Pacifiers -- blessing or curse?
I am unapologetically a huge proponent of pacifiers.
Some breastfeeding support folks argue that pacifiers interfere with a good latch, and that pacifiers shouldn't be introduced until six weeks of age, or not at all. But no one argues that you shouldn't offer a clean pinky to suck on. And why wouldn't that interfere with a good latch just as much?
Moreover, evidence-based research doesn't support the idea that pacifiers interfere with breastfeeding. Babies know the difference between what we call "non-nutritive sucking" and feeding. When I was a NICU nurse, I read academic articles that showed that pacifier useactually helped premature babies prepare for breastfeeding.
This double-blind meta-analysis (the most rigorous form of research) of 1302 infants found no difference in breastfeeding duration between babies who took a pacifier and those who did not. The study's authors concluded, "This meta-analysis shows that pacifier use does not decrease breastfeeding duration in full-term infants. The new evidence contradicts current WHO (World Health Organization) recommendations, however, which are based on less rigorous studies.8,9,13,14 The AAP (American Academy of Pediatrics) now recommends that pacifier use be implemented after breastfeeding is established.4 Based on the evidence, we think mothers who are motivated to breastfeed their infants should be allowed to make their own decisions regarding pacifier use, and pacifier use should not be discouraged."
Moreover, the AAP actually recommends the use of pacifiers as a way to decrease the incidence of SIDS. Dr. Harvey Karp recommends sucking as one of his "5 S's" as a way to soothe a newborn to sleep.
Anectdotally, as a parent and as a healthcare professional, I have never understand why one would offer breastfeeding when a baby wants to suck for comfort, not hunger. We wouldn't offer formula to a baby who wasn't hungry. Why would we offer breastmilk, then, when a breastfed baby isn't hungry?
As a baby grows older, out of the newborn stage, I recommend that pacifiers be restricted to times that a baby is tired or fussy. Babies use their mouths to explore the world, and that should be encouraged. They also need their mouths to coo and babble as the earliest stage of language development. But when it is time to sleep, pacifiers can be a wonderful tool.
That said, if pacifiers start to become more of a blessing than a curse, it's fine to eliminate them. Some babies love pacifiers but can't keep them from falling out of their mouths, and then cry for them to be replaced. If this happens to your baby multiple times a night, the pacifier may not be worth the inconvenience. In that case, I would recommend offering the pacifier once at bedtime but not replacing it, especially if your baby is no longer in your bedroom. Tugging gently on the pacifier once it's in your baby's mouth can strengthen the suction so it's less likely to fall out.
By six months, babies no longer have a biological need for sucking, but many still enjoy it for comfort. It's up to you if you want to eliminate it then or wait longer.
Both of my children used pacifiers. My older daughter used it until about four months old, and then gradually transitioned to sucking her thumb. She didn't stop sucking her thumb until five and a half years old and the weaning process required a full-scale assault. I wished many times that she used a pacifier instead -- it would have been so much easier to stop pacifier use than to stop using a thumb that was always with her!
My little one used a pacifier until age 3. It was an amazing help for her in sleeping through the night at ten weeks old. We kept her pacifiers -- a lot of them -- in the crib and car seat, only. Only once she was climbing in and out of the crib, and then transitioned to a toddler bed, did more frequent pacifier use become an issue since she was able to reach them whenver she wanted.
At age three, on the dentist's advice, we picked out a reward for giving up the pacifier -- she chose an Elmo doll -- and on the day she was ready, she threw the pacifiers in the trash and got her Elmo. Of course, a few minutes later, she changed her mind and wanted to throw Elmo in the trash and have her pacifiers back. But I held the boundary. At bedtime that night, I rubbed her back while she cried. I didn't try to plead or explain or convince her that her grief was wrong. And after about ten minutes, she fell asleep. The next night, she cried even less. And by the third night, we were done. She continued to speak fondly of her "pacis" for months to come but she never cried for them again.
I'm so glad that she was able to have the comfort of sucking when she needed it, and that she was able to partner in the process of giving them up. So to those who would argue that if you give a pacifier, it'll be hard to get rid of them -- no, I don't agree.
My girls preferred different kinds of pacifiers. One like the Phillips Avent pacifier while another preferred the Nuk. For each, I bought a few different options to see which they liked best. Oh, and each breastfed past a year, despite pacifier use and taking a bottle while I was at work.
So I recommend stocking up on a few different options and experimenting. Offer the breast or bottle first, if you think your baby is hungry. But if she's crying and pushing it out of her mouth, or if it's been less than 90 minutes and you're confident that she had a good feeding, try swaddling her or popping her in the baby carrier and offering a clean pacifier. She might just need some non-nutritive sucking to soothe herself to sleep. Rest assured, when the time comes that you need to wean her off it, you'll be able to manage it.
For more help with soothing your baby to sleep, or getting him to sleep all night, schedule a free chat with me and get your family sleep you deserve.
Newborns are hard. Really, really hard. And those early days seem to last forever. Sometimes they do last for months, if you have a colicky or overtired baby, or one with medical issues.
And it's remarkably easy to forget how hard it was, once we are out of those dark days.
I just went back and read my personal blog from the early days with my older daughter. I had forgotten how miserable I was. And how guilty I felt as a result. Guilty that I wasn't treasuring every moment.
"I'm not enjoying my life today. I feel guilty that I'm not appreciating C more. This morning, I laid her on the changing table and saw her sweet little face grinning up at me through my tears.
This made me feel terrible. Poor thing doesn't even realize that I'm upset.
Yesterday I accidentally woke her up while I was documenting her Baby Whispered status... and we've been off track ever since. And so now I feel like a baby sleep failure, on top of everything else.
And oh, sidebar, the pacifier: what a double edged sword. It helps her calm down so much and often soothes her to sleep. Until she loses it or spits it out... and immediately decides she wants it back. And so... Mommy goes to and fro, sticking the damn thing back in. Sometimes I don't give it to her... and then she cries, because she needs its magical soothing powers to calm herself down. I'm so frustrated!"
You are not alone if you are miserable, too. So many other women feel the same way. And our culture puts trememendous pressure on us to bounce back immediately, to fit into our pre-pregnancy jeans on our way home from the hospital, to have a spottless home and baked goods for our guests who want to see the new baby, to breastfeed effortlessly and painlessly -- after all, it's "natural," right?
I promise you, you will feel better. But possibly not right away. And if your baby or babies are not sleeping well, it may take quite a while. I know I never feel good when I am sleep deprived, and I know I'm not alone.
A cruel truth of sleep training is that is requires a reservoir of strength you may not feel you have. It generally gets harder before it gets easier. It's hard to believe that it will ever get better, especially when you are already exhausted and unable to think logically. When you are tired, it's also all the more agonizing to listen to your overtired baby cry. You just want that heartbreaking noise to stop. You just want to go to sleep yourself, as soon as humanly possibly. You don't care what you have to do to make it happen. Unfortunately, the shortcuts you take often make the overtiredness all the worse in the long run.
I wish we lived in a culture that valued vulnerability more. And supported new parents more. That told us it is okay to feel tired and hormonal and weepy. That we are beautiful in our milk-stained overstretched t-shirts and bagging yoga pants. We have created (or supported) new life. We are miraculous!
Brene Brown says, "Vulnerability is about showing up and being seen. It’s tough to do that when we’re terrified about what people might see or think. When we’re fueled by the fear of what other people think or that gremlin that’s constantly whispering 'You’re not good enough' in our ear, it’s tough to show up...
Vulnerability is the birthplace of love, belonging, joy, courage, empathy, and creativity. It is the source of hope, empathy, accountability, and authenticity. If we want greater clarity in our purpose or deeper and more meaningful spiritual lives, vulnerability is the path.”
(You should totally watch her excellent Ted talk on vulnerability here -- it can be watched while nursing or rocking a tired baby. But don't watch it if adding one more thing to your day will stress you out!)
The thing about being vulnerable and real about where you are right now is that it allows people to love you. Perfection is admirable but not loveable. When we show people our weaknesses and our needs, we invite them into our hearts. We let them love us. And if there was ever a time where you deserve support, it's when you have a new (or not so new) baby at home. People want to help. They just don't know how.
So let them in. Invite them into your heart. And ask for very specific help. They don't see the unmet need. You give them a beautiful gift when you show it to them.
This was hard for me, too. Reading back over my blog, I see that I asked one of my closest friends if she would spend a night with me and do just one four-hour stretch with my daughter in the evening while I slept. This friend never went to bed early, but still, I felt like I was asking her for an unforgiveably huge favor. It was deeply painful to ask. But I did anyway. (At that point, C was waking every three hours to feed, and it took about an hour to feed her and get her back to sleep.)
"I asked SL last week if she would come over and stay the night to do a late night feeding, back when I was desperate (well, more desperate) for sleep. We hadn't seen her since the birth, six weeks prior. Amazingly, she agreed!
So last night SL left work on time (for once!) and we had a lovely time catching up. At about 8 pm, I started to yawn. And when my friend asked if I wanted to go to bed, I realized I did. Even though I felt guilty to desert her.
Of course, C was resisting sleep, so it took a while... I didn't want to go to bed until she was down. But I finally gave up and went to bed anyway.
Well, my little Super Baby finally went to sleep and didn't wake up again to eat until four hours after the previous feeding, at midnight, then went back to sleep... for five and a half hours!
Could this be the light at the end of the tunnel???
My friend brought her to me shortly before 6 am. At that point I had been asleep more than nine hours! Of course, I had woken up multiple times to look at the clock and notice my engorged breasts and wonder how things were going... with gratitude in my heart.
After the 6 am feeding, C went back to sleep and slept another three and a half hours! I slept three of them, then got up to have a little time with my friend.
So not counting that one feeding at 6 am, and the little wake-ups here and there, I slept twelve hours!!!"
In this case, what I needed was someone to take that early evening shift. If you are still in the early days of infancy, you might need this too. It's perfectly acceptable to ask someone if they will sit with your baby from 8 pm to 12 am. The worst they can do is say no. And believe me, it's deeply uncomfortable for me to ask people for favors, and risk them saying no. In my crazy little head, that "no" takes on all sorts of meanings, like that they don't love me. Which is not rational, but that's a story for another day.
Anyway, try to remind your rational self that the worst thing that can happen if someone says no to you is an uncomfortable feeling. And Brooke Castillo at the Life Coach School reminds us that uncomfortable feelings are not dangerous. They are just a vibration in our body, caused by our thoughts. And we can choose to change our thoughts. So instead of thinking, "she said no because she doesn't really care about me," or even, "she said no because I'm an unacceptable human being," we can choose to think, "she said no because she doesn't have the capacity to help right now, which is about her, not me. I'm glad she felt safe enough to be honest with me. I will think about who else I can ask."
Don't be afraid to seek support from folks you don't know as well. Other moms may not be able to pitch in at night, but maybe your neighbor or co-worker or friendly acquaintance from your religious community would love to pitch in. If you are in a community like Single Mothers by Choice, there are likely members out there who would love to pitch in as they wait for their own turn at parenthood. Post to your local group as well as to the national organization and let folks know you need help. Remember, you are giving a gift by asking -- it helps build friendships and community.
Even if you don't need physical help, please let folks know when you are struggling. It doesn't mean you can't be there for them but sometimes, sharing your vulnerability is a beautiful gift. If you are overwhelmed by sadness or anxiety, or have thoughts of hurting yourself or your baby, please seek professional help immediately. It doesn't mean anything about you. It's not your fault. It's your hormones.
If you are ready to sleep train, ask for emotional support. Ask a friend or family member if you can call them to vent or cry. Ask them -- ahead of time -- to please support you by not offering advice or feedback. Just keep on reminding you that you are doing great, that your baby is crying because she's overtired and not because she feels abandoned. They need to remind you that she is going to feel so much better when she is getting the sleep she needs. I promise you it's true!
This is a big part of the work I do for tired parents. It's hard to have confidence that you are doing the right thing when both you and your child are exhausted. After we create a sleep plan together, my role is to troubleshoot but mostly, to cheer parents on. To tell them they are doing great. Over and over and over again. If you find someone who can help you stay consistent, you will see results.
If you're interested in getting support from me, let's schedule a free chat and help your family get the sleep you deserve. Remember, there is no shame in needing support. We all do. It's a beautiful thing.
Twins. Double trouble but triple the joy?
I haven't been lucky enough to experience multiples personally (though I was hoping for them with my firstborn!) . But I've recently had the pleasure of working with two sets of twins and I'd like to share a few tips for all those tired families of twins and higher-order multiples.
New Year's Resolutions (Like Sleep Training) Made Easier: Part Two. Make a Workable Plan Customized To Your Family.
In my previous blog post, I talked about how doing “thought work” has changed my life, and how it can make sleep training, or any big life change, a lot easier.
In this blog post, I’ll talk about figuring out how to actually execute the changes necessary to change your life. And your sleep.
First off, I recommend that you do daily thought downloads and thought models every single day. They help me stay motivated and I know they will help you, too. I would love to hear yours -- post in the comments below!
Secondly, you need to figure out how to execute the dramatic changes you wish to make in your life.
There is no one right answer to this. It really depends on you and your style.
Are you a rip-off-the-bandaid kind of person that would rather get the pain over and done with? Then you might consider doing an extinction-style method of sleep training. This method involves putting your baby to bed and not returning until morning.
Critics say that this method is cruel, but evidence-based research shows that short-term crying associated with sleep training is not dangerous and doesn’t hurt a child’s attachment to her parents.
Proponents say that extinction-style sleep training is the fastest method and involves the least amount of crying, overall, for children. And gets children (and their parents) the sleep they need in the least amount of time. Because it’s quick, it is more likely that parents can remain consistent long enough to get the training completed.
Others prefer a more gradual approach. For children older than four months, this typically involves sitting on a chair next to the crib every time the child is in the crib but not yet asleep. Every few days, the parent moves the chair further from the crib until eventually, they are in the hall and out of sight. At that point, the parent is free to leave the chair but can still call out to verbally reassure the child if needed.
Fans of this method like that the child can see the parent and doesn’t feel alone, especially if the child is accustomed to co-sleeping. Dissenters feel like this method takes too long and thus, is harder on both the child -- who is upset to see the parent and not be picked up -- and the parent, who has to be consistent for many nights in a row and can’t even read or look at a screen while sitting in the chair.
Some folks fall in the middle, choosing to leave the room but return briefly to check on the child at ever-increasing intervals of time. This is slower than extinction but faster than the chair method.
There is no one “correct” method. Every family is different. Only you know what is right for your family.
Regardless of the method chosen, families will want to make sure that bedtime, morning wake time, and naptimes are optimized to catch the child at just the right moment, tired but not overtired. Naptimes and bedtimes at inappropriate times can create overtiredness, which means cortisol, the “stress hormone,” makes it harder for the child to fall asleep and stay asleep.
But every child, and every parent, needs great sleep. Great sleep is a gift to the entire family.
Let’s make 2020 a well-rested year for your family. Schedule a free consult and see how we can get your family the sleep you deserve.
Abby Wolfson is a pediatric nurse practitioner, certified child sleep consultant and former NICU nurse. She divides her time between Brooklyn, NY and San Miguel de Allende, Mexico.