Slumpin’ and Sashayin’
Gregory Lawton, MD, Pediatrics, General, 09:00AM Oct 3, 2012
The parents of a newborn, one or two days home from the hospital, usually look beaten. Dad is unshaven, often employing a cap over his unkempt mop. Mom is squirming uncomfortably in her chair as she adjusts to the redistribution of weight from her abdomen to her arms, now laden with a swaddled bundle. The baby is the only one who has slept.
The parents of a one month old have regained a bit of their (presumed) pre-delivery swagger. Typically, their baby has gained the necessary ounce or so per day of weight. Sleep, for the parents, is still a luxury, a fuzzy dream from some time seemingly long ago. As I say to most of these parents when I join them in the room, "Time flies when you’re sleep deprived."
The parents of a two month old often have a full swagger. The coffee mug is clung to less for necessity than for habit. Longer stretches of sleep have been found at night. Higher level thought processes have returned to the parents’ consciousness. They have a "schedule" now. The new norm has been established.
I love watching this progression. Once I assure myself, and the parents, that their baby is gaining appropriate weight, I can be nearly certain that the important "what" is taking place. "What" is eating, sleeping, peeing, and pooping. Good weight gain = good "what."
My interest at this point is the "how." So much of what pediatricians do at these visits has less to do with the "what" and more to do with the "how."
In the newborn period, Goal #1 is weight gain. This is a "what." I tell parents that they need to help their new baby learn day from night. "They just came from a windowless Jacuzzi," I explain.
"Make daytime the obvious time for feeding them every 2-3 hours. Play with them, talk with them, keep them up a little more, and don’t let them sleep longer than 3 hours between feeds. Every minute that they are awake during the day and every extra minute of true feeding (nutritive sucking) is one additional minute of sleep AT NIGHT, when you need to sleep."
This is not rocket science. But it is an easy to follow plan of "how."
By one month of age, if they have followed my advice, and have been a little lucky, they have a baby who continues to gain weight and perhaps grants them four-five hours of sleep at night. IF so, the question they often ask is "when can we expect more?" I tell them, "Soon, you’re on the right path, just not at the destination."
"Bedtime is the time that you want them to be so full from frequent feedings during the day, and right on the edge of being so tired from having been awake for a good chunk of the day, that they resemble a guest after a Thanksgiving feast. ‘No, thank you, I couldn’t possibly eat anything else. Mind if I borrow your couch?’
Your goal is to get them to this spot in the evening. The trick is "how." Tweak, adjust, mold and modify your feedings and naps during the day to get here. Daytime is the time for doing this, as once the night arrives, you are where you are. There will be time for more "how" tomorrow."
At the two month visit, the hair and nails are done. Mom banters with dad about a date night. There is a sense of order and routine. The diaper bag is no longer an afterthought; it is part of the package now. The new norm has settled onto their lives, and they are comfortable wearing it. They are equally comfortable handling their baby, now likely three-four pounds heavier compared with two months ago.
"Great job. Your baby has gained weight and I can tell you’ve established a routine that works for you. Keep it up."
If they tell me about a desire to sleep better at night, perhaps have fewer feedings, I ask them about separate rooms. If they say that everyone is still in the same room, I tell them I live two minutes from a Trader Joe’s food store. "Some days, we go there three times – because it’s so close. Do you want to be Trader Joe’s?" I ask.
If they ask about a binky, I ask them what’s working for them now, be it self-soothing via the baby’s own hand or a binky. "Whatever you do make sure it’s working FOR YOU. If YOU are working FOR IT, such as getting up 3-4 times a night to replace a pacifier, then it’s not working FOR YOU."
More "how" issues. Not a lot of "what" issues.
This was never intended to be a treatise on Care of the Newborn through Two Months. My point is that all pediatricians, nurse practitioners, and family physicians that take care of newborns take care of the "what" with their own versions of "how."
There are some absolutes, such as car seats, safe sleep positions, and consistent growth in weight and head circumference. What makes our days enjoyable (aside from the ability to get more sleep at night than the parents of our patients 😉 is the opportunity to guide these new families through this process. We provide the words of advice, guidance, and encouragement to take these parents from "slumpin’" to "sashaying" in two short months.
At the end of their day, I hope these parents can get some sleep. At the end of my day, I feel as though I have done a bit of good. Sleep tight.