By Brian Symon

Background Information.

There are a few issues in the care of families with young children where I hold strong views about advice families may receive elsewhere. These opinions are strong in that the damage I see unintentionally caused to families and children by that advice is out of proportion to any potential gain.

Feed Play Sleep.

In Australia it is common for the large majority of mothers to be taught this philosophy of care. The basic concept is that early in life there is a need to ‘stimulate’ a child, to begin the process of bonding and skills development. Relatively often mothers are encouraged to develop daytime programs where a child is up, awake and stimulated for say 90 minutes or two hours. This advice can sometimes be given in the first few weeks of life.  It is common in my clinical practice to see mothers with babies say as young as two months trying to achieve a day pattern of something like 2 hours awake and 2 hours asleep. This is inappropriate in the large majority of babies.

The problem at this age is that the baby’s physical ability to be constructively awake is probably about half of this time. It would be unusual, in my experience, to see a baby less than 12 weeks, able to be awake for longer than about appropriately 60 minutes. Clearly there are days where a baby is awake for hours on end. These days however are unusual or at least I would want them to be the exception rather than the rule. Using the ‘feed play sleep’ philosophy however babies are held awake for periods that are too long for days on end.  The consequences are tiredness, then fatigue and finally severe fatigue.

Tiredness and over-tiredness lead to a number of consequences.

  • Tearfulness. The overtired baby will cry simply as they are overtired. Every woman who has had a baby can, I am sure, relate to this.  The day has been too busy, too long and too difficult.  Finally a minor event is the last straw and you unexpectedly cry because it has all become too much. Babies are exactly the same BUT their stamina and ability to manage fatigue is much lower.  They rapidly become overtired and cry as a result.  Unless the mother has been taught to understand this she can be left searching for possible diagnoses like wind, colic, reflux, teething etc. Often the baby is just plain overtired and needs to be asleep.
  • Poor feeding. This is in some ways the easiest to describe to you. The baby is overtired but also hungry. They come to the breast or the bottle for a feed and within a short time begin to doze. The feed is incomplete but the baby is asleep. So you now have a problem.  Do you force the baby awake or let them go to sleep and wake early e.g. in an hour because they were not fully fed?  There is no generic answer to that question and this is not the purpose of this information sheet. The main point here is to let you see the connection and diagnose the problem.  Overtiredness can lead to short, incomplete feeds followed by short broken sleeps.
  • Broken sleep. Elsewhere in this series of information sheets I have taught that sleep functions as a learned skill. This is a useful analysis that will guide you well. In the context of the ‘feed play sleep’ philosophy the baby is held awake artificially, becomes overtired and will then have trouble both achieving and maintaining sleep.  The tell tale signs are that the crying resolves rapidly upon you providing care and starts again almost as soon as you leave the child. The solution is to focus for a day or two on just catching up on sleep.
  • Loss of routine.  The day loses a pattern or routine and you feel as if you never quite know where you are or what to expect with day sleeps. You feel “out of control”.

My advice.

  • Never use ‘Feed Play Sleep’ as a philosophy of care for any baby at any age.
  • Use the philosophy of the “Happy Wake Time”. Babies will be constructively awake for a period of time and then become tired within a space of a few minutes i.e. 2-3-4 minutes for a baby in the first twelve weeks. Each baby has a fairly unique set of signals that they are starting to become tired. Examples include jerky movements, yawning, frowning, blinking, a ‘tired cry’, a loss of facial expression. By approximately three months of age a lot of babies will begin to rub their eyes with the back of their wrist. These signals are important.  They indicate that the baby has entered a “window of opportunity”. If the baby is put down in this time they achieve sleep efficiently.  If the window is missed by say 10-20-30 minutes the baby enters overtired time and has trouble achieving and maintaining sleep.  Trust yourself entirely.  You will learn your baby’s signals rapidly and will become amazingly efficient at choosing the time that your baby needs to go down to sleep accurately. Look forward to the moment when you KNOW the baby is tired and no-one else agrees and the baby is asleep in 5 minutes.

Attachment Parenting.

I once attended a lecture given by an invited Professor who showed slides of monkeys and women in developing nations all holding their infants. Thus she declared this is the ‘correct’ method of parenting.  She advised that babies should be held after birth for perhaps the first two years.  While this is extreme it was her genuine advice for women living in a developed nation, in a time based society, often functioning without extended families or paid family help and where they had perhaps other children, husbands and social responsibilities.

It is difficult to comprehend the practicality of such advice in the modern world. What do you do if you have twins or other children? What do you say when your husband wants some time with you alone (and you do too)? What are the practicalities of driving, showering, going to the toilet?  Anyway that is not really the main point that I wish to raise. There are other things in addition to the sheer impracticality.

  • Emotional well being of mother.  Having cared for a very small number of women who had tried this philosophy in the Australian setting I can assure you that they and the family unit were traumatised and profoundly altered by the effort.
  • Emotional well being of child. I have now cared for thousands of children over many years where the connection to the mother was exaggerated. The child is fearful outside of this relationship.  The child may become distressed if the mother leaves the room or puts the child down. This has a subtle but clear impact upon the child’s ability to relate to others. These children do not give and receive affection as easily. The relationship with their mother contains an element of dependency rather than the joy of shared love and affection. For the mother the day is often tiring and the way that affection is shared is draining rather than strengthening. The reverse is true where the physical connection is more “balanced”.
  • Family stability. The following is simply a statement of my view on life.  A baby is a member of and thrives as member of a family.  The baby is not THE family. All members of the family have genuine and appropriate needs for time, love and consideration. A mother loves her baby with all her heart. It is a wonderful thing to have a baby in a routine of sleep and feeding and interaction which allows you to balance caring for your child, getting “grownup” time with your husband/partner and to finish a day feeling that you life has balance. You will wake in the morning looking forward to spending a day with your baby. Attachment parenting steals these things away.

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