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Raising Sound Sleepers

Whether you bring home your child at three days or three years old, keep your expectations realistic and your routines flexible to ensure every family member a good night’s sleep.by Marybeth Lambe, M.D.



Sleep. The holy grail of parents everywhere. As the saying goes: “People who say they sleep like a baby usually don’t have one.” Few problems are so common—it’s estimated that 30 percent of children have difficulty falling or staying asleep—and yet few are so intensely personal. It’s as though we believe that admitting exhaustion, resentment, and confusion will make us a certifiable failure as a Mom or Dad.

And when a child’s sleep problems are compounded by the loss of familiar surroundings and, perhaps, jet lag, it’s even harder to find reliable advice—and so it’s no surprise that many new adoptive parents wonder whether they’ll ever get a good night’s rest again.

As a pediatrician, and a mom to nine through biology and adoption, I can assure you that you will (I say this even as the youngest of my brood approaches that second age when sleep seems an afterthought: the teen years). It will take time and patience, but you’ll eventually find the sleep rhythm that fits your family.

The first weeks home
Whether your newest arrival is a three-year-old from Russia, a 10-month-old from China, or a three-day-old from Nebraska, you shouldn’t expect that he’ll sleep through the night or be able to self-soothe. Newborns need time to adjust to new smells, sights, and sounds, and older children must get used to new surroundings, routines, and caretakers.

Your primary task as parents will be to teach your child that you can be trusted to consistently meet his needs. “Care for and comfort your newly arrived child as a newborn, regardless of age. That will help foster attachment,” advises Diana Schwab, M.Ed., of International Adoption Health Services of Western Pennsylvania, in Pittsburgh.

Although bedtime provides a natural opportunity to cuddle, stay close—rocking, carrying—during the day, as well. This daytime connection will teach your child that your home is a safe and loving place, that she need not be vigilant night after night. “Adults and children alike bring daytime conflicts to bed,” says Schwab. “It is rare for everything to tick along nicely but sleep. A sleep problem usually heightens or reveals other issues that may be going on.”

Schwab also reminds parents that a toddler or older baby may have a “honeymoon” period when he first comes home. “A child may go to sleep on his own and sleep well all night, because that is the routine he is used to. But weeks go by and, suddenly, he perceives he is fully dependent on you, and that everything is foreign and strange.” That’s when the sleep patterns he had learned fall apart.

Kristen Ghesquiere, of Ontario, Canada, can relate. “We thought we were going to get off easy. After we came home with our daughter, who was almost one year old, she went to bed every night at 8pm and slept the whole night through—for a couple weeks. Then she started waking up in the middle of the night. Once. Or twice. Or every two hours.”

Listen to your heart
While child and adoption experts can provide guidance, it is imperative that parents remain flexible and follow their gut. In my case, for instance, the family bed was a balm for several of my kids. For one, however, sharing a bed meant being kicked in the head all night, until we were all stumbling with exhaustion.

One of the best-known sleep strategies, named “progressive waiting” by pediatrician Richard Ferber, but often called “Ferberizing,” is based on the belief that babies can be trained to soothe themselves to sleep. The method encourages parents to increase the time they wait to respond to their baby’s cries night by night, over a period of about two weeks, and to comfort their baby without removing him from the crib.

SLEEP SOLUTIONS
ONLINE

Read these articles, and find much more, at AF's Sleep page.

  • A Good Night’s Sleep, by Sarah Springer, M.D.
  • The Family Bed, by Rick Waugh
  • Sleep Strategies for Nighttime Waking, by Susan Riter, M.D.
  • AF readers describe their sleep challenges and share their best bedtime tips.
  • No one, including Dr. Ferber, advocates letting a baby “cry it out,” leaving him to howl forlornly until exhaustion finally induces sleep. Even so, the understanding that a child engaged in attaching shouldn’t ever be left to cry alone explains why adoptive parents are often warned against Ferberizing. But, after their child’s initial adjustment period, many parents succeed with a milder form of Dr. Ferber’s strategy.

    Ghesquiere and her husband tried to solve their daughter’s nighttime waking by co-sleeping, then by cuddling and rocking her. What finally worked was a modified Ferber method. “I felt a huge amount of guilt,” she admits. “She’d be crying in her bed, and I’d be crying on the stairs outside her room.” But her daughter began falling asleep more and more quickly, and would wake up cheerful and affectionate.

    As Ghesquiere says, “Don’t look for the One Right Answer. What works for 80 percent of adopted kids might not work with yours. If one thing isn’t working (after a fair trial, of course), try something else. In the meantime, take care of yourself, and nap when you can.”

    Adjusting our sleep expectations
    Although newborns sleep for a total of about 17 hours a day, they sleep in stretches no longer than six hours. Their little tummies simply can’t hold enough milk to stay satisfied and sleepy for a full night, so their sleep/wake cycle is designed to accommodate feeding every few hours. At this stage, parents have no choice but to adapt their sleep schedules to their infant’s. Catch naps during the day, and let housework, cooking, or entertaining slide during those first weeks. Accept any offers from family or friends to help you out.

    The Family Bed
    Sleeping together as a family can be a fast track to forging a strong bond, and many families initially co-sleep. If you’ll be sharing a bed, here are a few suggestions and safety guidelines:

    > The mattress should be firm (never put a baby to sleep on a waterbed), and the bed should be free of loose blankets or pillows that could suffocate a child.

    > Be sure there’s no space between the bed and wall, where the baby could roll and become trapped.

    > Never co-sleep if you have consumed alcohol or taken any medication that might make you sleep too deeply.

    > Consider a sidecar—a crib that’s open on one side and attaches to the bed. This way, you have the bed to yourselves, and the baby stays safe, within arm’s reach (to see an example of a sidecar, go to armsreach.com).

    > When my family was sharing a bed, I kept a mattress nearby on the floor. If a child became restless, I would lie down there and return to my bed after the child calmed down.

    > As our children grew older, we kept sleeping bags on the floor of our bedroom. Our kids knew that they could come crawl into a sleeping bag if they woke up from a nightmare.

    An older baby or toddler may be used to sharing a crib or to being left with a bottle at bedtime, and grieve their loss because they were familiar. Toddlers are old enough to be aware of the change in their surroundings, but unable to truly understand the implications of that change, so they go through tremendous upheaval their first weeks—or months—home with you.

    It will be hard to be patient night after sleepless night, but “put yourself in your child’s shoes and act accordingly, with love,” says Carole Kagan, whose daughter came home from Russia at 16 months. “She had been abruptly removed from every sight, sound, smell, and person familiar to her, and whisked off through 15 time zones.”

    The comfort of bedtime rituals
    Bedtime rituals help your infant or child feel safe and secure. Even a small baby can sense a strong household rhythm, and benefits from knowing what is coming next throughout the day. As nighttime approaches, avoid overstimulating a child with games, excitement, or new faces. Instead, establish a set of peaceful and predictable rituals to help her associate bedtime with a gradual winding down.

    While you need not become a slave to exactness, “some parents abandon bedtime rituals too quickly,” says Schwab. The goal is to establish a pattern. “For some families, this may happen within days of coming home; in other households, it may take a month. Giving up after just a few days, allowing too many evening visitors early on, or taking the baby out every other night all work against setting a soothing and predictable tempo.”

    Your family’s bedtime routine might include a warm bath, a bottle of milk, a cuddle, and a lullaby. The important thing is to agree on the steps and not let it expand into hours of ceremony. Whatever is begun is what a child will come to expect—and demand—night after night. And if you have a spouse or partner, take turns overseeing the bedtime routine, lest one parent become the only one who can soothe your child to sleep.

    Nancy Savage, of Natick, Massachusetts, cautions against using any sort of “artificial circumstances” to encourage a child to sleep. “I’ve had friends who forgot the ‘special CD’ their child needed to listen to in order to fall asleep, and drove back in the middle of the night from vacation to get it.”

    “It was tempting to rock my nine-month-old daughter to sleep each night, after I’d waited so long to become a mother,” recalls Jo Laws. But the Hillsboro, Missouri, mom had been advised against that, so “we rocked and sang and talked at night, but I never let her fall asleep in my arms. She would be calm and ready to go to sleep when I laid her down, but she fell asleep on her own. I think some people disrupt a child’s sleep patterns out of excitement over finally being parents.”

    If your child is old enough, include her in your discussions, or at least explain the routine: “After your bath, we’ll brush your teeth and tuck you into bed. You can choose the story we’ll read. Then I’ll rub your back, and it will be time to rest. Mommy and Daddy will kiss you good night and go back downstairs while you fall asleep.”

    Savage’s daughter came home from the hospital at two days old, and she “learned from an early age that it was OK to lie in bed, look around, and drop off peacefully on her own.” At nine, the girl is still a “fantastic sleeper”—which means Mom and Dad are, too.

    Marybeth Lambe, M.D., is a family physician and the mother of nine, all of whom have outgrown the family bed. She lives on a farm in Washington state.


    How to Step Back?

    You’ll know that a bond’s firmly in place when your child starts offering spontaneous shows of affection and you have “mutual moments,” when he looks for you to share happiness and excitement. You’ll also recognize your own feelings of having bonded, says sleep expert Diana Schwab, M.Ed. At that point, she advises exhausted parents, “Tend to your child at night as much as needed and as little as he’ll tolerate,” taking a gradual approach.

    > At first, many adoptive parents find that the only thing that can soothe their child is close, physical contact. If you’ll be co-sleeping, move a larger bed into your child’s room, rather than let him fall asleep in your bed. When it’s time to wean yourself from his sleep routine, you’ll be able to do so without having to carry a sleeping child to his room and risk waking him or sending the message that he’s been pushed out of the family bed.

    > Next, sleep on a mattress placed on the floor next to your child’s bed or crib, then gradually move the mattress across the room, night by night.

    > Once he’s adjusted to this arrangement, you can sit quietly in a rocking chair in his room until he falls asleep.

    > After that, let him know that you’ll be sitting just outside his door.

    > If your child wakes at night during this transition period, you can stand by his bed and reassure him with your voice and pat his back, but resist the urge to pick him up or rock him back to sleep. The process may take time, but the end result will be a lifelong attachment and a child who’s comfortable with falling sleep on his own.

     



    How We Did It
    AF readers share their families’ sleep stories

    “When my daughter came home, at 16 months, she had never slept alone. Ferberizing was clearly not in order. She couldn’t sleep without continuous physical contact, so we slept together in a bed in her room for the first few weeks. Once she realized that I would always be there, she began to sleep in her crib, with me in the bed, close enough to touch her through the bars. Then I moved the crib to the other side of the room. After three months, she slept in her crib alone on an almost normal sleep schedule.”
    —Carole Kagan

    “After such a long wait to be a mother, I wanted so much to hold my new daughter as she fell asleep, but had been advised not to. Instead, we rocked her and sang and, once she was calm and sleepy, I put her in her crib to fall asleep on her own. Although I slept on the floor next to her crib the first few weeks, she always slept in her crib.”
    —Jo Laws

    “Given jet lag and separation anxiety, the first few days were challenging! She sleeps through the night now, but wakes frequently with night terrors. A set bedtime routine has been very helpful. Each night, we take a bath, change into PJs, read a book, rock to soft music, and into the crib she goes with a stuffed animal.

    All I can say to new parents is to be patient; this, too, will pass. Accept as much help as you can from friends and family, sleep when your baby sleeps, feed that caffeine addiction, and enjoy every minute of it.”
    —Jen Craig

    “I have two fantastic sleepers, one who came wired that way and one who was much tougher. I’m convinced that they learned as babies that it was OK to lie in bed awake, look around, and then drop off peacefully on their own. We followed our pediatrician’s advice: Always put babies down awake, pat their tummy or back for a few seconds, and then go away. If they fuss, come back briefly to reassure them (without picking them up again).”
    —Nancy Agris Savage

    “Although our daughter fell asleep easily, for the first two or three years, she woke up in the middle of the night with terrifying, blood-curdling screams. She was easily comforted and fell back to sleep peacefully, as if she simply needed assurance that we were there.”
    —Anonymous

    “At bedtime, we gave our newly arrived six-month-old a bottle and rocked him, then placed him in his crib after he fell asleep. For the first two months, we comforted him whenever he cried and continued to provide the midnight bottle that he’d gotten used to in foster care. Once we were confident in our bond, we stopped the bottle and began to let him cry without our going into his room. Within three days, he was sleeping through the night on his own.

    Despite ‘expert’ advice to the contrary, putting him in his crib asleep, which we continued to do until age two, had no effect on his ability to soothe himself back to sleep at night.”
    —Elizabeth Davis

    “When our son arrived, at 17 months, he hated to be left alone in his room. I lay on the floor next to his crib until he fell asleep. As time went on, I eased out of his room—gradually moving closer to the door, then out to the hall, and then finally closing the door. If he cried, I went in, rubbed his back, patted his head, reassured him, but didn’t hold him unless his cry was unusual in some way.”
    —Paula Riley

    “So many families struggle with sleep! Our daughter was 10 months old when we adopted her from Russia. At first we rocked her until she fell asleep. She loved to be held and rocked, and we loved it, too. But she developed more and more problems falling asleep, so we stopped rocking when she had been home for five months. (Friends and family scolded me for rocking her in the first place, but we felt that it helped our family bond.) She fought sleep tremendously.

    Ultimately, another mom told me to try swaddling, a practice common in Russian orphanages. She falls asleep in minutes now.”
    —Cara Bach

    “After reading bedtime stories and tucking my daughter into bed, I read my own book, by a small book light, in one of the extra bunks in her room. Though the room was relatively dark and quiet, she felt my proximity and became secure enough to fall asleep quickly and to sleep through the night. We took the time and care to help her feel secure in the beginning and it paid off. Now she goes to bed gladly, sleeps without nightmares, and wakes each morning with a smile.”
    —Barbara Ross-Ellis

    “Six months after my daughter came home, she was still waking every two hours for a bottle. She drank more at night than she did during the day! I used a method from Dr. Sears’s The Baby Book, called “watering down,” and diluted the bottles gradually. It worked! Within a week, she no longer found them worth waking for.

    My daughter has always slept next to me, but she is a very active sleeper and used to wake me up at night. The solution has been to place a booster pillow between us. If she wakes during the night, and wants me, I can just reach over the pillow to pat her.”
    —Casey


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    Comments

    We adopted our daughter from China when she was 11 months old. She was in an orphanage with a low ratio of children to nanny. From the day we brought her home, we fought for sleep. We tried modified suggestions from Feber, our pediatrician and a therapist. Our daughter would NOT go to bed at night. She was so sleep deprived that she started waking up 2-3 times per night. It is so true that a well-rested child sleeps better. At first we could rock her to sleep, but when that stopped working, we tried a modified crying it out method. We tried sleeping with her - in HER bed - not our's. We moved her to a big bed when she was 16 month because she could get out of the crib. After two years of no sleep for her or me, a little 16 year old girl told me to let her own her room. After much thought, we move all the hand me down furniture out of her room, let her pick out paint, a new bed, dresser, shelves, comforter, etc. (Of course, I helped a little by giving her 2-3 choices that I liked as well.) She helped paint her room, she helped put together all her new furniture, and she helped make her bed. We put a TV and DVD player in her room. Now at 3 1/2 years old, she runs to her room to put her PJs on, jumps in bed, reads her books and is allowed to watch 30 minutes of a movie - no "up" shows like Dora. She needs the extra time to wined down – so I don’t care what the books and others say about letting kids watch TV in bed. It really is the only time she watches TV anyways. Afterwards, we turn out the lights and she goes to bed. What a joyous child she is now. I no longer have the feelings of exhaustion and desperation that I have carried for two years.

    Posted by: Candi Amos at 9:08pm Oct 8

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