infant mental health

Sleep Training: Misinformation, Misunderstanding, and Missed Opportunities

How we interpret the science of infant sleep can have an impact on how we are able to trust our instincts. Our hearts and our minds can align if we ask ourselves the right question: “How can I support my baby’s sleep development?”.

Nightweaning: Evidence and Experience

Artist: Grace Laidlow. Shared here with a donation to the artist.  Art in the Public Domain.  https://www.publicdomainpictures.net/cn/view-image.php?image=211133&picture=

Artist: Grace Laidlow. Shared here with a donation to the artist. Art in the Public Domain. https://www.publicdomainpictures.net/cn/view-image.php?image=211133&picture=

When nighttime sleep has been a challenge for breastfeeding mamas, many will turn their attention to the question of whether night weaning from breastfeeding will lead to a better night’s sleep.

After all, it makes intuitive sense that, as Jay Gordon suggestions, if the diner is closed, there’s no point waking up for a midnight snack.

In this article, we will take a look at what we know about night weaning and explore what may work to support night weaning in an evolutionary and nurturing way.

In addition to exploring strategies for night weaning, I’ll indulge in a bit of storytelling, too, as I share my night weaning experiences with my three children. Most of the suggestions below assume that you are considering night weaning a baby over 12 months of age, and that your toddler is bed sharing with you, or are continuing to room share with you: the effort of continued night feeds for a child down the hall makes it likely that toddlers who are sleeping in their own room are already weaned. Also, night weaning before 12 months has special considerations that include development and growth that I won’t cover in this article.

The challenge for some parents (though not all) that emerges in the toddler years is that as parent longing for some personal space goes up, so does toddler restlessness, acrobatics, long lazy latches, and nighttime nibbling. Nipples get sore, heads get kicked by flailing toddler arms, and toddlers go through periods of increased feeding for comfort, emotional connection, nourishment, and more —nothing close to the straight trajectory towards natural weaning that we pictured when we first imagined natural child-led weaning. It can feel like a return to the early days of feeding, except kiddo is three times as big, and waaaay more active. Parents who are nursing a toddler through the night probably recognize some similarities with nighttime at the 7 to 10 month mark too —a typically challenging period of time for infant sleep.

As decisions are made about if and how to night wean, it can be helpful to keep two questions in mind: what are you reasons? And what are your goals?

I want to emphasize that when we, as parents, have decided we are “done” and want to end the nursing relationship, it is ok! Sometimes this is out of frustration, fatigue, being “touched out”, or wanting some flexibility through the night (to work, to rest, to be alone). As decisions are made about if and how to night wean, it can be helpful to keep two questions in mind: what are you reasons, and what are your goals. The answers to these questions will help guide your actions, and will also help you evaluate things, and change course (subtly or significantly) if what you are doing doesn’t align with your goals. Your goals, of course, may change too!

Often, breastfeeding parents feel that night weaning will reduce night waking. That connection is quite murky —I could find no evidence to support this idea in the literature, though certainly there are some children for whom this is true, anecdotally. I would suggest that in terms of sleeping through the night, it be approached more as a developmental skill, and one that may or may not be impacted by night nursing. However, despite this, moms may still feel a strong pull towards night weaning for their own physical comfort, and their desire for some bed boundaries and personal space. These are important things to honour!

There may be sweet spots that, developmentally, can make it better “timing” —these generally happen between Plooij and van de Rijt’s popular “Wonder Weeks” in addition to other frameworks of developmental jumps. However, timing isn’t everything —your needs are factors here too.

Before we delve into how to night wean, let’s take a peak at what we know about night breastfeeding.

Research doesn’t tell us much about weaning. And research tells us even less about night weaning. What do we know? We know that:

  • up to 1/3 of a child’s nutrition at 12 to 24 months of age can come from night feeding (WHO, 2015);

  • breastfeeding beyond the first and second year of a child’s life is recommended if it aligns with what a family feels is appropriate (CDC, 2014); and

  • night weaning can be among “the most logistically and emotionally challenging” aspects of weaning (Cuniff & Spatz, 2017, p.93)

  • Night feeding and bedsharing are highly correlated

What does that mean for moms who are ready to night-wean? It can be gradual. It can be your decision. And it can be difficult. But, as with many parenting situations, being difficult doesn’t necessarily mean it is not the right decision. Weigh the benefit and draw backs, be flexible, and be gentle with yourself. This, like so many other aspects of parenting, requires flexibility and an open mind.

Weigh the benefits and draw backs, be flexible, and be gentle with yourself.

Here, then, are some insights for those who have decided to nudge things towards night weaning.

One of the more popular suggestions for night weaning parents is Dr. Jay Gordon’s nighttime weaning process (Gordon, 2002). For kiddos above the age of twelve months (and more than likely 18 months and older) who are ready, his process can work well. However, in practical experience, these steps can be difficult, and distressing especially at a younger age —there are gentler, more developmentally-guided approaches. Likely, if his approach (some of which are incorporated in the suggestions below) is not working, it is not good timing: pause, re-evaluate, and try again. It is ok to stop, and wait for a better time. Other strategies that can feel more respectful, flexible, and gentle, are included below and are drawn, in part, from Elizabeth Pantley’s book, “No Cry Sleep Solutions".

I don’t remember many of the details of weaning my first born. I know there were portions of the process that were not easy. And there were a few re-starts, and pauses, and “try agains”. My toddler would rather have nursed, but I don’t recall the transition being an exceptionally difficult one, and the glorious indulgence of a bed I could stretch out in was pure bliss—a welcome focus on my needs after the intensity of the first year and a half of parenting, was nothing short of amazing.

With our second, I was glad to be done with night nursing by about age 2, motivated by my own worthwhile need to have my body be my own at night. It is not a decision that I regret, though I do know there are 101 different choices, options, strategies, and nuances that can make night weaning look different for every child, and every family.

We chose what we felt was best for us, with a great deal of flexibility, and our eye on the big picture: night weaning would happen eventually whether we promoted it or not. A bit of nudging in that direction was just fine. And assertive communication from our toddler was worth evaluating and re-evaluating: was our expectation of him reasonable? Was it best to wait a bit longer? Does this feel right?

We did play some musical beds during this period: sometimes my spouse was the one cuddling our weaning toddler at night, and we did not balk at changing the plan from night to night (or part way through the night!) if what we were doing was not working well for any one of us.

Night weaning generally falls into the “can do, but don’t have to” category of parenting decisions. Weaning will happen over time, even if you do nothing in particular to nudge it along.

By toddlerhood, parents are adapting to the assertive and big emotions from toddlers who don’t (can’t) always have their needs or desires met in precisely the way they would like them to be met: no matter how much they want to, they cannot run across the road, smash a glass on the floor, or hit their sibling. Night weaning, however, generally falls into the “can do, but don’t have to” category. Weaning will happen over time, even if don’t do anything in particular to nudge it along. If the timing is right for you, it’s a matter of balancing needs, and moving flexibly and sensitively towards your goal.

Keeping an open and flexible mind allowed me to use our toddler’s room for night weaning. The time spent with him at bedtime and through the night helped me figure out what parts of night weaning were workable, and what parts needed tweaking. There were many missteps (the bruise on my forehead from a sippy cup thrown in frustration by my toddler being one of them). My “in the moment” goals around night weaning shifted depending on how tired I was. What felt most important to me was to honour the ebb and flow: to know that I was not “giving in” if I chose to breastfeed him, and to know that weaning would happen eventually. Night weaning when mama is ready, but baby isn’t quite on board, is an exercise in respecting everyone’s needs, and finding solutions that work best under the circumstances.

With our third, I needed to be on medication that, based on multiple sources, required weaning. It was, quite frankly, an awful process for both of us, as neither of us was ready: I had had my intentions to night nurse for longer than I had the other two, and the sorrow and frustration we both felt with early weaning was heavy. If you are experiencing a similar situation, Dr. Jack Newman’s International Breastfeeding Clinic is a highly recommended resource for working out the necessity of, and the details of, weaning due to medical/medication needs, particularly with the closure of Sick Kids’ Mother Risk organization. If night weaning is not your personal goal, but appears to be medically necessary, gathering all the support you can to make a workable plan. This may include strategic, professionally-supported timing of medication, as well as validation of your feelings through this process, and practical strategies for paving the way.

Nurturing strategies can be applied to make the process of weaning smoother.

If night weaning is necessary, know that sometimes there are factors beyond your control, and that you have many other nurturing strategies at your disposal for maintaining a strong bond with your baby, even if circumstances (medical or otherwise) lead you to night wean before one or both of you are ready. Know as well that if night weaning is right for you, these nurturing strategies can be applied to make the process of weaning smoother, and respects the emotional well-being of both you and your baby.

If night weaning is chosen for your own well being, know that that is an important reason in and of itself. Night weaning before a child is ready can be challenging, and pulling in all the supports and strategies you can is important, too.

The following are some strategies to consider when night weaning your toddler.

Strategies for Parents Who Feel “Done” with the Nighttime Feedings:

  1. Reflect first. Is this feeling like a permanent shift in your feelings around nighttime nursing? Or is this feeling a blig in the road? Are you doing this for you (great! If it’s not working change it. Your priorities and preferences matter!) or is there pressure from others? I use a nighttime weaning readiness checklist with clients to explore this further.

  2. Eliminate barriers! Reflux, excema, tummy issues, and respiratory difficulties (apnea, environmental allergies, stuffy noses) can lead to frequent night nursing to relieve discomfort. Addressing these issues, and resolving them as best we can, paves the way for meeting night-time weaning goals. Occasionally something as straightforward as a diet change or fresher air in the bedroom can improve sleep, and make night-time weaning easier.

  3. Change it up: the bedtime order of breastfeeding and cuddles may not have a huge impact on overnight feeding, but it can help some parents feel that they are moving in the right direction. Toddlers may wake up sooner when they first shift away from nursing to sleep (we don’t really know —and some toddlers coast right through to the usual next wake up). Regardless, with the right routines in place, and an approach towards flexibility and gradual separation of nursing and falling asleep, your toddler may surprise you with their readiness.

  4. Close up shop: in the early days of breastfeeding, nursing shirts and button pajamas make it so much easier to breastfeed. If you are looking to wean, a change of clothes may be helpful. By switching to pull over shirts you’ve created a mild inconvenience; not enough to dissuade a child who continues to need the breast at night (physically or emotionally), but enough that a child that could take it or leave it might decide it’s not worthwhile. Button-up pajamas on backwards never appealed much to me, but by the time I was ready for nighttime weaning, the buttons on my pajamas were so loose that I may have seemed to have a flashing (no pun intended) neon sign that said “no need to knock: the door is already open”.

  5. Different space, different parent: Shifting primary parent at night to your partner, and potentially to a different room (a twin mattress floor bed in a toddler-proof room, for example) can allow for some musical beds. For a toddler who is ready, the different caregiver and different environment can make the shift through night weaning easier. A favourite sippy cup of water might help too, and expressed breastmilk in a bottle may help bridge the change.

  6. Shorten the meal: Keeping the nursing time to shorter and shorter intervals can still give toddlers the comfort they seek from the breast, while reducing how long they are on, and giving them the opportunity to adjust to coming off the breast before falling asleep. Your toddler will let you know loud and clear if they are ready for this! Adjust the interval if it’s not working as well as you hoped.

  7. Shorten the hours: Choosing a window of time when the diner is closed can work well for some kiddos. Some parents have “closed” one breast, and have found that the lower flow of the other breast has led rather smoothly to less interest in nursing.

  8. Use language to bolster your plan! Sometimes as parents we forget that our words, and tone of voice matter. In addition to reading picture books about night weaning, and explaining what to expect (in clear, simple words), having a short phrase to say at night as you unlatch or as you turn down a request for nursing, can have a profound effect. Not only is your voice one of the nurturing nighttime tools you have, but the combination of your simple, and soft words, with your actions can help move the process of night weaning forward.

  9. If it’s not working, it’s ok to pause, and re-evaluate. Sometimes timing is everything. I know how challenging it is to set your mind on something, and then have half a dozen other factors completely knock over your carefully laid plans: two year molars, a move to a new room at daycare, family vacation, and illness, can all make your dream of a night without nursing seem impossibly difficult to achieve. Pause, re-evaluate, and try again. No parent should feel they need to continue night nursing when they feel “done”, but it is ok if it is a jerky walk to the finish line: be gentle with yourself through the ups and down, and look at the trajectory over time.

As with all stages of childhood and motherhood, weaning is a natural and expected part of the mother/child relationship. As babies become older there is a shift more towards balancing the needs and intentions of both mama and babe. It is ok to move towards night weaning when you are ready. And like so many other aspects of mothering, it is a dance: with some back and forth, a shift in who is “leading”, and the occasional toe might get stepped on! You are both on the dance floor together, but sometimes mama gets to pick the next song.

RESOURCES:

Picture Books on Weaning/Night-Weaning

Havener, K. (2013). Nursies When the Sun Shines: A little book on night weaning.

Susan, M. & Low, H. (illustrator) (2018). A Time to Wean.

Saleem, J. (2014). Milkies in the Morning: A gentle night weaning storybook.

Parent Books on Night-Weaning

Wessinger, D. et al. (2014). Sweet Sleep: Nighttime and nap time strategies for breastfeeding families.

Gordon, J. (2002). Good Nights: The happy parents’ guide to the family bed (and a peaceful night’s sleep!)

Pantley, E. (2002) The No Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night.

Plooij, F. & van de Rijt, H. (2010). The Wonder Weeks: How to Stimulate Your Baby's Mental Development and Help Him Turn His 10 Predictable, Great, Fussy Phases Into Magical Leaps Forward.

Online Resources

Bonyata, K, Flora, B., & Yount, P. Night Weaning, www.kellymom.com.

Sears, W. & Sears, M. Night Weaning: 12 Alternatives to the All Night Toddler Nurser. www.askdrsears.com.

Peer Reviewed Articles

CDC (2014).

Cunniff, A., & Spatz, D. (2017). Mothersʼ Weaning Practices when Infants Breastfeed for More Than One Year. MCN, The American Journal of Maternal/Child Nursing, 42(2), 88–94. doi:10.1097/nmc.0000000000000310  Accessed online June 13, 2019.

World Health Organization (2015).

Book Review: Sweet Sleep -Nighttime and Naptime Strategies for the Breastfeeding Family

sweet sleep LLL.jpg

La Leche League’s 2014 book, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, is a book for families of infants which focuses on attachment-oriented research evidence and strategies for understanding and addressing sleep challenges.  The intent of the book is to provide breastfeeding-friendly infant sleep knowledge, support, and problem-solving and, as I describe below, the authors have succeeded in meeting this aim.  

Writing in a calm, articulate manner, Weissinger, West, and Pitman are appealing to educated and informed parents who are at least somewhat familiar and open to attachment-based parenting approaches to sleep.  Likely the La Leche League publication naturally draws the attention of those already inclined to providing nurturing measures, in general. Although not an academic paper, the level of education required is rather high.  The book’s strengths lie in its use of evidence and research balanced with clear descriptions and case studies that highlight the key points.

It is quite a lengthy book that takes several hours to read, something that may be a challenge for all but the most motivated sleep-deprived parents.  Despite this, the depth and quality of the information and evidence provided make this my new primary recommendation to clients who are keen to read about infant sleep. Unlike other books on infant sleep, this books looks specifically through the lens of breastfeeding. However, it is still appropriate for non-breastfeeding families if shared in a sensitive way to those not currently struggling with breastfeeding or with previous decisions/necessity of weaning.  There is enough valuable information to firmly entrench this as an infant sleep book for professionals to consistently draw from when providing eager parents with detailed information or references scientific evidence.

Reading this book now, as a weaned mother of three children who now sleep well, I was so excited about the evidence they include that supports attachment-based sleep support for families.  In particular, their section on bedsharing (detailing La Leche League’s Safe Sleep Seven principles) is both evidence-based and instinct-focused: you, as a parent, must weigh the information available to you in the context of your own infant, yourself, and your family.

The references and citations are the real strength of this book.  Subtitles and indexing make it fairly easy to navigate the kindle version. The richness of the content makes it likely that families would benefit from a print version, rather than kindle version, in order to mark particular sections and to use the index more freely. I suspect most families who are so inclined will have print versions decorated liberally with sticky notes.



sweet sleep LLL.jpg

Holiday Gift Giving: Re-thinking, Re-prioritizing, and Re-gifting

gift with ribbon.jpeg

Holiday Gift Giving : Re-thinking, Re-prioritizing, and Re-gifting
 

When we think of Christmas time we think of an abundance of joy, toys, wrapping paper scattered happily everywhere, and excited squeals of delight.

The reality may be quite different: overcharged credit cards, disappointed gift receivers who didn't get the latest toy, an overwhelming and cluttered play space, and toys that go untouched after the initial excitement is over.


It may be worthwhile, before preparations for the holidays go into full swing, to reflect on your priorities and your vision of what gift giving could be like in your family.  It is an especially good time to give this some thought if you are expecting a birth in the coming months, or if your children are very young.  Setting your family's intentions around gifts and toys early is easier, and can set the stage for many years to come.

If the idea of abundance and meaningful toys without the clutter is appealing, enjoy the links below this article about how to make the shift to more meaningful and minimalist gift giving in your home.  And if you would like exploring this idea more, send me an email ....I’d be pleased to organize a workshop to explore ideas around gift-giving in the new year (when you have lots of time to think about things for next year!). Simplicity is a central value of mine and one that can shift our thinking from how to buy the ‘right’ toy to:

  • How to choose developmentally appropriate toys that last;

  • How to enjoy the abundance of gift-giving while moving towards minimalism; 

  • The love language of gift giving and why it can be a wonderful thing and a challenge;

  • Gift giving traditions based on simplicity.

Heather

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Resources for Giving in Meaningful Ways:

https://www.happysimplemom.com/minimalist-gifts-for-kids/

Parentshttps://www.parents.com/fun/toys/baby-toys/your-guide-to-age-appropriate-toys/

https://www.friendshipcircle.org/blog/2014/04/30/the-five-types-of-toys-for-children-with-special-needs/


https://www.simplicityparenting.com/gift-giving-and-receiving-with-simplicity-and-relationships-in-mind/

Infant Mental Health

Infant Mental Health: A primary goal of attachment-based parenting

Early in my career as an occupational therapist, I had the privilege of participating in York University's inaugural Infant Mental Health certificate program.  The focus was on understanding the environmental and biological basis for infant mental health. 

Since that time I have studied the science of attachment theory and ecology, and learned the impact of our parenting approaches on infant mental health. What has struck me most across all of this learning was appreciating the impact that our environment can have on the developmental well-being of infants and young children. Our children’s environments are largely created but us in the early years, and we have a significant influence on how nurturing their environments are.

Nurturing, stable, safe, and loving environments can have a positive influence on children, including those with a history of trauma. Although we cannot change the past, what we do today to shift towards more nurturing environments can support infant mental health.


The passion I have for connected parenting in the early years and beyond is reflected heavily in my approach to supporting infant sleep.  Sleep deprivation can make even the most patient parent short-tempered and less compassionate.  Sleep-deficient infants are more easily upset, more 'wired', and often more difficult to get to sleep.  And yet, at the heart of it, infants need proximity to a loving adult who has the capacity to parent in a nurturing way. It is helpful to listen to our instincts about how to support their biological and emotional needs, and to seek support (from family, from friends, from skilled mental health care professionals) to do that.

My approach to infant sleep is to inform, to guide decisions, and to change the environment and expectations in order to progress towards sleep practices that support everyone's sleep needs.  For families who have additional challenges, including mental health issues, and trauma history, I connect families with local health care professionals who can continue to support families in ways that respect the family's needs and goals.

Understanding the huge impact that we, as parents, have on our children’s well being is not intended to add a burden. Rather, it can help make decisions easier: we can choose to meet the need. We can choose to connect. We can choose to be present with our children. And we can choose to take care of ourselves and to get support when we feel overwhelmed.

Key Messages:

  1. Attachment based parenting improves infant mental health.

  2. Our environment impacts our health.

  3. Decisions are easier when we know why attachment is important.

  4. Self-care is critical: fill your own cup so you can fill theirs too.

I am not a mental health professional. But there are talented and compassionate people in our community who are. If you are concerned about mental health and about your capacity to support a nurturing relationship with your child, reach out and seek support.

Niagara Resources:

In Niagara, local supports for infant and family mental health include:

  • Pathstone Mental Health Services, pathstonementalhealth.ca

  • Emily Pollak, Social Worker, individual and family counselling, St. Catharines, emilypollak.ca

  • Niagara Infant Mental Health website (Early Childhood Community Development Centre), http://www.eccdc.org/infant-mental-health/

Within and beyond Niagara, supports include:

  • 911 for medical emergencies

  • 411 for information about local mental health services in some jurisdictions

  • Your family physician

  • Local initiatives to support infant and child mental health