregnant, I realized I didn’t want to do this anymore, and she was old enough to understand & participate in coming up with a less work-intensive way to sleep.  We’d tried with varying levels of success at changing up her sleep routine over the years – but from birth she was high needs, colicky for many (9) months, required motion to feel comfortable (to this day, I blame this on all the boating we did in the last couple months of pregnancy – my baby had simply gotten used to consistent up/down motion in utero… whatever you do, stay away from boats when very pregnant.  :-D ), and was highly resistant to changes in her routine.  So I knew if I was taking on this task, it was going to be, by nature, slow & steady.  I was ready.

     

    THE NIGHT TIME PLAN

     

    Make sure baby is well fed & hydrated before sleep.

    There’s no sense in attempting to withhold nursing at night if you believe your baby still wakes hungry at night.  As I stated above, if you believe this is regularly still the case, it’s not a good time to start nightweaning.  Wait a few more weeks or months for baby to mature a bit, and try again. If you do believe nursing at night is mostly for pacification, I still think that recognizing the smallness of babies tummies, it is a good idea to be certain baby has had enough to eat before bed.  Be sure to nurse baby well before starting your bedtime routine, and/or offer some healthy snacks like banana, avocado, oatmeal, unsweetened yogurt, toast, along with water. I’m not talking about stuffing baby before sleep.  As I know with myself, if I eat  right before bed, I don’t sleep well.  But, a healthy nutrient-dense snack before starting your bedtime routine helps cover all the bases.

     

    Talk about nighttime routine during the day.

    We started talking regularly with our daughter about our current nighttime routine – and how we felt about it. We talked about it during the day, and as it was going on at night, just to bring her into greater awareness about what was happening. Having these conversations during the day, instead of right at bedtime, took some pressure off us all. Once the scene was set (a couple of days of saying things like, “At night, we usually take a long time to go to sleep.  We walk with you and sing and bounce for a long time.  Now that Mommy is expecting a baby, I’m getting more tired and need more sleep.  Our bedtime routine is very long for me”), we started introducing the concept of how Mom & Dad sleep, and how we could apply that to her own sleep.  We would have conversations like, “At night, Dad & Mom like to read books.  Sometimes we’ll give each other a backrub, and then we’ll go to sleep lying in our beds.  What do you like to do before going to sleep?”  And we’d offer ideas & get her suggestions for what she likes. Keep in mind that  that if your child is pre-verbal, you can make a suggestion and gauge her response to that suggestion.  Instead of, “what do you like to do to fall asleep”, you can say, “Do you like to have your back rubbed before bed?” or “Do you like to sing songs?” and wait for her response – even young babies can communicate acceptance or refusal of suggestions presented to them.  Once the alternatives to the regular routine have been chosen (like going to sleep in the crib instead of rocking to sleep in the rocking chair, or whatever), make sure to spend a few days talking about those alternatives & what they mean, practicing during nap time or even during wake time.  I remember “teaching” my daughter during the day what “cuddling to sleep” meant, so that when we put it into action at night, it wasn’t a surprise.  We’d lie down & play the “sleep game” during the day and “cuddle to sleep”.

     

    Start changing the bedtime routine gradually.

    Once the talking stage has been set – and the ideas are gathered and/or planted, the next step is to start altering the routine – slightly - at night.  For example, my daughter indicated she liked to sing songs before going to sleep.  I indicated I did not want to carry her anymore (at the time, that was the thing I most wanted to stop, because she was getting so heavy & my belly was going to be growing).  I suggested to her that we sing the same songs that she was used to singing while walking, only we’d skip the walking part and go right to bouncing on the ball.  If your routine includes a half hour in the rocking chair before transferring to the crib for a bottle or story, you might work out a routine that includes less time in the rocking chair to start, but keep the transferring to the crib & bottle part the same. The first few nights we kept our routine exactly the same, only went right to the bouncy ball.  Same songs, in the same order, moved to the bed asleep.  So, everything else stayed the same, but for the beginning part. I also introduced key words/phrases that I was going to be repeating, like “cuddling” and “sleepy time” at this point.  She took this step gracefully, and I talked about it all the while, praising her for her understanding & helpfulness in being so understanding of my need not to carry anymore.  When this step was more routine, we changed things up a bit more – moving off the ball.  This was a particularly difficult transition, because as I mentioned earlier, motion was very important to my daughter from the point of newborn through the present.  To remove the up/down motion she was used to since (pre) birth was a big deal. I would start by bouncing only for 5 minutes while singing, instead of allowing her to fall asleep on my shoulder in motion.  When she was drowsy, we’d move to the bed. I used the key words repeatedly during the transition, and kept the songs the same.  Unfortunately, she heavily protested this step. She was used to falling asleep in motion, and this was not part of her plan.

    In my desire not to disrupt everyone’s evening, or add trauma right before bed, or form a negative sleep association, I chose to make this transition as positive as possible (and, I might add, help her feel like she had more “say” in the transition – that it wasn’t just a change being imposed, but one she could affect).  When she’d protest, I’d remind her, as we were lying down, that we’d agreed we needed to make some changes at night, and not bouncing on the ball to sleep was a big part of the change.  She indicated she’d nurse to sleep.  I could have, at that point, nursed her to sleep on the bed, instead of going back up the ball, but, as I didn’t want to substitute one uncomfortable falling to sleep association for another, I decided instead, to ask her if she would lie with me for 10 seconds “cuddling” (key word!) and then we’d get back up on the ball.  She agreed, and we cuddled on the bed, counting down from 10 to 1, then back up on the ball, and went through the regular fall-to-sleep routine to the end.

     

    Up the nighttime changes.

    After a few nights of this new routine repeating itself, and us not getting much beyond 10 seconds, I chose to take a slightly more aggressive approach, and removed the ball from the room.  I told my daughter that I was too tired anymore to bounce on the ball, and that the ball would be sleeping in another room from this point on, and that we’d have to come up with a different routine. This was not well-received.  However, I did find that after removing the visual reminder/cue and physical presence of the ball, and getting beyond that initial adjustment, the rest of the transitional steps went a bit more smoothly.  That evening after moving the ball out of the room, we went directly to lying down in bed. We sang the same songs as usual, in the same order, and “cuddled” to sleep.  There was some protesting involved, but not much outright crying, just repeated fussy requests for the ball, followed by my repeating that the ball was going to sleep, and we were cuddling to sleep, just like Mommy & Daddy do. I kept reminding her that everything else was the same – that we could sing the same songs, I was using the same key words, and we talked about how I was still holding her – just like I used to on the ball, only we were lying down, that she could still fiddle with my belly button, etc.

    All told, moving from our work-intensive 30 – 45 minute bedtime routine to a 10 – 15 minute lie down in bed without nursing to sleep took about 1 full month. Throughout this process, when she did wake in the night and ask for milk, I’d still nurse her back to sleep. 

     

    Get on to night weaning.

    Once the new bedtime routine was fully established, I moved on to changing the waking up for milk routine.  It went MUCH more smoothly & quickly than the first routine change.  Probably because the new routine was now more familiar and acceptable to her as a source of comfort.  I capitalized on the fact that she had become comfortable with belly button fiddling as an acceptable replacement for nursing pacification, and that she’d become used to the key words & phrases signaling sleep time. When she’d wake the first time at night, I’d offer cuddling and belly button, and would sing our favorite song.  When she’d start fussing, I’d remind her of what we were trying to do, but if she continued to protest, I’d offer milk after a countdown.  Meaning, I would say, okay, you may have milk in 10 seconds (choose whatever works for you), but we have to cuddle, without crying for that time, then we’ll have milk. The first few nights, I had to do an outloud countdown, 10 – 9 – 8 –you’re doing great just a few more seconds of cuddling!- 7 – 6… Each waking I’d do the same.  And each night the countdown gradually increased until she no longer asked for milk, and started asking for belly button!  About a month into this process, she was no longer waking for milk at night.  When she would wake, she’d either ask for belly button or a song, or, just patting to sleep or a cuddle would work.  I also noticed during this time that her frequency of waking was decreasing – so two wins in one!

     

    Overall, our sleep association changeover & nightweaning plan took about 2 months from start to finish, with minimal stress on anyone.  I’m certain that the speed of this could be accelerated, depending on the temperament of your child (with my son, the same process took only about 2 weeks – though, unlike my daughter, he was not an all-night pacification nurser, and less high needs), and your level of patience. 

     

    The key points:

    1) Involve your child in the night weaning process – let them choose the bedtime alternative.  Make the changes into a game and talk with them about what’s going on, instead of just dropping a brand new routine on them at night.

    2) Patience & repetition.  Repeat the same key words, phrases, songs, and routines, changing things only slightly each night.

    3) Honor your child.  I tried to keep in mind, throughout this whole process, how I would feel in my child’s shoes. Having empathy for your child’s point of view is never the wrong way to go in parenting. Follow your heart.

    4) Take it easy on yourself & your child.  If you start this plan and its not working… stop.  You don’t need to follow what I did to the letter.  You can change things up.  You can go faster, slower, or not do it at all.  You can try again in a couple weeks. You can involve your partner or do it on your own. 

     

    I truly believe all babies sleep in their own time, when they are ready – regardless of the “habits” we help them create. I do not believe that babies need to be trained to sleep, any more than they need to be trained to walk. Getting to sleep and sleeping through the night are natural step that happen with time and maturity.  I also believe that babies change continually.  What works one week, may not work the next, but it just might work the following week… so take it easy on yourself.  When all else fails, I’ve been known to repeat this phrase to myself (at 3am when I haven’t yet slept): “This too shall pass…” and it will. 

     

    Peace to you. I hope some of this helps you & baby get a better, more peaceful night's sleep!

    Posted: Aug 17 2010, 14:33 by kelly | Comments (12) RSS comment feed |
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