Thursday, January 19, 2012

Behavioral Therapist

Anyone who has read this blog for any length of time knows that Henry is a terrible sleeper. I could link up a bunch of stories, but I think I've mentioned it in almost every Henry update ever. That's how bad it is. Here are Henry's sleeping stats after last night:

Hours Asleep Per Day: 12:00
Average Nighttime Sleep Length: 1:47
Average Daytime Sleep Length: 1:30 (this is higher than normal thanks to a 3:00 hour nap yesterday)
Longest Stretch of Sleep at Night: 3:05
Average Number of Sleep Periods Per Night: 5.4

So with that information, our failed attempt at letting Henry cry it out, our failed attempt at the No Cry Sleep Solution, and knowing Henry's general disposition our pediatrician referred him to a pediatric behavioral therapist.



This past Tuesday we went and saw the new doctor. She talked with me about Henry's medical history, his reflux struggles, his personality, and his current sleeping pattern. We also talked about my expectations. My willingness to try different techniques, and my desire to change current habits.

And out of that appointment we have learned a few things. One, Henry is pretty typical for a baby with bad reflux. The behaviorist said she wasn't surprised given his medical history, and that we didn't have anything to worry about long term. Basically, the reflux/colic has delayed his sleeping development. And we can't think of him as a typical 10 month old, but as a baby that hasn't had to deal with reflux for only 8 short weeks.

To me this made a lot of sense. During the reflux periods he never really got to work on sleep. His sleep cycle became more and more disorganized. And now we just have to help him get organized and work it out. This is made slightly more difficult based on Henry's personality. He is not flexible, not easy going, and very stubborn. And again, the doctor said that this is a very typical personality for a reflux/colicy baby.


So she came up with a plan for Henry. Henry will now have a forced wake up at 8 am (and of course he can wake up earlier). Then he needs to be down for his first nap 90 minuets after he wakes up in the morning. We can nurse before his nap but I must put him down awake in his crib. Then I leave for 60 minutes. I cannot return no matter what - as hard as that is. (As I write this he has been screaming for 50 minuets). Then I do the exact same routine for his second nap at 1 pm.

For nighttime we follow a slightly different plan. We follow our normal bedtime routine and time (bed by 8 pm). I will nurse but put him down awake. Then I can go in as often as I feel is necessary to comfort him. But I must comfort him without picking him up for at least 60 minuets (so shhhing, back rubbing and patting, comforting touches and just being there). After 60 minuets, I can pick him up and rock him, but must return him to his crib awake. Whatever I do, I cannot nurse until after 2 am and can only nurse once.


At night, we just want to avoid him getting in such a frenzy that he cannot fall asleep, which is what happened last time we let him cry it out. But we also want to give him the space to fall asleep on his own. It will be a fine balance, and a very hard few nights.

This is going to be very hard for me - emotionally and physically. I'm dreading every part of it. But I'm hoping its for the best. The behaviorist said that for a "normal" baby the plan will usually work in 3 days, but for Henry it could take a week, two weeks, a month. No one really knows. She and I will have a follow up chat after a week.


I'll keep you updated. I'm also going to be live tweeting for the next 10 nights like I did with No Cry (it helps with my sanity), so if your interested follow me on twitter @NicMKav.

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4 comments:

  1. Ugh. That does not sound like fun at all. :( I hope this gets worked out quickly for everyone's sanity!

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  2. I hope you don't mind my two cents...sticking my nose in without asking first, but I got home from work and haven't turned off my brain yet.

    Anyway - did the behavior analyst mention anything about a "discriminative stimulus" for Henry? This would be something that signaled to him that yes, you are available to pick him up or no, you are not available to pick him up. Brendan and I are debating between using a small colored light in the baby's room or a picture card on their crib. I am leaning towards the light for my baby, but I don't know how Henry reacts to lights or how his nursery is set up.

    Anyway, the point of the discriminative stimulus is to tell Henry when you are going to respond to his cries. Based on this behavior plan, there are periods of 60 minutes when you holding him is NOT available. You could put the light on during that time, and after the 60 minutes has elapsed, you can go in and turn the light off and pick him up. He will learn that when the light is on, you are not going to pick him up, and it might make some of this sleep training go faster.

    I think this behavior therapist (behavior analyst? Is she BCBA?) has a pretty decent plan outlined for you. Consistency is really key - so one slip up will lead to a big set back.

    I know it's got to be touch to listen to your baby cry - I am around outlining my own bedtime plan for my baby and he's not even here yet - but I SO hope this gives you some success and Henry is able to sleep through the night!! I am crossing my fingers for you!!!

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    Replies
    1. Thanks for you're input! The doctor we saw is an MD, a FAAP, and works in the developmental and behavioral pediatrics department.

      She didnt mention a stimulus, but that is a great idea. We use specific music as a cue that it's time to go to sleep, and that has been very successful in helping him calm before bed. So a light is doable. I would be too afraid that a card would be destroyed (Henry is not gentle).

      But youre smart to prepare for sleeping before the baby is here. I wish I had done more research on sleeping before Henry was here. I really liked No Cry Sleep Solution for creating a routine, I only wish it had helped Henry more than it did. But just remember to be flexible, so much changes once the baby is here.

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  3. The powers of psychotherapy have always amazed me. I am a voracious reader of books on psychotherapy which has amazing tales that show how powerful Cognitive Behavioral Therapy is. Read More Visit couples counseling

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