I am about to return to work and ...

Q1: I am about to return to work and my three-month old infant is not yet sleeping through the night. What can I do? 

Having an infant sleep through the night is a combination of two factors: your baby’s internal “clock” or sleep-wake cycle and a learned pattern of falling asleep. The first factor you do not have much control over, but the second one you do.

All babies will have an “up-and-down” pattern through the night where they are at different levels of sleep. Deeper stages of sleep—including REM sleep and dream states—can be characterized by bodily movements, various vocalizations, and even crying. Your infant is not awake so it does not do any good to pick them up and try to comfort them because they are not really alert. Some babies do seem to naturally have a shorter sleep cycle: six to seven hours, before they are awake again for a short period of time. If they are put in their crib between 8:00 to 9:00 p.m. and they are awake at 3:00 a.m., you may find that it is helpful to put them to bed a little later or adjust the time that you go to bed to better accommodate their 3:00 a.m. wakeful period.

The second factor—the learned pattern of falling asleep—is where parents can see some definite opportunities to improve sleep patterns. By four months of age, most babies will start to “learn” a pattern of falling asleep. Establishing a brief bedtime routine, allowing them to settle down and then putting them into their crib when they are almost asleep tends to work best. The important thing is that they actually fall asleep on their own in their crib. On the other hand, if they learn to fall asleep while you are holding them, they will likely need you to hold them to fall asleep again in the middle of the night. Having them learn to fall asleep on their own is one of the most important factors over which parents have some control.

Q2: How do I monitor my child or teen’s online activity while still giving them some privacy?

There is a range of opinions on this, but my personal recommendation is that you must do everything you can to protect your child or teen from accessing age-inappropriate content on the Internet. It only takes a few clicks of the mouse to get to some very “adult-oriented” websites that can adversely affect your child’s emotional development. In addition, the Internet is a place where adults can pose as “buddies” or “friends” to children and young teens for predatory purposes. This is not a safe place for children to explore without “guardrails” or some sort of safety measures.

Some solutions include blocking access to certain content—these are the “parental control” features on your computer. Periodically checking the Internet history of the computer your child or teen is using will give you some idea if your child is headed into trouble. Having them use the Internet only in a more public place in the house will help as well. Finally, if you start getting “pop-up” advertisements for adult-oriented content on your computer, chances are someone has been exploring related sites.

Above all, have periodic conversations with your child or teen about their use of the Internet and why they need to be extremely careful. Conveying a sense of trust in your child is always good, but it is also important to convey that keeping them safe is a very big part of being a loving parent.

Q3: I am expecting a new baby. Is there any reason why I can’t just give my baby formula from the start?

Breastfeeding is the best source of feeding for babies through the first 12 months of life. It not only serves as the best form of nutrition for babies, it is also best tolerated from a digestive standpoint and will also provide a number of immunity factors that will help your baby be healthier. In the short term, breastfed babies tend to have fewer ear infections. In the longer term, infants who are breastfed also tend to have fewer problems with obesity as children.

A combination of both breast and bottle feeding works well for many infants and can be started after the first few weeks of life. The main challenge with starting a lot of formula feeding too quickly is that it does not allow for your breast milk supply to get established and some infants will quickly transition to all bottle feeding. While formula feeding will generally do a good job of providing adequate calories and nutrition for your baby in these cases, your baby will not gain the additional benefits that come through breastfeeding for at least part of the time. 

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to drdehnel@mnparent.com.