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Babywise by Gary Ezzo and Robert Bucknam

Baby is coming soon! Are you ready? I’m not.

Chapter 1: Right Beginnings

Before we can even begin talking about babies, first we need to talk about Mom and Dad. You see, a loving and healthy relationship at home is the most crucial step to having a healthy and thriving children. Children need to see that Mom and Dad love each other. Mom and Dad need to talk, laugh, touch, spend time with, manage conflict, and respect each other. Children need to see their parents interacting with each other in a healthy manner. Healthy interactions between Mom and Dad will create healthy Parent-Child interactions and a health home overall.

Continue living your life! Mom and Dad should not sever other relationships just because of Baby. Continue building and maintaining relationships with family, friends, and communities. Also, Mom and Dad should continue dating each other. The book recommends “Couch Time” which is 15 minutes every day that Mom and Dad spend sitting on the couch and talking with each other. In my marriage, we call it “Dinner.” But the concept is the same. Mom and Dad need to spend time talking with each other every day, even if it is just a few minutes, and Baby needs to see this interaction.

Chapter 2: Feeding Philosophies

When it comes to feeding philosophies, there are two extremes: Clock Feeding and Child-Led Feeding. As with most things, the extreme options are rarely best, and there is usually an in-between option that is able to capture the benefits of both extremes. In this case, the more moderate and in-between option is the method described in this book, Parent-Directed Feeding (PDF).

  1. Clock Feeding – In this philosophy, parents feed the child strictly according to the clock. For example, feedings occur every 4 hours on the dot. The problem with this approach is that it ignores that fact that a baby might actually be hungry, and it can result in malnourishment

  2. Child-Led Feeding – In this philosophy (also sometimes called Attached Parenting), Baby is the center of the household and every effort is made to make Baby comfortable and not anxious. There is no regard for the clock, Baby is fed or comforted any time that Baby cries, and Baby is constantly held and nurtured by Mom. The main problem with this approach is that it is exhausting and debilitating for Mom, and it creates a needy, irritable, stubborn child

  3. Parent-Directed Feeding (PDF) – This philosophy, encouraged by Babywise, combines the philosophies of Clock Feeding and Child-Led Feeding. This method claims that for optimal learning, Baby needs to have maximum alertness, and for maximum alertness, Baby needs to have maximum sleep, and for maximum sleep, Baby needs to have a reliable and fully nourishing feeding schedule. In PDF, the clock is used as a bound to make sure that Baby is feeding correctly. If Baby is hungry every hour, then this indicates that Baby is not getting enough nutrition during each feeding. On the other hand, it ensures that Baby does not go 4-5 hours without nutrition, which is too long of a timespan for Baby to go without eating, and results in a malnourished Baby. In PDF, parents manage the Baby’s Day.

A newborn Baby is born with seven (7) capacities, and growth in each of these capacities indicates that Baby is maturing properly. These 7 capacities should be your goal, and is normal, for a Baby using PDF. Within the first 6 months, every Baby has the capacity to:

  1. Synchronize feed-wake-sleep cycles into predictable patterns

  2. Fall asleep without a rocking or nursing prop

  3. Sleep through the night 8-10 consecutive hours

  4. Have a predictable nap routine

  5. Have content wake-times and capable of self-play

  6. Self-soothe

  7. Find comfort with other caregivers, such as fathers, siblings, and grandparents

Chapter 3: Babies and Sleep

Parents must take the lead to develop structure and routine for their babies. Babies have the ability to follow a structured routine, but they do not have the ability to create that routine themselves.

“feed-wake-sleep” - The main idea of PDF is the order of these 3 daytime activities. Every cycle starts with a feeding, then progresses to waking, then napping. Then the cycle repeats itself… “feed-wake-sleep”

The order of these 3 activities is important, but so is the quality of each activity. Mom must work to make each feed cycle a full feeding. Babies, especially newborns, are prone to dozing to sleep while feeding. Mom should work to prevent this from happening, because an inadequate feeding has a ripple effect that leads to an unproductive wake time, which leads to poor sleep, and the poor cycle continues. The key to having a well-trained and rested baby starts with full feedings. When Baby is full, Baby can have a productive waketime that stimulates the brain and causes tiredness, which leads to peaceful sleep. And since Baby has a full stomach of food, Baby sleeps contentedly until the next “feed-wake-sleep” cycle.

Babies need routine feedings to establish proper metabolic functioning. Furthermore, babies that do not establish good sleeping habits mature into 2 year olds that have diminished motor skills, decreased ability to think, irritability, loss of ability to focus, emotional instability, and cellular and tissue breakdown.

Proper “feed-wake-sleep” cycles can be established with breastfeeding or bottle feeding. It makes no difference.

A typical baby has the ability to sleep through the night by the end of the second month.

Sleep props interfere with the natural process of developing the ability to learn how to sleep. Learning how to sleep is an acquired skill, and sleep props interfere with that development. Baby should use the feeling of sleepiness to fall asleep. Sleep props, such as nursing to sleep, rocking, or sleeping with the parents, teach Baby to fall asleep using the sleep cue instead of the natural sleepiness feeling.

Just before Baby falls asleep, Baby should be placed in the crib. After 4 weeks, the crib should not be located in the same room as the parents. For the first 4 weeks, it may be placed in the parents’ room out of convenience, but after that Baby should have his crib in his own room.

Chapter 4: Facts on Feeding

Mothers should work towards full feedings every 2.5-3 hours (measured from beginning of feeding to beginning of feeding), rather than clusters of small feedings. Feeding too often (1.5-2 hours) can exhaust Mom and negatively affect her ability to produce enough high quality milk. Feeding too infrequently (3.5 - 4 hours) fails to provide enough stimulus for more milk production in Mom and it can mean that Baby is not getting enough food.

  • Natural and healthy hunger cue: towards the end of nap time, Baby will start making sucking sounds, and bring his hand toward his mouth and start sucking. Then, he will start whimpering, and then progress into a full cry

  • Unhealthy hunger cue: Baby wants to eat every hour

Signs associated with a full feeding:

  • A healthy feeding time is 10-15 minutes per breast (20-30 minutes total) - during each feeding, both breasts need to be stimulated for proper milk production

  • Can hear the baby swallowing milk

  • Baby burps after feeding

  • Baby naps well

Nursing positions

  1. Cradle hold

  2. Side-lying hold

  3. Football hold

Babies like their sleep and will often fall asleep while breastfeeding. Mom should work to keep Baby awake while feeding so that Baby gets a full feeding. Remember that Mom needs to make sure that every feeding is a full one so that the average time between feedings in 2.5-3 hours. To keep Baby awake, Mom can rub Baby’s back, talk to Baby, rub Baby’s feet, etc.

First 7-10 days: Mom should ignore the clock and simply focus on getting a full feeding at every feeding (it should take 30-40 minutes / feeding)

After the first 7-10 days: Mom’s who focus on achieving full feedings during the first week of life often reach full feedings by 7-10 days, and Baby will automatically assume the 2.5-3 hour feeding pattern.

Growth Spurts: Baby will experience growth spurts when he requires more food and will be hungry more frequently than every 2.5-3 hours, even with full feedings. Always feed a hungry baby. Growth spurts occur approximately at 10 days, 3 weeks, 6 weeks, 3 months, 6 months. After 3-4 days of a growth spurt, Baby will resume his normal feeding pattern of every 2.5-3 hours.

How to tell if Baby is getting enough food:

  • First week: 5-7 wet diapers per day

  • First month: 3-5 yellow stools per day

  • Healthy weight gain after first month

Baby needs to be burped after eating, because all babies swallow air while feeding, which causes discomfort in their stomachs. Both bottle fed and breastfed babies need to be burped, but bottle fed babies generally need to be burped more. The most common burping positions include:

  1. Sitting Lap

  2. Tummy -Over-Lap

  3. Shoulder Position

  4. Cradle Position

A small amount of spit up is common after feeding. Also, if Baby does not burp after 5 minutes of trying, then prop Baby up in a car seat for about 10 minutes before laying Baby down for a nap. This will help dissipate the bubbles by using gravity. You can also try propping up the end of the crib that Baby’s head is on by using 1-2 books under the crib’s legs, so that Baby’s head is slightly elevated. This will help dissipate air bubbles as well.

Chapter 5: Managing Your Baby’s Day

The 3 activities of Baby’s routine:

  1. Feed

  2. Wake

  3. Sleep

Newborn babies are sleepy heads, and they will tend to fall asleep while feeding, and they like to snack feed a little now and a little later. Small snack feedings do not equal a full feeding. Both Mom and Baby need full feedings.

During the first month of life, Baby should not go more than 4 hours without food. During the day, do not let Baby go more than 3 hours without food. If it’s during the night, then it is ok to let Baby sleep 4 hours if Baby is able to. But do not let more than 4 hours between feed-wake-sleep cycles.

For a newborn, the typical feed-wake-sleep cycle is 2.5 hours

  1. Feed: 0.5 hours for feeding and burping

  2. Wake: 0.5 hours for diaper change and snuggles

  3. Sleep: 1.5 hours for sleeping

Feeding times can and should be flexible, but the first feeding of the day should always be consistent. It’s important to start each day at the same time. Also, every Baby is different, so the length between feedings might be different, and the time when you can merge feedings might be different. It’s important to pay attention to the cues from your Baby.

Weeks 1-2: Baby has 9 feed-wake-sleep cycles. Baby’s waketime is equal to Baby’s feeding time, because Baby will do nothing but sleep.

  1. 7:00am

  2. 9:30am

  3. 12:00pm

  4. 2:30pm

  5. 5:00pm

  6. 8:00pm

  7. 11:00pm

  8. 1:30am

  9. 4:00am

Weeks 3-6: Distinct wake cycles will begin to emerge. Merge middle of the night feedings (1:30am and 4:00am). Daytime feedings stay the same

  1. 7:00am

  2. 9:30am

  3. 12:00pm

  4. 2:30pm

  5. 5:00pm

  6. 8:00pm

  7. 11:00pm

  8. 3:00am

Weeks 7-10: Baby should drop the middle of the night feeding and sleep 8 hours per night. The rule of thumb is that by 5 weeks of age, most babies can extend their nighttime sleep by 1 hour for each week. A 5-week old can handle 5 hours of continuous sleep at night. A 7-week old can handle 7 hours of continuous sleep at night.

  1. 7:00am

  2. 9:30am

  3. 12:30pm

  4. 3:30pm

  5. 6:00pm

  6. 8:30pm

  7. 11:00pm

Weeks 10-15: Baby should drop the evening feeding and sleep 10-12 hours per night. At this point, Mom needs to be aware of her milk production and ensure that she is getting adequate stimulation to continue producing milk. She can pump in the middle of the night to ensure continued production.

  1. 7:00am

  2. 9:30am

  3. 12:30pm

  4. 3:30pm

  5. 6:00pm

  6. 8:30pm

Weeks 16-24: Baby’s morning waketime starts being longer, so Mom can merge the morning feedings. This is also around the time that Baby might start solid foods, which can impact feed-wake-sleep cycles.

  1. 7:00am

  2. 11:00am

  3. 2:30pm

  4. 5:30pm (feed-wake-no nap)

  5. 8:30pm

Weeks 24-39: Baby will start sleeping less in the afternoon, and have a “catnap” instead of a full nap. At this point, Baby can go between 3.5 - 4.5 hours between feed-wake-sleep cycles.

  1. 7:00am

  2. 11:00am

  3. 2:30pm (feed-wake-”catnap”)

  4. 5:30pm (feed-wake-no nap)

  5. 8:30pm

Weeks 28-40: Baby will drop the catnap and have 3 full feedings, plus dessert

  1. 7:00am

  2. 11:30am

  3. 4:00pm (Baby eats dinner with the family)

  4. 8:00pm

Weeks 48-52

  1. 7:00am

  2. 11:30am

  3. 4:00pm

  4. 8:00pm (bedtime - maybe a small feeding)

In general, babies drop feedings because they are either sleeping longer or staying awake longer.

Chapter 6: Waketimes and Naps

Most babies will learn to soothe themselves, and they will sleep longer, if they are allowed to cry a little bit before bedtime. Crying for 10-20 minutes will not harm Baby in any way.

The rest of this chapter offers a reference guide for possible reasons why Baby is waking early from naptime and how to fix the problem. It includes things such as:

  • Baby is hungry

  • Baby is uncomfortable (too hot, too cold, etc)

  • Baby needs to burp

  • Baby is starting a new sleep/nap transition

Chapter 7: When Your Baby Cries

Newborns routinely cry 1-4 hours per day. Crying is a signal that can have a variety of different meanings:

  • Hungry

  • Sick

  • Tired

  • Needs cuddles

  • Distress

Abnormal cries include:

  1. During feeding

  2. Immediately after feeding

  3. Middle of a sound nap

Normal cries include:

  1. Right before a feeding

  2. During the late afternoon/early evening period (this is a typical “fussy” time)

  3. When Baby is put down for a nap (some babies cry for 15 minutes, some for less- learn to identify your Baby’s cry pattern - it is also not unusual for Baby to offer small whimpering cries while sleeping)

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