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BOTTLE FEEDING

Look how happy Lucy is! Held in place at a steady thirty-degree angle, she sucks happily from her space-age “Riteflo” antireflux feeding device. This modern system is designed to provide a continuous flow and to detect any air bubble before it can reach the nipple. The nipple, by the way, is an exact molded replica of yours, with the same recoil coefficient as genuine skin. Each time the level of the fluid reaches a burping gradation, the Riteflo beeps to remind you to perform the ritual procedure. But that’s not all! The system is loaded with Riteflo brand formula’s latest blend, fortified for brain development and reinforced with mommy’s personal amino-acid profile . . . enhanced, of course, to be better than mommy! You can already tell Lucy is getting smart by the sparkle in her eye.

Even without fancy equipment or formula, bottle feeding is simple and straightforward. Here’s a how-to guide.

How?
Lucy may be a genius, but it doesn’t take a genius to suck on a bottle. As soon as she’s awake and shows an interest in sucking, put the nipple in her mouth. She will automatically move her jaw and suck out some of the milk. It’s as simple as that.

How Much?
At first, Lucy will drink very little, maybe a couple of ounces per feeding. When she’s hungry, the signs aren’t subtle: She’ll root or cry. When sated, she’ll push the nipple away, slow her sucking, or fall asleep. As she gets older, she’ll steadily increase the amount she ingests, from about twenty-four ounces at one month of age up to about thirty-two ounces at six months. These are rough numbers; the best way to know if Lucy is still hungry is to offer her a little more than usual on occasion and let her decide if she wants it.

Around eight months, when she’s eating a significant amount of solid food, Lucy will reduce her milk intake herself by simply not finishing her bottle the way she used to. Or she’ll just take fewer bottles. However, there are considerable variations at this stage. Some babies drink barely ten ounces of formula and already eat a tremendous amount of solid food, whereas others are still swilling their five bottles daily and hardly touching the stuff that requires chewing. Both are fine.

How Often?
Bottle feeding, like nursing, should occur on demand. Initially, Lucy will wake up at different intervals, seemingly hungry, and you should encourage her to regulate her own feeding. If you try to impose a more rigid schedule, you’ll find it rough going. She will end up imposing hers on you anyway, which will be on average every three hours until she is eating a significant amount of solid food at roughly six months [See: Schedule].

Around three to four months, the only noticeable change is that Lucy takes much less time to eat. She can gulp down her bottles in record time while looking around for distractions.

Real questions from real parents
How much is too much?
Be aware that overfeeding is relatively easy with a bottle, because the supply is unlimited and Lucy may take it just for soothing purposes. In any event, if you do happen to overfeed her, you’re likely to get the extra milk back in the form of spit-up.

How long can I leave a bottle out if it has been used?
Until the next feeding, which means as long as six hours.

Should I sterilize the bottle?
Washing of the nursing equipment is more than enough. Babies are able to fight germs and aren’t meant to ingest only sterile nutrients.

What kind of nipple is best?
Lucy can suck on any kind. Don’t pay attention to the brand or the shape; it’s all marketing. The hole of the nipple should be big enough that she can feed with ease but small enough that it doesn’t flood her mouth with milk. Don’t bother with the antigas bottles that provide a specific inclination or an extra plastic bag to squeeze the air out; they’re just more marketing rip-offs.

What about burping?
Babies swallow more air while bottle feeding, which causes more spit-up. This is easily remedied: Just keep Lucy upright for a while after feeding and massage her back. This will move the air up and the food down, even if she doesn’t muster a full burp.

If my baby wakes up ten minutes after feeding, does it mean she’s still hungry?
Not necessarily. She might simply crave comfort. The best way to know is to give her a little more food. If she takes it willingly, then she’s hungry; otherwise, she’s not. As with most feeding matters, common sense is the final authority.

When can I put cereals in her bottle? Never. There’s no obvious benefit. It won’t help her sleep at night, and the additional calories are unnecessary. Worse, it can bind the stools.


CHOOSE A TOPIC

SLEEP

Sleep or the lack of it, is one of the greatest concerns of new parents. After “Is my baby healthy?” the second most commonly asked question is “When is my baby going to sleep through the night?” The answer is (drum roll, please) . . .never.

Sleep is not a continuous process. Try to remember how you slept last night. At the end of each of your nocturnal cycles, you woke up (at least five or six times per night), made yourself cozy, rolled onto your other side, and fell back asleep.
The same thing happens for Lucy, except that for her, getting cozy means sucking. This starts right after birth. When Lucy is a newborn, every time she rises from slumber, you either feed her or rock her, which puts her to sleep again. After the first ten times, she begins to expect you to soothe her every time she wakes up at the end of her sleep cycle. When do people make the transition from being soothed to sleep by mom to being able to soothe themselves? That’s the ten-thousand-dollar question. But when it does happen, that’s when Lucy will “sleep through the night.”

The First Few Weeks
For the first few days after birth, don’t even think about sleeping at night. Lucy is getting used to you, and you’re getting used to her. Predictable sleep patterns really aren’t a priority at this point. Very young babies seem not to have a sense of day or night, or, even worse, the cycle sometimes seems reversed. Of course, it’s not reversed from Lucy’s point of view. She just left a pitch-black environment with no cycle to speak of. Until she gets a few weeks older, there is little you can do to keep her up during the day so that she’ll sleep more at night. Any attempts to keep her awake will only agitate her. In the meantime, try to sleep when Lucy sleeps, whether she’s in your bed or not. If you’re breast feeding, your best bet for getting your beauty rest is to learn to nurse on your side while you’re half asleep. You won’t even need to burp her, since she’ll be eating more slowly and therefore swallowing much less air as she nurses. As a rule, never wake her up to feed at night if she’s sleeping peacefully.

The First Couple of Months
This period is your best opportunity to make your baby a night sleeper. Here’s how.

After a couple of weeks, Lucy is sleeping more at night than during the day. Each waking period ends with a feeding, and nursing is as much about soothing as it is about nutrition. This is more pronounced in breast fed children, thanks to the physical intimacy of nursing. As time goes on, you’ve become more accustomed to Lucy’s temperament and needs, and she is getting used to the fact that when she has a need you will tend to her.

In the first couple of months, I suggest that you not jump up at her slightest peep and that you ignore her minor whining so she can soothe herself back to sleep. That means letting her wiggle, fuss, or suck on her fist for a while. If she manages to fall back to sleep without your help even once, she’s learned the basis of self-soothing, and it will happen more naturally the second time. Of course, if her requests become more persistent, you’ll have to feed her.

You can practice this laissez-faire method even if you’re cosleeping [See: Cosleeping]. While the average parent naturally reaches this point of adjustment around two months after birth, others come to it earlier, and some are still jumping up at every whim, long past the first birthday. Wherever you stand is fine, as long as you understand the implications.

In observing family dynamics, I was puzzled as to why some babies would sleep through the night and others wouldn’t. I learned that the parents who were a little less responsive to late-night fussing always had kids who were good sleepers, while the jumpy folks had kids who would wake up repeatedly at night until it became unbearable. For example, when a mother has three kids, it is rarely a question whether or not her third will sleep through the night early on. The family has learned when to react to a fussy baby and when to let her soothe herself back to sleep.

Over the years, I’ve come to recommend this somewhat laissez-faire attitude regarding nighttime behavior as soon as the shock of birth has passed. This approach is validated by the hundreds of families I see whose babies sleep effortlessly through the night. These parents never have to resort to the ugly “let the baby cry it out” approach described below, and many of them don’t even know they’ve missed out on one of infancy’s most nerve-wracking problems. As they say: An ounce of prevention . . .

Between Two and Four Months
In 1994, when Tribeca Pediatrics first opened its doors, we recommended that parents begin sleep-training their babies at around the age of four months. However, to the universal comfort and sanity of our patients, we have discovered that sleep-training is even more effective if begun at two months. Of course, it’s your decision when this process begins and how you choose to tackle it. But our years of experience, and the testimonials of our well-rested patients and their parents, have convinced us that this is the most effective, healthy time to begin sleep-training.

By now, if Lucy isn’t sleeping through the night, I am sorry to report that she’s very unlikely to do so on her own. Sooner or later, there’s going to be a struggle. You probably already sense that although Lucy eats at night, she’s less interested in the food than in the soothing experience it provides.

If you enjoy the cuddling or at least don’t mind the fact that Lucy wakes up at night, please skip to the next age group below. If, on the other hand, you feel sleep-deprived and want to handle the situation, I’ve broken the process down into three simple steps:
1 | Put Lucy in her crib at a reasonable hour (while she’s still awake, if possible). The best time is when both of you have had a chance to interact with her for a while after work.

2 | After the bath and the songs, kiss her good night.

3 | Come back the next morning at 7:00 A.M.

I have just heard the collective gasp of thousands of parents: “Are you out of your mind?!” Bear with me. I know this sounds drastic, but it’s the only way to get Lucy into the habit of soothing herself rather than relying on you. It’s true that the first few days she’ll soothe herself to sleep by crying, but eventually she’ll sleep just like, well, a baby. The first night she’ll cry two to three times, for twenty to thirty minutes (you’ll feel like crying too); the second night she’ll cry less; and the third even less. By the fourth night, you’re home free. Done.

REAL QUESTIONS FROM REAL PARENTS

What if I can’t do it?
Again, if you don’t mind waking up, then you don’t have a problem, and Lucy doesn’t either. But as much as I’d like to tell you her sleep patterns will get better, trust me and trust my experience, they won’t change on their own.

How long can I let her cry?
Until she falls asleep. It can take an awfully long time. If you last only twenty minutes, you’re teaching her to cry for twenty minutes before she gets her soothing.

Can I at least go touch the baby or kiss her, even if I don’t feed her?
If you do, she’ll see it as a tease, become more upset, and cry even longer because she won’t understand why you won’t feed her. Babies know nothing of moderation.

How do I know the baby isn’t hungry?
She is hungry. But she does not need to eat. After any three- or four-hour fasting period, she’ll be hungry. You’re hungry in the middle of the night, too; it’s just that you learn not to eat because it’s good for your belly to take a rest. Well, it’s good for hers too.

What about a little water at least?
Only if you want to wake up every couple of hours to give her water.

What about a pacifier?
Same thing.

Would it help if I gave her cereal before bed?
It’s a myth that porridge before bedtime helps a baby sleep, since it will be digested in the few hours to come. The same goes for topping off a feeding with a bottle of formula.

Can I feed the baby to sleep?
You can, but it’s better not to. Consistency is important, so why would you nurse Lucy to the edge of sleep at 8:00 P.M. but not, say, at 2:00 A.M.? It’s a habit you’ll have to struggle to overcome, and since you’re doing so much struggling as it is, you might as well struggle completely and be done with it. Also, if you’re going to struggle, I assure you that things will look much more dramatic to you at 2:00 A.M. than they will at 8:00 P.M. And most of the crying is done early on.

How long will Lucy sleep at this age?
Ten to twelve hours. Straight.

Without eating?
Without eating.

Can I go to her early in the morning?
Again, if you’re going to struggle, struggle all the way. Babies are notorious believers in the take-a-mile-if-given-an-inch philosophy. If you give Lucy attention at five-thirty, she’ll start looking for you at five. If you slide back to five, she’ll test you at four. And so forth. Hold to the schedule, on the other hand, and she’ll learn to put herself back to sleep in the morning hours.

Aren’t I traumatizing the baby?
At seven in the morning, you’ll be surprised to find a happy, smiling baby who loves you and loves to see you. And you’ll be rested and happy too. More to the point, your own smiles during the day won’t be as forced when you are no longer a zombie.

How about nap time?
Don’t worry about nap time. Once Lucy learns to sleep at night, daytime napping will be a breeze.

Is it really this easy?
As I said, after a few days of this, Lucy will sleep through the night. And if you wake up, it will only be because you’re surprised that you’re sleeping so well. But make no mistake: Be prepared for three or four brutally hard nights. It is never easy to let your baby cry. But once you start, stick to your guns; if you give in halfway through the process, you’ll only make it worse.

How do you know all of this?
I learned the hard way. With Abeline, our first daughter, my wife and I took turns on 2:00 A.M. Lullaby duty. I spent many nights walking around the loft with Abeline in my arms, singing any French lullaby that my sleep-starved brain could conjure. I wasn’t sleeping well at home and even less at work when I was on call. And I was probably just like you, thinking that if she woke up, she was calling us. At ten months, we were so exhausted from soothing her that we finally let her cry it out. Within a couple of days she was sleeping through the night. You’d think we’d have learned our lesson, but we hadn’t. With our second daughter, Nora, we made the same mistakes (tending to her every nighttime peep) and later resolved it the same way. It only took us six months to wise up that time. With Fanny, our third one, we let her cry herself to sleep early, just like I told you, and it worked like a charm. She’s a perfectly secure little kid who can fall asleep fine on her own. By contrast, Abeline, who got the most soothing before sleeping, still needs her head rubbed every once in a while to get to sleep, just like in the good old days.
I’ve also learned from the hundreds of sleepless parents to whom I’ve suggested this method. They initially look at me like I have two heads, but at the next month’s visit, they show up with broad smiles and tell me, “That was torture for a few days, but we’re so happy we did it!”

At Eight Months
If Lucy doesn’t sleep through the night at eight months, she probably spends a good part of the night in your bed, and you most likely breast-feed her a few times a night. You know she feeds at night more for the soothing than for the nourishment, but it’s much easier for you and you find it kind of sweet. If you’re still happy with this arrangement, skip ahead to the next sleep section. If you’re exhausted, though, prepare for action.

Before doing anything to help your eight-month-old sleep, you should take into consideration that at this age, babies are going through what we call separation anxiety [See: Separation and Stranger Anxiety]. At four months, when Lucy didn’t see you, she had no clue where the heck you were, and she didn’t even know you’d left; she had no concept that you’re a person separate from her. At eight months, Lucy has figured out not only that you’re a separate person but also that you can leave, which troubles her greatly. So if you leave her to cry at night, she knows perfectly well that you’re in the other room, and she could feel abandoned. Also, she’ll explore what brings you back: not just crying but shrieking, throwing things, even vomiting. (Yes, vomiting; babies that young can upset themselves so much that they vomit.) As a result, you must take a more subtle approach.

Here are the instructions for an eight-month-old:
1 | After your normal evening routine, put Lucy to bed at a reasonable hour, after you’ve both had time to interact with her.

2 | After a few good-night kisses, go out the door without breast feeding her.

3 | When she cries, let her, for ten minutes. Then come back and talk to her for thirty seconds. That’s all, just talking. Then leave. No holding, no nursing. The only purpose is to show her that you have not vanished. If she is indeed vomiting, just clean up matter-of-factly and move on.

4 | Repeat the exact same process until she falls asleep. This may take an hour or more.

5 | Each time she wakes up during the course of the night, repeat the same cycle.

6 | In the morning, pick her up and begin the day.

7 | The next night, let her crying jags go a little longer, say, fifteen minutes. Each night, increase that amount of time; eventually, she’ll learn to sleep for longer stretches.

Within a few days, Lucy will be sleeping through the night. This process is what people refer to as the Ferber method, or Ferberizing a baby, and while it’s down and dirty, it works.

Warning: If you use this method inconsistently, you not only decrease its chance of success, but you also make things more difficult for you and Lucy later on. She won’t know what to believe, and rather than being a source of consistent behavior, you will be an erratic and unpredictable comfort who appears without announcement and without rules.

At One Year of Age
Now the real trouble starts. If Jimmy is not sleeping through the night at a year, you have turned into a mechanical comfort machine and a good one too. You’ve become very proficient at feeding or soothing him back to sleep at the end of each sleep cycle without too much effort. But unless you still enjoy the ritual, I urge you to do something for yourself. Bypass Ferberizing, since separation anxiety is no longer an issue, and go straight to the cold-turkey method:
1 | After Jimmy’s bath and a book, put him to bed.
2 | Kiss him good night. Say “See you tomorrow.”
3 | Don’t go back in.

Same thing here: After a few nights of that regimen the problem is solved. This is even more brutal than it would have been at four months, because Jimmy can cry much more loudly and even call your name.

Eighteen Months and Beyond
When a toddler is still not sleeping through the night, I rarely find parents who are happy about waking up for soothing duty. Some parents deliberately choose this option as part of a “family bed” philosophy, however, which I totally respect [See: Family Bed]. But for those who don’t desire such an arrangement, the longer you wait to enforce a sleep regimen, the harder it gets. At this point, Jimmy is probably in your bed for a good part of the night. You should have no doubt that if you’re nursing him back to sleep, hunger is no longer the issue; it’s all about soothing. And while it may be cute for a two-year-old to end up in your bed night after night, it could be embarrassing when Jimmy turns nine. Also, be aware that nursing a toddler throughout the night often leads to dental decay [See: Tooth Rot].

If you want to break the cycle, here’s what you need to do:
1 | Put Jimmy into bed after the story, the other story, the kiss, and the last kiss.

2 | Explain that there is a new regimen. Tell him that if he gets out of bed, you’re going to bring him right back in. Tell him that the second time he comes out, you’re going to close the door or even lock it if he gets out. (By doing this, you’re simply staying consistent with your message.)

3 | Follow through on the promise until he falls asleep.

4 | Every time he wakes up, repeat the same cycle. You won’t have to close the door any longer, because he won’t attempt an escape now that he knows the consequences.

5 | If you live in a multi-unit building, you may want to warn those neighbors most likely to overhear the screams. It may seem embarrassing now, but it beats having to explain it all to the cops later.

After two or three days of that routine, the hard part will be done, even if you find him asleep on the floor in his room. But this is no party. Jimmy will scream loudly. To make matters worse, he’s old enough to shriek half-sentences and use your name. Again, cry yourself to sleep if you have to, but stay the course. In three days, you will have broken the cycle.

New-Onset Sleep Problems
If a child of any age who’s been sleeping well suddenly develops a sleeping problem, fear not. This is common, and it can happen at any age. Suppose Lucy is teething, has a cold, suffers from jet lag, has a bad dream, or goes through any minor upset. Now suppose you pamper her a little more than usual, to alleviate her discomfort. You give her a tour of the house on your hip, you cuddle her more than usual, or you put her in your bed and get cozy with her. This is all natural.

Before you know it, however, she’s back to the one-month-old stage again, unable to soothe herself back to sleep. It’s unbelievable how quickly this can happen! If you find yourself in this situation, I suggest you reset Lucy’s clock as soon as you can to avoid creating a bigger problem. When the triggering event has settled (the pain is gone, the jet lag has waned, the teeth have erupted, etc.), let Lucy whine in her own bed and get back to sleep on her own the way she used to do (see above, under the appropriate age group).

In Summary
Now that you’ve reached the end of this lesson plan, I hope you can see the wisdom of encouraging Lucy to learn how to soothe herself to sleep early on with the laissez-faire method. Don’t be fooled. Kids’ sleep issues won’t improve on their own. You risk sleep deprivation, guilt, and anger. I’ve seen parents strain and even destroy their relationship with each other as a result of these issues. If you deal with sleep issues consistently and early, however, you’ll profit from your efforts for years.









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