Tag Archives: Doula

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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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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Beat the BST sleep disruption.

Ann Caird, postnatal Doula and infant sleep consultant

As all parents know, getting babies off to sleep is a bit of a dark art at the best of times. Add to this the change in British Summer Time and all the old routines can be thrown out in a big way. Luckily, help is at hand… our baby and sleep expert Ann Caird is here to ease the BST sleep transition.

At the end of the month the clocks ‘spring forward’ an hour in keeping with British Summer Time. Adjusting to new times and losing an hour’s sleep can be very disruptive for little ones and may threaten your well planned schedules and routines. With a little forward planning though, the adjustment to BST can be made easier for all! Sleep experts suggest making changes to children’s waking/sleep times gradually in small steps, so start making changes a week before the clocks ‘spring forward’. The aim is to move your child’s day 15 minutes earlier every second day. To start then, if bedtime is normally 7.30pm and your little one wakes at 7am, bedtime becomes 7.15pm and waking time 6.45am. Do this for 2 days and move the day’s routines 15 minutes earlier as well. Then move the day forward another 15 minutes for 2 days, and repeat until you are putting your child to bed an hour earlier, which should coincide with the clocks ‘springing forward’ an hour early Sunday morning. Practical Tips for Success. Although there maybe some timings you can’t adjust, like nursery or playgroup times, try to keep your daily routine as consistent as possible during your ‘adjustment week’. The timing of mealtimes for example helps set children’s internal biological clock and sleep/wake cycles, so move your child’s mealtimes 15 minutes earlier too in relation to waking time and planned bedtime. Adjust naps according to wake-up time during the adjustment week. Try to avoid longer than usual naps – unless your little one is unwell or there is another reason for an increased sleep requirement. Start the bedtime routine 15 minutes earlier too and keep it consistent and predictable. The rituals you include within your routine help create feelings of security and emotional wellbeing for children by providing a predictable, loving wind-down to sleep. If your child enjoys favourite television programmes as part of the after tea or pre-bedtime routine, then think about recording some programmes in advance so you can continue to include them in routines during your adjustment week. Lots of outdoor play will promote sleep and reduce sleep latency, that is, help your child to get to sleep quicker! Babies may benefit more from an even more gradual adjustment period. So start about 10 days before the clocks spring forward and move your baby’s day forward by 10 minutes every 2 days.

Sleep well!!

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Doula?… What’s a Doula?

Ann Caird, postnatal Doula and infant sleep consultant

Following on from Ann’s first post on the subject of breast feeding she goes back to basics and explains the growing profession that is Doula…

Doula – pronounced ‘doola’ is an ancient Greek word meaning ‘caregiver or woman servant’. ‘Doula’ used today to refer to an experienced woman who is specifically trained to offer emotional, social and practical support to parents-to-be before, during and after childbirth. Although Doulas come from a variety of backgrounds, in our role as doulas we do not make medical diagnoses, advise or carry out clinical or medical tasks; we have a purely nurturing, supportive and empowering role.

Birth Doulas support parents during pregnancy and comforts, supports and reassures throughout labour and childbirth. The birth doula offers continuous support throughout labour helping to reduce stress, and can provide relaxation techniques such as massage. Research suggests that a birth doula’s presence can have many beneficial consequences for the parents and baby in reducing the need for epidurals and medical interventions, reducing duration of labour, decreasing the chance of caesarean section, and promoting breastfeeding. Doula trainer Valerie Goedkoop discusses the role of the Birth Doula.

Postnatal Doulas provide social, emotional and practical help which guides and supports mothers and families during the fourth trimester, or postpartum period. In effect, this support ‘mothers the mother’ and nurtures the family through the necessary transitions into its new roles and responsibilities.

Postnatal Doulas offer varied, flexible support to meet individual and family needs. We can also provide information and signpost parents to further support and services if required. Practical support may include cooking a meal, care of newborn, supporting breast or bottle feeding, and caring for older siblings while mum rests. This kind of help promotes the mother’s physical and emotional wellbeing, allowing her time to rest, enjoy and bond with her new baby. Doulas offer non-judgemental support; we support the new mother’s developing parenting instincts and skills thus empowering her in her new role. Our support can also help to reduce negative emotional and lifestyle factors such as stress, exhaustion, isolation and anxiety which may interact to increase the risk of postnatal depression. Central to the doula’s role is listening and ‘being’ which allows mothers to express, clarify and validate their feelings and emotions. We can recognise early symptoms of depression, support early diagnoses and thus encourage swift recovery.

Postnatal Doula support also has positive effects on breastfeeding. Research conducted by Nurturing Birth founder and doula trainer Valerie Goedkoop demonstrated that 88% of women who had a postnatal doula were still breastfeeding at 6 weeks, and 67% were still breastfeeding at 6 months. This compares with 21% at six weeks and only 7% at 3 months nationally, according to the Infant Feeding Survey of 2004 (Bolling et al, 2007).

The following websites provide more information and have facilities for finding local birth or postnatal doulas.

Doula UK the UK’s leading Doula organisation

Nurturing Birth the UK’s largest doula training organisation

Additional reading

Post Natal Doula & Preparation for Birth

Social support by Doulas during and after birth

The Doula and maternity care

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A big welcome to our latest health expert to join the panel; Post Natal Doula Ann Caird…

Ann Caird, Post Natal & Sleep Doula

I am very happy to announce that we have managed to get Ann’s regular input regarding all the things we should know but often get bad advise on regarding looking after the very small people in our lives; babies and toddlers…

Ann has extensive knowledge and experience in this area having graduated in Child and Youth studies followed by specialist training in Post Natal care, Breastfeeding and infant Sleep training. You can read more about Ann on Our Expert Panel page.

In her first post for 2011, Ann walks us though the importance of breastfeeding. With recent controversies being circulated in the news media her 10-top-tips and health benefits should help redress the situation.

10 Amazing Facts about Breastfeeding!

The World Health Organisation strongly recommends that babies are exclusively breastfed for the first 6 months of life to support optimal health, growth and development. Here are just a few of the many amazing facts about breastfeeding that support this recommendation.

1)    Human milk is easily digested by infants providing all the nutrients, hormones, enzymes and immunities to meet your baby’s requirements for optimal growth, development and health.

2)    Human milk contains antibodies that help protect against infection and disease such as ear and respiratory infections, allergies, intestinal infections and diseases, meningitis, diabetes and some cancers, including breast and ovarian cancer for girls.

3)    Breastfeeding helps prevent cancer in mothers too. The World Cancer Research Fund 2007 recommends breastfeeding to protect against pre-menopausal and post-menopausal breast cancer, and there is some evidence that breastfeeding also protects against ovarian cancer too.

4)    Human milk supports maximum brain growth and development. Analysis has concluded that not only is breastfeeding related to higher levels of cognitive function than formula feeding, but these benefits are greater for breastfed premature infants than full-term breastfed infants.

5)    Breastfeeding helps promote baby’s sleep. Recent research revealed high concentrations of three nucleotides in breast milk produced during the evening and night, which help to relax baby’s central nervous system and promote sleep.

6)    Sucking at the breast facilitates and promotes the development of the jaw and straight teeth, so children who were breastfed require less orthodontic work than those who were formula fed.

7)    Breastfeeding may protect against osteoporosis. Research now suggests that postmenopausal women who have breastfed for extended periods have comparable or higher bone mineral density and lower risk of hip fracture than women who have never breastfed.

8)    The hormone oxyocin plays an important role in lactation, stimulating the ‘letdown reflex’, and breastfeeding itself stimulates the release of oxytocin. High levels of oxytocin has a calming, relaxing effect for lactating mothers, triggering nurturing behaviours which supports the mother-baby attachment relationship.

9)    Breastfeeding protects against obesity. Research evidence concludes that duration of breastfeeding is directly related to decreased risk of a child becoming overweight or obese.

10)It’s the ultimate in convenience foods! It’s free, always the right temperature and always available, no preparation required!

Sources and Further Reading:

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

Newman, J and Pitman, T. (2006). The Ultimate Breastfeeding Book of Answers. Three Rivers Press

La Leche League, The Benefits of Breastfeeding

Ina May Gaskin (2009) Ina May’s Guide to Breastfeeding. Pinter and Martin.

While Ann can’t offer personal advise, please feel free to comment or pose general questions and she will do her very best to answer.

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