Saturday 31 January 2009

Sweet Dreams Baby... tips to help assist your baby to sleep




Natalie's tips & gentle techniques to assist your baby in becoming a great sleeper!















Using researched techniques and a gentle, nurturing approach, combined with (currently 9 years) experience as a mother of two will help you to assist your little one to sleep (day AND night)....


1. Learn your baby's tired signs (cue's) - it is very important for you to know and understand your baby's tired signs if you want your baby to fall asleep easier and reduce tears and tantrums! When your baby is showing 'tired signs', you need to give him reassurance and tell your child it's time for sleep - (TIP: be firm and consistent when putting child to bed. Older babies and toddlers will often 'fight' going to bed). Many say this is the 'window of opportunity', because if you keep your baby awake through play or other stimulation, he will quickly become over-tired and it will become harder to settle your baby to sleep (especially with newborns). Some signs to look out for include:
- yawning

- grimacing

- rubbing the eyes

- clenched fists

- jerking movements

- losing interest in toys and their surroundings

- fussing

- grizzly

- clumsy (older baby/child)


- crying (by now your child is overtired!)

For an older baby, missing a sleep during the day e.g due to over-stimulation, does not necessarily mean he will sleep better during the night. Often it is the opposite and they may wake more during the night (see also point 11.) (TIP: even from 1 to 2 yrs of age, young children still need at least one day sleep). The secret is to put your baby to sleep when they FIRST start to show signs of tiredness!



2. Establish a soothing bedtime ritual (including a 'wind down' period in the evening) -
A bedtime ritual or routine at night is a wonderful way to relax your child but more importantly, prepare them for bed. Ideally, a soothing ritual eg using calming/relaxing music, together with the TV off or volume low, lights dimmed is a good indicator for your child that bedtime is approaching. You could also incorporate into your bedtime ritual - reading a book or two (age appropriate, pictures rather than words for young babies), whilst snuggling up together with a blankie; maybe a warm bath (more suitable for babies over 6 months. For young babies or newborns a bath can often be too stimulating; top and tail is best. Bath water can be drying on a newborn's delicate skin and strip the natural oils on their skin), breast milk or a bottle and a massage (refer to point #3 below). Routines are reassuring and predictable for babies - this helps them settle quicker to ensure a good night's sleep!


3. Massage - Massaging your baby (the earlier you start the better) has many benefits, both for you and bubs. (TIP: you can massage your baby from birth). Regularly massaging your baby on a daily basis will help establish a better sleep pattern. Nurturing touch through massage releases the sleep hormone, melatonin. For further reading on why massage is so important for babies and how massage will help your baby with sleep, see Idibidi Kids BLOG post December 2008, "Sleep problems and babies: how massage can assist your baby to sleep". Learning massage with an instructor when they are a newborn gives your baby time to learn and understand what massage is and that massage can be very relaxing for them. This way they can "grow" with the feeling of massage as you incorporate it into your daily routine. The secret to success with massage is offering it to your child on a DAILY basis for them to receive the many benefits associated with massage and positive, nurturing touch. Repetition is an important part of your child's learning and development. Please note, for newborn babies under 5 months, avoid massaging after a bath in the evening. Certain massage strokes in particular can be too stimulating for a baby under 5 months. It is best to incorporate massage time during the day after your baby's sleep, at a time suitable to both you and your baby.









4. Relaxing music and 'white noise' - try playing a relaxation music CD or putting some background noise close by when they are settling to sleep. White noise is often said to help settle your baby to sleep, e.g playing the radio in between stations or a fan on low speed. Keep this going whilst they sleep because if they wake between sleep cycles (ie in the lighter stage of sleep) the constant background noise can be helpful to resettle little ones.

5. Your diet and breastfeeding - cut down your intake of caffeine and alcohol and avoid smoking. Keep in mind that breastfeeding your child is only a small portion of their life. Maintaining a healthy diet whilst feeding your baby is important for their health, growth and brain development. Increase foods in your diet that contain complex carbohydrates, protein, iron, zinc, calcium and essential fatty acids. Make sure you drink plenty of water! (TIP: drink a glass of water each time you feed your baby).


6. Swaddling - Swaddling is, in fact, an age-old practice that first developed around 4000B.C. These days it can be done using muslin cloth or specially designed 'winged' swaddle wraps (takes the 'fun' out of wrapping yourself!). Swaddling gives your baby a sense of security, (as it was once surrounded for 9 months in utero), and promotes a sounder sleep by staying in the REM sleep period for longer. Some say it does help reduce crying. Babies tend to startle whilst asleep which may disturb their sleep and they may even cry out. Known as the 'startle' or 'moro' reflex, babies will usually fling their arms and legs out and make jerky movements. Swaddling your newborn is a practical way to help your baby through the transition stage in his new life. It can be continued until your baby becomes more active, usually around 5 months of age or when they are rolling and crawling. (TIP: experiment with swaddling techniques to suit your baby. Some babies prefer one arm out or their feet exposed). By around 5 months or sometimes earlier, it is important to let your baby move freely whilst asleep as they process what they have 'learnt' or been exposed to during the day.

7. What's the difference between day and night time sleep? A young baby (newborn in the first couple of months) cannot tell the difference between day and night. Babies circadian rhythm (their natural body clock) starts anywhere from 6 to 14 weeks old (usually around 3 months). You can help your baby by keeping the house relatively light during the day, even whilst they are sleeping (unless you have block-out curtains in baby's bedroom, it wont be as dark as it is at night time). At night it is important to keep talking and movement to a minimum, to encourage your baby to settle themselves back to sleep.


8. Mummy's scent - to help your baby settle to sleep, he may be comforted by a piece of your clothing or something that has a familiar scent on it, like your body scent. You could tuck this into the side of the cot or underneath the sheet. Your body scent will also help with the parent-infant bonding process.

9. I'm full! - a contented baby who has a full tummy should sleep longer and wake happier than a baby who 'snacks' most of the time; newborns have a small tummy capacity and therefore require frequent feeding (no more than 4 hourly during the day). Be guided by when your baby seems hungry and not by the clock!


10. Room temperature - babies and toddlers may wake during the night if they are feeling cold or too hot. Ensure they are dressed appropriately and try to maintain an even room temperature. Even in summer the nights can be cool, especially in the early hours of the morning. You may like to try a 'grobag' for your baby : this way, babies who roll out of the covers are kept at a constant temperature (if babies could talk they might say "thanks Mum and Dad, my very first sleeping bag"!!)


11. Stimulation during the day - too much? A newborn can be overstimulated quite easily. Usually 20 minutes is enough play time for a young baby. Forget the gyms and fancy toys; your new baby craves love, nurturing and attention. Simply looking into your baby's eyes and talking to your baby builds trust and helps form a secure attachment between you and your child. A great book I often refer to is called "Baby Play - 100 fun-filled activities to maximise your baby's potential", a Gymboree book by Dr. W. Masi & Dr. R. Leiderman.


12. A little note on crying - you can never spoil a newborn with love! When he cries, offer a cuddle, a kiss, some gentle stroking over his clothes or a massage. Your newborn needs to know you are there for him! As long as all his other needs are met (e.g hunger, nappy change, too hot or too cold) he may just need reassuring. Babies need to feel safe and loved. This is important, too, for their psychological and physiological development. Research shows babies who are nurtured, loved and attended to when distressed, grow into healthier children who are able to cope better with stress later on in life.













13. ... and finally...be flexible - in the early days of your newborn's life, remember to be flexible in terms of finding a settling routine that works. Don't just stick to one method, discover what your baby prefers and stay with it. Feeling empowered and confident as a new parent may take time - lots of support and nurturing and finding what works best for your situation is often the key!

Monday 12 January 2009

Reflux in babies and Massage

The Digestive System, Vagus Nerve & How Massage Can Assist Babies with Reflux

By: Natalie Garmson, CIMI, MISI, Ass.Dip Sc, Cert I Aromatherapy, W.A. state rep. (International Association of Infant Massage)

The digestive system and the vagus nerve: a brief overview
Digestion is controlled by the Autonomic Nervous System (ANS), in particular, a branch of the ANS called the parasympathetic nervous system (1). Here you will find the vagus nerve (sometimes referred to as the vagal nerve). The vagus nerve sends signals from the brain to the stomach, pancreas and other digestive organs such as the oesophagus; its main use being to regulate the function of these major organs. The oesophagus is essentially a muscle under the control of the vagus nerve (2). The muscle at the lower end of the oesophagus (closest to the stomach) is the lower sphincter; this valve relaxes and contracts to allow food to pass through to the stomach. It is the lower oesophageal sphincter contracting that prevents the reflux reaction occurring. If this muscle is immature or weak, your child may experience reflux (Gastro-Oesophageal Reflux or GOR for short). Food passes down the oesophagus to the stomach by a series of wave-like contractions, known as peristalsis, forcing the sphincter muscle to contract and relax. The vagus nerve also controls peristalsis (2).

How human touch influences the vagus nerve:
The ANS comprises the sympathetic and parasympathetic branches. When your baby cries and is in pain (a symptom of reflux), the sympathetic branch is stimulated, releasing stress hormones such as adrenaline and cortisol (4). The sympathetic nervous system overpowers the parasympathetic (calm and relaxed) system (3). This is where the power of touch is in your hands. If you consider how massage can be used to effectively relax a tight muscle, normally you would directly massage that area and the muscle would loosen, however this becomes difficult in the case of reflux. When considering how massaging your baby is able to relieve symptoms of reflux, it helps to understand how the skin and the nervous system are connected. Massage on any area of the body is able to assist a reflux baby by stimulation of the vagus nerve and thus an increase in effectiveness of muscle control and regulation (remembering it is the vagus nerve that controls the lower sphincter in the oesophagus). Why is this so? Because the skin and the nervous system develop from the same cell layer (4). An increase in the amount and frequency of skin stimulation (eg pressure via massage) means that the vagus nerve is able to operate faster and more efficiently. This should result in greater muscle control. Remember, relief from reflux won’t happen overnight. Consistency is the key, especially to relieve the symptoms of reflux in infants. It has been suggested that massaging your baby twice a day for a reflux baby can help relieve symptoms. As one infant massage instructor recalls “I remember one little four month old girl… she had been diagnosed with reflux but her parents had seen no improvement after trying medications and various formulas. After introducing a simple massage routine twice a day, her parents reported complete improvement after only two weeks!” (6).

Did you know?
Touch is the earliest sense to develop in all animal species. (4). Massaging your baby is a wonderful way of communicating to your newborn through positive, nurturing touch. It is amazing to think that by the end of the fourth month of development, the skin is formed. You may also see the skin referred to in text books as ‘integument’ which forms a part of the integumentary system (5).

Recommendations for massaging a reflux baby:
There are a few considerations that need to be taken into account when massaging a baby who suffers from reflux.

(1) Alter the position of your baby for massage. Preferably lay your baby on a forty five (45) degree angle (as opposed to lying on the floor in front of you). You can do this simply by adding some cushions or a pillow, supporting their back and head or using a specially designed reflux sleeping wedge or reflux change mat (eg see http://www.pollywogbaby.com/ sleep wedge or http://www.buboo.com.au/ ). Note: you may want to experiment with the angle at which your baby sleeps. A lower angle (eg 15 degrees) may not be beneficial to assist a baby with reflux. An angle up to 45 degrees is recommended.

(2) If you baby’s abdomen is tender or you think he/she may posit, avoid massaging this area.

(3) When massaging your baby’s back, instead of them lying on their tummy on the floor, consider lying your baby on his/her side whilst remaining in a forty five degree angle, or try the cuddle position. This is where you cuddle your baby, using one hand to support their bottom and legs, whilst the other hand massages their back. It is important ensure your body is supported, for example, by leaning back on a sofa whilst sitting comfortably on the floor.

For practical advice and further information about reflux, silent reflux and Gastro-oesophageal Reflux Disease (GORD) and products available for reflux:

http://www.pollywogbaby.com/ Practical Solutions for Infant Reflux and Colic

http://www.reflux.org.au/ Reflux Infants Support Association Inc. Australia

http://www.infantreflux.org/ Infant Reflux Solutions For Your Baby!


References:
1. Nutritional Biochemistry, 2nd ed, Tom Brody, Academic Press, 1999, U.S.A.

2. Smith, Margaret.E, Morton, Dion.G, The Digestive System: Basic Science and Clinical Conditions Elsevier Health Sciences, 2001.

3. Sunderland,M. The Science of Parenting. DK Ltd, 2006, London, Great Britain

4. Field, T. Touch M.I.T, 2001, Massachusetts, U.S.A

5. Marieb,E. Human Anatomy & Physiology, 5th ed. Benjamin Cummings, 2001, U.S.A.

6. McLoughlin,H. I.M.I.S Infant Massage Training Manual, “Can Massage Help Reflux?” article, Australia, 2007 (an excert from the R.I.S.A NSW newsletter 2007)

Books Ive Read...

  • Frederick Leboyer: Loving Hands, The Traditional Art of Baby Massage
  • Kerstin Uvnas Moberg: The Oxytocin Factor
  • Tiffany Field: Touch
  • Vimala McClure: Infant Massage, A Handbook for Loving Parents