Though very brief (under twenty seconds) periods of breathing lapse can be normal, longer periods—or short periods in which the baby turns pale or blue or limp and has a very slowed heart-beat—require medical attention. If you have to take steps to revive your baby, call the doctor or emergency squad immediately. If you can’t revive your baby by gentle shaking, try CPR (see page 593), and call or have someone else call 911. Try to note the following to report to the doctor:
Did the breathing lapse occur when baby was asleep or awake?
Was baby sleeping, feeding, crying, spitting, gagging, or coughing when the event occurred?
Did baby experience any color changes; was he or she pale, blue, or red in the face?
Did baby need resuscitation? How did you revive him or her, and how long did it take?
Were there any changes in baby’s crying (higher pitch, for example) before the breathing lapse?
Did baby seem limp or stiff, or was he or she moving normally?
Does your baby often have noisy breathing; does he or she snore?
If tests at a local hospital are inconclusive, the doctor may recommend referral to a major SIDS center. For information on the center nearest you or for more information on SIDS, call the National SIDS Alliance (800-221-7437) or the American SIDS Institute (800-232-SIDS).
Sometimes the evaluation uncovers a fairly simple cause for such an event—an infection, a seizure disorder, or an airway obstruction—that can be treated, eliminating the risk of future problems. If the cause is undetermined, or if heart or lung problems that put him at high risk for sudden death are discovered, the doctor may recommend putting your baby on a device that monitors breathing and/or heartbeat at home. The monitor is usually attached to the baby with electrodes or is embedded in his crib, playpen, or bassinet mattress. You, and anyone else who cares for your baby, will be trained in connecting the monitor as well as in responding to an emergency with CPR. The monitor won’t give your baby absolute protection against SIDS, but it will help your doctor learn more about his condition and help you feel you are doing something, rather than sitting helplessly.
Keep in mind, however, that some research has questioned the effectiveness of monitors; apparently even healthy babies often experience periods of apnea or slowed heart rate that don’t increase their risk of SIDS. False alarms are also very common.
Don’t let the episode, the hospitalization, or any monitoring become the focus of your life. Doing so could turn your probably normal baby into a “patient,” even interfering with his growth and
development. Seek help from your doctor or a qualified counselor if a monitor seems to add to family tension rather than reduce it.
Though criteria may vary from doctor to doctor and community to community, babies who’ve had no critical episodes since their first usually come off a monitor when they have been free of events requiring prolonged or vigorous stimulation or rescue for two months. More stringent requirements for going off the monitor are usually set for those who have had a second critical episode. Though babies are rarely removed from the monitor until they pass six months, when the peak period for SIDS is over, a total of 90 percent are off their monitors by the time they reach one year.
“My premature baby had occasional periods of apnea for the first few weeks of her life, but her doctor says that I shouldn’t worry, that she doesn’t need to be monitored.”
Breathing lapses are very common in premature babies; in fact, about 50 percent of those born before 32 weeks’ gestation experience them. But this “apnea of prematurity,” when it occurs before the baby’s original due date is totally unrelated to SIDS; it doesn’t increase the risk of SIDS or of apnea, itself, later. So unless your baby has serious apneic episodes after her original due date, there’s no cause for concern or follow-up.
Even in full-term babies, brief lapses in breathing without any blueness or limpness or need for resuscitation are not believed by most experts to be a predictor of SIDS risk; few babies with such apnea are lost to SIDS, and most babies who do die of SIDS weren’t observed to experience apnea previously.
“I’ve heard that immunizations can cause SIDS, and I’m really worried about having my baby immunized.”
Research has confirmed that there is no link between the DTP vaccine and SIDS—and, yet, like many theories that have been disproved, it stubbornly continues to circulate. But not only was DTP never a factor in SIDS, the vaccine is not even given anymore. Your baby will be receiving the newer, safer form of the vaccine, DTaP (see page 224), which has never been related to SIDS even in theory. So there’s absolutely no cause for concern.
If you’re still worried, talk to your baby’s doctor, who will doubtless make you more comfortable about going ahead with your baby’s immunizations.
See page 226 for plenty more reasons why you should have your baby immunized.
SHARING A ROOM WITH BABY
“Our ten-week-old has been sharing our room since birth. We don’t really want to continue sharing, so when should we move him to his own room?”
In the first month or two of life, when baby’s at the breast or bottle as much as he’s in bed, and nights are a blur of feedings, diaper changes, and rocking sessions interrupted only occasionally by brief snatches of sleep, having him within a weary arm’s reach makes sense. And some parents find room sharing even beyond then—and well into childhood—convenient, pleasurable, or both for all
concerned (see next question). But if it’s not your plan to continue sharing a room with your baby indefinitely, it’s probably a good idea to make the break once he outgrows the physiological need for frequent feedings during the night (anywhere from about two to four months). After that, having your baby for a roommate raises a number of potential problems:
Less sleep for baby. Being in the same room with your baby all night, you’re tempted to pick him up every time he whimpers, possibly interrupting his sleep cycles. After all, babies make lots of noises while they sleep, and most of the time, they’ll fall right back asleep within minutes, without any prodding. If you pick up baby at the slightest whimper, you may be inadvertently waking him up and interrupting his sleep. In addition, during his lighter phases of sleep, your baby is likely to be
wakened by your activity, even if you tiptoe around in soft slippers and climb silently into bed.
Less sleep for parents. The fact that you pick him up more often at night if he’s in your room means less sleep not only for him but for you, too. And even if you resist picking him up, you’re sure to lie awake waiting for the whimper to turn to a howl. You may also lose a few good nights’ sleep over his tossing and turning; babies are notoriously restless sleepers. Some parents, however, aren’t bothered by baby’s nocturnal movements and find that the benefits of being in a baby-free quiet room are offset by the drawbacks of feeling their way down a dark hallway every time they have to fetch a crying infant from his crib.
Less lovemaking. Sure, you know (or at least you hope) your baby is sleeping when you start to make love. But how uninhibited can you really be when you’ve got company (breathing loudly, tossing his head back and forth, moaning softly in his sleep) so close by? Of course, this problem can be avoided if you’re creative in your choice of lovemaking locales (pull-out sofa, anyone?).
For some kids, more problems adjusting later. Having your baby in your room for an extended period may make it more difficult when you finally do move him to a room of his own. (Not all children have trouble adjusting later on; some just leave their parents’ room when they’re ready to sleep on their own and never look back.)
Of course, “a room of his own” isn’t possible in every household. If you live in a one-bedroom apartment or a small house with several children, there may be no option but for your baby to share. If that’s the case, consider a divider—either a screen, or a heavy drape hung from a ceiling track (the drape is also a good sound insulator). Or give your bedroom up to the baby and invest in a sleep sofa in the living room for you. Or partition off a corner of the living room for the baby and do your late- night TV watching or talking in the bedroom.
If your baby will have to share with another child, how well the sleeping arrangement will work out will depend on how well the two sleep. If either one or both are light sleepers with a tendency to awaken during the night, you may all be in for a difficult period of adjustment until each has learned to sleep through the other’s wakings. Again, a partition or drape may help muffle the sounds, while providing the older child with privacy.
SHARING A BED
“I’ve heard a lot about the benefits of children sharing a bed with their parents. And with all the night waking our daughter has been doing, it seems like such an arrangement would mean more sleep for everyone.”
For some families, co-sleeping, or sharing a “family bed,” is an unequivocal (and cuddly) joy. For others, it’s merely a convenience. For still others, it’s a nightmare. Proponents of co-sleeping cite several advantages to the family bed: It cultivates emotional bonds, makes it easy to nurse or comfort
a child, and combats loneliness. Supporters also say it reduces the risks of SIDS, though there are no data to show whether SIDS is more likely to occur during co-sleeping or when baby sleeps alone.
Those on the other side of the co-sleeping fence believe that having a baby learn to sleep on her own encourages independence; discourages the development of sleep disturbances; averts any danger of suffocation from the pillows and fluffy quilts often found on parental beds; and is more comfortable for the parents (not only because they sleep better, but because there’s no risk of rolling over into a pool of spit-up or the contents of a leaky diaper).
While there’s no shortage of theories and certainly no shortage of opinions on the issue, the decision of whether to have your baby join you in bed or sleep solo in her crib—like so many
decisions you’ll make in your tenure as parents—is a very personal one. And it’s a choice best made when you’re wide awake (read: not at 2 A.M.), and with your eyes wide open to the following
considerations:
Baby’s safety. In this country, where sleeping accommodations are usually pretty cushy, keeping baby safe in her parents’ bed takes extra precautions. A report by the Consumer Product Safety Commission linked the family bed (and the hazards that too often lie therein) to numerous infant deaths. Proponents of co-sleeping, however, find the study’s data flawed and point out that some babies die while sleeping alone in their cribs. And other researchers have found that there is an innate connection between a co-sleeping mother and child, possibly because of the hormone response
activated when the mother is in close proximity to, or breastfeeding, her child. These researchers theorize that this response may make a mother who co-sleeps more keenly aware of her child’s breathing and temperature throughout the night, allowing her to respond quickly to any significant changes. Not surprisingly, the hormone response is also responsible for the lighter sleep that women who co-sleep experience.
If you choose to co-sleep, make sure your bed and bedding meet the same safety criteria looked for in a crib. A firm mattress (not a pillow top or waterbed) is a must, as are tight-fitting sheets.
Avoid plush comforters; keep pillows out of baby’s creeping reach; check for entrapment dangers (headboard slats should be no farther apart than 2 inches; there should be no gaps between the mattress and the frame). Never put baby on a bed that’s next to a wall (she could slip between bed and wall and become entrapped) or leave her in a position where she could roll off the bed (this can happen at a very young age) or allow her to sleep with a parent who is intoxicated, is taking
medication that induces deep sleep, or is just a very deep sleeper. Never let a toddler or preschooler sleep directly next to your baby. And never smoke, or allow anyone else to smoke, in the family bed, since this can increase the risk of SIDS (as well as fires). A great way to keep your child close and safe is to use a bedside sleeper that attaches to your bed (see page 51).
Family feelings. A baby should come between her parents only if both have agreed she belongs there.
So make sure you’re both onboard with the family bed before you bring baby onboard your bed—and consider both your feelings and your spouse’s. Keep in mind, too, that if you co-sleep, you’ll need to make other arrangements for intimacy, or three could quickly become a crowd that compromises your
“two’s company.”
Sleep—yours and baby’s. For some parents, not having to get out of bed for midnight feedings or to calm a crying baby is reason enough to co-sleep. For breastfeeding moms, being able to nurse without having to be fully awake is a real plus. The flip side: Though they may never have to leave their beds
at night, the sleep co-sleepers do get may be more broken up and, although emotionally satisfying, less physiologically satisfying (parents and children who co-sleep tend to sleep less deeply and sleep less overall). Also, co-sleeping babies wake more often and may have trouble learning how to fall asleep on their own, a skill they’ll eventually need. Another possible side effect of frequent
awakenings is an increase in nighttime breastfeeding—fine when an infant is young, not so fine when she has several teeth. Continuous night feedings—breast or bottle—can lead to dental decay.
The future. In making your decision about the family bed, consider how long (ideally) you’d like the arrangement to continue. Some argue that co-sleeping causes prolonged dependency; others argue the opposite—that co-sleeping promotes independence by giving a child strong feelings of security.
Often, the longer it lasts, the tougher the transition to solo sleeping. Switching a six-month-old over to a crib shouldn’t take too much effort; moving a baby who’s approaching her first birthday may be a little more trying; weaning a toddler or preschooler from your bed may be even more challenging.
Some children voluntarily leave around age two or three, many are ready to move on by the time they start school, but a few stay on for the long haul—even through early adolescence.
Whether or not you decide to share your bed with baby at night, you’ll still enjoy bringing her in for early morning feedings or cuddling sessions. As your child gets older, you can continue to make family togetherness (if not a family bed) a favorite ritual on weekend mornings—complete with pillow fights.
STILL USING A PACIFIER
“I was planning to let my daughter use a pacifier only until she was three months old, but she seems so dependent on it, I’m not sure I can take it away now.”
Babies are creatures of comfort. The comfort they crave can come in a number of packages, including a mother’s breast, a father with a bottle full of breast milk or formula, a soothing lullaby, or a
pacifier. And the more accustomed they become to a particular source of comfort, the more difficult it becomes for them to do without it. If you don’t want to run into the problems that may later be
associated with pacifier use, now is an ideal time to make a break. For one thing, at this age your baby’s memory is short, so she’ll easily forget the pacifier when it disappears from her life. For another, she is more open to change than an older baby—more likely to accept an alternative route to pacification. A toddler not only won’t forget her pacifier, but will probably demand its return with a storm of will and temper. And, of course, a habit of three months is easier to break than one that has been building for a year or more.
To comfort your baby without a pacifier, try rocking, singing, a clean knuckle for sucking (or help her to find her own fingers), or some of the other techniques listed on page 192. Admittedly, all of these take more time and effort on your part than tucking a pacifier in her mouth, but they’ll be better for baby in the long run, especially if they are gradually eliminated in favor of letting baby learn to comfort herself (as she could with her own thumb, a “pacifier” that’s in her control. (See page 194 for the pros and cons of using a pacifier.)
If your baby doesn’t seem ready to let go of the pacifier, you can limit pacifier usage to just nap time or nighttime. This way, it won’t interfere with socializing and vocalizing during the day. But keep in mind that it may be a struggle to wean your child off of the sleep-time pacifier later on, too.
EARLY WEANING
“I’m going back to work full-time at the end of the month, and I’d like to give up nursing my daughter. Will it be hard on her?”
A three-month-old is, in general, a pretty agreeable and adaptable sort. Even with a budding
personality all her own, she’s still far from the opinionated (and sometimes tyrannical) toddler she’ll eventually turn into. So if you’re going to pick a time for weaning from the breast that’s going to be easiest for her, this may be it. Though she may thoroughly enjoy nursing, she probably won’t cling to it as stubbornly as a six-month-old who’s never had a bottle and is suddenly subjected to weaning.
All in all, you’ll probably find that weaning at three months is less difficult for your baby than it is for you. (Before you make your final decision, though, read over the section on making breastfeeding and working work, page 251; you may find that combining the two occupations for at least another few months—and possibly for the entire first year—may not be as difficult as you think.)
Ideally, mothers who want to wean their babies early should begin giving supplementary bottles, using either expressed milk or formula, by around four to six weeks so the infants become adjusted to suckling on the bottle as well as on the breast. If you haven’t, your first step is to get baby acclimated to an artificial nipple; you may have to try several different styles to find one your baby likes. At this point it would be best to use formula, so that your present breast milk supply will begin to diminish.
Be persistent, but don’t force the nipple. Try giving the bottle before the breast; if your baby rejects the bottle the first time, try again at the next feeding. Bottles may be more acceptable to baby if someone other than mom gives them. (See page 215 for more tips on introducing the bottle.)
Keep trying until she takes at least an ounce or two from the bottle. Once she does, substitute a meal of formula for a nursing at a midday feeding. A few days later, replace another daytime
breastfeeding with formula. Making the switch gradually, one feeding at a time, will give your breasts a chance to adjust without uncomfortable engorgement. Eliminate the evening breastfeeding last, as this will give you and your baby a quiet and relaxing time together when you get home from work. If you like, you may—assuming your milk supply doesn’t dry up entirely, and assuming your baby is still interested—be able to continue this once-a-day feeding for a while (or twice a day, if you’d like to nurse first thing in the morning, too), postponing total weaning until a later date, or until your milk is gone.
SUPPLEMENTING WITH COW’S MILK
“I’m breastfeeding and would like to give my baby a supplement, but formula’s so expensive.
Can’t I give him cow’s milk instead?”
Cow’s milk is a great drink for little cows and older humans, but it just doesn’t have the right mix of nutrients for human babies. It contains more salt (much more) and protein than breast milk or
commercial formula, and these excesses put a strain on young kidneys. It is also lacking in iron. The composition of cow’s milk varies from that of breast milk (and formula) in a variety of other ways, too. In addition, it causes mild intestinal bleeding in a small percentage of infants. Though the blood lost in the stool is generally not visible to the naked eye, the bleeding is significant because it can lead to anemia.