Kathryn Barnard, RN, PhD & Karen Thomas, RN, PhD Beginning Rhythms 2 nd Edition

Principle of Self Regulatory Behavior: Eating, Sleeping, Waking, Moving, reacting, and responding are affected by internal and external factors.

Sleep Activity Record

Pregnancy Self-Regulation  To monitor attachment moments  To promote mutual regulation  To promote bonding Photo credit: whattoexpect.com

Pregnancy – Mutual Regulation  The fetus learns about the mother’s patterns and mother’s patterns and rhythms. rhythms.  The mother comes to know her baby through his/her movement and activity. Photo credit: unknown

Fetal and newborn sleep/wake cycle comparison Figure 4.4. page 34

Mutual to Self-Regulation During pregnancy the fetus is influenced by the mother’s activity pattern.

Self Regulation At birth, the baby faces a tremendous challenge….setting it’s own biological clock. Self Regulation At birth, the baby faces a tremendous challenge….setting it’s own biological clock. Photo credit: malaysiagazette.com

Self Regulation Organization of Infant State Ability of newborn to modulate state Sensitivity of the caregiver to assist and respond

Repertoire of self regulatory skills  Bringing hands to mouth  Sucking on fists, fingers or tongue  Using voices, sounds, faces, or sights to quiet  Looking away to decrease stimulation Photo credit: duchessdaisy.wordpress.com

Feeding  Main event that regulates sleep/wake  Hunger produces arousal so a hungry baby won’t sleep well  Alert state for eating Photo credit: welladjustedbabies.com

Always acknowledge “back to sleep” Ways for caregivers to promote sleep? –Recognize changing patterns –Learn to recognize sleep cues –Encourage self soothing –Consistent sleep routines Parents can use mutual regulation activities to promote sleep Photo credit: babyworld.co.uk

Emotion Regulation  Basic emotional states of infant Contentment Contentment Distress (crying) Distress (crying)  Best to respond to cues before they reach the full blown cry they reach the full blown cry Needs help from caregiver to settle Needs help from caregiver to settle Increasingly hard to soothe as crying persists Increasingly hard to soothe as crying persists Photo credit: izismile.com

Temperament  Understanding a baby’s temperament helps parents promote self regulation How does your baby react to his/her environment? How does your baby react to his/her environment? How do they experience the world? How do they experience the world?

Self-Regulation First Year of Life  Number of feedings decrease  Amount of sleep increases  Emotions emerge Labeling and response to distress is important Labeling and response to distress is important  By 2 months of age, temperament may be emerging Baby’s sensitivity and irritability is important Baby’s sensitivity and irritability is important

Sleep Management/Issues  Sleep position  Sleep location  Sleep learning  Sleep safety  Self-soothing  Bedtime routines  Night waking  Sleep disorders and disruption Photo credit: minnesotaparent.com

What makes sleep so hard for babies?  Young, immature nervous system  Easily overstimulated and over tired Leads to fussiness Leads to fussiness Begins at about 2 weeks Begins at about 2 weeks Peaks about 6-8 weeks Peaks about 6-8 weeks

Will they ever sleep?  Usually begins to decrease by weeks  Clearer cues  Become more organized Feeding patterns Feeding patterns Naps Naps Night time sleep Night time sleep

Helpful advice  If you feel overwhelmed, put your baby in a safe place and take 5!  Splash cool water on your face, take a series of deep breaths, listen to some soft music for a few minutes, or get a drink of water.  Return to your baby and try soothing activities again.  ALWAYS call for help if you feel you may hurt your baby. Photo credit: telegraph.co.uk, Getty images

Help parents learn to be their baby’s sleep coach:  Hold baby a lot!  Watch for sleepy/tired cues aka “sleep gate”  Naps!  Consistent, early bedtime Photo credits: 1. babycentre.co.uk 2. Via Flickr: zuhair_ahmad

Distress and Crying  Infants way of signaling an unmet need or stimulation overload!  Anticipate an increase at 6- 8 weeks  Excessive? investigate further, offer support, acknowledge, safety plan Photo credit: lovebeingretired.com

Dealing with and Preventing Crying  Determine cause and attempt to alleviate the distress  Good support network  Asking for help when needed  Baby sling decreases crying  Infant massage  SAR to get an accurate picture of crying

Why use the Sleep Activity Record?  Obtain an average frequency of the selected behavior over seven days.  Gain an understanding about the occurrence of the behavior and whether self-regulation is developing.  Compare the difference in day/night behavior to see if biological clocks and rhythms are emerging.

Importance of SAR to parents  Normalize their baby’s behaviors/crying/sleeping  Help them begin to see patterns and assist their baby with self- regulation  Keep track of how much they are eating  Keep track of number of wet diapers

Suggestion for improving compliance  Walk through the last 24 hours with parent  Have her record what is important to HER!  Put record in a prominent place, easy to write and not forget.  Call her once or twice during the week to encourage, remind, coach.