Tag Archives: Ann Caird

The role of light and dark in good baby sleep.

Ann Caird, postnatal Doula and infant sleep consultant

Ann Caird, postnatal Doula and infant sleep consultant

Our periods of sleep and wakefulness are regulated by our internal biological clock. Without the influence of external cues such as light, dark and social cues like mealtimes (known as zeitgebers), it is suggested that our biological clocks would function to a 25 hour day. The most important and influential zeitgeber that keeps us on our 24 hour daily cycle is natural light; when light fades and darkness falls the pineal gland secrets the sleepy hormone melatonin which naturally prepares our bodies for sleep and keeps us sleepy. Daylight suppresses melatonin secretion, so helps us stay awake.

William Dement  provides a fascinating history of the role of light in regulating sleep. In a nutshell though – throughout history and until fairly recently, our internal clocks and our daily lives were regulated by natural light – the rising and setting of the sun; so we worked in daylight and slept in darkness. A fire or oil lamp may have served to lengthen the day a little, but the red/orange glow of these light sources was not enough to suppress melatonin secretion and interfere with our biological clocks. However, the structure of our days changed with the invention of electric light bulbs – our days can stretch well into the night now with the influence of artificial light! Lights, computers, televisions used in the evening can all delay the production of melatonin, and so delay the onset of sleepiness.

All this is relevant when establishing baby sleep. A baby’s biological clock starts to develop at around 2-3 months and is working pretty well by 4-5 months of age. By exposing their babies to natural daylight in those early weeks and months parents can support and encourage the development of the biological clock and its associated role in regulating the sleepy hormone melatonin.

Some practical tips for using light and dark to encourage your baby or child to sleep well:

  • It’s suggested  that exposing young babies (6 – 12 weeks) to natural daylight between 12 and 4pm helps establish good night sleep.
  • Support the wind down to sleep by keeping the lighting low an hour before your child’s bedtime.
  • Use blackout blinds to keep the bedroom dark and prevent street lights, car lights or light summer mornings stopping the flow of melatonin!
  • If you need to use a night light, keep it very dim or consider using a blue or red/yellow tinted bulb (remember the red/orange glow of the fire?)
  • Expose your child to natural light first thing in the morning to trigger wakefulness and to help him keep his biological clock ticking efficiently.
  • Finally – Televisions and computers are best kept out of children’s bedrooms!

Sources and Further Reading:

Dement, W; (2000). The Promise of Sleep. London: McMillan

Karp, H. (2012). The Happiest Baby Guide to Great Sleep. New York: Harper Collins.

 Daylight Aids Baby SleepBBC News, 22:11:04

 

Disclaimer: The purpose of this article is to inform and not for medical diagnoses or treatment. Please contact a health care professional if you have concerns about your child’s health.

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Rye Mind Body Spirit Fayre, 2012.

Rye Mind Body Spirit Fayre, 2012. Saturday 17th and Sunday 18th March, Time: 11am – 5pm.

Admission: FREE!!

Venue: Rye Community Centre, Conduit Hill, Rye, East Sussex; TN31 7LE.

This is a great opportunity to meet a diverse range of alternative, holistic and spiritual therapists, practitioners, artists and musicians. There’s a wonderful programme of workshops including yoga, dance, Qi Gong Tai Chi.. and loads more!

Ann Caird will be there talking baby sleep, colic calming techniques and promoting her Baby Sleep workshops.

Check out the website for more information and the full programme of workshops Rye Mind Body Spirit Fayre, 2012.

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Bedtime Routines: The Key to Sound Baby Sleep!

Ann Caird, postnatal Doula and infant sleep consultant

One of the easiest ways to help your little one sleep well is by establishing a relaxing bedtime routine. Babies and toddlers naturally enjoy routines – and establishing a consistent bedtime routine from about 3 months of age can have huge benefits for you and your baby throughout her childhood!

A well planned, relaxing bedtime routine ‘sets the scene’ for sleep. Research has demonstrated that establishing a consistent bedtime routine can reduce the time it takes for babies to fall asleep and decrease night wakings. But that’s not all – a routine can help prevent bedtime battles later in childhood because once established, it provides valuable wind-down time and clear, predictable steps to bedtime which communicate that it’s nearly time to sleep.

Top bedtime routine tips:

  • Reduce activity levels and encourage quieter play after tea and before the bedtime routine starts.

 

  • Plan a routine that works for you; one that you know you can manage and maintain consistently.

 

  • Keep it simple, about 30-45 minutes; for example bath, massage, into comfy nightwear, feed/drink, picture book/story, cuddles, lullaby….

 

  • Include massage; massage is relaxing and calming. It prepares your baby for sleep and it will help her associate her feelings of calmness and relaxation with sleep and her cot.

 

  • Think about context; start your routine in the bathroom and complete it in the bedroom, keep lighting low. Low lighting and darkness triggers the release of oxytocin and the sleepy hormone melatonin that helps to calm the brain.

 

  • Avoid feeding your baby to sleep; ensure feeding isn’t the last stage of your routine. Put your baby into the cot drowsy, relaxed and calm ready to fall asleep by herself.

 

  • Use a shorter version of your bedtime routine for daytime naps; nappy change, into sleep clothes (comfy sleepwear = comfy sleep!) drink/feed, book, cuddle and into the cot to settle to sleep.

 

  • Consistency is key! Little ones thrive on familiar, predictable routines, because routines communicate to them what it’s time to do and what’s happening next. So, your relaxing bedtime routine will help your little one feel emotionally safe and secure; feelings of emotional wellbeing at bedtime is the foundation of happy, sound sleep!

 

Further Reading:

Mindell, J, Telofski, L., Wiegand, B and Kurtz, E. A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood.  Sleep Vol 32; No 5. 2009.

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Unravelling the Swaddling Issue

Ann Caird, postnatal Doula and infant sleep consultant

This month Ann focuses on the issue of infant swaddling. For new Mums this can be a contentious issue with well meaning advise coming from all angles. We hope that Ann’s article can help to add some rationale and evidence to the swaddling debate. 

There is so much research indicating both positives and potential risks of swaddling associated with health and SIDS that no wonder parents end up confused! So, let’s look at the benefits, potential risks and related recommended guidelines associated with swaddling according to relevant research and the ISPID

Swaddling has been widely used as an infant care practice since ancient times and although the practice declined in Europe during the 20th century, it’s becoming increasingly popular again. Why? Well, it has the great benefit of reproducing the safe, confined womblike conditions the newborn baby has just left! Swaddling helps a new baby feel safe, secure and comforted, and further, a swaddled baby startles less… As all new parents know, new babies can often startle and disturb themselves due to their startle (or moro) reflex which is present from birth and evident throughout the first few months of life. So, swaddling helps to calm babies, induce sleep and increase sleep duration and overall, swaddled babies cry less which impacts positively on the parent-child relationship. Further, premature babies demonstrate improved neuromuscular development, better motor organisation and less physiological distress when swaddled.

There are though potential health risks associated with swaddling. While many would believe that restricting a baby’s motor activity could be detrimental to reaching motor developmental milestones such as walking and crawling, there is no research evidence to suggest this. However over tight swaddling carries potential risks. Tight swaddling around the baby’s hips may put the baby at risk of developmental dysplasia of the hip; tight swaddling around the chest may increase the risk of respiratory infection, and there is also a risk of swaddled babies overheating. These potential risks can be reduced by following recommended guidelines for swaddling.

What about swaddling and SIDS? Well, swaddling can be protective against SIDS if babies are swaddled and placed on their backs (supine position) to sleep; it restricts motor activity so reducing the chance of babies covering their head and face with bedding, and it’s also effective in helping parents keep their baby sleeping in the safe Back to Sleep position. Placing your baby prone (on tummy) to sleep increases the risks considerably. There has been concern regarding the possible association between swaddling and suppressed arousal, although evidence clearly demonstrates that swaddling and supine positioning decreases SIDS risk more than using supine positioning unswaddled due to the above described potential hazards. A recent influential study (abstract) highlights the importance of familiarity with swaddling and routinely swaddling from birth; a decrease in arousability and cortical arousal was demonstrated in 3 month old infants who were unfamiliar with being swaddled… coinciding with the peak age for SIDS.

Bearing in mind the risks then, here are recommendations for safe infant swaddling.

  • To prevent overheating, use light cotton materials for swaddling and avoid covering your baby’s head; refrain from swaddling if your baby is unwell and has a temperature.
  • Swaddle with your baby’s hips and knees in a neutral position, and wrap so legs have room to flex.
  • Avoid over tight wrapping; keep it snug so it doesn’t become loose but doesn’t restrict breathing.
  • Always place your baby on her back to sleep, never on her tummy. Recommendations suggest discontinuing swaddling at about 3 months or when your baby starts to roll onto her tummy.
  • Swaddling routinely from birth is safest; avoid starting to swaddle in later infancy particularly around the age of 3 months; always inform secondary care givers of your baby’s sleep routines, habits and environment.
  • Swaddle for sleeping times and when your baby is unsettled, always allow swaddle free times for play, movement and kicking!

 

Sources and Further Reading.

Horne, R. ISPID Physiology Working Group. To Swaddle or not to Swaddle?

Richardson, H., et al. Influence of Swaddling Experience on Spontaneous Arousal Patterns and Autonomic Control in Sleeping Infants. J Pediatrics. 2010 Jul; 157 (1):85-91. Epub 2010 Mar 15.

Safe Swaddling and Healthy Hips: Don’t toss the Baby with the Bath Water

Van Sleuwen et al, Swaddling: A Systematic Review. Pediatrics 2007; 120;e1097. DOI:10.1542/peds.2006-2083

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Cow’s milk allergy and infant sleep

Ann Caird, postnatal Doula and infant sleep consultant

Fussiness, sleeplessness and persistent crying in babies and young children is exhausting and distressing for all concerned. When all else has failed, it’s worth considering the possibility that your little one could have an allergy to cow’s milk protein. The proteins can be consumed by infants from formula, solid food or passed through breast milk. The symptoms of cow’s milk allergy are easily confused with – or even mistaken for – colic. Research abstract suggests a strong relationship between cow’s milk allergy and difficulty settling to sleep and staying asleep, the infant wakes frequently and cries repeatedly throughout the night, is fussy and irritable, and the total sleep hours each day can be minimal. Further symptoms that also impede sleep include eczema, skin irritations, gastrointestinal problems and breathing difficulties. The good news is, however, that research abstract demonstrates that eliminating cow’s milk protein results in a return to normal sleep for most infants, and in most cases the allergy resolves itself within 12 to 36 months. So, if cow’s milk allergy is suspected then an elimination diet is usually advised for 2-4 weeks. This means avoiding all dairy in foods, a change of formula and/or eliminating dairy from a breastfeeding mother’s diet. Its worth noting though, that many babies sensitive to or allergic to cow’s milk will be sensitive to goats and/or sheep’s milk, and possibly soya. Other foods that may affect sleep, or induce food allergy insomnia, include soya, wheat, eggs, nuts, chocolate, corn, yeast and red and yellow dyes.

Resolved the allergy but still experiencing poor sleep?

If an infant has had sleep difficulties related to food allergies for a while, then poor sleeping habits may have become habitual. In this case, helping develop self soothing skills, appropriate sleep associations and healthy sleep habits is well worth while, and could result in everyone gaining some much needed sleep at last!

Resources and Further Information.

Kahn, A., et al. (1989). Milk Intolerances in Children with Persistent Sleeplessness: A Double-blind Crossover Evaluation. abstract Paediatrics, 84, 595-603.

Zeretzke, K. Allergies and the Breastfeeding Family: Cow’s Milk Tops the List. New Beginnings, 1998, Vol 15, 4, 100.

Bonyata, K. 2010. Dairy and other Food Sensitivities in Breastfed Babies: Dairy Sensitivity in Babies

Anns new web site can be found by clicking here.

Disclaimer: Doulas and Peer Supporters are not medically trained, so do not diagnose or medically advise. Information provided is to inform parents, and complement but not replace that of a medical professional.

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Managing Reflux and the Happy Spitter!

Ann Caird, postnatal Doula and infant sleep consultant

My previous post considered the symptoms of the Happy Spitter and those of Gastro-Oesophageal Reflux. Now I’ll suggest some practical measures and strategies which may be useful in reducing and managing spitting up and GORD alongside medical treatments.

How Long does Reflux Last?

Usually the Lower Esophageal Sphincter (LES) tightens naturally over time reducing reflux and spitting up naturally. Developmental milestones may also impact on reflux; once a baby learns to be more upright – sitting and standing – this can naturally reduce symptoms, the crawler, on the other hand may experience more symptoms.

So what can help?

Practical management strategies fall broadly into 3 categories; feeding, positioning and mother’s diet.

1. Breastfeeding and Human Milk

Breastfed babies tend to suffer fewer episodes of reflux than formula fed babies. Why? Not only is human milk a natural antacid, but is also easily digested so leaves the stomach faster than formula, consequently breastfeeding reduces the chance of reflux especially at night. Further, the action of sucking at the breast is beneficial – the sucking action stimulates muscular contractions in the gastrointestinal tract which helps to keep food down as well as stomach emptying. It’s generally suggested to aim for small frequent feeds, allowing the baby to finish one breast completely before switching sides so the baby takes a balance of both fore milk and hind milk to support digestion of lactose in the fore milk. If a large amount of fore milk is taken without the higher fat hind milk, the high lactose foremilk can ferment in the baby’s stomach and may resulting in wind, colic and/or reflux type symptoms.

Sometimes, oversupply or fast let down may exacerbate reflux, as can poor latch, so if this is suspected, seek good breastfeeding support which can help tremendously.

2. Positioning.

It’s a good idea to try to position your baby in a more up-right position, elevated on your arm if lying down or in a sitting position when feeding, and avoid unnecessary jiggling or handling after feeding, especially when burping. On the whole symptoms tend worsen when the baby lies flat, and parents find that their baby is more comfortable in an upright position, therefore some parents find slings or baby carriers useful. Also, reducing pressure on baby’s tummy by avoiding tight clothing can make babies more comfortable and reduce reflux.

While some parents find elevating the cot head helpful, research suggests this is not effective, and placing the baby in a semi-upright position in an infant seat at 60o incline and slumping can worsen reflux. Research does suggest though that left lateral lying can ease reflux symptoms because then the stomach opening faces upwards helping to prevent the stomach contents escaping. If using this position, ensure your baby isn’t able to roll onto his tummy while sleeping. The prone position is also helpful in reducing reflux; however, this is only recommended for when the baby is awake and can be monitored, and is not recommended as a sleeping position.

3. Mother’s Diet and Environmental Factors.

Consideration of the mother’s diet is useful. Some studies show a link between allergy / intolerance to cow’s milk in the mother’s diet, so eliminating this may be useful. Babies may also react to wheat, eggs or soya, so this is worth considering, but seek medical support if food could be an issue. Caffeine can be problematic too, as too much may have the effect of relaxing the LES, causing problems for the baby. Finally, eliminating the baby’s exposure to tobacco smoke will help if this is an environmental issue, as tobacco smoke is a significant contributing factor to reflux.

Some alternative therapies that may help babies with reflux include craniosacral therapy and cranial osteopathyl . The Australian Breastfeeding Association also suggest that the Bowen technique, homeopathy and reflexology can have good results as they relax and calm tense and distressed babies.

Sources and Further Reading:

Aaron, et al, 2002. A Systematic Review of Nonpharmacological and Nonsurgical Therapies for Gastroesophageal Reflux in Infants. Archives of Paediatrics and Adolescent Medicine, 2002; 156: 109-113.

Analytical Armadillo (2010). Foremilk/Hindmilk…  and a lot of Confusion!Australian Breastfeeding Association, 2008. Gastro-oesophageal Reflux and the Breastfed Child (booklet) Available from the ABM

Barmby, L. (1998) Breastfeeding the Baby with Gastroesophageal Reflux

Bonyata, K.  Spitting up and Reflux in the Breastfed Baby

Bonyata, K. Forceful Let down and oversupply 

Knorr, S. (2003) Gerd and the Breastfed Baby

My baby has reflux. Can I still breastfeed him?

Tobin, J., McCloud, P., and Cameron, D. (1997) Posture and Gastro-oesophageal Reflux: a Case for Left Lateral Positioning.Archives of Disease in Childhood, 1997, 76; 254-258.

For an excellent critical analysis of reflux, diagnoses and treatment, see Reflux – Broken Babies or Profitable Product?

ABM Breastfeeding Helpline: 08444 122949

Anns new web site can be found by clicking here.

Disclaimer: Doulas and Peer Supporters are not medically trained, so do not diagnose or medically advise. Information provided is to inform parents, and complement but not replace that of a medical professional.

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A ‘Happy Spitter’… or could it be GORD?

Ann Caird, postnatal Doula and infant sleep consultant

A common problem new parents often face is the issue of spitting up and reflux. Almost all babies spit up sometimes, but what’s normal, and when should parent’s suspect Gastro-Oesophageal Reflux Disease (or ‘GORD’ for short)? This post looks at the symptoms of GOR or Gastro-Oesophageal Reflux, which is normal spitting up, and GORD, Gastro-oesophageal Reflux Disease, where symptoms of reflux becomes troublesome, complicated and severe. Reflux generally occurs when the Lower Esophageal Sphincter (or LES) is weak, and so doesn’t prevent the stomach contents from flowing back up the oesophagus. GOR – The Happy Spitters! Whether they are bottle or breastfed, many babies naturally spit up or posset because their digestive systems are immature and stomachs very small. Spitting up often occurs if mum has an oversupply of milk, if milk let down is fast and forceful or if baby gulps and swallows air when feeding. Often in these cases good breastfeeding support can help reduce spitting up. Many healthy babies will grow out of spitting up by around 7 months, and most will have stopped by 12 months, as the LES matures and becomes stronger. So, if your baby spits-up, but is growing, gaining weight, generally happy and content and not uncomfortable when she spits up, then she is what doctors and paediatricians call a ‘Happy Spitter’. Usually, this is a laundry issue rather than a medical problem; however consult a health professional or medical practitioner if you have any concerns. Could it be GORD? On the other hand, a small percentage of babies suffer with Gastro-oesophageal Reflux Disease (GORD) which is very different from normal spitting up. These babies typically suffer pain and burning with when the acidic stomach contents travel back up the oesophagus. Symptoms include frequent spitting up and/or vomiting with discomfort, crying, gagging, frequent burping and wind, bad breath, poor sleep, arching of the torso, fussiness and sore throat. Feeding may be difficult, and result in poor weight gain or even failure to thrive. Babies who have Silent Reflux, may experience GORD symptoms but there will be no visible regurgitation or possetting making diagnoses difficult. The severity of GORD symptoms varies between individual babies and children, and medical involvement is needed for accurate diagnoses and treatment. Medical treatment usually includes infant gaviscon and/or H2 receptor antagonists. Again, good breastfeeding support may help to improve the situation. There are further practical measures and strategies which may help to reduce and manage both GOR and GORD and complement medical treatment; these I will address in my next post. Sources and

Further reading:

GER: What it is, What to do, FAQs.

Reflux Disease: Understanding Reflux

Spitting up and Reflux in the Breastfed Baby

Torgus, J. And Gortsch, G. (2007) The Womanly Art of Breastfeeding. (7th Ed) Plume.

What is Silent Reflux?

ABM Breastfeeding Helpline: 08444 122949

Disclaimer: Doulas do not diagnose or medically advise. Information is provided to complement and not replace that of a medical professional.

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