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    SLEEP REGRESSIONS: the when & why

    SLEEP REGRESSIONS: the when & why

    Baby sleep is an ever-changing phenomenon. There are so many factors to consider, so many things to line up, such a balance to get it all right. Then along comes a growth spurt or an illness and it all goes belly up! From infancy to toddlerhood, there will be many things that affect your baby's sleep patterns and some of these are fleeting, like a cooler night, while other things stick around, like developmental leaps. Almost everything in your baby's world will have some impact on their sleep, so in a sense, babies regress and progress in their sleep all the time.

    That said, babies do go through several massive periods in the first year to 18 months where they experience genuine physiological "sleep regressions". In some cases babies have to re-learn sleep skills due to the parts of their brain responsible for sleep changing and maturing. Other times the regressions are more to do with developments in their physical and/or social skills and also around nap transitions. During these times, a baby's day naps and night time sleep can be affected, even if they were previously sleeping well, and your baby might be clingier in the day or harder to settle at bedtime.

    Here, we'll explain when the regressions occur, the reason for them and the way through!

     

    8 WEEKS 

    This is the magic mark where many babies begin to catnap and start sleeping worse in the day. Their newborn sleepiness has worn off and they've sort of "woken up" so your baby suddenly seems a lot more alert now. What also happens at this point is their maternal melatonin has worn off, so they need to produce their own melatonin in order to settle to sleep easily and sleep well. Melatonin is a sleep hormone that is only produced and released in the dark, so having a super dark room from this age onwards really helps babies link sleep cycles and stay asleep during naps and overnight. If your baby is continuing to catnap past this point, even if you are using blackout blinds, it could be that their nap timings need a bit of tweaking to move them gently away from newborn sleeping patterns. 

     

    4 MONTHS

    This is the famous 4 month sleep regression and is possibly the biggest change in your baby's sleep that will ever happen. This is where babies start to wake fully between each sleep cycle rather than drift between cycles automatically as they did when they were younger. Sleep has now become a very conscious thing for your baby and it takes a bit of practice for them to get this new skill right! If your baby is relying on you to go to sleep at the start of their naps and bedtime (by feeding, rocking, patting etc) they will now be needing you to replicate that every single time they wake between cycles because it's the only way they know how to go to sleep. That's every 35-45 minutes in the day and 2 hours overnight. Unfortunately this sleep regression won't go away until your baby has learnt how to go to sleep without needing your help.

    Older babies who continue to wake all through the night purely to be rocked or fed back to sleep are still experiencing the effects of the 4 month sleep regression.

     

    8 MONTHS

    This sleep regression at 8 months is all about the massive physiological developmental changes your baby is experiencing at this time. At around this age many babies are learning to crawl, might be pulling up to stand, they will have language explosions; this can mean your baby wants to wake in the night simply to practice their new skills! They might also start resisting some naps or waking earlier in their naps than they previously had been. They are quite literally distracted by their own amazingness! This is completely normal and unless they're upset you are best to leave them to it. If your baby is rolling or moving around their cot a lot, you can use a safe alternative to cot bumpers - such as the Pure Safety Vertical Cot Liners. This will mean your wee one can't bump their head on their cot bars and wake themselves up! 

     

    6/8 MONTHS & 12/15 MONTHS

    At these times there can be a tiny hiccup in your baby's sleep as they go through nap transitions. At 6 months (or thereabouts) your baby starts to drop their afternoon nap and then somewhere between 12-15 months your baby will drop the morning nap. Little Ones Sleep Programs are carefully formulated to make these transitions as easy as possible for your baby (by gradually reducing the nap times until they're gone), but there can still be a period of adjustment. This might mean your baby starts waking earlier in the morning or after one sleep cycle at bedtime for a few days. As with the 8 month regression, this will resolve itself once your baby is comfortably through the nap transition period.

     

    Remember not all babies will reach these developmental stages at these exact ages, so if your baby is 3.5 months and starts waking every 2 hours overnight, its safe to assume they've hit the 4 month regression.

    Baby sleep is delicate and complicated and there is SO much going on for them developmentally and neurologically in the first 12-18 months! We can certainly help minimise the disruption to your baby's sleep at these times; Little Ones Sleep Programs give your baby the best chance to sail through the regressions a lot easier. 

    Article supplied by Little ones

    SOLIDS - The when, what, how of solid food.

    SOLIDS - The when, what, how of solid food.

    SOLIDS

    There is a LOT of research and advice out there about when is the right or best time to start your baby on solids. It’s quite a controversial issue! Very recently released information has brought to light that previous feeding recommendations were in fact made based on doctor’s opinions rather than actual scientific and paediatric studies. The purpose of this article is to share the information we have researched from reliable health, nutrition and scientific sources in regards to starting solids. The decision to start solids needs to be made by parents in accordance with their baby's needs and medical advice. 

     

     Once your baby reaches between 4-6 months of age they may begin to start showing signs of being ready for solid food. The World Health Organisation recommendations are:

     

    “Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed what is provided by milk, and complementary foods are necessary to meet those needs. An infant of this age is also developmentally ready for other foods.”

     

    It is widely recommended by credible health sources (listed at the end of this blog) and in light of recent research into preventing allergies (where 146 studies were all reviewed by researchers) it was concluded that the timing and purpose of introducing solids and common allergens by this age (6 months), is so they’re taking enough food to really gain the nutritional benefit of it as they begin to rely on solid feeds more and more for their growth and development.

     

    If your baby is showing the following signs of being ready for solids, you can start them slowly with a teaspoon per day, increasing by a teaspoon every 2 days. We always recommend starting solids at lunchtime, then when your baby is taking half a cup (or more) at that meal, you introduce dinner. When your baby is taking half a cup (or more) at dinner, you introduce breakfast. This usually happens over the course of a few months.

     

    Signs of readiness include:

    • being able to hold their head up by themselves
    • some babies might be sitting, or sitting well in a highchair
    • making chewing motions with their mouths
    • showing a great interest in what you are eating and may be reaching for your food
    • baby opens their mouth readily when you hold a spoon or food against it


    Organizations such as www.forbaby.co.nz have some good guidelines as to which foods are best to give your babies and in which order. Usually you’d want to start your baby on something quite bland like apple or pear and pureed to a very smooth consistency. Never add sugar or salt to your baby’s food. Some good first foods are:


    Pear, cooked 
    Apple, cooked
    Avocado, uncooked and mashed/pureed
    Peach, cooked
    Sweet potato, cooked
    Pumpkin, cooked

    - Using fun platesbowls and cutlery for older babies and children, helps to encourage them to eat and enjoy their food.


    Stick with one food for a few days before introducing another. If your baby refuses to eat the food offered, try again in a couple of days. It is important not to force the food into your baby’s mouth or you risk them developing a food aversion. Remember, it is all very new to them and it’ll take some getting used to! Often babies will be more receptive to taking food off your finger as it’s familiar and softer on their gums than a spoon.


    It is a good idea to stick with fruit and starchy carbs initially, then when your baby is around 6 months old you can introduce protein at lunchtime. Chicken, fish, egg and lentils are great options that are gentle on baby’s tummy. From around 6 months you can also offer water when your baby eats their solids, as they can get thirsty - much like we do when we eat. It might take some time to find a sippy cup/drink bottle that your baby likes to drink from - some popular choices are drink bottles with straws, or soft-teat sippy cups. 


    Some mums choose to do a method called “Baby Led Weaning” with their babies – this is where you offer them food that isn’t pureed with the intention that they can mouth and eat the food when they’re ready. In general, babies who are doing Baby Led Weaning consume less calories earlier on and will need to continue night feeds to compensate. For more information on Baby Led Weaning please see www.babyledweaning.com


    Some facts about milk and solids:

    - Milk is still the most important food for a baby up until they’re 8+ months old, so you should always offer a milk feed before solids until they reach this age. The solids work like a top-up for your baby, as they get hungrier, rather than replacing actual milk feeds.

    - Beyond 8 months solids can be offered before milk feeds and can replace some milk feeds in the day, eg lunch.

    - Babies need protein and iron in their diet from 6 months onward. This helps them feel full enough to sleep well at their lunch nap and overnight. (Breast milk does not contain iron and the iron stores that the baby had from birth are now depleting at 6 months) 

    - Protein should be given at the lunch meal only until your baby is over 10 months old, when you can introduce it at dinner. The reason for this is that protein at dinner in a baby younger than 10 months can cause night waking as their body tries to digest the protein while they’re lying down and their digestive system has slowed.

     

    Things to remember:


    Solids WON’T make your baby sleep through the night straight away - they’ll be taking so small an amount to begin with it will take a while for their solids consumption to increase and have a knock-on effect with their night sleep. If your baby is starting later on solids or doing baby-led weaning you can expect them to still wake in the night for milk feeds until their solids amount increases.

    Tanking your baby up on solids at dinnertime won’t help them sleep through the night either, in babies younger than 10 months. They will still need a decent milk feed before going to bed and if they have too many solids they will refuse the milk and might wake in the night needing a milk feed. For babies younger than 10 months, lunch is the most important solids meal of the day.

    If your baby is close to 6 months old and you haven't started them on solids, they may start waking more in the night out of genuine hunger. This is a sign they now need solid food and additional protein in their diet.

    Once "established" on solids, which means your baby is taking at least half a cup at any particular meal, you can let them dictate how much they'll eat. Don't stop feeding them because you feel they've had enough. They'll take as much as they need and are far better at regulating their calorie intake than we are as adults!

    Solids can cause constipation in some babies, especially if they are taking a lot of solids very early on - their digestive system needs time to adapt to digesting something other than milk. You should always keep note of when your baby poops and what their poop is like. If your baby is struggling to poop you should reassess what solids you've given them recently and go back to a food that didn't affect their bowels. Pear is a good choice in this instance. Banana and cheese are common causes of constipation in young babies, despite being popular foods. Always talk to your healthcare professional if you are concerned about your baby's bowel movements.

    *This article is not intended to be used in place of medical advice by your healthcare professional. Please always seek medical advice if you are concerned about your baby's feeding.

     

    Sources:

    World Health Organisation

    Australian Family Physician

    The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

    American Academy of Allergy, Asthma and Immunology

    European Food Safety Authority

    Dietitians NZ

     

    SETTLING TECHNIQUES

    SETTLING TECHNIQUES

    SETTLING TECHNIQUES

    Despite words like “self-settling” and “sleep training” and “bad sleep habits” being thrown around in the direction of mums, the fact of the matter is that young babies very often need help to settle to sleep. There is NOTHING WRONG with this and up until around 3 months of age the way your baby falls asleep will have little to no impact on their ability to stay asleep (as it does in older babies). Prior to 3 months old you are NOT going to ruin your baby’s sleep for the rest of their lives by helping them to settle.

    Young babies get overtired and overstimulated very easily. We always recommend having your baby in a good Sleeping and Feeding Pattern to ensure they have the best chance to sleep at the right biological times, because a baby who isn't ready for sleep or is already overtired will be VERY hard to settle no matter what you do.

    Here are some ways to assist your little one to fall asleep in the early days.

    (Please bear in mind that at around 4 months babies do need to be able to self-settle in order to sleep well during day naps and through the night).

    Swaddling:

    Using a tight swaddle for babies under 4-5 months old is a crucial element in your baby settling and sleeping well. Swaddling replicates the tight, confined feeling of being in the womb and ensures babies can’t wake themselves up with their startle reflex. It is quite common that people assume their baby doesn’t like being swaddled, but more often than not, this is simply because the swaddle isn’t tight enough, the baby is already overtired or overstimulated, or they are too hot or cold. Persevere with it! In general, babies prefer to be swaddled. 

    We recommend the following swaddles:

    Movement:

    Movement is a really effective tool, especially if your baby is overtired or unsettled. They are used to a lot of swaying and jostling in the womb, so replicating this movement is a great way to calm them down. This is why many babies find it so easy to sleep in the car or stroller.  Using a rocking bassinet, baby hammock or a baby swing are effective ways to use movement to settle your baby. Likewise a baby carrier or stretchy wrap is another great option.

    Patting/Tapping:

    Instinctively when we are comforting a baby we pat their back or tap their bottoms. This is actually mimicking the heartbeat sensation they would have been exposed to constantly in the womb, and in fact, when baby was in the birth position (head down) mum’s heartbeat would have been able to be felt near baby’s bottom!  

    White noise:

    This is very important for young babies but it also definitely also helps older babies settle and sleep for longer too. White noise replicates the loud whooshing sounds babies hear in the womb, sounds that are louder than a vacuum cleaner in utero. Hearing loud white noise triggers the calming response in babies, especially if they are overtired, overstimulated or crying. White noise also disguises any noises from the household which might startle or wake a sleeping baby. When babies reach around 4 months and start waking between sleep cycles, their senses fully switch on. Having white noise playing means they are hearing the same comforting sound they heard when they fell asleep and they’ll find it easier to transition between sleep cycles.

    Shushing:

    Similar to white noise, shushing replicates the loud whooshing sounds your baby heard in utero. For shushing to be effective, we recommend placing your mouth close to baby’s ear and doing loud ssshhhh sounds, rhythmically, in their ear. This can be combined with patting for maximum effect. Or you can use a Baby Shusher.

    Sucking:

    This includes nursing or feeding your baby and the use of a dummy, which can be a really effective tool to help young babies settle and sleep. The desire to suck is very strong in babies and they find sucking incredibly calming.  If you’re going to use a dummy you do need to decide whether you’re prepared to go the distance with it.  This can mean a few frustrating months of having to replace the dummy each time it falls out once your baby reaches around 3-4 months old, however from 7 or 8 months onward babies can begin to learn to replace it themselves.  Alternatively you can use the dummy for the first few months and as long as you ditch it by around 3.5 months your baby shouldn’t have developed too strong a sleep association with it.  

    The winning combination - side-settling method:

    The most successful settling strategy for young babies is combining the above methods. This is especially effective for an overtired, overstimulated or crying baby. We recommend this as the best way to settle your baby to sleep (prior to 3 months), as it is helping teach them that their bed is where they fall asleep - something that will be very valuable to their sleep habits in the long term.

     Here is what you’d do:

    1. Swaddle baby tightly
    2. Put her in a completely dark room (babies find the dark SUPER calming and it promotes the production of melatonin - one of the hormones responsible for sleep)
    3. Play loud white noise or use a Shusher
    4. Put baby in her bassinet and roll her onto her side, supporting her tummy with one hand. A Snoozzz Babywrap can help with this.
    5. With the other hand, rhythmically pat (quite forcefully) her bottom in an upwards motion
    6. At the same time, if possible, rock the bassinet in a rhythmic motion
    7. Once asleep, roll your baby onto their back to sleep

     

    Side Settling Video: 

     

    You might need to keep side-settling for a while, depending on how overtired your baby is, however if they are ready for sleep they should fall asleep quite quickly with this method. Once asleep, roll baby onto her back for safe sleeping practices.

     

    THEN TIPTOE OUT OF THE ROOM LIKE A HIGHLY TRAINED NINJA.

    Once your baby is asleep, make a beeline for the couch, have a nice cuppa and some TV time mama, you deserve it xx 

    THE 4 MONTH SLEEP REGRESSION

    THE 4 MONTH SLEEP REGRESSION

    There is a lot of talk about how a baby’s sleep dramatically changes around the 4-month mark. You might have had an awesome sleeping newborn and suddenly they’ve started waking a lot more in the night and catnapping in the day. 

    Sound familiar?!

    This is commonly called the 4-month sleep regression; however, it is better not to think of it as a regression but more of a maturation of your baby’s neurological development. Their brains are developing and their sleep is becoming more like ours as adults.

    An adult sleep cycle goes through periods of deep sleep and periods of REM sleep. REM sleep is a lighter sleep where we dream and are more likely to be woken if something is different or bothering us in our environment. Our deep sleep is where we are unlikely to be woken. Adult sleep cycles are about 100 minutes long, then we rouse slightly and fall back asleep again, into the next sleep cycle without even realizing it.

    Young babies are a bit different. They have periods of active sleep and periods of quiet sleep. Active sleep is what the baby enters straight after falling asleep, this is like REM sleep in adults and they can be easily woken during this time. They breathe shallower, can grunt, cry out and if anything is bothering them they are easily woken. During this phase your baby is likely to wake if they went to sleep in your arms and you put them down. After active sleep they enter quiet sleep - this is when breathing is more rhythmic and it is like the deep sleep stage in adults. A baby’s sleep cycle is about 45 minutes in total and if tired enough, if nothing is bothering them and have a full tummy, babies under 3 months will rouse between sleep cycles but then enter into another 45-minute cycle of active through quiet sleep until they have had enough restorative sleep and wake up.

    After 3 months babies go through a massive development in their sleep cycles and they don't drift from one to another so easily. By four months they actually wake completely at the end of a sleep cycle and need to consciously try to go back to sleep. This wakefulness is the part that is referred to as the “four-month regression”.

    In babies 0-12 weeks, the way your baby goes to sleep at the start of their nap will have little impact on their ability to stay asleep longer than one sleep cycle; you're not going to "spoil" your baby or ruin their sleep if you are rocking or settling your baby to sleep in those first few months, despite what some old wives tales say! However, sleep habits are very easily formed in babies older than 3 months. The way we put these babies to sleep will dictate how they learn to go to sleep in this new phase of their development. We refer to this as creating “sleep associations”; cues or behaviours your baby associates so strongly with going to sleep that they can’t sleep without them. The most common sleep associations for babies are feeding, rocking or patting to sleep or the use of a pacifier (which can be a real pain in the butt until they learn to replace it themselves at around 8 months of age!).

     The 4 month regression affects babies in this way:

    • sleep is becoming a conscious activity for babies at this age - I like to think of it as "they won't just fallasleep anymore, they actively need to go to sleep"
    • therefore they need to re-learn how to do it now that their brains are treating sleep a bit differently from when they were younger
    • the way babies are put to sleep or go to sleep at the start of a nap or at bedtime is the only way they learn how to go to sleep
    • if they then wake at the end of a sleep cycle, 45 minutes later, they will need to go back to sleep the same way they fell asleep
    • if that same way of going to sleep isn't there or can't be replicated by them alone, they will not be able to go back to sleep without it
    • this is why, if you fed, used a pacifier, rocked or patted your baby to sleep at the start of the nap or at bedtime, your baby might now be waking every 45 minutes in the day and 1.5- 2 hours in the night and needing your help to go back to sleep
    • if your baby is relying on any parent-controlled sleep associations, they are not going to be able to self-settle, resettle during naps in the day or sleep through the night from around 4 months onwards.

    And this "sleep regression" won't go away... Unlike the 8 or 12 month sleep regressions, which are all linked to measurable periods of development, the 4 month regression/progression is the only one your baby won't simply "grow out of" unless they are no longer relying on you to actively put them to sleep.

    So, the best way to tackle this stage in your baby's development is to foster good sleep habits from early on, rather than have to try and change any parent-controlled sleep associations like rocking or patting down the track. Giving your baby the chance to learn to self-settle is a crucial element in getting through this stage of disrupted sleep. The Little Ones Sleeping and Feeding Patterns are the best place to start because your baby will be good and ready for sleep when you're trying to put them down, making it a lot easier for them to go to sleep on their own. 

     A few more good sleep habits you can be fostering are:

    • sleeping your baby in a totally dark room to allow the release of the sleep hormone melatonin. Black out blinds are an easy and inexpensive way to darken a room. Use them in the nursery or kids bedroom or take with you when traveling to use in a hotel room or other temporary accommodation.
    • use white noise for the duration of your baby's naps and overnight as a positive sleep association
    • use of a swaddle in babies under 5 months can help them resettle between sleep cycles
    • teach your baby to replace their own pacifier if over 7 months.
    • allow your baby to sleep in their own bed for their daytime naps as they will learn to associate their bed with sleep and this will help them settle and resettle easier during the night in their own bed
    • always give your baby the chance to resettle themselves if they wake between sleep cycles - rushing in and assisting them straight away is not giving them the chance to practice this new skill!

    NAPPING

    NAPPING

    It is true that babies need a lot of sleep, however their sleep needs change very rapidly so it is important you know just how much sleep your littlie should be having. 

    In our work with mums and dads whose babies just want to party all night long, very often the only thing “wrong” is either that their baby has had too much day sleep or hasn’t had enough!  Undertiredness and overtiredness are the biggest contributors to poor napping. It’s actually all rather scientific:

    Babies need a delicate balance of day sleep vs night sleep – too LITTLE day sleep results in cortisol (a stress hormone) building up in your baby which will make them harder to settle and also lead to night waking or early morning waking. Cortisol triggers the “fight or flight” function in babies and is like adrenaline coursing through their bodies…Impossible to sleep well under those conditions! Equally too MUCH day sleep can also lead to a lot of night waking and your baby being unsettled overnight because they just need some awake time.

    To put it simply, we need to look at the whole 24 hour period. Babies have a specific amount of sleep hours they can do in 24 hours, based on their age. If your baby is doing a lot of these sleep hours during the day, of course they will sleep less at night. The goal is to find the right balance.

    And the balance is constantly changing as your baby gets older. It is governed by two things: awake times and nap lengths.

    AWAKE TIMES

    This is the chunk of time your baby is awake for between each sleep (including feeds). If a baby’s awake times are a little too short between naps they won’t be tired enough to nap properly at the right times – this can mean they struggle to fall asleep for naps and at bedtime (because they’re not tired enough), and, if they do fall asleep, they’ll only sleep for a short time. Something we see very regularly is parents seeking our assistance because they can’t get their baby to fall asleep, assuming their baby is OVER tired, when actually their baby is UNDER tired.

    The opposite of undertiredness is overtiredness; keeping your baby up for too long between naps will mean they are just as hard to settle. Remember the cortisol hormone from earlier? It rears it’s ugly head if a baby is really overtired, which, completely unjustly, means your baby will then sleep worse as a result of their overtiredness. Waking after 45 minutes at bedtime, frequent night waking or early morning waking can be directly linked to a build-up of “sleep debt” during the day due to too much awake time and not enough nap hours. Which brings us to:

     

    NAP LENGTHS

    Once you’ve got awake times sorted, you need to look at the second part of the equation, nap lengths, and check that your baby is having the right amount of nap hours to lead to a well-rested baby who wants to sleep well at night. Here is a guide to help you (allowing for 12 hours overnight):

     

    Age

    Daytime cumulative nap hours

    2-3 weeks

    5 ½  hours across 3 sleeps

    3-5 weeks

    5 hours across 3 sleeps

    5-7 weeks

    4 ½  hours across 3 sleeps

    7-9 weeks

    4 hours across 3 sleeps

    9-12 weeks

    3 ½  hours across 3 sleeps

    3-4 months

    3 ¼ hours across 3 sleeps

    4-6 months

    3 hours across 3 sleeps

    6-9 months

    2.5 hours across 2 sleeps

    9-12 months

    2-2.5 hours across 2 sleeps

    12-24 months

    2 hours across 1 sleep

     

    As well as meeting the total allocation of nap hours, the way those hours are divvied up is just as important. It is physiologically better for babies and toddlers to get a good chunk of sleep in one consolidated nap around midday when all humans have a natural dip in their energy levels (from 12-2pm). A long nap at this time is most beneficial to your baby's 24-hour sleep log, so if a baby sleeps for too long in their morning nap and then doesn't have a long enough nap at midday, they will be going into the afternoon and then bedtime with a greater build-up of sleep debt/overtiredness.

    What we commonly see in babies over 3 or 4 months old is catnapping – sleeping for only one sleep cycle at a time. This is a developmental occurrence at this age (called the 4 month sleep regression) and while some of these babies will still be meeting their cumulative daily nap hours through several 45 minute naps, they don’t have the chance to catch-up on that restorative sleep and will still be in quite a lot of sleep debt come bedtime. If your baby is in this category, helping them learn to self-settle is your best line of defence against catnapping.

     

    So to gel together awake time vs nap time, here comes the sometimes contentious part…waking the baby. While it might seem very counter-instinctive (or downright mean) to wake a sleeping baby, we do advise doing it if your baby is at risk of having had too many daytime sleep hours, or of sleeping for too long in the morning nap which will mean their lunch nap is consequently shorter, or if they're sleeping too late or long in the afternoon which will have a negative impact on their bedtime settling and night time sleep.

    For day sleeps, where possible, put your baby in their own bassinet/cot with their appropriate sleep associations/tools - SwaddleBaby Sleeping Bags, White Noise, Comforter and Dummy. It is also good to do some naps in a front pack or carrier or a stroller so it gives you the freedom to get out of the house and your baby will get used to sleeping in a different place. 

    For day sleeps, we’d recommend using blackout curtains to achieve a nice dark room. This will not confuse your baby that it is night time, but it will ensure they settle easier and sleep better than being in a bright room.  

    Whether or not you are using one of Little Ones Sleep Programs, it is sometimes helpful to wake your baby from their naps if required, to ensure they don’t sleep for too long or miss any feeds. This is especially important for younger babies. This helps ensure your baby won’t have had too much day sleep, which will lead to a better night.

    It’s a  balance. And sometimes it is really tricky to get it right. Take the guesswork out with the Little Ones Sleeping and Feeding Patterns.

     

     

    CRYING OVER SPILT MILK....... WHAT IS REFLUX?

    CRYING OVER SPILT MILK....... WHAT IS REFLUX?

    Reflux is when the contents of the stomach (milk) comes back up the oesophagus (food pipe) instead of being digested, however it’s not just the stomach contents that comes up; it also comes up with stomach acid. This milk and acid mix regurgitates up the oesophagus and sometimes out the mouth.

    It is the acid that causes the pain as it burns the oesophagus and throat. In severe cases the lungs and ears are also affected by the acid being breathed into the windpipe and into the lungs, which is very serious and can cause permanent damage. Not to mention a very very very distraught baby (and mother, speaking from experience).

    The difference between “normal reflux” (Gastroesophageal reflux) and “silent reflux” (Laryngopharyngeal reflux) is that in cases of silent reflux you don't see the milk actually spill out the mouth. The milk and acid comes up the oesophagus and goes back down. Please note, not all babies that spill have reflux. There is a big difference between reflux and a happy chucker. Happy chuckers are babies that are spilling milk but completely happy about it (and this is totally normal!)


    How can you tell if your baby has reflux?
    Signs of mild reflux: crying after burping/winding, spilling or spitting up (but this is not always a sign of reflux), taking a long time to settle to sleep, once settled waking after 10 minutes or so, snack feeding or refusing to feed, not swallowing properly, tiny bubbles around baby’s mouth, baby prefers sleeping upright over shoulder, crying in capsule or sometimes also front pack, frequent hiccups, catnapping, not being able to burp properly, random bouts of very painful cries, frequent colds and ear infections.


    Signs of severe reflux: bad breath, no weight gain or loss of weight, hoarse voice, apnea (stopping breathing), lying awake in the middle of the night for no obvious reason, not taking a bottle due to pain of swallowing, choking, arching back, only feeding well when sleepy or asleep, crying when lying down or changing nappy.

    Now this is where it gets confusing…


    Signs of an overtired or overstimulated baby with NO reflux:
    Crying, taking a long time to settle, once settled waking after 10 minutes, cluster feeding, prefers sleeping on mother, random crying, catnapping, not being able to burp properly due to being too tired, laying awake in the middle of the night, arching back, feeding to sleep.


    Overtiredness and overstimulation in babies is actually often misdiagnosed as reflux. Especially seeing as the preliminary GP diagnosis is based on your observations of your baby rather than any testing. Too often babies end up being put on reflux medication unnecessarily, when all they really needed was for their napping and feeding to be more structured according to their age.


    The only way to rule out overtiredness and overstimulation is to have the baby sleeping as well as they possibly can. This is by far the easiest to do on a good Sleeping and Feeding Pattern.


    Causes of reflux:
    1. An immature stomach valve: the valve at the top of the stomach is meant to keep things down once eaten, however in babies they often have an immature valve which allows the contents of the stomach to come back up. This is the most common reason for reflux in babies. As the baby grows older and becomes more upright and sitting, the muscles at the top of the stomach generally close the valve and the reflux will go. If reflux continues past the sitting stage, once the baby is walking, most children will not have symptoms anymore.


    Until the valve matures, most babies will simply spill up some milk after a feed. It can look like a lot of milk that gets brought up, but try this experiment: spill a teaspoon of milk on the counter… You’ll be surprised how much milk it seems is spilt! If the baby does spill an entire feed, this is called possetting.


    1. Underlying allergies or intolerances:A baby that has allergies such as dairy or lactose intolerance will have reflux, but the reflux or vomiting is caused by the body not being able to tolerate the allergen. The baby will regurgitate and vomit the contents back up with acid. This can be why breastfeeding mothers are often advised by well-meaning friends to avoid dairy if their baby has reflux, however please note: most reflux in babies is caused by an immature stomach valve and not a dairy allergy. Please ONLY avoid dairy if you have been advised to do so by a health professional.

    2. Eosinophilic Oesophagitis (rare): this mimics reflux with a lot of the same symptoms, especially pain when feeding, difficulty swallowing and choking. This is however an immune response to certain food groups, which causes the oesophagus to be inflamed and painful which makes it very hard to swallow. Common among babies will allergic parents.


    Diagnosis of reflux:
    Diagnosis is often done by the doctor on symptoms explained by the parents. If you think your baby has reflux it's a good idea to write down as many of the signs listed above that your baby may have. Babies who have reflux often are very happy when distracted, people including doctors, may not believe that they are in much pain. It is a good idea to take a video of when they are having an episode to take along for your appointment.


    There are a few diagnostic tests that can be done: Barium swallow series, PH probe and Upper GI Endoscopy.


    How to treat reflux:
    The first and most important thing is to have a good Sleeping Pattern in place; this will highlight if your baby has any problems caused by reflux. Often people believe their baby has reflux because they are crying a lot, it can be that they are simply overtired and overstimulated.


    Keep the baby as upright as possible when awake. This can be done in a bouncer, baby chair or lying in a feeding pillow. Tilting the head-end of the cot for sleeping is also a good option.


    Avoid pressure on the baby’s stomach. Unless you are doing “tummy time” babies with reflux will not like pressure on their stomach as it brings up more acid. This includes tight baby carriers.


    Dummies - These can help soothe the baby by aiding them to swallow saliva which may be enough to wash the acid down and help with the pain.

    Natural Remedies - These can also help soothe your baby Rhuger Mixture, Dr Browns Bottles, Baby Wedges and Baby Nests.

    Prescribed medications - Gaviscon, Losec or Omeprazole are the common medications prescribed with reflux to neutralize the acid in the stomach for babies that don't respond to the above treatments. These medications don't stop the milk coming up and the baby spilling, but they do stop the pain from the acid burning the oesophagus.  


    Other investigations: If prescribed medications aren’t stopping the pain from reflux or the reflux is becoming worse, referral to an allergy specialist may be needed, for investigation into diary, other intolerances or eosinophilic oesophagitis.


    Definitely contact your GP if your baby is not feeding, is losing weight, is more unsettled than normal or you suspect they have reflux.