Tuesday, July 1, 2008

Preterm Babies and Babywise

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I wanted to do a post on preterm babies and Babywise. While Kaitlyn (now 14 months) was born 3 weeks early, I don't think it really had much of an affect on her ability to do Babywise. She was a really sleepy newborn, so we had about 6 weeks of really trying to get her to stay awake for feedings and waketimes, but she is also a big sleeper anyway.

So I turned to friends to share stories and advice of doing Babywise with a preterm baby (or babies). Here are their thoughts:

Melissa said...

"My son (I also have a Brayden:)) was a month early. I had pre-eclampsia. He was a VERY sleepy newborn. I had decided before he was born to do BW and I was very frustrated because he slept constantly the first month. Keeping him awake for nursing sessions was very difficult, let alon afterward. But, I was blessed with a healthy 7 lb baby, so like Kaitlyn there were no size issues.

My advice to other moms with preterm infants is to TRY to get them to take a full feed, and once they are having wakeful periods, try to have those occur after the feed. But don't sweat their sleeping all the time in the first month or so. I have a couple of friends who had pre-term babies and we are convinced they are all such good sleepers because they just got used to sleeping all the time from the beginning (BW has something to do with that too).

To keep him awake while nursing, I would keep a glass of water in the fridge with a baby washcloth in it. When he would nurse and get sleepy I'd stroke his face with it to keep him up. That was how I tried to get him to take a full feed. I think that is VERY important and the ultimate goal to strive toward, just like the book says.

He had very bad reflux, which I think may be more common in preterm infants. To combat that I let him sleep in his infant seat in his crib until he was 3 or 4 months. But, he was a great sleeper. Started STTN and 8 weeks, and I have never fed him in the middle of the night since. He's now 26 months old, 32 pounds and a great kid. No aftereffects of the preterm birth at all."

Lauren said...

The twins were 12 weeks early. They spent over 2 months in the NICU.

With such preemies, you really have to go with their corrected age. When they came home from the NICU, I was required to feed every 3 hours around the clock. I didn't even think about BW, STTN, naps, schedule at all. They would eat and then sleep, eat and sleep. No activity at all. Why should they? They were still supposed to be in the womb.

When they were around 4 mths old, (1 mths old corrected), I did incorporate some activity time, but not much. So they would eat, activity time for 5 minutes, then sleep. Repeat. After 10pm, they ate only when they woke up, whether it be once or twice and the day started at 6am. No schedules or naps, or anything BW still.

Around 5 mths old (actual age), they decided to wake up to the world (2 mths corrected). They had good weights and were relatively healthy. Hannah at this point had already been diagnosed as FTT [failure to thrive] and had severe reflux. Noah had severe reflux as well causing some breathing issues and was very very colicky. They no longer needed the nighttime bottles and they were fussy during the day. I had no idea where to begin. So i turned to BW at this point.

I think with preemies, you have to be comfortable and consistent. CIO worked well for N and was relatively painless for me. B/c of H's health issues, CIO didn't feel comfortable for me b/c i never knew why she was crying (could be pain, could be hunger, could be teething, could be anything).

Neither adhered well to the strict BW principles. Both are somewhat adverse to bottles and will never never take a bottle upon waking. so they get bottles before naps and bed. I was never concerned about them becoming attached to bottle b/c they just aren't. I also never put them to sleep wide-awake. I always rocked until drowsy and then put in crib. So I took the BW concepts of scheduling, routine, etc. and applied them that way.

We were late comers to BW (wish i had started earlier and had not been such a wimp about letting them CIO) and b/c of thier issues we have to do very small steps. They slept in bouncy seats for first 5 mths (for 3 mths once they came home). Getting them to sleep in crib was a huge huge transition. Getting them to take full feeds was a huge huge problem due to reflux. So I had to work on things very very slowly. The 45 min naps took forever to get rid of.
They are know a year old corrected. Noah sleeps consistently 10-12 hrs at night (H is all over the place still) and both take 2 1.5 hr naps. It just eventually fell into place. I wish it would have sooner, but i had to go with my comfortability, their health issues, etc. as well.

So...overall advice. Go with your gut. Be comfortable. Always use their corrected age.
I could write a book on this as usual (with many diversions I'm sure), but now that I'm a workin momma, not so much time. :)

I appreciate the contributions from these women. And as always, if you have any advice to add, please do so!

Added February 6, 2009:
In The Baby Whisperer Solves All Your Problems, Tracy Hogg discusses preterm, low-birthweight babies and routines. Here are some snippits of what she says:
  • Low-birthweight babies fall asleep while eating more often, so you have to work harder to keep them awake for feedings (page 27).
  • Swaddle them and have them sleep in a quiet, warm, darkened room (page 27).
  • Allow them to sleep all that they want to (page 27).
  • Low-birthweight babies likely need shorter cycles at first (page 29). For 5-6.5 pounds, feed every two hours. For 6.5-8 pounds, feed every 2.5-3 hours. For 8 pounds or more, feed every three hours.

18 comments:

AZReam said...

Readers of this blog may also be interested to learn about the RES-Q Infant Wedge & Sling - with advice available from the Pediatric OT Co-inventor

Kim said...

I am hoping someone will have some advice, I am a mother of three kids all of them followed babywise to a tee. I now have my fourth who is 5 weeks old. He is doing wonderful with his nighttime routine. Sleeps 5-6 hours wakes eats and then sleeps another 3-3 1/2 hours. The daytime is a different story. He will not nap. He eats, has about 20-30 min. of waketime, then I lay him down. He usually falls right to sleep but will only stay asleep for about 30-45 min. I have let him cry for about 15 min then check on him. I have tried everything from cutting back waketime, feeding him more (he is on formula), burping, ect. I am at a loss. I have never had this problem doing babywise before. Any suggestions? I am getting plenty of sleep at night but getting nothing done during the day and I feel like I am ignoring my other kids. Help!!!

Shari said...

Lauren....THANK YOU SO MUCH FOR THE INFORMATION IN THIS POST! I am the mother of a preemie born 12 weeks early as well. She has never fit into the BW "mold" & I have been so upset about it. My daughter (just like you noted about your children) most of the time won't take a bottle when she wakes up. But, like you stated about your little ones, it doesn't seem like she is attached to it or needs it to go to sleep.

Again, thanks so much...I really can not tell you how much it means to find out that someone is having the same issues with BW for their preemie.

Shari said...

Kim - my only advice to you is that in my experience & also researching sleep issues via various resources, waking in 45 minutes usually means your baby is Over Tired. I would watch his sleep cues (as much as you can having other children)...I know this can be hard when you are trying to get things done. But, I would put him down at the first sign of a sleep cue (like the first yawn).

BTW...I feel your pain. Lately, my daughter only sleeps 1 hour at a time for naps & I feel the same way...I feel like I can get nothing done.

Abby's Mom said...

Kim- My daughter, now 6.5 months has taken horrible naps since she was 6 weeks old. I tried EVERYTHING for the last 6 months and nothing works. I really have had to just accept that she is not a napper. Funny, because in my baby book my mom wrote that I refused to nap as a baby and would only take cat naps. I know BW says that if your child takes 45 min naps there is a problem, but I have to wonder if some kids just are not nappers. I have agonized over it so much and spend most days feeling like I spent my entire day trying to get her to nap. At this point we usually get two 45-60 min naps in the morning and then nothing else for the rest of the day. Sometimes she will sleep at 6pm which is only an hour before we start bedtime routine. I am really working on just trying to deal with it since I am pretty sure that there is nothing else I can do at this point to change her. So, I don't really have advice for you, accept that if you troubleshoot and cannot get your LO to take longer naps, please do not spend the next 6 months upset about it like me. We have followed BW since birth and just do the best we can with what she gives us. Like yours, my LO also has always slept pretty good at night. So, I just focus on that and be thankful for the sleep I get at night. Hopefully your LO will get past it. Unfortunately mine never did.

Plowmanators said...

Thanks AZReam!

Plowmanators said...

Kim,

This really isn't that uncommon for a baby who is learning to self-soothe. You are also close to growth spurt times, so if you didn't notice a 4 weeks spurt or might be approaching the 6 week spurt. At that age, they often really need to eat more often, not just more quantity at each meal (they usually can't eat enough in one sitting). However, the lack of nighttime disruptions would make me think it is likely just a self-soothing problem.

Be sure you are very consistent with naps. Also, take note of what is going on when he wakes. Were the other kids being noisy? Dog barking? Is it too hot for him? Think of all of those factors.

Also, see this post:

Waking Early From Naps/Won't Fall Asleep For Naps: http://babywisemom.blogspot.com/2008/01/waking-early-from-napswont-fall-asleep.html

Plowmanators said...

Shari,

I passed your note on to Lauren. I am sure she will appreciate the thanks!

Plowmanators said...

Shari,

Thanks for your thoughts for Kim!

Plowmanators said...

Abby's Mom,

Thanks for your thoughts here. I have a friend who is perfectly capable with BW theory and practice, but her LO takes short naps, also. She has tried everything. So I agree, do what you can, but try not to stress.

Alison said...

My son was born 3 1/2 weeks early. He is now 5 1/2 weeks old and we are still struggling to get him to wake for waketime. He really only gives us one good waketime per day and that is usually first thing in the morning. It wasn't to much of an issue at first as he would eat and then sleep until the next feeding but over the last week or so he wakes about an hour before he should. He is not yet hungry and will usually just hang out in his bouncer until its time to eat (we are on a 3 hour schedule). In fact he is quite content during this hour. How do I get him to stay awake for waketime and nap until he is supposed to?

Alison said...

Oh and I forgot to add that I try everything i can to get him to wake after he eats from stripping him to his diaper to singing and dancing around with him and nothing will work. Thanks so much!!

Plowmanators said...

Alison, see this post:

http://babywisemom.blogspot.com/2008/11/adding-waketime-to-your-newborns-day.html

About this Blog said...

I just wanted to add that both my girls were 5 weeks early. I did Babywise on both of them and fed them every 3 hours just made sure to get full feedings. My first weighed 5 lbs 1 oz and teh second was 4 lbs 13oz. they took about 2 oz per feeding in the first week or 2 then up to 3 oz per feeding. they did great on a 3 hour schedule. but again b/c they were premies i woke them even in the middle of the night so they were literally eating every 3 hours. for premies, the way i did it was started implementing babywise when they got to a normal birthweight around 7 -8 pounds and that's when I would feed them at nigth and let them sleep till they woke up. my latest is almost 5 months now and sleeps 12 hours at night and she was the 4 pounder! she started sleeping 7 hours at 3 months and progressed from there. love this blog!

Plowmanators said...

About This Blog, thanks for sharing that! That is great info!

Brian, Jamie, & Benjamin said...

First let me say that there is a huge difference in preemies depending on how early they were born and the challenges they have/do face. My son was a micro-preemie born at 25 weeks. He was in the NICU for 3 1/2 months and came home the day before his due date. One advantage to being in the NICU so long was that he came home on a schedule, as the nurses fed and changed him every 4 hours around the clock. We planned to use the Babywise system, but were not sure it would work on a micro-preemie, especially with his set of challenges. After 2 weeks of little sleep we decided to give it a shot. It was the best decision we could have made. We always used his due date to correct his age and within 2 months he was sleeping through the night, which was a huge blessing for all of us. We had to be a little flexible since he was very underweight and needed a certain amount of calories each day and for a few weeks of that time he was recovering from surgery. Our son is now 2 years old and very healthy and happy.

Plowmanators said...

Thanks for sharing your experience! I am glad things are going well.

Amy said...

I have 9 week (4 week adjusted) old twin boys. They are still feeding every 3 hours around the clock. They sleep great in between feeds whether in crib, swing, bouncer, doesn't matter. I have tried to give them a pacifier in the middle of the night to buy some more time but no success. I am pumping breast milk and bottle feeding them and they take between 3-4 oz a feed consistently. I have a lot of trouble keeping them awake during the day. They will stay awake 15-30 min max after 7am morning feed and then I struggle the rest of the day until their evening feed when we do bath time. Any suggestions? I go back to work in 2 1/2 weeks so I am concerned about getting up twice at night.

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