15-09 Story 2: Infant Sleep and Shaken Babies

 

Synopsis:  New parents are often at wits’ end when their baby won’t sleep. Infants who won’t sleep and cry inconsolably are also at major risk of being victims of shaken baby syndrome. Experts discuss the connection and ways babies can be more reliable sleepers.

Host: Nancy Benson. Guests: Dr. Ronald Barr, Professor of Pediatrics, University of British Columbia and Fellow, Canadian Institute for Advanced Research; Dr. Janet Krone Kennedy, clinical psychologist, founder, NYC Sleep Doctor and author, The Good Sleeper: The Essential Guide to Sleep For Your Baby and You

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Infant Sleep and Shaken Babies

Nancy Benson: Anger can be an incredibly destructive emotion, especially when it’s taken out on a tiny child. Shaken Baby Syndrome can be the result, and according to the National Center on Shaken Baby Syndrome it happens to 3 out of every 10,000 children under age one, leaving them with brain injuries…

Ronald Barr: …that usually, almost always, are related to the caregiver shaking the baby so hard that it produces subdural hemorrhages, retinal hemorrhages, (that means bleeding in the back of the eyes, and actually towards the front of the eyes as well,) and swelling of the brain or edema, and often some broken ribs and occasionally other sorts of injuries as well.

Nancy Benson: That’s Dr. Ronald Barr, Professor of Pediatrics at the University of British Columbia and a Fellow at the Canadian Institute for Advanced Research.

Ronald Barr: The immediate stimulus is most often, at least in children under one year of age and especially under 6 months of age, which accounts for the greatest majority of these infants, is the unsoothable crying that infants do. And this often is late at night and often is associated with difficulty getting babies to sleep. So, this is a really big challenge, because people who are otherwise completely normal and have no intention of harming their infants can lose it. And in a fit of frustration can, while they’re holding the baby, walking around trying to soothe them they take the baby under its arms and look at the baby and shake it back and forth, and say something like, “What are you doing? Why can’t I help you? Why aren’t you going to sleep? What do I need to do?”

Nancy Benson: One thing they can do is ask an infant sleep specialist for help.

Janet Krone Kennedy: Good sleepers are raised. This is something that they learn and we as parents can teach them. And there’s certainly some variation from child to child that is probably genetic, but any child can learn to be a good sleeper.

Nancy Benson: That’s Dr. Janet Krone Kennedy, a clinical psychologist, founder of NYC Sleep Doctor, and author of the Good Sleeper: The Essential Guide to Sleep For Your Baby and You.

Janet Krone Kennedy: A great sleeper is a child who loves to sleep, who learns how to self soothe, and will go to sleep willingly, and get the sleep that he or she needs without fighting it.

Nancy Benson: Kennedy says one reason babies cry and don’t sleep is because they’ve become overtired.

Janet Krone Kennedy: Parents tend to wait until the child is giving these really clear signs of fatigue like eye rubbing and crankiness and crying, and they try to put the baby down then. But once you’ve to got to that point, the baby’s actually overtired, the body has released adrenaline, and the baby’s going to fight sleep more than he would have maybe just 15 minutes before.

Nancy Benson: Adrenaline is the body’s fight or flight response to stress. Kennedy says it’s the same for babies as it is for adults.

Janet Krone Kennedy: As an adult, if you are not sleeping when you’re starting to feel tired your body assumes that there’s some reason you need to stay awake. Whether that’s because you are doing something like working, or if you are trying to solve some problem, or you’re very stressed. So your body releases adrenaline to help you stay awake and have the energy to solve that problem.

Nancy Benson: Kennedy says the best time to put baby down for a nap is before adrenaline has kicked in, just when the baby is beginning to get drowsy.
Janet Krone Kennedy: The signs of drowsiness are much more subtle. A baby will start to slow down, look away, be less engaged, stare out into space and maybe blink long and slow. The first yawn that you see, they might be cooing and talking and all of a sudden get quiet, and often that’s followed by another little burst of energy. And so you have to believe it when you see it the first time, because it’s easy to be convinced like, “Oh the baby really hasn’t been awake for that long, how could he possibly be tired?”

Nancy Benson: Kennedy says babies 3 months and younger should be awake no more than 90 minutes at a time. Sometimes even less. But parents often try to keep a baby awake for longer periods of time hoping he’ll sleep better at night. That doesn’t work.

Janet Krone Kennedy: A baby who sleeps well during the day is going to sleep better at night and that all goes back to adrenaline. So an overtired baby who’s not napping well is going to be going to bed at night with adrenaline in the system, and that adrenaline causes him to fight sleep at bedtime, or it causes him to wake up too much during the night. It sometimes even causes them to wake up at like 4:30 in the morning and not be able to go back to sleep, even though that’s nowhere near an appropriate wake up time.

Nancy Benson: But sometimes a baby cries no matter what you do.

Ronald Barr: It is important to teach parents to help the baby fall asleep. But what also has to be said in the same breath is that some of this crying is nothing that the parents can do anything about. It’s what we refer to as inconsolable crying, and of course it can be exacerbated if the parents are doing things to make it worse, but even in a totally normal, totally appropriate parent who doesn’t shake the baby, they’re still going to have episodes of inconsolable crying at least in the first few months of life. So, it’s also important to understand that it’s not just about whether you’re a good teacher of your infant as far as going to sleep. You can do a lot of things to facilitate the baby going to sleep that work some of the time but hardly anything, probably nothing, works all of the time.

Nancy Benson: Barr suggests 3 steps for inconsolable crying that also apply to sleeping. First, increase what he calls “carry, comfort, walk and talk.”

Ronald Barr: And then the second step is, if the baby’s crying continues, and you are getting frustrated by the crying as you’re doing this increased “carry, walk and talk,” then put the baby down in a safe place and walk away. You cannot comfort the baby if you’re frustrated yourself. And then come back and check on the baby every 10 or 15 minutes. And then the third one, of course, is never shake or harm your infant.

Nancy Benson: But not all experts agree that checking on your baby every 10 to 15 minutes is helpful. For example, Kennedy believes that the “cry it out” method of sleep training is the only one that will work for some babies. But it’s highly controversial.

Janet Krone Kennedy: Putting your baby down in the crib and teaching him how to fall asleep by letting him cry, will teach that child to self-soothe. They are in the habit of being soothed to sleep and being fed during the night and being helped all night long. Long after they have the ability to self-soothe and to sleep all night without feeding. So once they reach that age, which is as young as 3 months depending on how big they are, they’re capable of learning how to sleep, and if it’s not happening it’s a very good time to teach them, because it doesn’t get easier as they get older.

Ronald Barr: It’s fine and appropriate and helpful often to help the baby self regulate. There’s nothing inherently bad with that, from my point of view, but to expect that it will work all of the time, and they’ve got the necessary behavioral circuits, that they’re mature enough to handle that kind of independence, I think we’re asking a lot of these infants. So I would not be a strong proponent of the “cry it out” system for putting babies to bed. This baby will be the joy of your life, just don’t expect it to be perfect every time you try to put it to sleep or feed it or whatever you’re doing at the time. It’s just the way babies are. Be patient, be calm, be cool, and enjoy the good times and know that these crying times and the difficulty putting them to sleep will pass. It’s just that it may take a few weeks or months before that happens.

Nancy Benson: You can learn more about our guests and find a link to the book The Good Sleeper: The Essential Guide to Sleep For Your Baby and You through a link on our website at RadioHealthJournal.net.
Our writer this week is Polly Hansen. Our production director is Sean Waldron. I’m Nancy Benson.

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