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FAQ on Routines answered by Gina

Gina's Useful Articles on Routines

I am six months pregnant and, like many new mothers-to-be, I am concerned about how I am going to cope with the sleepless nights. My antenatal class stresses the importance of demand feeding and that new babies should be fed when they need it and that I should not attempt a routine in the early days. I am concerned that if I try to follow your strict routines, I may be denying my baby food when he is really hungry.

The Contented Little Baby routines are not about denying babies a feed when they are really hungry. Quite the opposite. My main concern about demand feeding with very young babies is that a great many babies do not demand to be fed in the very early days. This can lead to many serious problems, the main one being that a baby who is not feeding from the breast will not stimulate the breast to produce enough milk. We therefore arrive at the situation, three or four weeks down the line, where a mother is trying to feed her baby and not producing enough milk. A vicious circle then evolves where the mother is feeding the baby every 1-2 hours, night and day, to try to satisfy his needs - but by this time, exhaustion has set in. This is one of the main reasons why the milk supply decreases and women find they have to stop breastfeeding.

In the very early days I always advise a mother to assume that, if the baby is crying, then hunger is possibly the main reason why and the baby should be fed. However, I do stress the importance that, if a baby is continually crying and unhappy, then you should also look for reasons why the baby cannot last the three hours between feeds. There are many reasons for this, the main reason being that the baby has not been latched on properly to the breast and, while he may appear to be constantly sucking for up to an hour, much of the time he is not actually drinking well. This is why mothers who are breast feeding and finding that their baby is not going happily for 2-3 hours between feeds should always seek advice from an experienced breast-feeding counsellor. Any healthy baby weighing more than 6lbs at birth should manage to go three hours between feeds, three hours being from the beginning of a feed to the beginning of the next feed. This will only happen if the baby receives enough milk to satisfy his needs.

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Do I really have to wake my newborn baby up to feed him? He wants to sleep all the time and I am tempted to leave him.

I do understand - it is a great temptation when you are tired from the birth to catch up on rest during the daytimes while your baby sleeps. But your baby will only be this sleepy for a few short weeks and he will then increasingly want to be awake, playing and having social time with you and others. He won’t know the difference between day and night and unless you gently guide him into a routine, you could end up with him wide awake and wanting to play games at 4am. So, yes, I do stress in my book the importance of waking the baby every 2-3 hours during the first week to ensure that the breasts are stimulated enough to increase the mother’s milk production. Waking the baby three hourly throughout the day will ensure that the baby will more than likely only wake once in the night between 12pm and 6am. A mother who is well rested and relaxed will be much more likely to produce a more abundant milk supply than a mother who is tired and stressed. In the long-term you will both benefit from establishing this pattern.

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Several friends and relations have said that it is cruel to wake a sleeping baby and that he will wake up when he is ready to feed. I am a very organised person and feel that following a routine would be best for both my baby and me, but I am frightened that I could do some sort of psychological or physical damage to my baby by waking him.

It is obvious that the people who say it is cruel to wake a sleeping baby to feed it have never had to care for any very premature or sick babies. During my career as a maternity nurse, I had to care for many premature and sick babies. Waking these babies on a regular basis so they fed little and often was the only way to ensure their survival. Over the years, watching these babies grow up into young children, I have never encountered any of them showing any psychological or physical damage. I am convinced that there is a bigger risk of psychological and physical damage to both baby and mother if a situation arises where a baby is up and demanding to be fed every hour in the night. In the early days I advise feeding a baby little and often to establish breast feeding. Sometime this will involve waking him but I say in The New Contented Little Baby Book that, should a young baby demand feeding before three hours, then he must, of course, be fed. A pattern will quickly be established for both you and your baby.

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The current advice is that parents should have their baby sleep in their room with them for the first six months, but I read that you say the baby should be put in his own room from birth. I am concerned that my baby may feel alone and lonely shut away in a dark room by himself for hours at a time.

At the very beginning of my book, on page 2, I mention that the majority of parents I have worked with have their baby sleep with them in their room at night. It is important for new mothers to understand that when they do put their baby down for a nap in a dark, quiet room away from the hustle and bustle, they are doing so for their baby’s benefit. While some babies will sleep happily in the middle of the hustle and bustle of a busy household, some may not. How well would we, as adults, sleep in a chair in the middle of a noisy room? Babies will become stressed and exhausted through lack of good, quality sleep. You will also establish a stronger difference between wake time and sleep time when, after a peaceful sleep, you bring him downstairs into the activity of your home for some playtime.

Getting your baby settled into his own room sooner rather than later can help you avoid disrupting and unsettling him at some stage down the line when he is used to being in your room. We have all heard tales of parents struggling to get a two-year-old out of their bed. While you and your partner might not mind sharing a room or bed with your baby, you must ask yourself whether you are doing so for your own sake or your baby’s. You can make the nursery a peaceful haven for him by using it for nappy changing and naps. Once a bedtime routine is in place, your baby will feel calm and happy as soon as he is taken there. You can always settle him in his cot in his room at 7pm, feed him there again at 10pm and transfer him to your room for the middle of the night feed.

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Why do you say that babies should not be cuddled? I keep reading that babies need lots of cuddles and physical affection and attention in order for them to feel secure.

On page 106 in The New Contented Little Baby book I stress the importance of physical contact and affection with your baby. However, I do say that parents should make sure that the cuddling and affection they give is to satisfy their baby’s needs before their own. The baby's emotional needs should be put before the parents’. And, crucially, there is a difference between cuddling your baby and cuddling him to sleep. If he gets used to being cuddled to sleep, it will create a dependence that you will have to break at some point – and it is much easier to get him used to settling himself to sleep at three weeks of age than three months or three years.

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My friend is following your book with her baby daughter who is now nearly five weeks old. She seems to cry for ages every time they put her in her cot. While I would like a routine, I do not want to leave my baby to cry for long spells. Yet several parents I have spoke to say that if you follow the CLB routines you have to be prepared to leave the baby to cry itself to sleep, no matter how long it takes.

This is simply not true. Nowhere in my book do I say that young babies should be left to cry for lengthy periods of time to get themselves to sleep. I do stress that some babies will fight sleep and they should be allowed 5-10 minutes crying down period. They should never be left for any longer than this before they are checked again. I also stress that a baby should never be left crying for even 2-3 minutes if there is any doubt that he could be hungry or need winding.

The ‘crying to sleep’ that some critics refer to is actually a method that I recommend to use with older babies who have reached six months or a year and are waking several times a night because they have learned the wrong sleep associations, brought on by demand feeding or being rocked or cuddled to sleep. In these instances I recommend a form of sleep training that has been used by childcare experts, paediatricians and Health Visitors for many years.

In my book, The Complete Sleep Guide for Contented Babies and Toddlers, I stress that sleep training and controlled crying is always a last resort to get an older baby to sleep during the night and should only ever be used once parents are absolutely sure that the baby is not waking up because he is hungry. I also advise that before commencing sleep training you should take your baby to see the GP to check there are no medical problems.

The reason that sleep training and controlled crying fails to work for many people is because parents read, or are told, that a baby over six months old does not need to be fed in the night and can sleep for a longer period. While babies over six months can, most certainly, sleep a long period every night, this will not happen if the baby is not eating enough during the day (and if the baby is waking up and feeding several times a night he most certainly will not be getting enough during the day to eat), so parents who use controlled crying can find that they will leave their babies to cry for many nights in a row but the problem will not be resolved because the baby is continually hungry. Resolving the hunger problem by ensuring the baby receives most of his milk between 7am and 7pm will eventually stop night waking.

In all of my books I include case studies where older babies are waking in the night and continually need to be fed. I explain how to gradually reduce the number of feeds in the night by increasing what the baby eats during the day. It is only once I see an improvement in the baby’s daily food intake (i.e. between 7am and 7pm) that I would then possibly recommend controlled crying and then only if I thought that the baby also had a sleep association problem.

The whole aim of the Contented Little Baby routines is to ensure from the very beginning that the baby's needs are being met so that he does not need to cry for any length of time. The guidelines I give are also to help mothers understand the different reasons why a baby may cry. If a baby is in a routine from a very early age the mother will quickly learn to understand and hence anticipate his needs. I have found that this results in the baby crying very seldom – around 5-10 minutes a day in my experience.

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I have read that on your routines a baby should not be fed in the middle of the night once it reaches twelve weeks. Surely all babies are different and a baby should not be forced to go without food if it is really hungry.

In The New Contented Little Baby Book, I actually say that some babies, particularly breastfed babies, may need to be fed once in the middle of the night until they are five-six months old. I also say that the majority of babies I have cared for personally would go to sleep during the night (i.e. from the last feed at 11pm to 6-7am) somewhere between 8 and 12 weeks. The huge feedback that I receive from readers would indicate that this does seem to be the average age at which babies forming routines would sleep for a longer spell. Each baby of course is an individual, but if your baby does not sleep through the night until he is seven months old, you have not ‘failed’. My routines are there to help you begin to structure your days and nights and perseverance will pay off when your baby is ready.

How quickly a baby sleeps through the night is very much determined by his weight and the amount of milk he is capable of drinking at each feed during the day. Some babies who are only capable of drinking small amounts at each feed would obviously need a feed in the night for longer than a baby who is capable of drinking a larger amount at each feed during the day. The aim of the Contented Little Baby routines is not to push the baby through the night as quickly as possible or to deny the baby a feed in the night if he genuinely needs it. It is to ensure that the baby receives most of his nutritional needs during the day so that when he is physically and mentally ready to go through the night he will automatically do so. The feedback I have had, along with my many years of experience caring for babies, confirms this approach works.

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I read a message from a mother in one of the baby chat rooms that she is very lonely and depressed following your routines as it leaves her no time to get out and meet other mothers.

I have always said that putting a young baby into a routine can be very demanding on the parents, particularly in the early weeks. However, by the time a baby is two-three months of age, a pattern has usually emerged where the baby can stay awake for longer periods during the day and sleep for longer periods at night. In my experience of working with hundreds of mothers, their social outings were certainly restricted for the first three to four weeks but after that I cannot recall many mothers who did not manage to meet their friends most afternoons between 2pm and 5pm or meet up at friends’ houses for coffee in the mornings. Once you and your baby have got the hang of the routines you can adapt them to suit you all better. The mothers I have worked with have all felt that it is worth putting in the hard work at the beginning because the result is a contented baby who sleeps well at night and enjoys his social times during the day. A mother who has had a good night’s sleep will also be able to enjoy her days more too!

I always advise mothers, in the early days, to try and ensure that at least every second day they arrange for a friend or relative to come and visit them so that they do not feel lonely or abandoned. I also stress the importance of a walk every day in the park with the baby to get some fresh air. You can do this with friends - and chatting in the playground is also a great way to meet other mums.

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In your routines you tell mothers when to eat and drink. This strictness puts me off.

You can eat and drink whenever you like! In the early days mothers are often exhausted and put their own needs - even the basics like eating and drinking - at the bottom of their list of priorities. Struggling with a newborn on your own can mean that you find yourself at teatime having only had a piece of toast and half a cup of tea. As a nursing mum, you need to eat plenty of food regularly and to drink plenty of water in order to produce enough milk for your baby and to keep up your own energy levels. I know that many people using my routines refer to the book sometimes several times a day so the times suggested for breakfast, lunch and for drinking lots of water are a reminder not to neglect yourself - and they fit in with what your baby is doing, helping make it easier for you to care for yourself too.

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Why are your routines so rigid? Surely half and hour here or there won’t make much difference?

The New Contented Little Baby Book contains over ten different routines taking you from week one of your baby’s life, right up to the end of his first year. They have been carefully compiled, based on many years of experience, to allow for the fact that your baby will be growing and changing. As he goes through his first three months, he will need less and less daytime sleep as he will be enjoying being awake and playing with you. He needs stimulation and fun during the day. He will need weaning at some point between 4 and 6 months (although current guidelines recommend exclusive breast feeding for six months). His sleeping and feeding needs are constantly changing throughout his first six months of life. In my experience, adapting to your baby's changing needs is best done slowly and steadily. My routines are specific in order to help you to make those gradual changes. Once your baby is sleeping for twelve hours every night, you will feel a huge sense of relief and he will be getting the long deep sleep that he needs for healthy growth and development.

My routines are designed around babies’ natural rhythms and they work. You do not have to stick absolutely rigidly to them, but half an hour can have a knock-on effect which disrupts the rest of your day and, possibly, your night. For example, if your day begins nearer 8am than 7am, you will find your baby has a later nap at around midday. If he doesn’t wake until after 3pm you will find it difficult to get him to settle at 7pm as he is unlikely to be sleepy by then. If the last feed of the day is nearer 8pm, you could find as a result that he does not want his 10pm feed and will wake up in the night. This is certainly not the end of the world occasionally but, over a period of time and as his nutritional needs change, you could find night waking continues leaving you exhausted and less able to enjoy your baby.

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I have been trying to follow your routines for four weeks but my baby is not remotely near fitting in with them. I feel like a failure and wonder if I should just give up and let her do what she wants.

It can be very difficult in the early days and many parents understandably feel it would be easier on them if they let the baby decide what he wants to do. Bear in mind you are recovering from the birth and looking after a baby, routine or not, is extremely hard work. My routines make sure the hard work is limited to as short a period as possible. Think how hard it would be if your baby was still waking up in the night at nine months old… I can assure you it is worth persevering.

Don’t necessarily expect instant contentment but the result of sticking with the routines in the first weeks is a more enjoyable babyhood and toddlerhood for you and your child. When your baby does fit in, and he will very soon, I can guarantee you will never regret the effort you put in to follow the routines in the first few weeks. The routines are there to help guide you and your baby into what represents the baby’s natural patterns and rhythms. Remember that you are not ‘failing’ if your baby doesn't fit in, just keep going, taking a day at a time. As every established parent and grandparent will be telling you - the first few months, in hindsight, go very quickly.

Start each day at 7am and attempt to follow the day’s routine as best you can but if it’s gone pear-shaped by lunchtime because your baby is wide awake at naptime and sleepy during the social times I suggest - don’t panic. Keep repeating the same pattern of feeds and sleeps every day as best you can and your baby will pick it up very soon. If he is crying for food before I say he should be fed and you have tried distracting him or playing with him then you must, of course, feed him. If you really cannot rouse him from a sleep when it’s time to play, then leave him a bit longer and don’t give yourself or him a hard time. Get up in the morning and try again without feeling you or your baby are getting it ‘wrong’. I applaud mums these days who are probably looking after their babies on their own during the days without the support of grannies or aunties up the road. It’s very hard work. You are not alone in going through the experience, however, and you are certainly not a failure.

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You recommend that a baby only has two breastfeeds a day by the time he is one. I have read that the American Academy of Pediatrics advises that breast milk should be a baby’s primary source of nutrition until he is one. Could it be that your routines are best suited to bottle-fed babies?

I have worked with hundreds of mothers who have successfully and satisfactorily breastfed their babies while following my routines. I devote a great deal of space in my book to the subject of breast feeding, which I wholeheartedly support, and my routines are based primarily around breastfed babies. By the time a baby is one year old, his nutritional needs should be met by a balanced diet of carbohydrates, vegetables and fruit, protein and dairy products. This, of course, includes milk whether it is breast milk or, once baby is past one, cow’s milk. The official recommendations for daily milk intake for babies over one year is 12-20oz including milk used in cooking and with cereal. Babies of this age who drink in excess of this amount can become very fussy about their solids and could even develop iron deficiency anaemia. I suggest that milk be given be given in the morning and at bedtime and that the baby enjoys three solid meals a day.

The majority of babies I have been involved with over the years show signs of wanting more than milk somewhere between four and six months. The Department of Health recommends breast milk be the sole source of nutrition for the first six months. I advise mothers to watch their babies very carefully for signs that they need weaning and always to discuss weaning with their health visitor or GP. A baby who is not getting all he needs from milk will show you himself that he is hungry. By the time a baby is six months old, the iron stores he is born with are depleted and it is essential that he is supplied with iron in his diet in order to avoid developing iron deficiency anaemia – which is found in 12% of children in the UK aged between 18 and 29 months.

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Why are you so strict about avoiding eye contact at the 10pm feed? I feel very cruel depriving my baby of cuddles and this close contact.

On page 106 of my book, I say that babies need a lot of cuddling. Nowhere do I suggest you should not cuddle your baby. On the contrary, a baby who is being held close to his mother, whether breastfed or bottlefed, will enjoy his feed more and be ready to return to a contented sleep after he has been winded and settled down quietly. I suggest avoiding eye contact at 10pm and during night feeds to help you show your baby gently that this is not playtime. Your cuddles can be very close, but over-stimulating him at wind-down time can cause him to become overtired and not settle well. He needs his sleep for his mental and physical development and without it he could become fretful, irritable and inconsolable. I feel it is better for the baby to be played with, sung to, shown interesting toys and books when he is wide awake and able to really enjoy himself. Cuddling must be about your baby’s needs and not your own.

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Your routines are so strict. When can I enjoy my baby without worrying about what he should be doing next?

I sincerely hope that every parent enjoys his or her baby, from the first exciting day they come home from hospital, right through babyhood, toddlerhood and beyond. Every day is filled with opportunities for cuddling, playing, singing, reading, splashing in the bath, tickling toes while nappy changing and chatting to your baby. But it is beyond doubt that a contented baby is best able to appreciate and participate in these activities. My routines are there to support and help you find a structure to your days that will result in a contented baby. They are not for everyone, however, and if you feel stressed by following a routine then stop trying. My routines can help you avoid long-term problems such as: over-tiredness due to over-stimulation; sleep association where a baby has to be rocked to sleep or driven round the block; or continual night wakings which leave you feeling exhausted each morning. Should any of these problems develop, you could turn to my book later on for help.

Bonding evolves slowly over many weeks and for many mothers without help or support there can be, along with feelings of joy and love for a new baby, feelings of sheer exhaustion, failure and frustration. Nights of broken sleep do not help mothers to enjoy their babies and this is generally the problem I encounter when mothers contact me because they feel guilty and resentful that they are not enjoying their babies. Weeks of sleep-deprivation caused by endless middle-of-the-night feeding is bound to hamper bonding and enjoyment of your baby. My routines are there to help you and your baby, not to cause stress, anxiety or feelings of inadequacy. A positive approach to them will help enormously.

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I have a toddler as well as a new baby to care for and I cannot get your routines to work around both of them.

This is an important point and I have covered it in a new edition of my book From Contented Baby to Confident Child. Many mothers find that school runs or nursery for older children mean that the naptimes I suggest are not workable. If you used my routines with your first child, you will at least find the 7am start and 7pm bedtime already established in your household. Your toddler may even still take a lunchtime nap if he is under three and this can combine nicely with the baby’s nap. You might even get an overlap of half an hour to yourself! I suggest that you concentrate on sticking to my suggested amounts of daytime sleep. So if you have to adapt your baby’s daytime sleep around your toddler’s routine, try not to let the baby exceed the recommended amount of daily sleep. Then bedtime will at least be guaranteed and you can have an evening to rest and recover from caring for two young children.

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My baby was following your routines happily until he first caught a bad cold and then began teething. What do I do when your routines go wrong?

A baby who is unwell should get all his sleeping and feeding needs met immediately, regardless of my routines. It is most important that he is cared for and helped to recover as quickly as possible. No parent gets through childhood without spending at least a night sitting beside a baby’s cot or child’s bed looking after him and worrying about him. I have cared for many sick and premature babies and am well aware of the heartache illness can cause. Once your baby starts to regain strength and show signs of returning to full health you can slowly begin the routines again, allowing for him to take his own time to pick them up again and of course with the advice of your GP. Don’t give yourself a hard time about not being back on track immediately, do your best and you will find he slips back into it before long.

The average baby begins to cut his first teeth around six months. Symptoms vary widely from baby to baby and sleep may well be disrupted. In my experience, however, a baby who is well settled into a routine at six months will be used to a long, deep sleep and be less likely to wake up in the night as a result of teething.

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