Babies: Can't live with 'em, Can't leave 'em on a curb

Of course we don't MEAN THAT! We would never, ever condone leaving a baby on the curb. However, some of the bleary-eyed new parents among you have probably contemplated that, or at least sleeping on the curb yourself and leaving your little bundle to her own devices.

Here we will attempt to lay down some baby sleeping ground rules for you.

Baby Rule #1: This is not about you. Your baby doesn't care that you are a nuclear physicist or an astronaut (not, we hope, the crazy, stalking, murderous diaper-wearing type of astronaut) or a Starbucks barista or anyone else who is incredibly important and rules the world. Your baby doesn't care that you need to get up at 5AM to make your latte or have your jog or get the bus. Your baby doesn't care that you didn't sleep the entire last trimester of your pregnancy because she, the baby, was bouncing on your bladder ALL NIGHT LONG. So, you need to make a grown-up decision right now and resolve to stop whining about how you didn't get any sleep.

When you have a baby -- and this news may rock your world -- you may have to change some things in your life. You may not be able to watch TV until midnight. You may need to go to bed at 10, or 9, or even, GASP, 8. We know that this will cut into your time on the Internet looking for that perfect pair of cork-heel wedges on eBay or getting your fix of Wonkette or Style.com or Googling your creepy neighbor; surfing the Internet is what work is for. No, you cannot have sex with your partner (or with anyone else for that matter.) No, you cannot have adult conversations with other adults. You need to go to sleep.

Baby rule number 2 is also pretty straightforward: get the baby out of your bed. It is our opinion that co-sleeping equals no-sleeping. Not for anyone. When the baby moves, you wake up. Guess what: when you move, the baby wakes up. This makes for a cranky baby.

We don't understand the controversy over this topic. If you want to sleep with your baby, then that's fine. You will have poor sleep, and so will anyone else who is in the bed. So, return to rule #1 and stop whining about it and accept it as a fact.

If you are nursing, get one of those little attached beds or a bassinet. The car seat even works well at the beginning. But, really, how big is your house? Oh, you have a mansion? How nice for you. Then you probably can afford to have people do all sorts of things for you, like surf the Internet and watch Conan O'Brien so that you don't have to. For the rest of you: after week 6 of life, get the baby out of your bed. Keep him in the room with you if you must. You will all sleep better.

Baby Rule #3 is tied in with the breastfeeding issue: weaning and sleep problems are two different things. We recently counselled 2 women who complained that their children have difficulty maintaining sleep. Turns out that both women are actually having difficulty weaning their children from nursing. So, bambino wakes and is inconsolable unless she is allowed to nurse. Mom tries to withhold and bambino gets very, very testy. Even though this scenario is taking place at 1AM, this is not a sleeping problem; this is a weaning problem.

Finally, Baby Rule #4 is about scheduling. It is so easy to want the baby to sleep when it is convenient for you. And, hey, it would be great if the little darling would sleep blissfully for, oh, 18 hours a day and wake up just to look cute and coo and eat and let you dress him in cute outfits. Babies do sleep a lot. And you do have some control over when they sleep. If you want your bebe to sleep later in the morning, it's ok to push bedtime back a little, especially if it gives you a little more time with your evening routine. It is NOT ok to expect your cherub to sleep past 7 or to put him or her to bed much past 8 - 8:30.

We remember a new mom who was having some trouble coping with her own disrupted sleep and her main complaint was that she (the mom) liked to sleep until, um, 8 or 9 in the morning and, well, the baby just didn't. What this mom could do, though, was to switch nap times slightly so that baby was waking from an afternoon nap at around 4- 4:30 and then putting him to bed around 8-8:30. Baby then woke up around 6:30-7. This worked fine for Mom, who started going to bed by 10:30.

There, see how easy that was?

Freakin overachievers

DO NOT come to us, the children's sleep experts, telling us that your child is tired and falls asleep in school if your child fits one of the following categories:

1. Category A: You are probably upper-middle class. Your child is enrolled in honors courses or is a student at a private school that requires him or her to wake up at o'dark thirty and commute to school. Your child also has extra-curriculars that include things like sports for a travel-team; opera singing; musical endeavors that require lots of lessons and practice; debate team; junior paleontologist training. You get extra points if your child does all of the above. Your child arrives home after 5 o'clock (extra credit if she or he arrives after 7 at night) , eats, does homework until 11:00 PM and falls asleep until the alarm goes off at 5:30 AM. Even more extra credit if he or she has activities that run on the weekends.
2. Category B: You are, functionally or literally, a single parent. Your child needs to get up at the crack of dawn so that you can get him or her to school for the super-early breakfast club so that you can get to work. Your child then stays at school all day long and then does activities or stays in an after-school program until you can arrange to get him or her. Then you go home, have dinner, do homework and get to bed at 11:00 PM and get up the next morning at 5:30 AM.

Denise and I are not physicians, however, we feel comfortable in making this on-line diagnosis: your child is falling asleep because he or she is, how to say this gently, TIRED. There is NO WAY that an adolescent should be getting 6 or 7 hours of sleep at night. NO NO NO. So, if you fall into category A, then please spare us the tales of competing for college entry and the necessity of all of the extra-curriculars. Your kid needs more sleep. If you don't want to give him or her the time to get more sleep, then don't come whining to a sleep lab about the need for Provigil or a $4000 overnight test to figure out why your kid is tired. Stop focusing on getting into your first choice of schools and instead focus on getting your child there there well-rested.

If you fall into Category B, believe me, we feel your pain. Encourage your child to take naps during the downtime parts of the day. See if there's a way to get homework done during the after-school hours so that there's more time for bed at night. And please see rules #1 and 4 about TV and food.

Finally, if your kid doesn't fit into either of the above categories, keep in mind that even Trixie, who is perfect in every way, admits to having slept through most of high school. : )

a little rant about our esteemed co-workers

Since Denise and I are perfect, we are accustomed to traversing the world with those of you who are less than. And we can sympathize with how hard it must be to strive to the perfection that we have already achieved every single day. So, we are patient and understanding sorts. Sometimes, though, we think that we work with a small tribe of people who were raised by wolves. We think that things like this must not be unique to our place of work and so we thought that we would share.



For example, there are certain paper forms that we must fill out for billing and record-keeping purposes (some of it is a throwback to our old-fashioned, paper-loving medical director, but that's another story.) Denise and I work together one night a week, and on that night, every week, we find ONE remaining copy of the paperwork. So, we search thoughout our Big City Hospital in the wee hours for a working copy machine and we make many, many copies. Mysteriously, by the next week, ALL of the copies that we made are gone and we must go and make more. We also don't understand why no one else can CLEAN UP while at work. We collectively sigh and realize that this is the price that we pay for perfection.

You are what you eat

If you have ever watched the news, then you know that obesity is a problem in the good ol' US of A. The TV camera guys seem to love going to a food court at a mall somewhere and taking shots of people from the neck down. They seem to especially love shots of fat men in profile and fat women from behind. Whatever. Denise and I are here to attest to the fact that the problem is just as much of an issue in the under-eighteen age group as it is in the rest of the population. And we mean it is an ISSUE. We frequently see kids whose body mass index (BMI) is well over 30 (the marker for obesity.) Sometimes we see kids with a BMI in the 50's. Just to give you an example of what that means, if you have a 10 year old kid who is 56 inches tall and weighs 160 pounds, that child's BMI is 36. ONE HUNDRED SIXTY POUNDS. For someone who isn't even five feet tall and is years away from junior high. And we see this ALL THE TIME. In kids who have no medical reason (endocrine- or medication-related) to be this fat.

What we don't understand is how they get this fat. A 10 year old is not going grocery shopping, and is probably not preparing his or her own meals. SOME of this can, of course, be attributed to economic factors, however, we see solidly middle class kids who are obese. And we see kids whose parents are fit who are obese. So, we don't care what excuses you want to throw at it (remember, we are both moms who work full-time outside of the home): STOP FEEDING YOUR KIDS CRAP! NO, Susie cannot eat at McDonald's. NO, Joey cannot eat a big bag of chips while playing his computer game. NO, Luis cannot eat a box of Oreos for an after-school snack. NO, Monique cannot have a king-size KitKat bar.

Being a parent requires you to be the responsible party. Sometimes, that means acting like a grown-up and having your kid hate you and saying "no." Deal with it. Because if you don't, you are killing your child: with obesity, diabetes, hypertension, reactive airways disease and, yes, with obstructive sleep apnea.

Rule #4: Watch your child's mouth!

PS This goes for those of you who may give your non-obese yet sleepless child things like chocolate and sugar at bedtime and then wonder why he or she doesn't sleep. No sugar or chocolate after 6PM. We mean it. Don't be like the mom who brought in her son (who, btw, had a diagnosis of attention deficity hyperactivity disorder) and had brought along a big bagful of candy to help "calm him down." Huh?

Where we work

Strange things can happen in a big city hospital. This is no less true in our little part of the world in the Kiddy Corner.

More than half of the kids who we see here at our pediatric sleep lab have underlying medical issues. Some are very, very disabled and sometimes it's very, very sad and that makes us want to go home and hug our kids until they start squirming and whining and demanding that we stop. And, at other times, we see kids who are in truly bizarre circumstances.

Take last week: Denise showed up for work for her second 12 hour night shift in a row. She read the chart quickly and it looked pretty straightforward: a teenage girl with snoring and obesity. Rule out obstructive sleep apnea. The chart stated that the patient was in DSS custody; that's not uncommon. We see lots of foster kids and adopted kids. This girl, though, was accompanied by two attendants. When Denise went into the patient's room to start the set-up for the test, one of the patient's attendants asked, "Will her shackles get in the way of the wires?" Um, did she just say SHACKLES?! Apparently someone mistook DYS (i.e., INCARCERATION!) for DSS. So, Denise got the kid wired up and the shackles did not interfere with the study.

So, rule #3 is to remove your shackles before bed.

It's getting hot in here

At least that's what Denise thinks. We keep the room temp pretty cool in the sleep lab. Everyone complains about it. We hand out lots of extra blankets. Then, magically, in the morning, parents tell us that their children slept much better here than they do at home. Coincidence? Maybe. If you want a scientific dissertation, then subscribe to a medical journal. We see it enough to think it's not coincidental, though.

So, the first two rules of getting your kid to sleep better are:

1. Turn off the flipping TV
2. Turn down the heat.

It will decrease your carbon footprint, too.

Rule #1: Turn off the TV

If we had a nickel for every parent who came in here and told us that his or her child WOULD NOT SLEEP without the television turned on, well, we would be blogging from Cabo on matching little iBooks. The first thing that you need to do if your child will not sleep is to turn off the TV. Actually, we're not sure why you have a TV in the child's room, so while you're at it, take the TV OUT of the bedroom. This also goes for iPods and cell phones and laptops and Gameboys and any other electronic gadget that your child NEEDS in order to fall asleep.

Here is what we do in the sleep lab: we agree on a time to turn off the electronic devices. Then we turn them off at that time. Then we turn out the lights. Then the kid goes to sleep. In a strange bed. With 40 wires stuck all over his or her body. That's it, folks.

So, Rule #1 is: turn off the flipping TV.