10 TIPS FOR EASIER NIGHT NURSING

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During the first year you will spend a lot of time feeding your baby at night, so you might as well enjoy it. You have two nighttime goals: get sufficient rest yourself and meet the nutritional and emotional needs of your infant. Remember, a happy mother and a well-fed baby are the goals of both daytime and nighttime nursing. Here are some tricks of night nursing that have worked for us with our eight babies and that mothers in our practice have shared with us.

1. Remember your goal of nighttime parenting. You can't force your baby into a state of sleep. Your role as a parent is to create a sleep-inducing environment that allows sleep to overtake the baby naturally. We believe that the ultimate goal of nighttime parenting is: to help your baby develop a healthy attitude about sleep, so that your child grows up regarding sleep as a pleasant state to enter, with no fears of either falling asleep or staying asleep. To accomplish this goal, you will put a lot of effort into parenting your child to sleep and parenting her back to sleep when she awakens in the middle of the night. Eventually, your care and comfort will become part of her inner resources, and she will be able to do this for herself.

This goal is very different from training baby to sleep through the night as soon as possible by denying him parental comfort, in other words, letting him cry. This can lead to children developing unhealthy attitudes toward sleep. Worse, they learn that they can't depend on parents to meet their nighttime needs. Meanwhile, mom and dad become less sensitive to their child's signals.

With the cry-it-out method, what's the lesson baby learns? "They aren't going to come, so I may as well give up," or "It doesn't matter how I feel." Less-persistent babies give up quickly. Since they can't trust parents to be there, they "cope" and learn a big lesson: You have to look after number one because no one else will.

Think of nighttime parenting as a long-term investment. The middle-of-the- night time you put in now will save you sleep in the years ahead. Your children will sleep well when they are older, and the good relationship you have built with them will keep you from lying awake at night worrying when they are teenagers and young adults.

2. Develop a realistic mindset about night nursing. Begin your parenting career without preset ideas about how your baby is going to sleep at night. This will make it easier to reconcile yourself to the realities of nighttime parenting. You may have a mellow baby who breastfeeds predictably by day and sleeps 4-6 hour stretches at night. (and for sleep researchers, sleeping a five- hour stretch qualifies as "sleeping through the night" in an infant under six months of age.) Or, you may be blessed with a high-need baby, one who will settle for nothing less than frequent nourishment and comforting day and night. Both types of babies are normal. Also, realize that when babies wake frequently to nurse they are only asking for what they need to thrive. Thriving means more than getting bigger, it means developing to the fullest potential � physically, emotionally, and intellectually. Nearly all babies know intuitively how much nursing they need for nourishment and for comfort. Remember that at this young age, babies' wants are the same as their needs. So when your baby awakens to nurse at night, respect his judgment. He really needs this feeding. In fact, as we'll later see, a common medical cause for an infant failing to thrive is not getting sufficient feedings at night.

Of course, part of what your baby needs at night is contact with you, and you may even learn to appreciate these nighttime feedings. Here's an excerpt from the journal Martha kept while she was nursing our sixth baby, Matthew:

I look forward to night feedings. These are special times. No interruptions, just Matthew and me. We are both so relaxed and can truly enjoy one another. I cherish these special times because I know they will pass all too soon.

3. Be open to trying various sleeping arrangements. There is no right or wrong place for baby to sleep. Whatever sleeping arrangement meets the nighttime needs of all family members is the right arrangement for your family. Be open to trying various arrangements until you find the right one for your family. Sleeping arrangements may vary at different stages of your infant's development. Some infants settle better sleeping snuggled right next to mommy all through the night, others seem to sleep better in a crib, and others sleep well in various combinations of co-sleeping and solo sleeping. Most breastfeeding infants sleep best snuggled right next to mom. Where a baby sleeps is for mom, dad, and baby to decide. It's no one else's business. Do what feels right to you. Here's how one mother came to appreciate sharing sleep with her baby:

"The night I came home from the hospital I just couldn't put my tiny, helpless baby in her new crib to sleep. Instead, we took her into the security and warmth of our bed. Many people comment on how happy and content our baby seems to be all the time. I really believe this is due to nursing her when she needs it and having her sleep in our bed. I was ambivalent about sleeping with my baby until my pediatrician said, 'Do what you feel is right.' This helped me enjoy sleeping with my baby."

Some ultra-sensitive infants are so stimulated by mother's close presence that they need a bit of distance from mom in order to settle, yet they don't sleep well in their own rooms. In this case, try the sidecar arrangement . In this way, baby is within arm's reach for nursing, yet mother and baby are not so close that they keep each other awake. (You can buy a special baby bed called the "Arm's Reach� Co-Sleeper� Bassinet" that is designed to be used next to the parent's bed.)

4. Tank up baby with frequent feedings during the day. As babies get bigger, they get busier during the day and forget to eat. So, they make up for missed feedings at night. This happens especially after six months of age. In this situation mother may be the one who "demands" that baby breastfeeds at least every three hours during the day, so that he does not need to nurse as much at night.

5. Refill tiny tummies before you retire. Awaken baby for a feeding just before you go to bed. If baby nurses to sleep at nine, and you go to bed at 10:30, you may be awakened at 11:00 or 11:30 when you've barely had a chance to doze off. Better to awaken baby and fill his tummy right before you go to sleep, so that the two of you can enjoy a longer stretch of sleep at the same time.

6. Offer both breasts at a feeding. Since you're going to have to feed your baby in the middle of the night, you might as well do a thorough job of it and offer both breasts. There are two techniques for switching sides when nursing in the lying-down position. One is the across the chest roll: after your baby finishes nursing on the first breast, cradle him against your chest as you roll to the other side. Get settled and then latch baby onto your other breast. If rolling your baby across your body is more wiggling around than you want to do in the middle of the night, instead turn your upper shoulder toward baby as you adjust the level of the upper breast so that your baby can latch on.

7. Change baby before a feeding. If baby's diaper is wet or dirty, change him before a feeding so that he stays asleep after the feeding. This doesn't work for those "in and out" babies who seem to have a bowel movement every time milk is going in the other end.

8. Releasing the all-night sucker. Some babies love to sleep with a nipple in their mouth. After they have finished filling their tummies with milk, they continue to suck for a few minutes, a half-hour, or even longer. While some mothers can sleep with baby attached throughout the night or at naptime (they're just thankful that baby is sleeping), some mothers can't relax with baby still connected. To avoid waking your baby as you disengage the nipple, gradually ease him off the nipple by inserting your index finger in the side of your baby's mouth to pry his jaws open gently. As the jaws release, slowly draw the nipple out of his mouth, protecting it with your finger in case baby clamps down suddenly. Some babies will startle awake when they sense the loss of pressure inside their mouth. In this case, as you gently (or quickly) draw the nipple out, be ready to press with your index finger upward on his lower lip or chin as soon as your nipple is clear, and hold that pressure long enough for baby to adjust. Then slowly ease your finger pressure off. (Holding your breath seems to help, too.) If baby seems to wake, try patting her tummy gently. You may have to let her suck a while and try again.

9. Burping the night feeder. Many breastfeeding babies nurse less anxiously at night. They swallow less air and don't need to be burped. Even if you do need to help your baby bring up a bubble after nursing in the side-lying position, there's no need for you to get out of bed or even sit up. Prop baby up with his head and tummy against your body and pat his back until he burps.

10. Prop your baby to around a 30 degree angle. While most babies can night nurse while sleeping flat in the side-lying position, some babies suffer from gastroesophageal reflux (GER) and awaken with colicky abdominal pain during or right after the feeding. In feeding GER babies, gravity is your best friend. Instead of nursing in the side-lying position with baby lying flat, elevate baby on a foam wedge between a 30 to 45 degree angle and keep baby upright for at least thirty minutes after a feeding until gravity empties the stomach. (See Sleep Problems)

Parents also get into a sort of nighttime rut. The bottle or breast works so well that they stick to it. This is okay if you're going to offer the same prop every time baby wakes up. But if you want baby to learn to resettle himself without "ba-ba," offer a variety of go-to-sleep props. For example, give him his bottle in a rocking chair, then help baby snuggle to sleep with one arm around a teddy bear and the other around mommy or daddy. When he awakens, cuddling the bear may be enough to resettle him. Or, use a specially shaped snuggle bolster (available from catalogs or infant specialty shops) for baby to nestle his head into. (Our babies liked to have their heads pressed up against someone or something � a womb memory that is soothing to baby because it is familiar.) A solo sleeping baby may need this more, since he doesn't have human props.

Don't let baby sleep with a bottle of milk or juice. Bottles are not friendly to a sleeping baby's teeth. Especially blacklist honey-dipped pacifiers. When baby falls asleep, saliva flow decreases, diminishing its natural rinsing action on the teeth. The sugary stuff bathes the teeth. Plaque and bacteria have an enamel feast, resulting in severe tooth decay called bottle mouth. If a baby is hooked on the nap or nighttime bottle, try watering down the juice or milk, each night diluting it a bit more until it's all water. If baby clings to his nighttime bottle and won't settle for a diluted substitute, be sure to brush his teeth well on his first morning trip to the bathroom.

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